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  • 1.
    Forsum, Urban
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Klinisk mikrobiologi. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk mikrobiologi.
    Holst, E
    Larsson, Per-Göran
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Klinisk mikrobiologi.
    Vasquesz, A
    Jakobsson, Tell
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Klinisk mikrobiologi.
    Mattsby-Baltzer, I
    Bacterial vaginosis - A microbiological and immunological enigma2005Ingår i: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 113, nr 2, s. 81-90Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The development of bacterial vaginosis (BV) among women of childbearing age and the resulting quantitative and qualitative shift from normally occurring lactobacilli in the vagina to a mixture of mainly anaerobic bacteria is a microbiological and immunological enigma that so far has precluded the formulation of a unifying generally accepted theory on the aetiology and clinical course of BV. This critical review highlights some of the more important aspects of BV research that could help in formulating new basic ideas respecting the biology of BV, not least the importance of the interleukin mediators of local inflammatory responses and the bacterial shift from the normally occurring lactobacilli species: L. crispatus, L. gasseri, L. jensenii, and L. iners to a mixed flora dominated by anaerobic bacteria. Copyright © APMIS 2005.

  • 2.
    Forsum, Urban
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk mikrobiologi. Linköpings universitet, Hälsouniversitetet.
    Jakobsson, Tell
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet.
    Ison, C.
    Dept. of Medical Microbiology, Imperial College School of Medicine at St. Mary's, London, UK.
    Keane, F.
    Dept. of GU Medicine & Sexual Health, Royal Cornwall Hospital, Treliske, Truro, Great Britain.
    McDonald, H.
    Microbiology & Infectious Diseases Dept, Women's & Children's Hospital, North Adelaide, Australia.
    Moi, H.
    Olafia-kliniken, Oslo, Norway.
    Platz-Christensen, J-J.
    Dept. of Obstetrics and Gynaecology, Sahlgrenska Universitetssjukhuset, Göteborg, Sweden.
    Schwebke, J.
    Dept. of Obstetrics and Gynaecology, University of Alabama at Birmingham, USA.
    Larsson, P. G.
    Dept. of Obstetrics and Gynaecology, Kärnsjukhuset, Skövde, Sweden.
    Schmidt, H.
    General Practice, Aalborg, Denmark.
    Beverly, A.
    Dept. of Obstetrics and Gynaecology, University of Alabama at Birmingham, USA.
    Bjørnerem, A.
    Dept. of Obstetrics and Gynaecology, Regionssjukhuset, Tromsö, Norway.
    Carlsson, Bodil
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk mikrobiologi. Linköpings universitet, Hälsouniversitetet.
    Csango, P.
    Dept. of Microbiology, Vest-Agder Sykehus, Kristiansand, Norway.
    Donders, G.
    Dept. of Gynaecology, Gasthuisberg University Hospital, Leuven, Belgium.
    Hay, P.
    Dept. of Genito-Urinary Medicine, St. George's Hospital, London, UK.
    An international study of the inter-observer variation between the interpretations of vaginal smear criteria of Bacterial Vaginosis2002Ingår i: APMIS, ISSN 1600-0463, Vol. 110, nr 11, s. 811-818Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    An international workshop on vaginal smear-based diagnosis of bacterial vaginosis was organized where 13 investigators scoring 258 slides with smears from vaginal fluid. Interobserver reproducibility of interpretations of Nugent scores, Hay/Ison scores and wet smear scores for the diagnosis of bacterial vaginosis was shown to be high. Detailed analysis of individual scoring results however indicated that basic standards of quality control to ensure robust individual readings of slides must be adhered to.

