WorldWideScience

Sample records for vaginal mucosal flap

  1. Surgical revirgination: Four vaginal mucosal flaps for reconstruction of a hymen

    Directory of Open Access Journals (Sweden)

    Hemant A Saraiya

    2015-01-01

    Full Text Available Introduction: Over centuries, virginity has been given social, religious and moral importance. It is widely believed as a state of a female who has never engaged in sexual intercourse, and her hymen is intact. Hymenoplasty for torn hymen is carried out not only for the sake of cultural and religious traditions but also for the social status and interpersonal relationships. Materials and Methods: 2.5 cm long and 1 cm wide four vaginal mucosal flaps were raised from the anterior vaginal wall just behind labia minora. Two flaps were based proximally, and their two opposing flaps were based distally. These flaps were overlapped in a crisscross fashion and were sutured with 5/0 Polyglactin (Vicryl® sutures leaving no area raw. The donor area was closed primarily. When some remains of a torn hymen were found, one to three vaginal mucosal flaps were added to its remains as per the need for reconstruction. Results: We operated upon 11 patients. In nine cases, the hymen was reconstructed with four flaps. In remaining two, it was reconstructed from the remains using vaginal mucosal flaps. All flaps healed without any infection or disruption. Sutures got absorbed in 25-35 days. In all cases, this newly constructed barrier broke with only moderate pressure at the time of penetrative sex serving the purpose of the surgery completely. Conclusion: Erasing evidence of the sexual history simply by ′Surgical Revirgination′ is extremely important to women contemplating marriage in cultures where a high value is placed on virginity.

  2. Fasciocutaneous flap for vaginal and perineal reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Wang, T.N.; Whetzel, T.; Mathes, S.J.; Vasconez, L.O.

    1987-07-01

    A skin and fascia flap from the medial thigh is proposed for vaginal and perineal reconstruction. Dissection, vascular injection, and radiographs of 20 fresh cadaver limbs uniformly demonstrated the presence of a communicating suprafascial vascular plexus in the medial thigh. Three to four nonaxial vessels were consistently found to enter the proximal plexus from within 5 cm of the perineum. Preservation of these vessels permitted reliable elevation of a 9 X 20 cm fasciocutaneous flap without using the gracilis muscle as a vascular carrier. Fifteen flaps in 13 patients were used for vaginal replacement and coverage of vulvectomy, groin, and ischial defects. Depending on the magnitude of the defect, simultaneous and independent elevation of the gracilis muscle provided additional vascularized coverage as needed. Our experience indicates that the medial thigh fasciocutaneous flap is a durable, less bulky, and potentially sensate alternative to the gracilis musculocutaneous flap for vaginal and perineal reconstruction.

  3. Effects of feminine hygiene products on the vaginal mucosal biome

    Directory of Open Access Journals (Sweden)

    Raina N. Fichorova

    2013-02-01

    Full Text Available Background: Over-the-counter (OTC feminine hygiene products come with little warning about possible side effects. This study evaluates in-vitro their effects on Lactobacillus crispatus, which is dominant in the normal vaginal microbiota and helps maintain a healthy mucosal barrier essential for normal reproductive function and prevention of sexually transmitted infections and gynecologic cancer. Methods: A feminine moisturizer (Vagisil, personal lubricant, and douche were purchased OTC. A topical spermicide (nonoxynol-9 known to alter the vaginal immune barrier was used as a control. L. crispatus was incubated with each product for 2 and 24h and then seeded on agar for colony forming units (CFU. Human vaginal epithelial cells were exposed to products in the presence or absence of L. crispatus for 24h, followed by epithelium-associated CFU enumeration. Interleukin-8 was immunoassayed and ANOVA was used for statistical evaluation. Results: Nonoxynol-9 and Vagisil suppressed Lactobacillus growth at 2h and killed all bacteria at 24h. The lubricant decreased bacterial growth insignificantly at 2h but killed all at 24h. The douche did not have a significant effect. At full strength, all products suppressed epithelial viability and all, except the douche, suppressed epithelial-associated CFU. When applied at non-toxic dose in the absence of bacteria, the douche and moisturizer induced an increase of IL-8, suggesting a potential to initiate inflammatory reaction. In the presence of L. crispatus, the proinflammatory effects of the douche and moisturizer were countered, and IL-8 production was inhibited in the presence of the other products. Conclusion: Some OTC vaginal products may be harmful to L. crispatus and alter the vaginal immune environment. Illustrated through these results, L. crispatus is essential in the preservation of the function of vaginal epithelial cells in the presence of some feminine hygiene products. More research should be invested

  4. Hyperbaric oxygen therapy accelerates vascularization in keratinized oral mucosal surgical flaps

    NARCIS (Netherlands)

    Helmers, R.; Milstein, D.M.J.; van Hulst, R.A.; de Lange, J.

    2014-01-01

    Background Hyperbaric oxygen therapy (HBOT) is thought to promote vascular regeneration in wounds. The purpose of this study was to investigate the role of HBOT in advancing vascular regeneration in healing oral mucosal surgical flaps. Methods A palatine partial-thickness mucosal flap was raised in

  5. Successful pregnancy "during" pedicled transverse rectus abdominis musculocutaneous flap for breast reconstruction with normal vaginal delivery

    Directory of Open Access Journals (Sweden)

    Siew Cheng Chai

    2015-01-01

    Full Text Available A transverse rectus abdominis myocutaneous (TRAM flap is a popular choice for breast reconstruction. Pregnancies in women following a TRAM flap present concerns regarding both safety and the integrity of the abdominal wall. We report a case of a patient who was pregnant during immediate breast reconstruction with pedicled TRAM flap and had a successful spontaneous vaginal delivery. We also conducted a literature review using PubMed on pregnancy post TRAM flap, type of reconstruction, timing of pregnancy after TRAM flap, complication, and mode of delivery, which are summarised in this report. We concluded that patients may have safe pregnancies and normal deliveries following TRAM flap breast reconstruction regardless of the time frame of pregnancy after the procedure. Therefore, TRAM flaps can continue to be a reconstruction option, even in women of childbearing age.

  6. Mucosal HIV transmission and vaccination strategies through oral compared with vaginal and rectal routes.

    Science.gov (United States)

    Yu, Mingke; Vajdy, Michael

    2010-08-01

    There are currently over thirty million people infected with HIV and there are no vaccines available to prevent HIV infections or disease. The genitourinary, rectal and oral mucosa are the mucosal HIV transmission routes. An effective vaccine that can induce both systemic and local mucosal immunity is generally accepted as a major means of protection against mucosal HIV transmission and AIDS. Structure and cells that comprise the oral, vaginal and rectal mucosa pertaining to HIV transmission and vaccination strategies through each mucosal route to prevent mucosal and systemic infection will be discussed. Covering publications from 1980s through 2010, mucosal transmission of HIV and current and previous approaches to vaccinations are discussed. Although oral transmission of HIV is far less common than vaginal and rectal transmissions, infections through this route do occur through oral sex as well as vertically from mother to child. Mucosal vaccination strategies against oral and other mucosal HIV transmissions are under intensive research but the lack of consensus on immune correlates of protection and lack of safe and effective mucosal adjuvants and delivery systems hamper progress towards a licensed vaccine.

  7. Murine Vaginal Colonization Model for Investigating Asymptomatic Mucosal Carriage of Streptococcus pyogenes

    Science.gov (United States)

    Watson, Michael E.; Nielsen, Hailyn V.; Hultgren, Scott J.

    2013-01-01

    While many virulence factors promoting Streptococcus pyogenes invasive disease have been described, specific streptococcal factors and host properties influencing asymptomatic mucosal carriage remain uncertain. To address the need for a refined model of prolonged S. pyogenes asymptomatic mucosal colonization, we have adapted a preestrogenized murine vaginal colonization model for S. pyogenes. In this model, derivatives of strains HSC5, SF370, JRS4, NZ131, and MEW123 established a reproducible, asymptomatic colonization of the vaginal mucosa over a period of typically 3 to 4 weeks' duration at a relatively high colonization efficiency. Prior treatment with estradiol prolonged streptococcal colonization and was associated with reduced inflammation in the colonized vaginal epithelium as well as a decreased leukocyte presence in vaginal fluid compared to the levels of inflammation and leukocyte presence in non-estradiol-treated control mice. The utility of our model for investigating S. pyogenes factors contributing to mucosal carriage was verified, as a mutant with a mutation in the transcriptional regulator catabolite control protein A (CcpA) demonstrated significant impairment in vaginal colonization. An assessment of in vivo transcriptional activity in the CcpA− strain for several known CcpA-regulated genes identified significantly elevated transcription of lactate oxidase (lctO) correlating with excessive generation of hydrogen peroxide to self-lethal levels. Deletion of lctO did not impair colonization, but deletion of lctO in a CcpA− strain prolonged carriage, exceeding even that of the wild-type strain. Thus, while LctO is not essential for vaginal colonization, its dysregulation is deleterious, highlighting the critical role of CcpA in promoting mucosal colonization. The vaginal colonization model should prove effective for future analyses of S. pyogenes mucosal colonization. PMID:23460515

  8. Vaginal reconstruction with pedicled vertical deep inferior epigastric perforator flap (diep) after pelvic exenteration. A consecutive case series.

    Science.gov (United States)

    Ferron, Gwénael; Gangloff, Dimitri; Querleu, Denis; Frigenza, Melanie; Torrent, Juan Jose; Picaud, Laetitia; Gladieff, Laurence; Delannes, Martine; Mery, Eliane; Boulet, Berenice; Balague, Gisele; Martinez, Alejandra

    2015-09-01

    Vaginal reconstruction after pelvic exenteration (PE) represents a challenge for the oncologic surgeon. Since the introduction of perforator flaps, using pedicled vertical DIEP (deep inferior epigastric perforator) flap allows to reduce the donor site complication rate. From November 2012 to December 2014, 27 PEs were performed in our institution. 13 patients who underwent PE with vaginal reconstruction and programmed DIEP procedure for gynecologic malignancies were registered. Nine patients underwent PE for recurrent disease and four for primary treatment. Six of the 13 patients have a preoperative fistula. Anterior PE was performed in 10 patients, and total PE in 3 patients. A vertical DIEP flap was performed in 10 patients using one or two medial perforators. The reasons for abortion of vertical DIEP flap procedure were: failure to localizing perforator vessels in two cases, and unavailability of plastic surgeon in one case. A vertical fascia-sparring rectus abdominis myocutaneous flap was then harvested. Median length of surgery was 335min, and 60min for DIEP harvesting and vaginal reconstruction. No flap necrosis occurred. One patient in the VRAM (vertical rectus abdominis myocutaneous) group experienced a late incisional hernia and one patient in the DIEP flap group required revision for vaginal stenosis. In our experience, DIEP flap represents our preferred choice of flap for circumferential vaginal reconstruction after PE. To achieve a high reproducibility, the technically demanding pedicled vertical DIEP flap has to be harvested by a trained surgeon, after strict evaluation of the preoperative imaging with identification and localization of perforator vessels. Copyright © 2015. Published by Elsevier Inc.

  9. Martius flap and anterior vaginal wall sling for correction of urethrovaginal fistula (UVF associated with stress urinary incontinence (SUI after vaginal delivery

    Directory of Open Access Journals (Sweden)

    A.M. Abdelbary

    2012-12-01

    Conclusions: Patients with a post-birth trauma in the form of UVF should be examined intra-operatively for the presence of associated SUI following correction of UVF. The use of the Martius flap and anterior vaginal wall sling in treating such patients is safe, efficient and reproducible. An anterior vaginal wall sling should be avoided in distal UVF to avoid recurrence of SUI.

  10. Effect of Mucosal Cytokine Administration on Selective Expansion of Vaginal Dendritic Cells to Support Nanoparticle Transport.

    Science.gov (United States)

    Ramanathan, Renuka; Park, Jaehyung; Hughes, Sean M; Lykins, William R; Bennett, Hunter R; Hladik, Florian; Woodrow, Kim A

    2015-10-01

    The capacity of antigen-carrying vaccine nanoparticles (NPs) administered vaginally to stimulate local immune responses may be limited by the relatively low numbers of antigen-presenting cells (APCs) in the genital mucosa. Because inflammation is associated with increased susceptibility to sexually transmitted infections, we sought to increase APC numbers without causing inflammation. In this study, we evaluated intravaginal delivery of chemokines, growth factors, or synthetic adjuvants to expand APCs in reproductive tissues. We found that granulocyte-macrophage colony-stimulating factor (GM-CSF) stimulated expansion of CD11b+ dendritic cells (DCs) within 24 hr of intravaginal administration, with no effect on Langerhans cells or macrophages. Expansion of the CD11b+ DC population was not associated with increased inflammatory cytokine production, and these cells retained phagocytic function. Our data suggest that non-inflammatory expansion of mucosal APCs by intravaginal GM-CSF could be used as an adjuvanting strategy to potentiate the genital immune response to nanoparticulate mucosal vaccines. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Extensive full-thickness eyelid reconstruction with rotation flaps through “subcutaneous tunnel” and palatal mucosal grafts

    Directory of Open Access Journals (Sweden)

    Jian-Xia Cheng

    2015-08-01

    Full Text Available AIM: To reconstruct the extensive full-thickness defects of eyelids is a challenge for the plastic surgeon because of their complex anatomy and special functions. This article presents and discusses an improved surgical technique in which the orbicularis oculi myocutaneous flap is rotated through a “subcutaneous tunnel” in conjunction with a palatal mucosal graft employed for lining.METHODS: Data from 22 eyes with extensive full-thickness eyelid defects from various causes between 2009 and 2013 were analyzed in this study. After the different layers of eyelid were separated completely, a temporally based orbicularis oculi myocutaneous flap was designed following fishtail lines and was mobilized, leaving the base of the pedicle intact with a submuscular tissue attachment. The flap was then rotated through a “subcutaneous tunnel” to the defect, and the donor site was closed primarily. Posterior lamellar reconstruction was performed with a mucosal graft harvested from the hard palate.RESULTS:All the flaps were survived without any healing problems. There was no corneal irritation, flap contraction, or significant donor-site morbidity in the follow-up period. The incision scars were almost invisible. The defects were repaired completely, and the evaluations showed satisfactory function and appearance.CONCLUSION: This technique is an improved single-stage operation and can be applied to repair large, full-thickness eyelid defects from various causes. With our method, the functional and aesthetic results can be obtained in either the upper or lower eyelids.

  12. Cytological Characteristics of Mucose Cell and Vaginal Temperature and pH During Estrous Cycle in Local Sheep

    Directory of Open Access Journals (Sweden)

    Siti Darodjah Rasad

    2017-09-01

    Full Text Available Aim of this study was to examine the characteristics cytology of mucous cell-,temperature- and pH vagina during estrous cycle in local sheep.  31local sheep were synchronized with vaginal sponge consist of 20  mg  progesterone hormone before carried out observations of cytology of cells from the vaginal mucose through vaginal swabs, temperature and pH of the vagina.  Vaginal swabs were collected daily at 7 am for a weeks.Vaginal temperature and pH measurement is carried out twice a day, at 07.00 am and 15.00 pm for a weeks after vaginal swabs. Smears of the swab were then prepared on glass slide and they were stained with Giemsa.  Vaginal epithelial cells; Parabasal, intermediate and superficial cells were counted and their percentages during pro-estrous, estrous and di-estrous were determined. Di-estrous was characterized by the absent of superficial cells in the epithelial vagina. Pro-estrous was characterized by the increasing progressively of intermediate/superficial cells in epithelial vagina, whereas estrous was characterized by the presence of superficial/cornification cells in most epithelial vagina. Based on the dominance of superficial cell, the number of sheep identified as estrous is highest on third day, with 52%.  Observation on vaginal temperature also resulting that the highest temperature values obtained on the third day of 39,08±0.28°C.  It could be effected of the vaginal pH during the observation. Underthe influence ofestrogen, the epithelial vaginalcellssynthesizeand accumulateglycogenin large quantitiesdepositedin the lumen ofvagina. Vaginal bacteriametabolizethe glycogenformlactic acid, which causesvaginal pHis low.The pH conditions prevent from pathogenic microorganisms and fungi. Increased estrogenal so cause cell proliferation through the thickening of the epithelium lining of the vagina so that the cells differentiate.Increasing of glycogenin the superficial cells, and  ceratin cells found in the cytoplasm of

  13. Repair of a recurrent traumatic rectovaginal fistula using vaginal wall plication to reinforce a rectal wall advancement flap.

    Science.gov (United States)

    Sugrue, Jeremy; Kaminski, Jan; Patel, Supriya; Park, John; Prasad, Leela; Marecik, Slawomir

    2016-01-01

    Rectovaginal fistulas (RVF) can cause significant physical discomfort and psychological distress for patients and remain amongst the most challenging disorders for surgeons. A 28-year-old female with a history of a traumatic cloaca repaired 12 years prior was diagnosed with a recurrent RVF and underwent repair using a rectal wall advancement flap reinforced with posterior vaginal wall plication. This case is used to demonstrate surgical technique. The study adhered to the prescribed ethical guidelines. Informed consent was obtained from the patient to use the video recording of her operation for educational purposes. The patient had an uneventful postoperative course. The fistula was fully healed without any signs or symptoms of recurrence at 8 weeks follow-up exam. Her protective ileostomy was successfully closed. Transanal repair of a RVF through creation of a rectal advancement flap and plication of redundant vaginal wall can be used to treat appropriately selected patients with significant tissue defects.

  14. Endoscopic transnasal dacryocystorhinostomy with nasal mucosal and posterior lacrimal sac flap.

    Science.gov (United States)

    Sonkhya, N; Mishra, P

    2009-03-01

    To describe a new endonasal dacryocystorhinostomy technique and to assess its efficacy. Prospective, non-randomised, interventional case series. Patients with primary nasolacrimal duct obstruction were included. A prospective series of 226 consecutive endoscopic transnasal dacryocystorhinostomies performed between January 2003 and December 2006 were entered into the study. Patients who had undergone previous lacrimal surgery were excluded. The surgical technique involved the creation of nasal mucosal and large posterior lacrimal flaps at the medial lacrimal sac wall. The two flaps were placed in close apposition. The technique also involved creation of a large bony ostium. Success was defined as the resolution of symptoms, or unobstructed lacrimal irrigation and endoscopic visualisation of a patent rhinostomy. A total of 226 consecutive endoscopic transnasal dacryocystorhinostomy procedures performed between January 2003 and December 2006 were reviewed. The main presentation was with epiphora (95 per cent) and/or mucocele (13 per cent). Septoplasty was performed in 36 per cent of cases at the time of surgery. In 18 per cent of cases, endoscopic sinus surgery was also added to the procedure. The follow-up period ranged from six months to two years. Of the 226 patients, eight were lost to follow up and were thus excluded from the series. The procedure achieved a 92 per cent success rate, in terms of symptom relief and anatomical success. The described technique of endoscopic endonasal dacryocystorhinostomy had a success rate comparable to that of external dacryocystorhinostomy. The procedure is simple and cost-effective because it does not require sophisticated equipment such as lasers, optical fibres, silicone stents or a microdebrider.

  15. The vaginal microbiome: Associations with sexually transmitted infections and the mucosal immune response

    NARCIS (Netherlands)

    Borgdorff, H.

    2016-01-01

    A healthy vaginal microbiota is dominated by lactobacilli. Disturbance of the microbiological vaginal microbiota balance ("dysbiosis") is associated with an increased risk of acquisition of sexually transmitted infections including HIV, and preterm birth in pregnant women. Since 2002, studies have

  16. Immunization with HIV-1 gp41 subunit virosomes induces mucosal antibodies protecting nonhuman primates against vaginal SHIV challenges.

    Science.gov (United States)

    Bomsel, Morgane; Tudor, Daniela; Drillet, Anne-Sophie; Alfsen, Annette; Ganor, Yonatan; Roger, Marie-Gaëlle; Mouz, Nicolas; Amacker, Mario; Chalifour, Anick; Diomede, Lorenzo; Devillier, Gilles; Cong, Zhe; Wei, Qiang; Gao, Hong; Qin, Chuan; Yang, Gui-Bo; Zurbriggen, Rinaldo; Lopalco, Lucia; Fleury, Sylvain

    2011-02-25

    Human immunodeficiency virus (HIV)-1 is mainly transmitted mucosally during sexual intercourse. We therefore evaluated the protective efficacy of a vaccine active at mucosal sites. Macaca mulatta monkeys were immunized via both the intramuscular and intranasal routes with an HIV-1 vaccine made of gp41-subunit antigens grafted on virosomes, a safe delivery carrier approved in humans with self-adjuvant properties. Six months after 13 vaginal challenges with simian-HIV (SHIV)-SF162P3, four out of five vaccinated animals remained virus-negative, and the fifth was only transiently infected. None of the five animals seroconverted to p27gag-SIV. In contrast, all 6 placebo-vaccinated animals became infected and seroconverted. All protected animals showed gp41-specific vaginal IgAs with HIV-1 transcytosis-blocking properties and vaginal IgGs with neutralizing and/or antibody-dependent cellular-cytotoxicity activities. In contrast, plasma IgGs totally lacked virus-neutralizing activity. The protection observed challenges the paradigm whereby circulating antiviral antibodies are required for protection against HIV-1 infection and may serve in designing a human vaccine against HIV-1-AIDS. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Reduction of mandibular residual ridge after vestibuloplasty. A two-year follow-up study comparing the Edlan flap, mucosal and skin graft operations

    DEFF Research Database (Denmark)

    Hillerup, Søren; Eriksen, Erik; Solow, B

    1989-01-01

    Mandibular residual ridge reduction (RRR) after Edlan flap vestibuloplasty, buccal mucosal graft, and split skin graft vestibuloplasty was measured on lateral cephalometric radiographs obtained 1, 3, 6, 12 and 24 months postsurgery in 50 patients. The ridge reduction was most severe during the im...

  18. Original article Rolled Vaginal Wall Flap for The Treatment of Stress ...

    African Journals Online (AJOL)

    mn

    Tension free vaginal tape (TVT) and transobturator tape (TOT) procedures may have an acceptable rate of complications such as infection, organ injuries and erosion, but they are costly. Patients with SUI and limited financial resources may still prefer autologous materials for sling surgery to avoid the cost of modern tapes.

  19. Determination of Prognostic Factors for Vaginal Mucosal Toxicity Associated With Intravaginal High-Dose Rate Brachytherapy in Patients With Endometrial Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Bahng, Agnes Y.; Dagan, Avner [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA (United States); Bruner, Deborah W. [University of Pennsylvania School of Nursing, Philadelphia, PA (United States); Lin, Lilie L., E-mail: lin@xrt.upenn.edu [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA (United States)

    2012-02-01

    Purpose: The objective of this study was to determine the patient- and treatment-related prognostic factors associated with vaginal toxicity in patients who received intravaginal high dose rate (HDR) brachytherapy alone as adjuvant treatment for endometrial cancer. Secondary goals of this study included a quantitative assessment of optimal dilator use frequency and a crude assessment of clinical predictors for compliant dilator use. Methods and Materials: We retrospectively reviewed the charts of 100 patients with histologically confirmed endometrial cancer who underwent total hysterectomy and bilateral salpingo-oophorectomy with or without lymph node dissection and adjuvant intravaginal brachytherapy between 1995 and 2009 at the Hospital of University of Pennsylvania. The most common treatment regimen used was 21 Gy in three fractions (71 patients). Symptoms of vaginal mucosal toxicity were taken from the history and physical exams noted in the patients' charts and were graded according to the Common Toxicity Criteria for Adverse Events v. 4.02. Results: The incidence of Grade 1 or asymptomatic vaginal toxicity was 33% and Grade 2-3 or symptomatic vaginal toxicity was 14%. Multivariate analysis of age, active length, and dilator use two to three times a week revealed odds ratios of 0.93 (p = 0.013), 3.96 (p = 0.008), and 0.17 (p = 0.032) respectively. Conclusion: Increasing age, vaginal dilator use of at least two to three times a week, and shorter active length were found to be significantly associated with a decreased risk of vaginal stenosis. Future prospective studies are necessary to validate our findings.

  20. [BIPADDLED SPLIT PECTORALIS MAJOR MYOCUTANEOUS FLAPS FOR IMMEDIATE RECONSTRUCTION OF ORAL MUCOSAL DEFECTS AND NECK DEFECTS AFTER RESECTION OF RECURRENT ORAL CANCER].

    Science.gov (United States)

    Chen, Jie; Jiang, Canhua; Li, Ning; Gao, Zhengyang; Chen, Lichun; Wu, Xiaoshan; Chen, Xinqun; Jian, Xinchun

    2015-07-01

    To investigate the feasibility of the bipaddled split pectoralis major myocutaneous flap for immediate reconstruction of oral mucosal defects and neck defects after resection of recurrent oral cancer. Six patients with oral mucosal defects combined with neck defects after recurrent oral cancer resection were treated with bipaddled split pectoralis major myocutaneous flap between September 2013 and September 2014. There were 5 males and 1 female with an average age of 54.7 years (range, 45-62 years), including 4 cases of recurrent tongue cancer, 1 case of recurrent mandibular gingival cancer, and 1 case of mouth floor carcinoma. All patients underwent local recurrence at 8 to 14 months after first operation, with no distant metastasis. The defects of the intraoral mucosa was 4.0 cm x 2.5 cm to 6.5 cm x 3.5 cm and the defect of the neck skin was 5.5 cm x 3.5 cm to 7.5 cm x 5.0 cm. The pectoralis major myocutaneous flaps (14.0 cm x 3.5 cm to 17.0 cm x 5.5 cm) were incised at the level of the 3rd to the 4th rib, and then split down along the muscle fiber till about 2 cm away from the thoracoacromial vessels, forming 2 independent skin paddles with 1-2 branch vessels to the pedicles of the distal ones. The distal skin paddles were used for oral reconstruction while the proximal paddles for repair of neck defects. The chest donor sites were sutured directly. Cervical haematoma and infection happened in 1 patient respectively after operation, and were cured after symptomatic treatment. All 6 split pectoralis major myocutaneous flaps with 12 skin paddles completely survived. All patients were followed up 6 to 18 months (mean, 11 months). One patient died of pulmonary metastasis at 8 months after operation and the other 5 survived without relapse or metastasis during follow-up. The intraoral paddles showed good shape with satisfactory speech function and swallowing recovery. The paddles also healed perfectly on the neck with flat outlooks, and all patients obtained full

  1. Effect of Platform Shift/Switch and Concave Abutments on Crestal Bone Levels and Mucosal Profile following Flap and Flapless Implant Surgery.

    Science.gov (United States)

    Gamborena, Inãki; Lee, Jaebum; Fiorini, Tiago; Wenzel, Brent A; Schüpbach, Peter; Wikesjö, Ulf M E; Susin, Cristiano

    2015-10-01

    Crestal remodeling/bone loss appears to be a common sequel to dental implant placement. Several hypotheses/clinical strategies have been proposed to explain/avert crestal remodeling; however, causative mechanisms remain unclear and the efficacy of these clinical approaches uncertain. The objective of the present study was to provide a histological account of crestal bone levels and mucosal profile at platform shift/switch and concave abutments following flapless and conventional flap surgery and subcrestal implant placement using a dog model. Four dental implants each were placed in the left/right mandibular posterior jaw quadrants in five adult male Hound/Labrador mongrel dogs using flap surgery with a 1 × 5 mm gap defect or using a flapless approach, both involving placement 2 mm subcrestally and platform shift/switch versus concave abutments. Block biopsies for histological/histometric analysis were collected at 8 weeks. No significant differences were observed regarding crestal bone levels, with all groups showing mean bone levels above the implant platform. Similarly, crestal bone-implant contact was not significantly different among groups. Moreover, peri-implant mucosal profiles were not statistically different among groups for buccal sites; average mucosal height reached 4.1 to 4.9 mm above the implant platform. Comparison between buccal and lingual sites showed a nonsignificant tendency toward greater crestal resorption at buccal sites, adjusting for other factors. Mean crestal bone-implant contact level approximated the implant platform for lingual sites while consistently remaining below the platform at the buccal sites. Peri-implant mucosal height was significantly higher at buccal than at lingual sites, with the epithelial attachment located a significant distance away from the implant platform at buccal sites. The surgical approaches (subcrestal implant placement by flap surgery or a flapless approach) and abutment designs (platform shift/switch or

  2. Modified Gunderson Conjunctival Flap Combined with an Oral Mucosal Graft to Treat an Intractable Corneal Lysis after Chemical Burn: A Case Report

    Directory of Open Access Journals (Sweden)

    Kai-Chun Cheng

    2006-05-01

    Full Text Available Following a severe chemical injury, persistent corneal melting presents as a threatening condition for loss of vision or the eyeball itself. Keratoplasty (both lamellar and penetrating and amniotic membrane transplantation have been the usual modes of therapy. However, these may not halt the persistent melting process. We introduce here an alternative surgical procedure to resolve corneal melting and preserve the globe. This case concerns the right eye of a 36-year-old male who had suffered from severe ocular alkali chemical burns and sustained intractable corneal melting, despite receiving corneal transplants three times, a limbal stem cell transplantation once, a scleral graft twice, and amniotic membrane transplantation eight times. To circumvent the impending perforation, we performed a modified Gunderson conjunctival flap combined with an oral mucosal graft. The corneal melting was halted, and the eyeball was preserved. The combination of an oral mucosal graft to the modified Gunderson conjunctival flap provided an easy alternative to resolve a case of intractable corneal melting and impending perforation.

  3. SINGLE STAGE VENTRAL ONLAY BUCCAL MUCOSAL GRAFT URETHROPLASTY BASED ON TUNICA VAGINALIS FLAP FOR BALANITIS XEROTICA OBLITERANS RELATED URETHRAL MEATAL AND NAVICULAR FOSSA STRICTURES

    Directory of Open Access Journals (Sweden)

    Sathish Kumar G

    2017-07-01

    Full Text Available BACKGROUND Balanitis Xerotica Obliterans (BXO, also known as lichen sclerosus of penis is a chronic, progressive disease of the glans and prepuce that leads to phimosis and stricture of the urethra that can extend from the meatus and glanular urethra to the prostatic urethra. Urinary and sexual functions are affected and there is a severe reduction in quality of life. Many patients have been initially treated with tacrolimus or circumcision, when the disease has involved the prepuce and glans superficially, but conservative management has a limited role in this condition. Once stricture develops, surgical intervention in the form of grafts or flaps becomes necessary. We present our results with single-stage Ventral Onlay Buccal Mucosal Graft Urethroplasty (VOBMGU based on tunica vaginalis flap for BXO related strictures of meatus and fossa navicularis. MATERIALS AND METHODS From July 2014, six patients who underwent single stage Ventral Onlay Buccal Mucosal Graft Urethroplasty Graft (VOBMGU based on tunica vaginalis flap for BXO related strictures of urethral meatus and navicular fossa were included in the study. Patients presenting with BXO were clinically assessed for the extent of involvement as having BXO affecting the foreskin, glans, meatus, penile shaft, urethra and scrotum. They were radiologically assessed with a retrograde urethrogram and ultrasound abdomen. Outcome was assessed in terms of uroflowmetry, cosmetic appearance, stricture recurrence and complications. RESULTS Patients were reviewed every three months for over one year and six monthly. Only one patient had mild stenosis of the urethral meatus, as evidenced by change in flow, which was treated successfully with dilatation. One patient reported moderate splaying of urine, but this was mild in all other cases. All patients had a normal slit-like meatus, satisfactory voiding and sexual functions. CONCLUSION Isolated involvement of fossa navicularis and meatal stenosis stricture

  4. Setting of methods for analysis of mucosal antibodies in seminal and vaginal fluids of HIV seropositive subjects from Cambodian and Italian cohorts.

    Directory of Open Access Journals (Sweden)

    Carla Donadoni

    2010-03-01

    Full Text Available Genital mucosae play a key role in protection from STD and HIV infection, due to their involvement in both horizontal and vertical disease transmission. High variability of published observations concerning IgA isolation and quantification underlies the strong requirement of specific methods able to maximize investigation on HIV-specific IgA.Genital fluids from 109 subjects, including male and female cohorts from Italy and Cambodia, were collected, aliquoted and processed with different techniques, to assess optimal conditions maximizing mucosal antibody recovery. Three sampling techniques, up to sixteen preservation conditions, six ELISA methods and four purifications protocols were compared.The optimal method here described took advantage of Weck-Cel sampling of female mucosal fluids. Immediate processing of genital fluids, with the addition of antibiotics and EDTA, improved recovery of vaginal IgA, while the triple addition of EDTA, antibiotics and protease inhibitors provided the highest amount of seminal IgA. Due to low amount of IgA in mucosal fluids, a high sensitive sandwich ELISA assay was set; sensitivity was enhanced by milk-based overcoating buffer and by a two-step biotin-streptavidin signal amplification. Indeed, commercial antisera to detect human immunoglobulins showed weak cross-reactivity to different antibody types. Three-step affinity purification provided reproducible immunoglobulin recovery from genital specimens, while conventional immuno-affinity IgA purification was found poorly manageable. Affinity columns were suitable to isolate mucosal IgA, which are ten-fold less concentrated than IgG in genital specimens, and provided effective separation of IgA monomers, dimers, and J-chains. Jacalin-bound resin successfully separated IgA1 from IgA2 subfraction.Specific, effective and reliable methods to study local immunity are key items in understanding host mucosal response. The sequence of methods here described is effective

  5. Vulvar and vaginal melanoma: A unique subclass of mucosal melanoma based on a comprehensive molecular analysis of 51 cases compared with 2253 cases of nongynecologic melanoma.

    Science.gov (United States)

    Hou, June Y; Baptiste, Caitlin; Hombalegowda, Radhika Bangalore; Tergas, Ana I; Feldman, Rebecca; Jones, Nathaniel L; Chatterjee-Paer, Sudeshna; Bus-Kwolfski, Ama; Wright, Jason D; Burke, William M

    2017-04-15

    Optimal treatments for vulvar and vaginal melanomas (VVMs) have not been identified. Herein, the authors compare molecular profiles between VVM and nongynecologic melanoma (NGM) subtypes with the objective of identifying novel, targetable biomarkers. In total, 2304 samples of malignant melanoma that were submitted to Caris Life Sciences between 2009 and 2015 were reviewed. In situ hybridization and immunohistochemistry were used to assess copy numbers and protein expression of selected genes. Sequenced variants were analyzed using a proprietary cancer panel. In total, 51 VVMs (14 vaginal and 37 vulvar melanomas) were compared with 2253 malignant NGMs, including 2127 cutaneous, 105 mucosal, and 21 acral melanomas. In VVMs, B-Raf proto-oncogene serine/threonine kinase (BRAF) was the most frequently mutated gene (26%) compared with 8.3% of mucosal NGMs (P = .008). In BRAF-mutated tumors, fewer VVMs (50%), compared with NGMs (82.1%), had a variant within the valine codon 600 (V600) domain. The KIT mutation rate was highest in VVMs (22%) compared with 3% in cutaneous (P melanoma subtypes. NRAS mutations were rare in VVMs compared with cutaneous (25.9%; P = .009) and acral (40.6%; P = .002) melanoma subtypes. PD-L1 (56%) and PD-1 (75%) were frequently expressed in VVM, whereas PI3KCA pathway mutations and estrogen receptor/progesterone receptor expression were rare. Compared with VVMs that had KIT mutations, wild-type KIT VVMs were more likely to express molecular markers suggestive of platinum resistance (ERCC1), alkylating sensitivity (MGMT), and anthracycline sensitivity (TOP2A). The unique molecular features of VVM render this disease a distinct subtype of melanoma. Gene-based molecular therapy and immunotherapies may be promising and should be evaluated in clinical trials. Cancer 2017;123:1333-1344. © 2016 American Cancer Society. © 2016 American Cancer Society.

  6. Vaginal reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Lesavoy, M.A.

    1985-05-01

    Vaginal reconstruction can be an uncomplicated and straightforward procedure when attention to detail is maintained. The Abbe-McIndoe procedure of lining the neovaginal canal with split-thickness skin grafts has become standard. The use of the inflatable Heyer-Schulte vaginal stent provides comfort to the patient and ease to the surgeon in maintaining approximation of the skin graft. For large vaginal and perineal defects, myocutaneous flaps such as the gracilis island have been extremely useful for correction of radiation-damaged tissue of the perineum or for the reconstruction of large ablative defects. Minimal morbidity and scarring ensue because the donor site can be closed primarily. With all vaginal reconstruction, a compliant patient is a necessity. The patient must wear a vaginal obturator for a minimum of 3 to 6 months postoperatively and is encouraged to use intercourse as an excellent obturator. In general, vaginal reconstruction can be an extremely gratifying procedure for both the functional and emotional well-being of patients.

  7. MiniCD4 microbicide prevents HIV infection of human mucosal explants and vaginal transmission of SHIV(162P3 in cynomolgus macaques.

    Directory of Open Access Journals (Sweden)

    Nathalie Dereuddre-Bosquet

    Full Text Available In complement to an effective vaccine, development of potent anti-HIV microbicides remains an important priority. We have previously shown that the miniCD4 M48U1, a functional mimetic of sCD4 presented on a 27 amino-acid stable scaffold, inhibits a broad range of HIV-1 isolates at sub-nanomolar concentrations in cellular models. Here, we report that M48U1 inhibits efficiently HIV-1(Ba-L in human mucosal explants of cervical and colorectal tissues. In vivo efficacy of M48U1 was evaluated in nonhuman primate (NHP model of mucosal challenge with SHIV(162P3 after assessing pharmacokinetics and pharmacodynamics of a miniCD4 gel formulation in sexually matured female cynomolgus macaques. Among 12 females, half were treated with hydroxyethylcellulose-based gel (control, the other half received the same gel containing 3 mg/g of M48U1, one hour before vaginal route challenge with 10 AID(50 of SHIV(162P3. All control animals were infected with a peak plasma viral load of 10(5-10(6 viral RNA (vRNA copies per mL. In animals treated with miniCD4, 5 out of 6 were fully protected from acquisition of infection, as assessed by qRT-PCR for vRNA detection in plasma, qPCR for viral DNA detection in PBMC and lymph node cells. The only infected animal in this group had a delayed peak of viremia of one week. These results demonstrate that M48U1 miniCD4 acts in vivo as a potent entry inhibitor, which may be considered in microbicide developments.

  8. Serum, uterine, and vaginal mucosal IgG antibody responses against Tritrichomonas foetus after administration of a commercial killed whole T foetus vaccine in beef cows.

    Science.gov (United States)

    Palomares, R A; Hurley, D J; Crum, L T; Rollin, E; Collop, T; Williard, A; Felton, J; Parrish, J; Corbeil, L B

    2017-01-01

    The objective of this study was to determine the level and duration of IgG antibodies induced against killed whole Tritrichomonas foetus and T foetus-purified surface antigen (TF1.17) in serum, vaginal, and uterine secretions after systemic immunization of beef cows with a vaccine containing killed whole T foetus. Twenty nonpregnant beef cows were randomly assigned to vaccine or control groups as follows: Vaccine (n = 10): cows received 2 mL of a commercial vaccine containing killed whole T foetus subcutaneously and a 2-mL booster 2 weeks later. Control (n = 10): cows received 2 mL of sterile saline on the same schedule. Vaginal secretions and blood samples were collected on Days 0, 8, 15, 22, 29, 36, 43, 50, 60, 75, 89, 110, 146, and 182 relative to day of primary vaccination. Uterine flush fluid was collected on Days 0, 15, 29, and 43 after the day of primary vaccination. Samples were assayed for IgG antibodies to the killed whole T foetus and surface antigen TF1.17 using enzyme-linked immunosorbent assay. Serum whole T foetus-specific IgG levels were significantly increased (between Days 15 and 182) following vaccination with T foetus or with saline. No differences between vaccinates and controls in uterine responses to whole-cell antigen were detected. Serum anti-TF1.17 IgG responses to vaccination were significantly higher than Day 0 throughout the immunization period (P IgG levels was observed in vaginal and uterine fluids from Day 15 post vaccination compared to the Day 0 levels. These levels remained significantly elevated in vaginal and uterine fluids through Days 75 (P IgG to the T foetus TF1.17 surface antigen in serum, vaginal secretions, and uterine fluid, which remained elevated through Days 43, 75, and 182 in uterine fluids, vaginal secretions, and serum, respectively. Since purified TF1.17 antigen has been shown to protect against experimental T foetus infection in heifers, the vaccine-induced TF1.17-specific IgG response is likely to be

  9. Vaginal cysts

    Science.gov (United States)

    ... of tissue. It can be filled with air, fluid, pus, or other material. A vaginal cyst occurs on or under the vaginal lining. ... There are several types of vaginal cysts. Vaginal inclusion cysts ... may collect fluid and develop into a vaginal wall cyst later ...

  10. Mucosal Lactobacillus vectored vaccines.

    Science.gov (United States)

    Yu, Qinghua; Zhu, Liqi; Kang, Haihong; Yang, Qian

    2013-04-01

    Traditional non-gastrointestinal vaccines can prevent effectively the invasion of pathogens; however, these vaccines are less effective against mucosal infections because there is not a sufficient immune response at the mucosa. Most pathogens invade via a mucosal pathway (oral, intranasal, or vaginal). It is widely accepted that Lactobacillus species play a critical role as commensals in the gastrointestinal (GI) tract. Their ability to survive in the digestive tract, their close association with the intestinal epithelium, their immunomodulatory properties and their safety even when consumed in large amounts make lactobacilli attractive candidates for live vehicles for the delivery of immunogens to the intestinal mucosa. The oral or intranasal administration of Lactobacillus-based vaccines is a promising method to control mucosal infection because these vaccines could induce strong humoral and cellular immune responses both in the blood and at mucosal sites.

  11. Vaginal Atrophy

    Science.gov (United States)

    ... urinary signs and symptoms: Vaginal dryness Vaginal burning Vaginal discharge Genital itching Burning with urination Urgency with urination More urinary tract infections Urinary incontinence Light bleeding after intercourse Discomfort with ...

  12. Influences of different palatoplasties on palatal growth and speech development: comparison between Osada's two-stage palatoplasty and one-stage mucosal flap procedure.

    Science.gov (United States)

    Akamatsu, Tadashi; Tanino, Ryuzaburo; Osada, Mitsuhiro; Sakuma, Yuko

    2004-09-01

    Palatal growth and articulation in two different palatal closure techniques, Osada's two-stage procedure and the conventional one-stage procedure, were evaluated in 12 patients. Osada's procedure (hard palate closure using a vomer flap with complete closure of the raw surface by a full thickness skin graft) is a two-stage operation that consists of early soft palate closure at the time of lip closure (3 to 6 months of age). The palatal sizes and the depth of the palatal arch were significantly greater in the two-stage group than in the one-stage group at 1 year of age and, 3 to 5 years of age. There were no differences between the two groups at the velopharyngeal closure evaluation after hard palate closure and at final speech evaluation. Osada's two-stage palatoplasty has many advantages and we believe that this is one of the most recommendable procedures at present.

  13. Mucosal vaccines

    Science.gov (United States)

    Nizard, Mevyn; Diniz, Mariana O; Roussel, Helene; Tran, Thi; Ferreira, Luis CS; Badoual, Cecile; Tartour, Eric

    2014-01-01

    The mucosal immune system displays several adaptations reflecting the exposure to the external environment. The efficient induction of mucosal immune responses also requires specific approaches, such as the use of appropriate administration routes and specific adjuvants and/or delivery systems. In contrast to vaccines delivered via parenteral routes, experimental, and clinical evidences demonstrated that mucosal vaccines can efficiently induce local immune responses to pathogens or tumors located at mucosal sites as well as systemic response. At least in part, such features can be explained by the compartmentalization of mucosal B and T cell populations that play important roles in the modulation of local immune responses. In the present review, we discuss molecular and cellular features of the mucosal immune system as well as novel immunization approaches that may lead to the development of innovative and efficient vaccines targeting pathogens and tumors at different mucosal sites. PMID:25424921

  14. Vaginal Cancer

    Science.gov (United States)

    Vaginal cancer is a rare type of cancer. It is more common in women 60 and older. You are also more likely to get it if you have had a human ... test can find abnormal cells that may be cancer. Vaginal cancer can often be cured in its ...

  15. Peri-Vesical Fat Interposition Flap Reinforcement in High Vesico ...

    African Journals Online (AJOL)

    Background and Aim: The urinary bladder becomes small, contracted and is associated with excess pelvic fat in long standing cases of vesico-vaginal fistulas (VVFs). The aim of this new technique was to use this excess pelvic fat for harvesting an interposition flap. Materials and Methods: An interposition flap of peri-vesical ...

  16. The Development of an AIDS Mucosal Vaccine

    Directory of Open Access Journals (Sweden)

    Xian Tang

    2010-01-01

    Full Text Available It is well known that mucosal tissues contain the largest surface area of the human body and are the front line of natural host defense against various pathogens. In fact, more than 80% of infectious disease pathogens probably gain entry into the susceptible human hosts through open mucosal surfaces. Human immunodeficiency virus type one (HIV-1, a mainly sexually transmitted virus, also primarily targets the vaginal and gastrointestinal mucosa as entry sites for viral transmission, seeding, replication and amplification. Since HIV-1 establishes its early replication in vaginal or rectal mucosal tissues, the induction of sufficient mucosal immunity at the initial site of HIV-1 transmission becomes essential for a protective vaccine. However, despite the fact that current conventional vaccine strategies have remained unsuccessful in preventing HIV-1 infection, sufficient financial support and resources have yet to be given to develop a vaccine able to elicit protective mucosal immunity against sexual transmissions. Interestingly, Chinese ancestors invented variolation through intranasal administration about one thousand years ago, which led to the discovery of a successful smallpox vaccine and the final eradication of the disease. It is the hope for all mankind that the development of a mucosal AIDS vaccine will ultimately help control the AIDS pandemic. In order to discover an effective mucosal AIDS vaccine, it is necessary to have a deep understanding of mucosal immunology and to test various mucosal vaccination strategies.

  17. Vaginal evisceration

    Energy Technology Data Exchange (ETDEWEB)

    Choo, Y.C.; Lindenauer, S.M. (Michigan Univ., Ann Arbor (USA) Dept. of Obstetrics and Gynaecology)

    1981-08-01

    A patient with vaginal evisceration due to prior radiation treatment of cervical carcinoma is presented, together with a review to reported cases. The salient features, predisposing causes and management of this unusual problem are discussed.

  18. Vaginal cancer

    Science.gov (United States)

    Hacker NF. Vulvar and vaginal cancer. In: Hacker NF, Gambone JC, Hobel CJ, eds. Hacker and Moore's Essentials of Obstetrics and Gynecology . 6th ed. Philadelphia, PA: Elsevier; 2016:chap 40. Jhingran ...

  19. Metronidazole Vaginal

    Science.gov (United States)

    Metronidazole is used to treat vaginal infections such as bacterial vaginosis (an infection caused from too much of certain bacteria in the vagina). Metronidazole is in a class of medications called nitroimidazole ...

  20. Antifungal susceptibility profiles and risk factors of vaginal ...

    African Journals Online (AJOL)

    Vaginal candidiasis (VC) is second to bacterial vaginitis, as the most common opportunistic mucosal infection that affects large numbers of otherwise healthy women of childbearing age. The incidence of VC is significantly modified by dressing patterns and aberrant health-care practices. Contemporary young women often ...

  1. Oral mucositis

    Science.gov (United States)

    ... heals by itself when there is no infection. Healing usually takes 2 to 4 weeks. Mucositis caused ... March 20, 2016. Read More Bone marrow transplant HIV/AIDS Mastectomy Patient Instructions After chemotherapy - discharge Bleeding ...

  2. Vaginal microbicides: An overview

    Directory of Open Access Journals (Sweden)

    Hany Abdel-Aleem

    2011-03-01

    Full Text Available It is estimated that more than 340 million new cases of curable sexually transmitted infections occur every year throughout the world in men and women age (15–49years. Women bear an increasing burden of the epidemic as both caregivers for the ill and because of their heightened risk of infection due to biological, economic and social vulnerabilities. There is an urgent need for new prevention strategies that women can use themselves and initiate. A vaginal microbicide defined as substances intended to reduce or prevent transmission of HIV and/or other sexually transmitted infections (STIs when applied topically to genital mucosal surfaces, provides a woman-controlled method applied before sex that could kill, neutralize, or block HIV and other sexually transmitted diseases.

  3. Cryopreservation of Human Mucosal Leukocytes.

    Directory of Open Access Journals (Sweden)

    Sean M Hughes

    Full Text Available Understanding how leukocytes in the cervicovaginal and colorectal mucosae respond to pathogens, and how medical interventions affect these responses, is important for developing better tools to prevent HIV and other sexually transmitted infections. An effective cryopreservation protocol for these cells following their isolation will make studying them more feasible.To find an optimal cryopreservation protocol for mucosal mononuclear leukocytes, we compared cryopreservation media and procedures using human vaginal leukocytes and confirmed our results with endocervical and colorectal leukocytes. Specifically, we measured the recovery of viable vaginal T cells and macrophages after cryopreservation with different cryopreservation media and handling procedures. We found several cryopreservation media that led to recoveries above 75%. Limiting the number and volume of washes increased the fraction of cells recovered by 10-15%, possibly due to the small cell numbers in mucosal samples. We confirmed that our cryopreservation protocol also works well for both endocervical and colorectal leukocytes. Cryopreserved leukocytes had slightly increased cytokine responses to antigenic stimulation relative to the same cells tested fresh. Additionally, we tested whether it is better to cryopreserve endocervical cells on the cytobrush or in suspension.Leukocytes from cervicovaginal and colorectal tissues can be cryopreserved with good recovery of functional, viable cells using several different cryopreservation media. The number and volume of washes has an experimentally meaningful effect on the percentage of cells recovered. We provide a detailed, step-by-step protocol with best practices for cryopreservation of mucosal leukocytes.

  4. Cryopreservation of Human Mucosal Leukocytes.

    Science.gov (United States)

    Hughes, Sean M; Shu, Zhiquan; Levy, Claire N; Ferre, April L; Hartig, Heather; Fang, Cifeng; Lentz, Gretchen; Fialkow, Michael; Kirby, Anna C; Adams Waldorf, Kristina M; Veazey, Ronald S; Germann, Anja; von Briesen, Hagen; McElrath, M Juliana; Dezzutti, Charlene S; Sinclair, Elizabeth; Baker, Chris A R; Shacklett, Barbara L; Gao, Dayong; Hladik, Florian

    2016-01-01

    Understanding how leukocytes in the cervicovaginal and colorectal mucosae respond to pathogens, and how medical interventions affect these responses, is important for developing better tools to prevent HIV and other sexually transmitted infections. An effective cryopreservation protocol for these cells following their isolation will make studying them more feasible. To find an optimal cryopreservation protocol for mucosal mononuclear leukocytes, we compared cryopreservation media and procedures using human vaginal leukocytes and confirmed our results with endocervical and colorectal leukocytes. Specifically, we measured the recovery of viable vaginal T cells and macrophages after cryopreservation with different cryopreservation media and handling procedures. We found several cryopreservation media that led to recoveries above 75%. Limiting the number and volume of washes increased the fraction of cells recovered by 10-15%, possibly due to the small cell numbers in mucosal samples. We confirmed that our cryopreservation protocol also works well for both endocervical and colorectal leukocytes. Cryopreserved leukocytes had slightly increased cytokine responses to antigenic stimulation relative to the same cells tested fresh. Additionally, we tested whether it is better to cryopreserve endocervical cells on the cytobrush or in suspension. Leukocytes from cervicovaginal and colorectal tissues can be cryopreserved with good recovery of functional, viable cells using several different cryopreservation media. The number and volume of washes has an experimentally meaningful effect on the percentage of cells recovered. We provide a detailed, step-by-step protocol with best practices for cryopreservation of mucosal leukocytes.

  5. Oral mucositis

    NARCIS (Netherlands)

    Raber-Durlacher, J.E.; Elad, S.; Barasch, A.

    2010-01-01

    Mucosal damage is one of the most common adverse effects of radiotherapy and of cytotoxic therapy for cancer. With prevalence between 10% and 100%, depending of the cytotoxic regimen and patient-associated variables, this morbid condition represents a significant problem in oncology. In this paper

  6. Transgenic Killer Commensal Bacteria as Mucosal Protectants

    Directory of Open Access Journals (Sweden)

    Luciano Polonelli

    2001-01-01

    Full Text Available As first line of defense against the majority of infections and primary site for their transmission, mucosal surfaces of the oral cavity and genitourinary, gastrointestinal, and respiratory tracts represent the most suitable sites to deliver protective agents for the prevention of infectious diseases. Mucosal protection is important not only for life threatening diseases but also for opportunistic infections which currently represent a serious burden in terms of morbidity, mortality, and cost of cures. Candida albicans is among the most prevalent causes of mucosal infections not only in immuno- compromised patients, such as HIV-infected subjects who are frequently affected by oral and esophageal candidiasis, but also in otherwise healthy individuals, as in the case of acute vaginitis. Unfortunately, current strategies for mucosal protection against candidiasis are severely limited by the lack of effective vaccines and the relative paucity and toxicity of commercially available antifungal drugs. An additional option has been reported in a recent

  7. Vaginal sponge and spermicides

    Science.gov (United States)

    ... counter; Contraceptives - over the counter; Family planning - vaginal sponge; Contraception - vaginal sponge ... Spermicides and vaginal sponges do not work as well at preventing pregnancy as some other forms of birth control. However, using a spermicide ...

  8. Vaginitis test - wet mount

    Science.gov (United States)

    Wet prep - vaginitis; Vaginosis - wet mount; Trichomoniasis - wet mount; Vaginal candida - wet mount ... a rash, painful intercourse, or odor after intercourse. Trichomoniasis , a sexually transmitted disease. Vaginal yeast infection .

  9. The pudendal thigh flap as YV advanced flap for the release of perineum burns contractures.

    Science.gov (United States)

    Benito, P; De Juan, A; Cano, M

    2012-05-01

    Contractures secondary to burns affecting the perineum often cause severe functional, aesthetic and psychological harm. Many different surgical techniques are used to treat such conditions ranging from grafts, to triangular plasty transposition or advancement flaps of local tissue. It is usually advisable to use a flap or local perineoplasty because the quality of reconstruction tends to be better and the risk of reoccurrence of the contracture is lower. The pudendal thigh fasciocutaneous (PTF) flap is an axial patterned and sensate flap based on the groin crease. It has frequently been used for perineal and vaginal reconstructions. Technically, it is not difficult to perform, with a well tolerated scar located in the inguinal crease, and it is characterized by its thinness and its ready adaptation to the defects, and because it maintains sensitivity. To the best of our knowledge, no previous case of perineal contracture treatment has been reported with the use of a PTF flap harvested as an YV advanced flap. Here we report the case of a patient with a severe contracture who was treated using the flap described above, a satisfactory result being achieved. Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  10. Mucosal immunity and HIV-1 infection: applications for mucosal AIDS vaccine development.

    Science.gov (United States)

    Belyakov, Igor M; Ahlers, Jeffrey D

    2012-01-01

    Natural transmission of human immunodeficiency virus type 1 (HIV-1) occurs through gastrointestinal and vaginal mucosa. These mucosal tissues are major reservoirs for initial HIV replication and amplification, and the sites of rapid CD4(+) T cell depletion. In both HIV-infected humans and SIV-infected macaques, massive loss of CD4(+) CCR5(+) memory T cells occurs in the gut and vaginal mucosa within the first 10-14 days of infection. Induction of local HIV-specific immune responses by vaccines may facilitate effective control of HIV or SIV replication at these sites. Vaccines that induce mucosal responses, in particular CD8(+) cytotoxic T lymphocytes (CTL), have controlled viral replication at mucosal sites and curtailed systemic dissemination. Thus, there is strong justification for development of next generation vaccines that induce mucosal immune effectors against HIV-1 including CD8(+) CTL, CD4(+) T helper cells and secretory IgA. In addition, further understanding of local innate mechanisms that impact early viral replication will greatly inform future vaccine development. In this review, we examine the current knowledge concerning mucosal AIDS vaccine development. Moreover, we propose immunization strategies that may be able to elicit an effective immune response that can protect against AIDS as well as other mucosal infections.

  11. Rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a systematic review and meta-analysis.

    Science.gov (United States)

    Balciscueta, Zutoia; Uribe, Natalia; Balciscueta, Izaskun; Andreu-Ballester, Juan Carlos; García-Granero, Eduardo

    2017-05-01

    Rectal advancement flap is an accepted approach for treating complex fistula-in-ano. However, a diversity of technical modifications have been described. The aim of this study was to evaluate recurrence and fecal continence rates after performing rectal advancement flaps depending upon flap thickness (full-thickness, partial-thickness, or mucosal flaps) and treatment of the fistulous tract (core-out or curettage). Medline (PubMed, Ovid), the Cochrane Library database, and ClinicalTrials.gov were searched. Studies that involved patients with complex cryptoglandular fistulas who had been treated with rectal advancement flaps were included. The outcomes measured were recurrence and fecal continence. All of the statistical analyses were performed using Comprehensive Meta-Analysis software. A fixed model was used if there was no evidence of heterogeneity; otherwise, a random effects model was used. Twenty-six studies were included (1655 patients). The pooled rate of recurrence was 21%. Full-thickness flaps showed the best results concerning recurrence (7.4%), partial flaps revealed 19% and mucosal flaps 30.1%. Core-out and curettage had a similar recurrence (19 vs 21%). Regarding anal incontinence, the pooled rate was 13.3%. Mucosal- and partial-thickness flaps showed similar rates (9.3 vs 10.2%), while full-thickness flaps disturbed it in 20.4%. Most of these alterations were minor symptoms. Otherwise, core-out and curettage showed similar rates (14.3 vs 12%). 1. Full-thickness rectal advancement flaps offer better results regarding the recurrence than mucosal or partial flaps. 2. All flaps cause some incontinence, which increases with the thickness of the flap. 3. The results did not suggest differences in recurrence and incontinence between core-out and curettage.

  12. A Novel Technique for Anterior Vaginal Wall Prolapse Repair: Anterior Vaginal Wall Darn

    Directory of Open Access Journals (Sweden)

    Osman Köse

    2013-01-01

    Full Text Available Aim. The aim of this study is to introduce a new technique, anterior vaginal wall darn (AVWD, which has not been used before to repair the anterior vaginal wall prolapse, a common problem among women. Materials and Methods. Forty-five women suffering from anterior vaginal wall prolapse were operated on with a new technique. The anterior vaginal wall was detached by sharp and blunt dissection via an incision beginning from the 1 cm proximal aspect of the external meatus extending to the vaginal apex, and the space between the tissues that attach the lateral walls of the vagina to the arcus tendineus fascia pelvis (ATFP was then darned. Preoperation and early postoperation evaluations of the patients were conducted and summarized. Results. Data were collected six months after operation. Cough stress test (CST, Pelvic Organ Prolapse Quantification (POP-Q evaluation, Incontinence Impact Questionnaire (IIQ-7, and Urogenital Distress Inventory (UDI-6 scores indicated recovery. According to the early postoperation results, all patients were satisfied with the operation. No vaginal mucosal erosion or any other complications were detected. Conclusion. In this initial series, our short-term results suggested that patients with grade II-III anterior vaginal wall prolapsus might be treated successfully with the AVWD method.

  13. Role of Lactobacilli and Lactoferrin in the Mucosal Cervicovaginal Defense

    Directory of Open Access Journals (Sweden)

    Piera Valenti

    2018-03-01

    Full Text Available The innate defense system of the female mucosal genital tract involves a close and complex interaction among the healthy vaginal microbiota, different cells, and various proteins that protect the host from pathogens. Vaginal lactobacilli and lactoferrin represent two essential actors in the vaginal environment. Lactobacilli represent the dominant bacterial species able to prevent facultative and obligate anaerobes outnumber in vaginal microbiota maintaining healthy microbial homeostasis. Several mechanisms underlie the protection exerted by lactobacilli: competition for nutrients and tissue adherence, reduction of the vaginal pH, modulation of immunity, and production of bioactive compounds. Among bioactive factors of cervicovaginal mucosa, lactoferrin, an iron-binding cationic glycoprotein, is a multifunctional glycoprotein with antibacterial, antifungal, antiviral, and antiparasitic activities, recently emerging as an important modulator of inflammation. Lactobacilli and lactoferrin are largely under the influence of female hormones and of paracrine production of various cytokines. Lactoferrin is strongly increased in lower genital tract mucosal fluid of women affected by Neisseria gonorrheae, Chlamydia trachomatis, and Trichomonas vaginalis infections promoting both innate and adaptive immune responses. In vaginal dysbiosis characterized by low amounts of vaginal lactobacilli and increased levels of endogenous anaerobic bacteria, the increase in lactoferrin could act as an immune modulator assuming the role normally played by the healthy microbiota in vaginal mucosa. Then lactoferrin and lactobacilli may be considered as biomarkers of altered microbial homeostasis at vaginal level. Considering the shortage of effective treatments to counteract recurrent and/or antibiotic-resistant bacterial infections, the intravaginal administration of lactobacilli and lactoferrin could be a novel efficient therapeutic strategy and a valuable tool to restore

  14. Mucosal delivery routes for optimal immunization: targeting immunity to the right tissues.

    Science.gov (United States)

    Czerkinsky, C; Holmgren, J

    2012-01-01

    The mucosal immune system exhibits a high degree of anatomic compartmentalization related to the migratory patterns of lymphocytes activated at different mucosal sites. The selective localization of mucosal lymphocytes to specific tissues is governed by cellular "homing" and chemokine receptors in conjunction with tissue-specific addressins and epithelial cell-derived chemokines that are differentially expressed in "effector" tissues. The compartmentalization of mucosal immune responses imposes constraints on the selection of vaccine administration route. Traditional routes of mucosal immunization include oral and nasal routes. Other routes for inducing mucosal immunity include the rectal, vaginal, sublingual, and transcutaneous routes. Sublingual administration is a new approach that results in induction of mucosal and systemic T cell and antibody responses with an exceptionally broad dissemination to different mucosae, including the gastrointestinal and respiratory tracts, and the genital mucosa. Here, we discuss how sublingual and different routes of immunization can be used to generate immune responses in the desired mucosal tissue(s).

  15. Mucosal delivery of vaccines: role of mucoadhesive/biodegradable polymers.

    Science.gov (United States)

    Garg, Neeraj K; Mangal, Sharad; Khambete, Hemant; Sharma, Pradeep K; Tyagi, Rajeev K

    2010-06-01

    Majority of infectious microorganism make their gateway to the host through mucosal surfaces, such as gastrointestinal tract, nasal and vaginal tract. Mucosal immune response structured as sIgA can effectively prevent the attachment and invasion of the microorganism from mucosal surface and thereby serves as an efficient tool against infectious disease. There has been an increased demand for the development of novel vaccine that leads to the induction of immune response in systemic circulation as well as at mucosal surfaces against infectious disease. Mucosal delivery of vaccine provides basis for induction of both mucosal as well as systemic immune responses against the infectious organisms. However, a variety of factors such as mucociliary clearance, presence of deteriorating enzymes, pH extremes (GIT), low permeation and metabolic degradation limit the mucosal delivery of vaccine. Numerous strategies have been explored in the meadow of mucosal vaccination for the purpose of efficient antigen delivery through mucosal route(s). Polymeric carrier(s) such as nanoparticles and microparticles loaded with the antigen can serve as the basis for creation of important formulations for improved vaccine. Biodegradable and mucoadhesive polymeric carrier(s) seems to be most promising candidate for mucosal vaccine delivery. Several polymers from natural and synthetic origin, such as polylactide-co-glycolide, chitosan, alginate, carbopol, gelatin etc., have been explored for the efficient mucosal vaccine delivery and significant results have been obtained. This review outlines the polymers used in mucosal vaccine delivery with special reference to mucoadhesive/biodegradable polymers. This article also covers the recent patent granted in the field on polymeric carrier mediated mucosal vaccination.

  16. Free anterolateral thigh flap

    Directory of Open Access Journals (Sweden)

    Zoran M. Arnež

    2006-05-01

    Full Text Available Background: For reconstruction of soft tissue defects in reconstructive microsurgery after ablation of tumors or following trauma flaps having following characteristics are being searched for: large surface, long vascular pedicle with large diameter of vessels, possibility of transfer of multiple tissues (skin, muscle, fascia, tendons, bone on the same nutrient vessels, independent movement of different components of the flap in space, harvesting in supine position and primary donor site closure. Many of these characteristics are being met by the radial forearm flap however its main dissadvantage remains donor site closure by split thickness skin grafts. This can be avoided by the use of the anterolateral thigh (ALT flap.Methods: The ALT flap is raised, like other perforator flaps, arround the septocutaneous perforator, which is located by Doppler ultrasound at midpoint on the line connecting anterior superior iliac spine and upper lateral border of patella or arround musculocutaneous perforators. Vascular pedicle can be made longer by harvesting of the descendent branch of the lateral circomflex femoral artery.Results: We report the first successfull free ALT flap transfer for soft tissue reconstruction of oral cavity and cheek after ablation of a recurrency of a malignant tumor in Slovenia.Conclusions: Because of its proprieties the ALT flap is suitable for reconstruction of defects on head and neck and extremities following tumor ablation or trauma. Because of its advantages it will replace also in our country the radial forearm flap which is the most popular flap in Slovenija for these indications.

  17. Mucus-penetrating nanoparticles for vaginal and gastrointestinal drug delivery

    Science.gov (United States)

    Ensign-Hodges, Laura

    A method that could provide more uniform and longer-lasting drug delivery to mucosal surfaces holds the potential to greatly improve the effectiveness of prophylactic and therapeutic approaches for numerous diseases and conditions, including sexually transmitted infections and inflammatory bowel disease. However, the body's natural defenses, including adhesive, rapidly cleared mucus linings coating nearly all entry points to the body not covered by skin, has limited the effectiveness of drug and gene delivery by nanoscale delivery systems. Here, we investigate the use of muco-inert mucus-penetrating nanoparticles (MPP) for improving vaginal and gastrointestinal drug delivery. Conventional hydrophobic nanoparticles strongly adhere to mucus, facilitating rapid clearance from the body. Here, we demonstrate that mucoadhesive polystyrene nanoparticles (conventional nanoparticles, CP) become mucus-penetrating in human cervicovaginal mucus (CVM) after pretreatment with sufficient concentrations of Pluronic F127. Importantly, the diffusion rate of large MPP did not change in F127 pretreated CVM, implying there is no affect on the native pore structure of CVM. Additionally, there was no increase in inflammatory cytokine release in the vaginal tract of mice after daily application of 1% F127 for one week. Importantly, HSV virus remains adherent in F127-pretreated CVM. Mucosal epithelia use osmotic gradients for fluid absorption and secretion. We hypothesized that hypotonically-induced fluid uptake could be advantageous for rapidly delivering drugs through mucus to the vaginal epithelium. We evaluated hypotonic formulations for delivering water-soluble drugs and for drug delivery with MPP. Hypotonic formulations markedly increased the rate at which drugs and MPP reached the epithelial surface. Additionally, hypotonic formulations greatly enhanced drug and MPP delivery to the entire epithelial surface, including deep into the vaginal folds (rugae) that isotonic formulations

  18. Propeller TAP flap

    DEFF Research Database (Denmark)

    Thomsen, Jørn Bo; Bille, Camilla; Wamberg, Peter

    2013-01-01

    The aim of this study was to examine if a propeller thoracodorsal artery perforator (TAP) flap can be used for breast reconstruction. Fifteen women were reconstructed using a propeller TAP flap, an implant, and an ADM. Preoperative colour Doppler ultrasonography was used for patient selection...... to identify the dominant perforator in all cases. A total of 16 TAP flaps were performed; 12 flaps were based on one perforator and four were based on two. A permanent silicone implant was used in 14 cases and an expander implant in two. Minor complications were registered in three patients. Two cases had...... major complications needing additional surgery. One flap was lost due to a vascular problem. Breast reconstruction can be performed by a propeller TAP flap without cutting the descending branch of the thoracodorsal vessels. However, the authors would recommend that a small cuff of muscle is left around...

  19. Paediatric vaginal discharge

    African Journals Online (AJOL)

    Vaginal discharge in the prepubertal patient is a common symptom, and can be a source of distress for the caregiver and con- cern for the healthcare worker. Several factors predispose these patients to the development of recurrent vaginal discharge. Unless noticed by the caregiver, this problem can persist for long periods ...

  20. Pedicled perforator flaps

    DEFF Research Database (Denmark)

    Demirtas, Yener; Ozturk, Nuray; Kelahmetoglu, Osman

    2009-01-01

    adequately to cover the defect. Defects measuring 3 x 3 cm up to 20 x 20 cm at diverse locations were successfully reconstructed in 20 of 21 patients with 26 flaps. Pedicled perforator flaps offer us reliable and satisfactory results of reconstruction at different anatomic territories of the body. It sounds...

