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Kaltrina Krasniqi K Krasniqi, University of Warwick, Coventry, CV4 7AL, United Kingdom of Great Britain and Northern Ireland

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Naomi Black N Black, University of Warwick, Coventry, United Kingdom of Great Britain and Northern Ireland

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Erin Williams E Williams, R(D)SVS, The University of Edinburgh College of Medicine and Veterinary Medicine, Midlothian, EH25 9RG, United Kingdom of Great Britain and Northern Ireland

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Osvaldo Bogado Pascottini O Bogado Pascottini, Ghent University, Merelbeke, B-9820, Belgium

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Sarah Thornton S Thornton, Hook Norton Veterinary Group, White Hill Surgery, Hook Norton, OX15 5DG, Hook Norton, United Kingdom of Great Britain and Northern Ireland

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Siobhan Quenby S Quenby, Reproductive Health, University of Warwick , coventry, United Kingdom of Great Britain and Northern Ireland

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Joshua Odendaal J Odendaal, University of Warwick, Coventry, United Kingdom of Great Britain and Northern Ireland

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Chronic endometritis (CE) in humans is asymptomatic inflammation of the endometrium, associated with poor reproductive outcomes. Similarly asymptomatic endometrial inflammation in cows, termed subclinical endometritis (SCE), is associated with adverse reproductive outcomes. While the pathophysiology and treatment options for CE in humans remains poorly defined, the financial implications of SCE in dairy cows mean it has been intensively researched. We performed a systematic review with an emergent theme thematic analysis of studies of SCE in cows, to determine potential areas of interest in human CE research. A literature search for studies of subclinical endometritis in cows published between 1990 and November 2021 was performed across Embase, Medline, Scopus and CINAHL. Studies of symptomatic or clinical endometritis were excluded. Thematic analysis across two broad themes were explored: diagnostic methods and pathophysiology of SCE. In total, 44 bovine studies were included. 12 studies reported on diagnostic methodology. The primary emergent theme was the use of cytology for the diagnosis of SCE. This method has a lower sensitivity than histopathology but is less invasive and more specific than alternative techniques of ultrasound, vaginoscopy, or metabolic markers. The subthemes related to pathophysiology were identified as type of endometritis, metabolic stress, artificial insemination, infective causes, and altered cellular pathways. Despite the lack of symptoms, cellular pathways of inflammation including NFkB, MAPK, and inflammasomes were found to be activated. The key themes related to the diagnosis and pathophysiology of SCE in cows identified in this systematic review highlight potential areas for future research into human CE.

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