Lymphangiogenic cytokines such as vascular endothelial growth factor-C (VEGF-C) are critically required for lymphatic regeneration; however, in some circumstances, lymphatic function is impaired despite normal or elevated levels of these cytokines. The recent identification of anti-lymphangiogenic molecules such as interferon-γ (IFN-γ), transforming growth factor-β1, and endostatin has led us to hypothesize that impaired lymphatic function may represent a dysregulated balance in the expression of pro/anti-lymphangiogenic stimuli. We observed that nude mice have significantly improved lymphatic function compared with wild-type mice in a tail model of lymphedema. We show that gradients of lymphatic fluid stasis regulate the expression of lymphangiogenic cytokines (VEGF-A, VEGF-C, and hepatocyte growth factor) and that paradoxically the expression of these molecules is increased in wild-type mice. More importantly, we show that as a consequence of T-cell-mediated inflammation, these same gradients also regulate expression patterns of anti-lymphangiogenic molecules corresponding temporally and spatially with impaired lymphatic function in wild-type mice. We show that neutralization of IFN-γ significantly increases inflammatory lymph node lymphangiogenesis independently of changes in VEGF-A or VEGF-C expression, suggesting that alterations in the balance of pro- and anti-lymphangiogenic cytokine expression can regulate lymphatic vessel formation. In conclusion, we show that gradients of lymphatic fluid stasis regulate not only the expression of pro-lymphangiogenic cytokines but also potent suppressors of lymphangiogenesis as a consequence of T-cell inflammation and that modulation of the balance between these stimuli can regulate lymphatic function.

BackgroundEctopic pregnancy is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with assisted-reproductive technology (ART), occurring in approximately 1.5–2.1 % of patients undergoing in-vitro fertilization (IVF). Abdominal ectopic pregnancy is a rare yet clinically significant form of ectopic pregnancy due to potentially high maternal morbidity. While risk factors for ectopic pregnancy after IVF have been studied, very little is known about risk factors specific for abdominal ectopic pregnancy. We present a case of a 30 year-old woman who had an abdominal ectopic pregnancy following IVF and elective single embryo transfer, which was diagnosed and managed by laparoscopy. We performed a systematic literature search to identify case reports of abdominal or heterotopic abdominal ectopic pregnancies after IVF. A total of 28 cases were identified.ResultsPatients’ ages ranged from 23 to 38 (Mean 33.2, S.D. = 3.2). Infertility causes included tubal factor (46 %), endometriosis (14 %), male factor (14 %), pelvic adhesive disease (7 %), structural/DES exposure (7 %), and unexplained infertility (14 %). A history of ectopic pregnancy was identified in 39 % of cases. A history of tubal surgery was identified in 50 % of cases, 32 % cases having had bilateral salpingectomy. Transfer of two embryos or more (79 %) and fresh embryo transfer (71 %) were reported in the majority of cases. Heterotopic abdominal pregnancy occurred in 46 % of cases while 54 % were abdominal ectopic pregnancies.ConclusionsOur systematic review has revealed several trends in reported cases of abdominal ectopic pregnancy after IVF including tubal factor infertility, history of tubal ectopic and tubal surgery, higher number of embryos transferred, and fresh embryo transfers. These are consistent with known risk factors for ectopic pregnancy following IVF. Further research focusing on more homogenous population may help in better characterizing this rare IVF complication and its risks.

Endometriosis is a condition defined by the presence of endometrial glands and stroma in ectopic locations. While the most commonly seen symptoms of the disease are pelvic pain, dysmenorrhea, and infertility, endometriosis has also systemic effects in multiple organ systems. Here, we review literature describing closely associated comorbidities including cardiovascular disease, cancers, autoimmune disease, psychiatric conditions, and metabolism/body weight. We examine the pathophysiology and hypothesized mechanism by which endometriosis may lead to these systemic effects; mechanisms include cytokine and micro-RNA production as well as stem cell migration and dissemination. The broad systemic effects of endometriosis as well as correlated comorbidities are often overlooked in the treatment of patients with endometriosis. Increased awareness may lead to more effective treatment and prevention.

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the patient was found to have extensive vulvar erythema and swelling associated with bullous lesions and desquamation that was causing significant pain (Figure 1a). Differential diagnosis included: Steven-Johnson syndrome, scalded skin syndrome, herpes simplex virus, ebstein-barr virus, exfoliative dermatitis, vulvar cellulitis, and contact dermatitis. She was admitted to the hospital for further evaluation and symptomatic management. After exploration of the differential diagnosis and after further history was revealed, the patient was ultimately diagnosed with irritant contact dermatitis with a suspected superimposed bacterial infection. The contact irritant was suspected to be sanitary wipes used to obtain a clean catch urine sample in the week prior to presentation. She was treated with a course of antibiotics as well as topical steroids and topical lidocaine. The patient was seen in the outpatient setting 2 weeks following discharge and was noted to have almost complete resolution of her vulvar dermatitis (Figure 1b). Comments: This case is a model demonstration of the confusing clinical picture that often accompanies a diagnosis of vulvar dermatitis in the adolescent patient. Additionally, vulvar dermatitis is often a diagnosis of exclusion and this case provides a strong example of the evaluation of some of the less common causes of vulvar dermatoses. A better understanding of the pathophysiology and clinical presentations of vulvar dermatitis is required to allow for prompt diagnosis, treatment, and prevention. This is especially true in the pediatric/adolescent gynecology field as vulvar dermatoses are commonly the chief complaint of office visits. 42. Low-Grade Astrocytoma Within a Mature Cystic Teratoma in an Adolescent Patient: A Case Report

ELISA kit, Abcam). Patients completed the Beck Depression Inventory (BDI) and the Female Sexual Functioning Index (FSFI), which includes domains for desire, arousal, lubrication, orgasm, satisfaction, and pain, at study initiation and at 6 months. Pearson correlation was used to determine associations between total Vit D levels, BDI, and FSFI scores and paired T-Tests were used to determine change over time.RESULTS: Forty-seven women were initially evaluated; 5 were excluded with severe depression.

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