  1. Management of Vaginal Cancer.

    Science.gov (United States)

    Shrivastava, S B L; Agrawal, Gaurav; Mittal, Megha; Mishra, Priyanshi

    2015-01-01

    Vaginal cancer is a rare gynecologic cancer with very little documentation. Literature search to have useful information for the management of vaginal cancer and share. We have searched the PUBMED database, Google search engine and other database. A total of 26 references were taken into account. Once spread from primary other cancers or vulva is ruled out, vaginal cancer is designated to be primary in origin. It was revealed that majority of vaginal cancers reported are squamous cell carcinomas. The most common risk factors implicated are Human Papiloma Virus, age. Most common presenting symptoms were abnormal vaginal bleeding,. Diagnosis requires pathological confirmation. Management depends on staging work-up. Vaginal cancer is staged by FIGO system of staging and TNM staging. There are many prognostic factors influencing the choice of treatment. Lymph node metastasis is one of the important prognostic factors, others to mention are histology, size, age. In a recent SEER analysis of over 2000 patients, the 5 year disease specific survival was 84% for stage 1, 75% for stage II and 57% for advanced tumors. Early carcinomas are generally treated with either surgery or radiation therapy. Advanced cancers are treated with radiation therapy with simultaneous administration of combined chemotherapy. Preventive strategies include safe sex and HPV vaccination. Primary vaginal cancer is a rare entity, if there is no history of cancer cervix or vulva in past or absence of cervical squamous cell carcinoma or vulvar carcinoma within 5 years is usually considered as primary vaginal cancer. Though early stage vaginal cancers have better outcome treated with surgery or radiotherapy or surgery followed by radiotherapy, radiotherapy alone is preferred mode of treatment in vaginal cancers.

  2. Mucosal vaccine design and delivery.

    Science.gov (United States)

    Woodrow, Kim A; Bennett, Kaila M; Lo, David D

    2012-01-01

    Mucosal surfaces are a major portal of entry for many human pathogens that are the cause of infectious diseases worldwide. Vaccines capable of eliciting mucosal immune responses can fortify defenses at mucosal front lines and protect against infection. However, most licensed vaccines are administered parenterally and fail to elicit protective mucosal immunity. Immunization by mucosal routes may be more effective at inducing protective immunity against mucosal pathogens at their sites of entry. Recent advances in our understanding of mucosal immunity and identification of correlates of protective immunity against specific mucosal pathogens have renewed interest in the development of mucosal vaccines. Efforts have focused on efficient delivery of vaccine antigens to mucosal sites that facilitate uptake by local antigen-presenting cells to generate protective mucosal immune responses. Discovery of safe and effective mucosal adjuvants are also being sought to enhance the magnitude and quality of the protective immune response.

  3. Phase I Randomized Safety Study of Twice Daily Dosing of Acidform Vaginal Gel: Candidate Antimicrobial Contraceptive

    OpenAIRE

    Keller, Marla J.; Carpenter, Colleen A.; Yungtai Lo; Einstein, Mark H.; Congzhou Liu; David N Fredricks; Herold, Betsy C.

    2012-01-01

    Background Acidform gel, an acid-buffering product that inactivates spermatozoa, may be an effective topical non-hormonal contraceptive. This study was designed to evaluate the safety of vaginal dosing and effects of Acidform on mucosal immune mediators, antimicrobial properties of genital secretions, and vaginal microbiota. Methods Thirty-six sexually abstinent U.S. women were randomized to apply Acidform or hydroxyethylcellulose (HEC) placebo gel twice daily for 14 consecutive days. Safety ...

  4. Isolated mucosal Leishmaniasis

    OpenAIRE

    Deepak Sundriyal; Naveen Kumar; Raj Kumar; Brijesh Sharma

    2013-01-01

    Leishmaniasis is a term used to define a group of clinical syndrome caused by various species of parasite Leishmania. Three main clinical types of leishmaniasis are visceral leishmaniasis, cutaneous leishmaniasis and mucocutaneous leishmaniasis. However, isolated presentation as mucosal disease is rare. We report a case of primarily mucosal leishmaniasis.

  5. In Vivo Evaluation of Safety and Toxicity of a Lactobacillus jensenii Producing Modified Cyanovirin-N in a Rhesus Macaque Vaginal Challenge Model

    OpenAIRE

    Beda Brichacek; Lagenaur, Laurel A; Lee, Peter P.; David Venzon; Hamer, Dean H.

    2013-01-01

    Sexual transmission of human immunodeficiency virus type 1 (HIV-1) across the cervicovaginal mucosa in women is influenced by many factors including the microbiota and the presence of underlying inflammation. It is important that potential HIV preventative agents do not alter the mucosal environment in a way that enhances HIV acquisition. We examined the impact of a "live" microbicide on the vaginal mucosal environment in a rhesus macaque repeated vaginal simian-HIV (SHIVSF162P3) challenge mo...

  6. Radiation induced oral mucositis

    Directory of Open Access Journals (Sweden)

    P S Satheesh Kumar

    2009-01-01

    Full Text Available Patients receiving radiotherapy or chemotherapy will receive some degree of oral mucositis The incidence of oral mucositis was especially high in patients: (i With primary tumors in the oral cavity, oropharynx, or nasopharynx; (ii who also received concomitant chemotherapy; (iii who received a total dose over 5,000 cGy; and (iv who were treated with altered fractionation radiation schedules. Radiation-induced oral mucositis affects the quality of life of the patients and the family concerned. The present day management of oral mucositis is mostly palliative and or supportive care. The newer guidelines are suggesting Palifermin, which is the first active mucositis drug as well as Amifostine, for radiation protection and cryotherapy. The current management should focus more on palliative measures, such as pain management, nutritional support, and maintenance, of good oral hygiene

  7. Vaginal and Vulvar Cancer

    Science.gov (United States)

    ... Facts About Gynecologic Cancer campaign. The campaign helps women get the facts about gynecologic cancer, providing important “inside knowledge” about their bodies and health. What are vaginal and vulvar cancers? Cancer is ...

  8. Anterior vaginal wall repair

    Science.gov (United States)

    ... may have you: Learn pelvic floor muscle exercises ( Kegel exercises ) Use estrogen cream in your vagina Try ... repair; Urinary incontinence - vaginal wall repair Patient Instructions Kegel exercises - self-care Self catheterization - female Suprapubic catheter ...

  9. Vaginal Yeast Infections

    Science.gov (United States)

    ... Yeast Infections Print A A A en español Infecciones vaginales por hongos What Are Vaginal Yeast Infections? ... keep the amount in a person's body under control. But yeast in the vagina can sometimes "overgrow" ...

  10. Vaginal birth - slideshow

    Science.gov (United States)

    ... ency/presentations/100198.htm Vaginal birth - series—Normal anatomy To use the sharing features on this page, ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: ...

  11. Vaginal bleeding between periods

    Science.gov (United States)

    ... Inflammation or infection of the cervix (cervicitis) or uterus (endometritis) Injury or disease of the vaginal opening (caused by intercourse, trauma, infection, polyp, genital warts , ulcer, or varicose veins) ...

  12. Yeast Infection (Vaginal)

    Science.gov (United States)

    ... vaginal discharge with a cottage cheese appearance Complicated yeast infection You might have a complicated yeast infection ... have an uncomplicated or a complicated infection. Uncomplicated yeast infection For mild to moderate symptoms and infrequent ...

  13. Vaginal bacteria modify HIV tenofovir microbicide efficacy in African women.

    Science.gov (United States)

    Klatt, Nichole R; Cheu, Ryan; Birse, Kenzie; Zevin, Alexander S; Perner, Michelle; Noël-Romas, Laura; Grobler, Anneke; Westmacott, Garrett; Xie, Irene Y; Butler, Jennifer; Mansoor, Leila; McKinnon, Lyle R; Passmore, Jo-Ann S; Abdool Karim, Quarraisha; Abdool Karim, Salim S; Burgener, Adam D

    2017-06-02

    Antiretroviral-based strategies for HIV prevention have shown inconsistent results in women. We investigated whether vaginal microbiota modulated tenofovir gel microbicide efficacy in the CAPRISA (Centre for the AIDS Program of Research in South Africa) 004 trial. Two major vaginal bacterial community types-one dominated by Lactobacillus (59.2%) and the other where Gardnerella vaginalis predominated with other anaerobic bacteria (40.8%)-were identified in 688 women profiled. Tenofovir reduced HIV incidence by 61% ( P = 0.013) in Lactobacillus- dominant women but only 18% ( P = 0.644) in women with non- Lactobacillus bacteria, a threefold difference in efficacy. Detectible mucosal tenofovir was lower in non- Lactobacillus women, negatively correlating with G. vaginalis and other anaerobic bacteria, which depleted tenofovir by metabolism more rapidly than target cells convert to pharmacologically active drug. This study provides evidence linking vaginal bacteria to microbicide efficacy through tenofovir depletion via bacterial metabolism. Copyright © 2017, American Association for the Advancement of Science.

  14. Respuesta inmune mucosal inducida por proteoliposoma y cocleato derivados de N. meningitidis serogrupo B

    Directory of Open Access Journals (Sweden)

    Judith del Campo

    2009-08-01

    Full Text Available Mucosal vaccination offers attractive advantages to conventional systemic vaccination. Most pathogens enter or establish infection at mucosal surfaces. This represents an enormous challenge for vaccine development. Nevertheless, the availability of safe and effective adjuvants that function mucosally is the major limitation. Therefore, we investigated the impact of mucosal immunization with the Neisseria meningitidis B proteoliposome (AFPL1, Adjuvant Finlay Proteoliposome 1 and its-derived cochleate (Co, AFCo1. They contain multiple PAMPs as immunopotentiators and have delivery system ability as well as Th1 polarization activity. Groups of female mice were immunized by nasal, oral, intravaginal, or intramuscular routes with three doses with AFPL1/AFCo1 alone or containing ovalbumin or glycoprotein (g D2 from Herpes Simplex Virus type 2 (HSV-2. High levels of specific IgG antibodies were detected in sera of mice vaccinated with either route. However, specific IgA antibodies were produced in saliva and vaginal wash only following mucosal delivering. The polarization to a Th1 pattern was confirmed by testing the induction of IgG2a/IgG2c antibody, positive delayed-type hypersensitivity reactions, and gIFN production. Additionally, AFCo1gD2 showed practically no vaginal HSV-2 replication and 100% protection against lethal vaginal HSV-2 challenge. In conclusion, the results support the use of AFCo1 as potent Th1 adjuvant for mucosal vaccines, particularly for nasal route.

  15. Prediction of flap response.

    Science.gov (United States)

    Potgieter, Frederik J; Roberts, Cynthia; Cox, Ian G; Mahmoud, Ashraf M; Herderick, Edward E; Roetz, Marlize; Steenkamp, Wouter

    2005-01-01

    To find predictors of the induced biomechanical and optical effects of lamellar flap creation on the cornea. Optimed Eye and Laser Clinic, Pretoria, South Africa, and the Department of Ophthalmology and Biomedical Engineering Center, The Ohio State University, Columbus, Ohio, and Bausch & Lomb Vision Research Laboratory, Rochester, New York, USA. This prospective study monitored the refractive, wavefront aberration, and corneal topographic changes in 29 eyes of 15 patients for 3 months after the creation of a corneal lamellar flap. The main outcome measures for statistical analysis were refraction, total corneal thickness, residual corneal bed thickness, horizontal white-to-white corneal diameter, horizontal flap diameter, topography data, and wavefront data. Statistically significant changes were seen in the autorefraction mode. Wavefront data showed significant change in 4 Zernike modes-90/180-degree astigmatism, vertical coma, horizontal coma, and spherical aberration. The topography data indicated the corneal biomechanical response was significantly predicted by stromal bed thickness in the early follow-up period and by total corneal pachymetry and flap diameter in a 2-parameter statistical model in the late follow-up period. Uncomplicated lamellar flap creation is responsible for systematic changes in corneal topography and induction of higher-order optical aberrations. Predictors of this response include stromal bed thickness, flap diameter, and total corneal pachymetry.

  16. Nasal mucosal biopsy

    Science.gov (United States)

    Biopsy - nasal mucosa; Nose biopsy ... to fast for a few hours before the biopsy. ... Nasal mucosal biopsy is most often done when abnormal tissue is seen during examination of the nose. It may also be ...

  17. A novel strategy for inducing enhanced mucosal HIV-1 antibody responses in an anti-inflammatory environment.

    Directory of Open Access Journals (Sweden)

    Frank Wegmann

    2011-01-01

    Full Text Available Prophylactic vaccination against HIV-1 sexual transmission will probably require antibody elicitation at genital mucosal surfaces. However, HIV-1 envelope glycoprotein (Env-based antigens are weakly immunogenic, particularly when applied mucosally. The polyanion PRO 2000 is safe for human vaginal application, and thus may represent a potential formulating agent for vaginal delivery of experimental vaccine immunogens. Based upon its biochemical properties, we hypothesized that PRO 2000 might enhance mucosal immunogenicity of HIV-1 envelope glycoprotein (Env-based antigens, promoting local and systemic immune responses. Vaginal immunization with Env-PRO 2000 resulted in significantly increased titres of Env-specific mucosal IgA and IgG in mice and rabbits, respectively, compared to Env alone, revealing modest but significant mucosal adjuvant activity for PRO 2000. In vitro, PRO 2000 associated with Env, protecting the glycoprotein from proteolytic degradation in human vaginal lavage. Unexpectedly, PRO 2000 antagonized TLR4 activation, suppressing local production of inflammatory cytokines. Since inflammation-mediated recruitment of viral target cells is a major risk factor in HIV-1 transmission, the immune modulatory and anti-inflammatory activities of PRO 2000 combined with its intravaginal safety profile suggests promise as an HIV-1 mucosal vaccine formulating agent.

  18. Flap double twist technique for prevention of LASIK flap striae

    Directory of Open Access Journals (Sweden)

    Nabil KM

    2016-11-01

    Full Text Available Karim Mahmoud Nabil Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt Abstract: A novel flap double twist technique was applied to reduce the incidence of post-laser-assisted in situ keratomileusis (LASIK flap striae. The flap is floated and stroked in the same way as is done for management of first postoperative day striae, where the method is to float and irrigate the flap into position, followed by applying gentle pressure on the flap with a wet Merocel microsponge and moving the flap away from the hinge position. The sponge is then manually squeezed to become drier, and the flap is continuously stroked in a direction opposite to the hinge. Next, the flap is carefully twisted obliquely and sequentially in two opposite directions while applying gentle pressure on the flap in order to completely dehydrate the flap and stromal bed. Finally, the flap is repositioned while applying gentle horizontal pressure in two opposite directions. This novel flap double twist technique shows great success in post-LASIK striae prevention. Keywords: laser-assisted in situ keratomileusis, wrinkles, pressure, microsponge

  19. Prolonged Detection of Zika Virus in Vaginal Secretions and Whole Blood

    Science.gov (United States)

    Gorchakov, Rodion; Carlson, Anna R.; Berry, Rebecca; Lai, Lilin; Natrajan, Muktha; Garcia, Melissa N.; Correa, Armando; Patel, Shital M.; Aagaard, Kjersti; Mulligan, Mark J.

    2017-01-01

    Infection with Zika virus is an emerging public health crisis. We observed prolonged detection of virus RNA in vaginal mucosal swab specimens and whole blood for a US traveler with acute Zika virus infection who had visited Honduras. These findings advance understanding of Zika virus infection and provide data for additional testing strategies. PMID:27748649

  20. Prolonged Detection of Zika Virus in Vaginal Secretions and Whole Blood.

    Science.gov (United States)

    Murray, Kristy O; Gorchakov, Rodion; Carlson, Anna R; Berry, Rebecca; Lai, Lilin; Natrajan, Muktha; Garcia, Melissa N; Correa, Armando; Patel, Shital M; Aagaard, Kjersti; Mulligan, Mark J

    2017-01-01

    Infection with Zika virus is an emerging public health crisis. We observed prolonged detection of virus RNA in vaginal mucosal swab specimens and whole blood for a US traveler with acute Zika virus infection who had visited Honduras. These findings advance understanding of Zika virus infection and provide data for additional testing strategies.

  1. New approaches in the development of a vaccine for mucosal candidiasis: progress and challenges.

    Directory of Open Access Journals (Sweden)

    Anna eVecchiarelli

    2012-08-01

    Full Text Available The commensal fungus Candida albicans causes mucosal candidiasis in the rapidly expanding number of immunocompromised patients. Mucosal candidiasis includes orapharyngeal, esophageal, gastrointestinal, and vaginal infections. Vulvovaginal candidiasis (VVC and antimycotic-refractory recurrent VVC is a frequent problem in healthy child-bearing women. Both these mucosal infections can affect the quality of life and finding new therapeutical and preventive approaches is a challenge. A vaccine against candidal infections would be a new important tool to prevent and/or cure mucosal candidiasis and would be of benefit to many patients. Several Candida antigens have been proposed as vaccine candidates including cell wall components and virulence factors. Here we discuss the recent progress and problems associated with vaccination against mucosal candidiasis.

  2. MANAGEMENT OF VAGINAL DISCHARGE

    African Journals Online (AJOL)

    Enrique

    Northern Branch. He has conducted numerous clinical trials and has a research interest in infectious diseases with special emphasis on sexually transmitted infections. He is a recipi- ent of the NRFs grant for research in sexually transmitted diseases and is also the principal investigator for a phase III vaginal microbicide.

  3. Vaginal rejuvenation: current perspectives

    Directory of Open Access Journals (Sweden)

    Barbara G

    2017-07-01

    Full Text Available Giussy Barbara,1 Federica Facchin,2 Laura Buggio,3 Daniela Alberico,3 Maria Pina Frattaruolo,3 Alessandra Kustermann1 1Department of Obstetrics and Gynecology, Service for Sexual and Domestic Violence (SVSeD, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 2Faculty of Psychology, Catholic University of Milan, 3Department of Obstetrics and Gynecology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy Abstract: Female genital cosmetic surgery includes several procedures aimed at reaching better female genital appearance and/or improved sexual functioning. Among these procedures, vaginal rejuvenation is considered as one of the most controversial genital cosmetic surgical interventions and involves a range of surgical procedures performed by gynecologists or plastic surgeons to decrease the average diameter of the vagina, mainly for sexual reasons. In this narrative review, vaginal rejuvenation outcomes are examined in order to clarify the current scenario of the different vaginal rejuvenation techniques, as well as their effectiveness and associated complications. Psychological and ethical issues linked to these procedures are also addressed. Keywords: vaginal rejuvenation, female genital cosmetic surgery, vaginoplasty 

  4. Advances in mucosal vaccination.

    Science.gov (United States)

    Meeusen, Els N T; Scheerlinck, Jean-Pierre Y; Wattegedera, Sean; Entrican, Gary

    2004-12-01

    Pathogens that enter the body via mucosal surfaces face unique defense mechanisms that combine the innate barrier provided by the mucus layer with an adaptive response typified by the production and transepithelial secretion of pathogen-specific IgA. Both the measurement and induction of mucosal responses pose significant challenges for experimental and practical application and may need to be adapted to the species under study. In particular, for livestock, immunization procedures developed in small rodent models are not always effective in large animals or compatible with management practices. This paper reviews the latest advances in our understanding of the processes that lead to secretory IgA responses and how this relates to the development of mucosal immunization procedures and adjuvants for veterinary vaccines. In addition, it highlights the complex interactions that can take place between the pathogen and the host's immune response, with specific reference to Chlamydia/Chlamydophila infections in sheep.

  5. [Prevalence of 7 microorganisms in abnormal vaginal secretions (vaginitis)].

    Science.gov (United States)

    Roupas, A; Wyss, R; Anner, R

    1985-10-19

    Seven microorganisms (N. gonorrhoeae, C. albicans, T. vaginalis, G. vaginalis, M. hominis, U. urealyticum and Streptococcus of group B) have been assayed in genital samplings of 164 asymptomatic women (control group) and of 374 women suffering from abnormal vaginal secretions (vaginitis group). All these bacteria except group B Streptococci were isolated in the vaginitis group more frequently than in the control group (p less than 0.01). The proportion of negative cultures for all tested bacteria was 39% in the control group and 6.4% in the vaginitis group (p less than 0.01). This shows an association of these bacteria with 70% of the patients of the vaginitis group and with only 26% of the women of the control group (p less than 0.01). It is to be noted that the pH values are higher in the group of women with vaginitis than in the control group (p less than 0.01). Comparison of the microbial flora during "specific" an "non-specific" vaginitis indicates that G. vaginalis is isolated more frequently in patients with non-specific vaginitis than among those with specific vaginitis (p less than 0.01). Likewise, M. hominis is isolated more frequently in groups of women with either non-specific vaginitis or T. vaginalis vaginitis, than in groups of patients with a C. albicans vaginitis (p less than 0,01). The results of this study indicate that there is a causal relationship between vaginitis and the presence of T. vaginalis. C. albicans, G. vaginalis, M. hominis or N. gonorrhoeae, either as a single or a mixed infection, and that there is a relationship between increased pH values and abnormal vaginal secretions.

  6. An analysis of free flap failure using the ACS NSQIP database. Does flap site and flap type matter?

    Science.gov (United States)

    Kwok, Alvin C; Agarwal, Jayant P

    2017-09-01

    We sought to use the NSQIP database to determine the national rate and predictors of free flap failure based upon flap sites and flap types. Free flaps were identified using the 2005-2010 NSQIP database. We examined overall flap failure rates as well as failure rates based upon flap sites (head and neck, extremities, trunk, and breast) and flap types (muscle, fascial, skin, bone, and bowel flaps). Univariate and multivariate analyses were used to determine predictors of flap failure. There were 1,187 microvascular free tissue transfers identified. The overall flap failure rate was 5.1%. Head and neck flaps had the highest rate of free flap failure at 7.7%. Prolonged operative time is an independent predictor of flap failure for all free flaps (OR: 2.383, P = 0.0013). When examining predictors of failure by flap site, free flaps to the breast with prolonged operative time are independently associated with flap failure (OR: 2.288, P = 0.0152). When examining predictors of flap failure by flap type, muscle based free flaps with an ASA classification ≥3 are associated with flap failure (P = 0.0441). Risk factors for free flap failure differ based upon flap site and flap type. Prolonged operative time is an independent risk factor for the failure of free flaps used for breast reconstruction. An ASA classification ≥3 is associated with the failure of free muscle based flaps. Our findings identify actionable areas that may help to improve free flap success. © 2016 Wiley Periodicals, Inc.

  7. Angioembolisation in vaginal vascular malformation.

    Directory of Open Access Journals (Sweden)

    Srivastava D

    2001-01-01

    Full Text Available Vaginal arteriovenous malformations are rare entities and their most common presentation is vaginal haemorrhage. This case report describes a 22-year-old woman who presented at 20 weeks of gestation with slow growing soft and tender swelling at anterior vaginal wall. Diagnosis was confirmed as vaginal vascular malformation on contrast enhanced magnetic resonance imaging. The mass did not subside after delivery and patient developed dyspareunia. It was successfully treated by angioembolisation using polyvinyl alcohol particles. Angioembolisation being safe and effective should be the treatment of first choice for symptomatic vaginal vascular malformation.

  8. Commensal Bacteria Modulate Innate Immune Responses of Vaginal Epithelial Cell Multilayer Cultures

    Science.gov (United States)

    Rose, William A.; McGowin, Chris L.; Spagnuolo, Rae Ann; Eaves-Pyles, Tonyia D.; Popov, Vsevolod L.; Pyles, Richard B.

    2012-01-01

    The human vaginal microbiome plays a critical but poorly defined role in reproductive health. Vaginal microbiome alterations are associated with increased susceptibility to sexually-transmitted infections (STI) possibly due to related changes in innate defense responses from epithelial cells. Study of the impact of commensal bacteria on the vaginal mucosal surface has been hindered by current vaginal epithelial cell (VEC) culture systems that lack an appropriate interface between the apical surface of stratified squamous epithelium and the air-filled vaginal lumen. Therefore we developed a reproducible multilayer VEC culture system with an apical (luminal) air-interface that supported colonization with selected commensal bacteria. Multilayer VEC developed tight-junctions and other hallmarks of the vaginal mucosa including predictable proinflammatory cytokine secretion following TLR stimulation. Colonization of multilayers by common vaginal commensals including Lactobacillus crispatus, L. jensenii, and L. rhamnosus led to intimate associations with the VEC exclusively on the apical surface. Vaginal commensals did not trigger cytokine secretion but Staphylococcus epidermidis, a skin commensal, was inflammatory. Lactobacilli reduced cytokine secretion in an isolate-specific fashion following TLR stimulation. This tempering of inflammation offers a potential explanation for increased susceptibility to STI in the absence of common commensals and has implications for testing of potential STI preventatives. PMID:22412914

  9. Enhanced vaginal drug delivery through the use of hypotonic formulations that induce fluid uptake.

    Science.gov (United States)

    Ensign, Laura M; Hoen, Timothy E; Maisel, Katharina; Cone, Richard A; Hanes, Justin S

    2013-09-01

    Mucosal epithelia use osmotic gradients for fluid absorption and secretion. We hypothesized that administration of hypotonic solutions would induce fluid uptake that could be advantageous for rapidly delivering drugs through mucus to the vaginal epithelium. We found that hypotonic formulations markedly increased the rate at which small molecule drugs and mucoinert nanoparticles (mucus-penetrating particles, or MPP), but not conventional mucoadhesive nanoparticles (CP), reached the vaginal epithelial surface in vivo in mice. Additionally, hypotonic formulations greatly enhanced drug and MPP delivery to the entire epithelial surface, including deep into the vaginal folds (rugae) that drugs or MPP in isotonic formulations failed to reach efficiently. However, hypotonic formulations caused unencapsulated "free" drugs to be drawn through the epithelium, reducing vaginal retention. In contrast, hypotonic formulations caused MPP to accumulate rapidly and uniformly on vaginal surfaces, ideally positioned for localized sustained drug delivery. Using a mouse model of vaginal genital herpes (HSV-2) infection, we found that hypotonic delivery of free drug led to improved immediate protection, but diminished longer-term protection. In contrast, as we previously demonstrated, hypotonic delivery of drug via MPP led to better long-term retention and protection in the vagina. Importantly, we demonstrate that slightly hypotonic formulations provided rapid and uniform delivery of MPP to the entire vaginal surface, thus enabling formulations with minimal risk of epithelial toxicity. Hypotonic formulations for vaginal drug delivery via MPP may significantly improve prevention and treatment of reproductive tract diseases and disorders. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Commensal bacteria modulate innate immune responses of vaginal epithelial cell multilayer cultures.

    Directory of Open Access Journals (Sweden)

    William A Rose

    Full Text Available The human vaginal microbiome plays a critical but poorly defined role in reproductive health. Vaginal microbiome alterations are associated with increased susceptibility to sexually-transmitted infections (STI possibly due to related changes in innate defense responses from epithelial cells. Study of the impact of commensal bacteria on the vaginal mucosal surface has been hindered by current vaginal epithelial cell (VEC culture systems that lack an appropriate interface between the apical surface of stratified squamous epithelium and the air-filled vaginal lumen. Therefore we developed a reproducible multilayer VEC culture system with an apical (luminal air-interface that supported colonization with selected commensal bacteria. Multilayer VEC developed tight-junctions and other hallmarks of the vaginal mucosa including predictable proinflammatory cytokine secretion following TLR stimulation. Colonization of multilayers by common vaginal commensals including Lactobacillus crispatus, L. jensenii, and L. rhamnosus led to intimate associations with the VEC exclusively on the apical surface. Vaginal commensals did not trigger cytokine secretion but Staphylococcus epidermidis, a skin commensal, was inflammatory. Lactobacilli reduced cytokine secretion in an isolate-specific fashion following TLR stimulation. This tempering of inflammation offers a potential explanation for increased susceptibility to STI in the absence of common commensals and has implications for testing of potential STI preventatives.

  11. Free skin flap reconstruction after partial hypopharyngectomy with laryngeal preservation.

    Science.gov (United States)

    Ishida, Katsuhiro; Kato, Takakuni; Seino, Youichi; Uchida, Mitsuru

    2014-10-01

    Surgical resection of hypopharyngeal cancer often affects laryngeal function. The aim of this study is to assess the reliability and efficacy of free skin flap transfer after partial hypopharyngectomy with laryngeal preservation. This study designs a retrospective analysis. The subjects were 54 patients who underwent free skin flap reconstruction immediately after partial pharyngolaryngectomy or hypopharyngectomy with laryngeal preservation. The defects were classified into four types based on the location of the hypopharyngeal defect. Functional results were evaluated by routine physical examination findings and parameters related to swallowing function and X-ray barium deglutition examination. Perioperative mortalities and morbidities were reviewed. There were no perioperative mortalities and 98% of the flaps survived. Forty-three patients (80%) were able to eat an unrestricted diet and experienced no aspiration. Restriction of the diet was significantly associated with the extent of oesophageal mucosal resection. In conclusion, free skin flap reconstruction is confirmed to be a safe and effective strategy to maintain laryngeal function and good quality-of-life.

  12. Mucormycosis at pectoralis major myocutaneous flap donor site

    Directory of Open Access Journals (Sweden)

    Saraiya Hemant

    2006-01-01

    Full Text Available Background: Advanced carcinomas involving the head and neck present a major therapeutic challenge because of their poor prognosis particularly in old age irrespective of the treatment modality used. Materials and Methods: A 71-year-old patient presented with right-sided buccal mucosal carcinoma involving the mandible. Composite resection with removal of mandible and radical neck dissection was done. Pectoralis major myocutaneous flap (PMMC with deltopectoral flap was done to cover the defect. On the 14th day mucormycosis was noted on pectoralis major myocutaneous flap donor site. Radical debridement and appropriate antibiotic and antifungal treatment was started. The patient was put on life support system. Results: Despite aggressive treatment the patient died. Conclusion: This case reaffirms the views that radical surgical procedure should be carried out with caution in old patients with preexisting diseases as the chances of life-threatening complications are very high in these patients. Mucormycosis at pectoralis major myocutaneous flap (PMMC donor site is probably being reported for the first time.

  13. Modified trans-oral approach with an inferiorly based flap.

    Science.gov (United States)

    Al-Holou, Wajd N; Park, Paul; Wang, Anthony C; Than, Khoi D; Marentette, Lawrence J

    2010-04-01

    The trans-oral approach allows direct access to pathologies of the anterior craniocervical junction. However, the classic midline incision of the posterior pharyngeal wall can be surgically burdensome and limits lateral exposure. We reviewed the medical records of nine patients undergoing the trans-oral approach. The sites of the pathology ranged from the clivus to C2, and surgical exposure ranged from the clivus to C3. Each operation utilized an inferiorly based flap. None of the patients experienced vascular or neurologic complications, and no patient had a cerebrospinal fluid fistula, pseudomeningocele, or meningitis postoperatively. The trans-oral approach with an inferiorly based flap can therefore be safely and effectively performed with minimal oropharyngeal and neurologic morbidity. Not only does a U-shaped flap allow adequate exposure from the lower half of the clivus to C3, a flap improves lateral exposure, provides a clear operating field, and allows superficial mucosal closure not directly overlying the operative field. (c) 2009 Elsevier Ltd. All rights reserved.

  14. Vaccines against mucosal infections.

    Science.gov (United States)

    Holmgren, Jan; Svennerholm, Ann-Mari

    2012-06-01

    There remains a great need to develop vaccines against many of the pathogens that infect mucosal tissues or have a mucosal port of entry. Parenteral vaccination may protect in some instances, but usually a mucosal vaccination route is necessary. Mucosal vaccines also have logistic advantages over injectable vaccines by being easier to administer, having less risk of transmitting infections and potentially being easier to manufacture. Still, however, only relatively few vaccines for human use are available: oral vaccines against cholera, typhoid, polio, and rotavirus, and a nasal vaccine against influenza. For polio, typhoid and influenza, in which the pathogens reach the blood stream, there is also an injectable vaccine alternative. A problem with available oral live vaccines is their reduced immunogenicity when used in developing countries; for instance, the efficacy of rotavirus vaccines correlates closely with the national per capita income. Research is needed to define the impact of factors such as malnutrition, aberrant intestinal microflora, concomitant infections, and preexisting immunity as well as of host genetic factors on the immunogenicity of these vaccines. Copyright © 2012 Elsevier Ltd. All rights reserved.

  15. Mucosal vaccination of fish

    NARCIS (Netherlands)

    Rombout, J.H.W.M.; Kiron, V.

    2014-01-01

    Among the novel vaccination methods, mucosal vaccination seems to possess all the desired criteria. The chapter reviews the state-of-the-art knowledge regarding this type of vaccination with a focus on their uptake, immune stimulation, and where possible, discusses their potential as future

  16. Probiotics as Antifungals in Mucosal Candidiasis.

    Science.gov (United States)

    Matsubara, Victor H; Bandara, H M H N; Mayer, Marcia P A; Samaranayake, Lakshman P

    2016-05-01

    Candidais an opportunistic pathogen that causes mucosal and deep systemic candidiasis. The emergence of drug resistance and the side effects of currently available antifungals have restricted their use as long-term prophylactic agents for candidal infections. Given this scenario, probiotics have been suggested as a useful alternative for the management of candidiasis. We analyzed the available data on the efficacy of probiotics in candidal colonization of host surfaces. A number of well-controlled studies indicate that probiotics, particularly lactobacilli, suppressCandidagrowth and biofilm development in vitro.A few clinical trials have also shown the beneficial effects of probiotics in reducing oral, vaginal, and enteric colonization byCandida; alleviation of clinical signs and symptoms; and, in some cases, reducing the incidence of invasive fungal infection in critically ill patients. Probiotics may serve in the future as a worthy ally in the battle against chronic mucosal candidal infections. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  17. Pyomyositis after vaginal delivery.

    LENUS (Irish Health Repository)

    Gaughan, Eve

    2011-01-01

    Pyomyositis is a purulent infection of skeletal muscle that arises from haematogenous spread, usually with abscess formation. It can develop after a transient bacteraemia of any cause. This type of infection has never been reported before in the literature after vaginal delivery. A 34-year-old woman had progressive severe pain in the left buttock and thigh and weakness in the left lower limb day 1 post spontaneous vaginal delivery. MRI showed severe oedema of the left gluteus, iliacus, piriformis and adductor muscles of the left thigh and a small fluid collection at the left hip joint. She was diagnosed with pyomyositis. She had fever of 37.9°C immediately postpartum and her risk factors for bacteraemia were a mild IV cannula-associated cellulitis and labour itself. She required prolonged treatment with antibiotics before significant clinical improvement was noted.

  18. Vaginal vault prolapse.

    Science.gov (United States)

    Uzoma, Azubuike; Farag, K A

    2009-01-01

    Introduction. Vaginal vault prolapse is a common complication following vaginal hysterectomy with negative impact on women's quality of life due to associated urinary, anorectal and sexual dysfunction. A clear understanding of the supporting mechanism for the uterus and vagina is important in making the right choice of corrective procedure. Management should be individualised, taking into consideration the surgeon's experience, patients age, comorbidities, previous surgery and sex life. Result. Preexisting pelvic floor defect prior to hysterectomy is the single most important risk factor for vault prolapse. Various surgical techniques have been advanced at hysterectomy to prevent vault prolapse. Studies have shown the McCall's culdoplasty under direct visualisation to be superior. Vault prolapse repair rely on either the use of patient's tissue or synthetic materials and can be carried out abdominally or vaginally. Sacrospinous fixation and abdominal sacrocolpopexy are the commonly performed procedures, with literature in favour of abdominal sacrocolpopexy over sacrospinous fixation due to its reported higher success rate of about 90%. Other less commonly performed procedures include uterosacral ligament suspension and illiococcygeal fixation, both of which are equally effective, with the former having a high risk of ureteric injury. Colpoclesis will play a greater role in the future as the aging population increases. Mesh procedures are gaining in popularity, and preliminary data from vaginal mesh procedures is encouraging. Laparoscopic techniques require a high level of skill and experience. There are many controversies on the mechanism of prolapse and management techniques, which we have tried to address in this article. Conclusion. As the aging population increases, the incidence of prolapse will also rise, older techniques using native tissue will continue, while new techniques using the mesh needs to be studied further. The later may well be the way forward

  19. Perspectives on mucosal vaccines: is mucosal tolerance a barrier?

    Science.gov (United States)

    Mestecky, Jiri; Russell, Michael W; Elson, Charles O

    2007-11-01

    Mucosal administration of Ags induces specific Abs in external secretions and systemic unresponsiveness termed oral or mucosal tolerance. The dominant response depends on the species studied, the nature, dose, frequency, route of Ag application, and the use of adjuvants. The temporal sequence of Ag exposure determines the quality of the ensuing immune response; although initial mucosal Ag exposure results in systemic T cell hyporesponsiveness, pre-existing systemic responses are refractory to the tolerizing effects of mucosal Ag encounter. Mucosal and systemic humoral responses may be induced concomitantly with diminished systemic T cell responses, thereby permitting Ab-mediated containment of mucosal Ags without stimulation of the systemic immune compartment. B cell Ig isotype switching and differentiation toward IgA production share common regulatory mechanisms with the suppression of T cells. Optimization of mucosal vaccination strategies has the potential for enhancing protective immune responses and suppressing systemic responses to autoantigens desirable for the treatment of autoimmune diseases.

  20. Acceptability and feasibility of repeated mucosal specimen collection in clinical trial participants in Kenya.

    Directory of Open Access Journals (Sweden)

    Gloria Omosa-Manyonyi

    Full Text Available Mucosal specimens are essential to evaluate compartmentalized immune responses to HIV vaccine candidates and other mucosally targeted investigational products. We studied the acceptability and feasibility of repeated mucosal sampling in East African clinical trial participants at low risk of HIV and other sexually transmitted infections.The Kenya AIDS Vaccine Initiative (KAVI enrolled participants into three Phase 1 trials of preventive HIV candidate vaccines in 2011-2012 at two clinical research centers in Nairobi. After informed consent to a mucosal sub-study, participants were asked to undergo collection of mucosal secretions (saliva, oral fluids, semen, cervico-vaginal and rectal, but could opt out of any collection at any visit. Specimens were collected at baseline and two additional time points. A tolerability questionnaire was administered at the final sub-study visit. Of 105 trial participants, 27 of 34 women (79% and 62 of 71 men (87% enrolled in the mucosal sub-study. Nearly all sub-study participants gave saliva and oral fluids at all visits. Semen was collected from about half the participating men (47-48% at all visits. Cervico-vaginal secretions were collected by Softcup from about two thirds of women (63% at baseline, increasing to 78% at the following visits, with similar numbers for cervical secretion collection by Merocel sponge; about half of women (52% gave cervico-vaginal samples at all visits. Rectal secretions were collected with Merocel sponge from about a quarter of both men and women (24% at all 3 visits, with 16% of men and 19% of women giving rectal samples at all visits.Repeated mucosal sampling in clinical trial participants in Kenya is feasible, with a good proportion of participants consenting to most sampling methods with the exception of rectal samples. Experienced staff members of both sexes and trained counselors with standardized messaging may improve acceptance of rectal sampling.

  1. Acceptability and feasibility of repeated mucosal specimen collection in clinical trial participants in Kenya.

    Science.gov (United States)

    Omosa-Manyonyi, Gloria; Park, Harriet; Mutua, Gaudensia; Farah, Bashir; Bergin, Philip J; Laufer, Dagna; Lehrman, Jennifer; Chinyenze, Kundai; Barin, Burc; Fast, Pat; Gilmour, Jill; Anzala, Omu

    2014-01-01

    Mucosal specimens are essential to evaluate compartmentalized immune responses to HIV vaccine candidates and other mucosally targeted investigational products. We studied the acceptability and feasibility of repeated mucosal sampling in East African clinical trial participants at low risk of HIV and other sexually transmitted infections. The Kenya AIDS Vaccine Initiative (KAVI) enrolled participants into three Phase 1 trials of preventive HIV candidate vaccines in 2011-2012 at two clinical research centers in Nairobi. After informed consent to a mucosal sub-study, participants were asked to undergo collection of mucosal secretions (saliva, oral fluids, semen, cervico-vaginal and rectal), but could opt out of any collection at any visit. Specimens were collected at baseline and two additional time points. A tolerability questionnaire was administered at the final sub-study visit. Of 105 trial participants, 27 of 34 women (79%) and 62 of 71 men (87%) enrolled in the mucosal sub-study. Nearly all sub-study participants gave saliva and oral fluids at all visits. Semen was collected from about half the participating men (47-48%) at all visits. Cervico-vaginal secretions were collected by Softcup from about two thirds of women (63%) at baseline, increasing to 78% at the following visits, with similar numbers for cervical secretion collection by Merocel sponge; about half of women (52%) gave cervico-vaginal samples at all visits. Rectal secretions were collected with Merocel sponge from about a quarter of both men and women (24%) at all 3 visits, with 16% of men and 19% of women giving rectal samples at all visits. Repeated mucosal sampling in clinical trial participants in Kenya is feasible, with a good proportion of participants consenting to most sampling methods with the exception of rectal samples. Experienced staff members of both sexes and trained counselors with standardized messaging may improve acceptance of rectal sampling.

  2. Non-aqueous silicone elastomer gels as a vaginal microbicide delivery system for the HIV-1 entry inhibitor maraviroc

    Science.gov (United States)

    Forbes, Claire J.; Lowry, Deborah; Geer, Leslie; Veazey, Ronald S.; Shattock, Robin J.; Klasse, Per Johan; Mitchnick, Mark; Goldman, Laurie; Doyle, Lara A.; Muldoon, Brendan C.O.; Woolfson, A. David; Moore, John P.; Malcolm, R. Karl

    2011-01-01

    Aqueous semi-solid polymeric gels, such as those based on hydroxyethylcellulose (HEC) and polyacrylic acid (e.g. Carbopol®), have a long history of use in vaginal drug delivery. However, despite their ubiquity, they often provide sub-optimal clinical performance, due to poor mucosal retention and limited solubility for poorly water-soluble actives. These issues are particularly pertinent for vaginal HIV microbicides, since many lead candidates are poorly water-soluble and where a major goal is the development of a coitally independent, once daily gel product. In this study, we report the use of a non-aqueous silicone elastomer gel for vaginal delivery of the HIV-1 entry inhibitor maraviroc. In vitro rheological, syringeability and retention studies demonstrated enhanced performance for silicone gels compared with a conventional aqueous HEC gel, while testing of the gels in the slug model confirmed a lack of mucosal irritancy. Pharmacokinetic studies following single dose vaginal administration of a maraviroc silicone gel in rhesus macaques showed higher and sustained MVC levels in vaginal fluid, vaginal tissue and plasma compared with a HEC gel containing the same maraviroc loading. The results demonstrate that non-aqueous silicone gels have potential as a formulation platform for coitally independent vaginal HIV microbicides. PMID:21864598

  3. Airbag-induced corneal flap.

    Science.gov (United States)

    Liyanage, Sidath E; Mearza, Ali A

    2009-02-01

    To describe a case of airbag-induced corneal flap in a previously normal cornea. Case report. A 27-year-old woman presented with complete loss of vision in her left eye following a road traffic accident which involved airbag deployment. There was no previous ocular history. Examination revealed a large corneal flap of 6mm in diameter, extending to the depth of anterior stroma. This was accompanied by a traumatic optic neuropathy. One month follow-up revealed complete reattachment of the corneal flap. This is the first reported case of a corneal flap induced by airbag deployment in a cornea with previously normal architecture.

  4. Engineering intravaginal vaccines to overcome mucosal and epithelial barriers.

    Science.gov (United States)

    Ji, Zhonghua; Xie, Zhaolu; Zhang, Zhirong; Gong, Tao; Sun, Xun

    2017-06-01

    The mucosal surface of the vagina is a primary human immunodeficiency virus (HIV) entry portal, making it an attractive site for HIV vaccination. However, HIV vaccines based on recombinant adenovirus (rAd) do not efficiently cross the mucus layers or underlying epithelium of the vagina. Here we designed nanocomplexes of rAd particles coated with (1) the polyethylene glycol derivative APS to provide a hydrophilic surface that would prevent entrapment in the hydrophobic mucus, and (2) the cell-penetrating peptide TAT to improve transduction efficiency. The optimized rAd-TAT-APS nanocomplexes could achieve the balance of effective mucus-penetrating and cellular transduction. Intravaginal delivery of rAd-TAT-APS encoding HIVgag p24 into mice strongly enhanced HIVgag-specific systemic and mucosal immune responses. This rAd-TAT-APS system may allow effective vaginal delivery of vaccines against HIV and other infectious agents. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Mucosal immunology and probiotics.

    Science.gov (United States)

    Dongarrà, Maria Luisa; Rizzello, Valeria; Muccio, Letizia; Fries, Walter; Cascio, Antonio; Bonaccorsi, Irene; Ferlazzo, Guido

    2013-02-01

    The cross-talk between the mucosa-associated immune system and microbiota is critical in mucosal tissue homeostasis as well as in protection against infectious and inflammatory diseases occurring at mucosal sites. This recent evidence has paved the way to therapeutic approaches aimed at modulating the mucosa-associated immune system using probiotics. Different strains of probiotics possess the ability to finely regulate dendritic cell (DC) activation, polarizing the subsequent T cell activity toward Th1 (e.g. Lactobacillus (Lb) acidophilus), Th2 (Lb.reuteri and Bifidobacterium bifidum) or, as more recently demonstrated, Th17 responses induced by specific strains such as Lb.rhamnosus GG and Lac23a, the latter isolated in our laboratory. Here, we review some recent advances in our understanding of probiotics effects on mucosal immunology, particularly on cells of the innate immunity such as DCs. We also highlight our own experiences in modulating DC functions by commensal bacteria and discuss the relevance of probiotics administration in the treatment of human immunopathologies.

  6. Alpha-Toxin Promotes Mucosal Biofilm Formation by Staphylococcus aureus

    Directory of Open Access Journals (Sweden)

    Michele J Anderson

    2012-05-01

    Full Text Available Staphylococcus aureus causes numerous diseases in humans ranging from the mild skin infections to serious, life-threatening, superantigen-mediated Toxic Shock Syndrome (TSS. S. aureus may also be asymptomatically carried in the anterior nares, vagina or on the skin, which serve as reservoirs for infection. Pulsed-field gel electrophoresis clonal type USA200 is the most widely disseminated colonizer and a major cause of TSS. Our prior studies indicated that α-toxin was a major epithelial proinflammatory exotoxin produced by TSS S. aureus USA200 isolates. It also facilitated the penetration of TSS Toxin-1 (TSST-1 across vaginal mucosa. However, the majority of menstrual TSS isolates produce low α-toxin due to a nonsense point mutation at codon 113, designated hly, suggesting mucosal adaptation. The aim of this study was to characterize the differences between TSS USA200 strains [high (hla+ and low (hly+ α-toxin producers] in their abilities to infect and disrupt vaginal mucosal tissue. A mucosal model was developed using ex vivo porcine vaginal mucosa, LIVE/DEAD® staining and confocal microscropy to characterize biofilm formation and tissue viability of TSS USA 200 isolates CDC587 and MN8, which contain the α-toxin pseudogene (hly, MNPE (hla+ and MNPE isogenic hla knockout (hlaKO. All TSS strains grew to similar bacterial densities (1-5 x 108 CFU on the mucosa and were proinflammatory over 3 days. However, MNPE formed biofilms with significant reductions in the mucosal viability whereas neither CDC587, MN8 (hly+, or MNPE hlaKO, formed biofilms and were less cytotoxic. The addition of exogenous, purified α-toxin to MNPE hlaKO restored the biofilm phenotype. Our studies suggest α-toxin affects S. aureus phenotypic growth on vaginal mucosa, by promoting tissue disruption and biofilm formation; and α–toxin mutants (hly are not benign colonizers, but rather form a different type of infection, which we have termed high density pathogenic

  7. Utility and versatility of the supraclavicular artery island flap in head and neck reconstruction.

    Science.gov (United States)

    González-García, José A; Chiesa-Estomba, Carlos M; Sistiaga, Jon A; Larruscain, Ekhiñe; Álvarez, Leire; Altuna, Xabier

    2017-05-12

    The supraclavicular island flap is a rotational pedicled flap and may have some advantages in head and neck reconstruction compared with free-tissue transfer when this kind of reconstruction is not affordable or recommended. We present our experience during the year 2016 in the application of the supraclavicular island flap in five cases as an alternative to microvascular reconstruction in several defects after resection of head and neck tumours. In two patients, the flap was used to close the surgical pharyngostoma after total laryngectomy with partial pharyngectomy. In one patient, it was used in lateral facial reconstruction after partial resection of the temporal bone. In one case, it was used to close a skin defect after total laryngectomy with prelaryngeal tissue extension. And in the last case to close a neck skin defect after primary closure of a pharyngo-cutaneous fistula. There were no flap complications, and the result was satisfactory in all cases. The supraclavicular artery island flap is useful and versatile in head and neck reconstruction. Operating room time in aged patients or those with comorbidities will be reduced compared to free flaps. The surgical technique is relatively easy and can be used for skin and mucosal coverage. The supraclavicular island flap could be a recommended option in head and neck reconstruction, its use seems to be increasing and provides a safe and time-saving option to free flaps in selected patients. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  8. Frequency Distribution Candidal Vaginitis in Women Referred to Health Centers in Yazd

    Directory of Open Access Journals (Sweden)

    Ali Fattahi Bafghi

    2014-11-01

    Full Text Available Introduction: The vaginal flora is a dynamic ecosystem that can be easily altered. Although, there are four causes of vaginal discharges which cover almost 95% of vaginaitis. Candidal Vaginaitis is an infection of the vagina’s mucous membranes by Candida albicans (CA. Present study attempted to Candidal Vaginitis in women referred to health centers in Yazd and the role of innate & cell-mediated immunity against Candidal Vaginitis. Materials and Methods: A cross-sectional study conducted from September 2011 to September 2012 in Yazd city. A total of 360 women were recruited. The collection of material for diagnosis is ideally performed during a comprehensive pelvic examination using a speculum for diagnosis of CA with identify vaginal pH; smear preparing and staining and culturing. Results: Finally all of 360 women that observed and tested, 120 (33.33% of them have involved and 240 (66.67% have not involved. from 120 infected women, 55paitents had Bacterial vaginosis (15.6% 40 patients had Ca (10.8% and 25 patients had Trichomonas vaginalis (5.9%. Despite the role for cell-mediated immunity in host protection against the majority of mucosal CA infections, studied has been in women with recurrent vaginitis, in HIV-infected women. Thus, current investigations have been focused specifically on innate and acquired immune responses against CA at the vaginal mucosa instead of Vulvovaginal Candidiasis being caused by defective or dysfunctional CD4+ T helper 1-type cell-mediated immune reactivity. Conclusion: Strongly suggest that distinct vaginal lymphocyte subsets participate in the adaptive anti-Candida immunity at the vaginal level, with the vaginal CD4_ T cells probably playing a major role.

  9. Papilla Preservation Flap as Aesthetic Consideration in Periodontal Flap Surgery

    Directory of Open Access Journals (Sweden)

    Sandra Olivia

    2013-07-01

    Full Text Available Flap surgery is treatment for periodontal disease with alveolar bone destruction. Surgical periodontal flap with conventional incision will result in gingival recession and loss of interdental papillae after treatment. Dilemma arises in areas required high aesthetic value or regions with a fixed denture. It is challenging to perform periodontal flap with good aesthetic results and minimal gingival recession. This case report aimed to inform and to explain the work procedures, clinical and radiographic outcomes of surgical papilla preservation flap in the area that requires aesthetic. Case 1 was a surgical incision flap with preservation of papillae on the anterior region of teeth 11 and 12, with a full veneer crown on tooth 12. Case 2 was a surgical incision flap with preservation of papillae on the posterior region of tooth 46 with inlay restoration. Evaluation for both cases were obtained by incision papilla preservation of primary closure was perfect, good aesthetic results, minimal gingival recession and the interdental papillae can be maintained properly. In conclusion, periodontal flap surgery on the anterior region or regions that require high aesthetic value could be addressed with papilla preservation incision. Incision papilla preservation should be the primary consideration in periodontal flap surgery if possible.DOI: 10.14693/jdi.v19i3.144

  10. Mucosal vaccination by adenoviruses displaying reovirus sigma 1

    Energy Technology Data Exchange (ETDEWEB)

    Weaver, Eric A. [Department of Internal Medicine, Division of Infectious Diseases, Translational Immunovirology and Biodefense Program, Mayo Clinic, Rochester, MN 55902 (United States); Camacho, Zenaido T. [Department of Cell Biology, Department of Natural Sciences, Western New Mexico University, Silver City, NM 88062 (United States); Hillestad, Matthew L. [Nephrology Training Program, Mayo Clinic, Rochester, MN 55902 (United States); Crosby, Catherine M.; Turner, Mallory A.; Guenzel, Adam J.; Fadel, Hind J. [Virology and Gene Therapy Graduate Program, Mayo Clinic, Rochester, MN 55902 (United States); Mercier, George T. [Department of Physics, University of Houston, Houston, TX 77004 (United States); Barry, Michael A., E-mail: mab@mayo.edu [Department of Internal Medicine, Division of Infectious Diseases, Translational Immunovirology and Biodefense Program, Mayo Clinic, Rochester, MN 55902 (United States); Department of Immunology and Department of Molecular Medicine, Mayo Clinic, Rochester, MN 55902 (United States)

    2015-08-15

    We developed adenovirus serotype 5 (Ad5) vectors displaying the sigma 1 protein from reovirus as mucosal vaccines. Ad5-sigma retargets to JAM-1 and sialic acid, but has 40-fold reduced gene delivery when compared to Ad5. While weaker at transduction, Ad5-sigma generates stronger T cell responses than Ad5 when used for mucosal immunization. In this work, new Ad5-fiber-sigma vectors were generated by varying the number of fiber β-spiral shaft repeats (R) between the fiber tail and sigma. Increasing chimera length led to decreasing insertion of these proteinsAd5 virions. Ad-R3 and R14 vectors effectively targeted JAM-1 in vitro while R20 did not. When wereused to immunize mice by the intranasal route, Ad5-R3-sigma produced higher serum and vaginal antibody responses than Ad5. These data suggest optimized Ad-sigma vectors may be useful vectors for mucosal vaccination. - Highlights: • Constructed adenoviruses (Ads) displaying different reovirus sigma 1 fusion proteins. • Progressively longer chimeras were more poorly encapsidated onto Ad virions. • Ad5-R3-sigma mediated better systemic and mucosal immune responses than Ad5.

  11. Vaginitis: MedlinePlus Health Topic

    Science.gov (United States)

    ... Spanish Vulvovaginitis - overview (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Vaginitis updates by ... Vaginitis test - wet mount Vulvovaginitis - overview Related Health Topics Trichomoniasis Vaginal Diseases Yeast Infections Other Languages Find ...

  12. Vaginal Vault Prolapse

    Directory of Open Access Journals (Sweden)

    Azubuike Uzoma

    2009-01-01

    Vault prolapse repair rely on either the use of patient's tissue or synthetic materials and can be carried out abdominally or vaginally. Sacrospinous fixation and abdominal sacrocolpopexy are the commonly performed procedures, with literature in favour of abdominal sacrocolpopexy over sacrospinous fixation due to its reported higher success rate of about 90%. Other less commonly performed procedures include uterosacral ligament suspension and illiococcygeal fixation, both of which are equally effective, with the former having a high risk of ureteric injury. Colpoclesis will play a greater role in the future as the aging population increases. Mesh procedures are gaining in popularity, and preliminary data from vaginal mesh procedures is encouraging. Laparoscopic techniques require a high level of skill and experience. There are many controversies on the mechanism of prolapse and management techniques, which we have tried to address in this article. Conclusion. As the aging population increases, the incidence of prolapse will also rise, older techniques using native tissue will continue, while new techniques using the mesh needs to be studied further. The later may well be the way forward in future.

  13. Innervated digital artery perforator flap.

    Science.gov (United States)

    Ozcanli, Haluk; Coskunfirat, Osman Koray; Bektas, Gamze; Cavit, Ali

    2013-02-01

    To describe a technique for covering defects of the fingertips: the innervated digital artery perforator (IDAP) flap. A total of 17 patients were treated with an IDAP flap. The size of the flaps varied between 2 ×1 cm and 3.5 × 2 cm. Postoperative evaluation of the patients consisted of the Semmes-Weinstein Monofilament test, static 2-point discrimination, patient satisfaction, extension loss, and an investigation into complications. All IDAP flaps survived completely, and no patients required secondary interventions. The mean follow-up period was 7 months (range, 6-10 mo). The Semmes-Weinstein monofilament test results ranged from 3.22 to 3.84. The static 2-point discrimination in the flaps ranged from 2 mm to 4 mm (mean, 3.4 mm) compared with a range of 2 mm to 3 mm (mean, 2.7 mm) on the contralateral hand. There were no joint contractures in the reconstructed fingertips, although 2 patients developed mild hook nail deformity. One patient experienced mild cold intolerance, and 1 patient exhibited mild postoperative hypersensitivity. The advantages of the IDAP flap include minimally invasive surgery; a reliable, versatile flap; and the ease of the technique for different-sized fingertip defect reconstructions with few complications. The IDAP flap may be useful in fingertip amputations when the amputated part is not suitable for replantation. Therapeutic IV. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  14. Vaginal haemangioendothelioma: an unusual tumour.

    LENUS (Irish Health Repository)

    Mohan, H

    2012-02-01

    Vaginal tumours are uncommon and this is a particularly rare case of a vaginal haemangioendothelioma in a 38-year-old woman. Initial presentation consisted of symptoms similar to uterovaginal prolapse with "something coming down". Examination under anaesthesia demonstrated a necrotic anterior vaginal wall tumour. Histology of the lesion revealed a haemangioendothelioma which had some features of haemangiopericytoma. While the natural history of vaginal haemangioendothelioma is uncertain, as a group, they have a propensity for local recurrence. To our knowledge this is the third reported case of a vaginal haemangioendothelioma. Management of this tumour is challenging given the paucity of literature on this tumour. There is a need to add rare tumours to our "knowledge bank" to guide management of these unusual tumours.

  15. Vaginal pressure during daily activities before and after vaginal repair

    DEFF Research Database (Denmark)

    Mouritsen, L; Hulbaek, M; Brostrøm, S

    2007-01-01

    The objective of the study was to measure vaginal pressure during various daily activities in patients before and after vaginal surgery for pelvic organ prolapse, searching data for evidence-based activity guidelines. Vaginal pressure (VP) was studied in 23 patients during activities such as rest...... was not related to the type of vaginal repair. The results imply that post-operative counselling should concentrate more on treating chronic cough and constipation than restrictions of moderate physical activities.......The objective of the study was to measure vaginal pressure during various daily activities in patients before and after vaginal surgery for pelvic organ prolapse, searching data for evidence-based activity guidelines. Vaginal pressure (VP) was studied in 23 patients during activities such as rest...... and lifting 2 and 5 kg. Lifting in the walking position created a slightly higher VP compared to other lifting techniques, which did not differ. The VP did not increase when lifting 5 kg compared to 2 kg. Mean VP during coughing and Valsalva were significantly lower 1-5 days after the operation. VP...

  16. Mucosal immunology and virology

    National Research Council Canada - National Science Library

    Tyring, Stephen

    2006-01-01

    .... A third chapter focuses on the proximal end of the gastrointestinal tract (i.e. the oral cavity). The mucosal immunology and virology of the distal end of the gastrointestinal tract is covered in the chapter on the anogenital mucosa. Mucosa-associated lymphoid tissue (MALT) plays a role in protection against all viral (and other) infections except those that enter the body via a bite (e.g. yellow fever or dengue from a mosquito or rabies from a dog) or an injection or transfusion (e.g. HIV, Hepatitis B). ...

  17. Active Control of Long Bridges Using Flaps

    DEFF Research Database (Denmark)

    Hansen, H. I.; Thoft-Christensen, Palle

    The main problem in designing ultra-long span suspension bridges is flutter. A solution to this problem might be to introduce an active flap control system to increase the flutter wind velocity. The investigated flap control system consists of flaps integrated in the bridge girder so each flap...... is the streamlined part of the edge of the girder. Additional aerodynamic derivatives are shown for the flaps and it is shown how methods already developed can be used to estimate the flutter wind velocity for a bridge section with flaps. As an example, the flutter wind velocity is calculated for different flap...

  18. Vaginoscopic resection of vaginal septum.

    Science.gov (United States)

    Nassif, Joseph; Al Chami, Ali; Abu Musa, Antoine; Nassar, Anwar H; Kurdi, Ahmed Toufic; Ghulmiyyah, Labib

    2012-12-01

    We report the resection of a vaginal septum while preserving the virginity of a 12-year-old girl with Herlyn-Werner-Wunderlich Syndrome (HWWS) having a didelphys uterus, obstructed hemivagina, and an ipsilateral renal agenesis with follow-up at 18 months. Successful resection of the vaginal septum with conservation of the hymenal ring and complete drainage of both the hematocolpos and the hematometra were achieved. Cyclic dysmenorrhea and pelvic pain were completely resolved on follow-up visits at 4, 6, and 18 months. Office hysteroscopy performed during the last follow-up visit revealed a patent vaginal vault without evidence of adenosis or recurrence of the vaginal septum. Vaginoscopy is a safe, convenient, and efficient diagnostic and therapeutic modality that can be used in the management of patients with an obstructed hemivagina. It maintains the patient's virginity and it is useful in patients with a restrictive vaginal opening or narrow vaginal canal. Furthermore, the hysteroscopic excision of the vaginal septum offers minimal risk of recurrence of the septal defect.

  19. Versatility of the thin groin flap.

    Science.gov (United States)

    Murakami, R; Fujii, T; Itoh, T; Tsutsui, K; Tanaka, K; Lio, Y; Yano, H

    1996-01-01

    The groin flap is one of the most usable flaps. It provides a large amount of skin coverage with an easily concealed donor site. However, when the flap is used to reconstruct areas of the neck, hand, or foot, a secondary procedure for defatting is usually necessary. Thinner flaps are thought to be more useful in these areas. We present an anatomical study of the thin groin flap, including its dissection and defatting, and 12 clinical cases using the thin groin flap for neck (n = 7), foot (n = 4), and scalp (n = 1) reconstruction. The largest successful flap measured 13 x 30 cm. Eight flaps survived completely, two had partial necrosis, and two had total necrosis. Complications were thought to be caused by dissection around the pedicle. Meticulous dissection and thinning are required to create the thin groin flap. Excellent aesthetic results requiring no secondary defatting procedures are possible with this new thin groin flap.

  20. The Pedicled LICAP Flap Combined with a Free Abdominal Flap In Autologous Breast Reconstructions

    Directory of Open Access Journals (Sweden)

    Thomas Sjøberg, MD

    2018-01-01

    Conclusion:. In selected patients with insufficient abdominal flap tissue, a combination of a free abdominal flap and a pedicled LICAP flap is a valuable option to increase breast size and cosmetic outcome. Additional symmetrizing surgery might still be necessary.

  1. Dancing girl flap: a new flap suitable for web release.

    Science.gov (United States)

    Shinya, K

    1999-12-01

    To create a deep web, a flap must be designed to have a high elongation effect in one direction along the mid-lateral line of the finger and also to have a shortening effect in the other direction, crossing at a right angle to the mid-lateral line. The dancing girl flap is a modification of a four-flap Z-plasty with two additional Z-plasties. It has a high elongation effect in one direction (>550%) and a shortening effect in the other direction at a right angle (<33%), creating a deep, U-shaped surface. This new flap can be used to release severe scar contracture with a web, and is most suitable for incomplete syndactyly with webs as high as the proximal interphalangeal joint.

  2. The role of temporalis fascia for free mucosal graft survival in small nasal septal perforation repair.

    Science.gov (United States)

    Jeon, Eun-Ju; Choi, Jin; Lee, Joo-Hyung; Kim, Sung-Won; Nam, In-Chul; Park, Yong-Su; Jin, Sang-Gyun; Cheon, Byung-Jun

    2014-01-01

    Temporalis fascia has been used widely as a interposition graft for mucosal rotation flap in nasal septal perforation repair. However, the exact role of temporalis fascia in healing process has not yet been clarified. For the pedicle of rotation flap has been considered as a major vehicle for nutrition distribution, the role of temporalis fascia has been devaluated. In this study, we experienced small nasal septal perforation repairs using free mucosal graft not having pedicles but covered by temporalis fascia. Three patients with small nasal septal perforations not larger than 1 × 1 cm were included. In 2 patients, the perforations were repaired using free composite grafts from the inferior turbinate mucosa covered by continuous temporalis fascia not divided, and the surgical results were successful with complete healings. In 1 patient, however, the temporalis fascia was divided into 2 parts to better fit the shape of the perforation, and the graft failed to survive. These surgical results suggest that the temporalis fascia might have an important role in healing process of nasal septal defect and could be used as a beneficial options for small mucosal defect repair surgeries using free mucosal grafts.

  3. Multi-channel intracavitary vaginal brachytherapy using three-dimensional optimization of source geometry.

    Science.gov (United States)

    Tanderup, Kari; Lindegaard, Jacob C

    2004-01-01

    A new multi-channel vaginal cylinder has been constructed. The dose distribution is compared to that of a central channel cylinder. The source channels of the multi-channel cylinder are placed close to the treatment volume, which means that the dose gradient in the radial direction is steep. Therefore the dose is enhanced close to the cylinder surface and lowered at larger distances as compared to the central channel cylinder. Three patients were each CT-scanned twice with a vaginal cylinder in situ. CT-based 3D dose-planning studies were used to calculate the dose distribution. Dose-volume histograms (DVHs) were generated for rectum and bladder, and a quantification of high dose volumes was calculated from the DVHs. Dose to the vaginal mucosa was calculated. The dose to the critical organs depends on the depth of normalization. When the dose is normalized on the cylinder surface the hot spot dose to bladder and rectum is reduced by 16 and 17%, respectively, whereas mucosal dose remains the same. When the dose is normalized at 5 mm depth the hot spot dose to bladder and rectum is reduced by 1 and 3%, respectively, whereas mucosal dose is enhanced by 17%. The multi-channel cylinder makes it possible to spare the rectum and the bladder at the expense of enhanced mucosal dose.

  4. CCL19 and CCL28 augment mucosal and systemic immune responses to HIV-1 gp140 by mobilizing responsive immunocytes into secondary lymph nodes and mucosal tissue.

    Science.gov (United States)

    Hu, Kai; Luo, Sukun; Tong, Lina; Huang, Xin; Jin, Wei; Huang, Wenjie; Du, Tao; Yan, Yan; He, Siyi; Griffin, George E; Shattock, Robin J; Hu, Qinxue

    2013-08-15

    Induction of broad and potent neutralizing Abs at the mucosal portals of entry remains a primary goal for most vaccines against mucosally acquired viral infections. Selection of appropriate adjuvants capable of promoting both systemic and mucosal responses will be crucial for the development of effective immunization strategies. In this study, we investigated whether plasmid codelivery of cytokines APRIL, CCL19, or CCL28 can enhance Ag-induced immune responses to HIV-1 gp140. Our results demonstrated that pCCL19 and pCCL28, but not pAPRIL, significantly enhanced Ag-specific systemic and mucosal Ab responses. gp140-specific Abs in serum enhanced by pCCL19 or pCCL28 were broadly distributed across all four IgG subclasses, of which IgG1 was predominant. The enhanced systemic and mucosal Abs showed increased neutralizing activity against both homologous and heterologous HIV-1, and potency correlated with gp140-specific serum IgG and vaginal IgA levels. Measurement of gp140-specific cytokines produced by splenocytes demonstrated that pCCL19 and pCCL28 augmented balanced Th1/Th2 responses. pCCL19 and pCCL28 also increased IgA(+) cells in colorectal mucosal tissue. pCCL19 codelivery resulted in an increase of CCR7(+) CD11c(+) cells in mesenteric lymph nodes and both CCR7(+) CD11c(+) cells and CCR7(+) CD3e(+) cells in spleen, whereas pCCL28 codelivery resulted in an augment of CCR10(+) CD19(+) cells in both spleen and mesenteric lymph nodes. Together, our data indicate that pCCL19 and pCCL28 can enhance HIV-1 envelope-specific systemic and mucosal Ab responses, as well as T cell responses. Such enhancements appear to be associated with mobilization of responsive immunocytes into secondary lymphoid organs and mucosal tissues through interactions with corresponding receptors.

  5. Urinary incontinence - vaginal sling procedures

    Science.gov (United States)

    ... your doctor will have you try bladder retraining, Kegel exercises, medicines, or other options. If you tried ... vaginal sling; Transobturator sling; Midurethral sling Patient Instructions Kegel exercises - self-care Self catheterization - female Suprapubic catheter ...

  6. Drugs Approved for Vaginal Cancer

    Science.gov (United States)

    This page lists cancer drugs approved by the Food and Drug Administration (FDA) to prevent vaginal cancer. The list includes generic names and brand names. The drug names link to NCI’s Cancer Drug Information summaries.

