A randomised interventional parallel study to evaluate the effect of different frequencies of pelvic floor muscle exercises with core stabilisation using three-dimensional ultrasound: the PELSTAB study

INTRODUCTION AND HYPOTHESIS

The primary objective was to compare high- and low-frequency pelvic floor muscle training (PFMT) with the impact on urinary incontinence episode frequency over 1 week (IEF/week). The secondary objective was to compare the two groups with regard to pelvic floor muscle function, morphometry, incontinence quality of life, and patient global impression.

METHODS

This was a randomised parallel controlled study. The setting was regional gynaecological and urological outpatient clinics. The subjects consisted of a sample of 86 women with stress urinary incontinence (SUI). Group A underwent high-frequency PFMT and group B underwent low-frequency PFMT for 12 weeks. We recorded the IEF/week. The International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) was used. Pelvic floor muscle function was evaluated using a perineometer. Pelvic floor muscle morphometry was evaluated with 3D/4D ultrasound. The Urinary Incontinence Quality of Life Scale (I-QoL) was used.

RESULTS

Significant differences between group A and B after treatment (p<0.001) were noted in favour of group A in IEF/week (group A 10.2±7.0/2.3±3.0 vs group B 9.3±4.7/6.3±4.9), in the ICIQ-UI SF (group A 9.7±3.0/3.7 ± 3.6 vs group B 9.9±3.2/9.4±3.4). Significant differences between groups A and B after treatment were noted in favour of group A for pelvic floor muscle function in terms of maximal voluntary contraction and its duration, and also for pelvic floor muscle morphometry in terms of a reduction of the hiatal area during rest, contraction, and the Valsalva manoeuvre.

CONCLUSIONS

High-frequency PFMT for 12 weeks significantly decreased IEF/week in comparison with low-frequency PFMT. In the high-frequency exercise group, women had significantly better pelvic floor muscle function, morphometry and quality of life than the low-frequency exercise group.

The Importance of Natural Antioxidants in Female Reproduction

Oxidative stress (OS) has an important role in female reproduction, whether it is ovulation, endometrium decidualization, menstruation, oocyte fertilization, or development andimplantation of an embryo in the uterus. The menstrual cycle is regulated by the physiological concentration of reactive forms of oxygen and nitrogen as redox signal molecules, which trigger and regulate the length of individual phases of the menstrual cycle. It has been suggested that the decline in female fertility is modulated by pathological OS. The pathological excess of OS compared to antioxidants triggers many disorders of female reproduction which could lead to gynecological diseases and to infertility. Therefore, antioxidants are crucial for proper female reproductive function. They play a part in the metabolism of oocytes; in endometrium maturation via the activation of antioxidant signaling pathways Nrf2 and NF-κB; and in the hormonal regulation of vascular action. Antioxidants can directly scavenge radicals and act as a cofactor of highly valuable enzymes of cell differentiation and development, or enhance the activity of antioxidant enzymes. Compensation for low levels of antioxidants through their supplementation can improve fertility. This review considers the role of selected vitamins, flavonoids, peptides, and trace elements with antioxidant effects in female reproduction mechanisms.

Adolescent Pregnancy Outcomes and Risk Factors

One of the major social and public health problems in the world is adolescent pregnancy. Adolescent pregnancy is strongly associated to less favorable results for both the mother and the newborn. We conducted this research to ascertain the impact of teenage age on neonatal outcomes and also observed the lifestyles of pregnant teenage girls. We conducted a study of 2434 mothers aged ≤19 years (n = 294) or 20-34 years (n = 2140) who gave birth in 2019-2020 at the Department of Gynaecology and Obstetrics of Louis Pasteur University Hospital in Košice. The data on mothers and newborn infants have been reported from the reports on mothers at childbirth. Women between the ages of 20 and 34 served as the reference group. The teenage mothers were more likely to become pregnant if they were unmarried (OR = 14.2; 95% CI = 9.3-21.6; p < 0.001) and had a basic education or lack of education (OR = 16.8; 95% CI = 11.5-24.6; p < 0.001). Additionally, they were more likely to smoke when pregnant (OR = 5.0; 95% CI = 3.8-6.6; p < 0.001). Low birth weight was more common in newborns born to adolescent mothers than in those born to adult mothers (p < 0.001). Our findings showed that infants of teenage mothers often had lower birth weights (-332.6 g, p < 0.001). Adolescent mothers were associated with lower Apgar scores at the first minute (p = 0.003). As compared with the control group, pregnant teenage girls had a greater prevalence of preterm deliveries in our research (p = 0.004). This study finds significant age-related disparities in neonatal outcomes between mothers. These results might be used to identify vulnerable groups who need special assistance and actions to reduce the probability of negative outcomes for such groups.