  • 3.
    Jakobsson, Tell
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Klinisk mikrobiologi. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet.
    Lactobacilli dominating the normal vaginal flora2003Licentiatavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The microbiology of the ecological niche of the vagina is dynamic. There are numerous inhabitants, mainly anaerobic bacteria. During the fertile years the vaginal mucosa is normally dominated by lactobacilli, a fact that has been known for over a century. Lactobacilli are a phenotypically heterogeneous group of bacteria that first became possible to identify to the species level with some precision using recently developed nucleic acid based techniques. In this study vaginal fluid was cultured from women scheduled for their regular PAP smear. Two hundred and two isolates from 23 women with normal vaginal fluid were typed by randomly amplified polymorphic DNA (RAPD) PCR analysis and identified to the species level by temporal temperature gradient gel electrophoresis (TTGE), and 16S rDNA sequencing. Four hundred and four isolates from 23 women were typed with broad range PCR of 16S rRNA gene region V I and V3 by pyrosequencing. Most women harboured one single species, a few had two different species, and only one woman harboured more than two different species of lactobacilli. The species that were found, which were similar in the two studies, were: Lactobacillus crispalus, L. gasseri, L. jensenii and L. iners. L. iners has never been reported before as a member of the dominant normal vaginal lactobacillary flora. Under some conditions, which have not been determined with certainty, the lactobacilli are overgrown by large amounts of Gardnerella vaginalis and anaerobic bacteria, mainly Bacleroides spp and Mobiluncus, causing the syndrome of Bacterial Vaginosis (BV). BV is associated with several severe reproductive and genitourinary complications in women. A major issue in studying normal Lactobacilli in vaginal fluid samples from women of reproductive age is to differentiate the normal flora from that of BV. To sharpen the diagnostic tools (i.e. Nugent scoring of Gram stained slides) for separation of normal flora from that of BV, a workshop was set up. The major results showed discrepancies in diagnosis when there were very few lactobacilli. There was disagreement on where to delimit small lactobacilli from G. vaginalis and Bacteroides. The use of scoring to delimit normal flora, as was done in the workshop, is proposed as a prerequisite for further studies of normal vaginal flora

    Delarbeten
    1. Vaginal Lactobacillus flora of healthy Swedish women
    Öppna denna publikation i ny flik eller fönster >>Vaginal Lactobacillus flora of healthy Swedish women
    Visa övriga...
    2002 (Engelska)Ingår i: Journal of clinical microbiology, ISSN 0095-1137, Vol. 40, nr 8, s. 2746-2749Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Species of the Lactobacillus acidophilus complex are generally considered to constitute most of the vaginal Lactobacillus flora, but the flora varies between studies. However, this may be due to difficulties in identifying the closely related species within the L. acidophilus complex by using traditional methods and to variations in the vaginal status of the participants. Two hundred two isolates from the vaginal fluids of 23 Swedish women without bacterial vaginosis, as defined by the criteria of Nugent et al. (R. P. Nugent, M. A. Krohn, and S. L. Hillier, J. Clin. Microbiol. 29:297-301, 1991), were typed by randomly amplified polymorphic DNA (RAPD) analysis and identified to the species level by temporal temperature gradient gel electrophoresis, multiplex PCR, and 16S ribosomal DNA sequencing. The vaginal flora of most participants was dominated by a single RAPD type, but five of them harbored two RAPD types representing two different species or strains. The most frequently occurring species were Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners, and Lactobacillus jensenii. L. iners has not previously been reported as one of the predominant Lactobacillus species in the vagina.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-13051 (URN)10.1128/JCM.40.8.2746-2749.2002 (DOI)
    Tillgänglig från: 2008-03-19 Skapad: 2008-03-19 Senast uppdaterad: 2018-02-02
    2. Identification of randomly selected colonies of Lactobacilli from normal vaginal fluid by pyrosequencing of the 16S rDNA Variable V1 and V3 Regions
    Öppna denna publikation i ny flik eller fönster >>Identification of randomly selected colonies of Lactobacilli from normal vaginal fluid by pyrosequencing of the 16S rDNA Variable V1 and V3 Regions
    2002 (Engelska)Ingår i: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 110, nr 11, s. 802-810Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The present study aimed to characterize lactobacilli in vaginal fluid from 23 adult healthy women by using high-throughput DNA sequencing for identification of a large number of randomly selected colonies appearing on Rogosa and blood agar. The typing method was based on broad-range PCR of 16S rRNA gene variable regions V1 and V3, pyrosequencing, and classification of the fragments by alignment with NCBI-catalogued sequences and type strain sequences. Four major groups of sequences were found among the 402 isolates clearly corresponding to Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners and Lactobacillus jensenii when compared to the sequences obtained for type strains. Our results indicate that pyrosequencing of 16S rRNA gene fragments as used here is a fast and reliable method well suited for identification to the species level, even within the Lactobacillus acidophilus complex.