  7. Vaginal itching and discharge - child

    Science.gov (United States)

    ... Images Female reproductive anatomy Causes of vaginal itching Uterus References Davis AJ, Katz VL. Pediatric and adolescent gynecology: gynecologic examination, infections, trauma, pelvic mass, precocious puberty. In: Lentz GM, Lobo ...

  8. Predictors of the vaginal microflora.

    Science.gov (United States)

    Newton, E R; Piper, J M; Shain, R N; Perdue, S T; Peairs, W

    2001-04-01

    Our purpose was to define influences on the patterns of the vaginal microflora. We enrolled 617 African American and Mexican American women in a 1-year longitudinal study of sexual behaviors and the vaginal microflora on the basis of the presence of gonorrhea, chlamydial infection, trichomoniasis, or syphilis at the initial visit. The patients were assigned randomly to a behavioral intervention or standard counseling regarding sexually transmitted disease. We reevaluated 508 (82%) and 549 (89%) women at 6 and 12 months, respectively. A comprehensive survey of lower genital tract organisms was conducted at baseline and at 6 and 12 months. Behavioral and microbiologic associations were screened by bivariate analysis. All variables associated with an organism at P 3 times a week, and cunnilingus, fellatio, and anal intercourse at the last sexual encounter. M hominis (but not Ureaplasma urealyticum ), Gardnerella vaginalis, and Lactobacillus species were associated with bacterial vaginosis. Lactobacillus species appeared to protect against bacterial vaginosis and infection with G vaginalis. Sexually transmitted diseases (caused by M hominis, N gonorrhoeae, C trachomatis, and T vaginalis ) were associated with each other. In contrast, hormonal status, vaginal blood, and foreign bodies had little effect. The presence of other microorganisms and race have a more consistent association with the presence or absence of a cervical-vaginal organism than sexual behavior, hormonal status, vaginal devices, or the presence of abnormal vaginal bleeding.

  9. New advances in mucosal vaccination.

    Science.gov (United States)

    Ranasinghe, Charani

    2014-10-01

    The ICI 2013 Mucosal Vaccine Workshop presentations covered a wide range of topics, these mainly fell into three categories: (i) Understanding the interactions of host and microbes, specifically commensal pathogens and improving the antigen uptake via the (microfold cells) M cells to induce effective IgA antibody immunity at the gut mucosa; (ii) effective plant-based vaccines and (iii) development of prophylactic and therapeutic mucosal-based vaccine strategies for virus infections such as human immunodeficiency virus (HIV), influenza and human papillomavirus (HPV) associated head and neck cancers. How to improve the efficacy of oral vaccines, novel intranasal mucosal adjuvants and a unique intra-cheek delivery method were also discussed. Presenters emphasized the differences associated with systemic and mucosal vaccination, specifically, how mucosal vaccines unlike systemic delivery can induce effective immunity at the first line of defence. Collectively, the workshop provided insights into recent developments in the mucosal vaccine research field, highlighting the complexities associated with designing safe and effective mucosal vaccines. Copyright © 2014 Elsevier B.V. All rights reserved.

  10. Translational Mini-Review Series on Vaccines for HIV: T lymphocyte trafficking and vaccine-elicited mucosal immunity.

    Science.gov (United States)

    Kaufman, D R; Barouch, D H

    2009-08-01

    Many pathogens use mucosal surfaces to enter and propagate within the host, making particularly desirable vaccines that target immune responses specifically to mucosal compartments. The majority of mucosal vaccine design strategies to date have been empirical in nature. However, an emerging body of basic immunological knowledge is providing new insights into the regulation of tissue-specific lymphocyte trafficking and differentiation. These insights afford the opportunity for the rational design of vaccines that focus immune responses at mucosal surfaces. Mucosal cellular immunity may prove critical for protection in the context of HIV infection, and thus there has been considerable interest in developing vaccines that target HIV-specific cellular immune responses to the gastrointestinal and vaginal mucosa. However, the optimal strategies for eliciting mucosal cellular immune responses through vaccination remain to be determined. Here, we review both recent vaccine studies and emerging paradigms from the basic immunological literature that are relevant to the elicitation of potent and protective mucosal cellular immune memory. Increasing the synergy between these avenues of research may afford new opportunities for mucosal vaccine design.

  11. Vaginal estrogens for the treatment of dyspareunia.

    Science.gov (United States)

    Krychman, Michael L

    2011-03-01

    Vaginal atrophy, which is associated with vaginal itching, burning, dryness, irritation, and pain, is estimated to affect up to 40% of postmenopausal women. Estrogens play a key role in maintaining vaginal health; women with low serum estradiol are more likely to experience vaginal dryness, dyspareunia, and reduced sexual activity compared with women who have higher estradiol levels. The purpose of this review is to assess the prevalence and impact of dyspareunia, a symptom of vaginal atrophy, on the health of postmenopausal women and to evaluate treatment options using vaginal estrogens (U.S. Food and Drug Administration [FDA] approved). Relevant published literature was identified by searching Index Medicus using the PubMed online database. The search terms dyspareunia, vaginal estrogen, vaginal hormone therapy, vaginal atrophy, and atrophic vaginitis were the focus of the literature review. Current treatment guidelines for vaginal atrophy recommend the use of minimally absorbed local vaginal estrogens, along with non-hormonal lubricants or moisturizers, coupled with maintenance of sexual activity. Vaginal estrogen therapy has been shown to provide improvement in the signs and symptoms of vaginal or vulvar atrophy. Vaginal tablets, rings, and creams are indicated for the treatment of vaginal atrophy, and the FDA has recently approved a low-dose regimen of conjugated estrogens cream to treat moderate-to-severe postmenopausal dyspareunia. The use of low-dose vaginal estrogens has been shown to be effective in treating symptoms of vaginal atrophy without causing significant proliferation of the endometrial lining, and no significant differences have been seen among vaginal preparations in terms of endometrial safety. Women should be informed of the potential benefits and risks of the treatment options available, and with the help of their healthcare provider, choose an intervention that is most suitable to their individual needs and circumstances. © 2010

  12. Protection of pigs against genital Chlamydia trachomatis challenge by parenteral or mucosal DNA immunization.

    Science.gov (United States)

    Schautteet, Katelijn; De Clercq, Evelien; Jönsson, Yannick; Lagae, Stefanie; Chiers, Koen; Cox, Eric; Vanrompay, Daisy

    2012-04-16

    The current study evaluates combined aerosol-vaginal delivery of a MOMP-based Chlamydia trachomatis (serovar E) DNA vaccine in a pig genital challenge model. Most non-replicating antigens are rather poor mucosal immunogens in comparison to replicating antigens. Therefore, a mucosal administered DNA vaccine, which actually mimics a live vaccine, could be promising. Protection was promoted by plasmids encoding the porcine granulocyte macrophage-colony stimulating factor (pcDNA3.1zeo::GM-CSF), the Escherichia coli thermo-labile enterotoxin (LT) subunit A (plasmid PJV2004::LTa) and subunit B (plasmid PJV2005::LTb). Mucosal C. trachomatis DNA vaccination induced significant protection against genital C. trachomatis challenge although the infection could not be eradicated. Intradermal immunization was significantly less efficient in protecting experimentally infected pigs. Protection was correlated with efficient T cell priming and significantly higher serum IgA titers following primo vaccination. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Anterior vaginal compartment surgery.

    Science.gov (United States)

    Maher, Christopher

    2013-11-01

    To review the safety and efficacy of anterior vaginal compartment pelvic organ prolapse surgery. Every 4 years and as part of the Fifth International Collaboration on Incontinence we reviewed the English-language scientific literature after searching PubMed, Medline, Cochrane library and the Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials [RCT] or systematic reviews), level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies) and level 4 case reports. The highest level of evidence was utilised by the committee to make evidence-based recommendations based upon the Oxford grading system. A grade A recommendation usually depends on consistent level 1 evidence. A grade B recommendation usually depends on consistent level 2 and/or 3 studies, or "majority evidence" from RCTs. A grade C recommendation usually depends on level studies or "majority evidence" from level 2/3 studies or Delphi processed expert opinion. A grade D "no recommendation possible" would be used where the evidence is inadequate or conflicting and when expert opinion is delivered without a formal analytical process, such as by Delphi. Absorbable mesh augmentation of anterior compartment native tissue repair improves the anatomical outcome compared with native tissue repair alone with no increased complication rate in meta-analysis of 2 RCTS (grade B). Biological grafts in meta-analysis have improved anatomical outcomes with no change in subjective outcomes compared with native tissue repairs (grade B). There is conflicting level 1 evidence to support porcine dermis and a single RCT to support small intestine submucosa as graft agents in anterior compartment prolapse surgery (grade B). Consistent level 1 data support a superior anatomical outcome for polypropylene mesh compared with a biological graft in the anterior compartment. Mesh exposure rate was

  14. Mucosal healing in ulcerative colitis

    DEFF Research Database (Denmark)

    Seidelin, Jakob Benedict; Coskun, Mehmet; Nielsen, Ole Haagen

    2013-01-01

    . With the introduction of the tumor necrosis factor-alpha inhibitors for the treatment of UC, it has become increasingly evident that the disease course is influenced by whether or not the patient achieves mucosal healing. Thus, patients with mucosal healing have fewer flare-ups, a decreased risk of colectomy......, and a lower probability of developing colorectal cancer. Understanding the mechanisms of mucosal wound formation and wound healing in UC, and how they are affected therapeutically is therefore of importance for obtaining efficient treatment strategies holding the potential of changing the disease course of UC....... This review is focused on the pathophysiological mechanism of mucosal wound formation in UC as well as the known mechanisms of intestinal wound healing. Regarding the latter topic, pathways of both wound healing intrinsic to epithelial cells and the wound-healing mechanisms involving interaction between...

  15. Clinical parameters of implants placed in healed sites using flapped and flapless techniques: A systematic review.

    Science.gov (United States)

    Llamas-Monteagudo, O; Girbés-Ballester, P; Viña-Almunia, J; Peñarrocha-Oltra, D; Peñarrocha-Diago, M

    2017-09-01

    Dental implant placement using flapless surgery is a minimally invasive technique that improves blood supply compared with flapped surgery. However, the flapless technique does not provide access to allow bone regeneration. The aim of this systematic review was to evaluate the clinical parameters following implant surgery in healed sites, using two procedures: flapped vs. flapless surgery. A detailed electronic search was carried out in the PubMed/Medline, Embase and Cochrane Library databases. The focused question was, "How do flapped and flapless surgical techniques affect the clinical parameters of dental implants placed in healed sites?". All the studies included with a prospective controlled design were considered separately, depending on whether they had been conducted on animals or humans. The following data were recorded in all the included studies: number of implants, failures, location (maxilla, mandible), type of rehabilitation (partial or single), follow-up and flap design. The variables selected for comparison in the animal studies were the following: flap design, gingival index, mucosal height, recession and probing pocket depth. In humans studies the variables were as follows: flap design, plaque index, gingival index, recession, probing pocket depth, papilla index and keratinized gingiva. Ten studies were included, six were experimental studies and four were clinical studies. Studies in animals showed better results using the flapless technique in the parameters analyzed. There is no consensus in the clinical parameters analyzed in human studies, but there is a trend to better results using flapless approach. The animal studies included in the present review show that implants placed in healed sites with a flapless approach have better clinical parameters than the flapped procedure in a short-term follow-up. In human studies, there is no consensus about which technique offer better results in terms of clinical parameters. Therefore, more research in

  16. Mucositis Grades and Yeast Species

    OpenAIRE

    Ognjenović, Marina; Milatić, Katja; Parat, Katica; KOVAČIĆ, IVAN; Ježina Bušelić, Marina A.; Božić, Joško

    2013-01-01

    Surgically treated patients with oral, head and neck cancer commonly develop mucositis during additional irradiation therapy. Oral mucosa inflammation other than irradiation is mostly caused by Candida albicans, yeast of Candida genus. This study evaluated possible connection between grades of oral mucositis and oral yeast profile in irradiated patients before, during and after irradiation. In 25 examined patients mucosits grades »0« to »2« before irradiation with 20% positive smears and o...

  17. Cutaneous and mucosal pain syndromes

    Directory of Open Access Journals (Sweden)

    Siddappa K

    2002-01-01

    Full Text Available The cutaneous and mucosal pain syndromes are characterized by pain, burning sensation, numbness or paraesthesia of a particular part of the skin or mucosal surface without any visible signs. They are usually sensory disorders, sometimes with a great deal of psychologic overlay. In this article various conditions have been listed and are described. The possible causative mechanisms are discussed when they are applicable and the outline of their management is described.

  18. The "Tokyo" consensus on propeller flaps.

    Science.gov (United States)

    Pignatti, Marco; Ogawa, Rei; Hallock, Geoffrey G; Mateev, Musa; Georgescu, Alexandru V; Balakrishnan, Govindasamy; Ono, Shimpei; Cubison, Tania C S; D'Arpa, Salvatore; Koshima, Isao; Hyakusoku, Hikko

    2011-02-01

    Over the past few years, the use of propeller flaps, which base their blood supply on subcutaneous tissue or isolated perforators, has become increasingly popular. Because no consensus has yet been reached on terminology and nomenclature of the propeller flap, different and confusing uses of the term can be found in the literature. In this article, the authors report the consensus on the definition and classification of propeller flaps reached by the authors that gathered at the First Tokyo Meeting on Perforator and Propeller Flaps in June of 2009. Some peculiar aspects of the surgical technique are discussed. A propeller flap can be defined as an "island flap that reaches the recipient site through an axial rotation." The classification is based on the nourishing pedicle (subcutaneous pedicled propeller flap, perforator pedicled propeller flap, supercharged propeller flap), the degrees of skin island rotation (90 to 180 degrees) and, when possible, the artery of origin of the perforator. The propeller flap is a useful reconstructive tool that can achieve good cosmetic and functional results. A flap should be called a propeller flap only if it fulfils the definition above. The type of nourishing pedicle, the source vessel (when known), and the degree of skin island rotation should be specified for each flap.

  19. Mucosal vaccines for biodefense.

    Science.gov (United States)

    Mantis, N J; Morici, L A; Roy, C J

    2012-01-01

    Bioterrorism is the deliberate release of biological toxins, pathogenic viruses, bacteria, parasites, or other infectious agents into the public sphere with the objective of causing panic, illness, and/or death on a local, regional, or possibly national scale. The list of potential biological agents compiled by the Centers for Disease Control and Prevention is long and diverse. However, a trait common to virtually all the potential bioterrorism agents is the fact that they are likely to be disseminated by either aerosol or in food/water supplies with the intention of targeting the mucosal surfaces of the respiratory or gastrointestinal tracts, respectively. In some instances, inhalation or ingestion would mimic the natural route by which humans are exposed to these agents. In other instances, (e.g., the inhalation of a toxin is normally associated with food borne illness), it would represent an unnatural route of exposure. For most potential bioterrorism agents, the respiratory or gastrointestinal mucosa may simply serve as a route of entry by which they gain access to the systemic compartment where intoxication/replication occurs. For others, however, the respiratory or gastrointestinal mucosa is the primary tissue associated with pathogenesis, and therefore, the tissue for which countermeasures must be developed.

  20. Nivolumab or Expectant Observation Following Ipilimumab, Nivolumab, and Surgery in Treating Patients With High Risk Localized, Locoregionally Advanced, or Recurrent Mucosal Melanoma

    Science.gov (United States)

    2017-10-16

    Cervical Carcinoma; Esophageal Carcinoma; Mucosal Melanoma; Mucosal Melanoma of the Head and Neck; Oral Cavity Mucosal Melanoma; Recurrent Melanoma; Stage II Vulvar Cancer AJCC v7; Stage III Vulvar Cancer AJCC v7; Stage IIIA Vulvar Cancer AJCC v7; Stage IIIB Vulvar Cancer AJCC v7; Stage IIIC Vulvar Cancer AJCC v7; Stage IV Oral Cavity Cancer AJCC v6 and v7; Stage IV Vulvar Cancer AJCC v7; Stage IVA Oral Cavity Cancer AJCC v6 and v7; Stage IVB Oral Cavity Cancer AJCC v6 and v7; Stage IVC Oral Cavity Cancer AJCC v6 and v7; Vaginal Carcinoma

  1. Contraceptive vaginal rings: a review.

    Science.gov (United States)

    Brache, Vivian; Faundes, Anibal

    2010-11-01

    Development efforts on contraceptive vaginal rings were initiated over 40 years ago based on two principles: the capacity of the vaginal epithelium to absorb steroids and the capacity of elastomers to release these hormones at a nearly constant rate. Numerous models of contraceptive vaginal rings (CVRs) have been studied, but only two have reached the market: NuvaRing, a combined ring that releases etonogestrel (ENG) and ethinylestradiol (EE), and Progering, a progesterone-releasing ring for use in lactating women. The main advantages of CVRs are their effectiveness (similar to or slightly better than the pill), ease of use without the need of remembering a daily routine, user's ability to control initiation and discontinuation, nearly constant release rate allowing for lower doses, greater bioavailability and good cycle control with the combined ring. The main disadvantages are related to the mode of delivery; CVRs may cause vaginal discharge and complaints, ring expulsion is not uncommon, the ring may be felt during coitus and vaginal insertion may be unpleasant for some women. The studies reviewed in this article provide evidence that CVRs are safe, effective and highly acceptable to women. There is no doubt that CVRs offer a new, effective contraceptive option to women, expanding their available choices of hormonal contraception. Copyright © 2010 Elsevier Inc. All rights reserved.

  2. [Multipurpose treatment of vaginal infections].

    Science.gov (United States)

    Nikolov, A; Masseva, A; Shopova, E; Georgiev, S

    2012-01-01

    Untreated bacterial vaginosis is related with many complications for non-pregnant women in reproductive age, most common from them are vaginal discharge and postoperative infections. The aim of our investigation was to compare the effectiveness of two therapeutic regimes which consist in Macmiror/Macmiror Complex alone and in combination with Feminella Vagi C for treatment of bacterial vaginosis (BV) and/or mycotic infection. 117 non-pregnant women with symptoms of vaginal infection were prospectively enrolled into two groups according their treatment. First group consist 66 women treated with Macmiror tablets and vaginal capsules followed with local application of Feminella Vagi C, the second group consist 54 women treated with Macmiror tablets and vaginal capsules only. The impact of treatment on clinical symptoms was observed at the end of medication and 20 days after it. Microbiological testing was repeated 20 days after treatment. Over than 80% (78.6 divided by 86.7%) of the cases with vaginal infection (BV and mycotic one) were successfully treated with Macmiror/Macmiror Complex. Supplement treatment with Feminella Vagi C lead to higher percentage of clinically recovery (86.7% vs 84.6%), better microbiological cleaning (86.7% vs 82.1%) and longer effect of treatment. Used medication showed higher efficacy against BV than to fungal infection. According obtained results we may conclude that bacterial vaginosis was better treated with multipurpose treatment (Nifuratel, Nistatin and vit. C) than with Macmiror alone.

  3. Developmental Origin of Vaginal Epithelium

    Science.gov (United States)

    Kurita, Takeshi

    2010-01-01

    The developmental origin of vaginal epithelium has been controversial for nearly a century, with speculation that vaginal epithelium originates from the Müllerian duct, Wolffian duct, and/or urogenital sinus. None of these possibilities has been definitively proven or disproven by direct scientific data. To define precisely the origin of vaginal epithelium, epithelial cells of the Müllerian duct, Wolffian duct, or urogenital sinus were fluorescently labeled in mouse embryos by crossing tdTomato-EGFP dual-reporter transgenic mice with transgenic mouse lines that express Cre recombinase in each type of epithelium. In embryos and newborn mice, the vagina consisted of fused Müllerian ducts plus the sinus vagina of urogenital sinus origin. However, the proportion of the sinus vagina was significantly reduced as the Müllerian vagina grew caudally. By postpartum day 7, the Müllerian vagina extended to the caudal end of the body, whereas the sinus vagina remained only at the junction between the vagina and perineal skin. As the vagina opened in puberty, urogenital sinus epithelium was detected only in the vulva, but not in the vagina. Additionally, from embryo to adult stages, residual Wolffian duct epithelium was present in the dorsolateral stromal wall of the vagina, but not within vaginal or vulvar epithelium. In conclusion, adult mouse vaginal epithelium is derived solely from Müllerian duct epithelium. PMID:20638775

  4. Combined posterior flap and anterior suspended flap dacryocystorhinostomy: A modification of external dacryocystorhinostomy

    Directory of Open Access Journals (Sweden)

    Amarendra Deka

    2010-01-01

    Conclusion : We believe that combined posterior flap and anterior suspended flap DCR technique is simple to perform and has the advantage of both double flap DCR and anterior suspension of anterior flaps. The results of the study showed the efficacy of this simple modification.

  5. Rationale and Safety Assessment of a Novel Intravaginal Drug-Delivery System with Sustained DL-Lactic Acid Release, Intended for Long-Term Protection of the Vaginal Microbiome.

    Directory of Open Access Journals (Sweden)

    Hans Verstraelen

    Full Text Available Bacterial vaginosis is a prevalent state of dysbiosis of the vaginal microbiota with wide-ranging impact on human reproductive health. Based on recent insights in community ecology of the vaginal microbiome, we hypothesize that sustained vaginal DL-lactic acid enrichment will enhance the recruitment of lactobacilli, while counteracting bacterial vaginosis-associated bacteria. We therefore aimed to develop an intravaginal device that would be easy to insert and remove, while providing sustained DL-lactic acid release into the vaginal lumen. The final prototype selected is a vaginal ring matrix system consisting of a mixture of ethylene vinyl acetate and methacrylic acid-methyl methacrylate copolymer loaded with 150 mg DL-lactic acid with an L/D-lactic acid ratio of 1:1. Preclinical safety assessment was performed by use of the Slug Mucosal Irritation test, a non-vertebrate assay to evaluate vaginal mucosal irritation, which revealed no irritation. Clinical safety was evaluated in a phase I trial with six healthy nulliparous premenopausal volunteering women, with the investigational drug left in place for 7 days. Colposcopic monitoring according to the WHO/CONRAD guidelines for the evaluation of vaginal products, revealed no visible cervicovaginal mucosal changes. No adverse events related to the investigational product occurred. Total release from the intravaginal ring over 7 days was estimated through high performance liquid chromatography at 37.1 (standard deviation 0.9 mg DL-lactic acid. Semisolid lactic acid formulations have been studied to a limited extent in the past and typically consist of a large volume of excipients and very high doses of lactic acid, which is of major concern to mucosal safety. We have documented the feasability of enriching the vaginal environment with pure DL-lactic acid with a prototype intravaginal ring. Though the efficacy of this platform remains to be established possibly requiring further development, this

  6. Randomized clinical trial comparing collagen plug and advancement flap for trans-sphincteric anal fistula.

    Science.gov (United States)

    Bondi, J; Avdagic, J; Karlbom, U; Hallböök, O; Kalman, D; Šaltytė Benth, J; Naimy, N; Øresland, T

    2017-08-01

    The role of a collagen plug for treating anal fistula is not well established. A randomized prospective multicentre non-inferiority study of surgical treatment of trans-sphincteric cryptogenic fistulas was undertaken, comparing the anal fistula plug with the mucosal advancement flap with regard to fistula recurrence rate and functional outcome. Patients with an anal fistula were evaluated for eligibility in three centres, and randomized to either mucosal advancement flap surgery or collagen plug, with clinical follow-up at 3 and 12 months. The primary outcome was the fistula recurrence rate. Anal pain (visual analogue scale), anal incontinence (St Mark's score) and quality of life (Short Form 36 questionnaire) were also reported. Ninety-four patients were included; 48 were allocated to the plug procedure and 46 to advancement flap surgery. The median follow-up was 12 (range 9-24) months. The recurrence rate at 12 months was 66 per cent (27 of 41 patients) in the plug group and 38 per cent (15 of 40) in the flap group (P = 0·006). Anal pain was reduced after operation in both groups. Anal incontinence did not change in the follow-up period. Patients reported an increased quality of life after 3 months. There were no differences between the groups with regard to pain, incontinence or quality of life. There was a considerably higher recurrence rate after the anal fistula plug procedure than following advancement flap repair. Registration number: NCT01021774 (http://www.clinicaltrials.gov). © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  7. 14 CFR 23.701 - Flap interconnection.

    Science.gov (United States)

    2010-01-01

    ... Systems § 23.701 Flap interconnection. (a) The main wing flaps and related movable surfaces as a system... on one side of the plane of symmetry inoperative and the remaining engines at takeoff power. For...

  8. Citología Vaginal

    OpenAIRE

    Arrunategui, Ana María; Fundación Valle de Lili

    2001-01-01

    ¿Qué es una neoplasia?/ ¿Qué grupo de mujeres tiene un mayor riesgo de desarrollar cáncer del cuello de la matriz?/ ¿Cuáles son los síntomas más frecuentes del cáncer del cuello de la matriz?/ Anatomía de los órganos genitales femeninos/¿Cómo se realiza la prueba de la citología vaginal?/¿Cómo se interpretan los resultados de la citología vaginal?/ ¿Toda citología anormal es cáncer?/ ¿Qué otras utilidades tiene la citología vaginal?/ ¿Desde qué edad, hasta que edad y con qué frecuencia debe t...

  9. NK cell responses to simian immunodeficiency virus vaginal exposure in naive and vaccinated rhesus macaques.

    Science.gov (United States)

    Shang, Liang; Smith, Anthony J; Duan, Lijie; Perkey, Katherine E; Qu, Lucy; Wietgrefe, Stephen; Zupancic, Mary; Southern, Peter J; Masek-Hammerman, Katherine; Reeves, R Keith; Johnson, R Paul; Haase, Ashley T

    2014-07-01

    NK cell responses to HIV/SIV infection have been well studied in acute and chronic infected patients/monkeys, but little is known about NK cells during viral transmission, particularly in mucosal tissues. In this article, we report a systematic study of NK cell responses to high-dose vaginal exposure to SIVmac251 in the rhesus macaque female reproductive tract (FRT). Small numbers of NK cells were recruited into the FRT mucosa following vaginal inoculation. The influx of mucosal NK cells preceded local virus replication and peaked at 1 wk and, thus, was in an appropriate time frame to control an expanding population of infected cells at the portal of entry. However, NK cells were greatly outnumbered by recruited target cells that fuel local virus expansion and were spatially dissociated from SIV RNA+ cells at the major site of expansion of infected founder populations in the transition zone and adjoining endocervix. The number of NK cells in the FRT mucosa decreased rapidly in the second week, while the number of SIV RNA+ cells in the FRT reached its peak. Mucosal NK cells produced IFN-γ and MIP-1α/CCL3 but lacked several markers of activation and cytotoxicity, and this was correlated with inoculum-induced upregulation of the inhibitory ligand HLA-E and downregulation of the activating receptor CD122/IL-2Rβ. Examination of SIVΔnef-vaccinated monkeys suggested that recruitment of NK cells to the genital mucosa was not involved in vaccine-induced protection from vaginal challenge. In summary, our results suggest that NK cells play, at most, a limited role in defenses in the FRT against vaginal challenge. Copyright © 2014 by The American Association of Immunologists, Inc.

  10. Therapeutic activity of a Saccharomyces cerevisiae-based probiotic and inactivated whole yeast on vaginal candidiasis.

    Science.gov (United States)

    Pericolini, Eva; Gabrielli, Elena; Ballet, Nathalie; Sabbatini, Samuele; Roselletti, Elena; Cayzeele Decherf, Amélie; Pélerin, Fanny; Luciano, Eugenio; Perito, Stefano; Jüsten, Peter; Vecchiarelli, Anna

    2017-01-02

    Vulvovaginal candidiasis is the most prevalent vaginal infection worldwide and Candida albicans is its major agent. Vulvovaginal candidiasis is characterized by disruption of the vaginal microbiota composition, as happens following large spectrum antibiotic usage. Recent studies support the effectiveness of oral and local probiotic treatment for prevention of recurrent vulvovaginal candidiasis. Saccharomyces cerevisiae is a safe yeast used as, or for, the production of ingredients for human nutrition and health. Here, we demonstrate that vaginal administration of probiotic Saccharomyces cerevisiae live yeast (GI) and, in part, inactivated whole yeast Saccharomyces cerevisiae (IY), used as post-challenge therapeutics, was able to positively influence the course of vaginal candidiasis by accelerating the clearance of the fungus. This effect was likely due to multiple interactions of Saccharomyces cerevisiae with Candida albicans. Both live and inactivated yeasts induced coaggregation of Candida and consequently inhibited its adherence to epithelial cells. However, only the probiotic yeast was able to suppress some major virulence factors of Candida albicans such as the ability to switch from yeast to mycelial form and the capacity to express several aspartyl proteases. The effectiveness of live yeast was higher than that of inactivated whole yeast suggesting that the synergy between mechanical effects and biological effects were dominant over purely mechanical effects. The protection of epithelial cells to Candida-induced damage was also observed. Overall, our data show for the first time that Saccharomyces cerevisiae-based ingredients, particularly the living cells, can exert beneficial therapeutic effects on a widespread vaginal mucosal infection.

  11. Vascularized Fibula Flaps for Mandibular Reconstruction: An ...

    African Journals Online (AJOL)

    For decades, osseous vascularised flaps have been used for reconstruction of the mandible with the vascularised fibula flap (VFF) remaining the commonly used osseous free flap, reasons ranging from its adequate bone and pedicle length to its receptive dental implant placement quality. This report considers a modest use ...

  12. New model of flap-gliding flight.

    Science.gov (United States)

    Sachs, Gottfried

    2015-07-21

    A new modelling approach is presented for describing flap-gliding flight in birds and the associated mechanical energy cost of travelling. The new approach is based on the difference in the drag characteristics between flapping and non-flapping due to the drag increase caused by flapping. Thus, the possibility of a gliding flight phase, as it exists in flap-gliding flight, yields a performance advantage resulting from the decrease in the drag when compared with continuous flapping flight. Introducing an appropriate non-dimensionalization for the mathematical relations describing flap-gliding flight, results and findings of generally valid nature are derived. It is shown that there is an energy saving of flap-gliding flight in the entire speed range compared to continuous flapping flight. The energy saving reaches the highest level in the lower speed region. The travelling speed of flap-gliding flight is composed of the weighted average of the differing speeds in the flapping and gliding phases. Furthermore, the maximum range performance achievable with flap-gliding flight and the associated optimal travelling speed are determined. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Vaginal Bleeding: MedlinePlus Health Topic

    Science.gov (United States)

    ... bleeding in pregnancy (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Vaginal Bleeding updates ... late pregnancy Vaginal bleeding in pregnancy Related Health Topics Menstruation Disclaimers MedlinePlus links to health information from ...

  14. Vaginitis: current microbiologic and clinical concepts.

    Science.gov (United States)

    Hill, L V; Embil, J A

    1986-02-15

    Infectious vaginitis occurs when the normal vaginal flora is disrupted; it may arise when saprophytes overwhelm the host immune response, when pathogenic organisms are introduced into the vagina or when changes in substrate allow an imbalance of microorganisms to develop. Examples of these types of vaginitis include the presence of chronic fungal infection in women with an inadequate cellular immune response to the yeast, the introduction of trichomonads into vaginal epithelium that has a sufficient supply of glycogen, and the alteration in bacterial flora, normally dominated by Lactobacillus spp., and its metabolites that is characteristic of "nonspecific vaginitis". The authors review microbiologic and clinical aspects of the fungal, protozoal and bacterial infections, including the interactions of bacteria thought to produce nonspecific vaginitis, that are now recognized as causing vaginitis. Other causes of vaginitis are also discussed.

  15. Efficient flapping flight of pterosaurs

    Science.gov (United States)

    Strang, Karl Axel

    In the late eighteenth century, humans discovered the first pterosaur fossil remains and have been fascinated by their existence ever since. Pterosaurs exploited their membrane wings in a sophisticated manner for flight control and propulsion, and were likely the most efficient and effective flyers ever to inhabit our planet. The flapping gait is a complex combination of motions that sustains and propels an animal in the air. Because pterosaurs were so large with wingspans up to eleven meters, if they could have sustained flapping flight, they would have had to achieve high propulsive efficiencies. Identifying the wing motions that contribute the most to propulsive efficiency is key to understanding pterosaur flight, and therefore to shedding light on flapping flight in general and the design of efficient ornithopters. This study is based on published results for a very well-preserved specimen of Coloborhynchus robustus, for which the joints are well-known and thoroughly described in the literature. Simplifying assumptions are made to estimate the characteristics that can not be inferred directly from the fossil remains. For a given animal, maximizing efficiency is equivalent to minimizing power at a given thrust and speed. We therefore aim at finding the flapping gait, that is the joint motions, that minimize the required flapping power. The power is computed from the aerodynamic forces created during a given wing motion. We develop an unsteady three-dimensional code based on the vortex-lattice method, which correlates well with published results for unsteady motions of rectangular wings. In the aerodynamic model, the rigid pterosaur wing is defined by the position of the bones. In the aeroelastic model, we add the flexibility of the bones and of the wing membrane. The nonlinear structural behavior of the membrane is reduced to a linear modal decomposition, assuming small deflections about the reference wing geometry. The reference wing geometry is computed for

  16. Effects of vaginal prolapse surgery and ageing on vaginal vascularization

    NARCIS (Netherlands)

    Weber, M.A.

    2016-01-01

    Ageing affects pelvic floor anatomy and function, resulting in several disorders like pelvic organ prolapse (POP), lower urinary tract symptoms and vaginal atrophy (VA). In this thesis we searched for methods to link the function of pelvic organs to physiological changes. The effects of POP and

  17. Vaginitis: current microbiologic and clinical concepts.

    OpenAIRE

    Hill, L V; Embil, J A

    1986-01-01

    Infectious vaginitis occurs when the normal vaginal flora is disrupted; it may arise when saprophytes overwhelm the host immune response, when pathogenic organisms are introduced into the vagina or when changes in substrate allow an imbalance of microorganisms to develop. Examples of these types of vaginitis include the presence of chronic fungal infection in women with an inadequate cellular immune response to the yeast, the introduction of trichomonads into vaginal epithelium that has a suf...

  18. Characterisation of the vaginal microflora of human ...

    African Journals Online (AJOL)

    Lactobacilli predominate normal vaginal microflora and are important in maintenance of vaginal health. The current study set out to identify and compare culture isolates of vaginal microflora of human immunodeficiency virus (HIV) positive (HIV+) and HIV negative (HIV-) women at different phases during menstrual cycle ...

  19. Decreased beta-carotene levels in exfoliated vaginal epithelial cells in women with vaginal candidiasis.

    Science.gov (United States)

    Mikhail, M S; Palan, P R; Basu, J; Anyaegbunam, A; Romney, S L

    1994-10-01

    Women are more susceptible to vaginal candidiasis when the host immune response is suppressed. The antioxidant nutrient beta-carotene is postulated to possess immunoenhancing properties. The purpose of this study was to investigate beta-carotene concentrations in exfoliated vaginal epithelial (EVE) cells in women with vaginal candidiasis. Beta-carotene levels in EVE cells, collected by a saline lavage technique from 22 women with vaginal candidiasis and 20 normal controls, were analyzed. The diagnosis of vaginal candidiasis was established by the presence of pruritus, white cheesy vaginal discharge, and a positive potassium hydroxide preparation. Beta-carotene levels were assayed using high pressure liquid chromatography. Vaginal cell concentrations of beta-carotene were significantly decreased in women with vaginal candidiasis (P < 0.001). Decreased beta-carotene levels, and possibly other antioxidants, may alter the local immune response resulting in disturbances in the vaginal flora, overgrowth of candida, and the development of vaginal candidiasis.

  20. Fractional CO2 laser treatment for vulvovaginal atrophy symptoms and vaginal rejuvenation in perimenopausal women

    Directory of Open Access Journals (Sweden)

    Arroyo C

    2017-08-01

    Full Text Available César Arroyo HM Montepríncipe University Hospital Laser Unit, Madrid, Spain Background: This study investigated a novel fractional carbon dioxide (CO2 laser for treatment of symptoms associated with vulvovaginal atrophy (VVA in perimenopausal women.Methods: The study included 21 perimenopausal women (mean age 45±7 years treated three times by CO2 laser resurfacing and coagulation of the vaginal canal tissue and mucosal tissue of the introitus. Vaginal health index (VHI scores were computed by the investigator at baseline and follow-ups. Subjects reported on sexual function, satisfaction, and improvement with treatment. A visual analog scale was used to measure discomfort with treatment.Results: Vaginal health and subject assessment of vaginal symptoms improved with successive treatments. At 12 weeks following the third treatment, 82% of the patients showed a statistically significant improvement in VHI (P<0.05. Additionally, 81% of subjects reported improvement in sexual gratification, 94% reported improvement in vaginal rejuvenation, and 100% reported satisfaction with treatment. VHI improvement remained significant at 6–8 months after treatments (P<0.01. Most patients (97% reported no to mild discomfort with treatment. Responses were mild and transient following treatment, with itching being the most commonly reported (20% side effect.Conclusion: In this study, fractional CO2 laser treatment was associated with improvement of vaginal health and amelioration of symptoms of VVA, resulting in improved sexual function in perimenopausal women. Treatment time was quick, and there was minimal discomfort associated with treatment. Investigation of clinical outcome in a larger study population is warranted. Keywords: genitourinary syndrome of menopause, vaginal rejuvenation, stress urinary incontinence, collagen remodeling, sexual dysfunction, vulvovaginal atrophy

  1. The role of interstitial brachytherapy in the treatment of vaginal and vulvar malignancies

    Energy Technology Data Exchange (ETDEWEB)

    Seeger, A.R.; Windschall, A.; Lotter, M.; Sauer, R.; Strnad, V. [Dept. of Radiation Oncology, Univ. of Erlangen-Nuremberg, Erlangen (Germany); Mehlhorn, G.; Beckmann, M.W. [Dept. of Gynecology, Univ. of Erlangen-Nuremberg, Erlangen (Germany)

    2006-03-15

    Background: irradiation has established itself as a treatment for vulvar and vaginal malignancies. Due to the sensitive nature of the vulvar and vaginal tissues, interstitial brachytherapy (iBT) provides an effective, gentle and individualized therapy. Patients and Methods: patients with vulvar (nine of 22) and vaginal (13 of 22) malignancies were treated using interstitial pulsed-dose-rate brachytherapy (PDR-iBT). Twelve out of 22 patients were additionally treated using external-beam therapy to the pelvis and regional lymph nodes. The median total dose of PDR-iBT administered to patients with vulvar carcinoma was 55.0 Gy. The median total PDR dose administered to patients with vaginal malignancies amounted to 20.25 Gy. Results: the median follow-up time for patients with vulvar cancer was 19 months and for patients with vaginal malignancies 27 months. Acute mucositis or skin reactions during iBT were observed in 15 of 22 patients. Two of 22 patients showed delayed side effects. After 6 months, 77.8% of the patients with vulvar cancer (seven out of nine) and 100% of the patients with vaginal malignancies (13 out of 13) achieved complete local remission. One patient out of nine with vulvar carcinoma developed local recurrence, four out of nine regional recurrence, and two out of nine developed regional recurrence and had local tumor following therapy. In patients with malignancies of the vagina, no cases of local recurrence were observed, but distant metastases were found in five out of 13 patients. At the time of analysis, eleven out of 22 patients with vulvar or vaginal carcinoma were still alive. Conclusion: IBT achieved good local control without serious delayed side effects in both localizations. However, survival is limited by regional or distant metastases. (orig.)

  2. Vaginal immunization to elicit primary T-cell activation and dissemination.

    Directory of Open Access Journals (Sweden)

    Elena Pettini

    Full Text Available Primary T-cell activation at mucosal sites is of utmost importance for the development of vaccination strategies. T-cell priming after vaginal immunization, with ovalbumin and CpG oligodeoxynucleotide adjuvant as model vaccine formulation, was studied in vivo in hormone-synchronized mice and compared to the one induced by the nasal route. Twenty-four hours after both vaginal or nasal immunization, antigen-loaded dendritic cells were detected within the respective draining lymph nodes. Vaginal immunization elicited a strong recruitment of antigen-specific CD4(+ T cells into draining lymph nodes that was more rapid than the one observed following nasal immunization. T-cell clonal expansion was first detected in iliac lymph nodes, draining the genital tract, and proliferated T cells disseminated towards distal lymph nodes and spleen similarly to what observed following nasal immunization. T cells were indeed activated by the antigen encounter and acquired homing molecules essential to disseminate towards distal lymphoid organs as confirmed by the modulation of CD45RB, CD69, CD44 and CD62L marker expression. A multi-type Galton Watson branching process, previously used for in vitro analysis of T-cell proliferation, was applied to model in vivo CFSE proliferation data in draining lymph nodes 57 hours following immunization, in order to calculate the probabilistic decision of a cell to enter in division, rest in quiescence or migrate/die. The modelling analysis indicated that the probability of a cell to proliferate was higher following vaginal than nasal immunization. All together these data show that vaginal immunization, despite the absence of an organized mucosal associated inductive site in the genital tract, is very efficient in priming antigen-specific CD4(+ T cells and inducing their dissemination from draining lymph nodes towards distal lymphoid organs.

  3. Bioadhesive vaginal tablets containing spray dried microspheres loaded with clotrimazole for treatment of vaginal candidiasis.

    Science.gov (United States)

    Gupta, Naresh Vishal; Natasha, Shirodker; Getyala, Anil; Bhat, Ramnath Sudeendra

    2013-09-01

    The aim of the present investigation was to prepare and evaluate novel bioadhesive vaginal tablets containing clotrimazole loaded microspheres in order to provide long-term therapeutic activity at the site of infection. Tablets were prepared by incorporating drug loaded microspheres and using bioadhesive polymers hydroxypropylmethylcellulose, sodium carboxymethylcellulose and Carbopol. Microspheres were prepared by the spray drying technique using Eudragit RS-100 and Eudragit RL-100. Microspheres were characterized by SEM, DSC, FTIR, particle size analysis and evaluated for percentage yield, drug loading, encapsulation efficiency and in vitro drug release. To achieve bioadhesion to the mucosal tissue, optimized microspheres were incorporated into bioadhesive tablets and were evaluated for in vitro drug release, in vitro and in vivo mucoadhesion. FTIR and DSC studies showed that no chemical interaction occurred between the drug and polymers. The sphericity factor indicated that the prepared microspheres were spherical. Formulation Mt6 indicated a controlled in vitro drug release and good bioadhesive strength. The in vivo images confirmed the bioadhesion and retention property of tablets up to 24 h. The results indicated that this drug delivery system can be explored for controlled intravaginal drug release.

  4. Mucosal delivery of human papillomavirus pseudovirus-encapsidated plasmids improves the potency of DNA vaccination.

    Science.gov (United States)

    Graham, B S; Kines, R C; Corbett, K S; Nicewonger, J; Johnson, T R; Chen, M; LaVigne, D; Roberts, J N; Cuburu, N; Schiller, J T; Buck, C B

    2010-09-01

    Mucosal immunization may be important for protection against pathogens whose transmission and pathogenesis target the mucosal tissue. The capsid proteins of human papillomavirus (HPV) confer tropism for the basal epithelium and can encapsidate DNA during self-assembly to form pseudovirions (PsVs). Therefore, we produced mucosal vaccine vectors by HPV PsV encapsidation of DNA plasmids expressing an experimental antigen derived from the M and M2 proteins of respiratory syncytial virus (RSV). Intravaginal (IVag) delivery elicited local and systemic M-M2-specific CD8+ T-cell and antibody responses in mice that were comparable to an approximately 10,000-fold higher dose of naked DNA. A single HPV PsV IVag immunization primed for M-M2-specific-IgA in nasal and vaginal secretions. Based on light emission and immunofluorescent microscopy, immunization with HPV PsV-encapsidated luciferase- and red fluorescent protein (RFP)-expressing plasmids resulted in transient antigen expression (mucosal immunization that could provide new vaccine options for selected mucosal pathogens.

  5. TRANSVERSE VAGINAL SEPTUM: A CONGENITAL MALFORMATION AND ITS MANAGEMENT IN A FEMALE DROMEDARY CAMEL

    Directory of Open Access Journals (Sweden)

    Z. I. Qureshi, M. Iqbal, A. Wahab, R. Yass and M. Naif

    2005-01-01

    Full Text Available A seven year old female dromedary camel was examined for the complaint of inability to breed due to problem during penile intromission. Vaginoscopy, using equine tube vaginoscope, revealed the presence of a tissue flap cranial to the urethral opening, buldging caudally and separating the cranial and caudal parts of vagina. Digital palpation was also performed and the condition was diagnosed as transverse vaginal septum. For treatment, the vaginal septum was grasped with an Allis tissue forceps and a circular piece was severed from the center with the Metzenbaum scissors. The remaining portion of septum was then carefully trimmed. About 28 days after surgery, the animal showed heat signs and was mated. On ultrasonographic examination three months, post mating the animal was found pregnant.

  6. In vivo evaluation of safety and toxicity of a Lactobacillus jensenii producing modified cyanovirin-N in a rhesus macaque vaginal challenge model.

    Directory of Open Access Journals (Sweden)

    Beda Brichacek

    Full Text Available Sexual transmission of human immunodeficiency virus type 1 (HIV-1 across the cervicovaginal mucosa in women is influenced by many factors including the microbiota and the presence of underlying inflammation. It is important that potential HIV preventative agents do not alter the mucosal environment in a way that enhances HIV acquisition. We examined the impact of a "live" microbicide on the vaginal mucosal environment in a rhesus macaque repeated vaginal simian-HIV (SHIVSF162P3 challenge model. The microbicide contained a human vaginal Lactobacillus jensenii expressing the HIV-1 entry inhibitor, modified Cyanovirin-N (mCV-N, and henceforth called LB-mCV-N. Macaques were colonized vaginally each week with LB-mCV-N and sampled six days after colonization for culturable bacteria, pH and cervical-vaginal cytokines during the duration of the six-week study. We show that macaques that retained the engineered LB-mCV-N strain in their vaginal microbiota, during SHIV challenge, had lower pH, when colonization levels were higher, and had no evidence of inflammatory cytokines. Indeed, Interleukin-13, a mediator of inflammation, was detected less often in LB-mCV-N colonized macaques than in controls and we found higher levels of Interleukin 1 receptor antagonist (IL-1RA in LB-mCV-N colonized macaques during the SHIV challenge period. We noted an inverse correlation between levels of mucosal IL-1RA and peak plasma viral load, thus higher IL-1RA correlated with lower viral load in LB-mCV-N treated macaques. These data support the use of LB-mCV-N as a safe "live" microbicide and suggest that lactobacilli themselves may positively impact the mucosal environment.

  7. In vivo evaluation of safety and toxicity of a Lactobacillus jensenii producing modified cyanovirin-N in a rhesus macaque vaginal challenge model.

    Science.gov (United States)

    Brichacek, Beda; Lagenaur, Laurel A; Lee, Peter P; Venzon, David; Hamer, Dean H

    2013-01-01

    Sexual transmission of human immunodeficiency virus type 1 (HIV-1) across the cervicovaginal mucosa in women is influenced by many factors including the microbiota and the presence of underlying inflammation. It is important that potential HIV preventative agents do not alter the mucosal environment in a way that enhances HIV acquisition. We examined the impact of a "live" microbicide on the vaginal mucosal environment in a rhesus macaque repeated vaginal simian-HIV (SHIVSF162P3) challenge model. The microbicide contained a human vaginal Lactobacillus jensenii expressing the HIV-1 entry inhibitor, modified Cyanovirin-N (mCV-N), and henceforth called LB-mCV-N. Macaques were colonized vaginally each week with LB-mCV-N and sampled six days after colonization for culturable bacteria, pH and cervical-vaginal cytokines during the duration of the six-week study. We show that macaques that retained the engineered LB-mCV-N strain in their vaginal microbiota, during SHIV challenge, had lower pH, when colonization levels were higher, and had no evidence of inflammatory cytokines. Indeed, Interleukin-13, a mediator of inflammation, was detected less often in LB-mCV-N colonized macaques than in controls and we found higher levels of Interleukin 1 receptor antagonist (IL-1RA) in LB-mCV-N colonized macaques during the SHIV challenge period. We noted an inverse correlation between levels of mucosal IL-1RA and peak plasma viral load, thus higher IL-1RA correlated with lower viral load in LB-mCV-N treated macaques. These data support the use of LB-mCV-N as a safe "live" microbicide and suggest that lactobacilli themselves may positively impact the mucosal environment.

  8. Sternocleidomastoid Muscle Flap after Parotidectomy

    Directory of Open Access Journals (Sweden)

    Nofal, Ahmad Abdel-Fattah

    2015-04-01

    Full Text Available Introduction Most patients after either superficial or total parotidectomy develop facial deformity and Frey syndrome, which leads to a significant degree of patient dissatisfaction. Objective Assess the functional outcome and esthetic results of the superiorly based sternocleidomastoid muscle (SCM flap after superficial or total parotidectomy. Methods A prospective cohort study for 11 patients subjected to parotidectomy using a partial-thickness superiorly based SCM flap. The functional outcome (Frey syndrome, facial nerve involvement, and ear lobule sensation and the esthetic results were evaluated subjectively and objectively. Results Facial nerve palsy occurred in 5 cases (45%, and all of them recovered completely within 6 months. The Minor starch iodine test was positive in 3 patients (27%, although only 1 (9% subjectively complained of gustatory sweating. The designed visual analog score completed by the patients themselves ranged from 0 to 3 with a mean of 1.55 ± 0.93; the scores from the blinded evaluators ranged from 1 to 3 with a mean 1.64 ± 0.67. Conclusion The partial-thickness superiorly based SCM flap offers a reasonable cosmetic option for reconstruction following either superficial or total parotidectomy by improving the facial deformity. The flap also lowers the incidence of Frey syndrome objectively and subjectively with no reported hazard of the spinal accessory nerve.

  9. The inner arm fasciocutaneous flap.

    Science.gov (United States)

    Budo, J; Finucan, T; Clarke, J

    1984-04-01

    A fasciocutaneous flap raised on the inner surface of the upper arm has been used to release 16 burn scar contractures of the anterior axillary fold. It is a relatively quick and simple procedure that adequately corrects the contracture and does not have to followed by prolonged splinting.

  10. Mycoplasma pneumonia-associated mucositis.

    Science.gov (United States)

    Varghese, Cyril; Sharain, Korosh; Skalski, Joseph; Ramar, Kannan

    2014-03-13

    We present a case of a young man with severe mucositis following an upper respiratory tract infection limited to the ophthalmic and oral mucosa while sparing the rest of the skin, genitalia and perianal regions. Investigations revealed that the mucositis was a rare extrapulmonary manifestation of Mycoplasma pneumoniae infection. He had progressive vision-threatening symptoms despite antibiotics and best supportive care and thus was treated with intravenous corticosteroids, immunoglobulins, temporary ocular amniotic membrane grafts and tarsorrhaphy. The patient made an almost complete recovery over 6 weeks.

  11. Vaginal leiomyoma: MRI features with pathologic correlation

    Directory of Open Access Journals (Sweden)

    Avantika Gupta

    2015-06-01

    Full Text Available We present a rare case of vaginal leiomyoma presenting as prolapsed vaginal mass in a 45 years old woman. The leiomyoma was found to arise from the right lateral vaginal fornix with a vascular stalk. MRI showed homogenous hypointense signals on T1W1 and iso to hyperintense signals on T2W1 images with moderate heterogenous enhancement on post contrast images. It was enucleated via vaginal route and the histopathological examination confirmed the diagnosis of vaginal leiomyoma.

  12. Clotrimazole nanoparticle gel for mucosal administration

    Energy Technology Data Exchange (ETDEWEB)

    Esposito, Elisabetta, E-mail: ese@unife.it [Department of Pharmaceutical Sciences, University of Ferrara, I-44121 Ferrara (Italy); Ravani, Laura [Department of Pharmaceutical Sciences, University of Ferrara, I-44121 Ferrara (Italy); Contado, Catia [Department of Chemistry, University of Ferrara, Ferrara (Italy); Costenaro, Andrea [Department of Pharmaceutical Sciences, University of Ferrara, I-44121 Ferrara (Italy); Drechsler, Markus [Macromolecular Chemistry II, University of Bayreuth (Germany); Rossi, Damiano [Department of Biology and Evolution, LT Terra and Acqua Tech UR7, University of Ferrara, Ferrara (Italy); Menegatti, Enea [Department of Pharmaceutical Sciences, University of Ferrara, I-44121 Ferrara (Italy); Grandini, Alessandro [Department of Biology and Evolution, LT Terra and Acqua Tech UR7, University of Ferrara, Ferrara (Italy); Cortesi, Rita [Department of Pharmaceutical Sciences, University of Ferrara, I-44121 Ferrara (Italy)

    2013-01-01

    In this study a formulation suitable to be applied on oral and/or vaginal mucosa has been developed for the treatment of fungal infections. The aim of the research is a comparison between clotrimazole (CLO) containing semisolid formulations based on monoolein aqueous dispersion (MAD) or nanostructured lipid carrier (NLC). MAD and NLC have been characterized in terms of morphology and dimensional distribution by cryogenic Transmission Electron Microscopy (cryo-TEM) and Photon Correlation Spectroscopy (PCS). CLO was encapsulated with high entrapment efficiency both in MAD and in NLC, according to Sedimentation Field Flow Fractionation (SdFFF) combined with HPLC. CLO recovery in MAD and NLC has been investigated by time. In order to obtain formulations with suitable viscosity for mucosal application, MAD was diluted with a carbomer gel, while NLC was directly viscosized by the addition of poloxamer 407 in the dispersion. The rheological properties of MAD and NLC after viscosizing have been investigated. Franz cell has been employed to study CLO diffusion from the different vehicles, evidencing diffusion rates from MAD and NLC superimposable to that obtained using Canesten{sup Registered-Sign }. An anticandidal activity study demonstrated that both CLO-MAD and CLO-NLC were more active against Candida albicans with respect to the pure drug. Highlights: Black-Right-Pointing-Pointer Comparison between monoolein aqueous dispersion (MAD) and nanostructured lipid carrier (NLC). Black-Right-Pointing-Pointer Clotrimazole (CLO) encapsulated with high entrapment efficiency both in MAD and in NLC. Black-Right-Pointing-Pointer The solid matrix of NLC controls CLO degradation better than MAD. Black-Right-Pointing-Pointer CLO containing MAD and NLC exhibits a higher anticandidal activity than the free drug. Black-Right-Pointing-Pointer Simple production of CLO-NLC based poloxamer gel, suitable for industry scaling up.

  13. Targeting the vaginal mucosa with human papillomavirus pseudovirion vaccines delivering simian immunodeficiency virus DNA.

    Science.gov (United States)

    Gordon, Shari N; Kines, Rhonda C; Kutsyna, Galyna; Ma, Zhong-Min; Hryniewicz, Anna; Roberts, Jeffery N; Fenizia, Claudio; Hidajat, Rachmat; Brocca-Cofano, Egidio; Cuburu, Nicolas; Buck, Christopher B; Bernardo, Marcelino L; Robert-Guroff, Marjorie; Miller, Christopher J; Graham, Barney S; Lowy, Douglas R; Schiller, John T; Franchini, Genoveffa

    2012-01-15

    The majority of HIV infections occur via mucosal transmission. Vaccines that induce memory T and B cells in the female genital tract may prevent the establishment and systemic dissemination of HIV. We tested the immunogenicity of a vaccine that uses human papillomavirus (HPV)-based gene transfer vectors, also called pseudovirions (PsVs), to deliver SIV genes to the vaginal epithelium. Our findings demonstrate that this vaccine platform induces gene expression in the genital tract in both cynomolgus and rhesus macaques. Intravaginal vaccination with HPV16, HPV45, and HPV58 PsVs delivering SIV Gag DNA induced Gag-specific Abs in serum and the vaginal tract, and T cell responses in blood, vaginal mucosa, and draining lymph nodes that rapidly expanded following intravaginal exposure to SIV(mac251.) HPV PsV-based vehicles are immunogenic, which warrant further testing as vaccine candidates for HIV and may provide a useful model to evaluate the benefits and risks of inducing high levels of SIV-specific immune responses at mucosal sites prior to SIV infection.

  14. Surgical repair of rectovaginal fistula using gracilis muscular flap. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Inoue, Yasuhiro; Ooi, Masataka; Takeuchi, Kenji; Honzumi, Makoto [Nabari City Hospital, Mie (Japan); Fukunishi, Shigeji

    1999-07-01

    A 78 year-old female suffered from vaginal discharge of flatus and stool for 20 years after the radiation therapy for cervical cancer. Digital and endoscopic examination of the rectum and the vagina disclosed a large, short rectovaginal fistula at the level of the cervix. Since laparotomy and low anterior resection of the rectum were impossible, a perineal approach was adopted. After perineal skin incision, the fistula was resected and the defects of the rectum and the vagina were closed. Gracilis muscular flap was anchored between the two closures. Though the closure of the rectal side was torn, her postoperative course was uneventful. Endoscopic examination 24 days after the operation confirmed healing of the dehiscence. The results verified the usefulness of the perineal approach using the gracilis muscular flap as an alternative method to low anterior resection for troublesome radiation induced rectovaginal fistula. (author)

  15. Chitosan in Mucoadhesive Drug Delivery: Focus on Local Vaginal Therapy

    Directory of Open Access Journals (Sweden)

    Toril Andersen

    2015-01-01

    Full Text Available Mucoadhesive drug therapy destined for localized drug treatment is gaining increasing importance in today’s drug development. Chitosan, due to its known biodegradability, bioadhesiveness and excellent safety profile offers means to improve mucosal drug therapy. We have used chitosan as mucoadhesive polymer to develop liposomes able to ensure prolonged residence time at vaginal site. Two types of mucoadhesive liposomes, namely the chitosan-coated liposomes and chitosan-containing liposomes, where chitosan is both embedded and surface-available, were made of soy phosphatidylcholine with entrapped fluorescence markers of two molecular weights, FITC-dextran 4000 and 20,000, respectively. Both liposomal types were characterized for their size distribution, zeta potential, entrapment efficiency and the in vitro release profile, and compared to plain liposomes. The proof of chitosan being both surface-available as well as embedded into the liposomes in the chitosan-containing liposomes was found. The capability of the surface-available chitosan to interact with the model porcine mucin was confirmed for both chitosan-containing and chitosan-coated liposomes implying potential mucoadhesive behavior. Chitosan-containing liposomes were shown to be superior in respect to the simplicity of preparation, FITC-dextran load, mucoadhesiveness and in vitro release and are expected to ensure prolonged residence time on the vaginal mucosa providing localized sustained release of entrapped model substances.

  16. Once daily bioadhesive vaginal clotrimazole tablets: design and evaluation.

    Science.gov (United States)

    Sharma, Garima; Jain, S; Tiwary, A K; Kaur, Gurpreet

    2006-09-01

    In this study, a bioadhesive dosage form of clotrimazole was designed using a combination of bioadhesive polymers Carbopol 934P, sodium carboxymethyl cellulose and sodium alginate in different ratios. The bioadhesive strength was evaluated by measuring the force required to detach the tablets from porcine vaginal mucosal membrane. The strong interaction between polymer and mucus lining of the tissue helps increase the contact time and permits localization of activity. Carbopol 934P showed maximum bioadhesion and required maximum force for detachment; the force required for detachment was directly proportional to its content. The formulations were tested for their swelling behavior using the agar gel plate method. The swelling index was a function of the concentration of the hydrophilic polymer and the formulations containing Carbopol 934P and sodium carboxymethyl cellulose were found to swell to a greater extent than those containing Carbopol and sodium alginate. In vitro release studies showed that the batch consisting of 2:1 ratio of Carbopol 934P/sodium alginate (batch C3) released clotrimazole over 24 h. The similarity factor showed that the dissolution profiles of fresh and aged tablets were similar, suggesting good stability of vaginal tablets prepared using a combination of Carbopol 934P and sodium alginate.

  17. Mucosal vaccines: where do we stand?

    Science.gov (United States)

    Kraehenbuhl, Jean-Pierre; Neutra, Marian R

    2013-01-01

    Mucosal vaccinology is a relatively young but rapidly expanding discipline. At present the vast majority of vaccines are administered by injection, including vaccines that protect against mucosally acquired pathogens such as influenza virus and human papilloma virus. However, mucosal immune responses are most efficiently induced by the administration of vaccines onto mucosal surfaces. The small number of currently licensed mucosal vaccines have reduced the burden of disease and mortality caused by enteric pathogens including rotavirus, V. cholerae and S. typhi, or those that spread to affect distal organs such as poliovirus. Expanding knowledge about the special features of the mucosal immune system promises to accelerate development of mucosal vaccines that could contribute significantly to protection against pathogens that colonize or invade via mucosal surfaces including HIV, Shigella, ETEC, Campylobacter jejuni, Helicobacter pylori and many others.

  18. Vaginal pressure during daily activities before and after vaginal repair

    DEFF Research Database (Denmark)

    Mouritsen, L; Hulbaek, M; Brostrøm, S

    2007-01-01

    , pelvic floor contraction (PFC), coughing, Valsalva, rising from sitting to standing and lifting 2 and 5 kg with four different lifting techniques. VP was measured before, 1-5 days and 4-6 weeks after vaginal repair. Mean VP was four to five times higher during coughing and Valsalva compared to PFC...... and lifting 2 and 5 kg. Lifting in the walking position created a slightly higher VP compared to other lifting techniques, which did not differ. The VP did not increase when lifting 5 kg compared to 2 kg. Mean VP during coughing and Valsalva were significantly lower 1-5 days after the operation. VP...... was not related to the type of vaginal repair. The results imply that post-operative counselling should concentrate more on treating chronic cough and constipation than restrictions of moderate physical activities....

  19. Mucosal delivery of vaccines in domestic animals

    OpenAIRE

    Gerdts, Volker; Mutwiri, George; Tikoo, Suresh; Babiuk, Lorne

    2006-01-01

    International audience; Mucosal vaccination is proving to be one of the greatest challenges in modern vaccine development. Although highly beneficial for achieving protective immunity, the induction of mucosal immunity, especially in the gastro-intestinal tract, still remains a difficult task. As a result, only very few mucosal vaccines are commercially available for domestic animals. Here, we critically review various strategies for mucosal delivery of vaccines in domestic animals. This incl...

  20. The possibility for use of venous flaps in plastic surgery

    Energy Technology Data Exchange (ETDEWEB)

    Baytinger, V. F., E-mail: baitinger@mail.tomsknet.ru; Kurochkina, O. S., E-mail: kurochkinaos@yandex.ru; Selianinov, K. V.; Baytinger, A. V. [Research Institute of Microsurgery, Tomsk (Russian Federation); Dzyuman, A. N. [Siberian State Medical University, Tomsk (Russian Federation)

    2015-11-17

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.

  1. The possibility for use of venous flaps in plastic surgery

    Science.gov (United States)

    Baytinger, V. F.; Kurochkina, O. S.; Selianinov, K. V.; Baytinger, A. V.; Dzyuman, A. N.

    2015-11-01

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.

  2. Chitosan and Kappa-Carrageenan Vaginal Acyclovir Formulations for Prevention of Genital Herpes. In Vitro and Ex Vivo Evaluation

    Directory of Open Access Journals (Sweden)

    María-Pilar Sánchez-Sánchez

    2015-09-01

    Full Text Available Vaginal formulations for the prevention of sexually transmitted infections are currently gaining importance in drug development. Polysaccharides, such as chitosan and carrageenan, which have good binding capacity with mucosal tissues, are now included in vaginal delivery systems. Marine polymer-based vaginal mucoadhesive solid formulations have been developed for the controlled release of acyclovir, which may prevent the sexual transmission of the herpes simplex virus. Drug release studies were carried out in two media: simulated vaginal fluid and simulated vaginal fluid/simulated seminal fluid mixture. The bioadhesive capacity and permanence time of the bioadhesion, the prepared compacts, and compacted granules were determined ex vivo using bovine vaginal mucosa as substrate. Swelling processes were quantified to confirm the release data. Biocompatibility was evaluated through in vitro cellular toxicity assays, and the results showed that acyclovir and the rest of the materials had no cytotoxicity at the maximum concentration tested. The mixture of hydroxyl-propyl-methyl-cellulose with chitosan- or kappa-carrageenan-originated mucoadhesive systems that presented a complete and sustained release of acyclovir for a period of 8–9 days in both media. Swelling data revealed the formation of optimal mixed chitosan/hydroxyl-propyl-methyl-cellulose gels which could be appropriated for the prevention of sexual transmission of HSV.

  3. Chitosan and Kappa-Carrageenan Vaginal Acyclovir Formulations for Prevention of Genital Herpes. In Vitro and Ex Vivo Evaluation

    Science.gov (United States)

    Sánchez-Sánchez, María-Pilar; Martín-Illana, Araceli; Ruiz-Caro, Roberto; Bermejo, Paulina; Abad, María-José; Carro, Rubén; Bedoya, Luis-Miguel; Tamayo, Aitana; Rubio, Juan; Fernández-Ferreiro, Anxo; Otero-Espinar, Francisco; Veiga, María-Dolores

    2015-01-01

    Vaginal formulations for the prevention of sexually transmitted infections are currently gaining importance in drug development. Polysaccharides, such as chitosan and carrageenan, which have good binding capacity with mucosal tissues, are now included in vaginal delivery systems. Marine polymer-based vaginal mucoadhesive solid formulations have been developed for the controlled release of acyclovir, which may prevent the sexual transmission of the herpes simplex virus. Drug release studies were carried out in two media: simulated vaginal fluid and simulated vaginal fluid/simulated seminal fluid mixture. The bioadhesive capacity and permanence time of the bioadhesion, the prepared compacts, and compacted granules were determined ex vivo using bovine vaginal mucosa as substrate. Swelling processes were quantified to confirm the release data. Biocompatibility was evaluated through in vitro cellular toxicity assays, and the results showed that acyclovir and the rest of the materials had no cytotoxicity at the maximum concentration tested. The mixture of hydroxyl-propyl-methyl-cellulose with chitosan- or kappa-carrageenan-originated mucoadhesive systems that presented a complete and sustained release of acyclovir for a period of 8–9 days in both media. Swelling data revealed the formation of optimal mixed chitosan/hydroxyl-propyl-methyl-cellulose gels which could be appropriated for the prevention of sexual transmission of HSV. PMID:26393621

  4. Immunology of Gut Mucosal Vaccines

    Science.gov (United States)

    Pasetti, Marcela F.; Simon, Jakub K.; Sztein, Marcelo B.; Levine, Myron M.

    2011-01-01

    Summary Understanding the mechanisms underlying the induction of immunity in the gastrointestinal mucosa following oral immunization and the cross-talk between mucosal and systemic immunity should expedite the development of vaccines to diminish the global burden caused by enteric pathogens. Identifying an immunological correlate of protection in the course of field trials of efficacy, animal models (when available), or human challenge studies is also invaluable. In industrialized country populations, live attenuated vaccines (e.g. polio, typhoid, and rotavirus) mimic natural infection and generate robust protective immune responses. In contrast, a major challenge is to understand and overcome the barriers responsible for the diminished immunogenicity and efficacy of the same enteric vaccines in underprivileged populations in developing countries. Success in developing vaccines against some enteric pathogens has heretofore been elusive (e.g. Shigella). Different types of oral vaccines can selectively or inclusively elicit mucosal secretory immunoglobulin A and serum immunoglobulin G antibodies and a variety of cell-mediated immune responses. Areas of research that require acceleration include interaction between the gut innate immune system and the stimulation of adaptive immunity, development of safe yet effective mucosal adjuvants, better understanding of homing to the mucosa of immunologically relevant cells, and elicitation of mucosal immunologic memory. This review dissects the immune responses elicited in humans by enteric vaccines. PMID:21198669

  5. Immunology of gut mucosal vaccines.

    Science.gov (United States)

    Pasetti, Marcela F; Simon, Jakub K; Sztein, Marcelo B; Levine, Myron M

    2011-01-01

    Understanding the mechanisms underlying the induction of immunity in the gastrointestinal mucosa following oral immunization and the cross-talk between mucosal and systemic immunity should expedite the development of vaccines to diminish the global burden caused by enteric pathogens. Identifying an immunological correlate of protection in the course of field trials of efficacy, animal models (when available), or human challenge studies is also invaluable. In industrialized country populations, live attenuated vaccines (e.g. polio, typhoid, and rotavirus) mimic natural infection and generate robust protective immune responses. In contrast, a major challenge is to understand and overcome the barriers responsible for the diminished immunogenicity and efficacy of the same enteric vaccines in underprivileged populations in developing countries. Success in developing vaccines against some enteric pathogens has heretofore been elusive (e.g. Shigella). Different types of oral vaccines can selectively or inclusively elicit mucosal secretory immunoglobulin A and serum immunoglobulin G antibodies and a variety of cell-mediated immune responses. Areas of research that require acceleration include interaction between the gut innate immune system and the stimulation of adaptive immunity, development of safe yet effective mucosal adjuvants, better understanding of homing to the mucosa of immunologically relevant cells, and elicitation of mucosal immunologic memory. This review dissects the immune responses elicited in humans by enteric vaccines. © 2010 John Wiley & Sons A/S.