Influence of uterine manipulator use on the incidence of lymphovascular propagation in the treatment of endometrial cancer

BACKGROUND

Endometrial cancers are among the epithelial malignancies of the lining of the uterine cavity. The invasion of carcinoma into the lymphovascular space (LVSI) is considered a risk factor for the course of the disease.

MATERIAL AND METHODS

We evaluated 170 female patients. Our primary objective was to find any difference in the incidence of LVSI in female patients treated with and without an intrauterine manipulator. In addition, we analyzed the effect of the type of intrauterine manipulator used on the incidence of LVSI, tumor grading, myometrial invasion, and the method of obtaining primary histology with regard to the incidence of LVSI.

RESULTS

Using a manipulator during surgery was not associated with LVSI (with a manipulator vs. without, 11.5 vs. 21.7%; OR 1.8; 95% CI 0.73-4.39; p = 0.199). However, the method used to obtain the primary histology had a statistically significant effect on the incidence of LVSI in our set (p-value = 0.011).

CONCLUSIONS

In our study, we did not confirm the effect of a uterine manipulator on the possible increase of LVSI positive cases. The secondary analysis indicated a higher incidence of LVSI in the female patients diagnosed with curettage than in those who underwent hysteroscopy. Trail registration: Trail is registered in ClicincalTrails.gov with identifier: NCT05261165.

Influence of maternal smoking during pregnancy on birth outcomes

OBJECTIVES

Smoking during pregnancy is causally associated with reduced birth weight and is strongly related to preterm birth. This study analyses the differences in birth outcomes between non-smokers and women who continued to smoke during pregnancy.

METHODS

We conducted a study of 1,359 mothers who gave birth in 2017-2019 at the Department of Gynaecology and Obstetrics of Louis Pasteur University Hospital in Košice. Data on mothers and newborn infants have been reported from the birth book and from the reports on mothers at childbirth. For low birth weight we considered the weight of a newborn being less than 2,500 g and as for premature birth we referred to childbirth before pregnancy week 37. Two groups of mothers were classified according to the smoking habit during pregnancy and statistically processed in IBM SPSS Statistics 23.0.

RESULTS

Infants born by women who smoked during pregnancy had the lower birth weight (2,769.0 grams on average) compared to non-smokers (3,224.1 grams) (p < 0.001). The differences in prevalence of premature birth have not been confirmed as statistically significant. Women who continued smoking during pregnancy were significantly more likely to be very young (OR = 5.9; 95% CI: 3.9-8.9; p < 0.001), unmarried (OR = 9.3; 95% CI: 6.1-14.0; p < 0.001), of lower level of education (OR = 39.6; 95% CI: 22.6-69.5; p < 0.001), and more likely to consume alcohol (OR = 6.6; 95% CI: 5.8-7.5; p < 0.01), and drugs (OR = 6.6; 95% CI: 5.8-7.5; p < 0.01) during pregnancy. When pregnant, they were most likely to see a doctor for the first time after the first trimester (OR = 0.1; 95% CI: 0.1-0.2; p < 0.001) and were more likely to see a doctor less than 8 times (OR = 6.1; 95% CI: 4.2-8.8; p < 0.001) during pregnancy.

CONCLUSION

Tobacco prevention and cessation campaigns should focus on improving pregnancy outcomes in the future.

Risk factors associated with low birth weight

OBJECTIVES

Low birth weight (LBW) is one of the major factors affecting child morbidity and mortality worldwide. Every day, approximately 800 women die from causes related to pregnancy and childbirth worldwide. Maternal ill health increases the risk of LBW. This study seeks to investigate determinants and incidence of LBW.

METHODS

This study was conducted based on the medical records of mothers and their 1,946 infants born in 2016-2019 at the Department of Gynaecology and Obstetrics of Louis Pasteur University Hospital in Košice. Data on mothers and newborn infants were obtained from the Reports on mothers at childbirth. The inclusion criteria were singleton births and birth weight > 500 g. The exclusion criteria were twins or multiple births, congenital anomalies and stillbirths, birth weight ≥ 4,000 g or ≤ 500 g, and Roma ethnicity. Roma children are more likely to be born prematurely, with low birth weight. Roma mothers have different lifestyle. Univariate analysis was employed to evaluate the association between the independent variables and LBW. Variables that were found to be statistically significant were then further analysed using multivariable logistic analysis for each dependent variable. The implementation of the research was approved by the Ethics Committee.

