Exploring Localized Provoked Vulvodynia: Insights from Animal Model Research.

Provoked vulvodynia represents a challenging chronic pain condition, characterized by its multifactorial origins. The inherent complexities of human-based studies have necessitated the use of animal models to enrich our understanding of vulvodynia's pathophysiology. This review aims to provide an exhaustive examination of the various animal models employed in this research domain. A comprehensive search was conducted on PubMed, utilizing keywords such as "vulvodynia", "chronic vulvar pain", "vulvodynia induction", and "animal models of vulvodynia" to identify pertinent studies. The search yielded three primary animal models for vulvodynia: inflammation-induced, allergy-induced, and hormone-induced. Additionally, six agents capable of triggering the condition through diverse pathways were identified, including factors contributing to hyperinnervation, mast cell proliferation, involvement of other immune cells, inflammatory cytokines, and neurotransmitters. This review systematically outlines the various animal models developed to study the pathogenesis of provoked vulvodynia. Understanding these models is crucial for the exploration of preventative measures, the development of novel treatments, and the overall advancement of research within the field.

[IDENTIFICATION OF A NOVEL LTBP3 GENE PATHOGENIC VARIANT IN DRUZE ARAB PATIENTS PRESENTED WITH SYNDROMIC SHORT STATURE WITH BRACHYOLMIA AND AMELOGENESIS IMPERFECTA].

BACKGROUND: Short stature is a common finding among the general population, mostly presented as an isolated phenotype. The syndromic short statute is rare and complex. Recently, we examined several patients from related families sharing both short stature and congenital dental abnormalities. OBJECTIVES: 1. Clinical characterization of syndromic short stature; 2. To find the disease mutation and evaluate the carrier state in the particular community. METHODS: Clinical characterization- by medical history, medical records and physical examination; Homozygosity mapping - by using the Single nucleotide polymorphism (SNP) chromosomal microarrays (CMA) analysis and gene mutation detection by ABI Sanger sequence. RESULTS: All patients present with short stature severe dental anomalies including enamel formation and mineralization defect, oligodontia, abnormal shape and retarded eruption. CMA analysis in 3 patients and 2 healthy members of four families was normal. One homozygote region in chromosome 11 (11p11.2- 11q13.3) was found in all patients. By using the candidate gene approach, amongst the 301 genes found within this region, only one, the LTBP3 gene (Latent Transforming Growth Factor-Beta-Binding Protein-3) has high priority for sequence. Hence, LTBP3 (OMIM-602090) pathogenic variant is responsible for "brachyolmia with amelogenesis imperfecta" also known as "Dental Anomalies and Short Stature (DASS)" (OMIM- 601216). We sequenced all 29 LTBP3 exons and a novel splice pathogenic variant, c.1346-1G>A chr11:65319629, in exon 8 was identified. The variant segregated well within healthy tested family members. We found a high carrier rate in the village (1:15). CONCLUSIONS: We identified a novel and common LTBP3 gene pathogenic variant responsible for short stature, brachyolmia and amelogenesis imperfecta in Druze Arab patients.

Digital vs speculum-guided catheter balloon insertion for cervical ripening in multiparas: a randomized controlled trial.

BACKGROUND: Catheter balloon insertion into the maternal uterine cervix is routinely speculum guided; digital insertion has been reported, but it was not found to be more tolerable among nulliparas. OBJECTIVE: In a cohort of multiparas, we aimed to evaluate maternal pain, the induction to delivery interval, and maternal satisfaction with digital insertion vs speculum-guided placement of a Foley catheter balloon for labor induction. STUDY DESIGN: This randomized trial was conducted at a single, tertiary, university-affiliated hospital. The participants were multiparas (parity ≥1) and were admitted at term for labor induction with a Bishop score <6. They were randomized to 2 groups, namely the digital insertion and the speculum-guided Foley catheter insertion groups. An intention-to-treat analysis was performed. The co-primary outcomes were visual analog scale scores (0-10) and induction to delivery intervals. Secondary outcomes were procedure duration, maternal satisfaction, cervical ripening (Bishop score ≥6), delivery within 24 hours, infection rate, and neonatal outcomes. RESULTS: A total of 50 women were analyzed for each study group. For the digitally inserted vs speculum-guided insertion group, the median visual analog scale score at catheter insertion was lower (4; range, 0-10; vs 7; range, 0-10; P<.001), and the induction to delivery interval was similar. For the digitally inserted vs speculum-guided insertion group, the median maternal satisfaction score was greater (5; range 3-5; vs 4; 1-5; P=.01), and the median procedure duration was shorter (2.1; range, 1.4-5.3 minutes vs 3.0; range, 1.4-5.0; P<.001). In the multivariate analysis, digital insertion (P=.009) and increased parity (P=.001) independently decreased the visual analog scale score. Cervical ripening, the maternal infection rate, and the neonatal outcomes did not differ significantly between the groups. CONCLUSION: Digital insertion of a Foley catheter balloon for cervical ripening in multiparas is less painful and quicker than speculum-guided insertion. It is also not inferior in terms of successful cervical ripening.

