Effects of Hyperglycemia on Angiogenesis in Human Placental Endothelial Cells

The placenta is a temporary organ that provides communication between the mother and fetus. Maternal diabetes and abnormal placental angiogenesis may be linked. We investigated the angiogenesis mechanism resulting from VEGF and glucose stimulation in PECs obtained from human term placenta. Immunohistochemistry was performed to characterize PECs obtained from human term placenta. D-glucose was added to the medium containing PECs to establish normoglycemic and hyperglycemic conditions. The expression levels of VEGF, VEGFR-1 and VEGFR-2 genes and proteins in PECs from the control and experimental groups were analyzed by RT-PCR and Western blotting, respectively. With 48-hours incubation, gene expressions increased due to hyperglycemia, while protein levels increased due to the combined effect of VEGF and hyperglycemia. While VEGFR-2 gene expression and protein amounts increased in 24-hours due to the combined effect of VEGF and hyperglycemia, the effect of VEGF stimulation and glucose level on VEGFR-2 decreased in 48-hour incubation with time. VEGF, VEGFR-1 and VEGFR-2 genes and proteins were affected by hyperglycemic conditions in PECs. Hyperglycemia occurring in various conditions such as gestational diabetes mellitus and diabetes mellitus may affect VEGF, VEGFR-1 and VEGFR-2 genes and proteins of PECs derived from human term placenta.

Comparison of peripapillary vascular density as measured by optical coherence tomography angiography between various types of open-angle glaucoma

PURPOSE

The purpose of this study is to compare the peripapillary vascular density in patients with various types of open-angle glaucoma (primary open-angle glaucoma, pseudoexfoliative glaucoma and pigmentary glaucoma) with healthy subjects by optic coherence tomography angiography (OCTA).

METHODS

Twenty-seven eyes with diagnosed POAG, thirty-four eyes with diagnosed PXG, twenty eyes with diagnosed PG and thirty eyes of healthy individuals were included in our study. Peripapillary vessel density measurements were performed with all images; (AI-DD), intra-disc (ID-DD) and peripapillary (PP-DD); measurement of vascular density in the radial peripapillary capillary network was performed by OCTA. The Kruskal-Wallis test and post-hoc test were performed for statistical analysis.

RESULTS

AI-DD was 50.76±2.07% in the healthy group, 47.12±2.57% in POAG, 39.71±6.64% in PXG, and 43.37±1.55% in PG. ID-DD was 50.49±3.74% in the healthy group, 49.51±6.83% in POAG, 38.42±13.46% in PXG, and 40.9±4.45% in PG. PP-DD was 51.26±3.12% in the healthy group, 50.13±3.04% in POAG, 42.31±7.31% in PXG, and 47.6±1.40% in PG. While it was found that all image and intra-disc vascular density measurements were statistically significantly lower in the PG and PXG group compared to the healthy group and the POAG (P<0.001), there was no significant difference between PXG and PG or between the control group and POAG.

CONCLUSIONS

The lower radial peripapillary capillary density in PXG and PG compared to the POAG and healthy groups suggests that the blood flow around the optic disc is negatively affected in these patients.

A research on the chemical, mineral and fatty acid compositions of two almond cultivars grown as organic and conventional in southeastern Turkey

Organic farming is a human and environment friendly production system that is based on soil fertility and food safety without using chemical fertilizers and pesticides in production, aiming to re-establish the deteriorated ecological balance as a result of harmful production practices. Organic products attract the interest of consumers as they are strongly perceived as healthier products compared to conventional food. This study aimed to determine the differences in chemical, mineral, and fatty acid characteristics between conventionally and organically cultivated Ferragnes and Ferraduel almond cultivars. When conventional and organic almonds were evaluated in terms of fatty acids, proximate compositions, and minerals, crude oil and Mg were statistically insignificant, while Cu was significant (P < 0.05) and all others were quite significant (P < 0.001). Total sugar was higher in organic samples compared to conventional samples in both cultivars. The crude oil and linoleic acid (12.93% for Ferragnes and 14.99% for Ferraduel) were higher in conventional samples but oleic acid (78.9% for Ferragnes and 81.08% for Ferraduel) was higher in organic samples. In addition, organic samples contained higher Mg and Fe but lower P, K, Ca, Na, Zn, Mn and Cu when compared with conventional samples. The results indicate that conventionally cultivated almonds present higher mineral content and lower fatty acid value compared to organically cultivated almonds.