RESULTS

Of 1,946 newborns, 271 (13.90%) have low birth weight. The mean of birth weight at delivery was 3,068.62 (SD 671.16) grams. Factors that were associated with LBW were primary maternal education (OR = 2.98, 95% CI: 1.08-8.21, p = 0.034), marital status single (OR = 2.88, 95% CI: 1.68-4.94, p < 0.001), number of prenatal care visits less than 8 (OR = 1.62, 95% CI: 1.01-2.61, p = 0.047), and preterm birth (OR = 74.94, 95% CI: 45.44-123.61, p < 0.001).

CONCLUSION

The reducing of LBW requires strategies to improve maternal lifestyle, maternal care before, during and after birth and to strengthen social support.

Potential differences in occurrence of preterm births according to quality of relationship between mothers and fathers of the children

OBJECTIVES

Premature birth is a serious pregnancy complication that is affected by many biological as well as psychosocial factors. Several studies have shown that a mother's positive relationship with her child's father reduces the mother's stress, anxiety and depression during pregnancy, promotes a healthier mother's lifestyle and thus has a positive effect on pregnancy as such. This research was therefore aimed at identifying possible differences in the incidence of premature births in mothers depending on the quality of the relationship with the father of their child.

METHODS

The research involved 210 mothers after childbirth in the period from October 2020 to September 2021. A questionnaire aimed at obtaining descriptive data about the mother and her child and a questionnaire aimed at determining the quality of the relationship - Quality of Relationship Inventory (QRI) were distributed. Mann-Whitney U tests were used to determine differences between groups.

RESULTS

Of 210 children, 44 (21%) were born prematurely, 154 (73.3%) mothers were married and 176 (83.8%) lived with the father of their child in the same household. The results showed that the degree of quality of the mother's relationship with the child's father is approximately the same for mothers who gave birth prematurely and for those who gave birth at term, so there were no differences in this factor between the two groups of mothers.

CONCLUSION

The results of other researchers have shown the positive impact of partners on pregnancy and the overall well-being of the mothers. However, our research has not confirmed the positive effect of the quality of the relationship between mother and father of her child on reducing the incidence of premature births. Further research is needed to clarify how specifically and whether the quality of the relationship between parents can affect the incidence of premature births at all.

Lower-limb progressive paraparesis management and diagnosis overview in a pregnant woman with vertebral haemangioma

Vertebral haemangioma is a benign vascular tumour mostly seen in the thoracic region of the spine. Spinal haemangiomas are usually asymptomatic and are discovered incidentally. In a few patients, however, aggressive vertebral haemangiomas can cause local pain, radicular pain or neurologic deficits, which result from neural compression. The aetiology of the origin is unclear and is probably multifactorial. Hormonal and biological changes in pregnant women can lead to accelerated vascular growth of haemangioma. In our report, we present the case of a pregnant patient who was diagnosed with an aggressive vertebral haemangioma that further led to progressive paraparesis. We had to take the fact that she was pregnant into account in the diagnostic procedure, in the choice of examination method and also in the method of therapy. The goal of this case report is threefold: (1) provide an overview of the possible methods of management, specifically imaging, which will aid in diagnosis and based on that, (2) determining the appropriate therapy and (3) review the risks and benefits of each will be presented when choosing individual approaches.

Zinc(II) niflumato complex effects on MMP activity and gene expression in human endometrial cell lines

Endometriosis is a chronic inflammatory disease which increasingly affects young women under 35 years of age and leads to subfertility even infertility. Analysis of the cytotoxic effect of zinc(II) niflumato complex with neocuproine ([Zn(neo)(nif)2] or Zn-Nif) on immortalized human endometriotic cell line (12Z) and on control immortalized human endometrial stromal cell line (hTERT) was performed using xCELLigence technology for approximately 72 h following the treatment with Zn-Nif as well as cell viability Trypan Blue Assay. 12Z cell line proliferated more slowly compared to unaffected cells, whereas hTERT cells did not show similar behavior after treatment. The complex probably reduces the effect of pro-inflammatory pathways due to the effect of NSAID, while presence of zinc might reduce the level of ROS and regulate ER2 levels and MMP activity. The observed effects and high selectivity for rapidly proliferating cells with increased inflammatory activity suggest a good prognosis of successful decrease of endometriosis stage with this complex.

Pelvic organ prolapse and uterine preservation: a survey of female gynecologists (POP-UP survey)

Background

The aim of this study was to explore the personal views of female gynecologists regarding the management of POP with a particular focus on the issue of uterine sparing surgery.

Methods

A questionnaire based survey of practicing female gynecologists in the Czech Republic, Slovenia and Slovakia.