Third trimester re-screening for gestational diabetes in morbidly obese women despite earlier negative test can reveal risks for obstetrical complications.

AIM: We investigated associations of maternal obesity with late gestational diabetes mellitus (GDM) diagnosis (>34 weeks) in women with previous normal glucose screening, and associations of late GDM with obstetrical outcomes. METHODS: This retrospective cohort study assessed obstetrical and neonatal outcomes of 238 women with normal (24-28 week) glucose screening results, who underwent late repeat oral glucose tolerance tests (OGTT) (>34 weeks) due to a suspected LGA fetus (54.6%) or polyhydramnios (45.4%). A sub-analysis was performed of outcomes of women with late versus mid-trimester GDM. RESULTS: The GDM rate in repeat OGTT screening was 22.2% for the total sample, and 33% among women with morbid obesity. Among women with late GDM versus without late GDM, rates were higher for macrosomia, large-for-gestational-age fetus induction of labor, neonatal hypoglycemia, jaundice, and the need for phototherapy. Among women with late GDM, a higher pregestational BMI was associated with adverse maternal and perinatal outcomes. Higher risks for macrosomia and CS due to macrosomia were demonstrated in women with late vs. mid-trimester GDM. CONCLUSION: Late screening in pregnancy may reveal GDM among women with previous normal glucose screening, particularly among those with late third trimester BMI ≥ 35 kg/m2 , GDM in a previous pregnancy or fasting glucose >95 mg/dl. Women diagnosed with GDM at >34 weeks following normal glucose screening at 24-28 weeks are at higher risk for adverse perinatal outcomes. For women with morbid obesity, or suspected macrosomia or polyhydramnios in the late third trimester, and normal glucose screening in the second trimester, retesting should be considered.

Obstetrical Outcome following Diagnosis of Gestational Diabetes in the Third Trimester (>29 Weeks) versus Second Trimester (24-28 Weeks): A Retrospective Comparative Study.

OBJECTIVE: This study aimed to compare obstetrical outcomes between women diagnosed with gestational diabetes mellitus (GDM) in the third trimester after testing negative for GDM in two-step screening in the second trimester and women diagnosed in the second trimester. STUDY DESIGN: This retrospective study compared obstetrical outcomes between 375 women diagnosed with GDM in the second trimester and 125 diagnosed in the third trimester. RESULTS: Among women diagnosed with GDM in the third versus second trimester, the incidences were higher of morbid obesity (body mass index ≥35 kg/m2), macrosomia, and cesarean section (CS) due to suspected macrosomia: 23.2 versus 9.8%, p < 0.001; 44.0 versus 10.1%, p < 0.001; and 24.8 versus 6.3%, p < 0.001, respectively. For those diagnosed in the third versus second trimester, the incidences were lower of hypertensive disorders of pregnancy and intrauterine growth restriction, and a lower proportion of women needed pharmacological therapy for glucose control: 2.4 versus 9.0%, p = 0.016; 0.8 versus 8.2%, p < 0.001; and 12.0 versus 29.7%, p < 0.001, respectively. Multivariate analysis supported a correlation between third-trimester-diagnosed GDM and macrosomia, and between second-trimester-diagnosed GDM and hypertensive disorders of pregnancy. CONCLUSION: Among women diagnosed with GDM in the third compared with the second trimester, the incidence of morbid obesity was higher; accordingly, the risks were higher for large for gestational age infants and delivery by CS, and lower for hypertensive disorders. Guidelines regarding repeat oral glucose tolerance testing in the third trimester should be considered following prospective studies. KEY POINTS: · Third-trimester GDM was 29.9% among women with normal second-trimester screening.. · Morbid obesity and macrosomia were more frequent in third- versus second-trimester GDM.. · Incidence of preeclampsia was lower in third- versus second-trimester-diagnosed GDM..