The role of oxidative stress parameters in the differential diagnosis of malignant and benign ascites

OBJECTIVE

Ascites is the pathological fluid accumulation in the peritoneal cavity and there are mainly two reasons for its etiology. These are malignant diseases such as hepatoma or pancreas cancer and benign diseases such as liver cirrhosis and heart failure. In this study, we investigated the diagnostic utility of arylesterase (ARES), paraoxonase (PON), stimulated paraoxonase (SPON), catalase (CAT) and myeloperoxidase (MPO) in the differential diagnosis of malignant and benign ascites.

PATIENTS AND METHODS

This study was conducted between February and September 2016. Patients with acute infection, those taking vitamin supplements and antioxidant medication, smoking, and drinking alcohol were excluded from the study.

RESULTS

The study population consisted of 60 patients: 36 had benign (60%) and 24 had malignant (40%) ascites. The mean age of the patients was 63.3 years. MPO levels (14.2 vs. 4.2; p=0.028) were found to be higher and PON (2.6 vs. 4.5; p<0.001), SPON (10.7 vs. 23.9; p<0.001), ARES (615.7 vs. 823.5, p<0.001) and CAT (13.3 vs. 36.8; p=0.044) were found to be lower in malignant patients compared to benign patients. There was a positive correlation between PON, SPON, and ARES levels, and a negative correlation between MPO levels and SPON, ARES, and CAT levels. MPO levels showed superior diagnostic performance compared to ARES and CAT levels (p<0.05) for predicting malignancy but showed no diagnostic superiority compared to PON and SPON levels (p>0.05).

CONCLUSIONS

PON, SPON, ARES, CAT, and MPO can be used with high sensitivity and specificity in the differential diagnosis of malignant and benign ascites.

Comparison of laparoscopic lateral suspension and laparoscopic sacrocolpopexy with concurrent total laparoscopic hysterectomy for the treatment of pelvic organ prolapse: a randomized controlled clinical trial

INTRODUCTION AND HYPOTHESIS

We compared the outcomes of women who underwent laparoscopic lateral suspension with concurrent total laparoscopic hysterectomy (LLS-TLH) with those of women who underwent laparoscopic sacrocolpopexy with concurrent total laparoscopic hysterectomy (LSC-TLH) for apical and/or anterior vaginal wall prolapse.

METHODS

Eighty women underwent LLS-TLH or LSC-TLH operations. According to the Pelvic Organ Prolapse Quantification System (POP-Q), women with symptomatic pelvic organ prolapse of stage 2 or higher apical and/or anterior compartment prolapse were enrolled in the study. The objective cure rate according to the POP-Q system was the primary (objective) outcome. The International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Patient Global Impression of Improvement (PGI-I) questionnaire scores were the secondary (subjective) outcomes. The primary and secondary outcomes were evaluated at 1 year after surgery.

RESULTS

The primary and secondary outcomes indicated significant improvements in both groups (p < 0.05). The objective cure rate was 92.5% for apical and 78.6% for anterior compartment prolapse in the LLS-TLH group; the respective rates were 100% and 74.1% in the LSC-TLH group. The subjective cure rate was 87.5% for the LLS-TLH group and 90% for the LSC-TLH group. No statistically significant differences between groups were found in the objective cure rate, subjective cure rate, or ICIQ-VS, ICIQ-SF, or PGI-I scores at 1 year (p > 0.05).

CONCLUSIONS

LLS-TLH can serve as a safe, effective, and feasible alternative to LSC-TLH, with low complication rates and similar short-term objective and subjective outcomes.

Incidence and clinical significance of fovea plana in the French population with age-related cataract

BACKGROUND

Fovea plana is defined as an immature macula diagnosed by OCT, showing the unusual shunt of the inner retinal layers into the fovea. The incidence of fovea plana in the adult population remains to be determined. The aim of this study was to determine the incidence of fovea plana in the French population with age-related cataract.

METHODS

Consecutive patients who underwent cataract surgery in Rothschild Foundation Hospital, France, between January and March 2021, with preoperative analyzable OCT scans available, were retrospectively screened in order to determine the incidence of fovea plana in these population. Ophthalmological characteristics of patients were reported, and detailed.

RESULT

Fovea plana was encountered in 20 out of 204 patients during the 3 months corresponding to an incidence of 9.8%. One of those patients had stage 2 fovea plana.

CONCLUSION

Although fovea plana is defined as an immature macula, it is not rare in preoperative population. This macular aspect was not associated with poor visual acuity in our cohort.