Results

A total of 140 female gynecologists from 81 units responded to our questionnaire. The majority of respondents stated they would rely on a urogynecologist to aid them with their choice of POP management options. The most preferred options for POP management were sacrocolpopexy and physiotherapy. Almost 2/3 of respondents opted for a hysterectomy together with POP surgery, if they were menopausal, even if the anatomical outcome was similar to uterine sparing POP surgery. Moreover, 81.4% of respondents, who initially opted for a uterine sparing procedure, changed their mind if the anatomical success of POP surgery with concomitant hysterectomy was superior. Discussing uterine cancer risk in relation to other organs had a less significant impact on their choices.

Conclusions

The majority of female gynecologists in our study opted for hysterectomy if they were postmenopausal at the time of POP surgery. However, variation in information provision had an impact on their choice.

A randomized interventional parallel study to evaluate the effect of pelvic floor muscle training with stabilization exercises of high and low intensity in women with stress urinary incontinence: The PELSTAB study

INTRODUCTION

The effect of different intensities of pelvic floor muscle training (PFMT) assessed by 2D/3D ultrasound (USG) have not been sufficiently monitored in the literature. The objective of the study will be to evaluate the effect of this intervention by assessing the change in incontinence episode frequency, hiatal area (HA) and hiatal diameter by 2D/3D USG and quality of life over 12 weeks of treatment.

METHODS

Using a randomized interventional parallel study, patients will be assigned to groups A and B using simple software randomization according to odd and even patient sequence numbers. The following methods will be used for evaluation: change in incontinence episode frequency, power and endurance of pelvic floor muscles assessed by perineometer (in cmH2O), HA (in cm) during contraction, Valsalva manoeuvre assessed by 3D USG, hiatal diameter assessed by 2D USG, the Incontinence Quality of Life scale (I-QoL) and the Patient Global Impression of Improvement score (PGI-I).

INTERVENTIONS

Group A, high-intensity PFMT 5 times a week for 30 minutes per day. Group B, low-intensity PFMT twice a week for 15 minutes per day. The duration of the intervention will be 12 weeks.

DISCUSSION

The study protocol presents the starting points, design, and methods of the PELSTAB Study. We expect that, after 12 weeks of high-intensity PFMT, women with stress urinary incontinence will have significantly less incontinence episode frequency, better reduction of HA during contraction and Valsalva manoeuvre, higher power and endurance of pelvic floor muscles and better quality of life compared to the group with low-intensity PFMT.

REGISTRATION

This study was registered in the ClinicalTrials.govNCT04340323.

Possibilities of objectivization of pelvic floor muscle exercises in patients with urine leakage after delivery

BACKGROUND

Examination of pelvic floor muscle function is very important before starting exercises in patients with urine leakage and other pelvic floor dysfunctions. Perineometer and palpation examination is currently being used. A new trend in physiotherapy is the ultrasound examination of pelvic floor muscles. The examination can be performed by abdominal approach or perineal approach. We evaluate 2D and 3/4D images of pelvic floor muscles.

METHODS

The International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF). OAB-q - overactive bladder questionnaire - short form. The Urinary Incontinence Quality of Life scale (I-QoL) - self-assessment scale for assessing the quality of life of patients with urinary incontinence. Adjusted Oxford scale to assess pelvic floor muscle strength. PERFECT scheme by Laycock and Jerwood. Pelvic floor examination by perineometer (Peritron-Ontario, L4V, Canada). Pelvic floor examination by 2D and 3/4D ultrasound examination (Volunson-i BT 11 Console, VCI volume contrast imaging software, (GE Healthcare Austria GmbH & Co OG, Zipf, Austria, RAB4-8-RS 3D/4D 4-8 MHz probe). High intensity exercise of pelvic floor muscles with stabilization elements.

CONCLUSION

The effect of pelvic floor muscle training was objectively proved by the above mentioned objectivization methods with subjective improvement of quality of life. There was also a significant effect of education in USG exercise.

Risk factors of preterm birth and low birth weight neonates among Roma and non-Roma mothers

OBJECTIVE

This study analyses the differences in birth outcomes between Roma and non-Roma mothers and investigates the potential causes of such differences.

METHODS

We conducted a retrospective cohort study of 1,989 non-Roma and 799 Roma mothers who gave birth in 2014 and 2015 at the Gynaecology and Obstetrics Clinic of Louis Pasteur University Hospital in Košice. Data on mothers and new-born infants have been obtained from the birth book and from the reports on mothers at childbirth. For low birth weight we considered the weight of a new-born weighing less than 2,500 grams and as for premature birth we referred to childbirth before pregnancy week 37. The file was split by ethnicity and statistically processed in IBM SPSS Statistics 21.0.

