Microcellular approach for the pathogenesis of placenta accreta spectrum inflammatory versus apoptotic pathways; a thorough look on Treg, dNK and VEGF.

Placenta accreta spectrum (PAS) is a disorder of irregular placental invasion to the surrounding structures, it is a leading cause of maternal morbidity and mortality. This study was theorized to perceive the role of Treg cells and VEGF which appealed to play a role in the pathogenesis of nonstandard extreme placental invasion. The study was carried out on 40 pregnant women; Group I (control group), and Group II (placenta accrete spectrum PAS). Light microscopic, immune-histochemical; CD 56 (NK CELLS) and CD 45 RO (T reg) western blot; P53 and VEGF morphometry and statistical analysis were done. H&E-stained sections revealed Placental tissue in unswerving contact with the myometrium, deficient decidual layer, hemorrhage, congested edematous blood vessels. The mean area percent of collagen, Treg, P53, and VEGF exposed a significant increase in the placenta accreta group when compared to that of control women. Nonetheless, the mean area percent of NK cells displayed a significant decrement PAS cases are associated with low levels of NK cells and increased levels of Treg cells, P 53, and VEGF, promoting the hyperinvasive behavior of trophoblasts of placenta accreta and dysregulate placental vascular remodeling.

Pelvic floor dysfunction: assessment with combined analysis of static and dynamic MR imaging findings.

PURPOSE: To prospectively analyze static and dynamic magnetic resonance (MR) images simultaneously to determine whether stress urinary incontinence (SUI), pelvic organ prolapse (POP), and anal incontinence are associated with specific pelvic floor abnormalities. MATERIALS AND METHODS: This study had institutional review board approval, and informed consent was obtained from all participants. There were 59 women: 15 nulliparous study control women (mean age, 25.6 years) and 44 patients (mean age, 43.4 years), who were divided into four groups according to chief symptom. Static T2-weighted turbo spin-echo images were used in evaluating structural derangements; functional dynamic (cine) balanced fast-field echo images were used in detecting functional abnormalities and recording five measurements of supporting structures. Findings on both types of MR images were analyzed together to determine the predominant defect. Analysis of variance and the Bonferroni t test were used to compare groups. RESULTS: In the four patient groups, POP was associated with levator muscle weakness in 16 (47%) of 34 patients, with level I and II fascial defects in seven (21%) of 34 patients, and with both defects in 11 (32%) of 34 patients. SUI was associated with defects of the urethral supporting structures in 25 (86%) of 29 patients but was not associated with bladder neck descent. Levator muscle weakness may lead to anal incontinence in the absence of anal sphincter defects. Measurements of supporting structures were significant (P < .05) in the identification of pelvic floor laxity. CONCLUSION: Combined analysis of static and dynamic MR images of patients with pelvic floor dysfunction allowed identification of certain structural abnormalities with specific dysfunctions.

Anatomy of the urethral supporting ligaments defined by dissection, histology, and MRI of female cadavers and MRI of healthy nulliparous women.

OBJECTIVE: There has been no uniformity of opinion concerning the structures supporting the female urethra. Therefore, the aims of this prospective study were to define precisely the female urethral support structures at cadaveric anatomic dissection and histologic examination and to determine which of these structures can be detected on MRI of cadaveric specimens and of healthy volunteers. SUBJECTS AND METHODS: Dissection of seven formalin-preserved cadavers (age at death, 25-50 years; no parity history available) was performed by a professor of anatomy to explore the anatomy of the urethral supporting ligaments and was followed by MRI of the cadaveric specimens with ligamentous markers in place and then by histologic analysis of the dissected ligaments. MRI of 17 healthy nulliparous women (age range, 20-35 years; mean age, 25.5 years) was then performed using T2-weighted, dual turbo spin-echo, balanced fast-field echo, and STIR sequences. A standardized grid system that allowed us to record structural observations on sequentially numbered axial MR images was used by a radiologist who then applied a 4-point grading scale to assess ligament visibility. Three authors--one radiologist, one anatomist, and one urologist--then compared the appearance of each ligament seen in a cadaveric specimen with its appearance on MR images of the same cadaver and on MR images of volunteers. RESULTS: At cadaveric dissection we identified ventral and dorsal urethral ligaments. The ventral urethral ligaments included the pubourethral ligaments, which were found to consist of three separate components coursing anteroposterior from the bladder neck to the pubic bone; the periurethral ligament; and the paraurethral ligaments. Dorsal to the urethra, a slinglike ligament, which we believe should be named the "suburethral ligament," was identified. This ligament had a distinct plane of cleavage from the anterior vaginal wall. The MRI findings in the volunteers correlated with the MRI and gross anatomic findings in the cadavers. The proximal pubourethral, periurethral, paraurethral, and suburethral ligaments had visibility scores of 3 (moderately visible) or 4 (easily visible) on MRI in 47%, 65%, 47%, and 53% of volunteers, respectively. CONCLUSION: Our results present evidence that may help resolve previous controversies regarding the MR appearance of the ventral urethral ligaments and that better define the course of the ligament dorsal to the urethra, the suburethral ligament. We hope that this detailed anatomic information about the structures involved in continence may lead eventually to improvements in the treatments for women with stress urinary incontinence.