    Nyckelord
    Lactobacillus, vaginal fluid, 16S rRNA genes, pyrosequencing
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-13052 (URN)10.1034/j.1600-0463.2002.1101106.x (DOI)
    Tillgänglig från: 2008-03-19 Skapad: 2008-03-19 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    3. An international study of the inter-observer variation between the interpretations of vaginal smear criteria of Bacterial Vaginosis
    Öppna denna publikation i ny flik eller fönster >>An international study of the inter-observer variation between the interpretations of vaginal smear criteria of Bacterial Vaginosis
    Visa övriga...
    2002 (Engelska)Ingår i: APMIS, ISSN 1600-0463, Vol. 110, nr 11, s. 811-818Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    An international workshop on vaginal smear-based diagnosis of bacterial vaginosis was organized where 13 investigators scoring 258 slides with smears from vaginal fluid. Interobserver reproducibility of interpretations of Nugent scores, Hay/Ison scores and wet smear scores for the diagnosis of bacterial vaginosis was shown to be high. Detailed analysis of individual scoring results however indicated that basic standards of quality control to ensure robust individual readings of slides must be adhered to.

    Nyckelord
    Bacterial vaginosis, diagnosis, criteria
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-13050 (URN)10.1034/j.1600-0463.2002.1101107.x (DOI)
    Tillgänglig från: 2008-03-19 Skapad: 2008-03-19 Senast uppdaterad: 2013-09-12
  • 4.
    Jakobsson, Tell
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet.
    Lactobacillus iners and the normal vaginal flora2008Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [fi]

    The ecological niche of the vagina contains a large number of different microbes that are constantly interacting with each other and the host. Culture methods have not been sufficient in order to resolve the complexity of the normal vaginal flora. Further, the methods for delineating normal flora from not normal flora are not easily handled and are traditionally not based on culture but on microscopy of elements of the vaginal fluid. In the work presented in this thesis, an international collaboration was established that pin-pointed some of the difficulties in classifying vaginal floras, including staining, sampling, and discordance when lactobacilli are few in number, and that emphasized the importance of the size of the vision field in microscopes. As lactobacilli are prominent members of the normal vaginal flora they need to be carefully classified if further work towards more robust scoring tools is to be achieved.

    Phenotypic methods have not been able to separate the closely related Lactobacillus species of the vagina. Progress in molecular biology has provided possibilities to characterize these lactobacilli, which are mainly from the Lactobacillus acidophilus group. In this work a large number of strains collected by true random sampling were subjected to RAPD-PCR, TTGE and multiplex PCR for species identification. The major species found were L. crispatus, L. gasseri and L. jensenii and the recently described L. iners. The presence of L. iners has not been detected in previous studies due to its special nutrient requirements. Development of pyrosequencing technology also made it possible to match signatures of the two variable regions V1 and V3 of the 16S rRNA gene of the vaginal lactobacilli and identify them to the species level in a high throughput manner. The study confirmed that the dominating flora in women with normal vaginal flora comprises the four species mentioned previously. Repetitive sampling during IVF-treatment with highly varying oestrogen levels demonstrates changes that possibly occur during changes in the natural life cycle. Furthermore, L. iners was found to be the first species to be established after spontaneously resolved or treated Bacterial Vaginosis.

    These findings can be of help in developing new strategies for regaining and retaining the normal vaginal flora.

    Delarbeten
    1. An international study of the inter-observer variation between the interpretations of vaginal smear criteria of Bacterial Vaginosis
    Öppna denna publikation i ny flik eller fönster >>An international study of the inter-observer variation between the interpretations of vaginal smear criteria of Bacterial Vaginosis
    Visa övriga...
    2002 (Engelska)Ingår i: APMIS, ISSN 1600-0463, Vol. 110, nr 11, s. 811-818Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    An international workshop on vaginal smear-based diagnosis of bacterial vaginosis was organized where 13 investigators scoring 258 slides with smears from vaginal fluid. Interobserver reproducibility of interpretations of Nugent scores, Hay/Ison scores and wet smear scores for the diagnosis of bacterial vaginosis was shown to be high. Detailed analysis of individual scoring results however indicated that basic standards of quality control to ensure robust individual readings of slides must be adhered to.