  6. Effects of sea buckthorn oil intake on vaginal atrophy in postmenopausal women: a randomized, double-blind, placebo-controlled study.

    Science.gov (United States)

    Larmo, Petra S; Yang, Baoru; Hyssälä, Juha; Kallio, Heikki P; Erkkola, Risto

    2014-11-01

    Vaginal atrophy, the thinning and drying of vaginal mucosa, is associated with menopause. The standard estrogen treatment is not suitable for all women. To investigate the effects of oral sea buckthorn (SB) oil supplementation on vaginal atrophy. A total of 116 postmenopausal women experiencing symptoms of vaginal dryness, itching or burning were randomized to this placebo-controlled, double-blind study. Ninety-eight participants completed the intervention of three months, during which they consumed 3g of SB or placebo oil daily. At the beginning and end, factors of vaginal health were scored by a gynecologist, vaginal pH and moisture were measured and vaginal health index was calculated. Symptoms of atrophy and menopause were evaluated at study visits and by daily logbooks. Serum samples were collected for the analysis of circulating lipids, liver enzymes and C-reactive protein. Compared to placebo, there was a significantly better rate of improvement in the integrity of vaginal epithelium in the SB group when both compliant and noncompliant participants were included (odds ratio (OR)=3.1, 95% CI 1.11-8.95). A beneficial trend was observed when only the compliant participants were included (OR=2.9; 95% CI 0.99-8.35). There was a tendency (P=0.08) toward better improvement of vaginal health index from baseline to the end in the SB group [(0.8 (SD 2.8)] compared to placebo [-0.1 (SD 2.0)]. SB oil showed beneficial effects on vaginal health, indicating it is a potential alternative for mucosal integrity for those women not able to use estrogen treatment for vaginal atrophy. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  7. Dendritic cell-targeting DNA-based mucosal adjuvants for the development of mucosal vaccines

    OpenAIRE

    Kataoka, Kosuke; Fujihashi, Kohtaro

    2009-01-01

    In order to establish effective mucosal immunity against various mucosal pathogens, vaccines must be delivered via the mucosal route and contain effective adjuvant(s). Since mucosal adjuvants can simply mix with the antigen, it is relatively easy to adapt them for different types of vaccine development. Even in simple admixture vaccines, the adjuvant itself must be prepared without any complications. Thus, CpG oligodeoxynucleotides or plasmids encoding certain cDNA(s) would be potent mucosal ...

  8. Minimally invasive monitoring of CD4 T cells at multiple mucosal tissues after intranasal vaccination in rhesus macaques.

    Science.gov (United States)

    Dorta-Estremera, Stephanie; Nehete, Pramod N; Yang, Guojun; He, Hong; Nehete, Bharti P; Shelton, Kathryn A; Barry, Michael A; Sastry, K Jagannadha

    2017-01-01

    Studies in nonhuman primates (NHP) for prospective immune cell monitoring subsequent to infection and/or vaccination usually rely on periodic sampling of the blood samples with only occasional collections of biopsies from mucosal tissues because of safety concerns and practical constraints. Here we present evidence in support of cytobrush sampling of oral, rectal, and genital mucosal tissues as a minimally invasive approach for the phenotypic analyses of different T cells subsets de novo as well as prospectively after intranasal immunization in rhesus macaques. Significant percentages of viable lymphocytes were obtained consistently from both naïve and chronically SIV-infected rhesus macaques. The percentages of CD3+ T cells in the blood were significantly higher compared to those in the mucosal tissues analyzed in the naïve animals, while in the SIV+ animals the CD3+ T cells were significantly elevated in the rectal tissues, relative to all other sites analyzed. In the naïve, but not SIV+ macaques, the rectal and vaginal mucosal tissues, compared to oral mucosa and blood, showed higher diversity and percentages of CD4+ T cells expressing the HIV entry co-receptor CCR5 and mucosal specific adhesion (CD103) as well as activation (HLA-DR) and proliferation (Ki67) markers. Sequential daily cytobrush sampling from the oral, rectal, and genital mucosal tissues was performed in SIV+ animals from an ongoing study where they were administered intranasal immunization with adenoviral vectored vaccines incorporating the green fluorescent protein (GFP) reporter gene. We detected a transient increase in GFP+ CD4 T cells in only oral mucosa suggesting limited mucosal trafficking. In general, CD4+ and CD8+ T cells expressing Ki67 transiently increased in all mucosal tissues, but those expressing the CCR5, HLA-DR, and CD103 markers exhibited minor changes. We propose the minimally invasive cytobrush sampling as a practical approach for effective and prospective immune

  9. Prelaminated temporal fascia free flap for reconstruction of the floor of the mouth

    Directory of Open Access Journals (Sweden)

    Vojko Didanovič

    2011-03-01

    Conclusion: There is no ideal replacement for the oral mucosa. Scar as a result of healing by secondary intention prevents tongue mobility. The quantity of mucosa available for local flaps is limited. Oral cavity environment is not ideal for healing of split-thickness skin grafts and skin transferred into oral cavity is never accustomed to the local conditions. With buccal mucosa prelaminated temporal fascia, microvasculary transferred into the oral cavity, offers a valuable method of reconstruction of medium-size mucosal defects of the oral cavity in selected, motivated patients.

  10. [Significance of abdominal wall CT-angiography in planning DIEA perforator flaps, TRAM flaps and SIEA flaps].

    Science.gov (United States)

    Fansa, H; Schirmer, S; Frerichs, O; Gehl, H B

    2011-04-01

    Muscle sparing TRAM flaps and DIEA perforator flaps are standard procedures for breast reconstruction. Recently CT-angiography has been established to evaluate perforator vessels pre-operatively. CT-angiography was introduced to our department in July 2009. In a retrospective analysis data of the last 20 patients (altogether 22 flaps) before CT-angiography introduction and the following 20 (also 22 flaps) patients after introduction of CT-angiography were analysed with regard to the ratio of TRAM to DIEP flaps, and the time required to raise the flaps. The same surgeon raised all flaps. As different surgeons performed dissection of the recipient site, anastomoses, and insertion of flaps, and patients received primary (with sentinel or complete lymphadenctomy) or secondary reconstructions, only the time required harvesting the flap was compared. Thus other influences on raising the flap were eliminated. DIEP flaps were harvested with one single perforator. If perfusion or was considered not to be safe via one single perforator a muscle sparing TRAM flap (ms2) was raised. Angiography was performed using a 64-slice multi-detector CT scanner. CT-angiography did not lead to an increased rate of DIEP flaps in relation to ms2-TRAM flaps. Harvesting time of all flap types with CT-angiography on average was 121 min, without CT-angiography 135 min. This was not significantly different. However, separate analysis of DIEP flaps and ms2-TRAM flaps revealed a significant advantage of CT-angiography based harvesting of DIEP flaps of 26 min: with CT-angiography 101 min vs. 127 min without CT-angiography (p<0.028). There were no significant differences for ms2-TRAM flaps. All scans showed course and branching, diameter and size of the inferior epigastric artery. If evident the superficial inferior epigastric artery (SIEA) was marked. Dosage was 292 mGy-606 mGy×cm dependent on body weight. CTDI was 6.8-14.7 mGy. CT-angiography is a reproducible and observer independent procedure

  11. Exotic wakes of flapping fins

    DEFF Research Database (Denmark)

    Schnipper, Teis

    We present, in 8 chapters, experiments on and numerical simulations of bodies flapping in a fluid. Focus is predominantly on a rigid foil, a model fish, that performs prescribed pitching oscillations where the foil rotates around its leading edge. In a flowing soap film is measured, with unpreced......We present, in 8 chapters, experiments on and numerical simulations of bodies flapping in a fluid. Focus is predominantly on a rigid foil, a model fish, that performs prescribed pitching oscillations where the foil rotates around its leading edge. In a flowing soap film is measured......-speed and the strength ratio of the vortices formed at the foil’s leading and trailing edge. The simulated vortex particles and measured thickness variations in the soap film show similar behaviour which indicates that the soap film provides a good approximation the flow of a two-dimensional incompressible and Newtonian...

  12. Lactobacillus for Vaginal Microflora Correction

    Directory of Open Access Journals (Sweden)

    Saule Saduakhasova

    2014-12-01

    Full Text Available Introduction. Despite the significant progress made in prevention, diagnosis, and treatment, there is still a high rate of vaginal dysbiosis in Kazakh women. The use of antibiotics in the treatment of vaginal dysbiosis contributes to the elimination of pathogens as well as microflora, which can lead to a decrease in local immunity and more favorable conditions for infection spread. The most physiologically safe and promising method for the restoration of vaginal biocenosis is the use of probiotics administered by a vaginal route.Methods. We have allocated 64 of cultures of Lactobacillus from the vaginal epithelium of healthy women of reproductive age and women with diagnosed bacterial vaginosis (BV. Identification of cultures was performed by PCR analysis of 16S ribosomal RNA.  Evaluation of biological significance was determined by the following criteria: high antagonistic activity against Candida albicans, Escherichia coli, Serratia marcescens, Proteus mirabilis, Klebsiella ozaenae, and Staphylococcus aureus; and production of hydrogen peroxide, resistance to antibiotics, adhesive activity. We studied the symbiotic relationship of selected biologically active of cultures to each other and received options for consortiums with  properties of  probiotics through co-cultivation.Results. Results of genotyping  showed that the isolated lactobacilli belong to the seven species: L. fermentum, L. salivarius, L. gasseri, L. crispatus, L. jensenii, L. plantarum, and L. delbrueskii. L. fermentum, L. salivarius, L. gasseri, and L. jensenii occur in women with suspected BV. The highest percentage of occurrence in the vagina of healthy women was L. fermentum (28%. Most strains of lactobacilli possess high inhibitory activity for all test-strains, except Candida albicans (37.5%. 56% of studied cultures revealed high adhesion to human erythrocytes. All lactobacillus strains were resistant to metronidazole, 80% to kanamycin, 57%  to vancomycin, and

  13. Concurrent chemoradiation for vaginal cancer.

    Directory of Open Access Journals (Sweden)

    David T Miyamoto

    Full Text Available BACKGROUND: It is not known whether the addition of chemotherapy to radiation therapy improves outcomes in primary vaginal cancer. Here, we review clinical outcomes in patients with primary vaginal cancer treated with radiation therapy (RT or concurrent chemoradiation therapy (CRT. METHODS: Seventy-one patients with primary vaginal cancer treated with definitive RT with or without concurrent chemotherapy at a single institution were identified and their records reviewed. A total of 51 patients were treated with RT alone; 20 patients were treated with CRT. Recurrences were analyzed. Overall survival (OS and disease-free survival (DFS rates were estimated using the Kaplan-Meier method. Cox regression analysis was performed. RESULTS: The median age at diagnosis was 61 years (range, 18-92 years and the median follow-up time among survivors was 3.0 years. Kaplan-Meier estimates for OS and DFS differed significantly between the RT and CRT groups (3-yr OS = 56% vs. 79%, log-rank p = 0.037; 3-yr DFS = 43% vs. 73%, log-rank p = 0.011. Twenty-three patients (45% in the RT group had a relapse at any site compared to 3 (15% in the CRT group (p = 0.027. With regard to the sites of first relapse, 10 patients (14% had local only, 4 (6% had local and regional, 9 (13% had regional only, 1 (1% had regional and distant, and 2 (3% had distant only relapse. On univariate analysis, the use of concurrent chemotherapy, FIGO stage, tumor size, and date of diagnosis were significant predictors of DFS. On multivariate analysis, the use of concurrent chemotherapy remained a significant predictor of DFS (hazard ratio 0.31 (95% CI, 0.10-0.97; p = 0.04. CONCLUSIONS: Vaginal cancer results in poor outcomes. Adequate radiation dose is essential to ensure curative management. Concurrent chemotherapy should be considered for vaginal cancer patients.

  14. The Mucosal Immune System of Teleost Fish.

    Science.gov (United States)

    Salinas, Irene

    2015-08-12

    Teleost fish possess an adaptive immune system associated with each of their mucosal body surfaces. Evidence obtained from mucosal vaccination and mucosal infection studies reveal that adaptive immune responses take place at the different mucosal surfaces of teleost. The main mucosa-associated lymphoid tissues (MALT) of teleosts are the gut-associated lymphoid tissue (GALT), skin-associated lymphoid tissue (SALT), the gill-associated lymphoid tissue (GIALT) and the recently discovered nasopharynx-associated lymphoid tissue (NALT). Teleost MALT includes diffuse B cells and T cells with specific phenotypes different from their systemic counterparts that have co-evolved to defend the microbe-rich mucosal environment. Both B and T cells respond to mucosal infection or vaccination. Specific antibody responses can be measured in the gills, gut and skin mucosal secretions of teleost fish following mucosal infection or vaccination. Rainbow trout studies have shown that IgT antibodies and IgT(+) B cells are the predominant B cell subset in all MALT and respond in a compartmentalized manner to mucosal infection. Our current knowledge on adaptive immunity in teleosts is limited compared to the mammalian literature. New research tools and in vivo models are currently being developed in order to help reveal the great intricacy of teleost mucosal adaptive immunity and help improve mucosal vaccination protocols for use in aquaculture.

  15. Mucosal delivery of vaccines in domestic animals.

    Science.gov (United States)

    Gerdts, Volker; Mutwiri, George K; Tikoo, Suresh K; Babiuk, Lorne A

    2006-01-01

    Mucosal vaccination is proving to be one of the greatest challenges in modern vaccine development. Although highly beneficial for achieving protective immunity, the induction of mucosal immunity, especially in the gastro-intestinal tract, still remains a difficult task. As a result, only very few mucosal vaccines are commercially available for domestic animals. Here, we critically review various strategies for mucosal delivery of vaccines in domestic animals. This includes live bacterial and viral vectors, particulate delivery-systems such as polymers, alginate, polyphosphazenes, immune stimulating complex and liposomes, and receptor mediated-targeting strategies to the mucosal tissues. The most commonly used routes of immunization, strategies for delivering the antigen to the mucosal surfaces, and future prospects in the development of mucosal vaccines are discussed.

  16. New horizon of mucosal immunity and vaccines.

    Science.gov (United States)

    Takahashi, Ichiro; Nochi, Tomonori; Yuki, Yoshikazu; Kiyono, Hiroshi

    2009-06-01

    Progress in the past quarter-century on understanding the molecular, cellular, and in vivo components of the mucosal immune system have allowed us to develop a practical strategy for a novel mucosal vaccine. The mucosal immune system can induce secretory IgA (SIgA) and serum IgG responses to provide two layers of defense against mucosal pathogens. For SIgA-mediated immunity in the gastrointestinal tract, the gut-associated lymphoid tissue contains both the tissue-dependent and tissue-independent IgA components. Harnessing the mucosal immune system for vaccine development may help prevent the global health problems caused by enteric infectious diseases. We have therefore combined mucosal immunology and plant biology to create a rice-based mucosal vaccine that requires neither needles and syringes nor refrigeration.

  17. The Gradual Expansion Muscle Flap

    Science.gov (United States)

    2014-01-01

    struck an improvised explosive device, sustaining a III-B open tibia fracture with large anteromedial soft tissue defect and bone loss involving the...GEM flap technique. The average age was 26.0 years (range, 21–39 years), and all patients were male. Four patients had sustained their injuries as a...Biochem Cytol. 1961;9:493 495. 42. Sola OM, Christensen DL, Martin AW. Hypertrophy and hyperplasia of adult chicken anterior latissimus dorsi muscles

  18. The place of nasolabial flap in orofacial reconstruction: A review

    Directory of Open Access Journals (Sweden)

    Amin Rahpeyma

    2016-12-01

    Conclusion: Nasolabial flap is an old flap for reconstructive purposes. Over time different modifications have been introduced to expand its usage. Clear definition of the terms used with this flap is given.

  19. Congenital breast deformity reconstruction using perforator flaps.

    Science.gov (United States)

    Gautam, Abhinav K; Allen, Robert J; LoTempio, Maria M; Mountcastle, Timothy S; Levine, Joshua L; Allen, Robert J; Chiu, Ernest S

    2007-04-01

    Congenital breast deformities such as Poland syndrome, unilateral congenital hypoplasia, tuberous breast anomaly, and amastia pose a challenging plastic surgical dilemma. The majority of patients are young, healthy individuals who seek esthetic restoration of their breast deformities. Currently, both implant and autologous reconstructive techniques are used. This study focuses on our experience with congenital breast deformity patients who underwent reconstruction using a perforator flap. From 1994 to 2005, a retrospective chart review was performed on women who underwent breast reconstruction using perforator flaps to correct congenital breast deformities and asymmetry. Patient age, breast deformity type, perforator flap type, flap volume, recipient vessels, postoperative complications, revisions, and esthetic results were determined. Over an 11-year period, 12 perforator flaps were performed. All cases were for unilateral breast deformities. The patients ranged from 16 to 43 years of age. Six patients had undergone previous correctional surgeries. Eight (n = 8) flaps were used for correction of Poland syndrome and its associated chest wall deformities. Four (n = 4) flaps were used for correction of unilateral breast hypoplasia. In all cases, the internal mammary vessels were the recipient vessels of choice. No flaps were lost. No vein grafts were used. All patients were discharged on the fourth postoperative day. Complications encountered included seroma, hematoma, and nipple malposition. Revisional surgery was performed in 30% of the cases. Esthetic results varied from poor to excellent. Perforator flaps are an acceptable choice for patients with congenital breast deformities seeking autologous breast reconstruction. Deep inferior epigastric artery (DIEP) or superficial inferior epigastric artery (SIEA) flaps are performed when adequate abdominal tissue is available; however, many young patients have inadequate abdominal tissue, thus a GAP flap can be used

  20. Vaginal fold prolapse in a dog with pyometra and ovarian papillary cystadenocarcinoma.

    Science.gov (United States)

    Zedda, Maria-Teresa; Bogliolo, Luisa; Ariu, Federica; Ledda, Mauro; Falchi, Laura; Pinna-Parpaglia, Maria-Luisa; Pau, Salvatore

    2016-04-01

    A 7-year-old 42-kg (92.4-lb) sexually intact nulliparous female Italian Mastiff was examined because of a history of vaginal prolapse during diestrus. A physical examination revealed vaginal fold prolapse. Abdominal ultrasonography revealed an enlarged uterus with hypoechogenic content, corpora lutea in the ovaries, and a cyst in the right ovary. Hematologic abnormalities included leukocytosis, neutrophilia, mild anemia, and low Hct. Progesterone and estradiol concentrations were 9.36 ng/mL and 30.42 pg/mL, respectively, in serum and 72.72 ng/mL and 792 pg/mL, respectively, in the ovarian cystic fluid. Ovariohysterectomy was performed; the prolapsed tissue was repositioned by external manipulation and maintained in situ by temporary apposition of the vulvar lips with a retention suture. Anatomic and histologic examinations of the excised tissues revealed pyometra and papillary cystadenocarcinoma in the right ovary. The vaginal hyperplasia completely regressed at 35 days after surgery; 5 months after surgery, the dog's general condition was considered good. Findings in this case were indicative of a hormonally active ovarian papillary cystadenocarcinoma in a female dog in diestrus. Hormone production by the cystadenocarcinoma was the predisposing factor that induced pyometra, mucosal hyperplasia, and vaginal fold prolapse in the dog. On the basis of these concurrent disorders, ovariohysterectomy was an appropriate treatment.

  1. The Buccinator Mucomuscular Flap: An In-Depth Analysis and Evaluation of Its Role in the Management of Velopharyngeal Dysfunction.

    Science.gov (United States)

    Ahl, Rebecka; Harding-Bell, Anne; Wharton, Laura; Jordan, Adam; Hall, Per

    2016-09-01

    A significant proportion of patients with cleft palate experience persisting velopharyngeal dysfunction (VPD) after primary surgery. Pharyngoplasty is the most common procedure to correct inadequate velopharyngeal closure. Although it is often effective, it poses a risk for postoperative airway obstruction. The mucomuscular buccinator flap is a more recent alternative: In the largest case series to date, we outline its use and evaluate its effectiveness in managing persistent VPD. Over 9 years, 103 buccinator flap procedures were performed by the Cambridge group to improve velar function. Clinical records were retrospectively assessed: 60 patients were analyzed by two expert speech and language therapists external to the group using the Cleft Audit Protocol for Speech-Augmented. In a subset of patients, the buccinator flap was interpolated between the limbs of a large mucosal Z-plasty. Consensus listening was undertaken, and interrater reliability was calculated for 24.17% of the cohort. The remaining samples were assessed by a single listener following calibrated consensus listening. There was a significant reduction in VPD (P cleft speech characteristics, and audible nasal emission. Overall, 13.5% of patients required further corrective speech surgery. The buccinator mucomuscular flap reliably and effectively improves velar function in the management of VPD and has low complication rates. We therefore recommend the use of the buccinator flap in primary surgical management of persisting VPD.

  2. Vaginal delivery of breech presentation.

    Science.gov (United States)

    Kotaska, Andrew; Menticoglou, Savas; Gagnon, Robert

    2009-06-01

    To review the physiology of breech birth; to discern the risks and benefits of a trial of labour versus planned Caesarean section; and to recommend to obstetricians, family physicians, midwives, obstetrical nurses, anaesthesiologists, pediatricians, and other health care providers selection criteria, intrapartum management parameters, and delivery techniques for a trial of vaginal breech birth. Trial of labour in an appropriate setting or delivery by pre-emptive Caesarean section for women with a singleton breech fetus at term. Reduced perinatal mortality, short-term neonatal morbidity, long-term infant morbidity, and short- and long-term maternal morbidity and mortality. Medline was searched for randomized trials, prospective cohort studies, and selected retrospective cohort studies comparing planned Caesarean section with a planned trial of labour; selected epidemiological studies comparing delivery by Caesarean section with vaginal breech delivery; and studies comparing long-term outcomes in breech infants born vaginally or by Caesarean section. Additional articles were identified through bibliography tracing up to June 1, 2008. The evidence collected was reviewed by the Maternal Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and quantified using the criteria and classifications of the Canadian Task Force on Preventive Health Care. This guideline was compared with the 2006 American College of Obstetrician's Committee Opinion on the mode of term singleton breech delivery and with the 2006 Royal College of Obstetrician and Gynaecologists Green Top Guideline: The Management of Breech Presentation. The document was reviewed by Canadian and International clinicians with particular expertise in breech vaginal delivery. The Society of Obstetricians and Gynaecologists of Canada. SUMMARY STATEMENTS: 1. Vaginal breech birth can be associated with a higher risk of perinatal mortality and short-term neonatal morbidity than

  3. Use of vaginal estrogen in Danish women

    DEFF Research Database (Denmark)

    Meaidi, Amani; Goukasian, Irina; Lidegaard, Oejvind

    2016-01-01

    INTRODUCTION: We know little about the use of vaginal estrogen in perimenopausal and postmenopausal women. We aimed to assess the prevalence of vaginal estrogen use in Denmark. MATERIAL AND METHODS: The study was designed as a nationwide cross-sectional study of all Danish women aged 40-79 years......, living in Denmark during the period 2007-2013. The Danish Prescription Register delivered data permitting us to assess the prevalence, age and regional geographical belonging of women purchasing prescribed vaginal estradiol. The number of women using over-the-counter vaginal estriol products...... was estimated from sale statistics from the same register. RESULTS: In 2013, 10.2% of all Danish women between 40 and 79 years of age used vaginal estradiol. The prevalence of women using this type of vaginal estrogen increased from 8.5% in year 2007 to 10.2% in 2013. The use peaked at 16.5% in women aged 60...

  4. Complete Utero Vaginal Prolapse in a Woman with Prolapsed ...

    African Journals Online (AJOL)

    vault. Vaginal myomectomy, followed by interval vaginal hysterectomy, and pelvic floor repair a week later resulted in a satisfactory outcome. Keywords: Fibroid, Interval vaginal hysterectomy, Utero‑vaginal prolapse, Vaginal myomectomy. Access this article online. Quick Response Code: Website: www.amhsr.org. DOI: *****.

  5. Dendritic cell-targeting DNA-based mucosal adjuvants for the development of mucosal vaccines

    Science.gov (United States)

    Kataoka, Kosuke; Fujihashi, Kohtaro

    2009-01-01

    In order to establish effective mucosal immunity against various mucosal pathogens, vaccines must be delivered via the mucosal route and contain effective adjuvant(s). Since mucosal adjuvants can simply mix with the antigen, it is relatively easy to adapt them for different types of vaccine development. Even in simple admixture vaccines, the adjuvant itself must be prepared without any complications. Thus, CpG oligodeoxynucleotides or plasmids encoding certain cDNA(s) would be potent mucosal adjuvant candidates when compared with other substances that can be used as mucosal adjuvants. The strategy of a DNA-based mucosal adjuvant facilitates the targeting of mucosal dendritic cells, and thus is an effective and safe approach. It would also provide great flexibility for the development of effective vaccines for various mucosal pathogens. PMID:19722892

  6. Evaluation of TLR agonists as potential mucosal adjuvants for HIV gp140 and tetanus toxoid in mice.

    Directory of Open Access Journals (Sweden)

    Viviana Buffa

    Full Text Available In the present study we investigate the impact of a range of TLR ligands and chitosan as potential adjuvants for different routes of mucosal immunisation (sublingual (SL, intranasal (IN, intravaginal (IVag and a parenteral route (subcutaneous (SC in the murine model. We assess their ability to enhance antibody responses to HIV-1 CN54gp140 (gp140 and Tetanus toxoid (TT in systemic and vaginal compartments. A number of trends were observed by route of administration. For non-adjuvanted antigen, SC>SL>IN immunisation with respect to systemic IgG responses, where endpoint titres were greater for TT than for gp140. In general, co-administration with adjuvants increased specific IgG responses where IN = SC>SL, while in the vaginal compartment IN>SL>SC for specific IgA. In contrast, for systemic and mucosal IgA responses to antigen alone SL>IN = SC. A number of adjuvants increased specific systemic IgA responses where in general IN>SL>SC immunisation, while for mucosal responses IN = SL>SC. In contrast, direct intravaginal immunisation failed to induce any detectable systemic or mucosal responses to gp140 even in the presence of adjuvant. However, significant systemic IgG responses to TT were induced by intravaginal immunisation with or without adjuvant, and detectable mucosal responses IgG and IgA were observed when TT was administered with FSL-1 or Poly I∶C. Interestingly some TLRs displayed differential activity dependent upon the route of administration. MPLA (TLR4 suppressed systemic responses to SL immunisation while enhancing responses to IN or SC immunisation. CpG B enhanced SL and IN responses, while having little or no impact on SC immunisation. These data demonstrate important route, antigen and adjuvant effects that need to be considered in the design of mucosal vaccine strategies.

  7. Dynamic Clinical Measurements of Voluntary Vaginal Contractions and Autonomic Vaginal Reflexes

    NARCIS (Netherlands)

    Broens, Paul M. A.; Spoelstra, Symen K.; Weijmar Schultz, Willibrord C. M.

    2014-01-01

    IntroductionThe vaginal canal is an active and responsive canal. It has pressure variations along its length and shows reflex activity. At present, the prevailing idea is that the vaginal canal does not have a sphincter mechanism. It is hypothesized that an active vaginal muscular mechanism exists

  8. [The development of mucosal vaccine using bacterial function for targeting mucosal tissues].

    Science.gov (United States)

    Suzuki, Hidehiko; Kondoh, Masuo; Yagi, Kiyohito; Kiyono, Hiroshi; Kunisawa, Jun

    2014-01-01

    Most pathogens invade body through the mucosal epithelium, which is a primary target to prevent the infectious diseases. Mucosal vaccine has been considered to be an effective strategy to establish immunosurveillance against pathogens by the induction of antigen-specific immune responses at both mucosal and systemic immune compartments. The development of antigen delivery system and mucosal adjuvants are required for the sufficient induction of protective immunity in the development of mucosal vaccine. In this review, we shed light on the recent advances in the development of antigen delivery system using microbial functions for mucosal vaccines.

  9. Molecular investigations into vaginal immunization with HIV gp41 antigenic construct H4A in a quick release solid dosage form.

    Science.gov (United States)

    Pattani, Aditya; McKay, Paul F; Curran, Rhonda M; McCaffrey, Joanne; Gupta, Prem N; Lowry, Deborah; Kett, Vicky L; Shattock, Robin J; McCarthy, Helen O; Malcolm, R Karl

    2012-04-05

    A robust vaginal immune response is considered essential for an effective prophylactic vaccine that prevents transmission of HIV and other sexually acquired diseases. Considerable attention has recently focused on the potential of vaginally administered vaccines as a means to induce such local immunity. However, the potential for vaccination at this site remains in doubt as the vaginal mucosa is generally considered to have low immune inductive potential. In the current study, we explored for the first time the use of a quick release, freeze-dried, solid dosage system for practical vaginal administration of a protein antigen. These solid dosage forms overcome the common problem associated with leakage and poor retention of vaginally administered antigen solutions. Mice were immunized vaginally with H4A, an HIV gp41 envelope based recombinant protein, using quick release, freeze-dried solid rods, and the immune responses compared to a control group immunized via subcutaneous H4A injection. Vaginally immunized mice failed to elicit robust immune responses. Our detailed investigations, involving cytokine analysis, the stability of H4A in mouse cervicovaginal lavage, and elucidation of the state of H4A protein in the immediate-release dosage form, revealed that antigen instability in vaginal fluid, the state of the antigen in the dosage form, and the cytokine profile induced are all likely to have contributed to the observed lack of immunogenicity. These are important factors affecting vaginal immunization and provide a rational basis for explaining the typically poor and variable elicitation of immunity at this site, despite the presence of immune responsive cells within the vaginal mucosae. In future mucosal vaccine studies, a more explicit focus on antigen stability in the dosage form and the immune potential of available antigen-responsive cells is recommended. Copyright © 2012 Elsevier Ltd. All rights reserved.

  10. Manifestation pattern of early-late vaginal morbidity after definitive radiation (chemo)therapy and image-guided adaptive brachytherapy for locally advanced cervical cancer: an analysis from the EMBRACE study.

    Science.gov (United States)

    Kirchheiner, Kathrin; Nout, Remi A; Tanderup, Kari; Lindegaard, Jacob C; Westerveld, Henrike; Haie-Meder, Christine; Petrič, Primož; Mahantshetty, Umesh; Dörr, Wolfgang; Pötter, Richard

    2014-05-01

    Brachytherapy in the treatment of locally advanced cervical cancer has changed substantially because of the introduction of combined intracavitary/interstitial applicators and an adaptive target concept, which is the focus of the prospective, multi-institutional EMBRACE study (www.embracestudy.dk) on image-guided adaptive brachytherapy (IGABT). So far, little has been reported about the development of early to late vaginal morbidity in the frame of IGABT. Therefore, the aim of the present EMBRACE analysis was to evaluate the manifestation pattern of vaginal morbidity during the first 2 years of follow-up. In total, 588 patients with a median follow-up time of 15 months and information on vaginal morbidity were included. Morbidity was prospectively assessed at baseline, every 3 months during the first year, and every 6 months in the second year according to the Common Terminology Criteria for Adverse Events, version 3, regarding vaginal stenosis, dryness, mucositis, bleeding, fistula, and other symptoms. Crude incidence rates, actuarial probabilities, and prevalence rates were analyzed. At 2 years, the actuarial probability of severe vaginal morbidity (grade ≥3) was 3.6%. However, mild and moderate vaginal symptoms were still pronounced (grade ≥1, 89%; grade ≥2, 29%), of which the majority developed within 6 months. Stenosis was most frequently observed, followed by vaginal dryness. Vaginal bleeding and mucositis were mainly mild and infrequently reported. Severe vaginal morbidity within the first 2 years after definitive radiation (chemo)therapy including IGABT with intracavitary/interstitial techniques for locally advanced cervical cancer is limited and is significantly less than has been reported from earlier studies. Thus, the new adaptive target concept seems to be a safe treatment with regard to the vagina being an organ at risk. However, mild to moderate vaginal morbidity is still pronounced with currently applied IGABT, and it needs further attention

  11. Innovation in the planning of V-Y rotation advancement flaps: A template for flap design

    Directory of Open Access Journals (Sweden)

    Utku Can Dölen

    2018-01-01

    Full Text Available Local flaps exhibit excellent color matching that no other type of flap can compete with. Moreover, surgery using a local flap is easier and faster than surgery using a distant or free flap. However, local flaps can be much more difficult to design. We designed 2 templates to plan a V-Y rotation advancement flap. The template for a unilateral V-Y rotation advancement flap was used on the face (n=5, anterior tibia (n=1, posterior axilla (n=1, ischium (n=1, and trochanter (n=2. The template for a bilateral flap was used on the sacrum (n=8, arm (n=1, and anterior tibia (n=1. The causes of the defects were meningocele (n=3, a decubitus ulcer (n=5, pilonidal sinus (n=3, and skin tumor excision (n=10. The meningocele patients were younger than 8 days. The mean age of the adult patients was 50.4 years (range, 19–80 years. All the donor areas of the flaps were closed primarily. None of the patients experienced wound dehiscence or partial/total flap necrosis. The templates guided surgeons regarding the length and the placement of the incision for a V-Y rotation advancement flap according to the size of the wound. In addition, they could be used for the training of residents.

  12. Innovation in the planning of V-Y rotation advancement flaps: A template for flap design.

    Science.gov (United States)

    Dölen, Utku Can; Koçer, Uğur

    2018-01-01

    Local flaps exhibit excellent color matching that no other type of flap can compete with. Moreover, surgery using a local flap is easier and faster than surgery using a distant or free flap. However, local flaps can be much more difficult to design. We designed 2 templates to plan a V-Y rotation advancement flap. The template for a unilateral V-Y rotation advancement flap was used on the face (n=5), anterior tibia (n=1), posterior axilla (n=1), ischium (n=1), and trochanter (n=2). The template for a bilateral flap was used on the sacrum (n=8), arm (n=1), and anterior tibia (n=1). The causes of the defects were meningocele (n=3), a decubitus ulcer (n=5), pilonidal sinus (n=3), and skin tumor excision (n=10). The meningocele patients were younger than 8 days. The mean age of the adult patients was 50.4 years (range, 19-80 years). All the donor areas of the flaps were closed primarily. None of the patients experienced wound dehiscence or partial/total flap necrosis. The templates guided surgeons regarding the length and the placement of the incision for a V-Y rotation advancement flap according to the size of the wound. In addition, they could be used for the training of residents.

  13. More frequent vaginal orgasm is associated with experiencing greater excitement from deep vaginal stimulation.

    Science.gov (United States)

    Brody, Stuart; Klapilova, Katerina; Krejčová, Lucie

    2013-07-01

    Research indicated that: (i) vaginal orgasm (induced by penile-vaginal intercourse [PVI] without concurrent clitoral masturbation) consistency (vaginal orgasm consistency [VOC]; percentage of PVI occasions resulting in vaginal orgasm) is associated with mental attention to vaginal sensations during PVI, preference for a longer penis, and indices of psychological and physiological functioning, and (ii) clitoral, distal vaginal, and deep vaginal/cervical stimulation project via different peripheral nerves to different brain regions. The aim of this study is to examine the association of VOC with: (i) sexual arousability perceived from deep vaginal stimulation (compared with middle and shallow vaginal stimulation and clitoral stimulation), and (ii) whether vaginal stimulation was present during the woman's first masturbation. A sample of 75 Czech women (aged 18-36), provided details of recent VOC, site of genital stimulation during first masturbation, and their recent sexual arousability from the four genital sites. The association of VOC with: (i) sexual arousability perceived from the four genital sites and (ii) involvement of vaginal stimulation in first-ever masturbation. VOC was associated with greater sexual arousability from deep vaginal stimulation but not with sexual arousability from other genital sites. VOC was also associated with women's first masturbation incorporating (or being exclusively) vaginal stimulation. The findings suggest (i) stimulating the vagina during early life masturbation might indicate individual readiness for developing greater vaginal responsiveness, leading to adult greater VOC, and (ii) current sensitivity of deep vaginal and cervical regions is associated with VOC, which might be due to some combination of different neurophysiological projections of the deep regions and their greater responsiveness to penile stimulation. © 2013 International Society for Sexual Medicine.

  14. The Lateral Thigh Perforator Flap for Autologous Breast Reconstruction: A Prospective Analysis of 138 Flaps.

    Science.gov (United States)

    Tuinder, Stefania M H; Beugels, Jop; Lataster, Arno; de Haan, Michiel W; Piatkowski, Andrzej; Saint-Cyr, Michel; van der Hulst, René R W J; Allen, Robert J

    2018-02-01

    The septocutaneous tensor fasciae latae or lateral thigh perforator flap was previously introduced by the authors' group as an alternative flap for autologous breast reconstruction when the abdomen is not suitable as a donor site. The authors analyzed their experience with the lateral thigh perforator flap and present the surgical refinements that were introduced. A prospective study was conducted of all lateral thigh perforator flap breast reconstructions performed since September of 2012. Patient demographics, operative details, complications, and flap reexplorations were recorded. Preoperative imaging with magnetic resonance angiography was performed in all patients. Surgical refinements introduced during this study included limitation of the flap width and the use of quilting sutures at the donor site. A total of 138 lateral thigh perforator flap breast reconstructions were performed in 86 consecutive patients. Median operative times were 277 minutes (range, 196 to 561 minutes) for unilateral procedures and 451 minutes (range, 335 to 710 minutes) for bilateral. Median flap weight was 348 g (range, 175 to 814 g). Two total flap losses (1.4 percent) were recorded, and 11 flaps (8.0 percent) required reexploration, which resulted in viable flaps. The incidence of donor-site complications was reduced significantly after the surgical refinements were introduced. Wound problems decreased from 40.0 percent to 6.3 percent, seroma decreased from 25.0 percent to 9.5 percent, and infection decreased from 27.5 percent to 9.5 percent. The lateral thigh perforator flap is an excellent option for autologous breast reconstruction, with minimal recipient-site complications. The surgical refinements resulted in a significant reduction of donor-site complications. Therefore, the lateral thigh perforator flap is currently the authors' second choice after the deep inferior epigastric artery perforator flap. Therapeutic, IV.

  15. Reconstruction of Complex Facial Defects Using Cervical Expanded Flap Prefabricated by Temporoparietal Fascia Flap.

    Science.gov (United States)

    Zhang, Ling; Yang, Qinghua; Jiang, Haiyue; Liu, Ge; Huang, Wanlu; Dong, Weiwei

    2015-09-01

    Reconstruction of complex facial defects using cervical expanded flap prefabricated by temporoparietal fascia flap. Complex facial defects are required to restore not only function but also aesthetic appearance, so it is vital challenge for plastic surgeons. Skin grafts and traditional flap transfer cannot meet the reconstructive requirements of color and texture with recipient. The purpose of this sturdy is to create an expanded prefabricated temporoparietal fascia flap to repair complex facial defects. Two patients suffered severe burns on the face underwent complex facial resurfacing with prefabricated cervical flap. The vasculature of prefabricated flap, including the superficial temporal vessel and surrounding fascia, was used as the vascular carrier. The temporoparietal fascia flap was sutured underneath the cervical subcutaneous tissue, and expansion was begun in postoperative 1 week. After 4 to 6 months of expansion, the expander was removed, facial scars were excised, and cervical prefabricated flap was elevated and transferred to repair the complex facial defects. Two complex facial defects were repaired successfully by prefabricated temporoparietal fascia flap, and prefabricated flaps survived completely. On account of donor site's skin was thinner and expanded too fast, 1 expanded skin flap was rupture during expansion, but necrosis was not occurred after the 2nd operation. Venous congestion was observed in 1 patient, but after dressing, flap necrosis was not happened. Donor site was closed primarily. Postoperative follow-up 6 months, the color, texture of prefabricated flap was well-matched with facial skin. This method of expanded prefabricated flap may provide a reliable solution to the complex facial resurfacing.

  16. Median forehead flap - beyond classic indication

    Directory of Open Access Journals (Sweden)

    Cristian R. Jecan

    2016-11-01

    Full Text Available Introduction. The paramedian forehead flap is one of the best options for reconstruction of the median upper two-thirds of the face due to its vascularity, color, texture match and ability to resurface all or part of the reconstructed area. The forehead flap is the gold standard for nasal soft tissue reconstruction and the flap of choice for larger cutaneous nasal defects having a robust pedicle and large amount of tissue. Materials and Methods. We are reporting a clinical series of cutaneous tumors involving the nose, medial canthus, upper and lower eyelid through a retrospective review of 6 patients who underwent surgical excision of the lesion and primary reconstruction using a paramedian forehead flap. Results. The forehead flap was used for total nose reconstruction, eyelids and medial canthal reconstruction. All flaps survived completely and no tumor recurrence was seen in any of the patients. Cosmetic and functional results were favorable. Conclusions. The forehead flap continues to be one of the best options for nose reconstruction and for closure of surgical defects of the nose larger than 2 cm. Even though is not a gold standard, median forehead flap can be an advantageous technique in periorbital defects reconstruction.

  17. Analysis of tail effects in flapping flight

    NARCIS (Netherlands)

    Tay, W.B.; Bijl, H.; Van Oudheusden, B.W.

    2011-01-01

    Numerical simulations have been performed to examine the interference effects between an upstream flapping airfoil and a downstream stationary airfoil in a tandem configuration at a Reynolds number of 1000, which is around the regime of small flapping micro aerial vehicles. The objective is to

  18. POSTERIOR INTEROSSEOUS FLAP IN PEDIATRIC HAND RECONSTRUCTIONS

    Directory of Open Access Journals (Sweden)

    I. O. Golubev

    2014-01-01

    Full Text Available Purpose: to assess early and long-term results of the pediatric hand reconstructions with posterior interosseous flap, including those in children younger than 3 years old. Materials and methods: results of the hand reconstructions with posterior interosseous artery reverse flap were studied in 10 children (4 males and 6 females aged from 1 year and 1 month to 13 years old. In 4 cases flap coverage were performed due to acquired posttraumatic hand deformity, in 6 cases reconstruction was assumed for congenital hand deformities. Combined procedures consisted of posterior interosseous artery flap coverage and other types of microsurgical reconstructions were suggested in 4 patients. Preoperative color doppler visualization of the posterior interosseous vessels were mandatory. All flaps were risen under 3.5x-4.5x magnification. Results: all flaps survived completely in 3 weeks postoperatively. There were no postoperative complications such as flap’s arterial or venous insufficiency, deep infection, or posterior interosseous nerve palsy. Nearly whole group (9 of 10 of patients and/or their parents were satisfied with the esthetic view of the reconstructed hand and donor site of the forearm 1 year postoperatively. Conclusion: posterior interosseous flap is a reliable and versatile option in pediatric hand reconstructions, providing excellent skin coverage with good color match and texture. Preservation of major vascular bundles of the forearm (radial and ulnar arteries during flap harvest gives a possibility to perform a simultaneous microsurgical reconstructions of the hand (e.g. free toe transfer.

  19. Vaginitis

    Science.gov (United States)

    ... vagina as a cream or gel. What is trichomoniasis? Trichomoniasis is a condition caused by the microscopic ... transmitted infections (STIs) . What are the symptoms of trichomoniasis? Signs of trichomoniasis may include a yellow-gray ...

  20. Advances and challenges in mucosal adjuvant technology.

    Science.gov (United States)

    Newsted, Daniel; Fallahi, Firouzeh; Golshani, Ashkan; Azizi, Ali

    2015-05-15

    Adjuvants play attractive roles in enhancement of immune response during vaccination; however, due to several challenges, only a limited number of adjuvants are licensed by health authorities. The lack of an effective mucosal adjuvant is even more significant as none of the licensed adjuvants revealed a strong enhancement in immune system after mucosal administration. Over the past two decades, several mucosal adjuvants have been developed to deliver antigens to the target cells in the mucosal immune system and increase specific immune responses. However, the safety and efficacy of these adjuvants for testing in human trials is still an important issue, requiring further study. In this article, we briefly review the challenges associated with most common mucosal adjuvants and discuss potential strategies for targeting the mucosal immune system. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. VULVO-VAGINAL CANDIDIASIS ASSOCIATED WITH ACITRETIN

    NARCIS (Netherlands)

    STURKENBOOM, MCJM; MIDDELBEEK, A; VANDENBERG, LTWD; VANDENBERG, PB; STRICKER, BHC; WESSELING, H

    The aim of this study was to estimate the risk of vulvo-vaginal candidiasis among the users of acitretin. The incidence rate ratio of vulvo-vaginal candidiasis was estimated in a cohort of acitretin users by using prescription sequence analysis. Study subjects were 196 women between 15 and 45 years

  2. Blood flow autoregulation in pedicled flaps

    DEFF Research Database (Denmark)

    Bonde, Christian T; Holstein-Rathlou, Niels-Henrik; Elberg, Jens J

    2009-01-01

    INTRODUCTION: Clinical work on the blood perfusion in skin and muscle flaps has suggested that some degree of blood flow autoregulation exists in such flaps. An autoregulatory mechanism would enable the flap to protect itself from changes in the perfusion pressure. The purpose of the present study...... was to evaluate if, and to what extent, a tissue flap could compensate a reduction in blood flow due to an acute constriction of the feed artery. Further, we wanted to examine the possible role of smooth muscle L-type calcium channels in the autoregulatory mechanism by pharmacological intervention with the L......-type calcium channel blocker nimodipine and the vasodilator papaverine. MATERIAL AND METHODS: Pedicled flaps were raised in pigs. Flow in the pedicle was reduced by constriction of the feed artery (n=34). A transit time flow probe measured the effect on blood flow continuously. Following this, three different...

  3. A flight control through unstable flapping flight

    Science.gov (United States)

    Iima, Makoto; Yokoyama, Naoto; Hirai, Norio; Senda, Kei

    2012-11-01

    We have studied a flight control in a two-dimensional flapping flight model for insects. In this model, the model of center-of-mass can move in both horizontal and vertical directions according to the hydrodynamic force generated by flapping. Under steady flapping, the model converges to steady flight states depending on initial conditions. We demonstrate that simple changes in flapping motion, a finite-time stop of flapping, results in changes in the vortex structures, and the separation of two steady flight state by a quasi-steady flight. The model's flight finally converges to one of the final states by way of the quasi-steady state, which is not observed as a (stable) steady flight. The flight dynamic has been also analyzed. KAKENHI (23540433, 22360105, 21340019) and CREST No. PJ74100011.

  4. Value of bacterial culture of vaginal swabs in diagnosis of vaginal infections

    Directory of Open Access Journals (Sweden)

    Nenadić Dane

    2015-01-01

    Full Text Available Bacground/Aim. Vaginal and cervical swab culture is still very common procedure in our country’s everyday practice whereas simple and rapid diagnostic methods have been very rarely used. The aim of this study was to show that the employment of simple and rapid diagnostic tools [vaginal fluid wet mount microscopy (VFWMM, vaginal pH and potassium hydroxide (KOH test] offers better assessment of vaginal environment than standard microbiologic culture commonly used in Serbia. Methods. This prospective study included 505 asymptomatic pregnant women undergoing VFWMM, test with 10% KOH, determination of vaginal pH and standard culture of cervicovaginal swabs. Combining findings from the procedures was used to make diagnoses of bacterial vaginosis (BV and vaginitis. In addition, the number of polymorphonuclear leukocytes (PMN was determined in each sample and analyzed along with other findings. Infections with Candida albicans and Trichomonas vaginalis were confirmed or excluded by microscopic examination. Results. In 36 (6% patients cervicovaginal swab cultures retrieved several aerobes and facultative anaerobes, whereas in 52 (11% women Candida albicans was isolated. Based on VFWMM findings and clinical criteria 96 (19% women had BV, 19 (4% vaginitis, and 72 (14% candidiasis. Of 115 women with BV and vaginitis, pH 4.5 was found in 5, and of 390 with normal findings 83 (21% had vaginal pH 4.5. Elevated numbers of PMN were found in 154 (30% women - in 83 (54% of them VFWMM was normal. Specificity and sensitivity of KOH test and vaginal pH determination in defining pathological vaginal flora were 95% and 81%, and 79% and 91%, respectively. Conclusion. Cervicovaginal swab culture is expensive but almost non-informative test in clinical practice. The use of simpler and rapid methods as vaginal fluid wet mount microscopy, KOH test and vaginal pH offers better results in diagnosis, and probably in the treatment and prevention of sequels of vaginal

  5. Voice disorders in mucosal leishmaniasis.

    Directory of Open Access Journals (Sweden)

    Ana Cristina Nunes Ruas

    Full Text Available INTRODUCTION: Leishmaniasis is considered as one of the six most important infectious diseases because of its high detection coefficient and ability to produce deformities. In most cases, mucosal leishmaniasis (ML occurs as a consequence of cutaneous leishmaniasis. If left untreated, mucosal lesions can leave sequelae, interfering in the swallowing, breathing, voice and speech processes and requiring rehabilitation. OBJECTIVE: To describe the anatomical characteristics and voice quality of ML patients. MATERIALS AND METHODS: A descriptive transversal study was conducted in a cohort of ML patients treated at the Laboratory for Leishmaniasis Surveillance of the Evandro Chagas National Institute of Infectious Diseases-Fiocruz, between 2010 and 2013. The patients were submitted to otorhinolaryngologic clinical examination by endoscopy of the upper airways and digestive tract and to speech-language assessment through directed anamnesis, auditory perception, phonation times and vocal acoustic analysis. The variables of interest were epidemiologic (sex and age and clinic (lesion location, associated symptoms and voice quality. RESULTS: 26 patients under ML treatment and monitored by speech therapists were studied. 21 (81% were male and five (19% female, with ages ranging from 15 to 78 years (54.5+15.0 years. The lesions were distributed in the following structures 88.5% nasal, 38.5% oral, 34.6% pharyngeal and 19.2% laryngeal, with some patients presenting lesions in more than one anatomic site. The main complaint was nasal obstruction (73.1%, followed by dysphonia (38.5%, odynophagia (30.8% and dysphagia (26.9%. 23 patients (84.6% presented voice quality perturbations. Dysphonia was significantly associated to lesions in the larynx, pharynx and oral cavity. CONCLUSION: We observed that vocal quality perturbations are frequent in patients with mucosal leishmaniasis, even without laryngeal lesions; they are probably associated to disorders of some

  6. [Clinical applications of the anterolateral skin flap and the fascial flap in the lower leg].

    Science.gov (United States)

    Feng, D; Chen, P; Feng, D

    1999-07-01

    To introduce the applied anatomy, operative method and clinical application of the anterolateral skin flap and fascial flap of the lower leg. Anatomic dissection was performed on 14 adult cadavers' legs and one amputated lower limb. The origin, course and distribution of cutaneous branches of the superficial peroneal vessels were traced. Four types of anterolateral flaps were designed in the lower leg including the island skin flap, the island fascial flap, the rectangular flap, and the cross-leg flap. Since 1988, twenty-six cases of leg defects(21 patients), chronic osteomyelitis of the tibia(3 cases) and defects on the back of the opposite heel and ankle(2 cases) were treated with the operative methods. All the flaps survived. Primary healing occurred in 23 and secondary in 3 cases. Twenty cases were followed-up for 4 months to 5 years. The flaps were growing well, the tibia fracture healed 3 months after the treatment and the chronic osteomyelitis of tibia had no recurrence. This flap is a useful method for repairing various defects in the leg and adjacent regions. It is simple, safe and reliable in manipulation and has minimal influence to the donor site.

  7. Total endoscopic free flap harvest of a serratus anterior fascia flap for microsurgical lower leg reconstruction

    Directory of Open Access Journals (Sweden)

    Erdmann, Alfons

    2014-04-01

    Full Text Available [english] Background: A tremendous number of free flaps have been developed in the past. As the surgical result depends not only on a successful flap transfer but also on the harvest, this paper details the procedures for undertaking the first total endoscopic harvest of a serratus fascia flap for free flap transplantation to the lower leg. Patient and methods: In September 2012 we performed the first total endoscopic serratus anterior fascia free flap harvest. The incision of 2.5 cm length was made 10 cm in front of anterior muscle border of the latissimus dorsi at level with the midthorax. After insertion of a flexible laparoscopic single port system we started CO gas insufflation. We used this setting to meticulously prepare a neo cavity between atissimus dorsi and M. serratus anterior. The vessels were dissected and the thoraco-dorsal nerve was separated. With a second auxiliary incision we used a clamp to support the raising of the fascia flap from the underlying muscle. Finally we clipped the vessels to the latissimus dorsi muscle and the flap vessels at the Arteria and Vena axillaris. The flap was extracted via the 2.5 cm incision.Results: We were able to perform a total endoscopic harvest of a serratus fascia flap for free flap reconstruction of soft tissues. With this new operative technique we were able to avoid a long skin incision, which in our view lowers the morbidity at the harvest area.Conclusion: We describe a new method for the total endoscopic harvest of the serratus fascia flap for free flap transfer. The flap was harvested within reasonable time and following surgery leaves the patient with minimal donor site morbidity compared to the open technique.

  8. 14 CFR 23.699 - Wing flap position indicator.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Wing flap position indicator. 23.699... Construction Control Systems § 23.699 Wing flap position indicator. There must be a wing flap position indicator for— (a) Flap installations with only the retracted and fully extended position, unless— (1) A...

  9. Hydrodynamic schooling of flapping swimmers

    Science.gov (United States)

    Becker, Alexander D.; Masoud, Hassan; Newbolt, Joel W.; Shelley, Michael; Ristroph, Leif

    2015-10-01

    Fish schools and bird flocks are fascinating examples of collective behaviours in which many individuals generate and interact with complex flows. Motivated by animal groups on the move, here we explore how the locomotion of many bodies emerges from their flow-mediated interactions. Through experiments and simulations of arrays of flapping wings that propel within a collective wake, we discover distinct modes characterized by the group swimming speed and the spatial phase shift between trajectories of neighbouring wings. For identical flapping motions, slow and fast modes coexist and correspond to constructive and destructive wing-wake interactions. Simulations show that swimming in a group can enhance speed and save power, and we capture the key phenomena in a mathematical model based on memory or the storage and recollection of information in the flow field. These results also show that fluid dynamic interactions alone are sufficient to generate coherent collective locomotion, and thus might suggest new ways to characterize the role of flows in animal groups.

  10. Anterolateral thigh myocutaneous flaps as the preferred flaps for reconstruction of oral and maxillofacial defects.

    Science.gov (United States)

    Ren, Zhen-Hu; Wu, Han-Jiang; Wang, Kai; Zhang, Sheng; Tan, Hong Yu; Gong, Zhao Jian

    2014-12-01

    The anterolateral thigh myocutaneous flap is one of the most commonly used flaps in reconstructive procedures, but its application in oral and maxillofacial defects has not been fully determined. Herein, we summarize the application of 1212 anterolateral thigh myocutaneous flaps in the repair of oral and maxillofacial defects and examine their benefits in maxillofacial reconstruction of these defects. Patients were recruited from February 2002 to June 2013 in the Department of Oral and Maxillofacial Surgery of Central South University. All patients underwent reconstructive surgery employing anterolateral thigh myocutaneous flaps. Patient ages ranged from 6 to 82 years with a mean age of 51.2 years. There are 1015 flaps showing single lobe and 197 flaps showing a multi-island pedicle and one of which carries the iliac bone. The largest area among the single flaps was 28 × 12 cm(2), and the smallest was 3 × 2 cm(2). Among the 1212 transferred flaps, 1176 survived and 36 showed necrosis, a survival rate of about 97.0%. The common complications at flap donor site were poor wound healing (10.1%), localized paraesthesia (50.1%), and altered quadriceps force (11.0%). No cases presented with local serious complications, and 90% of patients achieved good functional recovery and aesthetically acceptable results after reconstruction of oral and maxillofacial defects at various locations using anterolateral thigh myocutaneous flaps. The time (23-121 min; average 51 min) for anastomosis of one vein and one artery was significantly less than that for two veins and one artery (45-153 min, average 83 min; p = 0.0003), which indicates one vein anastomosis can significantly reduce the operating time. The anterolateral thigh myocutaneous flaps can be easily obtained and can provide a good amount of muscle for filling dead space and fascia lata. These flaps can be prepared into a separate fat flap, multi-island fascia with iliac bone, and other composite pedicle flaps to meet the

  11. Phase I randomized safety study of twice daily dosing of acidform vaginal gel: candidate antimicrobial contraceptive.

    Directory of Open Access Journals (Sweden)

    Marla J Keller

    Full Text Available BACKGROUND: Acidform gel, an acid-buffering product that inactivates spermatozoa, may be an effective topical non-hormonal contraceptive. This study was designed to evaluate the safety of vaginal dosing and effects of Acidform on mucosal immune mediators, antimicrobial properties of genital secretions, and vaginal microbiota. METHODS: Thirty-six sexually abstinent U.S. women were randomized to apply Acidform or hydroxyethylcellulose (HEC placebo gel twice daily for 14 consecutive days. Safety was assessed by symptoms and pelvic examination. The impact of gel on mucosal immunity was assessed by quantifying cytokines, chemokines, antimicrobial proteins and antimicrobial activity of genital secretions collected by cervicovaginal lavage (CVL at screening, 2 hours after gel application, and on days 7, 14 and 21. Vaginal microbiota was characterized at enrollment and day 14 using species-specific quantitative PCR assays. RESULTS: The median vaginal and cervical pH was significantly lower 2 hours after application of Acidform and was associated with an increase in the bactericidal activity of CVL against E. coli. However, 65% of women who received Acidform had at least one local adverse event compared with 11% who received placebo (p = 0.002. While there was no increase in inflammatory cytokines or chemokines, CVL concentrations of lactoferrin and interleukin-1 receptor antagonist (IL-1ra, an anti-inflammatory protein, were significantly lower following Acidform compared to HEC placebo gel application. There were no significant changes in Lactobacillus crispatus or Lactobacillus jensenii in either group but there was a decrease in Gardnerella vaginalis in the Acidform group (p = 0.08. CONCLUSIONS: Acidform gel may augment mucosal defense as evidenced by an increase in bactericidal activity of genital secretions against E. coli and a decrease in Gardnerella vaginalis colonization. However, Acidform was associated with more irritation than

  12. Phase I randomized safety study of twice daily dosing of acidform vaginal gel: candidate antimicrobial contraceptive.

    Science.gov (United States)

    Keller, Marla J; Carpenter, Colleen A; Lo, Yungtai; Einstein, Mark H; Liu, Congzhou; Fredricks, David N; Herold, Betsy C

    2012-01-01

    Acidform gel, an acid-buffering product that inactivates spermatozoa, may be an effective topical non-hormonal contraceptive. This study was designed to evaluate the safety of vaginal dosing and effects of Acidform on mucosal immune mediators, antimicrobial properties of genital secretions, and vaginal microbiota. Thirty-six sexually abstinent U.S. women were randomized to apply Acidform or hydroxyethylcellulose (HEC) placebo gel twice daily for 14 consecutive days. Safety was assessed by symptoms and pelvic examination. The impact of gel on mucosal immunity was assessed by quantifying cytokines, chemokines, antimicrobial proteins and antimicrobial activity of genital secretions collected by cervicovaginal lavage (CVL) at screening, 2 hours after gel application, and on days 7, 14 and 21. Vaginal microbiota was characterized at enrollment and day 14 using species-specific quantitative PCR assays. The median vaginal and cervical pH was significantly lower 2 hours after application of Acidform and was associated with an increase in the bactericidal activity of CVL against E. coli. However, 65% of women who received Acidform had at least one local adverse event compared with 11% who received placebo (p = 0.002). While there was no increase in inflammatory cytokines or chemokines, CVL concentrations of lactoferrin and interleukin-1 receptor antagonist (IL-1ra), an anti-inflammatory protein, were significantly lower following Acidform compared to HEC placebo gel application. There were no significant changes in Lactobacillus crispatus or Lactobacillus jensenii in either group but there was a decrease in Gardnerella vaginalis in the Acidform group (p = 0.08). Acidform gel may augment mucosal defense as evidenced by an increase in bactericidal activity of genital secretions against E. coli and a decrease in Gardnerella vaginalis colonization. However, Acidform was associated with more irritation than placebo and lower levels of antimicrobial (lactoferrin) and anti

  13. Minocycline down-regulates topical mucosal inflammation during the application of microbicide candidates.

    Directory of Open Access Journals (Sweden)

    Liangzhu Li

    Full Text Available An effective anti-human immunodeficiency virus-1 (HIV-1 microbicide should exert its action in the absence of causing aberrant activation of topical immunity that will increase the risk of HIV acquisition. In the present study, we demonstrated that the vaginal application of cellulose sulfate (CS gel induced topical mucosal inflammatory responses; the addition of minocycline to CS gel could significantly attenuate the inflammation in a mice model. The combined gel of CS plus minocycline not only reduced the production of inflammatory cytokines in cervicovaginal lavages (CVLs, also down-regulated the activation of CD4+ T cells and the recruitment of other immune cells including HIV target cells into vaginal tissues. Furthermore, an In vitro HIV-1 pseudovirus infection inhibition assay showed that the combined gel decreased the infection efficacy of different subtypes of HIV-1 pseudoviruses compared with that of CS gel alone. These results implicate that minocycline could be integrated into microbicide formulation to suppress the aberrant activation of topical mucosal immunity and enhance the safety profile during the application of microbicides.

  14. Anatomic basis for an algorithmic approach for free fibula flap donor side selection in composite oro-mandibular defects

    Directory of Open Access Journals (Sweden)

    Mohit Sharma

    2015-01-01

    Full Text Available Introduction: Head and neck oncological resections may result in composite oro-mandibular defects involving the oral mucosa (lining, mandibular bone and the skin (cover. Reconstructive options for such defects have evolved over a period. Free fibula flap reconstruction is currently accepted the world over as the gold standard for oro-mandibular defect reconstruction. Existing literature provides conflicting views about the use of a particular side and orientation of the fibula flap for achieving the optimal outcome. The purpose of this study is to confirm anatomically the effect of bone, soft tissue and vessel orientation on the ease of doing reconstruction. Materials and Methods: This is a cadaveric study. A mandibular model with a defect was used. This was pre plated to maintain continuity. Composite fibula flaps of the same dimension were harvested from both legs of a fresh cadaver. The harvested flaps were used to reconstruct the mandibular defect in different orientations and the best configuration for each reconstructive requirement was assessed. Results: Keeping the peroneal surface for plating, that is, facing outwards, four different configurations of the fibula flap are possible for a given mandibular defect. With a posterior vascular pedicle ipsilateral fibula is suitable for skin cover and contralateral for mucosal lining and the reverse for an anteriorly placed pedicle. Conclusion: The algorithm based selection of appropriate sided fibula flap facilitates complex mandibular reconstruction by placing the right kind of tissue at the right place and helps in reducing the donor site morbidity by allowing the surgeon to harvest only the required amount of skin.

  15. Mucosal Immunosenescence In The Gastrointestinal Tract

    Science.gov (United States)

    Sato, Shintaro; Kiyono, Hiroshi; Fujihashi, Kohtaro

    2014-01-01

    It has been shown that pathogen-specific secretory IgA (SIgA) antibody (Ab) is the major player at mucosal surfaces for host defense. However, alterations in the mucosal immune system occur in advanced aging which results in a failure of induction of SIgA Abs for protection from infectious diseases. Signs of mucosal senescence first appear in the gut immune system. Further, changes in the intestinal microbiota most likely influence mucosal immunity. To overcome the immunological aging decline in mucosal immunity, several adjuvant systems including mucosal dendritic cell (DC) targeting have been shown to be attractive and effective immunological strategies. Similarly, antigen (Ag) uptake-M cells are ideal targets for facilitating Ag-specific mucosal immune responses. However, the numbers of M cells are reduced in aged mice. In this regard, Spi-B, an essential transcription factor for the functional and structural differentiation of M cells could be a potent strategy for the induction of effective mucosal immunity in aging. PMID:25531743

  16. Bioadhesive delivery systems for mucosal vaccine delivery.

    Science.gov (United States)

    Baudner, Barbara C; O'Hagan, Derek T

    2010-12-01

    Mucosal vaccine delivery potentially induces mucosal as well as systemic immune responses and may have advantages particularly for optimal protection against pathogens that infect the host through mucosal surfaces. However, the delivery of antigens through mucosal membranes remains a major challenge due to unfavorable physiological conditions (pH and enzymes) and significant biological barriers, which restrict the uptake of antigens. To improve mucosal vaccine delivery, the use of bioadhesive delivery systems offers numerous advantages, including protection from degradation, increasing concentration of antigen in the vicinity of mucosal tissue for better absorption, extending their residence time, and/or targeting them to sites of antigen uptake. Although some bioadhesives have direct immune stimulating properties, it appears most likely that successful mucosal vaccination will require the addition of vaccine adjuvants for optimal immune responses, particularly if they are to be used in an unprimed population. Thus, complex vaccine formulations and delivery strategies have to be carefully designed to appropriately stimulate immune response for the target pathogen. In addition, careful consideration is needed to define the "best" route for mucosal immunization for each individual pathogen.

  17. Nutrition and Gut Mucositis in Pediatric Oncology

    DEFF Research Database (Denmark)

    Pontoppidan, Peter Erik Lotko

    . Unfortunately, effective treatment strategies against mucositis are not in general available. The overall aim of the present PhD was to study interactions between mucositis, inflammation and nutrition. We hypothesized that toxic reactions in the alimentary tract, induced by chemotherapy, followed by release...

  18. Head and neck radiation and mucositis.

    Science.gov (United States)

    Garden, Adam S; Chambers, Mark S

    2007-04-01

    We will review the recent literature that has provided new insights into the pathogenesis, metrics and therapeutics of mucositis. Radiation techniques include conformal therapy and intensity modulated therapy that attempt to minimize dose to normal tissues while still delivering high doses to tumor targets. Drugs used to prevent or treat mucositis typically fall into three classes: antimicrobials, growth factors and radioprotectors. To date, drugs in all three categories have had little success in preventing radiation-induced mucositis, but palifermin, a keratinocyte growth factor, and RK-0202, a topical radioprotector, hold promise and are under investigation. Treatment of patients with head and neck cancers often requires multimodality therapy, and radiotherapy is often a critical component of this approach. Unfortunately, the dose intense regimens required to treat patients often results in mucositis. While this treatment sequela has long been recognized, only recently have researchers clearly identified its incidence and developed metrics to quantify mucositis and its resultant symptoms. Efforts to minimize mucositis have involved both advances in radiation physics, and the development of pharmacologic agents to prevent or treat mucositis. While no drug to date has shown significant efficacy in reducing the incidence of radiation-induced mucositis for head and neck cancer patients, several agents are currently being tested and hold promise.

  19. Mucosal vaccines: a paradigm shift in the development of mucosal adjuvants and delivery vehicles.

    Science.gov (United States)

    Srivastava, Atul; Gowda, Devegowda Vishakante; Madhunapantula, SubbaRao V; Shinde, Chetan G; Iyer, Meenakshi

    2015-04-01

    Mucosal immune responses are the first-line defensive mechanisms against a variety of infections. Therefore, immunizations of mucosal surfaces from which majority of infectious agents make their entry, helps to protect the body against infections. Hence, vaccinization of mucosal surfaces by using mucosal vaccines provides the basis for generating protective immunity both in the mucosal and systemic immune compartments. Mucosal vaccines offer several advantages over parenteral immunization. For example, (i) ease of administration; (ii) non-invasiveness; (iii) high-patient compliance; and (iv) suitability for mass vaccination. Despite these benefits, to date, only very few mucosal vaccines have been developed using whole microorganisms and approved for use in humans. This is due to various challenges associated with the development of an effective mucosal vaccine that can work against a variety of infections, and various problems concerned with the safe delivery of developed vaccine. For instance, protein antigen alone is not just sufficient enough for the optimal delivery of antigen(s) mucosally. Hence, efforts have been made to develop better prophylactic and therapeutic vaccines for improved mucosal Th1 and Th2 immune responses using an efficient and safe immunostimulatory molecule and novel delivery carriers. Therefore, in this review, we have made an attempt to cover the recent advancements in the development of adjuvants and delivery carriers for safe and effective mucosal vaccine production. © 2015 APMIS. Published by John Wiley & Sons Ltd.

  20. The plane problem of the flapping wing

    Science.gov (United States)

    Birnbaum, Walter

    1954-01-01

    In connection with an earlier report on the lifting vortex sheet which forms the basis of the following investigations this will show how the methods developed there are also suitable for dealing with the air forces for a wing with a circulation variable with time. The theory of a propulsive wing flapping up and down periodically in the manner of a bird's wing is developed. This study shows how the lift and its moment result as a function of the flapping motion, what thrust is attainable, and how high is the degree of efficiency of this flapping propulsion unit if the air friction is disregarded.