Correlation of Preoperative Serum and Intraoperative Peritoneal Lavage Fluid Ca-125 Levels with Postoperative Tumor Histology in Patients with Endometrial Cancer: A Prospective-Controlled Study

BACKGROUND

The role of Ca-125 in endometrial cancer is not fully known. Some authors have reported high Ca-125 levels in patients with recurrent or advanced endometrial cancer, whereas others have stated that Ca-125 levels and the advance of the disease were not correlated in endometrial cancer. This makes it inevitable for clinicians to search for different measurement methods or interpretation of the present tumor markers. The aim of this study was to evaluate the relationship between Ca-125 values of the serum and abdominal lavage fluid and postoperative histopathological parameters in patients with endometrial carcinoma.

METHODS

The study included patients who were diagnosed with endometrial cancer in the Gynecology Clinic and were planned to undergo surgery. The correlations of clinicopathological parameters with preoperative values of Ca-125 measured from serum and abdominal lavage fluid were investigated. The Spearman correlation test was applied in the analysis of correlations of serum and abdominal lavage fluid Ca-125 values with postoperative tumor characteristics.

RESULTS

The serum Ca-125 values were determined to be positively correlated with surgical stage, tumor diameter, and lymph node involvement (p = 0.03; p = 0.04; and p = 0.01, respectively). No correlation was determined between tumor grade and serum Ca-125 level. The level of Ca-125 in the abdominal lavage fluid was observed to be correlated with surgical stage and tumor grade, but not with tumor diameter or lymph node involvement (p = 0.01, p = 0.04, respectively).

CONCLUSIONS

The value of Ca-125 in the abdominal lavage fluid has a positive correlation with the surgical stage and tumor grade in patients with endometrial carcinoma.

Investigation of serum asprosin level in patients diagnosed of polycystic ovary syndrome in adolescent age

Polycystic ovary syndrome characterized by irregular menstruation, high serum androgen levels and infertility in the reproductive period. New markers are being studied to facilitate diagnosis. Asprosin is a peptide that is synthesized during fasting and stimulates glucose production from the liver. High levels of asprosin have been found to be associated with obesity, insulin resistance and diabetes. The aim is to answer the question 'Can serum asprosin level be used as a marker in the initial diagnosis of PCOS in adolescents without any disease?'. A total of 65 people between the ages of 12-18 who applied to the Antalya Training and Research Hospital Gynecology and Obstetrics Polyclinic between June 2020 and January 2021 were included in the study. The group was divided into two as 38 patients newly diagnosed with PCOS and 27 healthy control groups without any pathology. When the asprosin level of the cases diagnosed with PCOS and the cases in the control group were compared, it was observed that the asprosin level of the cases with PCOS was significantly higher (p=0.004). This study was a study showing that serum asprosin level can be used in the diagnosis of PCOS. It should be supported by other studies.

Hair Transplantation in Burn Scar Alopecia After Combined Non-Ablative Fractional Laser and Microfat Graft Treatment

BACKGROUND

Burn scar and alopecia on hair-bearing areas can severely affect the social life of patients. Unlike healthy skin, poor biological and mechanical properties of scar tissue in the recipient area can reduce the survival rate of hair graft following hair transplantation.

OBJECTIVES

The authors sought to determine if combined non-ablative fractional laser (NAFL) and microfat injection could improve the survival rate of hair grafts on post burn scar.

METHODS

Thirteen patients with alopecia resulting from burn scar in hair-bearing areas of the scalp and face were treated with combined NAFL and microfat graft and subsequent follicular unit extraction hair transplantation. Cicatricial alopecia occurred on the scalp, eyebrow, mustache, and beard areas. Patients were treated with 3 to 6 sessions of NAFL and 2 to 5 sessions of microfat graft injections, followed by 1 session of hair transplantation employing the follicular unit extraction technique.

RESULTS

Hair transplantation was successfully performed with good to excellent results. The survival rate of transplanted follicular units ranged from 76% to 95% (mean, 85.04%), and the density success rate per square centimeter ranged from 76.9% to 95.2% (mean, 84.54%). All patients expressed high satisfaction with the results and no complication was encountered.

CONCLUSIONS

Hair transplantation, after combined NAFL and microfat injection, is a promising treatment for post burn alopecia.

