The antitumoral effect of the esculetin in HeLa cells through endoplasmic reticulum stress

OBJECTIVE

Despite the multiple available treatment modalities, cervical cancer is one of the leading causes of mortality and morbidity among female gynecological cancers. Endoplasmic Reticulum (ER) is an effective organelle in ensuring cell homeostasis and is closely related to the development of cancer. Esculetin is a coumarin derivative that has anticancer, anti-inflammatory, antioxidant, and neuroprotective effects. Esculetin may have an anticancer effect by inducting apoptosis and ER stress. In this study, we evaluate that esculetin has an anti-tumor effect on human cervical cancer-derived (HeLa) cells via ER stress.

MATERIALS AND METHODS

Esculetin was applied to the HeLa cells, and a viability test was performed using the methyl thiazolyl tetrazolium proliferation (MTT) assay. Expression levels of apoptotic genes and anti-apoptotic genes were determined by real-time polymerase chain reaction. The results were statistically evaluated.

RESULTS

Analysis of the MTT assay detected that esculetin inhibited HeLa cell viability development. Based on Western blot and quantitative real-time polymerase chain reaction (qPCR) analyses, esculetin destroyed cervical cancer cells via the ER stress pathway.

CONCLUSIONS

The results showed that esculetin may have a potent antitumoral effect. It can potentially be utilized in the pharmacological therapy of cervical cancer.

The role of shear wave elastography in predicting endometrial cancer in patients presenting with abnormal uterine bleeding

OBJECTIVE

Shear Wave Elastography (SWE) is an objective quantitative ultrasound elastography technique that can demonstrate the stiffness of anatomical structures to aid in their detection and characterization. We aimed to evaluate the role of shear wave elastography in differentiating endometrial carcinoma from benign uterine pathologies in women with abnormal uterine bleeding.

PATIENTS AND METHODS

This prospective study was conducted at our institution from January 2020 to April 2020. A hundred patients with endometrial sampling planned and SWE due to abnormal uterine bleeding were included in the study. According to the histopathological results of the patients, those with normal and atrophic endometrium results were defined as group I (control group), those with benign results such as polyps and endometrial hyperplasia were defined as group II, and those with endometrial cancers were defined as group III.

RESULTS

After adjustment for age, a statistically significant difference was found in Emean (mean and adjusted mean) value between the study groups (F2.96=86.37, p<.001, η2=0.64). The post-hoc analysis was performed with a Bonferroni adjustment. The mean Emean value was found to be statistically significantly higher in group III (17.14±0.40) compared to group I (10.39±0.26) and group II (11.49±0.32) (p<0.001). In addition, a statistically significant difference was found between the benign and normal groups.

CONCLUSIONS

As a new diagnostic technique in gynecology, elastography appears to be a valuable tool in differentiating malign endometrial pathologies from normal or benign endometrial pathologies in females with abnormal uterine bleeding.

Prediction of lymph node metastasis based on tumor size in stage 1A endometrioid endometrium cancer

OBJECTIVE

Endometrium cancer (EC) is the most prevalent cancer affecting women in developed countries. There is debate about the need to perform lymphadenectomy in cases with a tumor diameter >2 cm. The aim of our study is to research the prediction of lymph node metastasis using tumor size in stage 1A endometrioid endometrium cancer (EEC).

PATIENTS AND METHODS

The study enrolled cases operated in the clinic due to stage 1A EEC (FIGO 2009) from December 2010-2021. The correlations of age, age interval, parity, type of operation, tumor diameter, myometrial invasion, histological grade, and lymph node metastasis were statistically analyzed. The cut-off point for tumor size was determined with the ROC curve and Youden index.

RESULTS

The study analyzed a total of 292 cases, and the mean age of cases was 62.3±10.0 years. Of the cases, 79.5% had histological grade 1, and 20.5% had grade 2. Myometrial invasion ≤50% was detected in 69.5%, and no myometrial invasion was detected in 30.5%. The mean tumor diameter was 34.0±18.0. Lymph node metastasis was identified in 6 cases (2.1%). Based on the tumor diameter cut-off value of 35 mm, sensitivity was 100%, and specificity was 50.3%. 116 cases with tumor diameter >35 mm and 176 with diameter ≤35 mm, and grade 2 histology and lymph node positivity were found statistically significant between these groups (respectively, p=0.012 and p=0.038). The lymph node metastasis risk was 0% in cases with tumor diameter ≤35 mm, while it was 5.2% in cases with tumor diameter >35 mm.

CONCLUSIONS

The general approach in stage 1A EEC is not to perform lymphadenectomy. However, when the tumor diameter is noted, lymphadenectomy may be considered as the lymph node metastasis risk increases in cases with a tumor diameter of 35 mm or more. There is a need for more clinical studies on this topic.