    Nyckelord
    Bacterial vaginosis, diagnosis, criteria
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-13050 (URN)10.1034/j.1600-0463.2002.1101107.x (DOI)
    Tillgänglig från: 2008-03-19 Skapad: 2008-03-19 Senast uppdaterad: 2013-09-12
    2. Vaginal Lactobacillus flora of healthy Swedish women
    Öppna denna publikation i ny flik eller fönster >>Vaginal Lactobacillus flora of healthy Swedish women
    Visa övriga...
    2002 (Engelska)Ingår i: Journal of clinical microbiology, ISSN 0095-1137, Vol. 40, nr 8, s. 2746-2749Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Species of the Lactobacillus acidophilus complex are generally considered to constitute most of the vaginal Lactobacillus flora, but the flora varies between studies. However, this may be due to difficulties in identifying the closely related species within the L. acidophilus complex by using traditional methods and to variations in the vaginal status of the participants. Two hundred two isolates from the vaginal fluids of 23 Swedish women without bacterial vaginosis, as defined by the criteria of Nugent et al. (R. P. Nugent, M. A. Krohn, and S. L. Hillier, J. Clin. Microbiol. 29:297-301, 1991), were typed by randomly amplified polymorphic DNA (RAPD) analysis and identified to the species level by temporal temperature gradient gel electrophoresis, multiplex PCR, and 16S ribosomal DNA sequencing. The vaginal flora of most participants was dominated by a single RAPD type, but five of them harbored two RAPD types representing two different species or strains. The most frequently occurring species were Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners, and Lactobacillus jensenii. L. iners has not previously been reported as one of the predominant Lactobacillus species in the vagina.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-13051 (URN)10.1128/JCM.40.8.2746-2749.2002 (DOI)
    Tillgänglig från: 2008-03-19 Skapad: 2008-03-19 Senast uppdaterad: 2018-02-02
    3. Identification of randomly selected colonies of Lactobacilli from normal vaginal fluid by pyrosequencing of the 16S rDNA Variable V1 and V3 Regions
    Öppna denna publikation i ny flik eller fönster >>Identification of randomly selected colonies of Lactobacilli from normal vaginal fluid by pyrosequencing of the 16S rDNA Variable V1 and V3 Regions
    2002 (Engelska)Ingår i: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 110, nr 11, s. 802-810Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The present study aimed to characterize lactobacilli in vaginal fluid from 23 adult healthy women by using high-throughput DNA sequencing for identification of a large number of randomly selected colonies appearing on Rogosa and blood agar. The typing method was based on broad-range PCR of 16S rRNA gene variable regions V1 and V3, pyrosequencing, and classification of the fragments by alignment with NCBI-catalogued sequences and type strain sequences. Four major groups of sequences were found among the 402 isolates clearly corresponding to Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners and Lactobacillus jensenii when compared to the sequences obtained for type strains. Our results indicate that pyrosequencing of 16S rRNA gene fragments as used here is a fast and reliable method well suited for identification to the species level, even within the Lactobacillus acidophilus complex.

    Nyckelord
    Lactobacillus, vaginal fluid, 16S rRNA genes, pyrosequencing
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-13052 (URN)10.1034/j.1600-0463.2002.1101106.x (DOI)
    Tillgänglig från: 2008-03-19 Skapad: 2008-03-19 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    4. Lactobacillus iners: a marker of changes in the vaginal flora?
    Öppna denna publikation i ny flik eller fönster >>Lactobacillus iners: a marker of changes in the vaginal flora?
    2007 (Engelska)Ingår i: Journal of Clinical Microbiology, ISSN 0095-1137, E-ISSN 1098-660X, Vol. 45, nr 9, s. 3145-Artikel i tidskrift, Letter (Övrigt vetenskapligt) Published
    Ort, förlag, år, upplaga, sidor
    American Society for Microbiology, 2007
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-13053 (URN)10.1128/JCM.00558-07 (DOI)000249506900072 ()
    Tillgänglig från: 2008-03-19 Skapad: 2008-03-19 Senast uppdaterad: 2017-12-13
    5. The predominant Human vaginal Lactobacillus flora during IVF treatment
    Öppna denna publikation i ny flik eller fönster >>The predominant Human vaginal Lactobacillus flora during IVF treatment
    2008 (Engelska)Ingår i: Journal of Clinical Microbiology, ISSN 0095-1137, E-ISSN 1098-660X, Vol. 7, nr 14, s. 1-9Artikel i tidskrift (Refereegranskat) Submitted
    Abstract [en]

