Objectives: The aim of this study was to determine if Lysyl Oxidase Like 1 (LOXL1) and Fibulin-5 (Fib5), two crucial proteins in the elastin metabolism pathway, are detectable in the vaginal secretions of women with and without Pelvic Organ Prolapse (POP). We then sought to quantify levels of these proteins in relation to prolapse. Methods: Vaginal secretions were obtained from 48 subjects (13 (27.1%) without and 35 (72.9%) with POP-Q Stage 2-4 prolapse). Eleven (22.9%) subjects were premenopausal and 37 (77.1%) were postmenopausal. Presence of LOXL1 and Fibulin-5 within specimens were first identified via western blotting. Enzyme-Linked Immunosorbent Assays specific for LOXL1 and Fibulin-5 were conducted to quantify total protein secretion. Results: LOXL1 was detected in 45/48 (93.8%) and Fibulin-5 was seen in 24/48 (50%) of subjects. LOXL1 values were lower in women without prolapse (13.3 ng/100 mg median, 24.4 IQR) vs. those with prolapse (26.4 ng/100 mg, 102.2 IQR). On multivariate analysis controlling for age, women with prolapse had a 544% (p=0.0042 higher LOXL1 protein level compared to those without. There was no significant differences in LOXL1 or Fibulin-5 protein detection with relation to menopausal status in bivariate analysis. Conclusions: This is the first published report of non-invasively measuring urogenital LOXL1 and Fibulin-5. In vaginal secretions, LOXL1 protein is higher in subjects with POP than those without.
Quemaduras en la mucosa oral y erosiones cutáneas Sr. Director: El término pénfigo se refiere a un grupo de enfermedades ampollosas autoinmunes de la piel y mucosas, caracterizadas histológicamente por ampollas intraepidérmicas debidas a acantolisis e inmunopatológicamente por el depósito de IgG e IgG circulante dirigida contra la superficie celular de los queratinocitos (1). Se distinguen dos tipos mayores de pénfigo: vulgaris, en el que las ampollas están en la parte más profunda de la epidermis, sobre la membrana basal y foliáceo, con ampollas más superficiales en la capa granulosa. Recientemente se describió el pénfigo paraneoplásico con características clínicas e histopatológicas úni-cas. El pénfigo es una enfermedad poco frecuente, tanto para el médico de atención primaria como para el internista, lo que dificulta su diagnóstico.Presentamos el caso de una mujer de 70 años que consultó porque unos tres meses antes del ingreso comenzó con molestias en orofaringe, por lo que hizo enjuagues bucales con alcohol de 96° en varias ocasiones, apareciendo posteriormente úlceras en la mucosa oral muy dolorosas, con hipersalivación continua y que finalmente le impedían la ingesta. Un mes después se añadieron lesiones cutáneas erosivas y pérdida de 20 kg de peso en este tiempo. En la exploración física destacaban erosiones en la mucosa oral, lengua y paladar con hipersialorrea y en la piel erosiones de 2 x 3 cm, no confluyentes, de distribución predominante en tronco y extremidades superiores, con signo de Nikolsky positivo. Las exploraciones complementarias básicas incluído hemograma, velocidad de sedimentación globular (VSG), bioquimica, coagulación, proteinograma y radiograffa de tórax eran normales. Se realizó un cultivo de exudado faringo-amigdalar que fue negativo. En la endoscopia digestiva alta se apreciaban lesiones erosivas en la mucosa oral, lingual y faríngea, con sobreinfección candidiásica y en esófago dos pequeñas lesiones mucosas vesiculares con signo de Nikolski positivo. La biopsia de piel realizada demostró zonas de acantolisis, con ampollas intraepidérmicas justo por encima de la capa basal. En la inmunofluorescencia se vio la presencia de depósitos a nivel de la epidermis entre los queratinocitos positivos para IgG y C3, diagnosticándose a la paciente de pénfigo vulgar.En la mayoría de pacientes el signo de presentación del pénfi-go son erosiones mucosas tremendamente dolorosas, precediendo incluso en meses a las lesiones cutáneas, como en nuestro caso (2). Otras enfermedades que pueden cursar con lesiones erosivas en cavidad oral, y con las que hay que hacer el diagnóstico diferencial son, otras enfermedades ampollosas autoinmunes, estomatitis gingival herpética, estomatitis micótica, estomatitis quí-mica, estomatitis acompañando a colagenosis, liquen plano y tumores (3). En nuestra paciente coexistía afectación oral por pénfigo, además de estomatitis química inducida por el alcohol y sobreinfección candidiásica. La afectación esofágica parece relativamente común según se desprende de una serie pu...
INTRODUCTION: Survivorship and survival rates amongst women with pelvic cancers continues to improve. While enteritis and cystitis are known side effects of radiation, there is a lack of information regarding its effect on sexual dysfunction. METHODS: This was an IRB-approved study of females with a pelvic cancer who underwent radiation treatment between 2010-2015. Demographic and clinical variables, as well as radiation treatment specifics, vaginal dilator counseling and sexual function assessment, were collected through electronic medical record review. Logistic regressions were performed using SPSS Statistics software. RESULTS: In this convenience sample, records of 87 pelvic cancer patients were extensively reviewed (71 with gynecologic malignancy and 16 with colorectal cancer). The mean age of the cohort was 55.4 years, with mean parity of 2.6 and average BMI 27.79. Eighty five percent (74/87) of the cohort received external beam radiation and 41/87 (47%) had vaginal brachytherapy. Mean cumulative radiation dose was 63.5 gray. In this cohort, 38/87 (43.6%) had documentation of vaginal dilator counseling following treatment. This counseling was significantly associated with a prior urogynecologic diagnosis, vaginal brachytherapy and dosage of radiation. Sexual function was assessed in 20/87 patients (22.9%). Patient age, menopausal status, history of voiding complaints, use of vaginal dilators as well as post-radiation urogynecologic evaluation and vaginal estrogen use were significantly associated with sexual function evaluation by providers. CONCLUSION: Prevention of vaginal stenosis and assessment of sexual dysfunction following pelvic radiation is low. Increased counseling and treatment may improve our survivors’ quality of life.
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