Evaluation of T-cell subsets in pregnant women infected with SARS-CoV-2

OBJECTIVE

Immune responses to SARS-CoV-2 are the main cause of tissue damage in coronavirus disease 2019. However, the pathophysiological mechanism of the disease has not been fully elucidated. The aim of this study was to examine T cell subsets of pregnant women infected with SARS-CoV-2 and evaluate the relationship between the possible differences in trimesters and clinical findings of the disease.

MATERIALS AND METHODS

Fifty-six pregnant patients with SARS-CoV-2 and 61 healthy pregnant controls were included in the study. T cell subsets were analyzed by flow cytometry.

RESULTS

The CD3+ total T cell (p = 0.006 and p = 0.027) of pregnant patients infected with SARS-CoV-2 in second and third trimesters was found to be lower than in the control group. CD3+CD4+ helper T cell (p = 0.035), Treg (p = 0.001), and Treg/Th17 ratio (p = 0.001) were found to be lower in the third trimester patients infected with SARS-CoV-2 than in the controls. Significant decreases were observed only in the Treg (p = 0.001) and Treg/Th17 ratio (p = 0.001) in the first trimester patients infected with SARS-CoV-2 compared to the controls. When trimesters were compared in terms of T subsets, no difference was found (p > 0.05).

CONCLUSION

The CD3+ total T cell (p = 0.001), CD3+CD4+ helper T cell (p = 0.011), Treg (p = 0.001), and Treg/Th17 ratio (p = 0.001) were found to be lower in pregnant women infected with SARS-CoV-2. This difference was associated with the development of pneumonia but not with adverse pregnancy outcomes.

Is HPV-negative cervical carcinoma a different type of cervical cancer?

OBJECTIVE

Human papillomavirus (HPV), which is known to play a very important role in genital area (vulva, vagina, and cervix) cancers in women, is responsible for almost all cervical cancers. However, a significant proportion of cervical carcinomas (approximately 7%) is HPV-negative. Therefore, there are still two important questions to be answered: 1. Why is HPV  Deoxyribonucleic acid (DNA) not found in all cervical carcinomas? 2. Are HPV-DNA-negative cervical cancers a specific subgroup of cervical cancers with different biological behavior (worse prognosis)? In this article, we aimed to evaluate the clinicopathological characteristics and survival of patients with confirmed HPV-negative tumors in order to answer these two questions.

PATIENTS AND METHODS

A total of 97 patients who underwent HPV-DNA testing and received a histological diagnosis of cervical cancer were included in the study. 14 HPV-DNA negative and 83 HPV-DNA positive cervical carcinoma patients were detected. Demographic profiles, clinicopathological characteristics, progression-free, and overall survival of all patients were analyzed.

RESULTS

Women with HPV-negative tumors were diagnosed at an older age range (p=0.05), and their demographic data other than age range were similar to HPV-positive tumors. P16 staining pattern was not observed in any of the HPV-negative tumors (p=0.001), and a positive P53 staining pattern was detected in 35.7% of the HPV-negative tumors. Although disease-free survival (PFS) (p=0.224) and overall survival (OS) (p=0.219) were worse in the HPV-negative patient group, this difference was not statistically significant.

CONCLUSIONS

HPV-negative cervical cancers do not have a poor prognosis unlike their counterparts in other anatomical regions where HPV-associated tumors are present.

Lymph node size detected by magnetic resonance imaging for prediction of lymph node involvement in locally advanced cervical cancer

OBJECTIVE

To investigate lymph node (LN) size detected by Magnetic Resonance Imaging (MRI) for prediction of LN involvement in locally advanced cervical cancer (LACC).

PATIENTS AND METHODS

A total of 55 cases diagnosed with LACC (IIB-IVA FIGO 2018) between 28 December 2010 and 30 October 2020 were evaluated in this retrospective study. LN involvement was evaluated in patients who underwent surgical staging and MRI. The prediction of LN involvement based on LN size on MRI was calculated statistically.

RESULTS

The mean age of 55 patients was 56 (33-78) years. For the cases, 76.4% were stage IIB, 12.7% were stage III, and 10.9% were stage IVA. Squamous cell histological type was detected with a rate of 90.9%. The cut-off value for pelvic LN diameter on MRI in predicting pelvic LN involvement was 18.5 mm, and the sensitivity and specificity values were calculated as 50.0% and 93.6%, respectively (p=0.027). The cut-off value for pelvic and para-aortic LN diameter on MRI in predicting pelvic and para-aortic LN involvement was 17.0 mm with a sensitivity of 41.7% and specificity of 88.4% (p=0.081).

CONCLUSIONS

In LACC, prediction of LN involvement by LN diameter detected on MRI has moderate sensitivity and high specificity with a cut-off value of 17.0 mm.

