Differences in the vaginal lactobacilli of postmenopausal women and influence of rectal lactobacilli.

OBJECTIVE: This study was undertaken to characterize the Lactobacillus spp. dominating the vaginal microbiota of healthy postmenopausal women and to determine the possible influence of rectal lactobacilli. METHODS: Sixty postmenopausal women aged 55-65 years without clinical signs of vaginal infection not receiving hormone replacement therapy were included in this cross-sectional observational study. Based on Gram-stained smears, 30 women with a normal vaginal flora (Nugent score 0) were included in Group 1, and 30 women with an intermediate vaginal flora characterized by an absence of vaginal lactobacilli (Nugent score 4) were included in Group 2. Vaginal and rectal smears were taken for molecular lactobacillus profiling using polymerase chain reaction and denaturing gradient gel electrophoresis. Diversity of vaginal and rectal lactobacilli in postmenopausal women was the main outcome measure. RESULTS: We noticed a minor interference of gut lactic acid bacteria on a normal vaginal microflora dominated by lactobacilli strains of the L. delbrueckii group. When the normal vaginal microflora is disturbed by depletion of lactobacilli, the gut may function as a reservoir for lactobacilli of the L. casei group, which then colonize the vagina. CONCLUSION: Our data indicate that rectal lactobacilli may affect the vaginal flora of postmenopausal women in the case of lactobacillary absence and help to maintain a normal vaginal microbiota.

Clinical ex vivo lung perfusion--pushing the limits.

Ex vivo lung perfusion (EVLP) provides the ability to evaluate donor lungs before transplantation. Yet, limited prospective clinical data exist with regard to its potential to recondition unacceptable donor lungs. This paper summarizes the results of a prospective study of lung transplantation using only initially unacceptable donor lungs, which were improved by EVLP for 2-4 h. From March 2010-June 2011, 13 lungs were evaluated ex vivo. Median donor PaO(2) at FiO(2) 1.0/PEEP5 was 216 mmHg (range 133-271). Four lungs, all with trauma history, showed no improvement and were discarded. Nine lungs improved to a ΔPO(2) higher than 350 mmHg. Median PvO(2) at final assessment in these lungs was 466 mmHg (range 434-525). These lungs were transplanted with a median total ischemic time of 577 min (range 486-678). None of the patients developed primary graft dysfunction grades 2 or 3 within 72 h after transplantation. One patient with secondary pulmonary hypertension was left on a planned prolonged extracorporeal membrane oxygenation postoperatively. Median intubation time was 2 days. Thirty-day mortality was 0%. During the observation period, 119 patients received standard lung transplantation with comparable perioperative outcome. EVLP has a significant potential to improve the quality of otherwise unacceptable donor lungs.