Introduction of a novel quantitative scoring system for acanthosis nigricans and its validation in a pilot study

Inconsistent data exist regarding the diagnostic value of acanthosis nigricans (AN) or skin tags as clinical markers for obesity or diabetes. In an outpatient department-based prospective study, we designed a scoring for AN severity (SCANS) to evaluate AN and skin tags, their correlation with obesity or diabetes. Quantification of AN in six anatomic sites, in consideration of the affected skin surface areas, texture changes, number of skin tags, leads to a total severity score between 0 and 46. Among 336 adult patients (aged ≥18 years) with AN, a higher BMI was associated with AN (r = 0.299, P < .001), but not with diabetes (P = .43), as compared with 243 age- and sex-matched controls without AN. Among nondiabetics, AN scores were significantly correlated with waist circumference (r = 0.131, P = .024) and total cholesterol levels (r = 0.155, P = .04). Skin tags alone in the absence of AN were not associated with obesity (P = .333) or diabetes (P = .164). The total AN scores were positively correlated with the presence of skin tags (r = 0.132, P < .001), and the involvement of anterior neck (r = 0.668, P < .001) and axilla (r = 0.793, P < .001). Knuckles and groins were unaffected in our series. Our results indicate that combination of AN with skin tags can be used as clinical marker for obesity, but not for diabetes. Large-scale studies on patients of different ethnic background are required to further validate our proposed scoring.

Time for a new paradigm shift from STE/non-STEMI to ACO/non-ACOMI?

Introduction

Although ST-segment elevation (STE) has been used synonymously with acute coronary occlusion (ACO), current STE criteria miss nearly one-third of ACO and cause a substantial amount of false catheterization laboratory activations.

Purpose

We sought whether a new ACO/non-ACO myocardial infarction (MI) paradigm would result in better identification of the patients who need acute reperfusion therapy.

Methods

A total of 3000 patients were enrolled in STEMI, non-STEMI and control groups. A combined ACO endpoint was composed of peak troponin level, troponin rise within the first 24 hours and angiographic appearance.

Results

In non-STEMI group, 282 patients were re-classified as having ACO. This subgroup had a higher ACO frequency and myocardial damage compared to NSTEMI group. More importantly, in-hospital and long-term mortality rates was similar to STEMI patients. The ECG reviewers prospectively classified 35.6% of ECGs as STEMI and 35.5% of ECGs as ACOMI; 25.6% being shared in the both definitions. Both unweighted and weighted diagnostic accuracy of STEMI/non-STEMI and ACOMI/non-ACOMI approaches for ACO and long-term mortality were presented in Table 1. The diagnostic accuracy of the ACOMI/non-ACOMI approach was superior to the STEMI/non-STEMI approach in three out of four comparisons. We also sought to compare ECG subtypes according to early (ECG-to-PCI time&lt;120 min) and late (ECG-to-PCI time over 120 min) coronary intervention (Figure 1).

Conclusions

We believe that it is time for a new paradigm shift from the STEMI/non-STEMI to the ACOMI/non-ACOMI in the acute management of MI.

Figure 1

Funding Acknowledgement

Type of funding source: None

The effect of adenosine triphosphate on sunitinib-induced cardiac injury in rats

In this study, we aimed to show the effect of adenosine 5'-triphosphate (ATP) on sunitinib-induced cardiac injury in rats. The rats (n = 30) were divided equally into three groups as sunitinib group (SG), sunitinib plus ATP group (SAG), and healthy group (HG); 2 mg/kg ATP was injected intraperitoneally (ip) to the SAG group. Same volume normal saline as solvent was administered ip to the other two groups. After 1 h, 25 mg/kg sunitinib was applied orally via catheter to stomach in the SAG and SG groups. This procedure was repeated once daily for 5 weeks. At the end of this period, all animals were sacrificed and their cardiac tissue was removed. Malondialdehyde (MDA), total glutathione (tGSH), tumor necrosis factor α (TNF-α), and nuclear factor κB (NF-κB) levels in rats' cardiac tissues and troponin I (Tp-I) levels in rats' blood samples were evaluated. Histopathological analysis was also performed in cardiac tissues of the animals. MDA, TNF-α, NF-κB, and Tp-I levels were higher in the SG group compared to the SAG and HG groups (p < 0.001). tGSH levels of the SG group were lower than the SAG and HG groups (p < 0.001). The structure and morphology of cardiac muscle fibers and blood vessels were normal in the control group. In the SG group, obvious cardiac muscle tissue damage with dilated myofibers, locally atrophic myofibers, and congested blood vessels were observed. In the SAG group, marked amelioration in these findings was observed. We showed this for the first time that ATP administration exerts a protective effect against cardiac effects of sunitinib.