RESULTS

Our results confirmed a lower birth weight among Roma children (-365.4 grams, p < 0.001). The shorter gestation age and higher risk of premature birth were not statistically significant regarding Roma children. Based on the characteristics of Roma mothers, they are at higher risk of giving birth as minor (OR = 23.64; 95% CI = 15.29-36.54; p < 0.001), as single mothers (OR = 7.13; 95% CI = 5.80-8.76; p < 0.001), with basic education or lack of education (OR = 141.31; 95% CI = 100.47-198.76; p < 0.001). They also have a higher risk of smoking during pregnancy (OR = 23.84; 95% CI = 18.06-31.49; p < 0.001); drinking alcohol (OR = 11.71; 95% CI = 3.36-40.90; p < 0.001) and taking drugs (OR = 8.70; 95% CI = 1.81-42.02; p < 0.001). Roma women attended gynaecologists more rarely.

CONCLUSION

It is therefore important to support the work of community health workers and stimulate collaboration between community health professionals, paediatricians and gynaecologists to overcome institutional barriers in maternity and child care for mothers living in Roma settlement.

Prevalence of lifestyle and cardiovascular risk factors in a group of medical students

OBJECTIVE

The aim of the cross-sectional study was to evaluate cardiovascular risk factors in the group of medical students with gender, overweight and obesity categorisation.

METHODS

Cross-sectional study included 364 medical students, 207 females and 157 males. We investigated anthropometric parameters, BMI, body fat percentage, WHR (waist-hip ratio), TCH (total cholesterol) and LDL-CH (LDL-cholesterol), SBP and DBP (systolic and diastolic blood pressure). The participants also completed questionnaires with socio-demographic characteristic, including smoking, unhealthy eating, self-perceived health, and physical activity status. Statistical analysis used t-test differences in arithmetic means and OR calculation with 95% CI.

RESULTS

Prevalence of increased blood pressure (> SBP/DBP 120/80 mmHg) among participants was 10.99% (SBP) and 9.07% (DBP). The results confirmed risk of "overweight + obesity" in 15.38% (using BMI evaluation) versus 18.54% cases (using body fat percentage evaluation). The results of the study confirmed statistically higher risk for males compared to females in the following parameters: SBP, DBP, BMI, body fat percentage, self-perceived health, unhealthy eating and body weight watching. "Overweight and obesity" group (BMI evaluation) confirmed all factors on statistically significant level a risky group: SBP, DBP, body fat percentage, TCH, self-perceived health, smoking, stress at university, and body weight watching. The outputs confirmed, on the other hand, low amount of clinical obesity (0.8%), clinical hypertension (BP > 140/90) 1.1%, and clinically higher cholesterol level (TCH > 5.2 mmol/l) in 8.7% participants.

CONCLUSIONS

We confirmed higher prevalence or cardiovascular risk factors among males. Also, group of "overweight and obese" students had higher frequency of cardiovascular risk factors. Border limits for risk evaluation were strong, so on clinical level we can evaluate the group of medical students as healthy. In the group of young medical students, we confirmed lower frequency of risk factors compared to the Slovak population average.

β-Escin Effectively Modulates HUVECS Proliferation and Tube Formation

In the present study we evaluated the anti-angiogenic activities of β-escin (the major active compound of Aesculus hippocastanum L. seeds). Human umbilical-vein endothelial cells (HUVECs) were used as an in vitro model for studying the molecular mechanism underlying the anti-angiogenic effect of β-escin. We investigated the in vitro effects on proliferation, migration, and tube formation of HUVECs and in vivo anti-angiogenic activity was evaluated in a chick chorioallantoic membrane (CAM) angiogenesis assay. Moreover, the effect on gene expressions was determined by the RT2 ProfilerTM human angiogenesis PCR Array. It was found that β-escin exerts inhibitory effect on the basic fibroblast growth factor (bFGF)-induced proliferation, migration and tube formation, as well as CAM angiogenesis in vivo. The inhibition of critical steps of angiogenic process observed with β-escin could be partially explained by suppression of Akt activation in response to bFGF. Moreover, the anti-angiogenic effects of β-escin could also be mediated via inhibition of EFNB2 and FGF-1 gene expressions in endothelial cells. In conclusion, β-escin affects endothelial cells as a negative mediator of angiogenesis in vitro and in vivo and may therefore be considered as a promising candidate for further research elucidating its underlying mechanism of action.

Analysis of transcriptional activities of angiogenic biomarkers during intrauterine complications leading to preterm birth

OBJECTIVE

Pre-eclampsia, growth retardation and preterm delivery are the most common reasons leading to increased maternal and perinatal mortality. The increased expression of hypoxia induced factors, such as HIF-1, triggers the overexpression of anti-angiogenic genes. The aim of this study was to determine the transcriptional activity of individual pro- and anti-angiogenic markers (VEGF, HIF-1, sEng, Flt-1, PlGF-1) in maternal blood samples from patients with spontaneous preterm labor, preterm labor in combination with pre-eclampsia and fetal growth restriction in comparison with physiologically terminated pregnancies.

