ʻO Vulva-vaginal atrophy (VVA) kekahi o nā hopena maʻamau o ka nele o ka estrogen, ʻoi aku ma hope o ka menopause.Ua loiloi kekahi mau haʻawina i nā hopena o ka hyaluronic acid (HA) ma nā hōʻailona kino a me ka moekolohe e pili ana me VVA a ua loaʻa i nā hopena hoʻohiki.Eia naʻe, ʻo ka hapa nui o kēia mau haʻawina i kālele ʻia i ka loiloi kumuhana o ka pane hōʻailona i nā ʻano kumuhana.Eia nō naʻe, he mole endogenous ʻo HA, a he mea kūpono ka hana maikaʻi loa inā hoʻokomo ʻia i loko o ka epithelium superficial.ʻO Desirial® ka waika hyaluronic i hoʻopili ʻia i hoʻopaʻa ʻia ma o ka hoʻokele mucosal vaginal.ʻO ke kumu o kēia noiʻi ʻana, ʻo ia ka noiʻi ʻana i ka hopena o ka nui o ka intravaginal intramucosal injection o kahi hyaluronic acid i hoʻopili ʻia (DESIRIAL®, Laboratoires VIVACY) ma nā hopena koʻikoʻi i hōʻike ʻia e ka maʻi.
Hoʻopaʻa haʻawina hoʻokele lua waena.ʻO nā hopena i koho ʻia, ʻo ia ka hoʻololi ʻana i ka mānoanoa o ka mucosal vaginal, nā biomarkers hoʻokumu collagen, floral floral, vaginal pH, vaginal health index, nā hōʻailona o ka vulvovaginal atrophy a me ka hana moe 8 mau pule ma hope o ka hoʻokele Desirial®.Ua hoʻohana pū ʻia ka manaʻo holoʻokoʻa o ka hoʻomaikaʻi ʻana o ka mea maʻi (PGI-I) e loiloi i ka ʻoluʻolu o ka maʻi.
He 20 ka nui o ka poe i komo mai 19/06/2017 a i 05/07/2018.I ka pau ʻana o ke aʻo ʻana, ʻaʻohe ʻokoʻa o ka mānoanoa o ka mucosa vaginal median a i ʻole procollagen I, III, a i ʻole Ki67 fluorescence.Eia naʻe, ua hoʻonui nui ʻia ka huaʻōlelo gene COL1A1 a me COL3A1 (p = 0.0002 a me p = 0.0010).ʻO ka dyspareunia i hōʻike ʻia, ka maloʻo ʻana o ka wahine, ka ʻili ʻana o ka maʻi, a me ka ʻeha ʻana o ka wahine, ua hoʻemi nui ʻia, a ua hoʻomaikaʻi maikaʻi ʻia nā ana o nā hana pili wahine.Ma muli o ka PGI-I, ua hōʻike nā maʻi 19 (95%) i nā pae like ʻole o ka hoʻomaikaʻi ʻana, a ʻo 4 (20%) i ʻoi aku ka maikaʻi;ʻOi aku ka maikaʻi o 7 (35%), a ʻoi aku ka maikaʻi o 8 (40%).
ʻO ka nui-point intravaginal injection o Desirial® (kahi cross-linked HA) i pili nui me ka hōʻike o CoL1A1 a me CoL3A1, e hōʻike ana ua hoʻoulu ʻia ka hoʻokumu ʻana o ka collagen.Eia kekahi, ua hoʻemi nui ʻia nā hōʻailona VVA, a ua hoʻomaikaʻi maikaʻi ʻia ka ʻoluʻolu o ka maʻi a me nā helu hana moe kolohe.Eia naʻe, ʻaʻole i loli nui ka mānoanoa o ka mucosa vaginal.