Determination of the antibiotic resistance rates of Serratia marcescens isolates obtained from various clinical specimens

Aim

Serratia marcescens clinical isolates are increasingly resistant to antibiotics. Therefore, the treatment of infections caused by S. marcescens becomes difficult. The aim of this study was to examine the antimicrobial resistance profiles of S. marcescens bacteria isolated from various clinical specimens according to body regions and clinics and to evaluate for enzyme production rates associated with antibiotic resistance of these isolates.

Materials and Methods

Blood culture samples were incubated in a fully automated BACTEC-FX system. Identification and antibiogram processing was carried out by fully automated VITEK 2 identification and antibiogram system. The obtained results were retrospectively screened.

Results

S. marcescens was identified in a total of 158 clinical specimens. The departments where S. marcescens was most commonly identified were the Anesthesia Intensive Care Unit (25.9%), followed by Chest Diseases (19.6%). Serratia isolates were most commonly determined in blood culture (35.4%) and sputum culture (24.6%). Resistance rates to ceftriaxone and ceftazidime were 22.7% and 19.6%, respectively. However, the rate of resistance detected to cefotaxime and gentamicin (0.6%) was very low.

Conclusion

Clinical isolates of Serratia exhibited highest resistance to ceftriaxone, ceftazidime, and piperacillin/tazobactam. However, it was found that the tested Serratia strains did not exhibit high resistance to other antibiotics. Our results suggest that cefotaxime and gentamicin are the most suitable antibiotics for treatment. The extended-spectrum β-lactamase and inducible β-lactamase ratios were found to be decreased by 6%-7%. Although different results may be obtained from different hospitals and regions, it should not be forgotten that Serratia strains may be resistant to many antibiotics and that the results of antibiotic susceptibility testing may help plan antibiotic treatment.

Misoprostol-Induced Modification of the Notch Signaling Pathway in the Human Cervix

The complex and multifactorial mechanisms that initiate and sustain the early labor process in the human uterus and cervix are still not well defined. Cervical maturation or ripening is likely to play a key role in preparing for birth. Prostaglandins have many different functions, including the regulation of uterine contractility and structure during pregnancy. The prostaglandin E1 analogue misoprostol is frequently used as a uterotonic and cervical ripening agent. Notch is a transmembrane receptor family responsible for basic functions such as cell survival, cell-cell communication, and differentiation and decidualization in pregnancy. However, our understanding of the effect of Notch signaling on the cervical ripening process is limited. This study was conducted in 20 pregnant women aged at 12 to 20 weeks of gestation undergoing medical abortion for fetal or maternal indications. True-Cut needle biopsies were taken from the anterior cervix 4 hours after oral ingestion of 200-μg misoprostol or before the ingestion of misoprostol in the control group. Cervical expression of Notch receptors and ligands changed during the early phase of prostaglandin-induced preterm labor. Four hours after the administration of misoprostol, it was seen that N1 expression increased in muscle, while DLL1 and J2 expression increased in blood vessels, and N4 expression increased in macrophages. Knowing the mechanisms that initiate preterm birth is the most important step in planning the treatments and actions to prevent premature birth. As a signal that affects and perhaps directs preterm labor, Notch is prone to be an important actor in this process.

[Continued development of drugs: the path of thioguanine]

Continued development of existing drugs ('drug rediscovery') may offer new therapeutic options and be cost-effective. Rediscovered drugs are commonly prescribed off-label, although licensing can be important to allow safe and controlled prescription of the drugs to patients. Licensing of a new indication for a generic drug, however, is a complicated process since there is no blueprint for this and there is little interest from the pharmaceutical industry due to an unattractive cost-recovery model. In this article, we illustrate the successful license-extension for thioguanine - initially developed in 1950 for leukaemia - as a new treatment for patients with inflammatory bowel disease.

Plantar Fibromatosis in a Mentally Challenged Man Treated with Intralesional Corticosteroids

A 21-year-old mentally challenged man presented with a fixed plaque lesion on the right foot, which had been present for 10 years. Dermatologic examination revealed an erythematous, painful, firm, fixed plaque-nodular lesion on the plantar aspect of the right foot (Figure 1A). Nothing of distinction was noted from his family history or his laboratory tests. An incisional biopsy revealed parallel, regular bundles composed of uniform, plump spindle cells. Thin collagen fibers were seen in contact with and located between the spindle cells. This mass was separated from the surrounding soft tissue by an irregular, unclear border (Figure 2A). İmmunohistochemically, the spindle cells showed diffuse, strong reactivity to vimentin (Figure 2B) and smooth muscle actin.