Effect of lymph node sampling type on oncologic outcomes in endometrial cancers: comprehensive pelvic and paraaortic lymphadenectomy vs. sentinel lymph node mapping with indocyanine green

OBJECTIVE

Sentinel lymph node biopsy refers to an innovative and minimalist surgical approach that has been introduced to reduce both complications and morbidity. A definitive answer to the question of whether lymphadenectomy is performed for staging or curative purposes in endometrial cancer has not yet been found. The aim of this study is to compare patients who underwent sentinel lymph node biopsy with indocyanine green and those who underwent laparoscopic complete surgical staging in terms of survival.

PATIENTS AND METHODS

A total of 182 patients was included in the study. The patients were divided into two groups according to the lymph node sample type. The two groups were compared in terms of oncological outcomes.

RESULTS

92 patients underwent sentinel lymph node mapping (SLNM cohort) and 90 patients underwent extensive pelvic and paraaortic lymphadenectomy (SCL cohort). Considering only patients with negative lymph nodes, the Sentinel cohort was associated with a reduced DFS and OS (p=0.008 and p=0.005, respectively). This difference may be due to the longer follow-up times of patients with comprehensive lymph node sampling. On the other hand, There was no difference in survival in lymph node positive cases.

CONCLUSIONS

Sentinel lymph node dissection has no negative effect on survival in lymph node positive patients.

The usability of the ratio of bi-humerus breadth to maximum pelvic breadth in sex estimation

BACKGROUND

Although sex can be determined with high accuracy in forensic anthropology, additional parameters are still required.

AIM

To estimate with known simple statistical methods, the usability of the bi-humerus/maximum pelvic breadth ratio in sex estimation.

SUBJECTS AND METHODS

Bi-humerus breadth and maximum pelvic breadth were measured using the topogram images (196 males, 171 females), the ratio between them was calculated. We examined the usability of the ratio of the distance between the lateral edges of the right and left humeral heads to the maximum distance between the two most lateral parts of the iliac crests in sex estimation.

RESULTS

There was significant difference in the bi-humerus breadth and "bi-humerus breadth/maximum pelvic breadth" according to sex. The greatest breadth of the pelvis was higher in females, yet the difference was not statistically significant. The ratio yielded 80.6%-90.3% accuracy for females and 73.6%-74.7% for males, depending on arm position.

CONCLUSIONS

The obtained data may contribute to the development of formulas created with metric measurements used in sex estimation. This can be used as a parameter to help in estimating the sex of skeletal remains found as a whole or excavated without losing their integrity, and also in the reconstruction of body structure.

Development of a Fast-Spectrum Self-Powered Neutron Detector for Molten Salt Experiments in the Versatile Test Reactor

The self-powered neutron detector (SPND) is a widely used flux monitor in thermal nuclear reactors. Although this is a mature technology, the current state of the art is tuned for a thermal neutron spectrum, so many of the devices currently in use lack sensitivity to fast neutrons. Because current in SPNDs is produced through nuclear reactions with the neutron flux inside a reactor, sensitivity in SPNDs is determined by the neutron cross section of the neutron-sensitive portion of the detector, termed the emitter. This neutron cross section drops by orders of magnitude between thermal and fast neutron energies for many emitters in currently used SPNDs, with a corresponding drop in current from the detector. This paper discusses efforts to develop a fast-spectrum self-powered neutron detector (FS-SPND) that is sensitive to neutrons with energies ranging from 0.025 eV up to 1 MeV. An in-depth analysis of Evaluated Nuclear Data File (ENDF)/B-VII.1 neutron-capture cross sections was performed, and four new materials were identified that are suitable emitter candidates for use in measuring fast neutrons. All four materials are stable mid-shell nuclei in the region between doubly magic 132Sn and 208Pb. Each candidate was simulated with the Geant4 Monte Carlo simulation toolkit to optimize overall detector efficiency.

Nutrient contents and in vitro digestibility of different parts of corn plant

AbstractThe objective of this study was to assess the nutrient contents and in vitro true digestibility (IVTD) of parts of the corn plant. The corn used in the study was P2088, a variety that is grown widely in Turkey. It had matured and was harvested 140 days after planting. Four replicate plants were separated into nine parts, namely lower stalk, central stalk, upper stalk, corn ear stalk, corn ear shuck, kernels, corn cob, leaf, tassel, plus the entire plant. The samples were dried and ground for analysis. Nutritional values were determined in the laboratory and in vitro digestibility was assessed. Significant differences in nutrient content were observed among parts of the corn plant. The highest crude protein (CP) content was found in the leaf (12.41%), followed by the grain (12.37%). Dry matter (DM) varied from 91.25% to 96.07%. The highest ether extract (EE) was in the grain (2.84%), and the upper stalk contained the least EE (0.29%). The parts also differed in their contents of crude cellulose (CS) and crude ash (CA) (P <0.001). Most organic matter (OM) was found in the corn cup (94.27%). The highest in vitro dry matter digestibility (IVDMD) was in the kernels (79.06%) and the lowest was in the lower stalk (38.13%). In terms of in vitro true organic matter digestibility (OMD) values of the corn plant and its 9 parts, the highest values were found in the kernels and the lowest in the lower stalk.Keywords: crude nutrients, in vitro true digestibility, parts of corn plant

The cultural adaptation of Aberdeen Low Back Pain Scale in Turkish patients and the evaluation of response to physical therapy: A Turkish version study

BACKGROUND

Unvalidated Turkish adaptations of existing low back pain disability scales are often used.