    Background: Signature matching of nucleotide sequences in the V1 and V3 regions 16S rRNA genes using pyrosequencing technology is a powerful tool for typing vaginal Lactobacilli to the species level and has been used for investigating the vaginal microbial niche.

    Methods: This study has characterized the normal cultivable vaginal Lactobacillus flora at varying estradiol levels in plasma; the study comprised 17 patients undergoing ovarian stimulation for In Vitro Fertilization (IVF) treatment. The vaginal status of each participant was initially assessed as normal according to Amsel and Nugent criteria.

    Results: L. crispatus, L. gasseri and/or L. jensenii were present in 10 of the patients throughout the study period, and little variation among these three species was encountered in individual patients. The flora of three women was dominated by L. delbrüeckii, L. rhamnosus or L. vaginalis. One woman exhibited a dominance of L. iners. The flora of the remaining three women were initially dominated by L. rhamnosus or L. reuteri, but as their estrogen levels rose, their flora composition altered, to become dominated by one of the three species most common in a normal, healthy vagina.

    Conclusion: Signature matching of nucleotide sequences in the V1 and V3 regions of 16S rRNA genes is a discriminative tool for the study of vaginal Lactobacilli and can be used to track the Lactobacillus flora under a variety of physiological conditions.

    Ort, förlag, år, upplaga, sidor
    American Society for Microbiology, 2008
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-13054 (URN)10.1186/1476-0711-7-14 (DOI)
    Tillgänglig från: 2008-03-19 Skapad: 2008-03-19 Senast uppdaterad: 2019-04-02Bibliografiskt granskad
  • 5.
    Jakobsson, Tell
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk mikrobiologi. Linköpings universitet, Hälsouniversitetet.
    Forsum, Urban
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk mikrobiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk mikrobiologi.
    Changes in the predominant human Lactobacillus flora during in vitro fertilisation2008Ingår i: Annals of Clinical Microbiology and Antimicrobials, ISSN 1476-0711, E-ISSN 1476-0711, Vol. 7, artikel-id 14Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Signature matching of nucleotide sequences in the V1 and V3 regions 16S rRNA genes using pyrosequencing technology is a powerful tool for typing vaginal Lactobacilli to the species level and has been used for investigating the vaginal microbial niche. Methods: This study has characterized the normal cultivable vaginal Lactobacillus flora at varying estradiol levels in plasma, the study comprised 17 patients undergoing ovarian stimulation for In Vitro Fertilization (IVF) treatment. The vaginal status of each participant was initially assessed as normal according to Amsel and Nugent criteria. Results: L. crispatus, L. gasseri and/or L. jensenii were present in 10of the patients throughout the study period, and little variation among these three species was encountered in individual patients. The flora of three women was dominated by L. delbrüeckii, L. rhamnosus or L. vaginalis. One woman exhibited a dominance of L. iners. The flora of the remaining three women were initially dominated by L. rhamnosus or L. reuteri, but as their estrogen levels rose, their flora composition altered, to become dominated by one of the three species most common in a normal, healthy vagina. Conclusion: Signature matching of nucleotide sequences in the V1 and V3 regions of 16S rRNA genes is a discriminative tool for the study of vaginal Lactobacilli and can be used to track the Lactobacillus flora under a variety of physiological conditions. © 2008 Jakobsson and Forsum, licensee BioMed Central Ltd.