PATIENTS AND METHODS

The transcriptional activity of specific genes was detected from the blood of patients using the chromatin immunoprecipitation capture method coupled with quantitative real-time PCR.

RESULTS

The maximum differences in mRNA levels of PlGF-1 and VEGF-A were detected in two groups: the group of normal-term birth with complications and the group of preterm labor with complications (both significantly lower than the control, p < 0.001). In contrast, a marked increase of mRNA levels was found in the same groups of patients for the HIF-1, endoglin and Flt-1 genes (p < 0.001).

CONCLUSIONS

According to our results, we can conclude that increased oxidative stress, increasing the expression levels of anti-angiogenic genes and reduction of the transcriptional activity of pro-angiogenic genes can provide additional information during diagnostics of pathological complications of labor.

[Risk of the prolapse "de novo" in primary unaffected compartment by using the syntethic mesh in the surgery treatment of the pelvic organe prolapse]

OBJECTIVE

The aim of this retrospective trial was to evaluate the risk of the prolapse "de novo" in primary unaffected compartment by using the syntethic mesh.

DESIGN

Rerospective multicentric trial.

SETTING

2nd department of Gynaecology and Obstetrics, Medical Faculty of Safarik's University and L. Pasteur Hospital, Kosice and Gynaecology department, Gynpor, s.r.o., Sliac, Slovakia.

POPULATION AND METHODS

One hundred and eleven women with stage > or = 2 prolapse according to the Pelvic Organe Prolapse - Quantification (POP-Q) system was enrolled into the study. In group MESH A (anterior compartment) was 86 (17x Prolift Anterior; 69x Prolift Anterior like MESH and group MESH P (posterior compartment) was 25 (9x Prolift Posterior; 16x Prolift posterior like MESH) of enrolled women. The primary outcome was the risk of POP > or = 2 "de novo" prolapse in primary unaffected compartment at 12 months follow-up. The second was the efficacy of the treatment by using synhetic mesh. Third was: Did uterus sparing operation increase the risk of reccurance of the prolapse. Complications was also reported.

RESULTS

For subject attendigs the 12-month follow-up, the risk of "de novo" prolapse in MESH A group was 20.9% (17/86) compared with only 16% (4/25) in the MESH P group and was not significantly different (p<0.13). The efficacy was 91.6% in the MESH A group and 84% in the MESH P group and was not significantly different. Uterus sparing operation did not increase the risk the prolapse,,de novo" in primary unaffected compartment. Vaginal mesh exposure occured in 14.4%.

CONCLUSION

Vaginal repair by using MESH is effective in the treatment of the pelvic organe prolapse, but is posible to provoke the development of prolapse in primary unaffected compartment.

[The impact of exogenous luteinizing hormone on IVF/ICSI cycles parameters]

OBJECTIVE

To evaluate the effect of exogenous luteinizing hormone on IVF/ICSI success.

DESIGN

Retrospective clinical study.

SETTING

2nd Department of Gynaecology and Obstetrics, Medical Faculty and L. Pasteur University Hospital Kosice, Slovak Republic.

METHODS

Individual parameters and clinical pregnancy rate of 232 IVF/ICSI cycles were compared in dependence on stimulation protocol (pure rFSH vs. rFSH and 75 IU rLH from S7).

RESULTS

There was no statistically significant difference in IVF/ICSI success between individual groups and subgroups, but we demonstrated the increase in clinical pregnancy rate per ET in agonist cycles group with exogenous LH activity totally above 11% (27.6% vs. 38.6%), in patients under 35 years above 12% (30.4% vs. 42.6%) and in patients over 35 years above 14% (16.7% vs. 30.8%). In antagonist cycles group there was demonstrated the increase in clinical pregnancy rate only in women over 35 years - above 14% (13.3% vs. 30.8%).

CONCLUSIONS

Despite of negative statistical analyses, from the clinical point of view we can strongly recommend the LH addition during COH, especially in agonist cycles and in older women.

Photodynamic effect of hypericin in primary cultures of human umbilical endothelial cells and glioma cell lines

Hypericin is the most powerful naturally occurring photosensitizer and as such there is renaissant interest in the potentials of this compound for anticancer photodynamic therapy (PDT). The purpose of this study was to investigate the hypericin-mediated photodynamic therapy effects on normal human umbilical endothelial cells (HUVECs) in comparison with cancer human glioma cell lines U-87 MG and U-373 MG, in in vitro conditions. The data suggest that endothelial cells as well as glioma cell lines are sensitive only to photoactivated hypericin. The inhibitory effects of photoactivated hypericin did not differ in endothelial compared with tumor cells in cytotoxicity MTT and DNA fragmentation assays. However, an important difference in sensitivity was found between the above mentioned cell types in migration and metalloproteinases inhibition assays performed as cell function tests. The findings in both function tests were supported by the high sensitivity of endothelial cells in an additional angiogenesis test of tubular formation in vitro.