OBJECTIVE

To evaluate the validity and the reliability of the Turkish version of Aberdeen Low Back Pain Scale (ALBP).

METHODS

The cross-cultural adaptation was performed in accordance with recently published guidelines. The Turkish version was administered to 120 patients. Test-retest and internal consistency were evaluated for reliability. Construct validity and criterion validity were measured. Responsiveness of the questionnaire towards changes by the treatment were assessed. All questionnaires were administered at admission, 1 day later, at the end of treatment, and a month after the end of treatment. Patients were assessed with Ostwestry (OLBP), physical and mental component of SF-36 (PCSSF-36, MCSSF-36), Beck Depression Inventory (BDI), Schober test and visual analog scale for pain (VAS).

RESULTS

Retest scores were significant and high (Internal Correlation Coefficent: 0.963). For internal consistency, Cronbach's alpha was 0.889. For construct validity, Spearman's Correlation Coefficent was 0.882. For criterion validity of ALBP, correlations were found significant and acceptable for OLBP, PCSSF-36, MCSSF-36, BDI, and VASactivity (p < 0.05). According to responsiveness; ALBP, OLBP, PCSSF-36, VAS and Schober test showed significant improvement after the treatment (p < 0.05).

CONCLUSIONS

The Turkish version of the ALBP is reliable, valid and responsive.

Turkish Adaptation of Dentine Hypersensitivity Experience Questionnaire (DHEQ)

OBJECTIVE

The Dentine Hypersensitivity Experience Questionnaire (DHEQ) is a valid and reliable instrument for oral health-related quality of life (OHRQoL) studies. This study aimed to assess the Turkish version of the DHEQ and determine the effects of degree of DH, sex, and age on OHRQoL.

MATERIALS

The study participants were 251 DH patients (age 18-78 years; 68.5% female) who completed the Turkish version of the DHEQ. The reliability of the instrument was assessed in terms of internal consistency, using item-total correlations and Cronbach's alpha and test-retest reliability using intra-class correlation coefficients (ICCs) among 51 patients who repeated the DHEQ following a 2-week interval. Construct validity was determined based on exploratory factor analysis (EFA). Convergent validity was tested through correlating DHEQ total and subscale scores with the global rating of oral health and effect on life overall. Discriminative validity was tested by comparing the total and subscale scores against the degree of sensitivity.

RESULTS

Patients with more severe hypersensitivity showed higher DHEQ scores and greater OHRQoL impairment. Female and older (⟩40 years) patients had significantly greater OHRQoL impairment. Cronbach's alpha exceeded 0.70, indicating good internal consistency reliability. The ICC values measured were ⟩0.60 for the overall scale and each subscale of the DHEQ, signifying good to excellent test-retest reliability.

CONCLUSION

The results suggested that the Turkish version of the DHEQ is appropriate for assessing the OHRQoL among people with dentine hypersensitivity.

Temperament and Character Profile in Failed Back Surgery Syndrome: A Cross-Sectional Clinical Study

AIM

Some psychometric properties may predict the development of failed back surgery syndrome (FBSS). The aim of this study was to determine the pain, disability, and depression severity in patients diagnosed with FBSS, and to determine the temperament and character subgroups in comparison with control group.

MATERIAL AND METHODS

Thirty-eight patients diagnosed with FBSS, and 35 patients with favourable outcome after lumbar spinal surgery were included to the study. Pain intensity, disability, depression scores, temperament and character profile were determined by the visual analogue scale (VAS), Roland Morris Disability Index, Beck Depression Inventory, and Temperament and Character Inventory.

RESULTS

Pain intensity, disability, and depression scores were higher in the FBSS group (p < 0.001). There were no significant differences between temperament and character subgroups between study groups except one of the temperament subgroup, reward dependence (p=0.05). There was a negative correlation between self-directedness and leg pain severity in the FBSS group (p=0.01, r=-0.400).

CONCLUSION

No significant differences were found between the FBSS and control groups with respect to temperament and character profile but FBSS was the cause of severe pain, disability, and higher depression scores. This group of patients must therefore be evaluated psychiatrically and should also be subjected to a clinical examination, and they should be managed using a multidisciplinary approach.

Intelligence Functioning and Associated Factors in Children with Cerebral Palsy

Objectives

Cerebral palsy (CP) is described as a primary disorder of posture and movement; however, intellectual impairment is prevalent in children with CP.