ʻO Vulva-vaginal atrophy (VVA) kekahi o nā hopena maʻamau o ka nele o ka estrogen, ʻoi loa ma hope o ka menopause [1,2,3,4].Hoʻopili ʻia kekahi mau maʻi maʻi maʻi me VVA, ʻo ia hoʻi ka maloʻo, ka huhū, ka ʻili, ka dyspareunia, a me nā maʻi maʻi urinary tract, hiki ke loaʻa i kahi hopena maikaʻi ʻole i ka maikaʻi o ke ola o nā wahine [5].Eia naʻe, hiki ke maʻalahi ka hoʻomaka ʻana o kēia mau hōʻailona, a hoʻomaka e ʻike ʻia ma hope o ka pau ʻana o nā hōʻailona menopausal.Wahi a nā hōʻike, a hiki i ka 55%, 41%, a me 15% o nā wahine postmenopausal e loaʻa ana i ka maloʻo maloʻo, dyspareunia, a me nā maʻi maʻi urinary tract, kēlā me kēia [6,7,8,9].Eia naʻe, manaʻo kekahi poʻe ʻoi aku ka kiʻekiʻe o ka nui o kēia mau pilikia, akā ʻaʻole ʻimi ka hapa nui o nā wahine i ke kōkua olakino ma muli o nā hōʻailona [6].
ʻO ka ʻike nui o ka hoʻokele VVA ʻo ia ka maʻi hōʻailona, me ka hoʻololi ʻana i ke ʻano o ka nohona, non-hormonal (e like me nā lubricants vaginal a i ʻole moisturizers a me ka lāʻau laser) a me nā papahana mālama hormone.Hoʻohana nui ʻia nā lubricant vagina e hoʻomaha i ka maloʻo o ka wahine i ka wā o ka moekolohe, no laila ʻaʻole hiki iā lākou ke hāʻawi i kahi hopena kūpono i ka maʻi a me ka paʻakikī o nā hōʻailona VVA.ʻO ka mea ʻē aʻe, ua hōʻike ʻia ʻo ka moisturizer vaginal kahi ʻano huahana "bioadhesive" hiki ke hoʻoikaika i ka mālama ʻana i ka wai, a hiki i ka hoʻohana mau ʻana ke hoʻomaikaʻi i ka huhū vaginal a me ka dyspareunia [10].Eia nō naʻe, ʻaʻohe mea e pili ana i ka hoʻomaikaʻi ʻana i ka helu kikoʻī o ka epithelial vaginal maturity index [11].I nā makahiki i hala iho nei, ua nui nā koi e hoʻohana i ka radiofrequency a me ka laser e mālama i nā hōʻailona menopausal vaginal [12,13,14,15].Eia nō naʻe, ua hoʻopuka ka FDA i nā ʻōlelo aʻo i nā maʻi, e ʻōlelo ana i ka hoʻohana ʻana i ia mau kaʻina hana e alakaʻi i nā hanana koʻikoʻi koʻikoʻi, a ʻaʻole naʻe i hoʻoholo i ka palekana a me ka pono o nā mea e pili ana i ka ikehu i ka mālama ʻana i kēia mau maʻi [16].ʻO nā hōʻike mai kahi meta-analysis o kekahi mau haʻawina randomized e kākoʻo i ka maikaʻi o ka topical and systemic hormone therapy i ka hoʻohaʻahaʻa ʻana i nā hōʻailona pili VVA [17,18,19].Eia naʻe, ua loiloi kekahi helu palena o nā haʻawina i nā hopena hoʻomau o ia mau lapaʻau ma hope o 6 mau mahina o ka mālama ʻana.Eia kekahi, ʻo kā lākou contraindications a me nā koho pilikino e kaupalena ana i nā kumu no ka hoʻohana ākea a lōʻihi o kēia mau koho lapaʻau.No laila, aia nō ka pono no kahi hopena palekana a maikaʻi hoʻi e mālama i nā hōʻailona pili i ka VVA.