In vitro antiproliferative and antiangiogenic effects of Flavin7

Flavin7 (F7) is a nutritional supplement often taken by cancer patients in Central Europe during chemo- and radiation therapy. In this study, investigation of the antiproliferative and antiangiogenic activities of this supplement were performed. Flavin7 showed antiproliferative activity in Jurkat as well as in HeLa cells. It significantly reduced the growth of both cancer cell lines at the doses of 200 microg/ml to 20 microg/ml (p<0.001 and p<0.01, respectively). In F7-treated Jurkat cells we found a significant increase in the fraction of cells with sub-G(0)/G(1) DNA content, which is considered to be a marker of apoptotic cell death. Apoptosis was also confirmed by annexin V staining and DNA fragmentation. Furthermore, F7 at the doses of 100 microg/ml to 4 microg/ml inhibited endothelial cell migration and capillary tube formation what indicates its potential antiangiogenic properties. Flavin7 also inhibited the activity of matrix metalloproteinases (MMPs), preferentially MMP-9, at the doses of 100 microg/ml to 4 microg/ml. Our data suggest that F7 possesses marked antiproliferative and antiangiogenic properties in vitro. Further research is needed to elucidate also its in vivo activities.

[Prediction of preeclampsia using the integrated test markers]

OBJECTIVE

Author's objective was to ascertain the option for prediction of preeclampsia using the integrated test markers on the population of pregnant women in Kosice city.

DESIGN

Retrospective, longitudinal, multicenter study.

SETTING

2nd Department of Obstetrics and Gynecology University of P. J. Safárik, Kosice, Slovak Republic.

METHODS

The study group comprised 578 pregnant patients of 2nd Department of Obstetrics and Gynecology, the period from 01.11.2001 until 31.01.2005 for integrated test consisting of (CRL, NT, concentration of PAPP-A, uE3, hCG, AFP). Primary outcome was defined as incidence of preeclampsia during pregnancy. Data on incidence of preeclampsia was collected from birth journals and records in 578 patients retrospectivelly. In order to make use of the summary information provided by the markers we have used the method of logistic regression to identify statistically significant predictors of the binary outcome measure of preeclampsia. First we developed an equation based on all available predictors. Statistically insignificant predictors were gradually eliminated from the model (Stepwise regression) until the final model remained, for which a ROC curve was developed and values of sensitivity, specificity, positive and negative predictive values at 5% FP (false positivity) were calculated.

RESULTS

The final model of preeclampsia, which is based only on statistically significant markers of integrated test achieved--at 5% FP and 95% specificity--36.4% sensitivity and 22.7% positive and 97,4 negative predictive value for prediction of preeclampsia in pregnant women.

CONCLUSION

Our results, as well as the results of other studies, lead to the conclusion, that in spite of the multitude of biochemical markers and various options for their combination with ultrasound markers for prediction of preeclampsia, so far it has been impossible to find a combination which would meet the following criteria: (1) high sensitivity and specificity at low false positive values and high positive and negative predictive value, (2) application as a screening method for prediction of preeclampsia in unselected population of pregnant women.

[Prediction of intrauterine growth retardation using the integrated test markers]

OBJECTIVE

Author's objective was to ascertain the option for prediction of intrauterine growth retardation using the integrated test markers on the population of pregnant women in Kosice city.

DESIGN

Retrospective, longitudinal, multicenter study.

SETTING

2nd Department of Obstetrics and Gynecology University of P. J. Safárik, Kosice, Slovak Republic.

METHODS

The study group comprised 578 pregnant patients of 2nd Department of Obstetrics and Gynecology, in the period from 01.11.2001 until 31.01.2005 for integrated test consisting of (examination of the gestation age using CRL, concentration of PAPP-A, NT, AFP, uE3, hCG). Information on birth weight, gender, gestation age at the time of delivery, occurrence of preeclampsia and other pregnancy complications were found in 578 patients retrospectivelly. We have designed two outcome criteria: 1. intrauterine growth retardation <5th fetal weight percentile - IUGR 5 - and intrauterine growth retardation <10th percentile - IUGR 10. In order to make use of the summary information provided by the markers, we have used the method of logistic regression to identify statistically significant predictors of individual binary outcomes (IUGR 5 and IUGR 10). First we developed an equation based on all available predictors. Statistically insignificant predictors were gradually eliminated from the model (Stepwise regression) until the final model remained, for which a ROC curve was developed and values of sensitivity, specificity, positive and negative predictive values at 5% FP (false positivity) were calculated.