  • 6.
    Jakobsson, Tell
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet.
    Forsum, Urban
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk mikrobiologi. Linköpings universitet, Hälsouniversitetet.
    Lactobacillus iners: a marker of changes in the vaginal flora?2007Ingår i: Journal of Clinical Microbiology, ISSN 0095-1137, E-ISSN 1098-660X, Vol. 45, nr 9, s. 3145-Artikel i tidskrift (Övrigt vetenskapligt)
  • 7.
    Jakobsson, Tell
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet.
    Forsum, Urban
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk mikrobiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk mikrobiologi.
    The predominant Human vaginal Lactobacillus flora during IVF treatment2008Ingår i: Journal of Clinical Microbiology, ISSN 0095-1137, E-ISSN 1098-660X, Vol. 7, nr 14, s. 1-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Signature matching of nucleotide sequences in the V1 and V3 regions 16S rRNA genes using pyrosequencing technology is a powerful tool for typing vaginal Lactobacilli to the species level and has been used for investigating the vaginal microbial niche.

    Methods: This study has characterized the normal cultivable vaginal Lactobacillus flora at varying estradiol levels in plasma; the study comprised 17 patients undergoing ovarian stimulation for In Vitro Fertilization (IVF) treatment. The vaginal status of each participant was initially assessed as normal according to Amsel and Nugent criteria.

    Results: L. crispatus, L. gasseri and/or L. jensenii were present in 10 of the patients throughout the study period, and little variation among these three species was encountered in individual patients. The flora of three women was dominated by L. delbrüeckii, L. rhamnosus or L. vaginalis. One woman exhibited a dominance of L. iners. The flora of the remaining three women were initially dominated by L. rhamnosus or L. reuteri, but as their estrogen levels rose, their flora composition altered, to become dominated by one of the three species most common in a normal, healthy vagina.

    Conclusion: Signature matching of nucleotide sequences in the V1 and V3 regions of 16S rRNA genes is a discriminative tool for the study of vaginal Lactobacilli and can be used to track the Lactobacillus flora under a variety of physiological conditions.

  • 8.
    Jakobsson, Tell
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Klinisk mikrobiologi. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk mikrobiologi.
    Forsum, Urban
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Klinisk mikrobiologi. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk mikrobiologi.
    Vaginala laktobaciller som normalflora2004Ingår i: Bakteriell Vaginos / [ed] Larsson, P-G,Bergström, Mats och Forsum, Urban, Växjö: Grafiska Punkten , 2004, s. 31-35Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 9.
    Larsson, Per-Göran
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Genus och medicin.
    Carlsson, Bodil
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk mikrobiologi. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk mikrobiologi.
    Fåhraeus, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Obstetrik och gynekologi. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Jakobsson, Tell
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Obstetrik och gynekologi.
    Forsum, Urban
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk mikrobiologi. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk mikrobiologi.
    Diagnosis of bacterial vaginosis: need for validation of microscopic image area used for scoring bacterial morphotypes2004Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 80, nr 1, s. 63-67Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The diagnosis of bacterial vaginosis (BV) is often made according to Nugent's classification, a scoring system based on bacterial counting of Gram stained slides of vaginal secretion. However as the image area of the microscope field will influence the number of morphotypes seen there is a need to standardise the area. Methods: A graph intended for recalculation of number of bacterial morphotypes seen by the observer using 1000 x magnification from various microscope set-ups was constructed and applied to data sets typical for scoring BV. The graph was used in recalculation of Nugent scores, which were also compared with the Ison/Hay scores to evaluate the consequences for the diagnosis of BV. Results: The observed image area differed by 300% among the investigated microscope set-ups. In two different data sets, one treatment study and one screening study, a considerable change in the number of women classified as intermediate was seen when the graph was used to standardise the image area. The recalculated numbers were also compared to the Ison/Hay classification. Weighted kappa indexes between the different methods were 0.84, 0.88, and 0.90, indicating that the methods are comparable. Conclusion: Because of the considerable differences among image areas covered by different microscope set-ups used in Nugent and Ison/Hay scoring, there is a need to standardise the area in order to reach comparable scores reflecting the diagnosis of BV in different laboratories. The differences in the intermediate group will have a considerable effect on the results from both treatment and prevalence studies, even though the kappa indexes indicate very good agreement between the methods used.