ʻO ka Hyaluronic acid (HA) kahi mole nui o ka matrix extracellular, aia i loko o nā ʻiʻo like ʻole me ka mucosa vaginal.He polysaccharide ia mai ka ʻohana glycosaminoglycan, he mea nui ia i ka mālama ʻana i ke koena o ka wai a me ka hoʻoponopono ʻana i ka mumū, ka pane ʻana o ka immune, ka hoʻokumu ʻana o ka scar a me ka angiogenesis [20, 21].Hāʻawi ʻia nā hoʻomākaukau HA Synthetic ma ke ʻano o nā gels topical a loaʻa ke kūlana o "nā mea lapaʻau".Ua loiloi kekahi mau haʻawina i ka hopena o HA ma nā hōʻailona kino a me ka wahine e pili ana me VVA a ua loaʻa i nā hopena hoʻohiki [22,23,24,25].Eia naʻe, ʻo ka hapa nui o kēia mau haʻawina i kālele ʻia i ka loiloi kumuhana o ka pane hōʻailona i nā ʻano kumuhana.Eia nō naʻe, he mole endogenous ʻo HA, a he mea kūpono ka hana maikaʻi loa inā hoʻokomo ʻia i loko o ka epithelium superficial.ʻO Desirial® ka waika hyaluronic i hoʻopili ʻia i hoʻopaʻa ʻia ma o ka hoʻokele mucosal vaginal.
ʻO ke kumu o kēia haʻawina hoʻokele lua-waena ʻo ia ka ʻimi ʻana i ka hopena o ka nui o nā kikoʻī intravaginal intramucosal injection o kahi hyaluronic acid (DESIRIAL®, Laboratoires VIVACY) i nā hopena kumu o kekahi mau hōʻike lapaʻau a me nā mea maʻi, a no ka loiloi ʻana. ke kūpono o ka loiloi loiloi Sex i kēia mau hopena.ʻO nā hopena holoʻokoʻa i koho ʻia no kēia noiʻi ʻana, ʻo ia ka hoʻololi ʻana i ka mānoanoa o ka mucosal vaginal, nā biomarkers o ka hoʻōla hou ʻana o ka ʻiʻo, nā floral floral, ka pH vaginal a me ka helu helu olakino vaginal 8 mau pule ma hope o ka hoʻokele Desirial®.Ua ana mākou i nā hopena i hōʻike ʻia e kekahi mau maʻi, me ka hoʻololi ʻana i ka hana moe kolohe a me ka helu hōʻike o nā hōʻailona pili VVA i ka manawa like.I ka pau ʻana o ke aʻo ʻana, ua hoʻohana ʻia ka manaʻo holoʻokoʻa o ka hoʻomaikaʻi (PGI-I) o ka mea maʻi e loiloi i ka ʻoluʻolu o ka maʻi.
ʻO ka heluna kanaka i noiʻi ʻia nā wahine postmenopausal (2 a 10 mau makahiki ma hope o ka menopause) i hoʻouna ʻia i kahi keʻena menopause me nā hōʻailona o ka ʻehaʻeha a / a i ʻole dyspareunia lua i ka maloʻo ʻana.Pono nā wāhine ma ≥ 18 makahiki a ma lalo o 70 mau makahiki a loaʻa iā BMI <35.Ua hele mai ka poʻe i komo mai kekahi o 2 mau hui komo (Centre Hospitalier Régional Universitaire, Nîmes (CHRU), Farani a me Karis Medical Center (KMC), Perpignan, Farani).Manaʻo ʻia he kūpono nā wahine inā he ʻāpana lākou o kahi hoʻolālā ʻinikua olakino a pōmaikaʻi paha mai kahi hoʻolālā ʻinikua olakino, a ʻike lākou hiki iā lākou ke komo i ka manawa 8 pule i hoʻolālā ʻia.ʻAʻole kūpono nā wāhine e komo ana i nā haʻawina ʻē aʻe i kēlā manawa.≥ Papa 2 apical pelvic organ prolapse, stress urinary incontinence, vaginismus, vulvovaginal or urinary tract infection, hemorrhagic or neoplastic genital lesions, hormone-dependent tumor, genital bleeding of unknown etiology, recurrent porphyria, uncontrolled epilepsy, cardiac recurrent disorders , Rheumatic fever, vulvovaginal or urogynecological surgery before, hemostatic disorders, and the tendency to form hypertrophic scars were considerable terms.ʻO nā wāhine e lawe ana i nā lāʻau antihypertensive, steroidal a me non-steroidal anti-inflammatory drugs, anticoagulants, antidepressants nui a aspirin, a me nā anesthetics kūloko i hoʻopili ʻia me HA, mannitol, betadine, lidocaine, amide a i ʻole nā wahine i maʻi i kekahi o nā mea hoʻohui i kēia lāʻau. manaʻo ʻia ʻaʻole kūpono no kēia haʻawina.