Uterus transplantation: From animal models through the first heart beating pregnancy to the first human live birth

Absolute uterine factor infertility affects 3-5% of the general population, and unfortunately this condition is untreatable. There are some available options, including surrogacy or adoption, but neither of these suits each and every woman who desires to have her own genetic child. With recent advances in surgery and transplant immunology, uterus transplantation may be a source of hope for these women with uterine infertility. In the last decade, a number of animal species including rats, mice, rabbits, pigs, sheep, and primates have been used as experimental models, and pregnancies were achieved in some of these. Human data consist of 11 subjects yielding positive pregnancy results with no live births in the second trial from Turkey and, more fortunately, live births from the latest trial from Sweden. In the light of all these studies, uterus transplantation has been proven to be a viable option for women with uterine factor infertility.

Comparison of sedation method in pediatrics cardiac catheterization

OBJECTIVE

Purpose of this study is to compare the effects of various anaesthetic combinations on hemodynamics, sedation level, recovery period and complications in the patients which undergo pediatric cardiac catheterization.

PATIENTS AND METHODS

Four groups of anaesthetic combinations was created. The groups are classified as propofol-ketamine (group 1), propofol-dexmedetomidine (group 2), dexmedetomidine-ketamine (group 3), midazolam-ketamine (group 4) (for each group n=20). Baseline heart rate (HR), mean arterial blood pressure (MAP), respiratory rate (RR), peripheral oxygen saturation (SpO2) were recorded. This parameters values were recorded at 0., 5., 10., 15., 20., 25., 30. minutes; and the groups were compared according to these measurements data.

RESULTS

For heart rate, Group 2 and 3 reduce the HR more than the drugs of Group 1 and 4 (p < 0.05). The SpO2 values of Group 1 were measured to have 5% further reduction compared to the Group 2 and 3; and Group 4 has the same SpO2 recordings compared to the Group 3 (p < 0.05). Comparing the recovery times; Group 4 was found to have the highest recovery time compared to the other drug groups. It is found that additional doses are needed for recovery in Group 4 (p < 0.008). Side effects were lowest for Group 3 and highest for Group 4.

CONCLUSIONS

Considering the complication rates, it is concluded that Group 3 is spotted as the better sedation method among the other groups. In terms of additional propofol dose, Group 1 would be the better choice. Thus, the clinician should choose the suitable methods for the patient.

Alternatives to surgical approach for giant spinal schwannomas

OBJECTIVE

To review the diagnoses and surgical approach characteristics of giant spinal schwannomas (GSS) patients.

METHODS

We reviewed the preoperative and postoperative radiological and clinical data, and the surgical aspects of 18 GSS patients who underwent surgery in the Department of Neurosurgery, Umraniye Teaching Hospital and Research State Hospital, Istanbul, Turkey between January 2008 and December 2013.

RESULTS

There were 15 (83.3%) female and 3 (16.6%) male patients. The age range was 16-70 years (average: 45.8). Average symptom duration was 1.5 months (range: 1-48). There was local pain in 15 cases, and radicular pain in 6 cases. The GSSs were most frequently located in the lumbosacral area (11 cases, 61.1%). An extraforaminal surgical approach was employed in 7 cases, a posterior approach was employed in 6 cases, a combined anterior transabdominal and posterior approach was employed in 2 cases, a combined posterior and extraforaminal approach was employed in 2 cases, and a retroperitoneal approach was applied in one case. The tumors were completely excised in all cases. The mean follow-up period was 38.5 months (range: 20-68).

CONCLUSION

Giant spinal schwannomas exhibit unique diagnostic and surgical factors. The selection of an appropriate approach significantly influences the success of the treatment.

Comparison of pre-procedural anxiety and depression scores for patients undergoing chorion villus sampling and amniocentesis: An alternative perspective on prenatal invasive techniques

OBJECTIVE

To compare the pre-procedural anxiety and depression levels of patients undergoing chorion villus sampling (CVS) and amniocentesis (AC).

METHODS

Patients referred to our department for fetal karyotype analysis with a positive first or second trimester screening test for aneuploidy between January 2013 to June 2015 were included. CVS and AC procedures were performed in patients with gestation periods of between 11-14 and 16-20 weeks, respectively. Anxiety was evaluated using the Spielberger State-Trait Anxiety Inventory (STAI), and depression was assessed using the Beck Depression Inventory II (BDI-II).

RESULTS

A total of 1,400 patients were included. Compared to first trimester controls, patients undergoing CVS had significantly higher STAI-state and BDI-II results. Likewise, patients undergoing AC had higher STAI-state and BDI-II scores than controls in the second trimester. In terms of STAI-trait results, no difference was found between the groups. Our results also showed that, compared to AC group, patients undergoing CVS had similar STAI-state, STAI-trait and but higher BDI-II scores.

CONCLUSION

We conclude that evaluating the stress and depression levels of these patients should be one of the routine procedures in pregnancy follow-up.