RESULTS

The final model of IUGR 5, containing only statistically significant markers of integrated test achieved - at 5% FP level and 95% specificity level - a 34.8% sensitivity, 24.1% positive and 97.0% negative predictive value - in prediction of birth weight under 5th percentile with respect to gestation age and gender. The final model of IUGR 10, containing only statistically significant markers achieved - at 5% FP level and 95% specificity level - a 36.4% sensitivity, 32.1% positive and 95.8% negative predictive value - in prediction of birth weight under 10th percentile with respect to gestation age and gender.

CONCLUSION

Our results, as well as the results of other studies, lead to the conclusion, that in spite of the multitude of biochemical markers and various options for their combination with ultrasound markers, so far it has been impossible to find a combination which would meet the following criteria: 1. high sensitivity and specificity at low false positive values and high positive and negative predictive value, 2. application as a screening method for prediction of intrauterine growth retardation and preeclampsia in unselected population of pregnant women.

[Pulsatility index and resistance index in the aortic bifurcation area of growth retarded fetuses]

To specify diagnostic importance of fetoplacental flow parameters PI, RI during pregnancy complicated by ultrasonografically detected intrauterine growth retardation-IUGR.

SETTING

Dpt. of Obstetric and Gynaecology, Safarik's University and University Hospital L. Pasteur, Kosice, Slovak Republic, Obst/Gynae Dpt., Victoria Hospital, Mahé, Seychelles Republic, Indian Ocean.

SUBJECT AND METHOD

The autors measured fetal circulation on the level of descending aortal bifurcation. The results were compared in the Group-A of 112 pregnancies complicated by mild, moderate and several praeeclampsia, eclampsia with detected IUGR, and comparative Group-B of 106 pregnancies.

INTERVENTION

The ACUSONIC 8, ALOKA 680 SSD using transabdominal 3.5 MHz probe with color doppler facility. The parameters were measured in weekly intervals according the clinical protocol for management of high risk pregnancies.

SUBJECTS

There was opened a prospective comparative study of 112 risk pregnancies (Group-A) and a comparative Group-B of 106 pregnancies with normal growth of fetuses. Group-A was devided according classification of praeeclampsia to Subgroup-A1, mild praeeclampsia, Subgroup-A2, moderate praeeclampsia, Subgroup-A3, severe praeclampsia and Subgroup-A4, eclampsia. Parameters of vascular resistance in descending aorta were calculated from 28th week of gestation to termination of pregnancy and compared average values in corresponding stage in the Group-A and the comparative Group-B. Number of IUGR fetuses or restricted with the growth were calculated in Subgroups-A.

RESULTS

Descending aorta presents significantly higher average values of PI, RI during pregnancy from 28th week of gestation in Group-A. There is no evidence of diastolic decrease after 34th week of gestation in Group-A. In Group-A 52.6% fetuses were ultrasonograficaly IUGR detected or restricted. In Subgroup-A1 of mild praeeclampsia were 20.5% of the IUGR fetuses. Subgroup-A2 of moderate praeeclampsia showed 51.3% and Subgroup-A3 severe praeeclampsia 87.8% of the IUGR fetuses of restricted. Three cases of eclampsia were restricted for growth.

MAIN OUTCOME

Functional assessment of the descending aorta flow is the most reliable method for differentiation of praeclamptic and eclamptic pregnancies with suspected fetal starvation and intrauterine growth retardation.

Detection of virulence factors in alpha-haemolytic Escherichia coli strains isolated from various clinical materials

In total, 201 alpha-haemolytic Escherichia coli isolates from various clinical materials (urine samples and vaginal and rectal swabs) were examined by PCR for the presence of genes for the virulence factors alpha-haemolysin (hly), cytotoxic necrotising factor type 1 (cnf1), P-fimbriae (pap), S/F1C-fimbriae (sfa/foc), aerobactin (aer) and afimbrial adhesin (afaI). Among vaginal isolates, 96% were positive for cnf1, compared with 80% of urine strains (p 0.02) and 63% of rectal strains (p 0.0001). Similarly, sfa/foc-specific DNA sequences were found in 97% of vaginal isolates compared with 75% of rectal strains (p 0.004). The afa1 and aer genes were associated more with rectal alpha-haemolytic E. coli strains than with extra-intestinal isolates. The results suggested that CNF1 and/or S/F1C-fimbriae contribute to colonisation and persistence of alpha-haemolytic E. coli strains in the vaginal environment.