Ma ka papa kuhikuhi, ua noi ʻia nā wahine e hoʻopiha i ka Female Sexual Function Index (FSFI) [26] a hoʻohana i ka 0-10 visual analog scale (VAS) e hōʻiliʻili i ka ʻike e pili ana i nā hōʻailona VA (dyspareunia, maloʻo maloʻo, abrasions vaginal, a me ka ʻili ʻana o ke kino. ) ʻike.ʻO ka loiloi mua o ka hana ʻana, ʻo ia ka nānā ʻana i ka pH vaginal, me ka hoʻohana ʻana i ka Bachmann Vaginal Health Index (VHI) [27] no ka loiloi lapaʻau o ka ʻōpū, Pap smear no ka loiloi ʻana i nā floral vaginal, a me ka biopsy mucosal vaginal.E ana i ka pH vaginal kokoke i kahi i hoʻolālā ʻia a i loko o ka fornix vaginal.No nā mea ulu lāʻau, ʻo Nugent score [28, 29] hāʻawi i kahi mea hana e helu ai i ke kaiaola kaiaola, kahi 0-3, 4-6 a me 7-10 mau helu e hōʻike ana i ka flora maʻamau, ka pua waena a me ka vaginosis, kēlā me kēia.Hana ʻia nā loiloi āpau o ka flora vaginal ma ke Keʻena Bacteriology o ka CHRU ma Nimes.E hoʻohana i nā kaʻina hana maʻamau no ka biopsy mucosal vaginal.Hana i kahi biopsy punch 6-8 mm mai kahi o ka wahi i hoʻolālā ʻia.Wahi a ka mānoanoa o ka papa basal, ka papa waena a me ka papa superficial, ua loiloi ʻia ka biopsy mucosal i ka histologically.Hoʻohana pū ʻia ka biopsy e ana i ka COL1A1 a me COL3A1 mRNA, me ka hoʻohana ʻana i ka RT-PCR a me ka procollagen I a me III immunotissue fluorescence ma ke ʻano he pani no ka hōʻike collagen, a me ka fluorescence o ka proliferation marker Ki67 ma ke ʻano he pani no ka hana mucosal mitotic.Hana ʻia ka hoʻāʻo genetic e ka BioAlternatives laboratory, 1bis rue des Plantes, 86160 GENCAY, Farani (loaʻa ka ʻaelike ma ke noi).
Ke hoʻopau ʻia nā laʻana kumu a me nā ana, ua hoʻopili ʻia ka HA (Desirial®) i hoʻopili ʻia e kekahi o nā loea i aʻo ʻia e like me ka protocol maʻamau.ʻO Desirial® [NaHa (sodium hyaluronate) cross-linked IPN-Like 19 mg/g + mannitol (antioxidant)] he injectable HA gel o ke kumu holoholona ʻole, no ka hoʻohana hoʻokahi a hoʻopaʻa ʻia i loko o ka Syringe i hoʻopaʻa mua ʻia (2 × 1 ml. ).He lāʻau lapaʻau Class III (CE 0499), i hoʻohana ʻia no ka injection intramucosal i nā wahine, i hoʻohana ʻia no ka biostimulation a me ka rehydration o ka ʻili mucosal o ka ʻāpana genital (Laboratoires Vivacy, 252 rue Douglas Engelbart-Archamps Technopole, 74160 Archamps, Farani).Ma kahi o 10 injections, kēlā me kēia 70-100 µl (0.5-1 ml i ka nui), e hana ʻia ma 3-4 mau laina ākea ma ka ʻaoʻao triangular o ka paia vaginal hope, ʻo ke kumu o ia ma ka pae o ka vaginal hope. paia, a me ka piko ma 2 knm ma luna (helu 1).