Effect of a re-wetting agent on bond strength of an adhesive to primary and permanent teeth dentin after different etching techniques

OBJECTIVE

This study investigated the effect of a re-wetting agent on the microtensile bond strengths (mTBS) of primary and permanent dentin after acid or laser etching.

MATERIALS AND METHODS

Twelve permanent and 12 primary molar teeth were ground to expose an occlusal dentin surface. Each group teeth were randomly divided into groups; I-II: 37% phosphoric acid etching with/without re-wetting agent, III-IV: Erbium: Yttrium aluminium garnet laser etching with/without re-wetting agent. An etch-and-rinse adhesive was used, and vertical sticks were obtained for the microtensile test.

RESULTS

mTBS of permanent teeth was higher than that of primary teeth (P < 0.05). Re-wetting agent groups were similar with control groups in both etching groups in the permanent teeth (P > 0.05). Re-wetting agent group was similar with the control group in acid etch group (P > 0.05) and lower than the control group in laser etch group in primary teeth (P < 0.05).

CONCLUSION

Acid etching in permanent teeth; laser etching in primary teeth was found more successful. The use of re-wetting agent did not provide an advance on bond strength of the adhesive in both primary and permanent teeth after acid-etch or laser-etch.

Robotic spine surgery: a preliminary report

AIM

Robotic spine surgery techniques provide reduced pedicle screw malposition and radiation exposure during surgery. The aim of this study is to review clinical and radiological results of robotic spine surgery.

MATERIAL AND METHODS

The preoperative, intraoperative and postoperative data for 27 patients were reviewed. To reveal the effect of a learning curve, the cases were divided into two groups: Group A and Group B The clinical data and radiological data were compared with the values obtained from preoperative planning.

RESULTS

The patients consisted of 23 females and 4 males. A total of 136 screws were placed in the 27 cases. The accuracy rate of the screw positions was 98.5%. The overall mean procedure duration was 73.2 minutes for Group A and 46.1 minutes for Group B. The overall mean x-ray exposure time per screw was 1.3 seconds, 1.8 seconds for Group A and 0.9 seconds for Group B. Postoperative imaging revealed that 126 screws were perfect, screw malposition of < 2mm was observed for 8 screws, and malposition of > 2mm was observed for 2 screws.

CONCLUSION

Robotic spine surgery provides a high degree of accuracy for pedicle screw placement and allows for reduced radiation exposure.

Lumbar intradural paragangliomas: report of two cases

Paraganglioma (PG) is a rare tumor of the dispersed neuroendocrine system. PG derives from the embryonic sympathetic and parasympathetic nervous system. Paraganglioma is a neoplasm of the dispersed neuroendocrine system that affects a variety of anatomic sites, mainly the head and neck. It occurs commonly in the carotid body, glomus jugulare, mediastinum and retroperitoneum. Primary spinal paragangliomas are quite rare tumors. They are commonly located in the cauda equina region, and manifest their own clinical and radiological features. In this study, two cases of lumbar intradural paragangliomas are presented. Both of the tumors were totally resected with surgery and there was no evidence of recurrence or metastases during follow-up period. It was concluded that paragangliomas should be taken into consideration during the preoperative workup studies of lumbar intradural tumors.

PRENATAL DIAGNOSIS OF DE NOVO SUPERNUMERARY MARKER CHROMOSOME ORIGINATED FROM CHROMOSOME 16 BY ARRAY-CGH

A 33 years-old pregnant woman was referred for amniocentesis at 19 weeks of gestation due to abnormal serum biochemistry. A non-satellited, monocentric marker chromosome was observed with a frequency of 50% in cultured amniocytes. Parental karyotypes were normal. The marker chromosome was found to be derived from chromosome 16 by FISH and array-CGH analysis. Genetic counseling was given to parents and the family decided to terminate the pregnancy. Dysmorphic findings including; low set ears, exophtalmos depressed nasal bridge, large mouth and lips, posture anomalies at the extremities were detected at autopsy.

Intravaginal misoprostol alone versus intravaginal misoprostol and extraamniotic Foley catheter for second trimester pregnancy termination: an observational study

BACKGROUND

No systematic empirical research exists addressing the question of optimal pregnancy termination method in second trimester pregnancies.

OBJECTIVES

The purpose of this study was to determine the efficacy and safety of intravaginal misoprostol and extraamniotic Foley catheter combination for second trimester pregnancy termination.

METHODS

A single center observational study was conducted in a total of 91 pregnancies. Women who met the termination of pregnancy criteria due to feto-maternal indications between 13 to 26 gestational weeks were included into the study. Study participants received intravaginal misoprostol in combination with Foley catheter (n = 46) or intravaginal misoprostol alone (n = 45).