Aim

The aim of the present study was to examine the association with intellectual level and gross motor function, hand function, type of CP, and the presence of co-morbid disorders in these children.

Methods

A total of 107 children with CP were included in the study. Intellectual functions of the children were determined by clinical assessment, adaptive function of daily life, and individualized standardized intelligence testing. Gross motor function and hand function of the patients were classified using the gross motor function classification system and the bimanual fine motor function measurements.

Results

The mean age of the patients were 8.10 ± 3.43 years (age: 2–16 years). During clinical typing, we observed that 80.4% of the patients were spastic, 11.2% were mixed, 4.7% were dyskinetic, and 3.7% were ataxic. No significant relationship was determined between the type of CP and intellectual functioning (P > 0.05). Intellectual functioning was found to be significantly correlated negatively with both gross motor function and hand functions level (P < 0.001). The factors related to intellectual functioning were neonatal convulsion (x2 = 12.97, P = 0.002), epilepsy (x2 = 29.221, P < 0.001), and speech disorders (x2 = 23.29, P < 0.001).

Conclusions

There is an association between intellectual functioning in children with CP and the degree of motor impairment, neonatal convulsion, epilepsy, and speech disorders. Intelligence assessment should be an essential part of CP evaluation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Nocturnal hypoxia and functional outcome in stroke patients

BACKGROUND

Sleep disorders and nocturnal hypoxia are common in patients with cerebrovascular disease. Sleep-disordered breathing is associated with a poor functional outcome in stroke patients.

OBJECTIVE

We investigated the relationship between nocturnal hypoxia and functional outcome in the rehabilitation phase of stroke patients.

METHODS

Thirty patients with stroke and 20 controls were included. Functional status was evaluated with the Functional Independence Measure (FIM). Pulse oximetry was performed overnight from 21.00  h to 07.00  h. Baseline awake oxygen saturation, nocturnal oxygen saturation, the lowest nocturnal oxygen saturation, and the >4% Oxygen Desaturation Index (ODI) were calculated.

RESULTS

The mean oxygen saturation measurements were not significantly different among the groups (p >  0.05). There was no significant relationship between the FIM scores and the oxygen saturation measurements of the stroke patients (p >  0.05). The baseline oxygen saturation in patients with disease duration of 3 months or less was 94.67, and it was 96.56 (p = 0.016) in those with disease duration of more than 3 months.

CONCLUSION

This study showed that nocturnal oxygen saturation was not associated with functional outcome in therehabilitation phase of stroke patients.

The role of fetuin-A in cardiac functions and metabolism in peritoneal dialysis patients

AIM

Fetuin-A is a member of protease inhibitors that act as an inhibitor of vascular calcification. In our study, the relationship of fetuin-A with metabolic and echocardiographic parameters in peritoneal dialysis (PD) patients has been investigated.

METHODS

Besides demographic, clinical and laboratory data, fetuin-A level was recorded. Echocardiographic examinations were performed by the same operator.

RESULTS

Fifty-two chronic PD patients (mean age: 52.7 ± 15.4 years) and 31 healthy volunteers (mean age: 41.3 ± 10.7 years) were included. Fetuin-A levels were significantly lower in the patient group (57.5 ± 31.5 ng/mL vs. 72.5 ± 34.0 ng/mL, P = 0.002). There was a significant relation between age and fetuin-A levels (P = 0.025). Four patients with chronic heart failure had significantly lower fetuin-A levels compared with those without. There was no relation between fetuin-A levels and the presence of diabetes mellitus, left ventricular hypertrophy and ischemic heart disease. No relationship was detected between fetuin-A level and any echocardiographic parameter. Age and hematocrite were correlated negatively, and serum albumin positively with fetuin-A levels. On linear regression analysis, fetuin-A level was related with age, hematocrite and presence of heart failure.

CONCLUSION

PD patients with heart failure have significantly lower fetuin-A levels. Age is a main determinant of fetuin-A level and fetuin-A may act as a negative acute phase reactant in PD patients.

BILATERAL RAPIDLY DESTRUCTIVE HIP OSTEOARTHRITIS: A CASE REPORT

Although hip osteoarthritis usually shows a slow progression, a rapidly destructive osteoarthritis is observed in approximately 10% of patients. We aimed to present a case with rapidly destructive osteoarthritis in bilateral hip joints. A 78-year-old male patient was admitted due to pain in hip joints. In examination, hip movements were minimally painful and limited. The patient was able to walk independently with a cane. When he re-applied six months later, hip movements were severely limited and painful. In plain radiographs, while a slight narrowing in hip joint space, sclerosis and minimal osteophyte had been observed at the first administration, extreme narrowing, subluxation, flattening of femoral head, increased sclerosis, resorption in femoral head and acetabulum were detected six months later. We consider that hip osteoarthritis in elderly people should be monitored at frequent intervals in terms of clinic and radiological progression.