  • 10.
    Larsson, Per-Göran
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Genus och medicin.
    Fåhraeus, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Obstetrik och gynekologi. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Carlsson, Bodil
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Klinisk mikrobiologi. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk mikrobiologi.
    Jakobsson, Tell
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Klinisk mikrobiologi. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk mikrobiologi.
    Forsum, Urban
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Klinisk mikrobiologi. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk mikrobiologi.
    Late miscarriage and preterm birth after treatment with clindamycin: A randomised consent design study according to Zelen2006Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 113, nr 6, s. 629-637Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To screen for bacterial vaginosis (BV) and to investigate the effect of treatment with vaginal clindamycin in order to observe the effect on late miscarriage and delivery prior to 37 completed weeks (primary outcome). Design: Randomised consent design for clinical trials according to Zelen. Setting: Southeast region of Sweden. Population: A total of 9025 women were screened in early pregnancy. Methods: A total of 819 women with a Nugent score of 6 and above were considered to have BV and treated according to Zelen allocation. The incidence of late miscarriage and spontaneous (noniatrogenic) preterm birth was assessed. Main outcome measures: Late miscarriage and spontaneous preterm delivery before 37 weeks. Results: Therapy with vaginal clindamycin had no significant impact on the incidence of spontaneous preterm delivery prior to 37 completed weeks, OR 0.90, 95% CI 0.40-2.02 (primary outcome variable). However, only 1 of 11 women in the treatment group versus 5 of 12 in the control group delivered prior to 33 completed weeks, OR 0.14, 95% CI 0.02-0.95. Treatment was associated with 32 days longer gestation for the 23 participants who had late miscarriage or spontaneous preterm birth (P= 0.024, Mann-Whitney U test) and significantly fewer infants had a birthweight below 2500 g (secondary outcome). A follow up of infants born preterm 4 years postnatally indicated that extending gestational age did not increase the number of sequelae. Conclusions: Clindamycin vaginal cream therapy was associated with significantly prolonged gestation and reduced cost of neonatal care in women with BV. Early screening for BV and treatment with clindamycin saved approximately €27 per woman. © RCOG 2006 BJOG An International Journal of Obstetrics and Gynaecology.

  • 11.
    Larsson, P-G
    et al.
    Avd för Obstretik och Gynekologi Kärnsjukhuset, Skövde.
    Fåhraeus, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Obstetrik och gynekologi. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Carlsson, Bodil
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Klinisk mikrobiologi. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk mikrobiologi.
    Jakobsson, Tell
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Obstetrik och gynekologi.
    Forsum, Urban
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Klinisk mikrobiologi. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk mikrobiologi.
    Predisposing factors for bacterial vaginosis, treatment efficacy and pregnancy outcome among term deliveries, results from a preterm delivery study2007Ingår i: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Bacterial vaginosis (BV) during pregnancy is associated with an increased risk of preterm delivery but little is known about factors that could predict BV. We have analyzed if it is possible to identify a category of pregnant women that should be screened for BV, and if BV would alter the pregnancy outcome at term, we have also studied the treatment efficacy of clindamycin. Methods: Prospective BV screening and treatment study of 9025 women in a geographically defined region in southeast Sweden. BV was defined as a modified Nugent score of 6 and above. Data was collected from the Swedish Medical Birth Register. Women allocated to treatment were supplied with vaginal clindamycin cream. The main outcome goals were to identify factors that could predict BV. Results: Vaginal smears were consistent with BV criteria in 9.3%. Logistic regression indicates a significant correlation between smoking and BV (p < 0.001) and a greater prevalence of BV in the lower age groups (p < 0.001). We found no correlation between BV and history of preterm deliveries, previous miscarriages, extra-uterine pregnancies, infertility problems or reported history of urinary tract infections-factors that earlier have been associated with BV. Treatment with clindamycin cream showed a cure rate of 77%. Less than 1% of women with a normal vaginal smear in early pregnancy will develop BV during the pregnancy. There was no association between BV and the obstetric outcome among women who delivered at term. Women with BV, both treated patients and nontreated, had the same obstetric outcome at term as women with normal vaginal flora. Conclusion: BV is more than twice as common among smokers, and there is a higher prevalence in the younger age group. However these two markers for BV do not suffice as a tool for screening, and considering the lack of other risk factors associated with BV, screening of all pregnant women might be a strategy to follow in a program intended to reduce the number of preterm births. © 2007 Larsson et al, licensee BioMed Central Ltd.