  1. New drag laws for flapping flight

    Science.gov (United States)

    Agre, Natalie; Zhang, Jun; Ristroph, Leif

    2014-11-01

    Classical aerodynamic theory predicts that a steadily-moving wing experiences fluid forces proportional to the square of its speed. For bird and insect flight, however, there is currently no model for how drag is affected by flapping motions of the wings. By considering simple wings driven to oscillate while progressing through the air, we discover that flapping significantly changes the magnitude of drag and fundamentally alters its scaling with speed. These measurements motivate a new aerodynamic force law that could help to understand the free-flight dynamics, control, and stability of insects and flapping-wing robots.

  2. Mucosal vaccines: novel strategies and applications for the control of pathogens and tumors at mucosal sites.

    Science.gov (United States)

    Nizard, Mevyn; Diniz, Mariana O; Roussel, Helene; Tran, Thi; Ferreira, Luis Cs; Badoual, Cecile; Tartour, Eric

    2014-01-01

    The mucosal immune system displays several adaptations reflecting the exposure to the external environment. The efficient induction of mucosal immune responses also requires specific approaches, such as the use of appropriate administration routes and specific adjuvants and/or delivery systems. In contrast to vaccines delivered via parenteral routes, experimental, and clinical evidences demonstrated that mucosal vaccines can efficiently induce local immune responses to pathogens or tumors located at mucosal sites as well as systemic response. At least in part, such features can be explained by the compartmentalization of mucosal B and T cell populations that play important roles in the modulation of local immune responses. In the present review, we discuss molecular and cellular features of the mucosal immune system as well as novel immunization approaches that may lead to the development of innovative and efficient vaccines targeting pathogens and tumors at different mucosal sites.

  3. Prolapso vaginal e uterino em ovelhas

    OpenAIRE

    Maíra Bianchi R. Alves; Benesi,Fernando J.; Lilian Gregory; Della Libera, Alice M.M.P.; Sucupira,Maria Cláudia A.; Fábio C. Pogliani; Viviani Gomes

    2013-01-01

    O presente trabalho objetivou realizar um estudo retrospectivo sobre os prolapsos vaginal e uterino em ovelhas atendidas no Serviço de Clínica de Bovinos e Pequenos Ruminantes (CBPR) da FMVZ/USP no período compreendido entre 2000 a 2010, no qual, foram atendidas 56 ovinos com problemas inerentes ao sistema reprodutivo, dessas, 25 apresentaram prolapso vaginal ou uterino (44,6%). O prolapso vaginal total foi o de maior frequência (72%). As ovelhas acometidas, em sua maioria, possuíam idade sup...

  4. BISPHOSPHONATE - RELATED MUCOSITIS (BRM: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Pavel Stanimirov

    2017-03-01

    Full Text Available Bisphosphonates (BPs are the most widely used and effective antiresorptive agents for the treatment of diseases in which there is an increase in osteoclastic resorption, including post-menopausal osteoporosis, Paget’s disease, and tumor-associated osteolysis. Oral and maxillofacial surgeons are well aware of the side effects of bisphosphonates and mainly with bisphosphonate-related osteonecrosis of the jaws (BRONJ. Less known are the mucosal lesions associated with the use of these agents. In the scientific literature, there are only few reports of mucosal lesions due to the direct contact of the oral form of BPs with the mucosa (bisphosphonate-related mucositis. They are mostly related to improper use of bisphosphonate tablets that are chewed, sucked or allowed to melt in the mouth before swallowing. Lesions are atypical and need to be differentiated from other mucosal erosions. We present a case of bisphosphonate-related mucositis due to the improper use of alendronate.

  5. Women's Intention to Prevent Vesico Vaginal Fistula Recurrence in ...

    African Journals Online (AJOL)

    Objective: The study purpose was to determine the association between intention to prevent Vesico-Vaginal Fistula recurrence and knowledge of the risk factors of Vesico Vaginal Fistula recurrence, attitude towards Vesico Vaginal Fistula prevention and self esteem among women with Vesico-Vaginal Fistula in two repair ...

  6. Endometrial safety of ultra-low-dose estradiol vaginal tablets

    DEFF Research Database (Denmark)

    Simon, James; Nachtigall, Lila; Ulrich, Lian G

    2010-01-01

    To evaluate the endometrial hyperplasia and carcinoma rate after 52-week treatment with ultra-low-dose 10-microgram 17β-estradiol vaginal tablets in postmenopausal women with vaginal atrophy.......To evaluate the endometrial hyperplasia and carcinoma rate after 52-week treatment with ultra-low-dose 10-microgram 17β-estradiol vaginal tablets in postmenopausal women with vaginal atrophy....

  7. Endometrial safety of ultra-low-dose estradiol vaginal tablets

    DEFF Research Database (Denmark)

    Simon, James; Nachtigall, Lila; Ulrich, Lian G

    2010-01-01

    To evaluate the endometrial hyperplasia and carcinoma rate after 52-week treatment with ultra-low-dose 10-microgram 17ß-estradiol vaginal tablets in postmenopausal women with vaginal atrophy.......To evaluate the endometrial hyperplasia and carcinoma rate after 52-week treatment with ultra-low-dose 10-microgram 17ß-estradiol vaginal tablets in postmenopausal women with vaginal atrophy....

  8. Surgical removal of a large vaginal calculus formed after a tension-free vaginal tape procedure.

    Science.gov (United States)

    Zilberlicht, Ariel; Feiner, Benjamin; Haya, Nir; Auslender, Ron; Abramov, Yoram

    2016-11-01

    Vaginal calculus is a rare disorder which has been reported in association with urethral diverticulum, urogenital sinus anomaly, bladder exstrophy and the tension-free vaginal tape (TVT) procedure. We report a 42-year-old woman who presented with persistent, intractable urinary tract infection (UTI) following a TVT procedure. Cystoscopy demonstrated an eroded tape with the formation of a bladder calculus, and the patient underwent laser cystolithotripsy and cystoscopic resection of the tape. Following this procedure, her UTI completely resolved and she remained asymptomatic for several years. Seven years later she presented with a solid vaginal mass. Pelvic examination followed by transvaginal ultrasonography and magnetic resonance imaging demonstrated a large vaginal calculus located at the lower third of the anterior vaginal wall adjacent to the bladder neck. This video presents the transvaginal excision and removal of the vaginal calculus.

  9. Surgical mistake causing an high recto-vaginal fistula. A case report with combined surgical and endoscopic approach: therapeutic considerations

    Science.gov (United States)

    2013-01-01

    Background Rectovaginal fistulas (RVFs) have multiple causes, size and location on which the surgical treatment depends. Description The Authors consider different approaches to RVFs and describe a clinical case of recurrent high RVF. Conclusions Most RVFs can be successfully repaired, although many interventions may be necessary. A colostomy with delayed repair may improve RVFs outcome. Moreover, several authors indicate Mucosal Advancement Flap and Babcock-Bacon technique as the treatments of choice respectively for low and high RVFs (complex and recurrent) and emphasize the placement of endoscopic prothesis in cases of difficult healing of the anastomosis. PMID:24266908

  10. Vaginal Calculus in a Woman With Mixed Urinary Incontinence and Vaginal Mesh Exposure.

    Science.gov (United States)

    Winkelman, William D; Rabban, Joseph T; Korn, Abner P

    2016-01-01

    Vaginal calculi are extremely rare and are most commonly encountered in the setting of an urethrovaginal or vesicovaginal fistula. We present a case of a 72-year-old woman with mixed urinary incontinence and vaginal mesh exposure incidentally found to have a large vaginal calculus. We removed the calculus surgically and analyzed the components. Results demonstrated the presence of ammonium-magnesium phosphate hexahydrate and carbonate apatite.

  11. Human vaginal mucosa as a model of buccal mucosa for in vitro permeability studies: an overview.

    Science.gov (United States)

    van der Bijl, Pieter; van Eyk, Armorel D

    2004-04-01

    The buccal cavity is attractive for noninvasive, controlled transmucosal delivery of both local and systemic therapeutically active compounds. Administering drugs via this route is advantageous due to the rich vasculature of the oral mucosa, and the absence of gastrointestinal and "first-pass" hepatic degradation. Moreover, the barrier properties of the oral mucosa against noxious substances and its role in disease require further investigation. However, the scarcity of sizeable specimens of human oral mucosa for in vitro experimental studies has hampered research on this tissue. For this reason we developed a model in which human vaginal mucosa is used as a substitute for buccal mucosa. In this article the quality and predictive value of the human vaginal/buccal in vitro model with respect to a number of drugs and other chemical compounds differing widely in molecular size and lipophilicity, including water, arecoline, arecaidine, benzo[a]pyrene, 17beta-estradiol, sumatriptan, vasopressin and dextrans, are reviewed. In addition some applications of the model for investigating the effect of areca nut extract on epithelial barrier properties, temperature effects on water and 17beta-estradiol flux rates, and cyclosporin diffusion through mucosal membranes are described. The permeability characteristics of vaginal mucosa, as a model of buccal mucosa, are compared with those of other human tissue, including mucosae from the small intestine and colon.

  12. Colorectal endoscopic mucosal resection (EMR).

    Science.gov (United States)

    Kandel, Pujan; Wallace, Michael B

    2017-08-01

    Colonoscopy has the benefit of detecting and treating precancerous adenomatous polyps and thus reduces mortality associated with CRC. Screening colonoscopy is the keystone for prevention of colorectal cancer. Over the last 20 years there has been increased in the management of large colorectal polyps from surgery to endoscopic removal techniques which is less invasive. Traditionally surgical resection was the treatment of choice for many years for larger polyps but colectomy poses significant morbidity of 14-46% and mortality of up to 7%. There are several advantages of endoscopic resection technique over surgery; it is less invasive, less expensive, has rapid recovery, and preserves the normal gut functions. In addition patient satisfaction and efficacy of EMR is higher with minor complications. Thus, this has facilitated the development of advanced resection technique for the treatment of large colorectal polyps called as endoscopic mucosal resection (EMR). Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Radiation-Induced Oral Mucositis

    Directory of Open Access Journals (Sweden)

    Osama Muhammad Maria

    2017-05-01

    Full Text Available Radiation-induced oral mucositis (RIOM is a major dose-limiting toxicity in head and neck cancer patients. It is a normal tissue injury caused by radiation/radiotherapy (RT, which has marked adverse effects on patient quality of life and cancer therapy continuity. It is a challenge for radiation oncologists since it leads to cancer therapy interruption, poor local tumor control, and changes in dose fractionation. RIOM occurs in 100% of altered fractionation radiotherapy head and neck cancer patients. In the United Sates, its economic cost was estimated to reach 17,000.00 USD per patient with head and neck cancers. This review will discuss RIOM definition, epidemiology, impact and side effects, pathogenesis, scoring scales, diagnosis, differential diagnosis, prevention, and treatment.

  14. Prevalence of vaginal candidiasis among pregnant women with abnormal vaginal discharge in Maiduguri.

    Science.gov (United States)

    Ibrahim, S M; Bukar, M; Mohammed, Y; Mohammed, B; Yahaya, M; Audu, B M; Ibrahim, H M; Ibrahim, H A

    2013-01-01

    Pregnancy represents a risk factor in the occurrence of vaginal candidiasis. To determine the prevalence and clinical features associated with abnormal vaginal discharge and C. albicans infection in pregnant women. High vaginal swab samples and data on epidemiological characteristics were collected from 400 pregnant women with complaints of abnormal vaginal discharge at booking clinic of University of Maiduguri Teaching Hospital. The data was analysed using SPSS 16.0 statistical software. The prevalence of abnormal vaginal discharge in pregnancy was 31.5%. The frequency of abnormal vaginal discharge was 183 (45.8%) among those aged 20-24 years, 291 (72.8%) in multipara, 223 (55.8%) in those with Primary education and 293 (73.2%) in unemployed. Vulval pruritus 300 (75.0%) was significantly related to abnormal vaginal discharge (P vaginal discharge in pregnancy was high in this study and C. albicans was the commonest cause. It is recommended that a pregnant woman complaining of abnormal vaginal discharge be assessed and Laboratory diagnosis done in order to give appropriate treatment.

  15. Relationship among vaginal palpation, vaginal squeeze pressure, electromyographic and ultrasonographic variables of female pelvic floor muscles

    National Research Council Canada - National Science Library

    Pereira, Vanessa S; Hirakawa, Humberto S; Oliveira, Ana B; Driusso, Patricia

    2014-01-01

    .... PFM function was assessed based on digital palpation, vaginal squeeze pressure, electromyographic activity, bilateral diameter of the bulbocavernosus muscles and the amount of bladder neck movement...

  16. Postirradiation flap infection about the oral cavity

    Energy Technology Data Exchange (ETDEWEB)

    Cabbabe, E.B.; Herbold, D.R.; Sunwoo, Y.C.; Baroudi, I.F.

    1983-06-01

    Postirradiation alteration of oral flora is well documented in the literature. Infection as a complication leading to partial or complete loss of a flap used to reconstruct a defect in the oral cavity is a worrisome outcome. We describe how a flap that was judged clinically to be viable became overwhelmingly infected with the Klebsiella oxytoca, an oral cavity pathogen encountered in this patient following irradiation. Local and systemic changes led to detachment of the flap. This complication may be explained, in view of the absence of venous congestion or arterial ischemia both clinically and pathologically, by the proven contamination of the flap by the Klebsiella pathogen. Local factors resulted in lower resistance and subsequent overwhelming infection. Discussion of the case, review of pertinent literature, and proposed solutions are presented.

  17. Periodic and Chaotic Flapping of Insectile Wings

    CERN Document Server

    Huang, Yangyang

    2015-01-01

    Insects use flight muscles attached at the base of the wings to produce impressive wing flapping frequencies. The maximum power output of these flight muscles is insufficient to maintain such wing oscillations unless there is good elastic storage of energy in the insect flight system. Here, we explore the intrinsic self-oscillatory behavior of an insectile wing model, consisting of two rigid wings connected at their base by an elastic torsional spring. We study the wings behavior as a function of the total energy and spring stiffness. Three types of behavior are identified: end-over-end rotation, chaotic motion, and periodic flapping. Interestingly, the region of periodic flapping decreases as energy increases but is favored as stiffness increases. These findings are consistent with the fact that insect wings and flight muscles are stiff. They further imply that, by adjusting their muscle stiffness to the desired energy level, insects can maintain periodic flapping mechanically for a range of operating condit...

  18. Do vaginal lactobacilli prevent preterm labour?

    African Journals Online (AJOL)

    % before 34 weeks (obstetric database - Tygerberg Hospital). Therefore, it is not surprising that preterm labour is the main cause of perinatal mortality.1According to recent information, infection and particularly vaginal bacteriosis play a major ...

  19. Vaginal Discharge: What's Normal, What's Not

    Science.gov (United States)

    ... School Has a Weapon. What Should I Do? School Counselors Kidney Stones Brain and Nervous System ... the vagina, and helping to prevent and fight infections. Although it's normal for the color, texture, and amount of vaginal fluids to vary ...

  20. VBAC (Vaginal Birth After C-Section)

    Science.gov (United States)

    ... www.uptodate.com/home. Accessed May 19, 2015. Lang CT, et al. Uterine dehiscence and rupture after ... Health Letter PRC-20395237 Patient Care & Health Information Tests & Procedures Vaginal birth after C-section (VBAC) Request ...

  1. ureteric perforation following laparoscopic assisted vaginal ...

    African Journals Online (AJOL)

    2011-03-03

    Mar 3, 2011 ... SUMMARY. Ureteric injury is one of the most common complications of hysterectomy, both in open ... the laparoscopic hysterectomy (abdominal or vaginal approaches) is ... primary end to end anastomosis due big gap, the.

  2. Vaginal itching and discharge - adult and adolescent

    Science.gov (United States)

    ... other symptoms ( atrophic vaginitis ). Forgotten tampon or foreign body, which may cause a foul odor. Chemicals found in detergents, fabric softeners, feminine sprays, ointments, creams, douches, and contraceptive foams or jellies or creams, ...

  3. Microbes on the Human Vaginal Epithelium

    National Research Council Canada - National Science Library

    Richard W. Hyman; Marilyn Fukushima; Lisa Diamond; Jochen Kumm; Linda C. Giudice; Ronald W. Davis

    2005-01-01

    Using solely a gene-based procedure, PCR amplification of the 16S ribosomal RNA gene coupled with very deep sequencing of the amplified products, the microbes on 20 human vaginal epithelia of healthy...

  4. Induction of Murine Mucosal CCR5-Reactive Antibodies as an Anti-Human Immunodeficiency Virus Strategy

    Science.gov (United States)

    Barassi, C.; Soprana, E.; Pastori, C.; Longhi, R.; Buratti, E.; Lillo, F.; Marenzi, C.; Lazzarin, A.; Siccardi, A. G.; Lopalco, L.

    2005-01-01

    The genital mucosa is the main site of initial human immunodeficiency virus type 1 (HIV-1) contact with its host. In spite of repeated sexual exposure, some individuals remain seronegative, and a small fraction of them produce immunoglobulin G (IgG) and IgA autoantibodies directed against CCR5, which is probably the cause of the CCR5-minus phenotype observed in the peripheral blood mononuclear cells of these subjects. These antibodies recognize the 89-to-102 extracellular loop of CCR5 in its native conformation. The aim of this study was to induce infection-preventing mucosal anti-CCR5 autoantibodies in individuals at high risk of HIV infection. Thus, we generated chimeric immunogens containing the relevant CCR5 peptide in the context of the capsid protein of Flock House virus, a presentation system in which it is possible to engineer conformationally constrained peptide in a highly immunogenic form. Administered in mice via the systemic or mucosal route, the immunogens elicited anti-CCR5 IgG and IgA (in sera and vaginal fluids). Analogous to exposed seronegative individuals, mice producing anti-CCR5 autoantibodies express significantly reduced levels of CCR5 on the surfaces of CD4+ cells from peripheral blood and vaginal washes. In vitro studies have shown that murine IgG and IgA (i) specifically bind human and mouse CD4+ lymphocytes and the CCR5-transfected U87 cell line, (ii) down-regulate CCR5 expression of CD4+ cells from both humans and untreated mice, (iii) inhibit Mip-1β chemotaxis of CD4+ CCR5+ lymphocytes, and (iv) neutralize HIV R5 strains. These data suggest that immune strategies aimed at generating anti-CCR5 antibodies at the level of the genital mucosa might be feasible and represent a strategy to induce mucosal HIV-protective immunity. PMID:15890924

  5. Flapping flight aerodynamics for flying animals

    OpenAIRE

    Norizham, Abdul Razak; Dimitriadis, Grigorios

    2011-01-01

    Most research into the aerodynamics of flying animals is based on aircraft aerodynamics. Aircraft have rigid wings, therefore such research is mostly suited to the study of the gliding flight of animals. However, many species spend more time flapping than gliding. Some species don’t glide at all. This seminar presents recent work on flapping flight carried out at the University of Liège.

  6. Aerodynamic effects of flexibility in flapping wings.

    Science.gov (United States)

    Zhao, Liang; Huang, Qingfeng; Deng, Xinyan; Sane, Sanjay P

    2010-03-06

    Recent work on the aerodynamics of flapping flight reveals fundamental differences in the mechanisms of aerodynamic force generation between fixed and flapping wings. When fixed wings translate at high angles of attack, they periodically generate and shed leading and trailing edge vortices as reflected in their fluctuating aerodynamic force traces and associated flow visualization. In contrast, wings flapping at high angles of attack generate stable leading edge vorticity, which persists throughout the duration of the stroke and enhances mean aerodynamic forces. Here, we show that aerodynamic forces can be controlled by altering the trailing edge flexibility of a flapping wing. We used a dynamically scaled mechanical model of flapping flight (Re approximately 2000) to measure the aerodynamic forces on flapping wings of variable flexural stiffness (EI). For low to medium angles of attack, as flexibility of the wing increases, its ability to generate aerodynamic forces decreases monotonically but its lift-to-drag ratios remain approximately constant. The instantaneous force traces reveal no major differences in the underlying modes of force generation for flexible and rigid wings, but the magnitude of force, the angle of net force vector and centre of pressure all vary systematically with wing flexibility. Even a rudimentary framework of wing veins is sufficient to restore the ability of flexible wings to generate forces at near-rigid values. Thus, the magnitude of force generation can be controlled by modulating the trailing edge flexibility and thereby controlling the magnitude of the leading edge vorticity. To characterize this, we have generated a detailed database of aerodynamic forces as a function of several variables including material properties, kinematics, aerodynamic forces and centre of pressure, which can also be used to help validate computational models of aeroelastic flapping wings. These experiments will also be useful for wing design for small

  7. Aerodynamic effects of flexibility in flapping wings

    Science.gov (United States)

    Zhao, Liang; Huang, Qingfeng; Deng, Xinyan; Sane, Sanjay P.

    2010-01-01

    Recent work on the aerodynamics of flapping flight reveals fundamental differences in the mechanisms of aerodynamic force generation between fixed and flapping wings. When fixed wings translate at high angles of attack, they periodically generate and shed leading and trailing edge vortices as reflected in their fluctuating aerodynamic force traces and associated flow visualization. In contrast, wings flapping at high angles of attack generate stable leading edge vorticity, which persists throughout the duration of the stroke and enhances mean aerodynamic forces. Here, we show that aerodynamic forces can be controlled by altering the trailing edge flexibility of a flapping wing. We used a dynamically scaled mechanical model of flapping flight (Re ≈ 2000) to measure the aerodynamic forces on flapping wings of variable flexural stiffness (EI). For low to medium angles of attack, as flexibility of the wing increases, its ability to generate aerodynamic forces decreases monotonically but its lift-to-drag ratios remain approximately constant. The instantaneous force traces reveal no major differences in the underlying modes of force generation for flexible and rigid wings, but the magnitude of force, the angle of net force vector and centre of pressure all vary systematically with wing flexibility. Even a rudimentary framework of wing veins is sufficient to restore the ability of flexible wings to generate forces at near-rigid values. Thus, the magnitude of force generation can be controlled by modulating the trailing edge flexibility and thereby controlling the magnitude of the leading edge vorticity. To characterize this, we have generated a detailed database of aerodynamic forces as a function of several variables including material properties, kinematics, aerodynamic forces and centre of pressure, which can also be used to help validate computational models of aeroelastic flapping wings. These experiments will also be useful for wing design for small robotic

  8. Mucosal Vaccine Development Based on Liposome Technology.

    Science.gov (United States)

    Bernasconi, Valentina; Norling, Karin; Bally, Marta; Höök, Fredrik; Lycke, Nils Y

    2016-01-01

    Immune protection against infectious diseases is most effective if located at the portal of entry of the pathogen. Hence, there is an increasing demand for vaccine formulations that can induce strong protective immunity following oral, respiratory, or genital tract administration. At present, only few mucosal vaccines are found on the market, but recent technological advancements and a better understanding of the principles that govern priming of mucosal immune responses have contributed to a more optimistic view on the future of mucosal vaccines. Compared to live attenuated vaccines, subcomponent vaccines, most often protein-based, are considered safer, more stable, and less complicated to manufacture, but they require the addition of nontoxic and clinically safe adjuvants to be effective. In addition, another limiting factor is the large antigen dose that usually is required for mucosal vaccines. Therefore, the combination of mucosal adjuvants with the recent progress in nanoparticle technology provides an attractive solution to these problems. In particular, the liposome technology is ideal for combining protein antigen and adjuvant into an effective mucosal vaccine. Here, we describe and discuss recent progress in nanoparticle formulations using various types of liposomes that convey strong promise for the successful development of the next generation of mucosal vaccines.

  9. Twin vaginal delivery: innovate or abdicate.

    Science.gov (United States)

    Easter, Sarah Rae; Taouk, Laura; Schulkin, Jay; Robinson, Julian N

    2017-05-01

    Neonatal safety data along with national guidelines have prompted renewed interest in vaginal delivery of twins, particularly in the case of the noncephalic second twin. Yet, the rising rate of twin cesarean deliveries, coupled with the national decline in operative obstetrics, raises concerns about the availability of providers who are skilled in twin vaginal birth. Providers are key stakeholders for increasing rates of twin vaginal delivery. We surveyed a group of practicing obstetricians to explore potential barriers to the vaginal birth of twins with a focus on delivery of the noncephalic second twin. Among 107 responding providers, only 57% would deliver a noncephalic second twin by breech extraction. Providers who preferred breech extraction had a higher rate of maternal-fetal medicine subspecialty training (26.2% vs 4.3%; P30 sets of twins annually (57.4% vs 34.8%; P=.02). Most providers (54.2%) were familiar with the findings from the recent randomized trial that demonstrated the safety of twin vaginal birth. However, knowledge of the trial was not associated statistically with a preference for breech extraction (62.3% vs 43.5%; P=.05). Providers who preferred breech extraction were more likely to agree with recent society guidelines that encourage the vaginal birth of twins (86.9% vs 63.0%; Pinnovation. Without novel provider-focused strategies, we may relinquish passively the requisite skills for not only our patients but also for future generations of obstetricians. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. [Frequency of epidural analgesia for vaginal delivery].

    Science.gov (United States)

    Atanassova, M; Nikolov, A

    2011-01-01

    To establish the frequency of epidural analgesia for vaginal delivery. The research includes 51 632 deliveries for 16 years period. Total frequency of vaginal delivery with EA, compared to total number of vaginal deliveries for period is 11.77%. The frequency shows tendency to slowly increase in the beginning of the period, probably because of getting experienced among some of the obstetricians, after then frequency stay relatively constant. Except care of somatic health of mother and foetus, modern obstetrics requires to ensure maximum comfort of parturient, to satisfy requirements of modern women for "painless" delivery and leave a positive memory of birth. That is why more frequently use of EA for vaginal delivery is necessary. EA is an approved method for anesthetizing vaginal delivery. It is established slowly increasing frequency of EA for anesthetizing vaginal delivery. The frequency of EA in University hospital "Maichin dom" is relatively low in comparison with mentioned in literature values, which raises the question of finding ways to further promote and increase the application of EA.

  11. Mastoid fascia kite flap for cryptotia correction.

    Science.gov (United States)

    Simon, François; Celerier, Charlotte; Garabedian, Erea-Noël; Denoyelle, Françoise

    2016-11-01

    Cryptotia is one of the most common malformations of the upper auricle with aesthetic and functional consequences, however there is no standard treatment. We present the surgical technique and results of a kite flap procedure which can be used in the different cryptotia subtypes. We reviewed all patients treated in our department from 2010 to 2015, using a mastoid fascia kite flap technique. The incision of this local flap follows the retro-auricular sulcus along the rim of the helix superiorly and drawing a skin paddle inferiorly. The mastoid fascia is exposed and a superiorly and posteriorly based flap is drawn and detached from the skull. Finally, the skin paddle is rotated and sutured between the superior helix and temporal skin creating the superior sulcus. The retro-auricular incision is closed directly inferiorly. Six patients (mean age 12) and seven ears were studied. One patient had bilateral cryptotia and only two had a normal contralateral ear. Mean follow-up was of 45 months. There was no skin necrosis, no complications reported and no revision surgery. We describe a reliable flap with a simple design and improved aesthetic result, as the thickness of the flap projects the helix well, the scar is entirely hidden in the retro-auricular sulcus and the direct suture induces a harmonious medialization of the inferior part of the ear and earlobe. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Cervicovaginal microbiome dysbiosis is associated with proteome changes related to alterations of the cervicovaginal mucosal barrier.

    Science.gov (United States)

    Borgdorff, H; Gautam, R; Armstrong, S D; Xia, D; Ndayisaba, G F; van Teijlingen, N H; Geijtenbeek, T B H; Wastling, J M; van de Wijgert, J H H M

    2016-05-01

    Vaginal microbiome (VMB) dysbiosis is associated with increased acquisition of HIV. Cervicovaginal inflammation and other changes to the mucosal barrier are thought to have important roles but human data are scarce. We compared the human cervicovaginal proteome by mass spectrometry of 50 Rwandan female sex workers who had previously been clustered into four VMB groups using a 16S phylogenetic microarray; in order of increasing bacterial diversity: Lactobacillus crispatus-dominated VMB (group 1), Lactobacillus iners-dominated VMB (group 2), moderate dysbiosis (group 3), and severe dysbiosis (group 4). We compared relative protein abundances among these VMB groups using targeted (abundance of pre-defined mucosal barrier proteins) and untargeted (differentially abundant proteins among all human proteins identified) approaches. With increasing bacterial diversity, we found: mucus alterations (increasing mucin 5B and 5AC), cytoskeleton alterations (increasing actin-organizing proteins; decreasing keratins and cornified envelope proteins), increasing lactate dehydrogenase A/B as markers of cell death, increasing proteolytic activity (increasing proteasome core complex proteins/proteases; decreasing antiproteases), altered antimicrobial peptide balance (increasing psoriasin, calprotectin, and histones; decreasing lysozyme and ubiquitin), increasing pro-inflammatory cytokines, and decreasing immunoglobulins immunoglobulin G1/2. Although temporal relationships cannot be derived, our findings support the hypothesis that dysbiosis causes cervicovaginal inflammation and other detrimental changes to the mucosal barrier.

  13. Vaginal fold histology reduces the variability introduced by vaginal exfoliative cytology in the classification of mouse estrous cycle stages

    OpenAIRE

    Arnon, Gal; Po-Ching, Lin; Anne M, Barger; Amy L, MacNeill; CheMyong, Ko

    2014-01-01

    Vaginal exfoliative cytology is commonly used in biomedical and toxicological research to classify the stages of the rodent estrous cycle. However, mouse vaginal exfoliative cytology is commonly used as a stand-alone tool and has not been evaluated in reference to vaginal histology and serum sex hormone levels. In this study, the direct and Giemsa-stained methods of vaginal exfoliative cytology were compared in reference to vaginal fold histology and serum sex hormone levels. Both methods pre...

  14. Modern mucosal vaccines, adjuvants and microbicides.

    Science.gov (United States)

    Cranage, Martin P; Manoussaka, Maria

    2009-02-01

    Preventing infection at the pathogen portal of entry through induction of mucosal immunity and the use of microbicides has always been an exciting prospect. Moreover, the promise of needle-free prophylaxis is attractive for many reasons. This meeting report highlights some of the critical issues that were discussed concerning recent advances in the field. New routes of vaccination and modalities of delivery are still being discovered, and important advances are occurring in the development of safe mucosal adjuvants. Protection of mucosal surfaces is likely to be particularly crucial to prevent infections with pathogens, such as HIV, that can be sequestered rapidly.

  15. Backup perforator flap derived from a previously transferred musculocutaneous free flap.

    Science.gov (United States)

    Topalan, Murat; Guven, Erdem; Demirtas, Yener

    2010-09-01

    Reconstruction of the lower leg commonly requires a free tissue transfer after Gustillo grade IIIB-IIIC injuries and severe postoncological resections, where, free musculocutaneous flaps (MCF) are preferred for their size and robust blood supply. The anastomoses are performed at more proximal levels to keep them away from the trauma zone. This reasonable maneuver causes the distal of the flap to cover the most critical part of the defect. Any marginal necrosis, then, ends in exposure of the bone or implant. Reported here is the use of a perforator flap derived from a previously transferred free MCF as a backup tissue. Distal marginal necrosis exposing vital structures were encountered after six free MCF transfers during the last 6 years. These were highly complicated cases in which no regional flap options were available and a second free flap was unfeasible due to recipient vessel problems. A perforator flap was elevated on the perforator vessel(s) penetrating the underlying muscle of the previous MCF and either advanced or transposed to cover the defect. Donor sites on MCF were closed primarily. Wound dehiscence that healed secondarily was observed in two cases. The knee prosthesis was removed in one case due to uncontrolled osteomyelitis. No complications were detected in other three cases. The described flap can be a leg saver whenever a previously transferred free MCF fails to cover the distal site of the defect. The flap can be advanced for 3-5 cm and allows more than 90 degrees of rotation.

  16. The prepuce free flap in 10 patients : modifications in flap design and surgical technique

    NARCIS (Netherlands)

    Werker, Paul M N

    The prepuce free flap was used in 10 oral and oropharyngeal reconstructions. During the course of this study, various modifications took place. Residual penile skin necrosis and skin island necrosis early in the series led to modification of flap design. This solved the donor-site problem by placing

  17. Rescue of Primary Incomplete Microkeratome Flap with Secondary Femtosecond Laser Flap in LASIK

    Directory of Open Access Journals (Sweden)

    E. A. Razgulyaeva

    2014-01-01

    Full Text Available For laser-assisted in situ keratomileusis (LASIK retreatments with a previous unsuccessful mechanical microkeratome-assisted surgery, some surgical protocols have been described as feasible, such as relifting of the flap or the creation of a new flap and even the change to a surface ablation procedure (photorefractive keratectomy (PRK. This case shows the use of femtosecond technology for the creation of a secondary flap to perform LASIK in a cornea with a primary incomplete flap obtained with a mechanical microkeratome. As we were unable to characterize the interface of the first partial lamellar cut, a thick flap was planned and created using a femtosecond laser platform. As the primary cut was very thick in the nasal quadrant, a piece of loose corneal tissue appeared during flap lifting which was fitted in its position and not removed. Despite this condition and considering the regularity of the new femtosecond laser cut, the treatment was uneventful. This case report shows the relevance of a detailed corneal analysis with an advanced imaging technique before performing a secondary flap in a cornea with a primary incomplete flap. The femtosecond laser technology seems to be an excellent tool to manage such cases successfully.

  18. Aerodynamics power consumption for mechanical flapping wings undergoing flapping and pitching motion

    Science.gov (United States)

    Razak, N. A.; Dimitriadis, G.; Razaami, A. F.

    2017-07-01

    Lately, due to the growing interest in Micro Aerial Vehicles (MAV), interest in flapping flight has been rekindled. The reason lies in the improved performance of flapping wing flight at low Reynolds number regime. Many studies involving flapping wing flight focused on the generation of unsteady aerodynamic forces such as lift and thrust. There is one aspect of flapping wing flight that received less attention. The aspect is aerodynamic power consumption. Since most mechanical flapping wing aircraft ever designed are battery powered, power consumption is fundamental in improving flight endurance. This paper reports the results of experiments carried out on mechanical wings under going active root flapping and pitching in the wind tunnel. The objective of the work is to investigate the effect of the pitch angle oscillations and wing profile on the power consumption of flapping wings via generation of unsteady aerodynamic forces. The experiments were repeated for different airspeeds, flapping and pitching kinematics, geometric angle of attack and wing sections with symmetric and cambered airfoils. A specially designed mechanical flapper modelled on large migrating birds was used. It will be shown that, under pitch leading conditions, less power is required to overcome the unsteady aerodnamics forces. The study finds less power requirement for downstroke compared to upstroke motion. Overall results demonstrate power consumption depends directly on the unsteady lift force.

  19. Umbilicoplasty with 3 triangular skin flaps and excised diamond-shaped skin flap.

    Science.gov (United States)

    Takasu, Hidemi; Watanabe, Yoshio

    2010-10-01

    In cases of large umbilical hernias, standard surgical techniques have proven inadequate for diminishing the diameter of the umbilicus. We have modified the 3- and 4-triangular-skin-flap techniques to diminish the diameter of the umbilicus and achieve a cosmetically acceptable umbilicus. Umbilicoplasty was performed in 149 children (median age, 2.5 years; range, 3 months-10 years) between 2003 and 2008. We created 4 skin flaps 1.5 cm in length on the umbilicus and excised the cranial diamond-shaped skin flap. After closure of the fascial defect, the diameter of the umbilicus was diminished by suturing the opened cranial part of the diamond-shaped skin flap vertically. The tips of the 3 remaining flaps were then anchored to the closed fascia. Postoperatively, granulation tissue occurred in 18 cases (12%), transient erythema of a flap in 15 cases (10%), and bulging of a skin flap in 15 cases (10%). These complications were reduced by suturing adjoining skin flaps. No recurrent hernias were encountered. The postoperative umbilical appearance was satisfactory in all cases. This surgical technique is effective for diminishing the diameter of the umbilicus and creating a cosmetically acceptable shaped umbilicus, even for large umbilical hernias. Copyright © 2010 Elsevier Inc. All rights reserved.

  20. Phase I randomised clinical trial of an HIV-1(CN54, clade C, trimeric envelope vaccine candidate delivered vaginally.

    Directory of Open Access Journals (Sweden)

    David J Lewis

    Full Text Available We conducted a phase 1 double-blind randomised controlled trial (RCT of a HIV-1 envelope protein (CN54 gp140 candidate vaccine delivered vaginally to assess immunogenicity and safety. It was hypothesised that repeated delivery of gp140 may facilitate antigen uptake and presentation at this mucosal surface. Twenty two healthy female volunteers aged 18-45 years were entered into the trial, the first receiving open-label active product. Subsequently, 16 women were randomised to receive 9 doses of 100 µg of gp140 in 3 ml of a Carbopol 974P based gel, 5 were randomised to placebo solution in the same gel, delivered vaginally via an applicator. Participants delivered the vaccine three times a week over three weeks during one menstrual cycle, and were followed up for two further months. There were no serious adverse events, and the vaccine was well tolerated. No sustained systemic or local IgG, IgA, or T cell responses to the gp140 were detected following vaginal immunisations. Repeated vaginal immunisation with a HIV-1 envelope protein alone formulated in Carbopol gel was safe, but did not induce local or systemic immune responses in healthy women.ClinicalTrials.gov NCT00637962.

  1. Vaginal orgasm is associated with vaginal (not clitoral) sex education, focusing mental attention on vaginal sensations, intercourse duration, and a preference for a longer penis.

    Science.gov (United States)

    Brody, Stuart; Weiss, Petr

    2010-08-01

    Evidence was recently provided for vaginal orgasm, orgasm triggered purely by penile-vaginal intercourse (PVI), being associated with better psychological functioning. Common sex education and sexual medicine approaches might undermine vaginal orgasm benefits. To examine the extent to which women's vaginal orgasm consistency is associated with (i) being told in childhood or adolescence that the vagina was the important zone for inducing female orgasm; (ii) how well they focus mentally on vaginal sensations during PVI; (iii) greater PVI duration; and (iv) preference for above-average penis length.   In a representative sample of the Czech population, 1,000 women reported their vaginal orgasm consistency (from never to almost every time; only 21.9% never had a vaginal orgasm), estimates of their typical foreplay and PVI durations, what they were told in childhood and adolescence was the important zone for inducing female orgasm, their degree of focus on vaginal sensations during PVI, and whether they were more likely to orgasm with a longer than average penis. The association of vaginal orgasm consistency with the predictors noted above. Vaginal orgasm consistency was associated with all hypothesized correlates. Multivariate analysis indicated the most important predictors were being educated that the vagina is important for female orgasm, being mentally focused on vaginal sensations during PVI, and in some analyses duration of PVI (but not foreplay) and preferring a longer than average penis. Focusing attention on penile-vaginal sensation supports vaginal orgasm and the myriad benefits thereof. Brody S, and Weiss P. Vaginal orgasm is associated with vaginal (not clitoral) sex education, focusing mental attention on vaginal sensations, intercourse duration, and a preference for a longer penis. © 2009 International Society for Sexual Medicine.

  2. [Application of the tension skin flap with different shapes in the pedicle of the reverse neurocutaneous island flap].

    Science.gov (United States)

    Li, Meng; Lan, Xu; Zheng, Ping; Liu, Xing-Yan; Gao, Qiu-Ming; Song, Ming-Jia

    2013-08-01

    To investigate the effects of the tension skin flap with different shapes on the transplantation of the reverse neurocutaneous island flap. From January 2006 to January 2012,there were 21 patients in the study (including 15 males and 6 females), and aged from 14 to 58 years old (35 years old on average). Tension skin flaps with different shapes (triangle ,round and ellipse) were used to improve the blood supply of the reverse neurocutaneous island flap. The tension skin flaps in the pedicle were designed triangularly (10 patients), spherically (8 patients) or elliptically (3 patients). There were 5 patients with defects in the hand (the size from 5.0 cm x 2.0 cm to 8.0 cm x 5.0 cm), and 16 patients with defects in the foot and inferior segment of leg, or around the ankle (the size from 6.0 cm x 4.0 cm to 13.0 cm x 7.0 cm). And all the patients were with the tendon and bone exposed. All the flaps were reversal transplanted, including 5 dorsal neurocutaneous flaps of foot, 4 superficial peroneal neurocutaneous flaps, 4 saphenous neurocutaneous flaps, 3 sural neurocutaneous flaps, 2 superficial radial neurocutaneous flaps, 3 lateral neurocutaneous flaps of forearm. And the survival rate, appearance and sensory recovery of the flaps were analyzed. The distant part of the reversed sural neurocutaneous island flap in 1 case necrosized and healed after dressing change. The other flaps survived entirely, and the donor site all healed primarily. The follow-up time was from 3 months to 2 years (averaged 7 months), and all the flaps had recovered pain and warm sensation with perfect appearance. The tension skin flap in the pedicle can enhance the blood supply and promote survival rate of the reverse neurocutaneous island flap, and can also improve its appearance.

  3. Intraoperative local flap transforming (iLoFT method; from hachet to reading-man flap

    Directory of Open Access Journals (Sweden)

    Motoi Kato

    2017-06-01

    Full Text Available Local flaps are widely used in soft tissue reconstruction because they result in good colour and texture match. They can be quickly placed without donor site morbidity. However, it is not always easy to preoperatively design a feasible procedure, predict the final scar line or image the tension that may occur on and around the flap, especially for inexperienced surgeons. Because the elasticity of the skin varies with anatomical location and among individuals, unpredictable intraoperative design changes are sometimes required. Therefore, a preoperative back-up plan would be helpful. We evaluated the possibilities and advantages of an intraoperative switch from a hatchet flap (HF to a reading man flap (RMF procedure. Using a previously reported computer simulation with the finite element method (FEM analysis, we developed an intraoperative local flap transformation (iLoFT model.

  4. Unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse

    Directory of Open Access Journals (Sweden)

    Assem A.M. Elbiaa

    2015-09-01

    Full Text Available Aim of the study was to estimate the incidence of unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse. Material and methods : Eighty women with asymptomatic utero-vaginal prolapse were included in this prospective study for vaginal hysterectomy after preoperative preparation and after written informed consent. Women included in this study were screened preoperatively by high vaginal swab, Pap smear, endometrial biopsy and trans-vaginal ultrasound. Surgically removed uteri and ovaries were sent for histopathological examination. Results of histopathological examination as gold standard were compared with conventional gynecological screening methods. Results : Histopathological examination of surgically removed uteri and ovaries after vaginal hysterectomy for uterovaginal prolapse showed abnormal findings in 61.25% (49/80 of studied cases (10 chronic cervicitis; 20 cervical intra-epithelial neoplasia-1 [CIN-1]; 5 CIN-2; 2 CIN-3; 10 simple endometrial hyperplasia without atypia and 2 simple serous ovarian cyst. Also, histopathological examination showed premalignant changes in 33.75% (27/80 of studied cases (20 CIN-1; 5 CIN-2 and 2 CIN-3, which mean 50% sensitivity of pre-operative Pap smear to detect premalignant cervical changes. Conclusions : Asymptomatic women with utero-vaginal prolapse may have associated premalignant lesions which may not be detected by conventional screening methods, and this should be explained preoperatively for women undergoing surgery, especially if conservative management was considered.

  5. The vaginal microbiota: what have we learned after a decade of molecular characterization?

    Directory of Open Access Journals (Sweden)

    Janneke H H M van de Wijgert

    Full Text Available We conducted a systematic review of the Medline database (U.S. National Library of Medicine, National Institutes of Health, Bethesda, MD, U.S.A to determine if consistent molecular vaginal microbiota (VMB composition patterns can be discerned after a decade of molecular testing, and to evaluate demographic, behavioral and clinical determinants of VMB compositions. Studies were eligible when published between 1 January 2008 and 15 November 2013, and if at least one molecular technique (sequencing, PCR, DNA fingerprinting, or DNA hybridization was used to characterize the VMB. Sixty three eligible studies were identified. These studies have now conclusively shown that lactobacilli-dominated VMB are associated with a healthy vaginal micro-environment and that bacterial vaginosis (BV is best described as a polybacterial dysbiosis. The extent of dysbiosis correlates well with Nugent score and vaginal pH but not with the other Amsel criteria. Lactobacillus crispatus is more beneficial than L. iners. Longitudinal studies have shown that a L. crispatus-dominated VMB is more likely to shift to a L. iners-dominated or mixed lactobacilli VMB than to full dysbiosis. Data on VMB determinants are scarce and inconsistent, but dysbiosis is consistently associated with HIV, human papillomavirus (HPV, and Trichomonas vaginalis infection. In contrast, vaginal colonization with Candida spp. is more common in women with a lactobacilli-dominated VMB than in women with dysbiosis. Cervicovaginal mucosal immune responses to molecular VMB compositions have not yet been properly characterized. Molecular techniques have now become more affordable, and we make a case for incorporating them into larger epidemiological studies to address knowledge gaps in etiology and pathogenesis of dysbiosis, associations of different dysbiotic states with clinical outcomes, and to evaluate interventions aimed at restoring and maintaining a lactobacilli-dominated VMB.

  6. Promoting Vaginal Distribution of E7 and MCL-1 siRNA-Silencing Nanoparticles for Cervical Cancer Treatment.

    Science.gov (United States)

    Lechanteur, Anna; Furst, Tania; Evrard, Brigitte; Delvenne, Philippe; Piel, Géraldine; Hubert, Pascale

    2017-05-01

    There is an urgent need to develop a less aggressive and more effective treatment against cervical lesions induced by different high-risk human papillomavirus (HR-HPV). We investigated the potential of a cocktail of small interfering RNA (siRNA) directed against the oncoprotein E6 (E6), the oncoprotein E7 (E7), or the antiapoptotic protein MCL-1 (MCL-1). The combination of siRNA anti-E7 and anti-MCL-1 demonstrated high efficacy on multiple HPV16 and HPV18 cell lines and no effects on healthy keratinocytes. This gene therapy has been considered for a vaginal administration since this route of application holds high potential for the treatment of diseases in the female reproductive tracts. Therefore, PEGylated lipoplexes have been designed and characterized to protect siRNA and to diffuse in the mucosal environment before they reach the cervico/vaginal epithelium. This new nanovector complexed to the combination of active siRNA induced an efficient mRNA knockdown since biological effects were obtained in vitro. This work also provided evidence that the PEGylated lipoplexes had appropriate physicochemical properties to diffuse into a mucin network according to size measurement experiments in artificial mucus. After demonstrating the distribution and the efficacy of siRNA into a 3D-cervical model lesion and through porcine vaginal mucosa, in vivo experiments in mouse have been performed under physiological conditions. This study revealed a complete and sustained coverage of the mucosal epithelium following an unique vaginal administration of fluorescent PEGylated lipoplexes. Overall, our results showed the potential of the PEGylated lipoplexes for the prolonged delivery of active siRNA to treat HPV-induced lesions.

  7. Semaphorin 4D induces vaginal epithelial cell apoptosis to control mouse postnatal vaginal tissue remodeling.

    Science.gov (United States)

    Ito, Takuji; Bai, Tao; Tanaka, Tetsuji; Yoshida, Kenji; Ueyama, Takashi; Miyajima, Masayasu; Negishi, Takayuki; Kawasaki, Takahiko; Takamatsu, Hyota; Kikutani, Hitoshi; Kumanogoh, Atsushi; Yukawa, Kazunori

    2015-02-01

    The opening of the mouse vaginal cavity to the skin is a postnatal tissue remodeling process that occurs at approximately five weeks of age for the completion of female genital tract maturation at puberty. The tissue remodeling process is primarily composed of a hormonally triggered apoptotic process predominantly occurring in the epithelium of the distal section of the vaginal cavity. However, the detailed mechanism underlying the apoptotic induction remains to be elucidated. In the present study, it was observed that the majority of BALB/c mice lacking the class 4 semaphorin, semaphorin 4D (Sema4D), developed imperforate vagina and hydrometrocolpos resulting in a perpetually unopened vaginal cavity regardless of a normal estrogen level comparable with that in wild‑type (WT) mice. Administration of β‑estradiol to infant Sema4D‑deficient (Sema4D‑/‑) mice did not induce precocious vaginal opening, which was observed in WT mice subjected to the same β‑estradiol administration, excluding the possibility that the closed vaginal phenotype was due to insufficient estrogen secretion at the time of vaginal opening. In order to assess the role of Sema4D in the postnatal vaginal tissue remodeling process, the expression of Sema4D and its receptor, plexin‑B1, was examined as well as the level of apoptosis in the vaginal epithelia of five‑week‑old WT and Sema4D‑/‑ mice. Immunohistochemical analyses confirmed the localization of Sema4D and plexin‑B1 in the mouse vaginal epithelia. Terminal deoxynucleotidyl transferase dUTP nick end labeling assay and immunohistochemistry detecting activated caspase‑3 revealed significantly fewer apoptotic cells in situ in the vaginal mucosa of five‑week‑old Sema4D‑/‑ mice compared with WT mice. The addition of recombinant Sema4D to Sema4D‑/‑ vaginal epithelial cells in culture significantly enhanced apoptosis of the vaginal epithelial cells, demonstrating the apoptosis‑inducing activity of Sema4D. The

  8. Novel developments in endoscopic mucosal imaging

    NARCIS (Netherlands)

    van der Sommen, F; Curvers, W L; Nagengast, W B

    2018-01-01

    Endoscopic techniques such as High-definition and optical-chromoendoscopy have had enormous impact on endoscopy practice. Since these techniques allow assessment of most subtle morphological mucosal abnormalities, further improvements in endoscopic practice lay in increasing the detection efficacy

  9. Microneedle and mucosal delivery of influenza vaccines

    Science.gov (United States)

    Kang, Sang-Moo; Song, Jae-Min; Kim, Yeu-Chun

    2017-01-01

    In recent years with the threat of pandemic influenza and other public health needs, alternative vaccination methods other than intramuscular immunization have received great attention. The skin and mucosal surfaces are attractive sites probably because of both non-invasive access to the vaccine delivery and unique immunological responses. Intradermal vaccines using a microinjection system (BD Soluvia) and intranasal vaccines (FluMist) are licensed. As a new vaccination method, solid microneedles have been developed using a simple device that may be suitable for self-administration. Because coated micorneedle influenza vaccines are administered in the solid state, developing formulations maintaining the stability of influenza vaccines is an important issue to be considered. Marketable microneedle devices and clinical trials remain to be developed. Other alternative mucosal routes such as oral and intranasal delivery systems are also attractive for inducing cross protective mucosal immunity but effective non-live mucosal vaccines remain to be developed. PMID:22697052

  10. Microbiota and Mucosal Immunity in Amphibians

    Science.gov (United States)

    Colombo, Bruno M.; Scalvenzi, Thibault; Benlamara, Sarah; Pollet, Nicolas

    2015-01-01

    We know that animals live in a world dominated by bacteria. In the last 20 years, we have learned that microbes are essential regulators of mucosal immunity. Bacteria, archeas, and viruses influence different aspects of mucosal development and function. Yet, the literature mainly covers findings obtained in mammals. In this review, we focus on two major themes that emerge from the comparative analysis of mammals and amphibians. These themes concern: (i) the structure and functions of lymphoid organs and immune cells in amphibians, with a focus on the gut mucosal immune system; and (ii) the characteristics of the amphibian microbiota and its influence on mucosal immunity. Lastly, we propose to use Xenopus tadpoles as an alternative small-animal model to improve the fundamental knowledge on immunological functions of gut microbiota. PMID:25821449

  11. Microbiota and mucosal immunity in amphibians

    National Research Council Canada - National Science Library

    Colombo, Bruno M; Scalvenzi, Thibault; Benlamara, Sarah; Pollet, Nicolas

    2015-01-01

    ...) the characteristics of the amphibian microbiota and its influence on mucosal immunity. Lastly, we propose to use Xenopus tadpoles as an alternative small-animal model to improve the fundamental knowledge on immunological functions of gut microbiota.

  12. Microbiota and mucosal immunity in amphibians

    Directory of Open Access Journals (Sweden)

    Bruno M Colombo

    2015-03-01

    Full Text Available We know that animals live in a world dominated by bacteria. In the last twenty years we have learned that microbes are essential regulators of mucosal immunity. Bacterias, archeas and viruses influence different aspects of mucosal development and function. Yet the literature mainly covers findings obtained in mammals. In this review, we focus on two major themes that emerge from the comparative analysis of mammals and amphibians. These themes concern: i the structure and functions of lymphoid organs and immune cells in amphibians, with a focus on the gut mucosal immune system; and ii the characteristics of the amphibian microbiota and its influence on mucosal immunity. Lastly, we propose to use Xenopus tadpoles as an alternative small animal model to improve the fundamental knowledge on immunological functions of gut microbiota.

  13. Microbiota and mucosal immunity in amphibians.

    Science.gov (United States)

    Colombo, Bruno M; Scalvenzi, Thibault; Benlamara, Sarah; Pollet, Nicolas

    2015-01-01

    We know that animals live in a world dominated by bacteria. In the last 20 years, we have learned that microbes are essential regulators of mucosal immunity. Bacteria, archeas, and viruses influence different aspects of mucosal development and function. Yet, the literature mainly covers findings obtained in mammals. In this review, we focus on two major themes that emerge from the comparative analysis of mammals and amphibians. These themes concern: (i) the structure and functions of lymphoid organs and immune cells in amphibians, with a focus on the gut mucosal immune system; and (ii) the characteristics of the amphibian microbiota and its influence on mucosal immunity. Lastly, we propose to use Xenopus tadpoles as an alternative small-animal model to improve the fundamental knowledge on immunological functions of gut microbiota.

  14. Does vaginal estrogen treatment with support pessaries in vaginal prolapse reduce complications?

    Science.gov (United States)

    Bulchandani, Supriya; Toozs-Hobson, Philip; Verghese, Tina; Latthe, Pallavi

    2015-12-01

    Pelvic organ prolapse is often co-existant with atrophy of the genital tract in older women who tend to prefer vaginal pessaries for prolapse. Vaginal estrogen therapy is used by some along with a support pessary for prolapse with no robust evidence to back this practice. We aimed to evaluate differences in complications of support pessaries for vaginal prolapse in postmenopausal women, with and without vaginal estrogen use. We prospectively assessed postmenopausal women attending the urogynaecology clinic for a pessary change. We asked them about the level of discomfort during pessary change (visual analogue scale for pain), discharge, bleeding and infection. Ethics approval was not required as this was a service evaluation project. Statistical analysis for relative risk was performed, including sub-group analysis for 'ring pessary' and 'non-ring group' (Shelf, Gellhorn, Shaatz). Between July 2013 and December 2014, we assessed 120 postmenopausal women using support pessaries for prolapse. The mean age was 70 years; 45% of the patients used vaginal estrogen. There were no statistically significant differences in complications with or without vaginal estrogen use, although the trend was higher amongst non-users. The 'non-ring' sub-group not using vaginal estrogen had a higher risk of vaginal ulceration, bleeding and discharge. Postmenopausal women may have lesser complications when using vaginal estrogen with a support pessary for prolapse, particularly with pessaries other than the ring. An adequately powered randomised controlled trial is needed to assess conclusively whether vaginal estrogen enhances comfort and reduces complications of support pessaries for prolapse. © The Author(s) 2015.

  15. Aerobic vaginal pathogens and their sensitivity pattern.

    Science.gov (United States)

    Mumtaz, Shamim; Ahmad, Mumtaz; Aftab, Irum; Akhtar, Naeem; ul Hassan, Masood; Hamid, Abdul

    2008-01-01

    The vaginal flora is a complicated environment, containing dozens of microbiological species in variable quantities and relative proportions. The frequent cause of vaginal discharge is an infection or colonization with different microorganisms. Some pathologic conditions causing vaginitis are well defined yet, 7-72% of women with vaginitis may remain undiagnosed and such forms of abnormal vaginal flora neither considered as normal, nor can be called bacterial vaginosis have been termed as 'intermediate flora' and its management probably differ from that of bacterial vaginosis. It is of crucial importance in pregnant females at risk of preterm delivery. The present study has been conducted especially to elucidate this type of aerobic vaginal isolates and their culture and sensitivity towards currently used antibiotics. This study was conducted at the Microbiology Department of Fauji Foundation Hospital, Rawalpindi over a period of two years (April 2004-March 2006). One thousand, nine hundred and twenty three high vaginal swabs, both from indoor and outdoor patients were collected, cultured and their susceptibility to various antibiotics was determined. Significant growth was obtained in 731 samples. The highest frequency of infection (39.5%) was observed at 31-40 years followed by 41-50 years (35.8%). About 76% were from outdoor and 24% were from indoor patients. Staphylococcus aureus was the most prevalent vaginal pathogen at 11-60 yrs & with highest prevalence at 31-40 years followed by 41-50 years. It was a predominant pathogen in both indoor (35%) as well as outdoor (41.6%) patients, followed by enteric gram-negative bacilli and other gram-positive cocci. There were very few antibiotics among the conventionally available aminoglycosides, third generation cephalosporins, penicillin, quinolones, sulfonamides and tetracyclines possessing good sensitivity (> 80%) against any one the common aerobic vaginal pathogens. The effective chemotherapeutics agents belong to

  16. Screening of mucoadhesive vaginal gel formulations

    Directory of Open Access Journals (Sweden)

    Ana Ochoa Andrade

    2014-12-01

    Full Text Available Rational design of vaginal drug delivery formulations requires special attention to vehicle properties that optimize vaginal coating and retention. The aim of the present work was to perform a screening of mucoadhesive vaginal gels formulated with carbomer or carrageenan in binary combination with a second polymer (carbomer, guar or xanthan gum. The gels were characterised using in vitroadhesion, spreadability and leakage potential studies, as well as rheological measurements (stress and frequency sweep tests and the effect of dilution with simulated vaginal fluid (SVF on spreadability. Results were analysed using analysis of variance and multiple factor analysis. The combination of polymers enhanced adhesion of both primary gelling agents, carbomer and carrageenan. From the rheological point of view all formulations presented a similar behaviour, prevalently elastic and characterised by loss tangent values well below 1. No correlation between rheological and adhesion behaviour was found. Carbomer and carrageenan gels containing the highest percentage of xanthan gum displayed good in vitro mucoadhesion and spreadability, minimal leakage potential and high resistance to dilution. The positive results obtained with carrageenan-xanthan gum-based gels can encourage the use of natural biocompatible adjuvants in the composition of vaginal products, a formulation field that is currently under the synthetic domain.

  17. Comparison of free anterolateral thigh flaps and free muscle-musculocutaneous flaps in soft tissue reconstruction of lower extremity.

    Science.gov (United States)

    Demirtas, Yener; Kelahmetoglu, Osman; Cifci, Mehmet; Tayfur, Volkan; Demir, Ahmet; Guneren, Ethem

    2010-01-01

    The objective of this study was to compare the free muscle-musculocutaneous flaps and free perforator skin flaps used for soft tissue reconstruction of the lower extremities. Fifty-three patients whose skin and soft tissue of the lower extremities had been reconstructed were divided into two groups: a perforator flap group, reconstructed using anterolateral thigh (ALT) free flap (23 cases), and a muscle-musculocutaneous flap group, in whom latissimus dorsi and rectus abdominus muscle-musculocutaneous free flaps were used (30 cases). Postoperative complications, long-term results, and donor site morbidities were studied in the two groups. Complete flap survival was 78.3% with four total and one partial flap loss in the ALT group and 90.0% with one total and two partial failure in the muscle-musculocutaneous flap group. Muscle-musculocutaneous flaps were the flaps of choice in Gustillo grade IIIB-C injuries and for reconstruction of more proximal localizations. ALT was preferred in relatively younger patients and was typically used for coverage of the distally localized defects. Flap complication rate was significantly higher in the ALT group, but the overall complication rate was similar between the groups. ALT perforator flap is a precious option for lower extremity soft tissue reconstruction with minimal donor site morbidity. Nevertheless, the beginners should be attentive to an increased rate of flap complications with the ALT flap and free axial muscle-musculocutaneous flaps would still be the tissue of choice for coverage of leg defects for a surgeon before gaining enough experience with perforator flap dissection.

  18. Flow field of flexible flapping wings

    Science.gov (United States)

    Sallstrom, Erik

    The agility and maneuverability of natural fliers would be desirable to incorporate into engineered micro air vehicles (MAVs). However, there is still much for engineers to learn about flapping flight in order to understand how such vehicles can be built for efficient flying. The goal of this study is to develop a methodology for capturing high quality flow field data around flexible flapping wings in a hover environment and to interpret it to gain a better understanding of how aerodynamic forces are generated. The flow field data was captured using particle image velocimetry (PIV) and required that measurements be taken around a repeatable flapping motion to obtain phase-averaged data that could be studied throughout the flapping cycle. Therefore, the study includes the development of flapping devices with a simple repeatable single degree of freedom flapping motion. The acquired flow field data has been examined qualitatively and quantitatively to investigate the mechanisms behind force production in hovering flight and to relate it to observations in previous research. Specifically, the flow fields have been investigated around a rigid wing and several carbon fiber reinforced flexible membrane wings. Throughout the whole study the wings were actuated with either a sinusoidal or a semi-linear flapping motion. The semi-linear flapping motion holds the commanded angular velocity nearly constant through half of each half-stroke while the sinusoidal motion is always either accelerating or decelerating. The flow fields were investigated by examining vorticity and vortex structures, using the Q criterion as the definition for the latter, in two and three dimensions. The measurements were combined with wing deflection measurements to demonstrate some of the key links in how the fluid-structure interactions generated aerodynamic forces. The flow fields were also used to calculate the forces generated by the flapping wings using momentum balance methods which yielded

  19. Medroxyprogesterone acetate and levonorgestrel increase genital mucosal permeability and enhance susceptibility to genital herpes simplex virus type 2 infection.

    Science.gov (United States)

    Quispe Calla, N E; Vicetti Miguel, R D; Boyaka, P N; Hall-Stoodley, L; Kaur, B; Trout, W; Pavelko, S D; Cherpes, T L

    2016-11-01

    Depot-medroxyprogesterone acetate (DMPA) is a hormonal contraceptive especially popular in areas with high prevalence of HIV and other sexually transmitted infections (STI). Although observational studies identify DMPA as an important STI risk factor, mechanisms underlying this connection are undefined. Levonorgestrel (LNG) is another progestin used for hormonal contraception, but its effect on STI susceptibility is much less explored. Using a mouse model of genital herpes simplex virus type 2 (HSV-2) infection, we herein found that DMPA and LNG similarly reduced genital expression of the desmosomal cadherin desmoglein-1α (DSG1α), enhanced access of inflammatory cells to genital tissue by increasing mucosal epithelial permeability, and increased susceptibility to viral infection. Additional studies with uninfected mice revealed that DMPA-mediated increases in mucosal permeability promoted tissue inflammation by facilitating endogenous vaginal microbiota invasion. Conversely, concomitant treatment of mice with DMPA and intravaginal estrogen restored mucosal barrier function and prevented HSV-2 infection. Evaluating ectocervical biopsy tissue from women before and 1 month after initiating DMPA remarkably revealed that inflammation and barrier protection were altered by treatment identically to changes seen in progestin-treated mice. Together, our work reveals DMPA and LNG diminish the genital mucosal barrier; a first-line defense against all STI, but may offer foundation for new contraceptive strategies less compromising of barrier protection.

  20. Intraoperative flap complications in lasik surgery performed by ophthalmology residents

    Directory of Open Access Journals (Sweden)

    Lorena Romero-Diaz-de-Leon

    2016-01-01

    Conclusion: Flap-related complications are common intraoperative event during LASIK surgery performed by in-training ophthalmologists. Keratometries and surgeon's first procedure represent a higher probability for flap related complications than some other biometric parameters of patient's eye.

  1. The Versatile Extended Thoracodorsal Artery Perforator Flap for Breast Reconstruction

    DEFF Research Database (Denmark)

    Jacobs, Jordan; Børsen-Koch, Mikkel; Gunnarsson, Gudjon Leifur

    2015-01-01

    BACKGROUND: The thoracodorsal artery perforator (TAP) flap is a versatile tool that can be used to reconstruct the breast. The authors use preoperative perforator mapping using color Doppler ultrasonography and present a safe, efficient harvesting technique to demonstrate reliable use of the TAP...... flap in reconstructive surgery. METHODS: A multicenter, retrospective review was performed on all patients undergoing TAP flap reconstruction from August 2011 to November 2014. Data were collected from patient records as well as outpatient interviews. RESULTS: A total of 106 TAP flaps were performed...... complications occurred in 10 of 106 (10%) cases and included hematoma (1/108), venous congestion (2/108), and partial flap necrosis (7/108). The reconstructive goal was achieved in 103 of 106 (97%) flaps. CONCLUSIONS: The TAP flap is a pedicled, fasciocutaneous flap that can be used for total breast...

  2. Breast shaping by an isolated tissue flap.

    Science.gov (United States)

    Voigt, Matthias; Andree, C

    2006-01-01

    Breast reshaping surgery for tuberous breast, breast reduction, and mastopexy procedures aim to keep the gained shape for a long time. In breast reduction, the surgeon must avoid loss of fullness in the upper pole, descent of the breast mass known as secondary dropout, and relapsed shape of the repaired tuberous breasts. As described in their clinical report, the authors use a caudally based thoracic wall flap to avoid these problems. The blood supply to the breast comes from two main sources: the mammary internal and lateral arteries. Because of vessels constantly perforating the pectoralis major muscle, it is possible to isolate a caudally based thoracic wall flap. These vessels originate from intercostal arteries as anteromedial intercostal perforators, and from the thoracoacromial artery as in the skin paddle of the pectoralis major muscle flap. This flap is long enough to reach every part of the breast where it is needed. Between January 2002 and June 2005, 64 patients underwent procedures in which the caudally based thoracic wall flap was used.

  3. The forked flap repair for hypospadias

    Directory of Open Access Journals (Sweden)

    Anil Chadha

    2012-01-01

    Full Text Available Context: Despite the abundance of techniques for the repair of Hypospadias, its problems still persist and a satisfactory design to correct the penile curvature with the formation of neourethra from the native urethral tissue or genital or extragenital tissues, with minimal postoperative complications has yet to evolve. Aim: Persisting with such an endeavor, a new technique for the repair of distal and midpenile hypospadias is described. Materials and Methods: The study has been done in 70 cases over the past 11 years. The "Forked-Flap" repair is a single stage method for the repair of such Hypospadias with chordee. It takes advantage of the rich vascular communication at the corona and capitalizes on the established reliability of the meatal based flip-flap. The repair achieves straightening of the curvature of the penis by complete excision of chordee tissue from the ventral surface of the penis beneath the urethral plate. The urethra is reconstructed using the native plate with forked flap extensions and genital tissue relying on the concept of meatal based flaps. Water proofing by dartos tissue and reinforcement by Nesbit′s prepucial tissue transfer completes the one stage procedure. Statistical Analysis: An analysis of 70 cases of this single stage technique of repair of penile hypospadias with chordee, operated at 3 to 5 years of age over the past 11 years is presented. Results and Conclusion: The Forked Flap gives comparable and replicable results; except for a urethrocutaneous fistula rate of 4% no other complications were observed.

  4. Hardware removal after osseous free flap reconstruction.

    Science.gov (United States)

    Day, Kristine E; Desmond, Renee; Magnuson, J Scott; Carroll, William R; Rosenthal, Eben L

    2014-01-01

    Identifying risk factors for hardware removal in patients undergoing mandibular reconstruction with vascularized osseous free flaps remains a challenge. The purpose of this study is to identify potential risk factors, including osteocutaneous radial forearm versus fibular flap, for need for removal and to describe the fate of implanted hardware. Case series with chart review Setting Academic tertiary care medical center. Two hundred thirteen patients undergoing 227 vascularized osseous mandibular reconstructions between the years 2004 and 2012. Data were compiled through a manual chart review, and patients incurring hardware removals were identified. Thirty-four of 213 evaluable vascularized osseous free flaps (16%) underwent surgical removal of hardware. The average length of time to removal was 16.2 months (median 10 months), with the majority of removals occurring within the first year. Osteocutaneous radial forearm free flaps (OCRFFF) incurred a slightly higher percentage of hardware removals (9.9%) compared to fibula flaps (6.1%). Partial removal was performed in 8 of 34 cases, and approximately 38% of these required additional surgery for removal. Hardware removal was associated with continued tobacco use after mandibular reconstruction (P = .03). Removal of the supporting hardware most commonly occurs from infection or exposure in the first year. In the majority of cases the bone is well healed and the problem resolves with removal.