RESULTS

The efficacy of intravaginal misoprostol and Foley catheter insertion combination was comparable to that of intravaginal misoprostol alone in terms of time to abortion/birth [median (95% Confidential Interval [95% CI]): 14.33 (11.33-17.25) hours and 12.08 (9.50-15.33) hours, respectively Hazard Ratio: 0.73, 95% CI: 0.47 to 1.12, p = 0.14 (log-rank)]. The only serious maternal event was uterine rupture observed in one woman in Foley combination group.

CONCLUSION

The combination of intravaginal misoprostol and extraamniotic Foley catheter for second trimester pregnancy termination does not provide additional efficacy.

Prenatal management, pregnancy and pediatric outcomes in fetuses with septated cystic hygroma

It has been reported that, compared with simple increased nuchal translucency, fetal cases with septated cystic hygroma (CH) are more likely to face perinatal handicaps. However, pediatric outcomes and proper prenatal counseling for this anomaly have not yet been truly defined. We performed this study to determine pregnancy and pediatric outcomes of fetuses with septated CH. We searched records for cases with septated CH and collected data for structural abnormalities, karyotype analysis, and pregnancy outcomes. Fetuses born with septated CH were also evaluated for their pediatric outcomes. Sixty-nine fetuses with septated CH were enrolled in the study. Results showed that chromosomal abnormalities were present in 28 fetuses (40.6%), and the most common aneuploidy was Turner syndrome (n=14, 20.3%); 16 (23.2%) of the remaining cases, in which aneuploidy was not found, had coexistent structural malformations; 25 (36.2%) cases had normal karyotype and morphology. The total number of live births and infants with unfavorable neurologic follow-up were 13 (18.8%) and 2 (2.9%), respectively. Septated CH is associated with poor perinatal outcomes; therefore, karyotype analysis and ultrasonographic anomaly screening should be performed as initial steps, and expectant management should be offered to couples with euploid fetuses that have normal morphology.

Robotic assisted sacroplasty: a case report

AIM

Sacral insufficiency fracture is an important cause of lower back and groin pain among the osteoporotic population. Diagnosis and treatment of SIFs are challenging. Currently, surgical treatment includes sacroplasty under C-arm fluoroscopy or computed tomography. Both techniques have a risk of accuracy and high radiation exposure. A sacral insufficiency fracture patient treated using robotic assisted surgery is presented and present literature is discussed.

METHOD

A bilateral sacral insufficiency fracture patient with an additional L5 osteoporotic vertebra fracture is treated by bilateral percutaneous vertebroplasty using robotic assisted surgery.

RESULTS

Robotic assisted surgery provided less x-ray exposure to the patient and the surgeon with additional accuracy and comfort.

CONCLUSION

Robotic assisted surgery in treatment of sacral insufficiency fracture can be an important alternative method.

The association between ischaemia-modified albumin levels in umbilical vein and intrauterine growth restriction

Intrauterine growth restriction (IUGR) is one of the most common problems in obstetrics. Ischaemia-modified albumin (IMA), a product deriving from albumin as a result of the modification by oxidative free radicals in response to hypoxia, was previously used as a marker of ischaemia in acute coronary syndrome. We performed this study to determine whether umbilical venous IMA levels are associated with IUGR. A total of 40 pregnancies with IUGR were compared with 40 of normal fetal development. Blood samples were obtained from the umbilical vein after delivery. IMA levels in the IUGR group were higher than in the control group (78.74 ± 6.87 vs 74.43 ± 7.84 U/ml, respectively, p = 0.011). An elevated IMA level was associated with IUGR (OR: 1.079, 95% CI: 1.000-1.163, p = 0.049). We suggest that IMA, which was formerly proved to arise in ischaemic conditions, may also be a valuable marker in perinatal hypoxia and IUGR detection.

What is the impact of SOCS3, IL-35 and IL17 in immune pathogenesis of recurrent pregnancy loss?

OBJECTIVE

To investigate the plasma levels of interleukin-4 (IL-4), IL-6, IL-10, tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), transforming growth factor-beta (TGF-beta), IL-17, IL-35 and suppressor of cytokine signaling 3 (SOCS3) in the women with history of idiopathic recurrent pregnancy loss (RPL) and in the fertile controls.

METHODS

This study was conducted with 60 idiopathic RPL cases and 40 age-matched fertile controls. Mid-follicular plasma levels of IL-17, IFN-gamma, TNF-alpha, TGF-beta, IL-6, IL-4, IL-10, SOCS3 and IL-35 were assayed by an enzyme linked immunosorbent assay.