  • 12. Suhonen, Satu
    et al.
    Haukkamaa, Maija
    Jakobsson, Tell
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Obstetrik och gynekologi.
    Rauramo, Ilkka
    Clinical performance of a levonorgestrel-releasing intrauterine system and oral contraceptives in young nulliparous women: A comparative study2004Ingår i: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 69, nr 5, s. 407-412Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This 1-year randomized study was carried out at family-planning clinics of two university hospitals to compare the safety and acceptability of a levonorgestrel-releasing intrauterine system (LNG IUS) and oral contraceptives (OCs) in young nulliparous women. The study population consisted of 200 women aged 18-25 years seeking contraception. Ninety-four women entered the LNG IUS group and 99 entered the OC group. Continuation rates, reasons leading to discontinuation, adverse events, menstrual questionnaires, subjective well-being and sexual behavior were evaluated. Nineteen women (20%) in the LNG IUS group discontinued the study during the 1-year observation period, and 27 discontinued (27%) in the OC group. The most common reason (31%) for discontinuation in the IUS group was pain. In the OC group, hormonal side effects were the predominant medical reason for study termination. The safety and acceptability of the LNG IUS for contraception was observed to be as good as with OCs, with a high continuation rate.

  • 13.
    Tärnberg, Maria
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk mikrobiologi. Linköpings universitet, Hälsouniversitetet.
    Jakobsson, Tell
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet.
    Jonasson, Jon
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Molekylär och immunologisk patologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk patologi och klinisk genetik.
    Forsum, Urban
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk mikrobiologi. Linköpings universitet, Hälsouniversitetet.
    Identification of randomly selected colonies of Lactobacilli from normal vaginal fluid by pyrosequencing of the 16S rDNA Variable V1 and V3 Regions2002Ingår i: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 110, nr 11, s. 802-810Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The present study aimed to characterize lactobacilli in vaginal fluid from 23 adult healthy women by using high-throughput DNA sequencing for identification of a large number of randomly selected colonies appearing on Rogosa and blood agar. The typing method was based on broad-range PCR of 16S rRNA gene variable regions V1 and V3, pyrosequencing, and classification of the fragments by alignment with NCBI-catalogued sequences and type strain sequences. Four major groups of sequences were found among the 402 isolates clearly corresponding to Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners and Lactobacillus jensenii when compared to the sequences obtained for type strains. Our results indicate that pyrosequencing of 16S rRNA gene fragments as used here is a fast and reliable method well suited for identification to the species level, even within the Lactobacillus acidophilus complex.

  • 14.
    Vásquez, Alejandra
    et al.
    Laboratory of Food Hygiene, Division of Food Technology, Lund University, Lund, Sweden.
    Jakobsson, Tell
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet.
    Ahrné, Siv
    Division of Food Technology, Lund University, Lund.
    Forsum, Urban
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk mikrobiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk mikrobiologi.
    Molin, Göran
    Division of Food Technology, Lund University, Lund, Sweden.
    Vaginal Lactobacillus flora of healthy Swedish women2002Ingår i: Journal of clinical microbiology, ISSN 0095-1137, Vol. 40, nr 8, s. 2746-2749Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Species of the Lactobacillus acidophilus complex are generally considered to constitute most of the vaginal Lactobacillus flora, but the flora varies between studies. However, this may be due to difficulties in identifying the closely related species within the L. acidophilus complex by using traditional methods and to variations in the vaginal status of the participants. Two hundred two isolates from the vaginal fluids of 23 Swedish women without bacterial vaginosis, as defined by the criteria of Nugent et al. (R. P. Nugent, M. A. Krohn, and S. L. Hillier, J. Clin. Microbiol. 29:297-301, 1991), were typed by randomly amplified polymorphic DNA (RAPD) analysis and identified to the species level by temporal temperature gradient gel electrophoresis, multiplex PCR, and 16S ribosomal DNA sequencing. The vaginal flora of most participants was dominated by a single RAPD type, but five of them harbored two RAPD types representing two different species or strains. The most frequently occurring species were Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners, and Lactobacillus jensenii. L. iners has not previously been reported as one of the predominant Lactobacillus species in the vagina.

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