  5. Perforator plus flaps: Optimizing results while preserving function and esthesis

    Directory of Open Access Journals (Sweden)

    Mehrotra Sandeep

    2010-01-01

    Full Text Available Background: The tenuous blood supply of traditional flaps for wound cover combined with collateral damage by sacrifice of functional muscle, truncal vessels, or nerves has been the bane of reconstructive procedures. The concept of perforator plus flaps employs dual vascular supply to flaps. By safeguarding perforators along with supply from its base, robust flaps can be raised in diverse situations. This is achieved while limiting collateral damage and preserving nerves, vessels, and functioning muscle with better function and aesthesis. Materials and Methods: The perforator plus concept was applied in seven different clinical situations. Functional muscle and fasciocutaneous flaps were employed in five and adipofascial flaps in two cases, primarily involving lower extremity defects and back. Adipofascial perforator plus flaps were employed to provide cover for tibial fracture in one patients and chronic venous ulcer in another. Results: All flaps survived without any loss and provided long-term stable cover, both over soft tissue and bone. Functional preservation was achieved in all cases where muscle flaps were employed with no clinical evidence of loss of power. There was no sensory loss or significant oedema in or distal to the flap in both cases where neurovascular continuity was preserved during flap elevation. Fracture union and consolidation were satisfactory. One patient had minimal graft loss over fascia which required application of stored grafts with subsequent take. No patient required re-operation. Conclusions: Perforator plus concept is holistic and applicable to most flap types in varied situations. It permits the exercise of many locoregional flap options while limiting collateral functional damage. Aesthetic considerations are also addressed while raising adipofascial flaps because of no appreciable donor defects. With quick operating times and low failure risk, these flaps can be a better substitute to traditional flaps and at

  6. Girth augmentation of the penis using flaps "Shaeer's augmentation phalloplasty": the superficial circumflex iliac flap.

    Science.gov (United States)

    Shaeer, Osama

    2014-07-01

    Penile girth augmentation can be achieved by various techniques, among which are liposuction injection, synthetic grafts, and autologous grafts, with variable outcome, mostly related to viability and receptivity of the tissue used for augmentation. Flaps are considered superior to grafts considering their uninterrupted blood supply. The current work describes long-term experience with penile girth augmentation using the superficial circumflex iliac artery and vein (SCIAV) flap. SCIAV flap was used for penile girth augmentation in 40 candidates who followed up for a minimum of 18 months. The flap was mobilized from the groin region. The penis was pulled out of a peno-pubic incision. The flap was tunneled under the pubic region to emerge at the base of the penis and was sutured to the subcoronal area and on either sides of the spongiosum. Another session was required for either de-bulking of the oversized flap (four overweight candidates), flap pedicle (n = 6), or for donor site scar revision (n = 11). Gain in girth in centimeters was evaluated. Excluding dropouts (n = 8) and participants who had encountered de-bulking of the flap body (n = 4), 40 participants had a preoperative average flaccid girth (AFG) of 9.3 ± 1.1 cm. Immediately postoperative AFG was 14.9 ± 1.1 cm (P < 0.001). Postoperative AFG at the final follow-up visit (a minimum of 18 months) was 14.5 ± 1.1 cm (55.6% gain compared with baseline, P < 0.001). SCIAV flap is a reliable option for long-lasting and sizable penile girth augmentation. One-stage augmentation is more suited for non-obese candidates. A second session may be indicated in overweight candidates or for scar revision. © 2014 International Society for Sexual Medicine.

  7. Vaginal Biogenic Amines: Biomarkers of Bacterial Vaginosis or Precursors to Vaginal Dysbiosis?

    Directory of Open Access Journals (Sweden)

    Tiffanie Maree Nelson

    2015-09-01

    Full Text Available Bacterial vaginosis (BV is the most common vaginal disorder among reproductive age women. One clinical indicator of BV is a ‘fishy’ odor. This odor has been associated with increases in several biogenic amines (BAs that may serve as important biomarkers. Within the vagina, BA production has been linked to various vaginal taxa, yet their genetic capability to synthesize BAs is unknown. Using a bioinformatics approach, we show that relatively few vaginal taxa are predicted to be capable of producing BAs. Many of these taxa (Dialister, Prevotella, Parvimonas, Megasphaera, Peptostreptococcus, and Veillonella spp. are more abundant in the vaginal microbial community state type (CST IV, which is depleted in lactobacilli. Several of the major Lactobacillus species (L. crispatus, L. jensenii, and L. gasseri were identified as possessing gene sequences for proteins predicted to be capable of putrescine production. Finally, we show in a small cross sectional study of 37 women that the BAs putrescine, cadaverine and tyramine are significantly higher in CST IV over CSTs I and III. These data support the hypothesis that BA production is conducted by few vaginal taxa and may be important to the outgrowth of BV-associated (vaginal dysbiosis vaginal bacteria.

  8. Inside the mucosal immune system.

    Directory of Open Access Journals (Sweden)

    Jerry R McGhee

    Full Text Available An intricate network of innate and immune cells and their derived mediators function in unison to protect us from toxic elements and infectious microbial diseases that are encountered in our environment. This vast network operates efficiently by use of a single cell epithelium in, for example, the gastrointestinal (GI and upper respiratory (UR tracts, fortified by adjoining cells and lymphoid tissues that protect its integrity. Perturbations certainly occur, sometimes resulting in inflammatory diseases or infections that can be debilitating and life threatening. For example, allergies in the eyes, skin, nose, and the UR or digestive tracts are common. Likewise, genetic background and environmental microbial encounters can lead to inflammatory bowel diseases (IBDs. This mucosal immune system (MIS in both health and disease is currently under intense investigation worldwide by scientists with diverse expertise and interests. Despite this activity, there are numerous questions remaining that will require detailed answers in order to use the MIS to our advantage. In this issue of PLOS Biology, a research article describes a multi-scale in vivo systems approach to determine precisely how the gut epithelium responds to an inflammatory cytokine, tumor necrosis factor-alpha (TNF-α, given by the intravenous route. This article reveals a previously unknown pathway in which several cell types and their secreted mediators work in unison to prevent epithelial cell death in the mouse small intestine. The results of this interesting study illustrate how in vivo systems biology approaches can be used to unravel the complex mechanisms used to protect the host from its environment.

  9. Transoral Mucosal Excision Sutured Gastroplasty

    Science.gov (United States)

    Legner, Andras; Altorjay, Aron; Juhasz, Arpad; Stadlhuber, Rudolph; Reich, Viktor; Hunt, Brandon; Rothstein, Richard

    2014-01-01

    Introduction. An outpatient transoral endoscopic procedure for gastroesophageal reflux disease (GERD) and obesity would be appealing if safe, effective, and durable. We present the first in human experience with a new system. Methods. Eight patients with GERD (3) and obesity (5) were selected according to a preapproved study protocol. All GERD patients had preprocedure manometry and pH monitoring to document GERD as well as quality of life and symptom questionnaires. Obese patients (body mass index >35) underwent a psychological evaluation and tests for comorbidities. Under general anesthesia, a procedure was performed at the gastroesophageal junction including mucosal excision, suturing of the excision beds for apposition, and suture knotting. Results. One patient with micrognathia could not undergo the required preprocedural passage of a 60 F dilator and was excluded. The first 2 GERD patients had incomplete procedures due to instrument malfunction. The subsequent 5 subjects had a successfully completed procedure. Four patients were treated for obesity and had an average excess weight loss of 30.3% at 2-year follow-up. Of these patients, one had an 8-mm outlet at the end of the procedure recognized on video review—a correctable error—and another vomited multiple times postoperatively and loosened the gastroplasty sutures. The treated GERD patient had resolution of reflux-related symptoms and is off all antisecretory medications at 2-year follow-up. Her DeMeester score was 8.9 at 24 months. Conclusion. The initial human clinical experience showed promising results for effective and safe GERD and obesity therapy. PMID:24623807

  10. scrotal reconstruction with a pedicled gracilis muscle flap after ...

    African Journals Online (AJOL)

    better functional and cosmetic outcomes. Muscle and myocutaneous flaps like gracilis, rectus abdominis, split gluteus maximus flaps are needed for large skin defects with deep pockets or cavities to eliminate the dead space (2,3). The pedicled or free greater omental flap as well as scrotal tissue expansion have also been ...

  11. Study of design parameters of flapping-wings

    NARCIS (Netherlands)

    Wang, Q.; Goosen, J.F.L.; Van Keulen, F.

    2014-01-01

    As one of the most important components of a flapping-wing micro air vehicle (FWMAV), the design of an energy-efficient flapping-wing has been a research interest recently. Research on insect flight from different perspectives has been carried out, mainly with regard to wing morphology, flapping

  12. Prospective evaluation of outcome measures in free-flap surgery.

    LENUS (Irish Health Repository)

    Kelly, John L

    2004-08-01

    Free-flap failure is usually caused by venous or arterial thrombosis. In many cases, lack of experience and surgical delay also contribute to flap loss. The authors prospectively analyzed the outcome of 57 free flaps over a 28-month period (January, 1999 to April, 2001). The setting was a university hospital tertiary referral center. Anastomotic technique, ischemia time, choice of anticoagulant, and the grade of surgeon were recorded. The type of flap, medications, and co-morbidities, including preoperative radiotherapy, were also documented. Ten flaps were re-explored (17 percent). There were four cases of complete flap failure (6.7 percent) and five cases of partial failure (8.5 percent). In patients who received perioperative systemic heparin or dextran, there was no evidence of flap failure (p = .08). The mean ischemia time was similar in flaps that failed (95 +\\/- 29 min) and in those that survived (92 +\\/- 34 min). Also, the number of anastomoses performed by trainees in flaps that failed (22 percent), was similar to the number in flaps that survived (28 percent). Nine patients received preoperative radiotherapy, and there was complete flap survival in each case. This study reveals that closely supervised anastomoses performed by trainees may have a similar outcome to those performed by more senior surgeons. There was no adverse effect from radiotherapy or increased ischemia time on flap survival.

  13. Peroperative evaluation of vascularity of various flaps by fluorescein technique

    Directory of Open Access Journals (Sweden)

    Bhattacharya V

    2006-01-01

    Full Text Available Background: The viability of any pedicled flap depends upon its vascularity. When a flap is dissected it becomes relatively ischaemic. Ultimately, the viability of the flap depends on the vessels incorporated in the pedicle and their perfusion capacity. There are different techniques to evaluate the blood supply of a flap. Aims: This study deals with experimental and clinical efficiency of fluorescein dye technique to evaluate the vascularity of flaps of various compositions. Materials and Methods: The experimental study was conducted on rats to standardize the technique. Thereafter clinical evaluation was conducted for different flaps namely fasciocutaneous, skeletonized perforator based fasciocutaneous, adipofascial, fasciocutaneous flap with adipofascial extension, fasciocutaneous flap with fascial extension and fasciocutaneous flap with split fascial extension. Conclusions: The paper deals in detail with the technique and method of documentation of a fluorescein study on flaps both experimentally and clinically. The appearance of fluorescein on both the surfaces and distal margin of the flap confirmed the adequacy of vascularity soon after dissection of the flaps. It was found to be an easy, safe and reliable objective method.

  14. Propeller Flap for Complex Distal Leg Reconstruction: A Versatile ...

    African Journals Online (AJOL)

    Reverse sural artery fasciocutaneous flap has become a workhorse for the reconstruction of distal leg soft ... A Versatile Alternative when Reverse Sural Artery Flap is. Not Feasible. Samuel A. Ademola, Afieharo I. .... flaps that were raised in the patient and the logistics of limb positioning after application of external fixators ...

  15. The management of pelvic pressure ulcers by myocutaneous flaps ...

    African Journals Online (AJOL)

    The sex ratio was 5 men for 4 women 10 sacral ulcers were treated by gluteus maximus myocutaneous flaps, 10 trochanteric and 4 ischiatic ulcers were covered by tensor fascia lata myocutaneous flaps. The cure rate was 100%. The main complications were: infection (63.5%), serous fluid discharge (21.05%), and flap ...

  16. Posttraumatic eyebrow reconstruction with hair-bearing temporoparietal fascia flap

    Science.gov (United States)

    Denadai, Rafael; Raposo-Amaral, Cassio Eduardo; Marques, Frederico Figueiredo; Raposo-Amaral, Cesar Augusto

    2015-01-01

    The temporoparietal fascia flap has been extensively used in craniofacial reconstructions. However, its use for eyebrow reconstruction has been sporadically reported. We describe a successfully repaired hair-bearing temporoparietal fascia flap after traumatic avulsion of eyebrow. Temporoparietal fascia flap is a versatile tool and should be considered as a therapeutic option by all plastic surgeons. PMID:25993077

  17. Pregnancy's stronghold on the vaginal microbiome.

    Directory of Open Access Journals (Sweden)

    Marina R S Walther-António

    Full Text Available To assess the vaginal microbiome throughout full-term uncomplicated pregnancy.Vaginal swabs were obtained from twelve pregnant women at 8-week intervals throughout their uncomplicated pregnancies. Patients with symptoms of vaginal infection or with recent antibiotic use were excluded. Swabs were obtained from the posterior fornix and cervix at 8-12, 17-21, 27-31, and 36-38 weeks of gestation. The microbial community was profiled using hypervariable tag sequencing of the V3-V5 region of the 16S rRNA gene, producing approximately 8 million reads on the Illumina MiSeq.Samples were dominated by a single genus, Lactobacillus, and exhibited low species diversity. For a majority of the patients (n = 8, the vaginal microbiome was dominated by Lactobacillus crispatus throughout pregnancy. Two patients showed Lactobacillus iners dominance during the course of pregnancy, and two showed a shift between the first and second trimester from L. crispatus to L. iners dominance. In all of the samples only these two species were identified, and were found at an abundance of higher than 1% in this study. Comparative analyses also showed that the vaginal microbiome during pregnancy is characterized by a marked dominance of Lactobacillus species in both Caucasian and African-American subjects. In addition, our Caucasian subject population clustered by trimester and progressed towards a common attractor while African-American women clustered by subject instead and did not progress towards a common attractor.Our analyses indicate normal pregnancy is characterized by a microbiome that has low diversity and high stability. While Lactobacillus species strongly dominate the vaginal environment during pregnancy across the two studied ethnicities, observed differences between the longitudinal dynamics of the analyzed populations may contribute to divergent risk for pregnancy complications. This helps establish a baseline for investigating the role of the microbiome in

  18. Double papilla flap technique for dual purpose

    Directory of Open Access Journals (Sweden)

    P Mohan Kumar

    2012-01-01

    Full Text Available Marginal tissue recession exposes the anatomic root on the teeth, which gives rise to -common patient complaints. It is associated with sensitivity, tissue irritation, cervical abrasions, and esthetic concerns. Various types of soft tissue grafts may be performed when recession is deep and marginal tissue health cannot be maintained. Double papilla flap is an alternative technique to cover isolated recessions and correct gingival defects in areas of insufficient attached gingiva, not suitable for a lateral sliding flap. This technique offers the advantages of dual blood supply and denudation of interdental bone only, which is less susceptible to permanent damage after surgical exposure. It also offers the advantage of quicker healing in the donor site and reduces the risk of facial bone height loss. This case report presents the advantages of double papilla flap in enhancing esthetic and functional outcome of the patient.

  19. Fanconi anemia and vaginal squamous cell carcinoma

    Directory of Open Access Journals (Sweden)

    Jesus Paula Carvalho

    2012-01-01

    Full Text Available Fanconi Anemia (FA is an autosomal recessive disease characterized by chromosome instability, cellular hypersensitivity to DNA cross-linking agents, and increased predisposition to malignancies. We describe here a 28 year-old female with FA and vaginal squamous cell carcinoma treated by radiation therapy alone. The patient developed arm phlebitis, pulmonary fungal infection, and severe rectal bleeding, followed by hypocalcaemia, hypokalemia, vaginal bacterial and fungal infection, with subsequent leg and arm phlebitis, perineal abscess, and sepsis. The patient died 12 weeks later.

  20. Directed shift of vaginal microbiota induced by vaginal application of sucrose gel in rhesus macaques.

    Science.gov (United States)

    Hu, Kai-tao; Zheng, Jin-xin; Yu, Zhi-jian; Chen, Zhong; Cheng, Hang; Pan, Wei-guang; Yang, Wei-zhi; Wang, Hong-yan; Deng, Qi-wen; Zeng, Zhong-ming

    2015-04-01

    Sucrose gel was used to treat bacterial vaginosis in a phase III clinical trial. However, the changes of vaginal flora after treatment were only examined by Nugent score in that clinical trial, While the vaginal microbiota of rhesus macaques is characterized by anaerobic, Gram-negative bacteria, few lactobacilli, and pH levels above 4.6, similar to the microbiota of patients with bacterial vaginosis. This study is aimed to investigate the change of the vaginal microbiota of rehsus macaques after topical use of sucrose gel to reveal more precisely the bacterial population shift after the topical application of sucrose gel. Sixteen rhesus macaques were treated with 0.5 g sucrose gel vaginally and three with 0.5 g of placebo gel. Vaginal swabs were collected daily following treatment. Vaginal pH levels and Nugent scores were recorded. The composition of the vaginal micotbiota was tested by V3∼V4 16S rDNA metagenomic sequencing. Dynamic changes in the Lactobacillus genus were analyzed by qPCR. The vaginal microbiota of rhesus macaques are dominated by anaerobic Gram-negative bacteria, with few lactobacilli and high pH levels above 4.6. After five days' treatment with topical sucrose gel, the component percentage of Lactobacillus in vaginal microbiota increased from 1.31% to 81.59%, while the component percentage of Porphyromonas decreased from 18.60% to 0.43%, Sneathia decreased from 15.09% to 0.89%, Mobiluncus decreased from 8.23% to 0.12%, etc.. The average vaginal pH values of 16 rhesus macaques of the sucrose gel group decreased from 5.4 to 3.89. There were no significant changes in microbiota and vaginal pH observed in the placebo group. Rhesus macaques can be used as animal models of bacterial vaginosis to develop drugs and test treatment efficacy. Furthermore, the topical application of sucrose gel induced the shifting of vaginal flora of rhesus macaques from a BV kind of flora to a lactobacilli-dominating flora. Copyright © 2015 The Authors. Published by

  1. Prolapso vaginal e uterino em ovelhas Uterine and vaginal prolapse in ewes

    OpenAIRE

    Maíra Bianchi R. Alves; Benesi,Fernando J.; Lilian Gregory; Della Libera, Alice M.M.P.; Sucupira,Maria Cláudia A.; Fábio C. Pogliani; Viviani Gomes

    2013-01-01

    O presente trabalho objetivou realizar um estudo retrospectivo sobre os prolapsos vaginal e uterino em ovelhas atendidas no Serviço de Clínica de Bovinos e Pequenos Ruminantes (CBPR) da FMVZ/USP no período compreendido entre 2000 a 2010, no qual, foram atendidas 56 ovinos com problemas inerentes ao sistema reprodutivo, dessas, 25 apresentaram prolapso vaginal ou uterino (44,6%). O prolapso vaginal total foi o de maior frequência (72%). As ovelhas acometidas, em sua maioria, possuíam idade sup...

  2. Preliminary findings on vaginal epithelial cells and body ...

    African Journals Online (AJOL)

    sahelian zone of Cameroon, in order to assess vaginal cytology and body temperature variations during oestrous cycle. Swabbing was done daily in the vagina, and vaginal smears were stained according to Romanowski method.

  3. Vaginitis: How Many Women Are Affected/at Risk?

    Science.gov (United States)

    ... About 3% of women of childbearing age have trichomoniasis. 4 Many women with vaginal infections have no ... a yeast infection. 15 to 20 women have trichomoniasis. Who gets vaginitis and who is at risk? ...

  4. The transversely split gracilis twin free flaps

    Directory of Open Access Journals (Sweden)

    Upadhyaya Divya

    2010-01-01

    Full Text Available The gracilis muscle is a Class II muscle that is often used in free tissue transfer. The muscle has multiple secondary pedicles, of which the first one is the most consistent in terms of position and calibre. Each pedicle can support a segment of the muscle thus yielding multiple small flaps from a single, long muscle. Although it has often been split longitudinally along the fascicles of its nerve for functional transfer, it has rarely been split transversely to yield multiple muscle flaps that can be used to cover multiple wounds in one patient without subjecting him/her to the morbidity of multiple donor areas .

  5. Characterisation of probiotic properties in human vaginal lactobacilli strains

    OpenAIRE

    Hütt, Pirje; Lapp, Eleri; Štšepetova, Jelena; Smidt, Imbi; Taelma, Heleri; Borovkova, Natalja; Oopkaup, Helen; Ahelik, Ave; Rööp, Tiiu; Hoidmets, Dagmar; Samuel, Külli; Salumets, Andreas; Mändar, Reet

    2016-01-01

    Background: Vaginal lactobacilli offer protection against recurrent urinary infections, bacterial vaginosis, and vaginal candidiasis.Objective: To characterise the isolated vaginal lactobacilli strains for their probiotic properties and to compare their probiotic potential.Methods: The Lactobacillus strains were isolated from vaginal samples by conventional culturing and identified by sequencing of the 16S rDNA fragment. Several functional properties were detected (production of hydrogen pero...

  6. OUTCOME OF INSTRUMENTAL VAGINAL DELIVERIES IN REFERRED CASES

    OpenAIRE

    Prameela; Asha; Prajwal

    2015-01-01

    INTRODUCTION: Instrumental vaginal deliveries are important procedures. Performed in indicated cases and attending to the well laid criterias will reduce the fetal and maternal morbidity. These assisted instrumental vaginal deliveries help in reducing the caesarean sec tion rate. AIMS AND OBJECTIVES: To determine the incidence and indications of instrumental vaginal deliveries. To know the maternal and fetal outcome in ventouse (vaccum assisted vaginal delivery) and...

  7. Variety of Candida in Women with Abnormal Vaginal Discharge

    OpenAIRE

    Guevara Duncan, José; Instituto de Medicina Tropical "Daniel A. Carrión" Facultad de Medicina Universidad Nacional Mayor de San Marcos Lima, Perú; Béjar, Vilma; Instituto de Medicina Tropical "Daniel A. Carrión" Facultad de Medicina Universidad Nacional Mayor de San Marcos Lima, Perú; Cáceres, Alfredo; Hospital Arzobispo Loayza Lima, Perú; Valencia, Esther; Instituto de Medicina Tropical "Daniel A. Carrión" Facultad de Medicina Universidad Nacional Mayor de San Marcos Lima, Perú

    2014-01-01

    OBJECTIVES: Vaginal discharge and related aymptoms are frequent complaints among young women. The aim of this study was to describe Candida species isolated from vaginal discharge samples, as well as the relationship between Candida species and some of these symptoms. MATERIAL AND METHODS: A survey of consecutive patients presenting with vaginal discharge in the course of normal consultations was conducted at the Hospital Loayza. One hundred women with vaginal discharge were surveyed, with ma...

  8. Clinical predictors and risk factors for vaginal mesh extrusion.

    Science.gov (United States)

    Khrucharoen, Usah; Ramart, Patkawat; Choi, Judy; Kang, Diana; Kim, Ja-Hong; Raz, Shlomo

    2017-11-24

    Our study aims to enhance the accuracy of the clinical diagnosis in patients with vaginal mesh extrusion following transvaginal mesh placement for pelvic organ prolapse using significant clinical parameters and risk factors. All patients who underwent vaginal mesh removal were retrospectively reviewed from January 2000 to May 2014. Eligible patients were divided into two groups according to the presence of vaginal mesh extrusion. A total of 862 patients, 798 were included. 357 (44.7%) had evidence of vaginal mesh extrusion, and 441 (55.3%) had no evidence of vaginal mesh extrusion. The mean age of the vaginal mesh extrusion group was slightly higher than in the group without vaginal mesh extrusion (58.7 ± 11.2 vs. 56.4 ± 11.5, respectively; p = 0.002). From multivariate analysis, the significant clinical correlations for vaginal mesh extrusion were vaginal bleeding [60 (16.9) vs. 14 (3.2%), p vaginal discharge [45 (12.6) vs. 18 (4.1%), p = 0.001]. The risk factors were multiple mesh implantations [218 (67.06) vs. 175 (39.68%), p vaginal atrophy, both local and systemic hormonal use, smoking status, and hysterectomy status, were not significantly different, as well as the clinical symptoms including dyspareunia, vaginal infection, and symptomatic vaginal bulge. Vaginal bleeding, hispareunia, and vaginal discharge were the most significant clinical predictors for raising suspicion of vaginal mesh extrusion. Multiple mesh implantations were a significant risk factor for extrusion.

  9. An audit of instrumental vaginal delivery in Aminu Kano Teaching ...

    African Journals Online (AJOL)

    Context: Operative vaginal delivery is used to shorten the second stage of labour. Objective: The aim of this study is to determine the incidence of instrumental vaginal deliveries in a large teaching hospital. Study design and setting: Descriptive study involving 354 women, who either had forceps or vacuum operative vaginal ...

  10. Prevalence of Vaginal Candidiasis among Pregnant Women with ...

    African Journals Online (AJOL)

    BACKGROUND: Pregnancy represents a risk factor in the occurrence of vaginal candidiasis. OBJECTIVES: To determine the prevalence and clinical features associated with abnormal vaginal discharge and C. albicans infection in pregnant women. METHODS: High vaginal swab samples and data on epidemiological ...

  11. Complete utero vaginal prolapse in a woman with prolapsed ...

    African Journals Online (AJOL)

    Case: A case of irreducible complete utero-vaginal and infected sub-mucous fibroid prolapse, in a 45-year-old grandmultiparous woman, is reported. Bed rest and antibiotics failed to relief edema and infection of the vault. Vaginal myomectomy, followed by interval vaginal hysterectomy, and pelvic floor repair a week later ...

  12. Transcytosis of HIV-1 through vaginal epithelial cells is dependent on trafficking to the endocytic recycling pathway.

    Directory of Open Access Journals (Sweden)

    Ballington L Kinlock

    Full Text Available While it is accepted that viruses can enter epithelial cells by endocytosis, the lack of an established biological mechanism for the trafficking of infectious virions through vaginal epithelial cells and their release from the plasma membrane has contributed to ongoing controversy about whether endocytosis is a mere artifact of some cell culture systems and whether squamous vaginal epithelial cells are even relevant as it pertains to HIV-1 transmission.In this study, we investigated the intracellular trafficking pathway that HIV-1 exploits to transcytose vaginal epithelial cells. The reduction of endosome tubulation by recycling endosome inhibitors blocked transcytosis of HIV-1 in a cell culture and transwell system. In addition, we demonstrate that although heat-inactivated virus was endocytosed as efficiently as native virus, heat-inactivated virus was trafficked exclusively to the lysosomal pathway for degradation following endocytosis. Lysosomal protease-specific inhibitors blocked the degradation of inactivated virions. Immunofluorescence analysis not only demonstrated that HIV-1 was inside the cells but the different colocalization pattern of native vs. heat inactivated virus with transferrin provided conclusive evidence that HIV-1 uses the recycling pathway to get across vaginal epithelial cells.Altogether, our findings demonstrate the precise intracellular trafficking pathway utilized by HIV-1 in epithelial cells, confirms that HIV-1 transcytosis through vaginal epithelial cells is a biological phenomenon and brings to light the differential intracellular trafficking of native vs heat-inactivated HIV-1 which with further exploration could prove to provide valuable insights that could be used in the prevention of transcytosis/transmission of HIV-1 across the mucosal epithelia.

  13. Recent progress in mucosal vaccine development: potential and limitations.

    Science.gov (United States)

    Lycke, Nils

    2012-07-25

    Most pathogens access the body through the mucosal membranes. Therefore, effective vaccines that protect at these sites are much needed. However, despite early success with the live attenuated oral polio vaccine over 50 years ago, only a few new mucosal vaccines have been subsequently launched. This is partly due to problems with developing safe and effective mucosal adjuvants. In the past decade, however, the successful development of live attenuated mucosal vaccines against influenza virus and rotavirus infections has boosted interest in this field, and great expectations for new mucosal vaccines lie ahead. Here, I discuss the expanding knowledge and strategies used in the development of mucosal vaccines.

  14. Suspension Bridge Flutter for Girder with Separate Control Flaps

    DEFF Research Database (Denmark)

    Huynh, T.; Thoft-Christensen, Palle

    Active vibration control of long span suspension bridge flutter using separated control flaps (SFSC) has shown to increase effectively the critical wind speed of bridges. In this paper, an SFSC calculation based on modal equations of the vertical and torsional motions of the bridge girder including...... the flaps is presented. The length of the flaps attached to the girder, the flap configuration and the flap rotational angles are parameters used to increase the critical wind speed of the bridge. To illustrate the theory a numerical example is shown for a suspension bridge of 1000m+2500m+1000m span based...... on the Great Belt Bridge streamlined girder....

  15. Fascia-only anterolateral thigh flap for extremity reconstruction.

    Science.gov (United States)

    Fox, Paige; Endress, Ryan; Sen, Subhro; Chang, James

    2014-05-01

    The ability to use the anterolateral thigh (ALT) flap as a vascularized fascial flap, without skin or muscle, was first documented by Koshima et al in 1989. The authors mention the possibility of using the fascia alone for dural reconstruction. Despite its description more than 20 years ago, little literature exists on the application of the ALT flap as a vascularized fascial flap. In our experience, the ALT flap can be used as a fascia-only flap for thin, pliable coverage in extremity reconstruction. After approval from the institutional review board, the medical records and photographs of patients who had undergone fascia-only ALT free flaps for extremity reconstruction were reviewed. Photographic images of patients were then matched to patients who had undergone either a muscle-only or a fasciocutaneous free flap reconstruction of an extremity. Photographs of the final reconstruction were then given to medical and nonmedical personnel for analysis, focusing on aesthetics including color and contour. Review of cases performed over a 2-year period demonstrated similar ease of harvest for fascia-only ALT flaps compared to standard fasciocutaneous ALT flaps. Fascia-only flaps were used for thin, pliable coverage in the upper and lower extremities. There was no need for secondary procedures for debulking or aesthetic flap revision. In contrast to muscle flaps, which require muscle atrophy over time to achieve their final appearance, there was a similar flap contour from approximately 1 month postoperatively throughout the duration of follow-up. When a large flap is required, the fascia-only ALT has the advantage of a single-line donor-site scar. Photograph comparison to muscle flaps with skin grafts and fasciocutaneous flaps demonstrated improved color, contour, and overall aesthetic appearance of the fascia-only ALT over muscle and fasciocutaneous flaps. The fascia-only ALT flap provides reliable, thin, and pliable coverage with improved contour and color over

  16. Relationship among vaginal palpation, vaginal squeeze pressure, electromyographic and ultrasonographic variables of female pelvic floor muscles.

    Science.gov (United States)

    Pereira, Vanessa S; Hirakawa, Humberto S; Oliveira, Ana B; Driusso, Patricia

    2014-01-01

    The proper evaluation of the pelvic floor muscles (PFM) is essential for choosing the correct treatment. Currently, there is no gold standard for the assessment of female PFM function. To determine the correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the female PFM. This cross-sectional study evaluated 80 women between 18 and 35 years of age who were nulliparous and had no pelvic floor dysfunction. PFM function was assessed based on digital palpation, vaginal squeeze pressure, electromyographic activity, bilateral diameter of the bulbocavernosus muscles and the amount of bladder neck movement during voluntary PFM contraction using transperineal bi-dimensional ultrasound. The Pearson correlation was used for statistical analysis (ppalpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the PFM in nulliparous women. The strong correlation between digital palpation and PFM contraction pressure indicated that perineometry could easily be replaced by PFM digital palpation in the absence of equipment.

  17. [Prolapse surgery. With abdominal or vaginal meshes?].

    Science.gov (United States)

    Loertzer, H; Schneider, P; Thelen, P; Ringert, R H; Strauß, A

    2012-09-01

    In prolapse surgery several surgical techniques are available. The different open, laparoscopic and vaginal approaches are distinguished by distinct success and relapse rates and operation-specific complications. A safe and optimal therapeutic pelvic floor surgery should be based on the three support levels according to DeLancy and be individually adjusted for every patient. The vaginal approach may be used for all kinds of female genital prolapse and is a comparatively less invasive technique with a short time of convalescence. Apart from stress incontinence there is no need for synthetic meshes in primary approaches and excellent results with low complication and relapse rates can be achieved. An uncritical application of synthetic material is to be avoided in vaginal repair at all times. Abdominal surgical techniques, both open and laparoscopic, present their strengths in the therapeutic approach to level 1 defects or stress incontinence. They provide excellent functional and anatomical corrections and low relapse rates. Abdominally inserted meshes have lower complication rates than vaginal ones.

  18. Predictors of vaginal delivery in nulliparous mothers

    African Journals Online (AJOL)

    Background: Nulliparity is an obstetric high-risk group whose labor, compared with multiparae, are more likely to develop labor abnormalities that requires intervention. The aim of this report is todetermine factors that influence vaginal delivery in nulliparae. Materials and Methods: A prospective cross-sectional study was ...

  19. Vaginal plethysmography in women with dyspareunia

    NARCIS (Netherlands)

    Wouda, JC; Hartman, Petra M; Bakker, Riksta M; Bakker, JO; van de Wiel, HBM; Schultz, WCMW

    We investigated by means of vaginal plethysmography the extent to which the genital reactions of women with dyspareunia (N = 18) differed from those of women without dyspareunia (N = 16) during sexual arousal. In addition, we used questionnaires to investigate whether the genital reaction was

  20. Vaginal Lacerations from Consensual Intercourse in Adolescents

    Science.gov (United States)

    Frioux, Sarah M.; Blinman, Thane; Christian, Cindy W.

    2011-01-01

    Objective: (1) To describe lacerations of the vaginal fornices, an injury known to be associated with consensual sexual intercourse, including known complications and treatment course, (2) to contrast these injuries with injuries sustained during sexual assault, and (3) to discuss the assessment of adolescent patients for sexual injuries. Methods:…

  1. assisted vaginal hysterectomy versus abdominal hysterectomy on ...

    African Journals Online (AJOL)

    J Gynecol Surg 1989;. 5: 213-216. 2. Garry R. Various approaches to laparoscopic hysterectomies. Curr Opin Obstet. Gynecol 1994; 6: 215-222. 3. Dickec RC, Greenspan J. Strauss LT, et al. Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. Am J Obstet. Gynecol ...

  2. VAGINAL HYSTERECTOMY - CEFUROXIME, METRONIDAZOLE OR BOTH

    NARCIS (Netherlands)

    KAUER, FM; WIJMA, J; MANSON, WL

    1990-01-01

    A randomized double-blind prospective study on the efficacy of single-dose antibiotic prophylaxis compared cefuroxime versus metronidazole versus the combination of both agents in vaginal hysterectomy. Overall antibiotic prophylaxis was effective in abscess prevention (one abscess in 68 patients).

  3. [Significance of laparoscopic assistance in vaginal hysterectomy].

    Science.gov (United States)

    Malinowski, Andrzej; Bobin, Leszek; Maciołek-Blewniewska, Grazyna

    2005-01-01

    The objective of this publication was the analysis of laparoscopically assisted vaginal hysterectomies (LAVH) performed in Department of Surgical and Endoscopic Gynecology of Polish Mother Health Centre Research Institute. There was the analysis of 57 LAVHs performed from June 2002 to December 2003. Following parameters were evaluated: indications to LAVH, operating time, weight of the removed uterus, complications, blood loss, duration of postoperative hospitalisation, the day of introducing general diet, anesthetic and antibiotic demand in postoperative period. There were indications to LAVH: fibroid uterus, endometrial hyperplasia, endometrial cancer, adnexal mass, cervix dysplasia. Previous laparotomy and caesarean section, endometriosis, narrow vagina of non-parous women were additional indications to use of laparoscopy during the operation. Complications were found in two (3,5%) cases: bleeding to abdominal cavity from infundibulo-pelvic ligament demanding reoperation and superficial epigastric artery injury no demanding reoperation. There were no infection, conversion to laparotomy, abdominal cavity organs injury and other complications. It was observed short time of introducing general diet, low anesthetic consumption and short post-operation stay in hospital (mean 3,6 days). Laparoscopically assisted vaginal hysterectomy is an operation with a small risk of intra- and postoperative complications, quick return to general diet and full life activity, short post-operation stay in hospital, low anesthetic consumption and good cosmetic effect. Use of laparoscopic stage in vaginal hysterectomy make possible evasion of laparotomy in the situation of impossible performance of ordinary vaginal hysterectomy.

  4. Vaginal yeast infections in diabetic women

    African Journals Online (AJOL)

    The overall vaginal prevalence of C. albicans was 12,8% (26/203 patients). This yeast was associated with genital symp- toms in 84,6% (22/26) ofthe patients from whom it was isolated. Only 4 patients without symptoms yielded C. albicans. One of these had classic candidiasis on clinical grounds, while the other 3 patients ...

  5. Red alert – Infant vaginal bleeding

    Directory of Open Access Journals (Sweden)

    Veerabhadra Radhakrishna

    2015-02-01

    Full Text Available Infant vaginal bleeding is an alarming symptom in an infant. Although several causes can be listed, the possibility of malignancy still needs to be ruled out in view of the guarded prognosis of these uncommon infantile tumors. This case report aims to raise the awareness towards the workup and management of infantile malignancies in a baby girl

  6. The vaginal microflora in relation to gingivitis

    Science.gov (United States)

    2009-01-01

    Background Gingivitis has been linked to adverse pregnancy outcome (APO). Bacterial vaginosis (BV) has been associated with APO. We assessed if bacterial counts in BV is associated with gingivitis suggesting a systemic infectious susceptibilty. Methods Vaginal samples were collected from 180 women (mean age 29.4 years, SD ± 6.8, range: 18 to 46), and at least six months after delivery, and assessed by semi-quantitative DNA-DNA checkerboard hybridization assay (74 bacterial species). BV was defined by Gram stain (Nugent criteria). Gingivitis was defined as bleeding on probing at ≥ 20% of tooth sites. Results A Nugent score of 0–3 (normal vaginal microflora) was found in 83 women (46.1%), and a score of > 7 (BV) in 49 women (27.2%). Gingivitis was diagnosed in 114 women (63.3%). Women with a diagnosis of BV were more likely to have gingivitis (p = 0.01). Independent of gingival conditions, vaginal bacterial counts were higher (p gingivitis had higher counts of Prevotella bivia (p 1.0 × 104 cells) and a diagnosis of gingivitis was 3.9 for P. bivia (95% CI 1.5–5.7, p gingivitis in comparison to women with BV but not gingivitis. P. bivia and P. disiens may be of specific significance in a relationship between vaginal and gingival infections. PMID:19161595

  7. Prolapso vaginal e uterino em ovelhas

    National Research Council Canada - National Science Library

    Maíra Bianchi R. Alves; Fernando J. Benesi; Lilian Gregory; Alice M.M.P. Della Libera; Maria Cláudia A. Sucupira; Fábio C. Pogliani; Viviani Gomes

    2013-01-01

    ... de Clínica de Bovinos e Pequenos Ruminantes (CBPR) da FMVZ/USP no período compreendido entre 2000 a 2010, no qual, foram atendidas 56 ovinos com problemas inerentes ao sistema reprodutivo, dessas, 25 apresentaram prolapso vaginal ou uterino (44,6...

  8. vaginal histological changes of the baboon

    African Journals Online (AJOL)

    2009-04-04

    Apr 4, 2009 ... VAGINAL HISTOLOGICAL CHANGES OF THE BABOON DURING THE NORMAL MENSTRUAL CYCLE AND. PREGNANCY. A. Nyachieo ... During the luteal phase, menstrual phase and pregnancy the squamous epithelium was ... point, an endoscopic cup (Karl Storz, GmbH & Co. KG, Germany) was used ...

  9. Lactobacilli Dominance and Vaginal pH: Why is the Human Vaginal Microbiome Unique?

    Directory of Open Access Journals (Sweden)

    Elizabeth A. Miller

    2016-12-01

    Full Text Available The human vaginal microbiome is dominated by bacteria from the genus Lactobacillus, which create an acidic environment thought to protect women against sexually transmitted pathogens and opportunistic infections. Strikingly, lactobacilli dominance appears to be unique to humans; while the relative abundance of lactobacilli in the human vagina is typically >70%, in other mammals lactobacilli rarely comprise more than 1% of vaginal microbiota. Several hypotheses have been proposed to explain humans' unique vaginal microbiota, including humans' distinct reproductive physiology, high risk of STDs, and high risk of microbial complications linked to pregnancy and birth. Here, we test these hypotheses using comparative data on vaginal pH and the relative abundance of lactobacilli in 26 mammalian species and 50 studies (N=21 mammals for pH and 14 mammals for lactobacilli abundance. We found that non-human mammals, like humans, exhibit the lowest vaginal pH during the period of highest estrogen. However, the vaginal pH of non-human mammals is never as low as is typical for humans (median vaginal pH in humans = 4.5; range of pH across all 21 non-human mammals = 5.4 to 7.8. Contrary to disease and obstetric risk hypotheses, we found no significant relationship between vaginal pH or lactobacilli abundance and multiple metrics of STD or birth injury risk (P-values ranged from 0.13 to 0.99. Given the lack of evidence for these hypotheses, we discuss two alternative explanations: the common function hypothesis and a novel hypothesis related to the diet of agricultural humans. Specifically, with regard to diet we propose that high levels of starch in human diets have led to increased levels of glycogen in the vaginal tract, which, in turn, promotes the proliferation of lactobacilli. If true, human diet may have paved the way for a novel, protective microbiome in human vaginal tracts. Overall, our results highlight the need for continuing research on non

  10. Patterns of flap loss related to arterial and venous insufficiency in the rat pedicled TRAM flap.

    Science.gov (United States)

    Qiao, Q; Moon, W; Zhang, F; Chen, S G; Kunda, L; Lineaweaver, W C; Buncke, H J

    1999-08-01

    Vascular supply to the contralateral portion of the conventional transverse rectus abdominis musculocutaneous (TRAM) flap (zone IV) may become compromised, resulting in partial flap loss and requiring segmental excision. The etiology of this necrosis is not clear. This study determines skin necrosis patterns on a superiorly pedicled caudal TRAM flap during conditions of venous and arterial insufficiency, and determines whether cutaneous venous outflow can sustain a flap with venous insufficiency. Twenty-eight adult male Sprague-Dawley rats underwent superior pedicled TRAM flap elevation, and the zones were marked on the skin paddle. The animals were divided into four groups: control (group A, N = 6), arterial ligation (group B, N = 6), venous ligation (group C, N = 8), and venous ligation with cutaneous venous outflow (group D, N = 8). After 10 days, the skin paddle was photographed and the areas of necrotic skin were measured. Results showed that group B (selective arterial ligation) had 51.7 +/- 2.8% and 40.0 +/- 2.0% skin necrosis in zones I and II respectively. Zone I necrosis was significantly greater in group B compared with the control (p < 0.05). Group C (selective venous ligation) resulted in 73.8 +/- 16.4% and 93.8 +/- 33.4% skin necrosis in zones III and IV respectively. This necrosis was significantly greater compared with the control (p < 0.001). Group D rats' lateral skin necrosis compared significantly less with group C (p < 0.001). These results demonstrate that the patterns of flap necrosis in rat TRAM flaps with poor arterial inflow differ from those with venous stasis. Necrosis of the contralateral portion (zone IV) of human TRAM flaps may be related to problems with venous stasis; thus, a cutaneous venous outflow may prevent this problem.

  11. Mucosal vaccines against respiratory syncytial virus.

    Science.gov (United States)

    Yang, Kejian; Varga, Steven M

    2014-06-01

    Respiratory syncytial virus (RSV) is a leading cause of severe respiratory disease in infants, young children, immune-compromised and elderly populations worldwide. Natural RSV infection in young children does not elicit long-lasting immunity and individuals remain susceptible to repeated RSV infections throughout life. Because RSV infection is restricted to the respiratory tract, an RSV vaccine should elicit mucosal immunity at upper and lower respiratory tracts in order to most effectively prevent RSV reinfection. Although there is no safe and effective RSV vaccine available, significant progress has been recently made in basic RSV research and vaccine development. This review will discuss recent advances in the identification of a new neutralizing antigenic site within the RSV fusion (F) protein, understanding the importance of mucosal immune responses against RSV infection, and the development of novel mucosal vaccination strategies. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Mucosal Immunity and Candida albicans Infection

    Directory of Open Access Journals (Sweden)

    David L. Moyes

    2011-01-01

    Full Text Available Interactions between mucosal surfaces and microbial microbiota are key to host defense, health, and disease. These surfaces are exposed to high numbers of microbes and must be capable of distinguishing between those that are beneficial or avirulent and those that will invade and cause disease. Our understanding of the mechanisms involved in these discriminatory processes has recently begun to expand as new studies bring to light the importance of epithelial cells and novel immune cell subsets such as Th17 T cells in these processes. Elucidating how these mechanisms function will improve our understanding of many diverse diseases and improve our ability to treat patients suffering from these conditions. In our voyage to discover these mechanisms, mucosal interactions with opportunistic commensal organisms such as the fungus Candida albicans provide insights that are invaluable. Here, we review current knowledge of the interactions between C. albicans and epithelial surfaces and how this may shape our understanding of microbial-mucosal interactions.

  13. Breast reconstruction by pedicled transverse rectus abdominis myocutaneous flap

    Directory of Open Access Journals (Sweden)

    Kozarski Jefta

    2004-01-01

    Full Text Available Reconstruction of the amputated breast in female patients after surgical management of breast carcinoma is possible with the use of autologous tissue, synthetic implants, or by combining autologous tissue and synthetic materials. Autologous tissue provides soft and sufficiently elastic tissue which is usable for breast reconstruction and eventually obtains original characteristics of the surrounding tissue on the chest wall. The use of the TRAM flap for breast reconstruction was introduced in 1982 by Hartrampf Scheflan, and Black. The amount of the TRAM flap tissue allows breast reconstruction in the shape most adequate to the remaining breast. The possibilities of using the TRAM flap as pedicled myocutaneous flap or as free TRAM flap make this flap a superior choice for breast reconstruction in comparison with other flaps.

  14. Prevention of hair growth in myocutaneous flap reconstruction.

    Science.gov (United States)

    Eliachar, I; Kraus, D H; Bergfeld, W F; Tucker, H M

    1990-08-01

    Myocutaneous flaps play a prominent role in the immediate reconstruction of surgical defects following ablative oncologic procedures in the head and neck. Transfer of hair-bearing skin into the reconstructed upper digestive tract can be a major disadvantage associated with the pectoralis major flap. De-epithelialization of skin to the dermal level, removing the majority of skin appendages, can convert a myocutaneous flap to a "myodermal" flap. Platysma myocutaneous and myodermal flaps were grafted into the oral cavity of 13 dogs. Gross and histologic evaluation confirmed decreased hair growth in the experimental myodermal flap. Wound complications and graft survival were similar for both techniques. Diminished hair growth further supports the utility of myodermal flaps in hairy male patients undergoing upper digestive tract reconstruction.

  15. Usefulness of myofascial flap without skin in contemporary oral and maxillofacial reconstruction.

    Science.gov (United States)

    Wada, Takeshi; Nakatani, Ken; Hiraishi, Yukihiro; Negoro, Kenji; Iwagami, Yoshinobu; Fujita, Shigeyuki

    2011-06-01

    Pedicle myofascial graft should be considered in contemporary oral and maxillofacial reconstruction for the following reasons: 1) the pedicle myofascial unit is reliable and easily handled; 2) on the grafted myofascia in the oral cavity, the mucosa regenerates naturally with regard to suppleness and surface characteristics; and 3) vascularized myofascial coverage of tissues or materials is useful in some clinical situations. The purpose of this retrospective study was to evaluate the usefulness of this graft material. Using myofascial flaps from the pectoralis major muscle in 15 patients and from the platysma muscle in 11 patients, several types of reconstructive procedures were conducted in the Department of Oral and Maxillofacial Surgery, Wakayama Medical University. Myofascial tissue was used to cover the surgical defect and for regeneration of oral mucosa (24 patients), to prevent exposure of the mandibular reconstruction plate (4 patients), for prevention of wound breakdown and secondary infection in the oral cavity (2 patients), for vascularized coverage of free grafted autologous bone (2 patients), and for protection of large vessels after radical neck dissection (9 patients). Although partial flap necrosis or wound dehiscence was noticed in 3 patients with a platysma-myofascial graft, the healing process of all patients was favorable and required no additional operations. This procedure is most suitable for the reconstruction of small to medium-sized soft tissue defects in the oral cavity, because it induces the formation of nearly normal mucosa through epithelial regeneration without clear scar formation. Myofascial flap is a useful option in certain oral and maxillofacial reconstruction cases in which mucosal regeneration and/or vascularized soft tissue coverage are required. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  16. To flap or not to flap: a discussion between a fish and a jellyfish

    Science.gov (United States)

    Martin, Nathan; Roh, Chris; Idrees, Suhail; Gharib, Morteza

    2016-11-01

    Fish and jellyfish are known to swim by flapping and by periodically contracting respectively, but which is the more effective propulsion mechanism? In an attempt to answer this question, an experimental comparison is made between simplified versions of these motions to determine which generates the greatest thrust for the least power. The flapping motion is approximated by pitching plates while periodic contractions are approximated by clapping plates. A machine is constructed to operate in either a flapping or a clapping mode between Reynolds numbers 1,880 and 11,260 based on the average plate tip velocity and span. The effect of the total sweep angle, total sweep time, plate flexibility, and duty cycle are investigated. The average thrust generated and power required per cycle are compared between the two modes when their total sweep angle and total sweep time are identical. In general, operating in the clapping mode required significantly more power to generate a similar thrust compared to the flapping mode. However, modifying the duty cycle for clapping caused the effectiveness to approach that of flapping with an unmodified duty cycle. These results suggest that flapping is the more effective propulsion mechanism within the range of Reynolds numbers tested. This work was supported by the Charyk Bio-inspired Laboratory at the California Institute of Technology, the National Science Foundation Graduate Research Fellowship under Grant No. DGE-1144469, and the Summer Undergraduate Research Fellowships program.

  17. The vastus intermedius periosteal (VIP) flap: a novel flap for osteoinduction.

    Science.gov (United States)

    Maercks, Rian Adam; Runyan, Christopher Michael; Jones, Donna Carlson; Taylor, Jesse Adam

    2010-07-01

    Periosteum's role in fracture healing is widely recognized, and its function in bone tissue engineering shows great potential. Here we introduce a novel periosteal free flap to be used as an abundant source of periosteum in the engineering and repair of bone. The descending branch of the lateral femoral circumflex vessels were isolated on 11 fresh human cadavers, preserving perforators to the vastus intermedius muscle. A cuff of vastus intermedius and approximately 75% of the circumference of the femoral periosteum were harvested from 6 cm proximal to the knee to 8 cm distal to the greater trochanter. Flap pedicle length and periosteal dimensions were measured. The pedicle arteries were injected with radiopaque dye, and radiographs were taken. A musculoperiosteal flap was elevated with visible descending perforators in each case. Mean flap surface area was 128 cm(2) (+/-99-143 cm(2)). Average pedicle length was 8 cm (+/-6-11 cm). Dye injection confirmed that the flaps blood supply was the descending branch of the lateral femoral circumflex artery. This anatomical study confirms the vascular supply of this large musculoperiosteal flap. Future work will test its efficacy as an osteoinductive agent in bone repair and tissue engineering in humans. Thieme Medical Publishers.

  18. Novel vaccine development strategies for inducing mucosal immunity

    Science.gov (United States)

    Fujkuyama, Yoshiko; Tokuhara, Daisuke; Kataoka, Kosuke; Gilbert, Rebekah S; McGhee, Jerry R; Yuki, Yoshikazu; Kiyono, Hiroshi; Fujihashi, Kohtaro

    2012-01-01

    To develop protective immune responses against mucosal pathogens, the delivery route and adjuvants for vaccination are important. The host, however, strives to maintain mucosal homeostasis by responding to mucosal antigens with tolerance, instead of immune activation. Thus, induction of mucosal immunity through vaccination is a rather difficult task, and potent mucosal adjuvants, vectors or other special delivery systems are often used, especially in the elderly. By taking advantage of the common mucosal immune system, the targeting of mucosal dendritic cells and microfold epithelial cells may facilitate the induction of effective mucosal immunity. Thus, novel routes of immunization and antigen delivery systems also show great potential for the development of effective and safe mucosal vaccines against various pathogens. The purpose of this review is to introduce several recent approaches to induce mucosal immunity to vaccines, with an emphasis on mucosal tissue targeting, new immunization routes and delivery systems. Defining the mechanisms of mucosal vaccines is as important as their efficacy and safety, and in this article, examples of recent approaches, which will likely accelerate progress in mucosal vaccine development, are discussed. PMID:22380827

  19. Flapping micro plane watches where it goes

    NARCIS (Netherlands)

    de Wagter, C.; Lentink, D.; Mols, B.

    2005-01-01

    In a time span of only ten weeks, a team of eleven highly dedicated students have managed to design a unique flapping miniature aircraft, named DelFly. The aircraft can hover almost motionless in one spot and fly at considerable speed as well while being more stable and less vulnerable than a

  20. Computational Aerodynamics of Insects' Flapping Flight

    Science.gov (United States)

    Yang, Kyung Dong; Kyung, Richard

    2011-11-01

    The kinematics of the Insects' flapping flight is modeled through mathematical and computational observations with commercial software. Recently, study on the insects' flapping flight became one of the challenging research subjects in the field of aeronautics because of its potential applicability to intelligent micro-robots capable of autonomous flight and the next generation aerial-vehicles. In order to uncover its curious unsteady characteristics, many researchers have conducted experimental and computational studies on the unsteady aerodynamics of insects' flapping flight. In the present paper, the unsteady flow physics around insect wings is carried out by utilizing computer software e-AIRS. The e-AIRS (e-Science Aerospace Integrated Research System) analyzes and models the results of computational and experimental aerodynamics, along with integrated research process of these two research activities. Stroke angles and phase angles, the important two factors in producing lift of the airfoils are set as main parameters to determine aerodynamic characteristics of the insects' flapping flight. As a result, the optimal phase angle to minimize the drag and to maximize the lift are found. Various simulations indicate that using proper value of variables produce greater thrust due to an optimal angle of attack at the initial position during down stroke motion.

  1. Regional skin flaps in partial laryngectomy.

    Science.gov (United States)

    Conley, J

    1975-06-01

    The use of regional neck flaps for rehabilitation has permitted an extension of operations on the glottis. The resection may include both vocal cords, both ventricular bands, one arytenoid and slight subglottic extension in a one- or two-stage technique. The resultant voice is low pitched, soft and has limited range. The cure rate was 85 percent.

  2. Clinical application of free omental flap transfer

    Energy Technology Data Exchange (ETDEWEB)

    Harii, K.

    1978-04-01

    In the field of reconstruction surgery, the greater omentum has been used as a transposed flap for the treatment of chronic lymphedema, radionecrosis, and so forth. Its transferable range was limited by the length of its pedicle. Microvascular anastomosis allows for free transplantation of this organ and has vastly expanded its usefulness.

  3. Oral cavity reconstruction with the masseter flap

    NARCIS (Netherlands)

    Mahieu, R.; Russo, S.; Gualtieri, T.; Colletti, G.; Deganello, A.

    The purpose of this report is to highlight how an unusual, outdated, unpopular and overlooked reconstructive method such as the masseter flap can be a reliable, straightforward and effective solution for oral reconstruction in selected cases. We report the transposition of the masseter crossover

  4. Flapping wing aerodynamics: from insects to vertebrates.

    Science.gov (United States)

    Chin, Diana D; Lentink, David

    2016-04-01

    More than a million insects and approximately 11,000 vertebrates utilize flapping wings to fly. However, flapping flight has only been studied in a few of these species, so many challenges remain in understanding this form of locomotion. Five key aerodynamic mechanisms have been identified for insect flight. Among these is the leading edge vortex, which is a convergent solution to avoid stall for insects, bats and birds. The roles of the other mechanisms - added mass, clap and fling, rotational circulation and wing-wake interactions - have not yet been thoroughly studied in the context of vertebrate flight. Further challenges to understanding bat and bird flight are posed by the complex, dynamic wing morphologies of these species and the more turbulent airflow generated by their wings compared with that observed during insect flight. Nevertheless, three dimensionless numbers that combine key flow, morphological and kinematic parameters - the Reynolds number, Rossby number and advance ratio - govern flapping wing aerodynamics for both insects and vertebrates. These numbers can thus be used to organize an integrative framework for studying and comparing animal flapping flight. Here, we provide a roadmap for developing such a framework, highlighting the aerodynamic mechanisms that remain to be quantified and compared across species. Ultimately, incorporating complex flight maneuvers, environmental effects and developmental stages into this framework will also be essential to advancing our understanding of the biomechanics, movement ecology and evolution of animal flight. © 2016. Published by The Company of Biologists Ltd.

  5. Electrochemotherapy of mucosal head and neck tumors

    DEFF Research Database (Denmark)

    Plaschke, Christina Caroline; Gothelf, Anita; Gehl, Julie

    2016-01-01

    with head and neck cancer treated across the mucosal surface with electrochemotherapy. The search resulted in 11 studies with a total of 72 patients. RESULTS: Overall complete response was reported as good, especially in primary small tumors. Side effects were minor in primary tumors whereas large......, recurrent tumors displayed more frequent side effects and some serious adverse events. Design and structure of the studies differed considerably, making general comparisons difficult. CONCLUSION: Few studies concerning electrochemotherapy on mucosal head and neck tumors are available and they are not easily...

  6. A quantitative multiplex nuclease protection assay reveals immunotoxicity gene expression profiles in the rabbit model for vaginal drug safety evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Fichorova, Raina N., E-mail: rfichorova@rics.bwh.harvard.edu [Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women' s Hospital and Harvard Medical School, Boston, MA (United States); Mendonca, Kevin; Yamamoto, Hidemi S.; Murray, Ryan [Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women' s Hospital and Harvard Medical School, Boston, MA (United States); Chandra, Neelima; Doncel, Gustavo F. [CONRAD, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (United States)

    2015-06-15

    Any vaginal product that alters the mucosal environment and impairs the immune barrier increases the risk of sexually transmitted infections, especially HIV infection, which thrives on mucosal damage and inflammation. The FDA-recommended rabbit vaginal irritation (RVI) model serves as a first line selection tool for vaginal products; however, for decades it has been limited to histopathology scoring, insufficient to select safe anti-HIV microbicides. In this study we incorporate to the RVI model a novel quantitative nuclease protection assay (qNPA) to quantify mRNA levels of 25 genes representing leukocyte differentiation markers, toll-like receptors (TLR), cytokines, chemokines, epithelial repair, microbicidal and vascular markers, by designing two multiplex arrays. Tissue sections were obtained from 36 rabbits (6 per treatment arm) after 14 daily applications of a placebo gel, saline, 4% nonoxynol-9 (N-9), and three combinations of the anti-HIV microbicides tenofovir (TFV) and UC781 in escalating concentrations (highest: 10% TFV + 2.5%UC781). Results showed that increased expression levels of toll-like receptor (TLR)-4, interleukin (IL)-1β, CXCL8, epithelial membrane protein (EMP)-1 (P < 0.05), and decreased levels of TLR2 (P < 0.05), TLR3 and bactericidal permeability increasing protein (BPI) (P < 0.001) were associated with cervicovaginal mucosal alteration (histopathology). Seven markers showed a significant linear trend predicting epithelial damage (up with CD4, IL-1β, CXCL8, CCL2, CCL21, EMP1 and down with BPI). Despite the low tissue damage RVI scores, the high-dose microbicide combination gel caused activation of HIV host cells (SLC and CD4) while N-9 caused proinflammatory gene upregulation (IL-8 and TLR4) suggesting a potential for increasing risk of HIV via different mechanisms depending on the chemical nature of the test product. - Highlights: • A transcriptome nuclease protection assay assessed microbicides for vaginal safety. • Biomarkers were

  7. Mucosal vaccines: recent progress in understanding the natural barriers.

    Science.gov (United States)

    Borges, Olga; Lebre, Filipa; Bento, Dulce; Borchard, Gerrit; Junginger, Hans E

    2010-02-01

    It has long been known that protection against pathogens invading the organism via mucosal surfaces correlates better with the presence of specific antibodies in local secretions than with serum antibodies. The most effective way to induce mucosal immunity is to administer antigens directly to the mucosal surface. The development of vaccines for mucosal application requires antigen delivery systems and immunopotentiators that efficiently facilitate the presentation of the antigen to the mucosal immune system. This review provides an overview of the events within mucosal tissues that lead to protective mucosal immune responses. The understanding of those biological mechanisms, together with knowledge of the technology of vaccines and adjuvants, provides guidance on important technical aspects of mucosal vaccine design. Not being exhaustive, this review also provides information related to modern adjuvants, including polymeric delivery systems and immunopotentiators.

  8. CTA1-DD adjuvant promotes strong immunity against human immunodeficiency virus type 1 envelope glycoproteins following mucosal immunization.

    Science.gov (United States)

    Sundling, Christopher; Schön, Karin; Mörner, Andreas; Forsell, Mattias N E; Wyatt, Richard T; Thorstensson, Rigmor; Karlsson Hedestam, Gunilla B; Lycke, Nils Y

    2008-12-01

    Strategies to induce potent and broad antibody responses against the human immunodeficiency virus type 1 (HIV-1) envelope glycoproteins (Env) at both systemic and mucosal sites represent a central goal for HIV-1 vaccine development. Here, we show that the non-toxic CTA1-DD adjuvant promoted mucosal and systemic humoral and cell-mediated immune responses following intranasal (i.n.) immunizations with trimeric or monomeric forms of HIV-1 Env in mice and in non-human primates. Env-specific IgG subclasses in the serum of immunized mice reflected a balanced Th1/Th2 type of response. Strikingly, i.n. immunizations with Env and the CTA1-DD adjuvant induced substantial levels of mucosal anti-Env IgA in bronchial alveolar lavage and also detectable levels in vaginal secretions. By contrast, parenteral immunizations of Env formulated in Ribi did not stimulate mucosal IgA responses, while the two adjuvants induced a similar distribution of Env-specific IgG-subclasses in serum. A single parenteral boost with Env in Ribi adjuvant into mice previously primed i.n. with Env and CTA1-DD, augmented the serum anti-Env IgG levels to similar magnitudes as those observed after three intraperitoneal immunizations with Env in Ribi. The augmenting potency of CTA1-DD was similar to that of LTK63 or CpG oligodeoxynucleotides (ODN). However, in contrast to CpG ODN, the effect of CTA1-DD and LTK63 appeared to be independent of MyD88 and toll-like receptor signalling. This is the first demonstration that CTA1-DD augments specific immune responses also in non-human primates, suggesting that this adjuvant could be explored further as a clinically safe mucosal vaccine adjuvant for humoral and cell-mediated immunity against HIV-1 Env.

  9. Atrophic Vaginitis in Breast Cancer Survivors: A Difficult Survivorship Issue

    Directory of Open Access Journals (Sweden)

    Joanne Lester

    2015-03-01

    Full Text Available Management of breast cancer includes systematic therapies including chemotherapy and endocrine therapy can lead to a variety of symptoms that can impair the quality of life of many breast cancer survivors. Atrophic vaginitis, caused by decreased levels of circulating estrogen to urinary and vaginal receptors, is commonly experienced by this group. Chemotherapy induced ovarian failure and endocrine therapies including aromatase inhibitors and selective estrogen receptor modulators can trigger the onset of atrophic vaginitis or exacerbate existing symptoms. Symptoms of atrophic vaginitis include vaginal dryness, dyspareunia, and irritation of genital skin, pruritus, burning, vaginal discharge, and soreness. The diagnosis of atrophic vaginitis is confirmed through patient-reported symptoms and gynecological examination of external structures, introitus, and vaginal mucosa. Lifestyle modifications can be helpful but are usually insufficient to significantly improve symptoms. Non-hormonal vaginal therapies may provide additional relief by increasing vaginal moisture and fluid. Systemic estrogen therapy is contraindicated in breast cancer survivors. Continued investigations of various treatments for atrophic vaginitis are necessary. Local estrogen-based therapies, DHEA, testosterone, and pH-balanced gels continue to be evaluated in ongoing studies. Definitive results are needed pertaining to the safety of topical estrogens in breast cancer survivors.

  10. Corneal flap thickness and topography changes induced by flap creation during laser in situ keratomileusis.

    Science.gov (United States)

    Güell, José L; Velasco, Fortino; Roberts, Cynthia; Sisquella, Maria Teresa; Mahmoud, Ashraf

    2005-01-01

    To determine the corneal flap thickness profile produced by 3 microkeratomes and the topographic changes induced by flap creation in laser in situ keratomileusis (LASIK). Cornea and Refractive Surgery Unit, Instituto de Microcirugia Ocular de Barcelona, Autonoma University, Barcelona, Spain. In this prospective consecutive nonrandomized comparative study, patients were divided into 2 groups. In Group 1 (75 eyes), 3 microkeratomes were used: Moria LSX One, Moria M2, and Amadeus (AMO); 25 eyes per microkeratome. Pachymetry was measured with a DGH pachymeter in the center of the cornea and 3.0 mm from the center at 4 cardinal points (superior, inferior, nasal, and temporal; 3 measurements at each point) before and after the cut. The flap thickness in each sector was calculated by subtracting the mean post-flap corneal thickness from the mean pre-flap corneal thickness. In Group 2 (33 eyes), the M2 microkeratome with a 130 microm plate was used to create a superotemporal hinged flap (9 eyes) or a superonasal hinged flap (24 eyes). The topographic change induced by the microkeratome cut was evaluated using 4 sequential data acquisitions by the Keratron Scout topographic unit (Optikon) before and immediately after the cut (before laser ablation). Cardinal and oblique astigmatism and change in the axis were calculated by vectorial analysis of the simulated keratometry. Topographic Zernike analysis was performed in a subgroup. With the LSX One microkeratome, the mean flap thickness was 151.7 microm centrally, 161.9 microm superiorly, 151.4 microm inferiorly, 156.1 microm temporally, and 167.5 microm nasally. There was no statistically significant difference between the areas studied (P.05). With the Amadeus microkeratome, the mean flap thickness was 140.0 microm centrally, 152.5 superiorly, 128.5 microm inferiorly, 145.0 microm temporally, and 147.0 microm nasally. Statistically significant differences (P>.05) were found in the 4 sectors of the flap. With vectorial

  11. Reverse-Flow Lateral Tarsal Island Flap for Covering the Great Toe Donor Site of Wraparound Flap.

    Science.gov (United States)

    Jia, Yachao; Xu, Jia; Kang, Qinglin; Zhang, Changqing; Chai, Yimin

    2016-10-01

    Coverage of the great toe donor site of wraparound flap remains a challenge. This report presents the results of using an innervated pedicled reverse-flow lateral tarsal island flap for covering the great toe donor site of wraparound flap. Between 2005 and 2010, 11 reverse-flow lateral tarsal island flaps were used to cover the great toe donor site of wraparound flap in 11 patients. This pedicled flap designed on the lateral tarsal area of foot was based distally on the dorsalis pedis artery; the lateral dorsal pedal cutaneous nerve was incorporated into the reverse-flow lateral tarsal island flap and coapted with the first plantar digital nerve. The donor sites of reverse-flow lateral tarsal island flap were covered with inguinal full-thickness skin grafts. All flaps achieved primary healing except for two that suffered from mild venous insufficiency which was managed by conservative intervention. All skin grafts covering the donor site of reverse-flow lateral tarsal island flap healed uneventfully. The mean follow-up was 24 months (range, 18-48 months). The mean hallux metatarsophalangeal-interphalangeal scale score was 92 points (range, 85-97 points) at 6 months postoperatively. The static 2-point discrimination of the reverse-flow lateral tarsal island flap ranged from 6 to 14 mm (mean 10 mm). None of the patients were restricted in standing or walking during follow-up. The reverse-flow lateral tarsal island flap based distally on the dorsalis pedis artery has a constant pedicle that is sufficiently long. This innervated pedicle flap is a reliable option to cover the great toe donor site of wraparound flap with satisfactory functional and cosmetic results and acceptable donor site morbidity.

  12. Wing loading on a 60 degree delta wing with vortex flaps

    Science.gov (United States)

    Marchman, J. F., III; Donatelli, D. A.; Terry, J. E.

    1983-01-01

    Wind tunnel tests were conducted on a 60 deg delta wing with three vortex flap designs to determine pressure distributions over the wing and flap. The results showed that an optimum vortex flap design depends on proper definition of the vortex flap deflection angle. They also revealed that flap thickness plays an important role in the behavior of the vortex flow over the flap and wing and can have a substantial effect on wing and flap pressure loading. Design codes which fail to account for thickness may result in a much less than optimum flap and deprive the designer of an important tool in designing an effective flap with optimum loading.

  13. New generation of oral mucosal vaccines targeting dendritic cells

    OpenAIRE

    Owen, Jennifer L.; Sahay, Bikash; Mohamadzadeh, Mansour

    2013-01-01

    As most infectious organisms gain entry at mucosal surfaces, there is a great deal of interest in developing vaccines that elicit effective mucosal immune responses against pathogen challenge. Targeted vaccination is one of the most effective methods available to prevent and control infectious diseases. Mucosal vaccines can offer lower costs, better accessibility, needle free delivery, and a higher capacity for mass immunizations during pandemics. Both local mucosal immunity and robust system...