Hoʻonohonoho ʻia ka loiloi hope o ka haʻawina no 8 mau pule ma hope o ke kau inoa ʻana.ʻO nā ʻāpana loiloi no nā wahine e like me nā mea ma ka papa kuhikuhi.Eia kekahi, koi ʻia nā mea maʻi e hoʻopiha i ka Overall Improving Impression (PGI-I) Satisfaction Scale [30].
Ma muli o ka nele o ka ʻikepili mua a me ke ʻano hoʻokele o ka noiʻi, ʻaʻole hiki ke hoʻokō i kahi hoʻohālikelike nui o ka laʻana.No laila, ua koho ʻia kahi hōʻailona maʻalahi o ka huina o nā maʻi 20 ma muli o ka hiki o nā ʻāpana ʻelua i komo a lawa no ka loaʻa ʻana o kahi kuhi kūpono o nā pae hoʻohālike i manaʻo ʻia.Hana ʻia ka ʻikepili helu me ka hoʻohana ʻana i ka polokalamu SAS (9.4; SAS Inc., Cary NC), a ua hoʻonohonoho ʻia ka pae koʻikoʻi ma 5%.Ua hoʻohana ʻia ka hoʻāʻo kūlana i kau inoa ʻia e Wilcoxon no nā ʻano hoʻololi mau a ua hoʻohana ʻia ka hoʻāʻo ʻo McNemar no nā mea hoʻololi categorical e hoʻāʻo ai i nā loli i 8 pule.
Ua ʻae ʻia ka noiʻi e Comité d'ethique du CHU Carémeau de Nimes (ID-RCB: 2016-A00124-47, code protocol: LOCAL/2016/PM-001).Ua pūlima nā mea noiʻi a pau i kahi palapala ʻae palapala kūpono.No nā kipa haʻawina 2 a me 2 biopsies, hiki i nā mea maʻi ke loaʻa ka uku a hiki i 200 Euros.
He 20 mau mea i komo mai ka 19/06/2017 a 05/07/2018 (8 maʻi mai CHRU a me 12 maʻi mai KMC).ʻAʻohe kuʻikahi e uhaki ana i nā koina hoʻokomo a hoʻokuʻu ʻia.Ua palekana a maikaʻi nā kaʻina hana injection a pau i loko o 20 mau minuke.Hōʻike ʻia nā hiʻohiʻona demographic a me ka pae kumu o ka poʻe i komo i ke aʻo ʻana ma ka Papa 1. Ma ka papa kuhikuhi, 12 o 20 wahine (60%) i hoʻohana i ka lāʻau lapaʻau no kā lākou mau hōʻailona (6 hormonal a me 6 non-hormonal), ʻoiai ma ka pule 8 wale nō 2 mau maʻi. (10%) ua mālama ʻia e like me kēia (p = 0.002).