Association of clinical androgen excess with radial artery intima media thickness in women with polycystic ovary syndrome

This study explores the relationship between clinical cardiovascular risk factors and clinical androgen excess, with direct comparison to radial artery intima media thickness (rIMT). rIMT of 91 patients with polycystic ovary syndrome (PCOS) were compared with 72 healthy women. Patients were divided into three groups with regard to body mass index (BMI). Group1 = 56 women (31 controls and 25 PCOS) with low BMI(18-22.49 kg/m(2)), Group2 = 36 women (15 controls and 21 PCOS) with normal BMI (22.5-24.99 kg/m(2)) and Group3 = 71 women (26 controls and 45 PCOS) with high BMI (25-30 kg/m(2)). rIMT was significantly higher in patients with PCOS (p = 0.007). rIMT was significantly higher group1 and group3 in patients with PCOS compared to controls (p = 0.007 and p = 0.042, respectively). There was a significant positive association between rIMT levels and fT in women with PCOS in group1 (r = 0.24, p = 0.04). rIMT levels correlated to fT levels in women with PCOS in group3 (r = 0.32, p = 0.03). Modified Ferriman-Gallwey (mFG) scores demonstrated a positive association with free testosterone, total testosterone, free androgen index, waist circumference (WC), LH levels, insulin levels, Homeostasis Model Assessment index(HOMA-IR), rIMT and a negative correlation with sex hormone binding globulin in group1 and group2. mFG scores demonstrated a positive association with free testosterone (r = 0.33, p = 0.029) in group3, but no association was found between mFG and WC, HOMA-IR in group3. Our findings indicate that clinical androgen excess may be associated with cardiovascular disease in patients with PCOS.

Is 25(OH)D Associated with Cognitive Impairment and Functional Improvement in Stroke? A Retrospective Clinical Study

BACKGROUND

In recent years, vitamin D deficiency has been suggested as a risk factor for ischemic stroke and stroke severity in both animal models and clinical studies. In this retrospective study, we investigated the relationship between 25-hydroxyvitamin D [25(OH)D] levels and functional outcomes in stroke patients during neurological rehabilitation program. We also investigated whether there is an association between 25(OH)D levels and cognitive impairment.

METHODS

The study included the medical records of 120 stroke patients who participated in a neurological rehabilitation program. The motor and cognitive components of the Functional Independence Measurements of all patients at admission and discharge were recorded. The Functional Ambulatory Scale was used to assess motor functional status, and the Turkish-validated version of the minimental state examination test was used to assess cognitive status.

RESULTS

A significant correlation was found between 25(OH)D level and cognitive impairment among patients who had ischemic strokes. High levels of 25(OH)D were associated with greater functional gain during the rehabilitation program in both ischemic stroke patients and hemorrhagic stroke patients.

CONCLUSIONS

High 25(OH)D levels might be associated with greater functional improvement and with less cognitive impairment in stroke patients.

Pyometra in elderly post-menopausal women: a sign of malignity

PURPOSE

To describe the clinical and histopathological characteristics of 12 patients with pyometra and highlight the increased incidence of gynecological malignancy in these patients.

MATERIALS AND METHODS

The authors examined the medical records of 12 patients with pyometra, who were treated between 2009 and 2013.

RESULTS

All patients were post-menopausal, and their mean age was 70.83 ± 6.978 years (min = 61, max = 82). To remove purulent fluid via dilation and because of the probability of malignancy, three patients (25%) underwent cervical biopsy and endometrial curettage; the other nine patients (75%) underwent curettage alone, with suitable antibiotic therapy. Of the 12 patients, nine (75%) had gynecologic malignancy [(endometrial cancer, n = 5, 41.6%), (cervical cancer, n = 3, 25%), (uterine leiomyosarcoma, n = 1, 8.3%)]. In three (25%) patients, the cause of pyometra was benign pathologies, among which the most common were leiomyomas (n = 2, 66.6%).

CONCLUSION

Pyometra diagnosed during the post-menopausal period should be considered a complication caused by gynecological malignancy until proven otherwise.

Pentalogy of Cantrell accompanied by scoliosis and pes equinovarus deformity at 12 weeks gestation

Cantrell's pentalogy (CP) is a rare syndrome characterized by defects in the lower sternum with ectopia cordis, anterior diaphragm defects, midline supraumbilical abdominal wall defects, defects in the diaphragmatic pericardium, and congenital heart disease. The authors report a 12-weeks gestation with multiple fetal anomalies suggesting the diagnosis of CP (a large thoraco-abdominal defect with herniating liver and bowel, heart deviated anteriorly with concomitant ventricular septal defect), and the 'S' shaped fetal spine due to increased lumbar lordosis and scoliosis with accompanying pes equinovarus deformity. Chorionic villus sampling was performed due to increased nuchal translucency (3.7 mm). The fetal karotype was found to be 47, XX,+21 (trisomy 21). In the literature, three scoliosis cases have been reported accompanying the CP along with multiple anomalies and one concomitant pes equinovarus deformity has been reported previously.