  14. Mucosal Vaccination and Therapy with Genetically Modified Lactic Acid Bacteria

    NARCIS (Netherlands)

    Wells, J.

    2011-01-01

    Lactic acid bacteria (LAB) have proved to be effective mucosal delivery vehicles that overcome the problem of delivering functional proteins to the mucosal tissues. By the intranasal route, both live and killed LAB vaccine strains have been shown to elicit mucosal and systemic immune responses that

  15. Adaptive immune responses at mucosal surfaces of teleost fish

    NARCIS (Netherlands)

    Rombout, J.H.W.M.; Yang, G.; Kiron, V.

    2014-01-01

    This review describes the extant knowledge on the teleostean mucosal adaptive immune mechanisms, which is relevant for the development of oral or mucosal vaccines. In the last decade, a number of studies have shed light on the presence of new key components of mucosal immunity: a distinct

  16. Concomitant early mucosal and cutaneous leishmaniasis in Brazil.

    Science.gov (United States)

    Boaventura, Viviane S; Cafe, Virginia; Costa, Jackson; Oliveira, Fabiano; Bafica, Andre; Rosato, Andrea; de Freitas, Luiz A R; Brodskyn, Claudia; Barral-Netto, Manoel; Barral, Aldina

    2006-08-01

    Mucosal leishmaniasis (ML) is often clinically silent until reaching a highly advanced state. In this prospective study, 6 of 220 patients with early cutaneous leishmaniasis were diagnosed with mucosal involvement by otorhinolaryngological examination (a rate similar to the reported rate of late ML). Detection of early ML may represent an important strategy in preventing severe mucosal destruction in human leishmaniasis.

  17. Oral Mucositis: understanding the pathology and management

    OpenAIRE

    Georgiou, M; Patapatiou, G; Domoxoudis, S.; Pistevou-Gompaki, K; Papanikolaou, A

    2012-01-01

    Oral Mucositis is a common complication of cancer therapy which may limit the completion of treatment and affect the quality of life of the patient. As we have come to understand its pathogenesis new developments in its management and prevention have allowed us minimize this side effect.

  18. Mucosal melanoma of the head and neck.

    Science.gov (United States)

    Ascierto, Paolo Antonio; Accorona, Remo; Botti, Gerardo; Farina, Davide; Fossati, Piero; Gatta, Gemma; Gogas, Helen; Lombardi, Davide; Maroldi, Roberto; Nicolai, Piero; Ravanelli, Marco; Vanella, Vito

    2017-04-01

    Mucosal melanoma of the head and neck is a very rare and aggressive malignancy with a very poor prognosis. The nasal cavity, paranasal sinuses, and oral cavity are the most common locations. One-, 3- and 5-year survival rates between 2000 and 2007 were 63%, 30% and 20%, respectively. Cigarette smoking seems to be a risk factor even though the evidence for this is very low. Clinical signs and symptoms are usually nonspecific. While surgery is considered the mainstay of treatment for most mucosal melanomas of the head and neck region, radiotherapy has a role in local control of the disease after surgery. Many new treatment options in the last years, in particular targeted therapies (i.e. inhibitors of c-KIT, NRAS/MEK or BRAF) and immunotherapies (anti CTLA-4 and anti PD-1/PD-L1 antibodies), have changed the history of cutaneous melanoma. Despite the different biology, mucosal melanoma is currently treated in the same way as cutaneous melanoma; however, patients with mucosal melanoma were excluded from the majority of recent clinical trials. Recent molecular findings offer new hope for the development of more effective systemic therapy. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Plant-derived antigens as mucosal vaccines.

    Science.gov (United States)

    Mason, H S; Herbst-Kralovetz, M M

    2012-01-01

    During the last two decades, researchers have developed robust systems for recombinant subunit vaccine production in plants. Stably and transiently transformed plants have particular advantages that enable immunization of humans and animals via mucosal delivery. The initial goal to immunize orally by ingestion of plant-derived antigens has proven difficult to attain, although many studies have demonstrated antibody production in both humans and animals, and in a few cases, protection against pathogen challenge. Substantial hurdles for this strategy are low-antigen content in crudely processed plant material and limited antigen stability in the gut. An alternative is intranasal delivery of purified plant-derived antigens expressed with robust viral vectors, especially virus-like particles. The use of pattern recognition receptor agonists as adjuvants for mucosal delivery of plant-derived antigens can substantially enhance serum and mucosal antibody responses. In this chapter, we briefly review the methods for recombinant protein expression in plants, and describe progress with human and animal vaccines that use mucosal delivery routes. We do not attempt to compile a comprehensive list, but focus on studies that progressed to clinical trials or those that showed strong indications of efficacy in animals. Finally, we discuss some regulatory concerns regarding plant-based vaccines.

  20. Topical morphine for oral mucositis in children

    DEFF Research Database (Denmark)

    Nielsen, Bettina Nygaard; Aagaard, Gitte; Henneberg, Steen W

    2012-01-01

    Systemic opioids for painful chemotherapy-induced oral mucositis in children often result in unsatisfactory pain relief and a high frequency of side effects. Opioids applied topically can produce analgesia by binding to opioid receptors on peripheral terminals of sensory neurons. These receptors...

  1. The Comparison of vaginal cream of mixing yogurt, honey and clotrimazole on symptoms of vaginal candidiasis.

    Science.gov (United States)

    Darvishi, Maryam; Jahdi, Fereshteh; Hamzegardeshi, Zeinab; Goodarzi, Saied; Vahedi, Mohsen

    2015-04-03

    Vulvovaginal candidiasis is known as one of the most common fungal infection among women of reproductive age and considered as an important public health problem. In recent years, due to resistance to common antifungal medication, the use of traditional medicine of anti-fungal and herbal treatment increased. Therefore the objective of this study was to determine the effects of vaginal cream, mixture of yogurt and honey and comparing it with clotrimazole vaginal cream on symptoms of Vulvovaginal candidiasis in patients. In this randomized, triple blind clinical trial of 70 non-pregnant women infected with Candidal vulvovaginitis were placed in two groups of Vaginal cream mixed of yogurt and honey recipients (N=35) and clotrimazole vaginal cream (N=35). Both groups were treated for 7 days. At the beginning of study, Clinical and laboratory signs and symptoms were registered 7 and 14 days after treatment by questionnaire, observation form and secretions culture results. Data by chi-square test, t test, McNemar tests were analyzed by SPSS version 21. Significance level of 0.05 was considered. The result of present study reveals the significant differences in symptom improvement of ' yogurt and honey, than clotrimazole group (Pyogurt and honey" and clotrimazole (20% versus 8.6%) and second time cultivation (14 days after treatment) (17/1% versus 8.6%) were similar and there was no significant differences between the two groups. (P>0.05) CONCLUSION: This study indicated that he therapeutic effects of vaginal cream, yogurt and honey is not only similar with clotrimazole vaginal cream but more effective in relieving some symptoms of vaginal candidiasis. Therefore, the use of this product can be suggested as an herbal remedy for candida infection treatment.

  2. Lateral thoracic artery axial pattern flap in cats.

    Science.gov (United States)

    Benzioni, Hadas; Shahar, Ron; Yudelevich, Sigal; Shipov, Anna; Milgram, Joshua

    2009-01-01

    To describe the location of the lateral thoracic artery (LTA), determine dimensions of an axial pattern flap based on this artery, and report use of this flap in 2 cats. Ex vivo study and case reports. Cat cadavers (n=8); cats (n=2) with thoracic limb skin defects. Dissection of the LTA was carried out on 1 side of each cadaver and the contralateral side was used for injection studies. In 4 specimens, the LTA was cannulated and injected with positive contrast material and the flap was raised and radiographed. In 4 specimens, the flap was injected with methylene blue. Adequacy of flap injection was subjectively evaluated and leakage of methylene blue from the cut edge was noted. The cutaneous location of the LTA caudal to the triceps muscle was confirmed. Mean flap size was 8.7 cm x 15.5 cm for a mature, average-sized cat. Perfusion of the entire flap was demonstrated and viability of the flap was confirmed in 2 clinical cases. The LTA flap is useful for repair of skin defects of the brachium and antebrachium in cats. The LTA flap is an alternative technique for repair of skin defects involving the thoracic limb of cats.

  3. Heterogeneity of HIV-1 replication in ectocervical and vaginal tissue ex vivo.

    Science.gov (United States)

    Dezzutti, Charlene S; Park, Seo Young; Marks, Kenneth; Lawlor, Sidney; Russo, Julie; Macio, Ingrid; Chappell, Catherine; Bunge, Katherine

    2017-10-06

    In clinical trials evaluating HIV-1 prevention products, ex vivo exposure of mucosal tissue to HIV-1 is performed to inform drug levels needed to suppress viral infection. Understanding assay and participant variables that influence HIV-1 replication will help with assay implementation. Demographic and behavioral data were obtained from 61 healthy women aged 21-45. Paired cervical (CT) and vaginal (VT) tissue biopsies were collected and treated with HIV-1BaL or HIV-1JR-CSF, washed, and cultured. On days 3, 7, and/or 11, culture supernatant was collected and viral replication was monitored by p24 ELISA. Tissue was extracted at study end and HIV-1 relative RNA copies were determined by PCR. Cumulative p24 and RNA were log-transformed and analyzed using a linear mixed model, t-test, and an intra-class correlation coefficient (ICC). HIV replication was similar between CT and VT for each virus, but HIV-1BaL had 1.5 log10 and 0.9 log10 higher levels of p24 than HIV-1JR-CSF in CT and VT, respectively (p<.001), which correlated with HIV-1 relative RNA copies. Cumulative p24 and RNA copies in both tissues demonstrated low intra-person correlation for both viruses (ICC≤0.513 HIV-1BaL; ICC≤0.419 HIV-1JR-CSF). Enrollment into previous clinical studies in which genital biopsies were collected modestly decreased the HIV-1BaL cumulative p24 for CT, but not for VT. To improve the ex vivo challenge assay, viruses should be evaluated for replication in mucosal tissue prior to study implementation, baseline mucosal tissue is not needed if a placebo/no treatment group is included within the clinical trial, and previous biopsy sites should be avoided.

  4. Regulation of gastrointestinal mucosal growth during aging.

    Science.gov (United States)

    Majumdar, A P N

    2003-12-01

    The increase in the aging population has led to a growing interest in achieving a better understanding of the aging process and of diseases that are predominantly expressed during advancing age. Since the structural and, in turn, the functional integrity of the mucosa of the gastrointestinal tract (GI) are maintained by constant renewal of cells, a detailed knowledge of the events that initiate and regulate mucosal proliferative processes is essential for a better understanding of the normal aging process as well as age-associated dysfunctions, including malignancy that represent disorders of tissue growth. In Fischer-344 rats, aging is associated with increased mucosal proliferative activity in much of the GI tract. On the other hand, the functional properties are either decreased or remain unchanged during advancing age. Basal gastric acid and pepsin output decline during aging, as is gastrin secretion. In contrast, antral gastrin levels increase during this period, as is mucosal histidine decarboxylase activity. The age-related decline in gastrin secretion could partly be attributed to a higher ratio of somatostatin (D) to gastrin (G) cells in the antral mucosa. The age-related rise in GI mucosal proliferative activity could not be attributed to the trophic action of either gastrin or bombesin, since they caused no significant change in mucosal proliferation in aged rats. On the other hand, EGF and TGF-alpha appear to be involved in regulating mucosal proliferation during aging. Aging is associated with increased activation of EGF-receptor (EGFR), the common receptor for EGF and TGF-alpha. This could be due to (a) increased levels of membrane-bound precursor form(s) of TGF-alpha resulting in increased activation EGFR signaling processes through an autocrine/paracrine mechanism, (b) heightened sensitivity of mucosal EGFR to EGF and TGF-alpha such that comparatively lower levels of these peptides are required to activate EGFR in aged than in young animals and

  5. Treatment of Crohn's disease-related high perianal fistulas combining the mucosa advancement flap with platelet-rich plasma: a pilot study.

    Science.gov (United States)

    Göttgens, K W A; Smeets, R R; Stassen, L P S; Beets, G L; Pierik, M; Breukink, S O

    2015-08-01

    Healing rates after surgical closure for high perianal fistula in patients with Crohn's disease are even more disappointing than in patients with cryptoglandular fistulas. The objective was to improve healing rates by combining the well-known mucosal advancement flap with platelet-rich plasma. A prospective pilot study was conducted in one tertiary referral centre. Consecutive patients with primary or recurrent Crohn's disease-related high perianal fistulas, defined as involving the middle and/or upper third parts of the anal sphincter complex, were included. A staged procedure was performed with non-cutting seton treatment for 3 months first, followed by a mucosal advancement flap with injection of platelet-rich plasma into the fistula tract. Ten consecutive patients were operated on between 2009 and 2014. Half (50%) of the patients had undergone previous fistula surgery. Mean follow-up was 23.3 months (SD 13.0). Healing of the fistula was 70% (95% confidence interval, 33-89%) at 1 year. One (10%) patient had a recurrence, and in two (20%) patients, the fistula was persistent after treatment. An abscess occurred in one (10%) patient. The median post-operative Vaizey score was 8.0 (range 0-21), indicating a moderate to severe continence impairment. The results of combining the mucosal advancement flap with platelet-rich plasma in patients with Crohn's disease-related high perianal fistulas are moderate with a healing rate of 70%. Further investigation is needed to determine the benefits and risks on continence status for this technique in this patient population.

  6. Randomized Phase I: Safety, Immunogenicity and Mucosal Antiviral Activity in Young Healthy Women Vaccinated with HIV-1 Gp41 P1 Peptide on Virosomes.

    Science.gov (United States)

    Leroux-Roels, Geert; Maes, Cathy; Clement, Frédéric; van Engelenburg, Frank; van den Dobbelsteen, Marieke; Adler, Michael; Amacker, Mario; Lopalco, Lucia; Bomsel, Morgane; Chalifour, Anick; Fleury, Sylvain

    2013-01-01

    Mucosal antibodies harboring various antiviral activities may best protect mucosal surfaces against early HIV-1 entry at mucosal sites and they should be ideally induced by prophylactic HIV-1 vaccines for optimal prevention of sexually transmitted HIV-1. A phase I, double-blind, randomized, placebo-controlled trial was conducted in twenty-four healthy HIV-uninfected young women. The study objectives were to assess the safety, tolerability and immunogenicity of virosomes harboring surface HIV-1 gp41-derived P1 lipidated peptides (MYM-V101). Participants received placebo or MYM-V101 vaccine at 10 μg/dose or 50 μg/dose intramuscularly at week 0 and 8, and intranasally at week 16 and 24. MYM-V101 was safe and well-tolerated at both doses administered by the intramuscular and intranasal routes, with the majority of subjects remaining free of local and general symptoms. P1-specific serum IgGs and IgAs were induced in all high dose recipients after the first injection. After the last vaccination, vaginal and rectal P1-specific IgGs could be detected in all high dose recipients. Approximately 63% and 43% of the low and high dose recipients were respectively tested positive for vaginal P1-IgAs, while 29% of the subjects from the high dose group tested positive for rectal IgAs. Serum samples had total specific IgG and IgA antibody concentrations ≥ 0.4 μg/mL, while mucosal samples were usually below 0.01 μg/mL. Vaginal secretions from MYM-V101 vaccinated subjects were inhibiting HIV-1 transcytosis but had no detectable neutralizing activity. P1-specific Th1 responses could not be detected on PBMC. This study demonstrates the excellent safety and tolerability of MYM-V101, eliciting systemic and mucosal antibodies in the majority of subjects. Vaccine-induced mucosal anti-gp41 antibodies toward conserved gp41 motifs were harboring HIV-1 transcytosis inhibition activity and may contribute to reduce sexually-transmitted HIV-1. ClinicalTrials.gov NCT01084343.

  7. Randomized Phase I: Safety, Immunogenicity and Mucosal Antiviral Activity in Young Healthy Women Vaccinated with HIV-1 Gp41 P1 Peptide on Virosomes.

    Directory of Open Access Journals (Sweden)

    Geert Leroux-Roels

    Full Text Available Mucosal antibodies harboring various antiviral activities may best protect mucosal surfaces against early HIV-1 entry at mucosal sites and they should be ideally induced by prophylactic HIV-1 vaccines for optimal prevention of sexually transmitted HIV-1. A phase I, double-blind, randomized, placebo-controlled trial was conducted in twenty-four healthy HIV-uninfected young women. The study objectives were to assess the safety, tolerability and immunogenicity of virosomes harboring surface HIV-1 gp41-derived P1 lipidated peptides (MYM-V101. Participants received placebo or MYM-V101 vaccine at 10 μg/dose or 50 μg/dose intramuscularly at week 0 and 8, and intranasally at week 16 and 24. MYM-V101 was safe and well-tolerated at both doses administered by the intramuscular and intranasal routes, with the majority of subjects remaining free of local and general symptoms. P1-specific serum IgGs and IgAs were induced in all high dose recipients after the first injection. After the last vaccination, vaginal and rectal P1-specific IgGs could be detected in all high dose recipients. Approximately 63% and 43% of the low and high dose recipients were respectively tested positive for vaginal P1-IgAs, while 29% of the subjects from the high dose group tested positive for rectal IgAs. Serum samples had total specific IgG and IgA antibody concentrations ≥ 0.4 μg/mL, while mucosal samples were usually below 0.01 μg/mL. Vaginal secretions from MYM-V101 vaccinated subjects were inhibiting HIV-1 transcytosis but had no detectable neutralizing activity. P1-specific Th1 responses could not be detected on PBMC. This study demonstrates the excellent safety and tolerability of MYM-V101, eliciting systemic and mucosal antibodies in the majority of subjects. Vaccine-induced mucosal anti-gp41 antibodies toward conserved gp41 motifs were harboring HIV-1 transcytosis inhibition activity and may contribute to reduce sexually-transmitted HIV-1.ClinicalTrials.gov NCT01084343.

  8. Dectin-1 isoforms contribute to distinct Th1/Th17 cell activation in mucosal candidiasis

    Science.gov (United States)

    Carvalho, Agostinho; Giovannini, Gloria; De Luca, Antonella; D'Angelo, Carmen; Casagrande, Andrea; Iannitti, Rossana G; Ricci, Giovanni; Cunha, Cristina; Romani, Luigina

    2012-01-01

    The recognition of β-glucans by dectin-1 has been shown to mediate cell activation, cytokine production and a variety of antifungal responses. Here, we report that the functional activity of dectin-1 in mucosal immunity to Candida albicans is influenced by the genetic background of the host. Dectin-1 was required for the proper control of gastrointestinal and vaginal candidiasis in C57BL/6, but not BALB/c mice; in fact, the latter showed increased resistance in the absence of dectin-1. The susceptibility of dectin-1-deficient C57BL/6 mice to infection was associated with defects in IL-17A and aryl hydrocarbon receptor-dependent IL-22 production and in adaptive Th1 responses. In contrast, the resistance of dectin-1-deficient BALB/c mice was associated with increased IL-17A and IL-22 production and the skewing towards Th1/Treg immune responses that provide immunological memory. Disparate canonical/noncanonical NF-κB signaling pathways downstream of dectin-1 were activated in the two different mouse strains. Thus, the net activity of dectin-1 in antifungal mucosal immunity is dependent on the host's genetic background, which affects both the innate cytokine production and the adaptive Th1/Th17 cell activation upon dectin-1 signaling. PMID:22543832

  9. Manifestation Pattern of Early-Late Vaginal Morbidity After Definitive Radiation (Chemo)Therapy and Image-Guided Adaptive Brachytherapy for Locally Advanced Cervical Cancer: An Analysis From the EMBRACE Study

    Energy Technology Data Exchange (ETDEWEB)

    Kirchheiner, Kathrin, E-mail: kathrin.kirchheiner@meduniwien.ac.at [Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/General Hospital of Vienna (Austria); Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna (Austria); Nout, Remi A. [Department of Clinical Oncology, Leiden University Medical Center (Netherlands); Tanderup, Kari; Lindegaard, Jacob C. [Department of Oncology, Aarhus University Hospital (Denmark); Westerveld, Henrike [Department of Radiotherapy, Academic Medical Centre, University of Amsterdam (Netherlands); Haie-Meder, Christine [Department of Radiotherapy, Gustave-Roussy, Villejuif (France); Petrič, Primož [Department of Radiotherapy, Institute of Oncology Ljubljana (Slovenia); Department of Radiotherapy, National Center for Cancer Care and Research, Doha (Qatar); Mahantshetty, Umesh [Department of Radiation Oncology, Tata Memorial Hospital, Mumbai (India); Dörr, Wolfgang; Pötter, Richard [Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/General Hospital of Vienna (Austria); Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna (Austria)

    2014-05-01

    Background and Purpose: Brachytherapy in the treatment of locally advanced cervical cancer has changed substantially because of the introduction of combined intracavitary/interstitial applicators and an adaptive target concept, which is the focus of the prospective, multi-institutional EMBRACE study ( (www.embracestudy.dk)) on image-guided adaptive brachytherapy (IGABT). So far, little has been reported about the development of early to late vaginal morbidity in the frame of IGABT. Therefore, the aim of the present EMBRACE analysis was to evaluate the manifestation pattern of vaginal morbidity during the first 2 years of follow-up. Methods and Materials: In total, 588 patients with a median follow-up time of 15 months and information on vaginal morbidity were included. Morbidity was prospectively assessed at baseline, every 3 months during the first year, and every 6 months in the second year according to the Common Terminology Criteria for Adverse Events, version 3, regarding vaginal stenosis, dryness, mucositis, bleeding, fistula, and other symptoms. Crude incidence rates, actuarial probabilities, and prevalence rates were analyzed. Results: At 2 years, the actuarial probability of severe vaginal morbidity (grade ≥3) was 3.6%. However, mild and moderate vaginal symptoms were still pronounced (grade ≥1, 89%; grade ≥2, 29%), of which the majority developed within 6 months. Stenosis was most frequently observed, followed by vaginal dryness. Vaginal bleeding and mucositis were mainly mild and infrequently reported. Conclusion: Severe vaginal morbidity within the first 2 years after definitive radiation (chemo)therapy including IGABT with intracavitary/interstitial techniques for locally advanced cervical cancer is limited and is significantly less than has been reported from earlier studies. Thus, the new adaptive target concept seems to be a safe treatment with regard to the vagina being an organ at risk. However, mild to moderate vaginal morbidity

  10. Immunohistochemical analysis of blood vessels in peri-implant mucosa: a comparison between mini-incision flapless and flap surgeries in domestic pigs.

    Science.gov (United States)

    Lazić, Zoran; Golubović, Mileta; Marković, Aleksa; Šćepanović, Miodrag; Mišić, Tijana; Vlahović, Zoran

    2015-07-01

    The aim of this experimental study is to compare the effect of mini-incision flapless versus flap technique of implant placement on the amount of vascular structures and blood vessel elements in peri-implant soft tissue, using immunohistochemical analysis. The experiment was conducted on five domestic pigs. Each animal received six implants in mandible according to the split-mouth design. On one randomly chosen jaw side, mini-incision flapless surgery was performed, whereas on the opposite jaw side, flap was raised. After 3 months of implant healing through submerged approach, the experimental animals were sacrificed and samples for immunohistochemical analyses were taken from the buccal side of peri-implant mucosa next to the neck of implants, from three levels. The study outcome was the presence of vascular structures and elements of the blood vessels in the peri-implant mucosa per microscopic field, estimated through ordinal scores from 0 to 2. Effects of surgical approach, site of implantation, and their interaction on vascular scores of peri-implant mucosa were assessed by Brunner and Langer nonparametric analysis of longitudinal data. Statistically significant effect of surgical approach on vascularity of peri-implant mucosa has been revealed in the second mucosal layer, where flapless approach provided higher vascularity compared with flap approach (P = 0.002). In the remaining two layers, surgical approach did not affect mucosal vascularity significantly (layer 1: P = 0.071; layer 3: P = 0.433). The flapless surgical implant placement approach using mini-incision provides better vascularization of peri-implant mucosa after 3 months of healing compared with flap surgery. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Biofilms of vaginal Lactobacillus in vitro test.

    Science.gov (United States)

    Wei, Xiao-Yu; Zhang, Rui; Xiao, Bing-Bing; Liao, Qin-Ping

    2017-01-01

    This paper focuses on biofilms of Lactobacillus spp. - a type of normal flora isolated from healthy human vaginas of women of childbearing age; thereupon, it broadens the research scope of investigation of vaginal normal flora. The static slide culture method was adopted to foster biofilms, marked by specific fluorescence staining. Laser scanning confocal and scanning electron microscopy were used to observe the microstructure of the biofilms. Photographs taken from the microstructure were analysed to calculate the density of the biofilms. The body of Lactobacillus spp., though red, turned yellow when interacting with the green extracellular polysaccharides. The structure of the biofilm and aquaporin within the biofilm were imaged. Lactobacillus density increases over time. This study provides convincing evidence that Lactobacillus can form biofilms and grow over time in vitro. This finding establishes an important and necessary condition for selecting proper strains for the pharmaceutics of vaginal ecology.

  12. Adolescent Experiences with the Vaginal Ring

    Science.gov (United States)

    Epstein, Laura B.; Sokal-Gutierrez, Karen; Ivey, Susan L.; Raine, Tina; Auerswald, Colette

    2011-01-01

    Purpose To understand racial/ethnic minority adolescent females’ experiences with the vaginal ring. Methods We conducted in-depth interviews with a clinic-based sample of 32 young women aged 15–24 years who had used the vaginal ring. Results Qualitative analysis using grounded theory revealed that adolescents undergo a multi-stage process when trying the ring and adopting ring use. These stages include hearing about the ring, initial reactions, first experiences with insertion and removal, and first sexual experiences. Adolescents subsequently enter an assessment and adjustment stage in which they decide whether to adopt or discontinue ring use. Ultimately they share their experiences with friends. Conclusions The model developed provides a context within which providers may advise adolescents as they begin use of the ring. Some specific recommendations are offered. PMID:18565439

  13. [Morphogenesis of vaginal aplasia. Therapeutic deductions].

    Science.gov (United States)

    Minh, H N; Smadja, A; Belaisch, J

    1985-01-01

    On the basis of the studies of the embryogenesis of the vagina, the authors consider that malformations classically described as being partial aplasia should not be separated from the total absence of the vagina. The important feature is the association of a functioning or non functioning uterus with the absence of the vagina. They believe that it is incorrect to describe the pouch of menstrual retention associated with a functioning uterus as "haematocolpos" and that is not justified to describe the cup-shaped vestibular depression as "hemi-vagina". According to the authors, although vaginal aplasia with a functioning uterus forming a pouch of menstrual retention constitutes an absolute indication for surgery, surgery is not justified in cases of vaginal aplasia with a non functioning uterus. If Frank's method fails in these cases, the patient or the couple should be referred to a sexologist, as women with this anomaly retain a perfect femininity, although unable to conceive.

  14. Vaginal fibrosarcoma in bitch: a case report

    Directory of Open Access Journals (Sweden)

    E.R. Al-Kenanny

    2013-12-01

    Full Text Available A nine year–old wolf bitch was admitted to the surgical section of veterinary clinic teaching hospital in Mosul with abnormal mass occupying relatively the vulvar opening. According to the case history of owner, the bitch was suffered from varying degree of difficulty during parturition due to presence of this mass that showed during and after parturition. Appetite and all body health condition were normal. Clinical examination revealed presence of mass like tumor attached to the vaginal wall with numerous nodules or small growths originated also from wall of vulva near to large mass. The large growth was protruded completely through the vagina without any vaginal prolapse. After general anesthesia with ketamine and xylazine, the mass was surgically removed. Histopathological sections were revealed presence of fibrosarcoma which represented by arrangement of cells that have features of malignancy like darkly staining nuclei (hyperchromasia. The mass was diagnosed as a well-differentiated fibrosarcoma.

  15. Secretory Aspartyl Proteinases Cause Vaginitis and Can Mediate Vaginitis Caused by Candida albicans in Mice.

    Science.gov (United States)

    Pericolini, Eva; Gabrielli, Elena; Amacker, Mario; Kasper, Lydia; Roselletti, Elena; Luciano, Eugenio; Sabbatini, Samuele; Kaeser, Matthias; Moser, Christian; Hube, Bernhard; Vecchiarelli, Anna; Cassone, Antonio

    2015-06-02

    Vaginal inflammation (vaginitis) is the most common disease caused by the human-pathogenic fungus Candida albicans. Secretory aspartyl proteinases (Sap) are major virulence traits of C. albicans that have been suggested to play a role in vaginitis. To dissect the mechanisms by which Sap play this role, Sap2, a dominantly expressed member of the Sap family and a putative constituent of an anti-Candida vaccine, was used. Injection of full-length Sap2 into the mouse vagina caused local neutrophil influx and accumulation of the inflammasome-dependent interleukin-1β (IL-1β) but not of inflammasome-independent tumor necrosis factor alpha. Sap2 could be replaced by other Sap, while no inflammation was induced by the vaccine antigen, the N-terminal-truncated, enzymatically inactive tSap2. Anti-Sap2 antibodies, in particular Fab from a human combinatorial antibody library, inhibited or abolished the inflammatory response, provided the antibodies were able, like the Sap inhibitor Pepstatin A, to inhibit Sap enzyme activity. The same antibodies and Pepstatin A also inhibited neutrophil influx and cytokine production stimulated by C. albicans intravaginal injection, and a mutant strain lacking SAP1, SAP2, and SAP3 was unable to cause vaginal inflammation. Sap2 induced expression of activated caspase-1 in murine and human vaginal epithelial cells. Caspase-1 inhibition downregulated IL-1β and IL-18 production by vaginal epithelial cells, and blockade of the IL-1β receptor strongly reduced neutrophil influx. Overall, the data suggest that some Sap, particularly Sap2, are proinflammatory proteins in vivo and can mediate the inflammasome-dependent, acute inflammatory response of vaginal epithelial cells to C. albicans. These findings support the notion that vaccine-induced or passively administered anti-Sap antibodies could contribute to control vaginitis. Candidal vaginitis is an acute inflammatory disease that affects many women of fertile age, with no definitive cure and, in

  16. Use of the Anterolateral Thigh and Vertical Rectus Abdominis Musculocutaneous Flaps as Utility Flaps in Reconstructing Large Groin Defects

    Directory of Open Access Journals (Sweden)

    Edwin Jonathan Aslim

    2014-09-01

    Full Text Available BackgroundGroin dissections result in large wounds with exposed femoral vessels requiring soft tissue coverage, and the reconstructive options are diverse. In this study we reviewed our experience with the use of the pedicled anterolateral thigh and vertical rectus abdominis musculocutaneous flaps in the reconstruction of large groin wounds.MethodsGroin reconstructions performed over a period of 10 years were evaluated, with a mean follow up of two years. We included all cases with large or complex (involving perineum defects, which were reconstructed with the pedicled anterolateral thigh musculocutaneous or the vertical rectus abdominis musculocutaneous (VRAM flaps. Smaller wounds which were covered with skin grafts, locally based flaps and pedicled muscle flaps were excluded.ResultsTwenty-three reconstructions were performed for large or complex groin defects, utilising the anterolateral thigh (n=10 and the vertical rectus abdominis (n=13 pedicled musculocutaneous flaps. Femoral vein reconstruction with a prosthetic graft was required in one patient, and a combination flap (VRAM and gracilis muscle flap was performed in another. Satisfactory coverage was achieved in all cases without major complications. No free flaps were used in our series.ConclusionsThe anterolateral thigh and vertical rectus abdominis pedicled musculocutaneous flaps yielded consistent results with little morbidity in the reconstruction of large and complex groin defects. A combination of flaps can be used in cases requiring extensive cover.

  17. In vivo mucosal delivery of bioactive human interleukin 1 receptor antagonist produced by Streptococcus gordonii

    Directory of Open Access Journals (Sweden)

    Tagliabue Aldo

    2003-09-01

    Full Text Available Abstract Background Interleukin-1 (IL-1 is a cytokine involved in the initiation and amplification of the defence response in infectious and inflammatory diseases. IL-1 receptor antagonist (IL-1ra is an inactive member of the IL-1 family and represents one of the most potent mechanisms for controlling IL-1-dependent inflammation. IL-1ra has proven effective in the therapy of acute and chronic inflammatory diseases in experimental animal models and also in preliminary clinical trials. However, optimisation of therapeutic schedules is still needed. For instance, the use of drug delivery systems targeting specific mucosal sites may be useful to improve topical bioavailability and avoid side effects associated with systemic administration. Results In order to develop systems for the delivery of IL-1ra to mucosal target sites, a Streptococcus gordonii strain secreting human IL-1ra was constructed. The recombinant IL-1ra produced by S. gordonii was composed of the four amino acid residues RVFP of the fusion partner at the N-terminus, followed by the mature human IL-1ra protein. RFVP/IL-1ra displayed full biological activity in vitro in assays of inhibition of IL-1β-induced lymphocyte proliferation and was released by recombinant S. gordonii in vivo both at the vaginal and the gastrointestinal mucosa of mice. RFVP/IL-1ra appeared beneficial in the model of ulcerative colitis represented by IL-2-/- mice (knock-out for the interleukin-2 gene, as shown by the body weight increase of IL-2-/- mice locally treated with S. gordonii producing RFVP/IL-1ra. Conclusions These results indicate that recombinant S. gordonii can be successfully used as a delivery system for the selective targeting of mucosal surfaces with therapeutic proteins.

  18. Pregnancy and Vaginal Delivery after Sacrohysteropexy

    Directory of Open Access Journals (Sweden)

    Deniz Balsak

    2015-01-01

    Full Text Available Pregnancy and birth after a Pelvic Organ Prolapse (POP surgery is a rare condition and less is known about the method for delivery. A 31-year-old women with gravida 3 para 3 underwent abdominal sacrohysteropexy and transobturatuar tape (TOT procedures for stage III prolapse who delivered via vaginal birth and showed no relapse. Sacrohysteropexy is a good option for women with POP who desire fertility with a long term follow-up period.

  19. Bakri balloon in vaginal-perineal hematomas complicating vaginal delivery: a new therapeutic approach.

    Science.gov (United States)

    Gizzo, Salvatore; Saccardi, Carlo; Patrelli, Tito Silvio; Di Gangi, Stefania; D'Antona, Donato; Battista Nardelli, Giovanni

    2013-04-01

    The study aimed to evaluate the effectiveness of Bakri balloon as a hemostatic device in severe postpartum hemorrhage due to complicated vaginal-perineal hematoma not responsive to standard surgical treatments. The article discusses an effective and minimally invasive technique for resolving a case of massive vaginal-perineal bleeding after vaginal delivery complicated by ischiorectal fossa hematoma. A 36-year-old primipara white woman, 41 weeks 1 day pregnant, was admitted to our unit for beginning of labor. She experienced a precipitous delivery of a healthy male baby (3.72 kg, 51 cm in length), and spontaneous complete afterbirth of placenta and membranes. The intervention involved positioning of an hemostatic Bakri balloon device in the vagina, to compress the vaginal wall, ensuring that the draining apex was well positioned into the uterine cervix. The patient was discharged after having a puerperal course without further complications. Vaginal hemostatic Bakri balloon device shows hemostatic efficacy immediately assessable, is promptly removable, not interfering with subsequent surgical or radiological procedures, does not increase the risk of infections as other compressive procedures, allows flow of lochia, does not cause pain or discomfort in women, and permits adjustable compression when a drainage is placed during surgery. Despite the high cost, it does not show disadvantages.

  20. Relationship among vaginal palpation, vaginal squeeze pressure, electromyographic and ultrasonographic variables of female pelvic floor muscles

    Directory of Open Access Journals (Sweden)

    Vanessa S. Pereira

    2014-10-01

    Full Text Available Background: The proper evaluation of the pelvic floor muscles (PFM is essential for choosing the correct treatment. Currently, there is no gold standard for the assessment of female PFM function. Objective: To determine the correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the female PFM. Method: This cross-sectional study evaluated 80 women between 18 and 35 years of age who were nulliparous and had no pelvic floor dysfunction. PFM function was assessed based on digital palpation, vaginal squeeze pressure, electromyographic activity, bilateral diameter of the bulbocavernosus muscles and the amount of bladder neck movement during voluntary PFM contraction using transperineal bi-dimensional ultrasound. The Pearson correlation was used for statistical analysis (p<0.05. Results: There was a strong positive correlation between PFM function and PFM contraction pressure (0.90. In addition, there was a moderate positive correlation between these two variables and PFM electromyographic activity (0.59 and 0.63, respectively and movement of the bladder neck in relation to the pubic symphysis (0.51 and 0.60, respectively. Conclusions: This study showed that there was a correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the PFM in nulliparous women. The strong correlation between digital palpation and PFM contraction pressure indicated that perineometry could easily be replaced by PFM digital palpation in the absence of equipment.

  1. The radial artery superficial palmar branch flap: a modified free thenar flap with constant innervation.

    Science.gov (United States)

    Yang, Jae-Won; Kim, Jin-Soo; Lee, Dong-Chul; Ki, Sae-Hwi; Roh, Si-Young; Abdullah, Shalimar; Tien, Huey-Yuan

    2010-10-01

    The free thenar flap is useful for coverage of volar finger defects but has an inconstant innervation based on the presence of either the lateral antebrachial cutaneous nerve (LABC) or the superficial sensory branch of the radial nerve (SSRN). A detailed anatomic study on 30 adult fresh frozen cadavers preinjected with silicone rubber compound to demarcate arterial anatomy documented locations, numbers, and diameters of arteries and skin perforators with surrounding nerves. The palmar cutaneous branch of the median nerve (PCMN) was present within the flap in all cases. However, the LABC and the SSRN were available in only 43.33% and 46.66%, respectively, with neither of them in 33.33% of the cases. The constantly present PCMN allowed the design of a new flap named the radial artery superficial palmar branch (RASP) flap. The RASP flap is large enough to cover volar finger defects and contain direct skin perforators. Because it is constantly innervated, it is an excellent option for coverage of volar finger defects extending to the fingertips. © Thieme Medical Publishers.

  2. Proximally Based Anterolateral-Thigh (ALT) Flap for Knee Reconstruction: An Advancement Propeller Perforator Flap.

    Science.gov (United States)

    Cadenelli, Pierfrancesco; Bordoni, Daniele; Radaelli, Stefano; Marchesi, Andrea

    2015-10-01

    Adequate coverage of the knee region is often challenging for plastic and orthopedic surgeons. In the last decade, among several reconstructive techniques, local perforator flaps have become useful reconstructive units. After a wide resection for soft-tissue sarcoma, the knee vascular web may be reasonably damaged and, consequently, perforator flaps based on a local pedicle [such as the distally based anterolateral thigh (ALT) flap] are not reliable. Thus, we harvested a proximally based ALT for knee coverage. A 52-year-old man underwent local radiation therapy and a wide resection of a soft-tissue sarcoma on the anterior-lateral aspect of the left knee, which resulted in a 15 × 10 cm defect. The defect was covered with a proximally based ALT, through an advancement and propeller relocation of its skin paddle. All margins were tumor free. After 5 days, the donor site was closed primarily because of edema. Neither necrosis of the flap nor dehiscence of the wound was detected. No local relapses were detected at 6-month follow-up. In case of soft-tissue defects of the knee region, with likely involvement of the local vascular web, a local perforator solution is the advancement and propeller proximally based ALT flap. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  3. Magnetic resonance imaging of primary vaginal carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, M.B. [Department of Diagnostic Radiology, Christie Hospital NHS Trust, Withington, Manchester (United Kingdom)]. E-mail: ben.taylor@christie-tr.nwest.nhs.uk; Dugar, N. [Department of Diagnostic Radiology, Christie Hospital NHS Trust, Withington, Manchester (United Kingdom); Davidson, S.E. [Radiation Oncology, Christie Hospital NHS Trust, Withington, Manchester (United Kingdom); Carrington, B.M. [Department of Diagnostic Radiology, Christie Hospital NHS Trust, Withington, Manchester (United Kingdom)

    2007-06-15

    Aims: To describe the magnetic resonance imaging (MRI) features of vaginal carcinoma and to suggest a role for MRI in its management. Materials and methods: Twenty-five patients with primary vaginal carcinoma treated at our institution between 1996 and 2005 were included in the study. The MRI examinations were reviewed and tumour dimensions, signal characteristics and involvement of pelvic structures were documented, as were sites of enlarged lymph nodes and metastases. Details of patient treatment and outcome were obtained from the clinical notes. Results: The median patient age was 54 years (range 31-86 years). Tumour maximum diameter ranged from 1.6-11.3 cm (mean 3.7 cm). Most tumours were of iso-intense signal to muscle on T1-weighted images and hyper-intense to muscle on T2-weighted images. Eighty-eight percent of patients had tumour extending beyond the vagina and 56% of patients had Figo stage III or above tumours. Sixteen patients were treated with radiotherapy (two with chemoradiotherapy), five with surgery and four with supportive care. Ten patients (40%) died of their disease during the study period. The MRI stage of the tumour correlated with survival. Conclusion: MRI identified over 95% of primary vaginal tumours in the present study, enabled radiological staging, which correlated with outcome, and provided information of use in treatment planning.

  4. Antibiotic Susceptibility of Potentially Probiotic Vaginal Lactobacilli

    Directory of Open Access Journals (Sweden)

    Virginia Ocaña

    2006-01-01

    Full Text Available Objective. To study the antimicrobial susceptibility of six vaginal probiotic lactobacilli. Methods. The disc diffusion method in Müeller Hinton, LAPTg and MRS agars by the NCCLS (National Committee for Clinical Laboratory Standards procedure was performed. Due to the absence of a Lactobacillus reference strains, the results were compared to those of Staphylococcus aureus ATCC29213. Minimal Inhibitory Concentration (MIC with 21 different antibiotics in LAPTg agar and broth was also determined. Results. LAPTg and MRS agars are suitable media to study antimicrobial susceptibility of lactobacilli. However, the NCCLS procedure needs to be standardized for this genus. The MICs have shown that all Lactobacillus strains grew at concentrations above 10 μg/mL of chloramphenicol, aztreonam, norfloxacin, ciprofloxacin, ceftazidime, ceftriaxone, streptomycin and kanamycin. Four lactobacilli were sensitive to 1 μg/mL vancomycin and all of them were resistant to 1000 μg/mL of metronidazole. Sensitivity to other antibiotics depended on each particular strain. Conclusions. The NCCLS method needs to be standardized in an appropriate medium to determine the antimicrobial susceptibility of Lactobacillus. Vaginal probiotic lactobacilli do not display uniform susceptibility to antibiotics. Resistance to high concentrations of metronidazole suggests that lactobacilli could be simultaneously used with a bacterial vaginosis treatment to restore the vaginal normal flora.

  5. Antibiotic Susceptibility of Potentially Probiotic Vaginal Lactobacilli

    Science.gov (United States)

    Ocaña, Virginia; Silva, Clara; Nader-Macías, María Elena

    2006-01-01

    Objective. To study the antimicrobial susceptibility of six vaginal probiotic lactobacilli. Methods. The disc diffusion method in Müeller Hinton, LAPTg and MRS agars by the NCCLS (National Committee for Clinical Laboratory Standards) procedure was performed. Due to the absence of a Lactobacillus reference strains, the results were compared to those of Staphylococcus aureus ATCC29213. Minimal Inhibitory Concentration (MIC) with 21 different antibiotics in LAPTg agar and broth was also determined. Results. LAPTg and MRS agars are suitable media to study antimicrobial susceptibility of lactobacilli. However, the NCCLS procedure needs to be standardized for this genus. The MICs have shown that all Lactobacillus strains grew at concentrations above 10 μg/mL of chloramphenicol, aztreonam, norfloxacin, ciprofloxacin, ceftazidime, ceftriaxone, streptomycin and kanamycin. Four lactobacilli were sensitive to 1 μg/mL vancomycin and all of them were resistant to 1000 μg/mL of metronidazole. Sensitivity to other antibiotics depended on each particular strain. Conclusions. The NCCLS method needs to be standardized in an appropriate medium to determine the antimicrobial susceptibility of Lactobacillus. Vaginal probiotic lactobacilli do not display uniform susceptibility to antibiotics. Resistance to high concentrations of metronidazole suggests that lactobacilli could be simultaneously used with a bacterial vaginosis treatment to restore the vaginal normal flora. PMID:17485797

  6. Stereophotogrammetry of the perineum during vaginal delivery.

    Science.gov (United States)

    Zemčík, Robert; Karbanova, Jaroslava; Kalis, Vladimir; Lobovský, Libor; Jansová, Magdalena; Rusavy, Zdenek

    2012-10-01

    To analyze deformation of the perineum during normal vaginal delivery in order to identify clinical steps that might be beneficial when executing manual perineal protection. The present prospective study at Charles University Hospital, Pilsen, Czech Republic, enrolled 10 primiparous women at term undergoing non-instrumental vaginal delivery assisted by the same obstetrician between September 2009 and September 2010. A modified hands-poised technique performed concurrently with stereophotogrammetry was used to analyze and quantify perineal deformation and strain at the final stage of delivery. The highest tissue strain (mean, 177%; 95% confidence interval [CI], 106.3-248.5) was in a transverse direction and occurred at the level of the fourchette (i.e. 1cm was transversely stretched and deformed to 2.77 cm during the final stage of vaginal delivery). This strain was more than 4 times higher than the maximum anteroposterior strain (mean, 43%; 95% CI, 28.6-57.4). On the basis of these stereophotogrammetry data, a technique of perineal protection executed by fingers of the posterior (right) hand can be proposed. Further experimental and clinical studies are needed to evaluate whether this technique might assist in reducing obstetric perineal trauma. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  7. Postmenopausal Vaginal Endometriotic Cyst: A Case Report

    Directory of Open Access Journals (Sweden)

    Esengul Turkyilmaz

    2016-07-01

    Full Text Available A seventy-three-year-old patient%u2019s vaginal examination revealed a semi-mobile cystic structure visualised at the middle third portion of the posterior vaginal wall. The cyst was excised and the cyst wall was sent for pathological examination. The histopathological examination of the cyst with CD10 staining and tests for nuclear estrogen receptor positivity and nuclear progesteron receptor positivity revealed that the cyst wall contained endometrial stromal cells, endometrial surface epithelial cells, and hemosiderin-laden macrophages. Endometriosis externa was diagnosed based on the above findings. The case we report here, of an isolated vaginal endometriotic cyst, is unique because of its presentation in a postmenopausal woman without any history of infertility, any gynecologic surgery, or hormone replacement therapy. The reasonable explanation for this case might include certain mechanisms such as the self-sustaining existence of endometriotic cells that were implanted during the premenopausal period to the vagina and that maintain local estrogen production. No single hypothesis can explain the pathophysiology of endometriosis, given all of its various forms and presentations.

  8. Effects of intrauterine contraception on the vaginal microbiota.

    Science.gov (United States)

    Bassis, Christine M; Allsworth, Jenifer E; Wahl, Heather N; Sack, Daniel E; Young, Vincent B; Bell, Jason D

    2017-09-01

    There have been conflicting reports of altered vaginal microbiota and infection susceptibility associated with contraception use. The objectives of this study were to determine if intrauterine contraception altered the vaginal microbiota and to compare the effects of a copper intrauterine device (Cu-IUD) and a levonorgestrel intrauterine system (LNG-IUS) on the vaginal microbiota. DNA was isolated from the vaginal swab samples of 76 women using Cu-IUD (n=36) or LNG-IUS (n=40) collected prior to insertion of intrauterine contraception (baseline) and at 6 months. A third swab from approximately 12 months following insertion was available for 69 (Cu-IUD, n=33; LNG-IUS, n=36) of these women. The V4 region of the bacterial 16S rRNA-encoding gene was amplified from the vaginal swab DNA and sequenced. The 16S rRNA gene sequences were processed and analyzed using the software package mothur to compare the structure and dynamics of the vaginal bacterial communities. The vaginal microbiota from individuals in this study clustered into 3 major vaginal bacterial community types: one dominated by Lactobacillus iners, one dominated by Lactobacillus crispatus and one community type that was not dominated by a single Lactobacillus species. Changes in the vaginal bacterial community composition were not associated with the use of Cu-IUD or LNG-IUS. Additionally, we did not observe a clear difference in vaginal microbiota stability with Cu-IUD versus LNG-IUS use. Although the vaginal microbiota can be highly dynamic, alterations in the community associated with the use of intrauterine contraception (Cu-IUD or LNG-IUS) were not detected over 12 months. We found no evidence that intrauterine contraception (Cu-IUD or LNG-IUS) altered the vaginal microbiota composition. Therefore, the use of intrauterine contraception is unlikely to shift the composition of the vaginal microbiota such that infection susceptibility is altered. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Spectrum of vaginal discharge in a tertiary care setting

    Science.gov (United States)

    Sivaranjini, R; Jaisankar, TJ; Thappa, Devinder Mohan; Kumari, Rashmi; Chandrasekhar, Laxmisha; Malathi, M; Parija, SC; Habeebullah, S

    2013-01-01

    Introduction: Vaginal discharge is one of the common reasons for gynecological consultation. Many of the causes of vaginitis have a disturbed vaginal microbial ecosystem associated with them. Effective treatment of vaginal discharge requires that the etiologic diagnosis be established and identifying the same offers a precious input to syndromic management and provides an additional strategy for human immunodeficiency virus prevention. The present study was thus carried out to determine the various causes of vaginal discharge in a tertiary care setting. Materials and Methods: A total of 400 women presenting with vaginal discharge of age between 20 and 50 years, irrespective of marital status were included in this study and women who had used antibiotics or vaginal medication in the previous 14 days and pregnant women were excluded. Results: Of the 400 women with vaginal discharge studied, a diagnosis was established in 303 women. Infectious causes of vaginal discharge were observed in 207 (51.75%) women. Among them, bacterial vaginosis was the most common cause seen in 105 (26.25%) women. The other infections observed were candidiasis alone (61, 15.25%), trichomoniasis alone (12, 3%), mixed infections (22, 5.5%) and mucopurulent cervicitis (7 of the 130 cases looked for, 8.46%). Among the non-infectious causes, 72 (18%) women had physiological vaginal discharge and 13 (3.3%) women had cervical in situ cancers/carcinoma cervix. Conclusion: The pattern of infectious causes of vaginal discharge observed in our study was comparable with the other studies in India. Our study emphasizes the need for including Papanicolaou smear in the algorithm for evaluation of vaginal discharge, as it helps establish the etiology of vaginal discharge reliably and provides a valuable opportunity to screen for cervical malignancies. PMID:24470998

  10. Stability investigation of an airfoil section with active flap control

    DEFF Research Database (Denmark)

    Bergami, Leonardo; Gaunaa, Mac

    2010-01-01

    This work presents a method to determine flutter and divergence instability limits for a two-dimensional (2-D) airfoil section fitted with an actively controlled trailing edge flap. This flap consists of a deformable trailing edge, which deformation is governed by control algorithms based...... for fatigue load alleviation. The structural model of the 2-D airfoil section contains three degrees of freedom: heave translation, pitch rotation and flap deflection. A potential flow model provides the aerodynamic forces and their distribution. The unsteady aerodynamics are described using an indicial....... The implemented stability tool is then applied to an airfoil section representative of a wind turbine blade with active flap control. It is thereby observed that the airfoil stability limits are significantly modified by the presence of the flap, and they depend on several parameters: flap structural...

  11. Immediately observation on post-LASIK corneal flap

    Directory of Open Access Journals (Sweden)

    Kun Wu

    2014-08-01

    Full Text Available AIM:To immediately observe the complication of corneal flap after LASIK surgery.METHODS:A retrospective case series were studies.Totally 2 040 cases(4 080 eyesfrom January 2010 to October 2012 in our hospital were collected, the corneal flap was observed using lamp microscope after LASIK within 30min. Corneal flap dislocation, corneal flap strial and intraface debris were examined after operation, the effective treatment and controlled measure should be taken for these complications.RESULTS: Postoperative complications were corneal flap dislocation 102 eyes(2.5%, corneal flapstriae 95 eyes(2.33%, interface debris 105 eyes(2.57%. No failure case was seen. There had no corneal flap-related complications, which seriously impact the visual quality after the surgery.CONCLUSION: Carefully postoperative examination at the first-time is an effective way to manage some complications of post-LASIK. Thus promoting the diagnosis and treatment of post-LASIK complications.

  12. Temporal-based pericranial flaps for orbitofrontal Dural repair: A technical note and Review of the literature

    Directory of Open Access Journals (Sweden)

    Esther Dupépé

    2016-03-01

    Conclusions: A temporal-based pericranial flap represents an alternative vascularized pedicle flap to the classic frontal-based pericranial flap used in orbitofrontal dural repair. In certain clinical settings, the temporal-based flap may be preferable.

  13. Shape and Structural Optimization of Flapping Wings

    OpenAIRE

    Stewart, Eric C

    2014-01-01

    This dissertation presents shape and structural optimization studies on flapping wings for micro air vehicles. The design space of the optimization includes the wing planform and the structural properties that are relevant to the wing model being analyzed. The planform design is parameterized using a novel technique called modified Zimmerman, which extends the concept of Zimmerman planforms to include four ellipses rather than two. Three wing types are considered: rigid, plate-like deformable...

  14. Current indications for the osteoplastic flap.

    Science.gov (United States)

    Rivera, Teresa; Rodríguez, Manuel; Pulido, Natalia; García-Alcántara, Fernando; Sanz, Lorena

    2016-01-01

    Endoscopic sinus surgery is the technique of choice in most of the frontal sinus diseases, both inflammatory and tumour-related. This is why the external approach using osteoplastic flap (OF) would be limited to cases with a difficult endoscopic approach. Our aim was to review the current indications of the osteoplastic flap in the treatment of frontal sinus pathology, through a retrospective study of patients undergoing this technique. We performed a retrospective study of 14 patients who were treated with the osteoplastic flap procedure. All the surgical indication criteria, type of sinus disease, presence or absence of prior endoscopic surgery, surgical findings, complications and recurrence were reviewed. The pathologies found were 1 osteoma (7.1%), 3 inverted papilloma (21.4%) and 10 mucoceles (71.4%). Nine patients had a prior endoscopic surgery and 10 patients had an orbital dehiscence (9 mucocele, 1 papilloma). Frontal osteoma was Grade IV and the papilloma cases were Krouse Stage III. Surgical revision was required for 21.4%. The main indications for an OF in patients with inflammatory disease are lateral extension and frontal recess neo-osteogenesis. In osteoma cases, it depends on the size of the tumour. In inverted papilloma cases, the indication is multifocal implantation with origin in the anterior and lateral wall. In all cases, performing the osteoplastic flap must be individualised. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  15. Shape and Structural Optimization of Flapping Wings

    Science.gov (United States)

    Stewart, Eric Colby

    This dissertation presents shape and structural optimization studies on flapping wings for micro air vehicles. The design space of the optimization includes the wing planform and the structural properties that are relevant to the wing model being analyzed. The planform design is parameterized using a novel technique called modified Zimmerman, which extends the concept of Zimmerman planforms to include four ellipses rather than two. Three wing types are considered: rigid, plate-like deformable, and membrane. The rigid wing requires no structural design variables. The structural design variables for the plate-like wing are the thickness distribution polynomial coefficients. The structural variables for the membrane wing control the in-plane distributed forces which modulate the structural deformation of the wing. The rigid wing optimization is performed using the modified Zimmerman method to describe the wing. A quasi-steady aerodynamics model is used to calculate the thrust and input power required during the flapping cycle. An assumed inflow model is derived based on lifting-line theory and is used to better approximate the effects of the induced drag on the wing. A multi-objective optimization approach is used since more than one aspect is considered in flapping wing design. The the epsilon-constraint approach is used to calculate the Pareto optimal solutions that maximize the cycle-average thrust while minimizing the peak input power and the wing mass. An aeroelastic model is derived to calculate the aerodynamic performance and the structural response of the deformable wings. A linearized unsteady vortex lattice method is tightly coupled to a linear finite element model. The model is cost effective and the steady-state solution is solved by inverting a matrix. The aeroelastic model is used to maximize the thrust produced over one flapping cycle while minimizing the input power.

  16. Oral and vaginal epithelial cell lines bind and transfer cell-free infectious HIV-1 to permissive cells but are not productively infected.

    Directory of Open Access Journals (Sweden)

    Arinder Kohli

    Full Text Available The majority of HIV-1 infections worldwide are acquired via mucosal surfaces. However, unlike the vaginal mucosa, the issue of whether the oral mucosa can act as a portal of entry for HIV-1 infection remains controversial. To address potential differences with regard to the fate of HIV-1 after exposure to oral and vaginal epithelium, we utilized two epithelial cell lines representative of buccal (TR146 and pharyngeal (FaDu sites of the oral cavity and compared them with a cell line derived from vaginal epithelium (A431 in order to determine (i HIV-1 receptor gene and protein expression, (ii whether HIV-1 genome integration into epithelial cells occurs, (iii whether productive viral infection ensues, and (iv whether infectious virus can be transferred to permissive cells. Using flow cytometry to measure captured virus by HIV-1 gp120 protein detection and western blot to detect HIV-1 p24 gag protein, we demonstrate that buccal, pharyngeal and vaginal epithelial cells capture CXCR4- and CCR5-utilising virus, probably via non-canonical receptors. Both oral and vaginal epithelial cells are able to transfer infectious virus to permissive cells either directly through cell-cell attachment or via transcytosis of HIV-1 across epithelial cells. However, HIV-1 integration, as measured by real-time PCR and presence of early gene mRNA transcripts and de novo protein production were not detected in either epithelial cell type. Importantly, both oral and vaginal epithelial cells were able to support integration and productive infection if HIV-1 entered via the endocytic pathway driven by VSV-G. Our data demonstrate that under normal conditions productive HIV-1 infection of epithelial cells leading to progeny virion production is unlikely, but that epithelial cells can act as mediators of systemic viral dissemination through attachment and transfer of HIV-1 to permissive cells.

  17. Design, manufacturing and testing of Controllable Rubber Trailing Edge Flaps

    DEFF Research Database (Denmark)

    Løgstrup Andersen, Tom; Aagaard Madsen, Helge; Barlas, Thanasis K

    The overall goal for the INDUFLAP project was realization of a test facility for development and test of Controllable Rubber Trailing Edge Flaps (CRTEF) for wind turbines. This report covers experimental work at DTU Wind Energy including design, manufacture and test of different configurations...... of flaps with voids in chord- or spanwise direction. Development of rubber flaps has involved further design improvements. Non-metallic spring elements and solutions for sealing of continuous extruded rubber profiles have been investigated....

  18. A New Method for Creating the Bladder Flap

    Directory of Open Access Journals (Sweden)

    Alexandria J. Hill

    2013-01-01

    Full Text Available Background Bladder flaps are commonly created during routine cesarean deliveries and often require multiple steps that increase operating time and expose the surgeon to inadvertent injury. Objective We report a simple method of creating a bladder flap that eliminates the need for multiple instrument handoffs and repositioning. Conclusion The simplicity of this method allows the surgeon decreased operative entry time while decreasing exposure to injuries from multiple instrument handoffs during bladder flap development.

  19. New generation of oral mucosal vaccines targeting dendritic cells.

    Science.gov (United States)

    Owen, Jennifer L; Sahay, Bikash; Mohamadzadeh, Mansour

    2013-12-01

    As most infectious organisms gain entry at mucosal surfaces, there is a great deal of interest in developing vaccines that elicit effective mucosal immune responses against pathogen challenge. Targeted vaccination is one of the most effective methods available to prevent and control infectious diseases. Mucosal vaccines can offer lower costs, better accessibility, needle free delivery, and a higher capacity for mass immunizations during pandemics. Both local mucosal immunity and robust systemic responses can be achieved through mucosal vaccination. Recent progress in understanding the molecular and cellular components of the mucosal immune system have allowed for the development of a novel mucosal vaccine platform utilizing specific dendritic cell-targeting peptides and orally administered lactobacilli to elicit efficient antigen specific immune responses against infections, including Bacillus anthracis in experimental models of disease. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Mastectomy skin flap necrosis: challenges and solutions

    Science.gov (United States)

    Robertson, Stuart A; Jeevaratnam, Johann A; Agrawal, Avi; Cutress, Ramsey I

    2017-01-01

    Introduction Mastectomy skin flap necrosis (MSFN) has a reported incidence of 5%–30% in the literature. It is often a significant and underappreciated problem. The aim of this article was to review the associated challenges and possible solutions. Methods A MEDLINE search was performed using the search term “mastectomy skin flap necrosis”. Titles and abstracts from peer-reviewed publications were screened for relevance. Results MSFN is a common complication and may present as partial- or full-thickness necrosis. Predictive patient risk factors include smoking, diabetes, obesity, radiotherapy, previous scars and severe medical comorbidity. MSFN leads to a number of challenges, including wound management problems, delays to adjuvant therapy, esthetic compromise, implant extrusion, patient distress and financial loss. Careful preoperative planning and meticulous surgical technique may reduce the incidence of MSFN. A number of intraoperative techniques are available to try and predict skin flaps at risk of MSFN. MSFN may be managed operatively or nonoperatively. Early intervention may reduce the morbidity of MSFN in selected cases. Topical nitroglycerin ointment may be beneficial in reducing MSFN following immediate reconstruction, but the evidence base is still limited. Conclusion MSFN can result in considerable challenges for the patient and the health care service. This review discusses the management options for this problem. PMID:28331365

  1. The extended abdominal wall flap for transplantation.

    Science.gov (United States)

    Hollenbeck, S T; Senghaas, A; Turley, R; Ravindra, K V; Zenn, M R; Levin, L S; Erdmann, D

    2011-06-01

    Patients with extensive loss of the abdominal wall tissue have few options for restoring the abdominal cavity. Composite tissue allotransplantation has been used for limited abdominal wall reconstruction in the setting of visceral transplantation, yet replacement of the entire abdominal wall has not been described. The purpose of this study was to determine the maximal abdominal skin surface available through an external iliac/femoral cuff-based pedicle. Five human cadaveric abdominal walls were injected with methylene blue to analyze skin perfusion based on either the deep inferior epigastric artery (DIEA; n = 5) or a cuff of external iliac/femoral artery (n = 5) containing the deep circumflex iliac, deep inferior epigastric, and superficial inferior epigastric, and superficial circumflex iliac arteries. Abdominal wall flaps were taken full thickness from the costal margin to the midaxillary line and down to the pubic tubercle and proximal thigh. In all specimens, the deep inferior epigastric, deep circumflex iliac, superficial inferior epigastric, and superficial circumflex iliac arteries were found to originate within a 4-cm cuff of the external iliac/femoral artery. Abdominal wall flaps injected through a unilateral external iliac/femoral segment had a significantly greater degree of total flap perfusion than those injected through the DIEA alone (76.5% ± 4% vs 57.2% ± 5%; Student t test, P DIEA vessel alone. Copyright © 2011 Elsevier Inc. All rights reserved.

  2. Vaginal cuff closure: a comparison between the vaginal route and laparoscopic suture in patients undergoing total laparoscopic hysterectomy.

    Science.gov (United States)

    Hwang, Jong Ha; Lee, Jae Kwan; Lee, Nak Woo; Lee, Kyu Wan

    2011-01-01

    To compare the vaginal route and laparoscopic suture for vaginal cuff closure (VCC) in patients undergoing a total laparoscopic hysterectomy (TLH). A total of 471 women who required hysterectomy were allocated to two groups. 261 women had TLH via VCC by the vaginal route and 210 women had TLH via VCC by laparoscopic suture. All TLHs were performed by the same laparoscopic surgeon. The cuff-related complications included vaginal disruption (3.4%), dehiscence (1.27%), vaginal vault bleeding (1.91%), vaginal spotting (19.32%), granulation (1.27%), cuff infection (1.49%), and yellowish vaginal discharge (6.16%). No difference in vaginal cuff complications was found between the laparoscopic and vaginal approach. The median operation time was significantly shorter for the laparoscopic suture (76.74 min, range 40-220; 95% CI 74.84-83.45) than the vaginal route for VCC (85.77 min, range 45-290; 95% CI 86.87-95.36) after hysterectomy (p < 0.001). For VCC with TLH, laparoscopic suture was a safe and less time-consuming procedure. The cuff-related complications were similar in the two groups. Copyright © 2010 S. Karger AG, Basel.

  3. Perineoscrotal reconstruction using a medial circumflex femoral artery perforator flap.

    Science.gov (United States)

    Karsidag, Semra; Akcal, Arzu; Sirvan, Selami Serhat; Guney, Soner; Ugurlu, Kemal

    2011-02-01

    Major scrotal defects may result from infection due to Fournier's gangrene, excision of scrotal skin diseases, traumatic avulsion of scrotal and penile skin, and genital burns. The wide spectrum of bacterial flora of the perineum, difficulty in providing immobilisation, and obtaining a natural contour of the testes make testicular cover very difficult. Various methods have been reported to cover the penoscrotal area, including skin grafting, transposing them to medial thigh skin, and use of local fasciocutaneous or musculocutaneous flaps. In this report, reconstruction using six local medial circumflex femoral artery perforator (MCFAP) flaps was undertaken in five male patients (mean age, 47 years) with complex penoscrotal or perineal wounds. The cause of the wounds in four patients was Fournier's gangrene, and was a wide papillomateous lesion in the other patient. Flap width was 6-10 cm and flap length was 10-18 cm. The results showed that a MCFAP flap provided the testes with a pliable local flap without being bulky and also protected the testicle without increasing the temperature. The other advantage of the MCFAP flap was that the donor-site scar could be concealed in the gluteal crease. Our results demonstrated that the MCFAP flap is an ideal local flap for covering penoscrotal defects. Copyright © 2011 Wiley-Liss, Inc.

  4. Reconstruction of scalp defects with the radial forearm free flap

    Science.gov (United States)

    2012-01-01

    Background Advanced and recurrent cutaneous squamous cell carcinoma of the scalp and forehead require aggressive surgical excision often resulting in complex defects requiring reconstruction. This study evaluates various microvascular free flap reconstructions in this patient population, including the rarely utilized radial forearm free flap. Patients and methods A retrospective review of patients undergoing free flap surgeries (n = 47) of the scalp between 1997 and 2011 were included. Patients were divided primarily into two cohorts: a new primary lesion (n = 21) or recurrence (n = 26). Factors examined include patient demographics, indication for surgery, defect, type of flap used, complications (major and minor), and outcomes. Results The patients were primarily male (n = 34), with a mean age of 67 years (25–91). A total of 58 microvascular free flap reconstructions were performed (radial forearm free flap: n = 28, latissimus dorsi: n = 20, rectus abdominis: n = 9, scapula: n = 1). Following reconstruction with a radial forearm free flap, duration of hospitalization was shorter (P = 0.04) and complications rates were similar (P = 0.46). Donor site selection correlated with defect area (P scalp are aggressive and challenging to treat. The radial forearm free flap is an underutilized free flap in the reconstruction of complex scalp defects. PMID:22583845

  5. Dorsal hand coverage with free serratus fascia flap

    DEFF Research Database (Denmark)

    Fotopoulos, Peter; Holmer, Per; Leicht, Pernille

    2003-01-01

    In reconstructing a defect on the dorsum of the hand, with the extensor tendons exposed or even missing, functional, as well as cosmetic, goals are of major importance. The authors present three cases of extensor tendon reconstruction, combined with soft-tissue reconstruction, with the free...... in the flap, leaving the long thoracic nerve intact on the serratus muscle. Coverage of the flap with split-thickness skin graft is done immediately. The free serratus fascia flap is an ideal flap for dorsal hand coverage when the extensor tendons are exposed, especially because of low donor-site morbidity....

  6. Cervicopectoral flap in head and neck cancer surgery

    Directory of Open Access Journals (Sweden)

    Sivrioglu Nazan S

    2003-12-01

    Full Text Available Abstract Background Reconstruction of the head and neck after adequate resection of primary tumor and neck dissection is a challenge. It should be performed at one sitting in advanced tumors. Defects caused by the resection should be closed with flaps which match in color, texture and hair bearing characteristics with the face. Cervicopectoral flap is a one such flap from chest and neck skin mainly used to cover the cheek defects. Methods This study included twelve patients presenting with cancer of the head and neck to Izmir Ataturk Training Hospital and Adnan Menderes University Hospital. Tumor resection and neck dissection was performed in one session by the same surgeon. A single incision was made and a medially based cervicopectoral fascio-cutaneous flap was used for surgical exposure in neck dissection and for closure of defects after tumor resection. Results There was no major complication. Two flaps had partial superficial epidermolysis at the suture line. Good aesthetic and functional results were achieved. Conclusion The cervicopectoral flap is an excellent alternative for the reconstruction of head and neck. Harvesting and application of the flap is rapid and safe. Only a single incision is sufficient for dissection and flap elevation. This flap achieves perfect surgical exposure, makes neck dissection easy and allows one to perform both tumor resection and neck dissection in one session.