RESULTS

The mean age of RPL and control cases were 31.6 ± 0.6 and 32.1 ± 0.7 years, respectively. While plasma IL-35 and SOCS3 levels of RPL group were significantly lower than that of the control group; IFN-gamma, TNF-alpha, IL-4, IL-6, IL-10, IL-17 and TGF-beta levels of RPL group were significantly higher than that of the control group. The comparison of cytokine ratios between RPL and control groups indicated significantly high TNF-alpha/IL-10, TNF-alpha/IL-4, IFN-gamma/IL-10, IFN-gamma/IL-6 and IFN-gamma/IL-4 ratios in the RPL group. IL-35/IL-17 ratio was significantly low in the RPL group compared to that in the control group. Overstimulation of TNF-alpha presented moderate influence on recurrent miscarriage risk.

CONCLUSION

Decreased SOCS3 and IL-35 plasma levels and increased Th1/Th2 cytokine ratios in RPL cases pointed out the supression of anti-inflammatory process and this supression might play an important role in the pathogenesis of idiopathic RPL.

Plasma IL-17, IL-35, interferon-γ, SOCS3 and TGF-β levels in pregnant women with preeclampsia, and their relation with severity of disease

Abstract Objective: To research the hypothesis of preeclampsia (PE) is associated with increased systemic inflammatory responses of Th1-type as well as decreased Th2-type responses; we evaluated the maternal plasma levels of IFN-gamma, TNF-alpha, TGF-beta, IL-4, IL-6, IL-10, IL-17, IL-35 and SOCS3 in preeclamptic and healthy pregnants.

METHODS

This study was conducted with 40 preeclamptic (study group) and 40 normotensive pregnant (control) women in third trimester when they were admitted to the labor and delivery unit. The extracted maternal plasma samples were assayed by an enzyme-linked immunosorbent assay. Statistical analysis was performed by SPSS 16.0 version.

RESULTS

While IFN-gamma and TGF-beta levels of preeclamptic women were significantly higher (p < 0.01), IL-35 and IL-17 levels of preeclamptic women were significantly lower (p < 0.01) than those of controls. The ratios of IFN-gamma/IL-10, IFN-gamma/IL-6, IFN-gamma/IL-4 were significantly high and ratio of IL-35/IL-17 was significantly low in the PE group compared to those in the control group. Maternal plasma SOCS3 levels showed negative correlation with blood pressure and proteinuria severity, but none of the cytokines showed influence on blood pressure and proteinuria after adjusting for maternal and gestational age.

CONCLUSIONS

Increased IFN-gamma/TGF-beta production and reduced IL-35/IL-17/SOCS3 production in preeclamptic women may lead to less cytokine inhibitory activity in PE, which may account for the increased proteinuria and blood pressure in PE.

Investigation of apelin expression in endometriosis

BACKGROUND

Apelin is a mitogenic peptide; it has functions in vessel formation and cell proliferation. In this study we aimed to evaluate the serum and tissue levels and local expression pattern of apelin in eutopic and ectopic endometrium from patients with and without endometriosis and to compare the proliferative and secretory phase differences.

METHODS

Thirty women with endometriosis and 15 women without endometriosis undergoing surgery for benign indications as control group were included in the study. Serum and tissue concentrations and proliferative and secretory phase expression patterns of apelin were evaluated in the ectopic and eutopic endometrium using immunoassay and immunohistochemistry methods. The results were compared with Mann-Whitney U test. The p-values smaller than 0.05 were considered as statistically significant.

RESULTS

Apelin expression was detected in eutopic and ectopic endometrium of women with endometriosis and endometrium of control group. Intense immunoreactivity of apelin was observed in glandular cells of eutopic and ectopic endometrial tissues of women with endometriosis and endometrium of control group during secretory phase (p<0.01). In both groups, tissue concentrations of apelin were higher than of the serum (p=0.03) but, there were no significant differences between the two groups for tissue and serum concentrations of apelin.

CONCLUSION

Apelin expression showed cyclic changes in eutopic and ectopic endometrium. Its expression may be related to menstrual changes of angiogenesis in endometrium of women.

Coexistence of adenomyosis in women operated for benign gynecological diseases

BACKGROUND

To compare demographic, clinical and histopathological characteristics of women diagnosed with adenomyosis (AG) after hysterectomy to those of women diagnosed with leiomyoma (LG) and to investigate the predisposing factors for AG.

METHODS

This study was carried out on 204 patients who underwent gynecologic surgery for various indications except for gynecologic malignancy between January 2005 and December 2009 and whose histopathological analysis of hysterectomy/myomectomy specimen revealed either AG or LG. Women with AG and those with LG were compared with respect to age, parity, menstrual pattern, history of induced abortion, history of prior uterine surgery, smoking, dysmenorrhea, dyspareunia, chronic pelvic pain and coexisting endometrial and ovarian pathologies.