Hōʻike ʻia nā hopena o nā hōʻike hōʻike lapaʻau a me nā mea maʻi ma ka Papa 2 a me ka Papa 3. Ua hōʻole kekahi maʻi i ka biopsy vaginal W8;ua hōʻole ka mea maʻi i ka biopsy vaginal W8.No laila, hiki i nā mea komo 19/20 ke loaʻa i ka ʻikepili helu histological a me ka genetic.Ke hoʻohālikelike ʻia me D0, ʻaʻohe ʻokoʻa o ka mānoanoa median o ka mucosa vaginal i ka pule 8. Eia naʻe, ua piʻi ka mānoanoa median basal layer mai 70.28 a i 83.25 microns, akā ʻaʻole nui kēia piʻi (p = 0.8596).ʻAʻohe ʻokoʻa helu helu i ka fluorescence o procollagen I, III a i ʻole Ki67 ma mua a ma hope o ka mālama ʻana.Eia naʻe, ua piʻi nui ka huaʻōlelo gene COL1A1 a me COL3A1 (p = 0.0002 a me ka p = 0.0010).ʻAʻohe hoʻololi koʻikoʻi i ka helu, akā ua kōkua ia i ka hoʻomaikaʻi ʻana i ke ʻano o ka pua vaginal ma hope o ka hoʻokele Desirial® (n = 11, p = 0.1250).Pēlā nō, ma kahi kokoke i ka pūnaewele injection (n = 17) a me ka fornix vaginal (n = 19), ua emi iho ka waiwai pH vaginal, akā ʻaʻole nui kēia ʻokoʻa (p = p = 0.0574 a me 0.0955) (Table 2). .
Loaʻa i nā mea noiʻi āpau nā hopena i hōʻike ʻia e ka maʻi.Wahi a PGI-I, hoʻokahi mea komo (5%) i hōʻike ʻaʻole i loli ma hope o ka injection, aʻo nā mea maʻi 19 i koe (95%) i hōʻike i nā pae like ʻole o ka hoʻomaikaʻi ʻana, a ʻo 4 (20%) i ʻoi aku ka maikaʻi;ʻOi aku ka maikaʻi o 7 (35%), ʻoi aku ka maikaʻi o 8 (40%).ʻO ka dyspareunia i hōʻike ʻia, ka maloʻo maloʻo, ka ʻili ʻana o ka maʻi, nā abrasions vaginal, a me nā helu helu FSFI a me ko lākou makemake, lubrication, ʻoluʻolu, a me nā ʻāpana ʻeha i hoʻemi nui ʻia (Table 3).
ʻO ke kuhiakau e kākoʻo ana i kēia noiʻi ʻana, ʻo ia ka nui o nā inikini Desirial® ma ka paia hope o ka ʻōpū e mānoanoa i ka mucosa vaginal, haʻahaʻa i ka pH vaginal, hoʻomaikaʻi i ka floral floral, hoʻoulu i ka hana collagen a hoʻomaikaʻi i nā hōʻailona VA.Ua hiki iā mākou ke hōʻike i nā mea maʻi āpau i hōʻike i nā hoʻomaikaʻi koʻikoʻi, e like me ka dyspareunia, ka maloʻo ʻana o ka waha, ka ʻāʻī ʻana o ka wahine, a me ka ʻili ʻana.Ua hoʻomaikaʻi maikaʻi ʻia ʻo VHI a me FSFI, a ua hoʻemi nui ʻia ka nui o nā wahine e pono ai i nā lāʻau lapaʻau ʻē aʻe e hoʻomalu i kā lākou mau hōʻailona.E pili ana, hiki ke hōʻiliʻili i ka ʻike e pili ana i nā hopena a pau i hoʻoholo ʻia ma ka hoʻomaka ʻana a hiki ke hāʻawi i nā hana no nā mea aʻo a pau.Eia kekahi, 75% o ka poʻe i komo i ke aʻo ʻana i hōʻike ʻia ua hoʻomaikaʻi a ʻoi aku ka maikaʻi o kā lākou hōʻailona ma ka hopena o ke aʻo ʻana.