  7. Hypothyroidism improves random-pattern skin flap survival in rats.

    Science.gov (United States)

    Rahimpour, Sina; Nezami, Behtash Ghazi; Karimian, Negin; Sotoudeh-Anvari, Maryam; Ebrahimi, Farzad; Taleb, Shayandokht; Mirazi, Naser; Dehpour, Ahmad Reza

    2012-11-01

    The protective effect of hypothyroidism against ischemic or toxic conditions has been shown in various tissues. We investigated the effect of propylthiouracil (PTU)/methimazole (MMI)-induced hypothyroidism and acute local effect of MMI on the outcome of lethal ischemia in random-pattern skin flaps. Dorsal flaps with caudal pedicles were elevated at midline and flap survival was measured at the seventh day after surgery. The first group, as control, received 1 mL of 0.9% saline solution in the flap before flap elevation. In groups 2 and 3, hypothyroidism was induced by administration of either PTU 0.05% or MMI 0.04% in drinking water. The next four groups received local injections of MMI (10, 20, 50, or 100 μg/flap) before flap elevation. Local PTU injection was ignored due to insolubility of the agent. Hypothyroidism was induced in chronic PTU- and MMI-treated groups, and animals in these groups showed significant increase in their flap survival, compared to control euthyroid rats (79.47% ± 10.49% and 75.48% ± 12.93% versus 52.26% ± 5.75%, respectively, P hypothyroidism improves survival of random-pattern skin flaps in rats. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. Rotational flaps in oncologic breast surgery. Anatomical and technical considerations.

    Science.gov (United States)

    Acea Nebril, Benigno; Builes Ramírez, Sergio; García Novoa, Alejandra; Varela Lamas, Cristina

    2016-01-01

    Local flaps are a group of surgical procedures that can solve the thoracic closure of large defects after breast cancer surgery with low morbidity. Its use in skin necrosis complications after conservative surgery or skin sparing mastectomies facilitates the initiation of adjuvant treatments and reduces delays in this patient group. This article describes the anatomical basis for the planning of thoracic and abdominal local flaps. Also, the application of these local flaps for closing large defects in the chest and selective flaps for skin coverage by necrosis in breast conserving surgery. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. A novel animal model for skin flap prelamination with biomaterials

    Science.gov (United States)

    Zhou, Xianyu; Luo, Xusong; Liu, Fei; Gu, Chuan; Wang, Xi; Yang, Qun; Qian, Yunliang; Yang, Jun

    2016-09-01

    Several animal models of skin flap construction were reported using biomaterials in a way similar to prefabrication. However, there are few animal model using biomaterials similar to prelamination, another main way of clinical skin flap construction that has been proved to be reliable. Can biomaterials be added in skin flap prelamination to reduce the use of autogenous tissues? Beside individual clinical attempts, animal model is needed for randomized controlled trial to objectively evaluate the feasibility and further investigation. Combining human Acellular Dermal Matrix (hADM) and autologous skin graft, we prelaminated flaps based on inguinal fascia. One, two, three and four weeks later, hADM exhibited a sound revascularization and host cell infiltration. Prelaminated skin flaps were then raised and microsurgically transplanted back to groin region. Except for flaps after one week of prelamination, flaps from other subgroups successfully reconstructed defects. After six to sixteen weeks of transplantation, hADM was proved to being able to maintain its original structure, having a wealth of host tissue cells and achieving full revascularization.To our knowledge, this is the first animal model of prelaminating skin flap with biomaterials. Success of this animal model indicates that novel flap prelamination with biomaterials is feasible.

  10. Thermosensitive hydrogels a versatile concept adapted to vaginal drug delivery.

    Science.gov (United States)

    Taurin, Sebastien; Almomen, Aliyah A; Pollak, Tatianna; Kim, Sun Jin; Maxwell, John; Peterson, C Matthew; Owen, Shawn C; Janát-Amsbury, Margit M

    2017-11-15

    Vaginal drug delivery represents an attractive strategy for local and systemic delivery of drugs otherwise poorly absorbed after oral administration. The rather dense vascular network, mucus permeability and the physiological phenomenon of the uterine first-pass effect can all be exploited for therapeutic benefit. However, several physiological factors such as an acidic pH, constant secretion, and turnover of mucus as well as varying thickness of the vaginal epithelium can impact sustained drug delivery. In recent years, polymers have been designed to tackle challenges mentioned above. In particular, thermosensitive hydrogels hold great promise due to their stability, biocompatibility, adhesion properties and adjustable drug release kinetics. Here, we discuss the physiological and anatomical uniqueness of the vaginal environment and how it impacts the safe and efficient vaginal delivery and also reviewed several thermosensitive hydrogels deemed suitable for vaginal drug delivery by addressing specific characteristics, which are essential to engage the vaginal environment successfully.

  11. M cell-targeted mucosal vaccine strategies.

    Science.gov (United States)

    Yamamoto, M; Pascual, D W; Kiyono, H

    2012-01-01

    Immune responses in the aerodigestive tract are characterized by production and transport of specific IgA antibodies across the epithelium to act as a first line of defense against pathogens in the external environment. To sample antigens on mucosal surfaces in the intestine and upper respiratory tract, the immune system relies on a close collaboration between specialized antigen-sampling epithelial M cells and lymphoid cells. Depending on various factors, local antigen presentation in the mucosal tissue leads to tolerance or initiation of an active immune response. Recently, molecules that could be used to target vaccine antigens to apical M cell surfaces have been identified. Here we review the M cell-targeted vaccine strategy, an approach that could be used to enhance uptake and efficacy of vaccines delivered in the nasal cavity or intestine.

  12. Vaginal Approaches Using Synthetic Mesh to Treat Pelvic Organ Prolapse

    OpenAIRE

    Moon, Jei Won; Chae, Hee Dong

    2016-01-01

    Pelvic organ prolapse (POP) is a very common condition in elderly women. In women with POP, a sacrocolpopexy or a vaginal hysterectomy with anterior and posterior colporrhaphy has long been considered as the gold standard of treatment. However, in recent decades, the tendency to use a vaginal approach with mesh for POP surgery has been increasing. A vaginal approach using mesh has many advantages, such as its being less invasive than an abdominal approach and easier to do than a laparoscopic ...

  13. Optimization design and dynamic analysis on the drive mechanisms of flapping-wing air vehicles based on flapping trajectories

    Science.gov (United States)

    Xie, Lingwang; Zhang, Xingwei; Luo, Pan; Huang, Panpan

    2017-10-01

    The optimization designs and dynamic analysis on the driving mechanism of flapping-wing air vehicles on base of flapping trajectory patterns is carried out in this study. Three different driving mechanisms which are spatial double crank-rocker, plane five-bar and gear-double slider, are systematically optimized and analysed by using the Mat lab and Adams software. After a series debugging on the parameter, the comparatively ideal flapping trajectories are obtained by the simulation of Adams. Present results indicate that different drive mechanisms output different flapping trajectories and have their unique characteristic. The spatial double crank-rocker mechanism can only output the arc flapping trajectory and it has the advantages of small volume, high flexibility and efficient space utilization. Both planar five-bar mechanism and gear-double slider mechanism can output the oval, figure of eight and double eight flapping trajectories. Nevertheless, the gear-double slider mechanism has the advantage of convenient parameter setting and better performance in output double eight flapping trajectory. This study can provide theoretical basis and helpful reference for the design of the drive mechanisms of flapping-wing air vehicles with different output flapping trajectories.

  14. Identification of Flap Motion Parameters for Vibration Reduction in Helicopter Rotors with Multiple Active Trailing Edge Flaps

    Directory of Open Access Journals (Sweden)

    Uğbreve;ur Dalli

    2011-01-01

    Full Text Available An active control method utilizing the multiple trailing edge flap configuration for rotorcraft vibration suppression and blade loads control is presented. A comprehensive model for rotor blade with active trailing edge flaps is used to calculate the vibration characteristics, natural frequencies and mode shapes of any complex composite helicopter rotor blade. A computer program is developed to calculate the system response, rotor blade root forces and moments under aerodynamic forcing conditions. Rotor blade system response is calculated using the proposed solution method and the developed program depending on any structural and aerodynamic properties of rotor blades, structural properties of trailing edge flaps and properties of trailing edge flap actuator inputs. Rotor blade loads are determined first on a nominal rotor blade without multiple active trailing edge flaps and then the effects of the active flap motions on the existing rotor blade loads are investigated. Multiple active trailing edge flaps are controlled by using open loop controllers to identify the effects of the actuator signal output properties such as frequency, amplitude and phase on the system response. Effects of using multiple trailing edge flaps on controlling rotor blade vibrations are investigated and some design criteria are determined for the design of trailing edge flap controller that will provide actuator signal outputs to minimize the rotor blade root loads. It is calculated that using the developed active trailing edge rotor blade model, helicopter rotor blade vibrations can be reduced up to 36% of the nominal rotor blade vibrations.

  15. Supporting Women Planning a Vaginal Breech Birth: An International Survey.

    Science.gov (United States)

    Petrovska, Karolina; Watts, Nicole P; Catling, Christine; Bisits, Andrew; Homer, Caroline S E

    2016-12-01

    The aim of this study was to explore the experiences of women who planned a vaginal breech birth. An online survey was developed consisting of questions regarding women's experiences surrounding planned vaginal breech birth. The survey was distributed between April 2014 and January 2015 to closed membership Facebook groups that had a consumer focus on vaginal breech birth. In total, 204 unique responses to the survey were obtained from women who had sought the option of a vaginal breech birth in a previous pregnancy. Most women (80.8%) stated that they were happy with the birth choices they made, and a significant proportion (89.4%) would attempt a vaginal breech birth in subsequent pregnancies. Less than half of women were formally referred to a clinician skilled in vaginal breech birth when their baby was diagnosed breech (41.8%), while the remainder sourced a clinician themselves. Half of the women felt supported by their care provider (56.7%) and less than half (42.3%) felt supported by family and friends. The women who responded to this international survey sought the option of a vaginal breech birth, were subsequently happy with this decision, and would attempt a vaginal breech birth in their next pregnancy. Access to vaginal breech birth is important for some women; however, this choice may be challenging to achieve. Consistent information and support from clinicians is important to assist decision-making. © 2016 Wiley Periodicals, Inc.

  16. Human vaginal pH and microbiota: an update.

    Science.gov (United States)

    Godha, Keshav; Tucker, Kelly M; Biehl, Colton; Archer, David F; Mirkin, Sebastian

    2017-12-22

    A woman's vaginal pH has many implications on her health and it can be a useful tool in disease diagnosis and prevention. For that reason, the further examination of the relationship between the human vaginal pH and microbiota is imperative. In the past several decades, much has been learned about the physiological mechanisms modulating the vaginal pH, and exogenous/genetic factors that may influence it. A unified, coherent understanding of these concepts is presented to comprehend their interrelationships and their cumulative effect on a woman's health. In this review, we explore research on vaginal pH and microbiota throughout a woman's life, vaginal intermediate cell anaerobic metabolism and net proton secretion by the vaginal epithelial, and the way these factors interact to acidify the vaginal pH. This review provides foundational information about what a microbiota is and its relationship with human physiology and vaginal pH. We then evaluate the influence of physiological mechanisms, demographic factors, and propose ideas for the mechanisms behind their action on the vaginal pH.

  17. A simplified classification for describing colposcopic vaginal patterns.

    Science.gov (United States)

    Indraccolo, Ugo; Baldoni, Angelo

    2012-04-01

    This study aimed to highlight that colposcopic vaginal patterns are not specific, unlike cervical colposcopic patterns, and to provide a simpler classification of vaginal colposcopic patterns. A total of 223 patients who underwent colposcopy with Schiller test were assessed (hierarchical log-linear model) retrospectively. The greatest predictability for histologically confirmed warts and cancers is represented by colposcopic patterns of wart and cancer. Lugol-negative area is strongly predictive of koilocytosis, even if it is found in other vaginal lesions. Thickened epithelium seems to better predict a severe vaginal lesion, whereas thin white epithelium better suggests a mild vaginal lesion. Colposcopic patterns were simplified as follows: Lugol-negative area, white epithelia (thin white epithelium and white thickened epithelium), vascular lesions (regular and irregular mosaicisms and punctations), wart, and cancer. Thus, koilocytosis is predicted by the Lugol-negative area, whereas white epithelia patterns and vascular patterns are not specific, suggesting overall vaginal intraepithelial neoplasias. Wart and cancer patterns are pathognomonic for histologically confirmed warts and cancers. Vaginal colposcopy poorly predicts the severity of vaginal lesions. By including each type of white epithelium within a new category called "white epithelia patterns" and each type of vascular pattern within a new category called "vascular patterns," it is possible to simplify vaginal colposcopy without compromising its accuracy.

  18. Brain-gut axis and mucosal immunity: a perspective on mucosal psychoneuroimmunology.

    LENUS (Irish Health Repository)

    Shanahan, F

    2012-02-03

    The role of the brain-gut axis has traditionally been investigated in relation to intestinal motility, secretion, and vascularity. More recently, the concept of brain-gut dialogue has extended to the relationship between the nervous system and mucosal immune function. There is compelling evidence for a reciprocal or bi-directional communication between the immune system and the neuroendocrine system. This is mediated, in part, by shared ligands (chemical messengers) and receptors that are common to the immune and nervous systems. Although the concept of psychoneuroimmunology and neuroimmune cross-talk has been studied primarily in the context of the systemic immune system, it is likely to have special significance in the gut. The mucosal immune system is anatomically, functionally, and operationally distinct from the systemic immune system and is subject to independent regulatory signals. Furthermore, the intestinal mucosal immune system operates in a local milieu that depends on a dense innervation for its integrity, with juxtaposition of neuroendocrine cells and mucosal immune cells. An overview of evidence for the biologic plausibility of a brain-gut-immune axis is presented and its potential relevance to mucosal inflammatory disorders is discussed.

  19. Mucosal immune responses induced by transcutaneous vaccines.

    Science.gov (United States)

    Lawson, L B; Clements, J D; Freytag, L C

    2012-01-01

    The skin has been investigated as a site for vaccine delivery only since the late 1990s. However, much has been discovered about the cell populations that reside in the skin, their active role in immune responses, and the fate of trans- cutaneously applied antigens. Transcutaneous immunization (TCI) is a safe, effective means of inducing immune responses against a number of pathogens. One of the most notable benefits of TCI is the induction of immune responses in both systemic and mucosal compartments. This chapter focuses on the transport of antigen into and beyond intact skin, the cutaneous sentinel cell populations that play a role in TCI, and the types of mucosal immune responses that have been generated. A number of in vivo studies in murine models have provided information about the broad responses induced by TCI. Cellular and humoral responses and protection against challenge have been noted in the gastrointestinal, reproductive, and respiratory tracts. Clinical trials have demonstrated the benefits of this vaccine delivery route in humans. As with other routes of immunization, the type of vaccine formulation and choice of adjuvant may be critical for achieving appropriate responses and can be tailored to activate specific immune-responsive cells in the skin to increase the efficacy of TCI against mucosal pathogens.

  20. Checkpoint inhibition for advanced mucosal melanoma.

    Science.gov (United States)

    Thierauf, Julia; Veit, Johannes A; Hess, Jochen; Treiber, Nicolai; Lisson, Catharina; Weissinger, Stephanie E; Bommer, Martin; Hoffmann, Thomas K

    2017-04-01

    Whereas anti-PD-1 therapy has demonstrated a significant and durable response against advanced cutaneous melanoma, conventional chemotherapies have shown only minor benefit against advanced mucosal melanoma. To investigate the efficacy of anti-PD-1 therapy in a small cohort of patients with mucosal melanoma of the head and neck. We analysed five patients with mucosal melanoma of the head and neck who received nivolumab or pembrolizumab, at an advanced stage. Expression of PD-L1 and PD-1 in all tumour samples was evaluated immunohistochemically. All patients received at least two cycles of nivolumab or pembrolizumab. The most severe adverse events were categorised as CTCAE (common terminology criteria for adverse events) Grade 2. All patients showed progressive disease after restaging at three and six months, and no partial or complete response was observed. Immunohistochemical staining demonstrated PD-L1 expression in less than 5% of tumour cells. Systemic therapy with either nivolumab or pembrolizumab showed no clinical response, however, tumour progression was identified in all patients using Response Evaluation Criteria In Solid Tumors (RECIST) v1.1 and immune-related response criteria (irRC) to evaluate tumour response.

  1. Oral mucosal manifestations of autoimmune skin diseases.

    Science.gov (United States)

    Mustafa, Mayson B; Porter, Stephen R; Smoller, Bruce R; Sitaru, Cassian

    2015-10-01

    A group of autoimmune diseases is characterised by autoantibodies against epithelial adhesion structures and/or tissue-tropic lymphocytes driving inflammatory processes resulting in specific pathology at the mucosal surfaces and the skin. The most frequent site of mucosal involvement in autoimmune diseases is the oral cavity. Broadly, these diseases include conditions affecting the cell-cell adhesion causing intra-epithelial blistering and those where autoantibodies or infiltration lymphocytes cause a loss of cell-matrix adhesion or interface inflammation. Clinically, patients present with blistering, erosions and ulcers that may affect the skin as well as further mucosal surfaces of the eyes, nose and genitalia. While the autoimmune disease may be suspected based on clinical manifestations, demonstration of tissue-bound and circulating autoantibodies, or lymphocytic infiltrates, by various methods including histological examination, direct and indirect immunofluorescence microscopy, immunoblotting and quantitative immunoassay is a prerequisite for definitive diagnosis. Given the frequency of oral involvement and the fact that oral mucosa is the initially affected site in many cases, the informed practitioner should be well acquainted with diagnostic and therapeutic aspects of autoimmune dermatosis with oral involvement. This paper reviews the pathogenesis and clinical presentation of these conditions in the oral cavity with a specific emphasis on their differential diagnosis and current management approaches. Copyright © 2015 Elsevier B.V. All rights reserved.

  2. Hitting the mucosal road in tolerance induction.

    Science.gov (United States)

    Wiedermann, Ursula

    2009-01-01

    Within the last decades a dramatic increase in allergic diseases has been recognized in the Westernized societies, leading to the fact that meanwhile 25-30% of the population is afflicted by allergic disorders. Besides a hereditary disposition, other factors, including a reduced microbial contact early in life or changes in nutrition, might also have influenced this epidemiological development. So far the only causative treatment against type-I allergies is specific immunotherapy. In young and monosensitized patients this treatment is highly efficacious, while there are clear limitations in older or multisensitized patients. Allergy research therefore aims at establishing new and more efficacious treatment strategies in prophylactic as well as therapeutic settings. Our research programs focus on the development of novel allergy vaccines based on the induction of mucosal tolerance. In different mouse models of respiratory allergy mucosal treatment with genetically engineered allergen constructs proved to prevent the development of allergic mono- and multisensitivities. The additional use of mucosal adjuvants seems particularly important to improve therapeutic treatment approaches. Recent studies on the inverse relation of certain parasite infections and the development of allergy prompted us to search for selected parasitic molecules with immunosuppressive properties as potential adjuvant systems for novel allergy vaccines. An overview of our recent studies will be given. Copyright 2009 Nestec Ltd., Vevey/S. Karger AG, Basel.

  3. Enhanced mucosal immune responses induced by a combined candidate mucosal vaccine based on Hepatitis A virus and Hepatitis E virus structural proteins linked to tuftsin.

    Science.gov (United States)

    Gao, Yan; Su, Qiudong; Yi, Yao; Jia, Zhiyuan; Wang, Hao; Lu, Xuexin; Qiu, Feng; Bi, Shengli

    2015-01-01

    Hepatitis A virus (HAV) and Hepatitis E virus (HEV) are the most common causes of infectious hepatitis. These viruses are spread largely by the fecal-oral route and lead to clinically important disease in developing countries. To evaluate the potential of targeting hepatitis A and E infection simultaneously, a combined mucosal candidate vaccine was developed with the partial open reading frame 2 (ORF2) sequence (aa 368-607) of HEV (HE-ORF2) and partial virus protein 1 (VP1) sequence (aa 1-198) of HAV (HA-VP1), which included the viral neutralization epitopes. Tuftsin is an immunostimulatory peptide which can enhance the immunogenicity of a protein by targeting it to macrophages and dendritic cells. Here, we developed a novel combined protein vaccine by conjugating tuftsin to HE-ORF2 and HA-VP1 and used synthetic CpG oligodeoxynucleotides (ODNs) as the adjuvant. Subsequent experiments in BALB/c mice demonstrated that tuftsin enhanced the serum-specific IgG and IgA antibodies against HEV and HAV at the intestinal, vaginal and pulmonary interface when delivered intranasally. Moreover, mice from the intranasally immunized tuftsin group (HE-ORF2-tuftsin + HA-VP1-tuftsin + CpG) showed higher levels of IFN-γ-secreting splenocytes (Th1 response) and ratio of CD4+/CD8+ T cells than those of the no-tuftsin group (HE-ORF2 + HA-VP1 + CpG). Thus, the tuftsin group generated stronger humoral and cellular immune responses compared with the no-tuftsin group. Moreover, enhanced responses to the combined protein vaccine were obtained by intranasal immunization compared with intramuscular injection. By integrating HE-ORF2, HA-VP1 and tuftsin in a vaccine, this study validated an important concept for further development of a combined mucosal vaccine against hepatitis A and E infection.

  4. The immune responses to bacterial antigens encountered in vivo at mucosal surfaces.

    OpenAIRE

    Dougan, G; Ghaem-Maghami, M; Pickard, D; Frankel, G; Douce, G; Clare, S; Dunstan, S; Simmons, C

    2000-01-01

    Mammals have evolved a sophisticated immune system for handling antigens encountered at their mucosal surfaces. The way in which mucosally delivered antigens are handled influences our ability to design effective mucosal vaccines. Live attenuated derivatives of pathogens are one route towards the development of mucosal vaccines. However, some molecules, described as mucosal immunogens, are inherently immunogenic at mucosal surfaces. Studies on mucosal immunogens may facilitate the identificat...

  5. Practical Considerations for Perforator Flap Thinning Procedures Revisited

    Directory of Open Access Journals (Sweden)

    Theddeus OH Prasetyono

    2014-11-01

    Full Text Available BackgroundA thin perforator flap is one of the best methods for covering defects. This study aimed to revisit and further test the rapidly advancing field of flap thinning techniques.MethodsWe performed two cadaveric studies to test the known flap thinning methods, and then applied these methods to a clinical series. In the first study, five cadavers were used to observe the anatomical relation of the perforator with the subdermal plexuses and the subcutaneous fat layer by injecting a colored latex solution. The second study was done on four cadavers independently from the first study. Last, a clinical series was performed on 15 patients.ResultsThe areolar fat lobules of 10 anterolateral thigh perforator (ALT, seven deep inferior epigastric artery perforator (DIEAP, and six thoracodorsal artery perforator (TAP flaps were dissected to reduce the flap thickness guided by the colored vascular pattern. On average, the ALT, DIEAP, and TAP flaps were reduced to 32.76%±9.76%, 37.01%±9.21%, and 35.42%±9.41%, respectively. In the second study, the areolar fat lobules were directly dissected in six ALT, six TAP, and four MSAP flaps, and an average reduction in flap thickness of 53.41%±5.64%, 52.30%±2.88%, and 47.87%±6.41%, respectively, was found. In the clinical series, 13 out of the 15 cases yielded satisfactory outcomes with an average thickness reduction of 37.91%±7.15%.ConclusionsThese multiple studies showed that the deep fat layer could be safely removed to obtain a thin yet viable perforator flap. This evidence suggests that the macroscopic flap thinning technique can achieve thin flaps. Surgeons should consider this technique before embracing the latest technique of supermicrosurgery.

  6. A comparative analysis of HIV-specific mucosal/systemic T cell immunity and avidity following rDNA/rFPV and poxvirus-poxvirus prime boost immunisations.

    Science.gov (United States)

    Ranasinghe, Charani; Eyers, Fiona; Stambas, John; Boyle, David B; Ramshaw, Ian A; Ramsay, Alistair J

    2011-04-05

    In this study we have firstly compared a range of recombinant DNA poxvirus prime-boost immunisation strategies and shown that combined intramuscular (i.m.) 2× DNA-HIV/intranasal (i.n.) 2× FPV-HIV prime-boost immunisation can generate high-level of HIV-specific systemic (spleen) and mucosal (genito-rectal nodes, vaginal tissues and lung tissues) T cell responses and HIV-1 p24 Gag-specific serum IgG1, IgG2a and mucosal IgG, SIgA responses in vaginal secretions in BALB/c mice. Data indicate that following rDNA priming, two rFPV booster immunisations were necessary to generate good antibody and mucosal T cell immunity. This data also revealed that mucosal uptake of recombinant fowl pox (rFPV) was far superior to plasmid DNA. To further evaluate CD8+ T cell immunity, i.m. 2× DNA-HIV/i.n. 1× FPV-HIV immunisation strategy was directly compared with single shot poxvirus/poxvirus, i.n. FPV-HIV/i.m. VV-HIV immunisation. Results indicate that the latter strategy was able to generate strong sustained HIV-specific CD8+ T cells with higher avidity, broader cytokine/chemokine profiles and better protection following influenza-K(d)Gag(197-205) challenge compared to rDNA poxvirus prime-boost strategy. Our findings further substantiate the importance of vector selection/combination, order and route of delivery when designing effective vaccines for HIV-1. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. Induced vaginal birth after previous caesarean section

    Directory of Open Access Journals (Sweden)

    Akylbek Tussupkaliyev

    2016-11-01

    Full Text Available Introduction The rate of operative birth by Caesarean section is constantly rising. In Kazakhstan, it reaches 27 per cent. Research data confirm that the percentage of successful vaginal births after previous Caesarean section is 50–70 per cent. How safe the induction of vaginal birth after Caesarean (VBAC remains unclear. Methodology The studied techniques of labour induction were amniotomy of the foetal bladder with the vulsellum ramus, intravaginal administration of E1 prostaglandin (Misoprostol, and intravenous infusion of Oxytocin-Richter. The assessment of rediness of parturient canals was conducted by Bishop’s score; the labour course was assessed by a partogram. The effectiveness of labour induction techniques was assessed by the number of administered doses, the time of onset of regular labour, the course of labour and the postpartum period and the presence of complications, and the course of the early neonatal period, which implied the assessment of the child’s condition, described in the newborn development record. The foetus was assessed by medical ultrasound and antenatal and intranatal cardiotocography (CTG. Obtained results were analysed with SAS statistical processing software. Results The overall percentage of successful births with intravaginal administration of Misoprostol was 93 per cent (83 of cases. This percentage was higher than in the amniotomy group (relative risk (RR 11.7 and was similar to the oxytocin group (RR 0.83. Amniotomy was effective in 54 per cent (39 of cases, when it induced regular labour. Intravenous oxytocin infusion was effective in 94 per cent (89 of cases. This percentage was higher than that with amniotomy (RR 12.5. Conclusions The success of vaginal delivery after previous Caesarean section can be achieved in almost 70 per cent of cases. At that, labour induction does not decrease this indicator and remains within population boundaries.

  8. Prolapso vaginal e uterino em ovelhas Uterine and vaginal prolapse in ewes

    National Research Council Canada - National Science Library

    Maíra Bianchi R. Alves; Fernando J. Benesi; Lilian Gregory; Alice M.M.P. Della Libera; Maria Cláudia A. Sucupira; Fábio C. Pogliani; Viviani Gomes

    2013-01-01

    ... Clínica de Bovinos e Pequenos Ruminantes (CBPR) da FMVZ/USP no período compreendido entre 2000 a 2010, no qual, foram atendidas 56 ovinos com problemas inerentes ao sistema reprodutivo, dessas, 25 apresentaram prolapso vaginal ou uterino (44,6...

  9. Directed shift of vaginal microbiota induced by vaginal application of sucrose gel in rhesus macaques

    Directory of Open Access Journals (Sweden)

    Kai-tao Hu

    2015-04-01

    Conclusions: Rhesus macaques can be used as animal models of bacterial vaginosis to develop drugs and test treatment efficacy. Furthermore, the topical application of sucrose gel induced the shifting of vaginal flora of rhesus macaques from a BV kind of flora to a lactobacilli-dominating flora.

  10. Vaginal fold histology reduces the variability introduced by vaginal exfoliative cytology in the classification of mouse estrous cycle stages.

    Science.gov (United States)

    Gal, Arnon; Lin, Po-Ching; Barger, Anne M; MacNeill, Amy L; Ko, CheMyong

    2014-12-01

    Vaginal exfoliative cytology is commonly used in biomedical and toxicological research to classify the stages of the rodent estrous cycle. However, mouse vaginal exfoliative cytology is commonly used as a stand-alone tool and has not been evaluated in reference to vaginal histology and serum sex hormone levels. In this study, the direct and Giemsa-stained methods of vaginal exfoliative cytology were compared in reference to vaginal fold histology and serum sex hormone levels. Both methods predicted the estrous stages similarly with mean discordance rates of 55%, 77%, 46%, and 31%, for diestrus, proestrus, estrus, and metestrus, respectively. From these results, we conclude that vaginal exfoliative cytology may be used as a general guide to determine the desired estrous stage end point and that a definitive confirmation of the estrous stage should be obtained from evaluation of vaginal fold histology. Confirmation of the stage of the estrous cycle by vaginal fold histology will decrease the variability otherwise introduced by misclassification of estrous cycle stages with vaginal exfoliative cytology. © 2014 by The Author(s).

  11. Vaginal epithelioid angiosarcoma: a rare case.

    Science.gov (United States)

    Brătilă, Elvira; Ionescu, Oana Maria; Berceanu, Costin; Coroleucă, Ciprian Andrei; Ardeleanu, Carmen Maria; MehedinŢu, Claudia

    2016-01-01

    Epithelioid angiosarcoma of the vagina is a rare variant, easily misdiagnosed as other epithelial neoplasms. On Hematoxylin-Eosin-stained sections, the pathologist encounters sheets of large, mildly to moderately pleomorphic epithelioid cells, with abundant eosinophilic cytoplasm, vesicular nuclei, and prominent nucleoli. We report the case of a 22-year-old woman initially diagnosed with condiloma-like tumor of the left vaginal wall, which turned out positive at immunostaining for epithelioid angiosarcoma. In her case, after the failure of chemotherapy in controlling the relapse of the disease, the only treatment option was radical hysterectomy with bilateral salpingo-oophorectomy.

  12. The accuracy of computer-assisted primary mandibular reconstruction with vascularized bone flaps: iliac crest bone flap versus osteomyocutaneous fibula flap

    Directory of Open Access Journals (Sweden)

    Modabber A

    2014-06-01

    Full Text Available Ali Modabber,1 Nassim Ayoub,1 Stephan Christian Möhlhenrich,1 Evgeny Goloborodko,1 Tolga Taha Sönmez,1 Mehrangiz Ghassemi,2 Christina Loberg,3 Bernd Lethaus,1 Alireza Ghassemi,1 Frank Hölzle1 1Department of Oral, Maxillofacial and Plastic Facial Surgery, 2Department of Orthodontics, 3Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany Background: The intention of mandibular reconstruction is to restore the complex anatomy with maximum possible functionality and high accuracy. The aim of this study was to evaluate the accuracy of computer-assisted surgery in primary mandibular reconstruction with an iliac crest bone flap compared with an osteomyocutaneous fibula flap. Materials and methods: Preoperative computed tomography data of the mandible and the iliac crest or fibula donor site were imported into a specific surgical planning software program. Surgical guides were manufactured using a rapid prototyping technique for translating the virtual plan, including information on the transplant dimensions and shape, into real-time surgery. Using postoperative computed tomography scans and an automatic surface-comparison algorithm, the actual postoperative situation was compared with the preoperative virtual simulation. Results: The actual flap position showed a mean difference from the virtual plan of 2.43 mm (standard deviation [SD] ±1.26 and a surface deviation of 39% <2 mm and 15% <1 mm for the iliac crest bone flap, and a mean difference of 2.18 mm (SD ±1.93 and a surface deviation of 60% <2 mm and 37% <1 mm for the osteomyocutaneous fibula flap. The position of the neomandible reconstructed with an osteomyocutaneous fibula flap indicated a mean difference from the virtual plan of 1.25 mm (SD ±1.31 and a surface deviation of 82% <2 mm and 57% <1 mm, in contrast to a mean difference of 1.68 mm (SD ±1.25 and a surface deviation of 63% <2 mm and 38% <1 mm for the neomandible after

  13. Starter Feeding Supplementation Alters Colonic Mucosal Bacterial Communities and Modulates Mucosal Immune Homeostasis in Newborn Lambs.

    Science.gov (United States)

    Liu, Junhua; Bian, Gaorui; Sun, Daming; Zhu, Weiyun; Mao, Shengyong

    2017-01-01

    This study aims to investigate the effect of starter feeding supplementation on colonic mucosal bacterial communities and on mucosal immune homeostasis in pre-weaned lambs. We selected eight pairs of 10-day-old lamb twins. One twin was fed breast milk (M, n = 8), while the other was fed breast milk plus starter (M+S, n = 8). The lambs were sacrificed at 56 days age. Colonic content was collected to determine the pH and the concentrations of volatile fatty acids (VFA) and lactate. The colonic mucosa was harvested to characterize the bacterial communities using Illumina MiSeq sequencing and to determine mRNA expression levels of cytokines and toll-like receptors (TLR) using quantitative real-time PCR. The results show that starter feeding decreased luminal pH and increased the concentrations of acetate, propionate, butyrate, total VFA, and lactate in the colon. The principal coordinate analysis (PCA) and analysis of molecular variance show that starter feeding supplementation significantly affected the colonic mucosal bacterial communities with a higher relative abundance of the dominant taxa unclassified S24-7, Oscillibacter, Prevotella, Parabacteroides, Bifidobacterium, Ruminobacter, and Succinivibrio, and a lower proportion of unclassified Ruminococcaceae, RC9_gut_group, Blautia, Phocaeicola, Phascolarctobacterium, unclassified BS11_gut_group, unclassified family_XIII, and Campylobacter in lambs. Meanwhile, starter feeding decreased mRNA expression of TLR4 and cytokines TNF-α and IFN-γ in colonic tissue. Furthermore, the changes in the colonic mucosal mRNA expression of TLR and cytokines were associated with changes in mucosal bacterial composition. These findings may provide new insights into colonic mucosal bacteria and immune homeostasis in developing lambs.

  14. Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration

    Energy Technology Data Exchange (ETDEWEB)

    Koganemaru, Masamichi, E-mail: mkoganemaru@med.kurume-u.ac.jp; Nonoshita, Masaaki, E-mail: z2rs-1973@yahoo.co.jp; Iwamoto, Ryoji, E-mail: iwamoto-ryouji@kurume-u.ac.jp; Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp; Nabeta, Masakazu, E-mail: nabeta-masakazu@med.kurume-u.ac.jp; Kusumoto, Masashi, E-mail: kusumoto-masashi@med.kurume-u.ac.jp; Kugiyama, Tomoko, E-mail: kugiyama-tomoko@med.kurume-u.ac.jp [Kurume University School of Medicine, Department of Radiology (Japan); Kozuma, Yutaka, E-mail: kouduma-yutaka@kurume-u.ac.jp [Kurume University School of Medicine, Department of Obstetrics and Gynecology (Japan); Nagata, Shuji, E-mail: sn4735@med.kurume-u.ac.jp; Abe, Toshi, E-mail: toshiabe@med.kurume-u.ac.jp [Kurume University School of Medicine, Department of Radiology (Japan)

    2016-08-15

    PurposeWe evaluated the management of transcatheter arterial embolization for postpartum hemorrhage caused by vaginal laceration.Materials and MethodsWe reviewed seven cases of patients (mean age 30.9 years; range 27–35) with intractable hemorrhages and pelvic hematomas caused by vaginal lacerations, who underwent superselective transcatheter arterial embolization from January 2008 to July 2014. Postpartum hemorrhage was evaluated by angiographic vascular mapping to determine the vaginal artery’s architecture, technical and clinical success rates, and complications.ResultsThe vaginal artery was confirmed as the source of bleeding in all cases. The artery was found to originate from the uterine artery in three cases, the uterine and obturator arteries in two, or the internal pudendal artery in two. After vaginal artery embolization, persistent contrast extravasation from the inferior mesenteric artery as an anastomotic branch was noted in one patient. Nontarget vessels (the inferior vesical artery and nonbleeding vaginal arterial branches) were embolized in one patient. Effective control of hemostasis and no post-procedural complications were confirmed for all cases.ConclusionPostpartum hemorrhages caused by vaginal lacerations involve the vaginal artery arising from the anterior trunk of the internal iliac artery with various branching patterns. Superselective vaginal artery embolization is clinically acceptable for the successful treatment of vaginal laceration hemorrhages, with no complications. After vaginal artery embolization, it is suggested to check for the presence of other possible bleeding vessels by pelvic aortography with a catheter tip at the L3 vertebral level, and to perform a follow-up assessment.

  15. Development of a mouse model of abdominal cutaneous flaps for breast reconstruction.

    Science.gov (United States)

    Womac, Daniel John; Palanisamy, Arun Prathap; Eslick, Rene; Schimpf, Dennis Kenneth; Chavin, Kenneth David

    2013-01-01

    Autologous tissue transfer, in addition to replacing tissue that was lost during injury or surgery, offers women an excellent option to improve cosmetic appearance and self-confidence following mastectomy due to breast cancer. However, flap necrosis is a complication in obese patients undergoing this procedure. We created a mouse model to study the flap-related complications that leads to decreased flap survival in autologous breast reconstruction. Left superficial inferior epigastric (SIE) pedicle abdominal-cutaneous flaps were elevated in 8 week-old, obese ob/ob male mice and their lean littermates. Flaps were followed by serial photography. Area of flap necrosis was measured at 7 days. Statistical analysis was performed. Necrosis was observed at the distal margin of the flaps, in both lean and obese groups. Lean left SIE flaps (n = 8) had a total area flap necrosis of 9.1% at 7 days whereas obese left SIE flaps (n = 8) had a total area flap necrosis of 45.5% at 7 days. Obese flaps had a statistically significant increase in necrosis compared to the lean flaps, p = 0.001. There was a significant difference between flap survival in lean and obese SIE pedicle flaps in our mouse model. We have developed the first flap model of obesity utilizing the superficial epigastric pedicle in the mouse. This model is optimal for future studies to dissect out mechanisms that lead to the complications related to flap survival for breast reconstruction, especially in obese subjects.

  16. Regional Myocutaneous Flaps for Head and Neck Reconstruction ...

    African Journals Online (AJOL)

    Pectoralis major and other myofascial/ myocutaneous flaps in head and neck cancer reconstruction: Experience with 437 cases at a single institution. Head Neck. 2004;26:1018-23. 13. Funk GF, Karnell LH, Whitehead S, Paulino A, Ricks J, Smith RB. Free tissue transfer versus pedicled flap cost in head and neck cancer.

  17. Revisit of Nasolabial Flap in the Reconstruction of Defects Involving ...

    African Journals Online (AJOL)

    Departments of Oral and Maxillofacial Surgery, MGV's K.B.H. Dental College, Nashik, Maharashtra, 1Manipal College of Dental Sciences, Mangalore, Karnataka, ... oral cavity defects, reconstruction, regional flaps. Address for correspondence: ..... The Arterial Anatomy of Skin Flap. New York: Churchill Livingstone; 1986. 14.

  18. Propeller flaps for lower-limb trauma | Rogers | South African ...

    African Journals Online (AJOL)

    The minor blade of the propeller may be designed to close the donor defect completely for the 180o version. The propeller flap has the advantages of local flaps (reliability, contour, texture, 'like-with-like') with additional versatility of design and donor site management, and requires minimal expertise and operative time.

  19. Breast reconstruction using a latissimus dorsi flap after mastectomy

    DEFF Research Database (Denmark)

    Højvig, Jens B; Bonde, Christian Torsten

    2015-01-01

    INTRODUCTION: The latissimus dorsi (LD) myocutaneous flap has long been regarded as the second choice flap for autologous breast reconstruction following a mastectomy in our department. Despite uncertainty about donor-site morbidity, it is regarded as a relatively safe procedure; moreover...

  20. Flap Hitching Technique to the Teeth after Oral Cancer Resection

    African Journals Online (AJOL)

    Flap Hitching Technique to the Teeth after Oral Cancer. Resection. Krishnakumar Thankappan, Subramania Iyer, Mayuri Rajapurkar, Mohit Sharma, Pramod Subash1. INTRODUCTION. Flap surgery for reconstruction is an integral part in the surgical management of head and neck tumors. After resection of the tumors of oral ...

  1. Upper lip reconstruction using a pedicel superficial temporal artery flap

    Directory of Open Access Journals (Sweden)

    Mohammad M. Al-Qattan

    2018-01-01

    Conclusion: We demonstrate that the pedicle flap is much simpler than the free flap and is adequate for reconstruction of partial upper lip defects. We also demonstrate a good cosmetic and functional outcome; and highlight several technical points to ensure a satisfactory outcome.

  2. Propeller Flap for Complex Distal Leg Reconstruction: A Versatile ...

    African Journals Online (AJOL)

    A Versatile Alternative when Reverse Sural Artery Flap is. Not Feasible. Samuel A. Ademola, Afieharo I. Michael, Femi .... flaps that were raised in the patient and the logistics of limb positioning after application of external fixators for bone ... Financial support and sponsorship. Nil. Conflicts of interest. There are no conflicts of ...

  3. Scrotal Reconstruction with a Pedicled Gracilis Muscle Flap after ...

    African Journals Online (AJOL)

    We report a case of a 34 year old African male who presented as a referral from a district hospital with a scrotal defect and exposed testes following extensive debridement of Fournier's gangrene. Scrotal reconstruction with a pedicled gracilis muscle flap was done. The pedicled gracilis muscle flap is close to the scrotal area ...

  4. Restoration of thumb sensibility with innervated reverse homodigital dorsoradial flap.

    Science.gov (United States)

    Bao, Qi Yuan; Xiao, Cheng Wei; Peng, Feng; Han, Dong; Wang, Tao; Gu, Yu Dong

    2014-01-01

    This study investigates the use of homodigital reverse dorsoradial flap with neurorrhaphy for thumb soft tissue defect. From 1996 to 2010, the homodigital dorsoradial flap was performed on seven adult patients and one 3-year-old boy. The flaps ranged from 1.2 to approximately 3.0 cm × 2.0 to approximately 4.2 cm in size. In six of the eight patients, the dorsal collateral branch of the radial nerve supplying the flap was also included in the pedicle and coapted to the proper digital nerves of the thumb. At final follow-ups, flap sensation, thumb motion, and donor-site morbidity were assessed. All flaps survived completely. At final follow-up of 8.5 months (range, 3 to 14 months), all patients except the 3-year-old child (who could not express clearly) reported satisfactory sensory recovery, with the static two-point discrimination ranging between 6 and 12 mm (mean, 9.4 mm). Range of motion of the metacarpophalangeal and interphalangeal joints of the thumbs was also preserved with minimal donor-site morbidity in all cases. Innervated reverse homodigital dorsoradial flap serves as a reliable and sensate flap for extensive thumb soft tissue reconstruction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  5. The superiorly based bilobed flap for nasal reconstruction.

    Science.gov (United States)

    Kelly-Sell, Michael; Hollmig, S Tyler; Cook, Joel

    2018-02-01

    The laterally based bilobed flap is commonly used for the reconstruction of small- to medium-sized defects of the distal portion of the nose; However, when this flap is used to repair defects that are larger, more cephalic, or more lateral on the nose, there is a risk for lower nasal distortion. Reorienting the base superiorly preserves the advantages of the traditional design while minimizing this risk. To demonstrate the design, execution, and efficacy of the superiorly based bilobed flap. A retrospective review examined all superiorly based bilobed flaps performed by 1 surgeon (J.C.) in 2000-2016 after tumor extirpation by Mohs micrographic surgery at a single institution. A total of 41 surgical defects were closed with 40 flaps between June 2000 and August 2016 (1 patient had 2 defects closed with a single flap). Of the tumors, 55% were located on the nasal dorsum, and the median of the longest postoperative tumor axis was 1.4 cm. Follow-up was available for 40 flaps, and no infections, hematomas, or episodes of full-thickness necrosis were observed. Data were collected retrospectively from a single institution without a standardized assessment tool for aesthetic outcomes. The superiorly based bilobed flap is useful for nasal reconstruction. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  6. The use of free flaps in skull base reconstruction.

    Science.gov (United States)

    Macía, G; Picón, M; Nuñez, J; Almeida, F; Alvarez, I; Acero, J

    2016-02-01

    Skull base tumours are rare, comprising less than 1% of all tumours of the head and neck. Surgical treatment of these tumours involves the approach, the resection, and the reconstruction of the defect, which present a challenge due to the technical difficulty and anatomical complexity. A retrospective study of 17 patients with tumours involving the skull base, treated by resection and immediate reconstruction using microsurgical free flaps, is presented; 11 were men and six were women. The following types of flap were used: osteocutaneous fibula flaps, fasciocutaneous anterolateral thigh flaps, and myocutaneous latissimus dorsi flaps. The most common histology of the tumours was squamous cell carcinoma. The most frequent point of origin was the paranasal sinuses (58.8%). All of the free flaps used for reconstruction were viable. A cerebrospinal fluid fistula occurred in two patients, and in one of these cases, meningoencephalitis led to death. In conclusion, the reconstruction of large defects of the skull base after ablation requires a viable tissue that in many cases can be obtained only through the use of microvascular free flaps. The type of flap to be selected depends on the anatomical structures and size of the defect to be restored. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  7. Bifurcation to forward flapping flight at intermediate Reynolds number.

    Science.gov (United States)

    Vandenberghe, Nicolas; Zhang, Jun; Childress, Stephen

    2003-11-01

    The locomotion of most fish and birds is realized by flapping wings or fins transverse to the direction of travel. According to early theoretical studies, a flapping wing translating at finite speed in an inviscid fluid experiences a propulsive force. In steady forward flight this thrust is balanced by drag. Such "lift-based mechanisms" of thrust production are characteristic of the Eulerian realm, where discrete vortical structures are shed. But, when the Reynolds number is small, viscous forces dominate and reciprocal flapping motions are ineffective. A flapping wing experiences a net drag and cannot be used to propel an organism. We have devised an experiment to bridge the two regimes, and to examine the transition to forward flight at intermediate Reynolds numbers. We study the dynamics of an horizontal wing that is flapped up and down and is free to move either forwards or backwards. This very simple kinematics emphasizes the demarcation between low and high Reynolds number because it is effective in the Eulerian realm but has no effect in the Stokesian realm. We show that flapping flight occurs abruptly as a symmetry breaking bifurcation at a critical flapping frequency. Beyond the bifurcation the forward speed increases linearly with the flapping frequency. The experiment establishes a clear demarcation between the different strategies of locomotion at large and small Reynolds number.

  8. Revisit of Nasolabial flap in the reconstruction of defects involving ...

    African Journals Online (AJOL)

    Aim: The aim of this article is to present the usefulness of the nasolabial flap (NL flap) along with a detailed review of the factors that lead to its selection for the reconstruction of post-ablative oral floor defects. Materials and Methods: The records of patients who underwent the procedure between June 2009 and June 2011 ...

  9. Experience With Ventral Penile Skin Island Flap urethroplasty | Ntia ...

    African Journals Online (AJOL)

    Background:Island flap techniques currently used in urethroplasty utilize the prepuce and the dorsal penile skin. Our experience with a one-stage island flap urethroplasty for urethral strictures utilizing the ventral penile skin is described. Patients and Method: This is a longitudinal study of seventy six consecutive patients ...

  10. COLIBRI : A hovering flapping twin-wing robot

    NARCIS (Netherlands)

    Roshanbin, A.; Altartouri, H.; Karasek, M.; Preumont, André

    2017-01-01

    This paper describes the results of a six-year project aiming at designing and constructing a flapping twin-wing robot of the size of hummingbird (Colibri in French) capable of hovering. Our prototype has a total mass of 22 g, a wing span of 21 cm and a flapping frequency of 22 Hz; it is actively

  11. Abdominal wall reconstruction using De-epithelialized dermal flap: A ...

    African Journals Online (AJOL)

    The aim of this study is to determine the place of de-epithelialized dermal flap in the reconstruction of abdominal wall hernias. Materials and Methods: A five-year prospective, descriptive analysis of eligible patients with difficult abdominal wall hernias closed with de-epithelialized dermal flap in a Nigerian Tertiary Health ...

  12. Roles of M cells in infection and mucosal vaccines.

    Science.gov (United States)

    Wang, Miao; Gao, Zeqian; Zhang, Zhongwang; Pan, Li; Zhang, Yongguang

    2014-01-01

    The mucosal immune system plays a crucial part in the control of infection. Exposure of humans and animals to potential pathogens generally occurs through mucosal surfaces, thus, strategies that target the mucosa seem rational and efficient vaccination measures. Vaccination through the mucosal immune system can induce effective systemic immune responses simultaneously with mucosal immunity compared with parenteral vaccination. M cells are capable of transporting luminal antigens to the underlying lymphoid tissues and can be exploited by pathogens as an entry portal to invade the host. Therefore, targeting M-cell-specific molecules might enhance antigen entry, initiate the immune response, and induce protection against mucosal pathogens. Here, we outline our understanding of the distribution and function of M cells, and summarize the advances in mucosal vaccine strategies that target M cells.

  13. Use of nonhuman primate models to develop mucosal AIDS vaccines.

    Science.gov (United States)

    Genescà, Meritxell; Miller, Christopher J

    2010-02-01

    The HIV vaccines tested in the halted Step efficacy trial and the modestly successful phase 3 RV144 trial were designed to elicit strong systemic immune responses; therefore, strategies to direct immune responses into mucosal sites should be tested in an effort to improve AIDS vaccine efficacy. However, as increased CD4(+) T-cell activation and recruitment to mucosal sites have the potential to enhance HIV transmission, mucosal immune responses to HIV vaccines should primarily consist of effector CD8(+) T cells and plasma cells. Controlling the level of mucosal T-cell activation may be a critical factor in developing an effective mucosal AIDS vaccine. Immunization routes and adjuvants that can boost antiviral immunity in mucosal surfaces offer a reasonable opportunity to improve AIDS vaccine efficacy. Nonhuman primate models offer the best system for preclinical evaluation of these approaches.

  14. [Current progress in the development of mucosal vaccines].

    Science.gov (United States)

    Takeyama, Natsumi; Yuki, Yoshikazu; Kiyono, Hiroshi

    2011-09-01

    Mucosal vaccination has several advantages compared with that of injection-type vaccination. Secretory IgA(SIgA) produced at mucosal surface plays a key role for inactivation of toxins and inhibition of pathogen invasion. Although oral or nasal vaccination with attenuated live microorganisms have been shown to be effective in the induction of protective immunity, these types of vaccine have the ability to infect transiently to the host. For the development of safe and effective mucosal vaccine, an obvious strategy is the preparation of inactivated subunit-type mucosal vaccine. Here we introduce our frontier technology for the development of rice-based oral vaccines, as a new generation of mucosal vaccine. Further, we also discuss recent progress in the development of other types of mucosal vaccine and adjuvant.

  15. Antibodies and their receptors: different potential roles in mucosal defence

    Directory of Open Access Journals (Sweden)

    Rachel eHorton

    2013-07-01

    Full Text Available Over recent years it has become increasingly apparent that mucosal antibodies are not only restricted to the IgM and IgA isotypes, but that also other isotypes and particularly IgG can be found in significant quantities at some mucosal surfaces, such as in the genital tract. Their role is more complex than traditionally believed with, among other things, the discovery of novel function of mucosal immunoglobulin receptors. A thorough knowledge in the source and function and mucosal immunoglobulins is particularly important in development of vaccines providing mucosal immunity, and also in the current climate of microbicide development, to combat major world health issues such as HIV. We present here a comprehensive review of human antibody mediated mucosal immunity.

  16. Experimental investigation of a flapping wing model

    Energy Technology Data Exchange (ETDEWEB)

    Hubel, Tatjana Y.; Tropea, Cameron [Technische Universitaet Darmstadt, Fachgebiet Stroemungslehre und Aerodynamik, Darmstadt (Germany)

    2009-05-15

    The main objective of this research study was to investigate the aerodynamic forces of an avian flapping wing model system. The model size and the flow conditions were chosen to approximate the flight of a goose. Direct force measurements, using a three-component balance, and PIV flow field measurements parallel and perpendicular to the oncoming flow, were performed in a wind tunnel at Reynolds numbers between 28,000 and 141,000 (3-15 m/s), throughout a range of reduced frequencies between 0.04 and 0.20. The appropriateness of quasi-steady assumptions used to compare 2D, time-averaged particle image velocimetry (PIV) measurements in the wake with direct force measurements was evaluated. The vertical force coefficient for flapping wings was typically significantly higher than the maximum coefficient of the fixed wing, implying the influence of unsteady effects, such as delayed stall, even at low reduced frequencies. This puts the validity of the quasi-steady assumption into question. The (local) change in circulation over the wing beat cycle and the circulation distribution along the wingspan were obtained from the measurements in the tip and transverse vortex planes. Flow separation could be observed in the distribution of the circulation, and while the circulation derived from the wake measurements failed to agree exactly with the absolute value of the circulation, the change in circulation over the wing beat cycle was in excellent agreement for low and moderate reduced frequencies. The comparison between the PIV measurements in the two perpendicular planes and the direct force balance measurements, show that within certain limitations the wake visualization is a powerful tool to gain insight into force generation and the flow behavior on flapping wings over the wing beat cycle. (orig.)

  17. Traumatic corneal flap displacement after laser in situ keratomileusis (LASIK

    Directory of Open Access Journals (Sweden)

    Tsai TH

    2017-04-01

    Full Text Available Tsung-Han Tsai,1 Kai-Ling Peng,1 Chien-Jen Lin2 1Department of Ophthalmology, 2Department of Radiology, Chi Mei Medical Center, Tainan, Taiwan Background: Laser in situ keratomileusis (LASIK is the most common and popular procedure performed for the correction of refractive errors in the last two decades. We report a case of traumatic flap displacement with flap folding which occurred 3 years after LASIK was performed. Previous literature suggests that vision prognosis would be closely related to proper and prompt management of traumatic flap displacement with flap folding 3 years after LASIK.Case presentation: A 23-year-old female presented to our hospital who had undergone uneventful LASIK in both eyes 3 years prior. Unfortunately, she had suffered a blunt trauma in her right eye in a car accident. A late onset of corneal flap displacement was found with upper and lower portion of the flap being folded inside the corneal bed. Surgical intervention for debridement with subsequent reposition of corneal flap was performed as soon as possible in the operating room. A bandage contact lens was placed, and topical antibiotic and corticosteroids were given postoperatively. Two days after the operation, the displaced corneal flap was found to be well attached smoothly on the corneal bed without folds. The best-corrected visual acuity was 6/6 with refraction of −0.75 D to 1.0 D ×175° in her right eye 1 month later.Literature review: We reviewed a total of 19 published cases of late-onset traumatic flap dislocations or displacements after LASIK with complete data from 2000 to 2014.Conclusion: Traumatic displacement of corneal flaps after LASIK may occur after blunt injury with specific direction of force to the flap margin, especially tangential one. According to the previous literature, late-onset traumatic flap displacement may happen at any time after LASIK and be caused by various types of injuries. Fortunately, good visual function could

  18. Breast Reconstruction Using Tram Flap: Prospective Outcome and Complications

    Directory of Open Access Journals (Sweden)

    Homayoon Zehtab

    2006-07-01

    Full Text Available Background:The transverse rectus abdominis musculocutaneous TRAM flap remains the gold standard for postmastectomy reconstruction either immediate or delayed.However,transfer of TRAM flap can be associated with donor site morbidities and complications in flap.A successful reconstruction consists of careful patient selection, surgical technique and meticulous preoperative planning.This study was designed to evaluate outcome and complications of breast reconstruction with TRAM flap in association with patient conditions and risk factors, prospectively. Methods: Breast reconstruction was performed in 44 women consecutively,using the TRAM flap during a 3-year period, 1999–2002. Modified radical mastectomy accompanying immediate reconstructions with TRAM flap was performed for 12 patients and delayed reconstruction was used for other patients with previous mastectomy. Results: The mean age of the patients was 40.41±4.43 years. Thirty (68.18% patients had comorbidities, consisting of radiation therapy, obesity, hypertension, diabetes mellitus, smoking and abdominal scar. Contralateral and ipsilateral TRAM flaps were used in 26(59.09% and 14(31.81% reconstructions, respectively. The abdominal defect was repaired in layers with the use of synthetic mesh in 30(68.18% patients. The overall complication rate was 31.82%, such as fat necrosis (15.91%, partial flap loss (13.64%, etc. Satisfaction rates were excellent in 10 (22.72%, good in 25 (56.82%, moderate in five (11.36%, and poor in four (9.09% patients. The mean of postoperative inpatient hospital days were 15.18±4.89 and 14.28±6.52 in patients with contralateral and ipsilateral flaps,respectively (p>0.05.A significant association was observed between overall complications and comorbidities. Partial flap loss and fat necrosis was associated with smoking, and abdominal hernia was associated with obesity marginally.Conclusions:The outcome of breast reconstruction using TRAM flap is similar by

  19. Propeller Flaps: A Review of Indications, Technique, and Results

    Directory of Open Access Journals (Sweden)

    Salvatore D'Arpa

    2014-01-01

    Full Text Available In the last years, propeller flaps have become an appealing option for coverage of a large range of defects. Besides having a more reliable vascular pedicle than traditional flap, propeller flaps allow for great freedom in design and for wide mobilization that extend the possibility of reconstructing difficult wounds with local tissues and minimal donor-site morbidity. They also allow one-stage reconstruction of defects that usually require multiple procedures. Harvesting of a propeller flap requires accurate patient selection, preoperative planning, and dissection technique. Complication rate can be kept low, provided that potential problems are prevented, promptly recognized, and adequately treated. This paper reviews current knowledge on propeller flaps. Definition, classification, and indications in the different body regions are discussed based on a review of the literature and on the authors’ experience. Details about surgical technique are provided, together with tips to avoid and manage complications.

  20. Plantar reconstruction using a step-ladder advancement flap

    Directory of Open Access Journals (Sweden)

    G. Furubayashi

    2017-09-01

    Full Text Available A medial plantar flap is superior as a sensory flap with regard to tissue wear, prevention of ulcer recurrence, and other such factors. However, a wound at a plantar weight-bearing site is likely to lead to abnormal hyperkeratosis that can cause pain and fissures. In addition, the development of a scar contracture in infant patients can cause failure of normal foot development. To overcome these issues, we developed a method in which an island flap from a non-weight-bearing site is used as a step-ladder advancement plantar flap for moderate-sized tissue loss at a plantar weight-bearing site, followed by primary closure of the flap donor site with suturing to prevent scar contracture and abnormal hyperkeratosis. This technique showed good functional and cosmetic outcomes, as the step-ladder-like suture lines were unlikely to cause scar contracture and abnormal hyperkeratosis owing to the staggered scar, leading to pain prevention.

  1. [Renaissance of pedicled flaps in oral and maxillofacial surgery].

    Science.gov (United States)

    Twieg, M; Reich, W; Dempf, R; Eckert, A W

    2014-06-01

    A retrospective analysis in the period 2007 to 2011 included 71 surgically treated patients for carcinoma of the head and neck region and subsequent reconstruction with 36 pedicled distant flaps and 47 free flaps. Patient specific parameters of data collection with SPSS 17.0 were age and sex distribution, TNM stage and treatment. The specific type of flap reconstruction, duration of surgery, complications, intensive care and inpatient treatment were recorded. The results showed that the healing process was uneventful in 26 (72.2 %) pedicled flaps, 14 (38.9 %) pedicled flaps were transplanted in a preoperatively irradiated area of the head and neck region and in 86.0 % with a positive healing process. Tumor stage, general physical condition of the patient and type of therapy are the key parameters for the choice of reconstruction.

  2. Concurrent Mucosal Melanoma and Angiofibroma of the Nose

    OpenAIRE

    Hwang, Jae Hyung; Ha, Jin Bu; Lee, Junguee; Lee, Joohyung

    2016-01-01

    Malignant melanoma rarely develops in the paranasal sinuses, and generally has a poor prognosis. However, mucosal melanoma can masquerade both clinically and histopathologically as a benign lesion, rendering accurate early diagnosis difficult. On the other hand, angiofibroma, a benign tumor, is more easily diagnosed than a mucosal melanoma, because the former exhibits specific histopathological features. No cases of concurrent angiofibroma and mucosal melanoma have been reported to date. We d...

  3. Low-Level Laser Therapy for Treatment of Oral Mucositis

    OpenAIRE

    Ravina Naomi Tarigan; Yuniardini Septorini Wimardhani

    2012-01-01

    Radiation and chemotherapy are the treatment options for head and neck cancer. Several side effects related to those treat-ment have been shown. Oral mucositis is a common side effect in patients undergoing those treatment. The presence of oral mucositis in these patients would influencing quality of life therefore compromising treatment outcome. The spec-trum of oral mucositis can be clinically seen as thinning of oral mucosa, oral discomfort to painful oral lesion causing mastication impair...

  4. Chitosan-Based Nanoparticles for Mucosal Delivery of RNAi Therapeutics

    DEFF Research Database (Denmark)

    Martirosyan, Alina; Olesen, Morten Jarlstad; Howard, Kenneth A.

    2014-01-01

    of the polysaccharide chitosan have been used to facilitate delivery of siRNA across mucosal surfaces following local administration. This chapter describes the mucosal barriers that need to be addressed in order to design an effective mucosal delivery strategy and the utilization of the mucoadhesive properties...... of chitosan. Focus is given to preparation methods and the preclinical application of chitosan nanoparticles for respiratory and oral delivery of siRNA....

  5. Probiotic supplements and debridement of peri-implant mucositis

    DEFF Research Database (Denmark)

    Hallström, Hadar; Lindgren, Susann; Widén, Cecilia

    2016-01-01

    OBJECTIVE: The aim of this double-blind randomized placebo-controlled trial was to evaluate the effects of probiotic supplements in adjunct to conventional management of peri-implant mucositis. MATERIALS AND METHODS: Forty-nine adult patients with peri-implant mucositis were consecutively recruited...... debridement and oral hygiene reinforcement resulted in clinical improvement of peri-implant mucositis and a reduction in cytokine levels. Probiotic supplements did not provide added benefit to placebo....

  6. Operative vaginal deliveries in Zaria, Nigeria | Adaji | Annals of ...

    African Journals Online (AJOL)

    Background : Operative vaginal deliveries are frequent features of obstetrics practice in tertiary levels of care even in developing countries. It is essential to review these practices in order to assess their benefits or otherwise to safe motherhood in resource limited settings Study design : Labor records on operative vaginal ...

  7. The use of supersaturation for the vaginal application of microbicides

    DEFF Research Database (Denmark)

    Grammen, Carolien; Plum, Jakob; Van Den Brande, Jeroen

    2014-01-01

    In this study, we investigated the potential of supersaturation for the formulation of the poorly water-soluble microbicide dapivirine (DPV) in an aqueous vaginal gel in order to enhance its vaginal tissue uptake. Different excipients such as hydroxypropylmethylcellulose, polyethylene glycol 1000...

  8. THE USE OF ISOLATED SIGMOID COLON SEGMENT FOR VAGINAL

    African Journals Online (AJOL)

    hack JT, Howards SS, Duckett JW (eds.): Adult vaginal reconstruction. BJU 2000, 85:715. RESUME. L'Utilisation du colon sigmoide dans le remplacement vaginal chez les jeunes adultes. Objectlfs : La vaginoplastie pour atrésie congénitale, un élément du syndrome de Mayer-Ftokitansky-. Kuster, ou la confirmation du sexe ...

  9. Evaluation of vaginal implant transmitters in elk (Cervus elaphus nelsoni).

    Science.gov (United States)

    Bruce K. Johnson; Terrance McCoy; Christopher O. Kochanny; Rachel C. Cook

    2006-01-01

    The effects of vaginal implant transmitters for tissue damage after 11 wk in 13 captive adult elk (Cervus elaphus nelsoni) and subsequent reproductive performance in 38 free-ranging elk were evaluated. Vaginal implant transmitters are designed to be shed at parturition and are used to locate birth sites of wild ungulates; however, potential adverse...

  10. Perception of Vaginal Discharge and Care Seeking Behaviour ...

    African Journals Online (AJOL)

    Perception of Vaginal Discharge and Care Seeking Behaviour among Obstetric and Gynaecological Clinic Attendees in Abakaliki, Southeastern Nigeria. ... and their paradoxical poor knowledge about the causes of vaginal discharge underscore the need to incorporate reproductive health education into secondary schools ...

  11. 539 Prevalence of Vaginal Candidiasis among Pregnant Women in ...

    African Journals Online (AJOL)

    User

    2010-10-17

    Oct 17, 2010 ... asymptomatic women do have Candida organisms as part of their endogenous vaginal flora; hence limitations of signs and symptoms in the diagnosis of vaginal infection has been recognised (Akinbiyi et al., 2008). Thus, mere isolation of Candida in the laboratory does not show real indication that it is the ...

  12. Pregnancy outcome in asymptomatic women with abnormal vaginal ...

    African Journals Online (AJOL)

    The presence of abnormal vaginal flora was correlated with pregnancy outcomes in terms of preterm delivery or late miscarriage, premature rupture of the membranes (PROM) and puerperal sepsis. Results. A total of 242 patients with abnormal vaginal flora for whom outcome data were complete were analysed. Intervention ...

  13. Vaginal drug delivery systems: A Review of Current Status | Dobaria ...

    African Journals Online (AJOL)

    Among the various routes of drug delivery, the vaginal route offers many advantages due to its large permeation area, rich vascularization, avoidance of first pass metabolism and relatively low enzymatic activity. Several studies have shown that the vaginal cavity is an effective route for drug administration intended mainly ...

  14. The threat of aerobic vaginitis to pregnancy and neonatal morbidity ...

    African Journals Online (AJOL)

    Aerobic vaginitis (AV) is an endogenous opportunistic infection brought about by the disruption of the normal vaginal microbiota. Its early diagnosis and treatment during pregnancy may reduce the risk of negative pregnancy outcomes. The aim of this review was to report on the aerobic bacteria most prevalent in AV and to ...

  15. Leech as a cause of abnormal vaginal bleeding: Presentation of ...

    African Journals Online (AJOL)

    Bleeding stopped soon. The patient was discharged in a good condition with hemoglobin on 8gm% on iron tablets. Leech as a cause of abnormal vaginal bleeding: Presentation of three cases in adults. Kibreab Asrat MD. Orotta National referral Maternity Hospital, Asmara, Eritrea. Abstract. Vaginal bleeding in women ...

  16. a case report of premenarchial transverse vaginal septum at the ...

    African Journals Online (AJOL)

    INTRODUCTION. The incidence of vaginal atresia has been estimated to be 1 in 400,000 female children.1 The vagina is derived from interaction between the uterovaginal primordium and the pelvic part of the urogenital sinus.2 The causes of vaginal anomalies are difficult to discern because of the controversial subject of ...

  17. Vaginal breech births in a hospital where caesarean section is ...

    African Journals Online (AJOL)

    SCIENTIFIC LETTER. Objectives. Caesarean section has become the preferred delivery method for breech presentation at Chris Hani Baragwanath Academic ... This study has shown that vaginal breech births continue to occur as unexpected events. ... descriptive study was to understand why and how vaginal breech.

  18. Vaginal practices of HIV-negative Zimbabwean women

    NARCIS (Netherlands)

    Turner, Abigail Norris; Morrison, Charles S.; Munjoma, Marshall W.; Moyo, Precious; Chipato, Tsungai; van de Wijgert, Janneke H.

    2010-01-01

    Vaginal practices (VPs) may increase HIV risk by injuring vaginal epithelium or by increasing risk of bacterial vaginosis, an established risk factor for HIV. HIV-negative Zimbabwean women (n = 2,185) participating in a prospective study on hormonal contraception and HIV risk completed an ancillary

  19. Vaginal metastasis of pancreatic cancer | Benhayoune | Pan African ...

    African Journals Online (AJOL)

    Vaginal metastasis from pancreatic cancer is an extreme case and often indicates a poor prognosis. We present a case of pancreatic carcinoma with metastasis to the vagina that was discovered by vaginal bleeding. To our knowledge, this is the third case in the world of a primary pancreatic adenocarcinoma discovered of ...

  20. Species distribution and antifungal sensitivity patterns of vaginal ...

    African Journals Online (AJOL)

    Objectives: To identify yeast isolates in vaginal specimens to species level and determine their antifungal susceptibility patterns. Design: Cross-sectional laboratory-based study. Setting: The Aga Khan University Hospital (AKUH), Nairobi. Subjects: Yeast isolates from high vaginal swabs presented to the laboratory for ...