RESULTS

The mean age of our patients was 51 ± 8 years (range 28-85), 40% of them were postmenopausal, and 64% had a history of uterine surgery. The mean age (p = 0.014), gravida (p = 0.018), parity (p = 0.017) and previous endometrial sampling (p < 0.01) were significantly higher in AG. Main symptoms were abnormal uterine bleeding (39%), dysmenorrhea (63%) and nonmenstrual pelvic pain (62%). Age (p = 0.01), menometrorrhagia (p = 0.02) and endometrial sampling (p < 0.01) were the significant covariants in binary logistic regression for AG.

CONCLUSION

AG is an enigmatic disease frequently causing gynecologic complaints and endomyometrial junction deterioration during endometrial sampling may be a trigger point for developing AG.

Association of first trimester low PAPP-A levels with adverse pregnancy outcomes

OBJECTIVE

To investigate whether first trimester low PAPP-A levels are associated with adverse pregnancy outcomes.

METHODS

A case control retrospective study including 663 pregnant women whose gestational age ranged between 11 and 14 weeks attending prenatal care at Akdeniz University Hospital was carried out. Chromosomal abnormalities, spontaneous abortions, and multiple pregnancies were excluded from the study. Finally 318 singleton pregnancies were included in this study. Pregnant women whose PAPP-A levels were < or =10th percentile were compared with PAPP-A levels > 10'h percentile for the frequency of pregnancy complications such as SGA, preeclampsia, preterm delivery, gestational diabetes mellitus and gestational hypertension.

RESULTS

The most common complication of pregnancy was SGA (9.4%, n=30). There was no significant association between low PAPP-A levels and incidence of subsequent pregnancy outcomes. Maternal age was found to be a risk factor for gestational diabetes (p = 0.00). Small for gestational age was significantly associated with nulliparity and smoking during pregnancy (p = 0.03 and p = 0.01, respectively).

CONCLUSION

First trimester of low PAPP-A level (< or = 10th percentile) was not associated with SGA, preeclampsia, preterm delivery, gestational hypertension or gestational diabetes mellitus.

Prenatal diagnosis of β-thalassemia and other hemoglobinopathies in southwestern Turkey

Our aim was to evaluate the prenatal diagnosis of β-thalassemia (β-thal) and other hemoglobinopathies in a region with high frequency. After detection by premarital or antenatal screening, 312 patients underwent 420 prenatal diagnostic procedures for 407 fetuses in a 10-year period. Fetal samples were collected by chorionic villi sampling (CVS) in the first trimester and amniocentesis and cordocentesis in the second trimester. Mutation analyses of β-globin and cytogenetic analyses were performed and the most common mutations detected were: IVS-I-110 (G>A), IVS-II-1 (G>A), IVS-I-6 (T>C) and IVS-II-745 (C>G). Hb S [β6(A3)Glu→Val, GAG>GTG)] was the most common hemoglobin (Hb) variant with a frequency of 6.3%. Among 407 fetuses, 105 (25.8%) were diagnosed as affected, while 201 (49.4%) were carriers and 101 (24.8%) were normal. Cytogenetic analyses revealed nine fetuses (2.3%) with numerical chromosomal abnormalities as regular or mosaicism. Prenatal diagnosis of common hemoglobinopathies is safe and effective. Performing cytogenetic analysis in excess fetal material is an acceptable option.

Apoptosis and expression of Bcl-2, Bax, p53, caspase-3, and Fas, Fas ligand in placentas complicated by preeclampsia

AIM

To determine whether preeclampsia is associated with an increase in placental apoptosis and altered expression of mediators of apoptosis such as Fas, Fas ligand, caspase-3, p53, Bcl-2 and Bax.

METHODS

Placental samples obtained from 20 women with preeclampsia and 14 normal women were analyzed using the Klenow, Frag-EL DNA fragmentation detection kit for apoptosis. Expression of Fas, Fas ligand, caspase-3, p53 Bcl-2, and Bax was assessed using immunohistochemistry.

RESULTS

The median percentage of apoptotic nuclei in trophoblasts was significantly higher for the preeclampsia group than for the controls (6.9 vs 0.25; p =.001). Fas ligand expression was significantly higher in the decidua among the subjects with preeclampsia compared with controls (1.2 vs 0; p = .023). Otherwise no difference was observed in the expression of Bax , Bcl-2, p53, caspase-3, and Fas between groups.

CONCLUSION

Increased apoptosis in preeclampsia may not be associated with significant alterations in Fas, Fas ligand, caspase-3, p53, Bcl-2 and Bax expression.