Eia naʻe, ʻoiai ka piʻi iki ʻana o ka mānoanoa awelika o ka papa basal, ʻaʻole hiki iā mākou ke hōʻoia i ka hopena koʻikoʻi i ka nui o ka mānoanoa o ka mucosa vaginal.ʻOiai ʻaʻole hiki i kā mākou noiʻi ke loiloi i ka pono o Desirial® i ka hoʻomaikaʻi ʻana i ka mānoanoa mucosal vaginal, ke manaʻoʻiʻo nei mākou ua pili nā hopena no ka mea ua hoʻonui nui ʻia ka hōʻike ʻana o nā māka CoL1A1 a me CoL3A1 ma W8 i hoʻohālikelike ʻia me D0.ʻO ia hoʻi ka hoʻoulu ʻana i ka collagen.Eia nō naʻe, aia kekahi mau pilikia e noʻonoʻo ai ma mua o ka noʻonoʻo ʻana i kāna hoʻohana ʻana i ka noiʻi e hiki mai ana.ʻO ka mea mua, he pōkole loa ka manawa o ka hahai ʻana i nā pule he 8 e hōʻoia i ka hoʻomaikaʻi ʻana i ka mānoanoa mucosal?Inā lōʻihi ka manawa hahai, ua hoʻokō ʻia nā hoʻololi i ʻike ʻia ma ka papa kumu ma nā papa ʻē aʻe.ʻO ka lua, ʻo ka mānoanoa histological o ka papa mucosal e hōʻike ana i ka hana hou ʻana o ka ʻiʻo?ʻO ka loiloi histological o ka mānoanoa mucosal vaginal ʻaʻole pono e noʻonoʻo i ka papa basal, ʻo ia hoʻi ka ʻiʻo i hana hou ʻia e pili ana me ka ʻiʻo pili lalo.
Hoʻomaopopo mākou ʻo ka liʻiliʻi o ka poʻe i komo a me ka nele o ka nui o ka laʻana mua i nā palena o kā mākou noiʻi;akā naʻe, ʻelua mau hiʻohiʻona maʻamau o ka haʻawina hoʻokele.ʻO ia ke kumu e pale aku ai mākou i ka hoʻonui ʻana i kā mākou mau ʻike i nā koi o ka pono lapaʻau a i ʻole ke kūpono ʻole.Eia naʻe, ʻo kekahi o nā pono nui o kā mākou hana, ʻo ia ka mea e hiki ai iā mākou ke hoʻohua i ka ʻikepili no nā hopena he nui, e kōkua iā mākou e helu i ka nui o ka laʻana maʻamau no ka noiʻi deterministic e hiki mai ana.Eia kekahi, ua ʻae ka pilote iā mākou e hoʻāʻo i kā mākou hoʻolālā hoʻolālā, churn rate, feasibility o ka hōʻiliʻili laʻana a me ka nānā ʻana i nā hopena, e hāʻawi i ka ʻike no kekahi hana e pili ana.ʻO ka mea hope loa, ʻo ke ʻano o nā hopena a mākou i loiloi ai, me nā hopena lapaʻau pahuhopu, nā biomarkers, a me nā hopena i hōʻike ʻia e ka mea maʻi i loiloi ʻia me ka hoʻohana ʻana i nā ana i hōʻoia ʻia, ʻo ia ka ikaika nui o kā mākou noiʻi.
ʻO Desirial® ka waika hyaluronic i hoʻopili ʻia i hoʻopaʻa ʻia ma o ka hoʻokele mucosal vaginal.I mea e hoʻopuka ai i ka huahana ma kēia ala, pono e loaʻa i ka huahana ka nui o ka wai i hiki ke maʻalahi ke hoʻokomo ʻia i loko o ka ʻiʻo hoʻohui kūikawā kūikawā me ka mālama ʻana i kona hygroscopicity.Hoʻokō ʻia kēia ma ka hoʻonui ʻana i ka nui o nā molekala gel a me ke kiʻekiʻe o ka gel cross-linking e hōʻoia i ke kiʻekiʻe o ka gel ʻoiai e mālama ana i ka viscosity haʻahaʻa a me ka elasticity.