Evaluation of human chaperonin 10 and high-sensitivity C-reactive protein levels of infertile women who underwent ovulation induction and intra-uterine insemination

INTRODUCTION

The implantation of embryo is one of the crucial steps of a successful pregnancy. The foetus should be protected from maternal immune system, for the appropriate implantation and modification in maternal immunity is crucial. We investigated high-sensitivity C-reactive protein (hs CRP), which is an indicator of low-grade inflammation and Cp10 that has immunosuppressant and growth-promoting capabilities at embryo levels in ovulation induction and intra-uterine insemination (IUI)applied in infertile women. The ovulation induction was maintained by clomiphene citrate or gonadotropins for 42 infertile patients. After successful ovulation induction, IUI was carried out. The blood samples were taken 2 and 8 days after IUI to evaluate Cp10 and hs CRP levels. The pregnant and non-pregnant groups' results were analyzed. The Cp10 levels 8 days after IUI were higher in pregnant group, whereas there was no difference for the 2 days after levels between pregnant and non-pregnant group. The hs CRP levels were similar for both 2nd and 8th days when we compared pregnant and non-pregnant groups. The Cp10 levels increased from day 2 to day 8 in pregnant group. In contrast, the Cp10 levels decreased in non-pregnant group. The change in hs CRP levels from day 2 to day 8 was not significant in pregnant and non-pregnant groups. The Cp10 levels were higher in early phases of fertilisation and elevated through the preceding days of conception in pregnant patients, while it decreased in non-pregnant patients with failed cycles.

Comparison of effects of lower extremity orthoses on energy expenditure in patients with cerebral palsy

OBJECTIVE

The aim of the study was to compare the effects of lower extremity orthoses on energy expenditure in patients with cerebral palsy (CP).

METHODS

We included 48 children with CP using lower extremity orthosis. Energy expenditures determined based on heart rate, yielded an energy expenditure index (EEI) with and without orthosis during walking. RESULTS were compared statistically between orthosis groups (solid polyethylene ankle foot orthosis (PAFO), articulated PAFO, ground reaction foot orthosis (GRAFO), plastic and metallic knee-ankle-foot-orthosis (KAFO), and metallic AFO).

RESULTS

It was found that an advancement in energy expenditure was seen with plastic orthoses which is more prominent by solid PAFO (p = 0.008).

CONCLUSION

It was concluded that especially solid PAFO can be more beneficial in terms of energy consumption in CP patients. In rehabilitation phase, the EEI measurement was seen to be a useful and practical method for choosing the proper orthosis type.

Anti-Müllerian hormone is associated with extrauterine involvement and stage of disease in patients with endometrial cancer

Our aim was to evaluate serum levels of anti-Müllerian hormone (AMH) and also immunohistochemical (IHC) staining properties of AMH receptor type II (AMHRII) in patients with endometrial cancer (EC) and a control group. Preoperatively, serum levels of AMH were assessed and AMHRII expression was evaluated by immunohistochemistry in a benign and malignant group. AMH serum levels of the control group and EC patients were comparable. For EC patients, there was no difference with respect to the AMH levels and tumour stage; grade; histological type; deep myometrial invasion; lymphovascular space invasion or lymph node involvement. However, AMH levels in patients with extrauterine involvement were higher than patients with disease confined to the uterus. EC samples were more likely to be stained positive for AMHRII than benign lesions. Also, as the stage of the lesion worsens, the rate of IHC staining of AMHRII decreases. In conclusion, AMHRII is expressed in normal endometrial cells as well as endometrial cancer cells. AMH levels increase in EC, with extrauterine involvement at least in locally advanced disease. Also AMH expression decreases as the disease is staged-up.

Expression of cyclin A, cyclin E and p27 in normal, hyperplastic and frankly malignant endometrial samples

Cellular growth is under the control of certain molecules such as cyclins and cyclin dependent kinases. Dysregulation of these proteins disrupt cell cycle and may trigger malignant transformation. Cyclins and kinase inhibitors also play essential roles in endometrial cellular proliferation. But the exact roles of these mediators in the disease process is not clear. We evaluated expression of cyclin A, cyclin E and p27 in normal, hyperplastic and malignant endometrial samples assuming different expression patterns in physiological and pathological processes. A total of 75 patients with histopathological diagnosis of normal proliferative, hyperplastic or malignant endometrial samples were evaluated with different cellular proliferation markers, cyclin A, cyclin E and p27. For cyclin E, endometrial cancer samples had higher rate of immunoreactivity than normal proliferative and hyperplastic endometrial samples. Staining properties for cyclin A were comparable for three groups. However, p27 immunoreactivity decreased progressively as lesions progress from proliferative benign endometrium to frank carcinoma. Further large-scale studies with clinical follow-up will reveal the exact role of cyclins on endometrial carcinogenesis.