Ua loiloi ka nui o nā haʻawina i nā hopena maikaʻi o HA, ʻo ka hapa nui o ia mau mea he RCT ʻole haʻahaʻa, e hoʻohālikelike ana i ka HA me nā ʻano ʻano lapaʻau ʻē aʻe (ka nui o nā hormones) [22,23,24,25].Ua lawelawe ʻia ka HA ma kēia mau haʻawina ma ka ʻāina.ʻO HA kahi mole endogenous i hōʻike ʻia e kona hiki ke hoʻoponopono a lawe i ka wai.Me ka makahiki, e emi iho ana ka nui o ka waikawa hyaluronic endogenous i loko o ka mucosa vaginal, a emi iho kona mānoanoa a me ka vascularization, a laila e hōʻemi ana i ka exudation plasma a me ka lubrication.I loko o kēia haʻawina, ua hōʻike mākou e pili ana ʻo Desirial® injection me ka hoʻomaikaʻi nui ʻana i nā hōʻailona pili VVA āpau.Ua kūlike kēia mau ʻike me kahi noiʻi mua i hana ʻia e Berni et al.Ma ke ʻano he ʻāpana o ka ʻae hoʻoponopono Desirial® (ʻike ʻike ʻole-hoʻohui ʻia) (File Hoʻohui 1).ʻOiai he manaʻo noʻonoʻo wale nō, kūpono ke ʻano o kēia hoʻomaikaʻi ʻana i ka lua o ka hiki ke hoʻihoʻi i ka hoʻololi ʻana o ka plasma i ka ʻili epithelial vaginal.
Ua hōʻike pū ʻia ka gel HA i hoʻopili ʻia e hoʻonui i ka synthesis o ke ʻano I collagen a me ka elastin, e hoʻonui ai i ka mānoanoa o nā ʻiʻo a puni [31, 32].I kā mākou noiʻi ʻana, ʻaʻole mākou i hōʻoia i ka ʻokoʻa o ka fluorescence o procollagen I a me III ma hope o ka mālama ʻana.Akā naʻe, ua piʻi nui ka hōʻike gene COL1A1 a me COL3A1.No laila, hiki i ka Desirial® ke hoʻoulu i ka hoʻokumu ʻana o ka collagen i loko o ka vagina, akā pono nā haʻawina nui me ka lōʻihi o ka hahai ʻana e hōʻoia a hōʻole i kēia hiki.
Hāʻawi kēia haʻawina i ka ʻikepili kumu a me ka nui o ka hopena no kekahi mau hopena, e kōkua ana i ka helu ʻana i ka nui o ka laʻana.Eia kekahi, ua hōʻoia ka haʻawina i ka hiki ke hōʻiliʻili i nā hopena like ʻole.Eia nō naʻe, e hōʻike ana i kekahi mau pilikia e pono e noʻonoʻo pono i ka wā e hoʻolālā ai i ka noiʻi e hiki mai ana ma kēia wahi.ʻOiai ʻo Desirial® ka mea e hoʻomaikaʻi nui ai i nā hōʻailona VVA a me ka hana moe kolohe, ʻaʻole maopopo kāna ʻano hana.E like me ka mea i ʻike ʻia mai ka hōʻike koʻikoʻi o CoL1A1 a me CoL3A1, ʻike ʻia he mau hōʻike mua e hoʻoulu ai i ka hoʻokumu ʻana o ka collagen.Akā naʻe, ʻaʻole i loaʻa i ka procollagen 1, procollagen 3 a me Ki67 nā hopena like.No laila, pono e ʻimi ʻia nā hōʻailona histological a me ke olaola hou i ka noiʻi e hiki mai ana.
Hoʻopili nui ʻia ʻo Desirial® (he cross-linked HA) me ka hōʻike ʻana o CoL1A1 a me CoL3A1, e hōʻike ana i ka hoʻoulu ʻana o ka collagen, hoʻemi nui i nā hōʻailona VVA, a hoʻohana i nā lāʻau lapaʻau ʻē aʻe.Eia kekahi, ma muli o nā helu PGI-I a me FSFI, ua hoʻomaikaʻi nui ʻia ka ʻoluʻolu o ka maʻi a me ka hana moekolohe.Eia naʻe, ʻaʻole i loli nui ka mānoanoa o ka mucosa vaginal.
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Ka manawa hoʻouna: Oct-26-2021