Role of matrix metalloproteinases and tissue inhibitor of matrix metalloproteinases-1 in Crimean-Congo hemorrhagic fever disease

AIM

Crimean-Congo hemorrhagic fever is a potentially fatal viral disease in humans caused by CCHF virus. We aimed to demonstrate change in serum levels of matrix metallopeinase/tissue matrix metalloproteinase inhibitor (MMP/TIMP) associated with CCHF.

PATIENTS AND METHODS

Blood specimens were collected in acute and convalescence periods from the patients presented to Cumhuriyet University Hospital, Department of Emergency and Infection Diseases with presumed as CCHF between May 2010 and September 2010. Forty-one age and gender matched healthy individuals had not any viral, bacterial, acute or chronic disease were enrolled as the controls. Blood specimens were centrifuged at 4000 rpm for 5 min with in "Hettich universal 32" centrifuge. Serum samples obtained were kept at -80°C. All the specimens were brought to room temperature during the study and MMP-1, 2, 7, 9, 10 and TIMP-1 tests were studied at one time using "RayBiotech" brand kit in "Grifols" brand "Triturus" model ELISA device. Acute, convalescence and control groups were compared in terms of the serum levels of MMP-1, 2, 7, 9, 10 and TIMP-1.

RESULTS

There was a statistically significant increase in serum levels of MMP-1, 7, 9, 10 and TIMP-1 in the convalescence period (p < 0.05) compared to the controls, while the increase in levels of MMP-2 was not statistically significant (p > 0.05). In acute period of CCHF, mean TIMP-1 levels of severe patients was significantly lower than that of the non-severe patients (207913 ± 31051 versus 231300 ± 13267, respectively, p = 0.023).

CONCLUSIONS

High serum levels of MMP and TIMP in CCHF disease were found to decrease as progressed to convalescence from the acute period. It is thought MMP and TIMP plays a significant role in pathogenesis of CCHF.

Evaluation of embryo transfer time (day 2 vs day 3) after imposed single embryo transfer legislation: when to transfer?

To determine whether the timing of embryo transfer (day 2 or day 3) affects pregnancy outcome in IVF patients, receiving single or double embryo transfer, 380 patients were included in this retrospective study. All patients underwent GnRH antagonist protocol. When stratified by number of transferred embryos, single embryo transfer (SET) patients undergoing a day 2 embryo transfer (ET) had similar biochemical pregnancy (25% vs 20.4%; p > 0.05) and clinical pregnancy (16.6% vs 14.6%; p > 0.05) rates to SET patients that were undergoing a day 3 ET. A similar observation was again noted in double embryo transfer (DET) patients undergoing a day 2 ET, with similar biochemical pregnancy (35% vs 29.8%; p > 0.05) and clinical pregnancy (25% vs 15.5%; p > 0.05) rates to DET patients undergoing a day 3 ET. Women, despite age, number of transferred embryos and ET timing, have similar reproductive outcomes. Shortening or lengthening the duration of in vitro culture provides no obvious benefit.

The effects of intrathecal morphine on patient-controlled analgesia, morphine consumption, postoperative pain and satisfaction scores in patients undergoing gynaecological oncological surgery

OBJECTIVE

Gynaecological oncological surgery (GOS) includes a wide variety of surgical procedures and postoperative pain is a major concern. This study compared the impact of intrathecal morphine (ITM) plus patient-controlled analgesia (PCA) with PCA alone on morphine consumption, pain relief and patient satisfaction after GOS.

METHODS

Sixty women undergoing GOS under general anaesthesia were randomized to receive either 0.3 mg ITM or placebo. On arrival at the postanaesthesia care unit each patient received a morphine PCA pump. The three primary outcome measures were pain, patient satisfaction scores evaluated using a 100-mm visual analogue scale and cumulative PCA morphine consumption.

RESULTS

No significant differences were observed in the demographic data. Cumulative PCA morphine consumption was significantly lower in the ITM group compared with the control group. Fatigue scores were lower in the ITM group compared with the control group but did not reach statistical significance. Pain, sedation and patient satisfaction scores, and the rate of side-effects were similar for the two groups.

CONCLUSIONS

Administering ITM in GOS could improve postoperative analgesia and reduce morphine consumption without serious side-effects.

Epidermolysis bullosa simplex associated with muscular dystrophy and cardiac involvement

We report a new clinical variant of epidermolysis bullosa simplex with muscular dystrophy (EBS-MD) that was associated with cardiac involvement. A 33-year-old patient had atrial fibrillation, pericardial effusion, and hypokinetic left ventricular cardiac walls. The muscle biopsy material revealed diffuse endomysial fibrosis and small atrophic muscle fibers with rounded contours. A positive desmin expression with abnormal localization in the subsarcolemmal groups was observed. We concluded that patients with EBS-MD should be investigated carefully when there are associated cardiac findings.