LEVEL OF EVIDENCE: 4

Reference ranges for the flow velocities and the indices of the ductus venosus in low-risk pregnancies

Objective:

Ductus venosus blood flow velocity measurements are mandatory in many clinical indications. The evaluation of the flow is performed either by comparing results with general reference tables or by qualitative assessment of the “a” flow, in regard to reversed or absent flow in the spectral waveforms. The aim was to develop normal reference ranges in low-risk pregnancies in our population.

Material and Methods:

Measurements of flow velocities (S, v, D, a) and indices (pulsatility index for veins, peak velocity index for veins, a/S, S/a) were performed by a single experienced specialist in 1279 singleton, uncomplicated pregnancies between 11 and 40 weeks gestation. The absolute flow velocities (S, v, D, a, VmPeak) and indices were obtained from spectral waveforms using the equipment producer’s inbuilt system. The still images were stored in the picture archiving and communication system.

Results:

The predicted reference ranges of the ductus venosus blood flow velocities according to the gestational age are shown in tables and graphics. Predicted reference curves based on the 5th and 95th percentiles according to gestational week were plotted and are given in tables and figures.

Conclusion:

Normal reference ranges for absolute flow velocities and indices were calculated from a population of uncomplicated pregnancies attending a tertiary care center. The measurements were made from both the classic patterns of the waveforms and also considered variants of the spectral waveforms, which have recently been reported, for the first time in the medical literature.

The impact of timing for estrogen supplementation in polycystic ovary syndrome patients undergoing primed in vitro maturation

OBJECTIVE

This study aims to determine the effects of early and late onset estrogen supplementation on the immature oocyte retrieval, fertilization and clinical pregnancy rates in follicle stimulating hormone (FSH) and human chorionic hormone (hCG) primed in vitro maturation (IVM) cycles of the patients with polycystic ovary syndrome (PCOS).

METHODS

This is a retrospective analysis of 161 patients with PCOS who underwent FSH and hCG primed IVM. Group 1 included 120 patients who received early onset estrogen supplementation while group 2 consisted of 41 patients who had late onset estrogen supplementation in primed IVM cycles. Immature oocyte (germinal vesicle and/or metaphase I) retrieval and fertilization rates were the primary outcomes, whereas clinical pregnancy and live rates were the secondary outcomes.

RESULTS

Group 1 patients had significantly higher body mass index and more previous IVF attempts (p = 0.001 and p = 0.008, respectively). All of the retrieved oocytes from the PCOS patients were either germinal vesicle or metaphase I oocytes and there were no metaphase II oocytes among the retrieved oocytes. Both groups had statistically similar numbers of metaphase I and fertilized oocytes (p > 0.05 for both). However, group 1 patients had significantly lower number of germinal vesicle oocytes but significantly higher number of metaphase II oocytes (p = 0.001 for both). Both groups had statistically similar fertilization (85.0% vs 78.0%), clinical pregnancy (49.2% vs 43.9%) and live birth (37.5% vs 39.0%) rates (p > 0.05 for all).

CONCLUSION

Early onset estrogen supplementation appears to improve the quality of retrieved immature oocytes and contribute to the maturation of oocytes in stimulated IVM cycles.

In vitro maturation with letrozole priming: Can it be a solution for patients with cancerophobia? A pilot study

Objective:

To investigate whether letrozole priming could be used efficiently in patients undergoing in vitro maturation (IVM) as compared with follicle-stimulating hormone (FSH) priming.

Materials and Methods:

This is a retrospective analysis of 63 patients who underwent IVM due to the high risk of Ovarian Hyperstimulation syndrome (OHSS) (n=39), cancerophobia (n=16), and desire for IVM after failed in vitro fertilization attempts (n=8). Forty-two patients received FSH priming and 21 patients received letrozole priming.

Results:

The patients who had FSH or letrozole priming were statistically similar with respect to age, body mass index, duration of infertility, basal antral follicle count, serum anti-Müllerian hormone levels, and IVM indications (p>0.05 for all). When compared with the FSH priming group, the number of germinal vesicle oocytes, metaphase II and fertilized oocytes were significantly higher (p=0.003, p=0.001, and p=0.016, respectively), but the number of metaphase I oocytes was significantly lower in the letrozole priming group (p=0.002). The patients who received FSH and letrozole priming had statistically similar rates of implantation (33.3% vs 37.0%, p=0.709), clinical pregnancy (31.5% vs 33.3%, p=0.848), twinning (1.9% vs 3.7%, p=0.611), and live birth (24.1% vs 29.6%, p=0.682).

Conclusion:

Potential indications for IVM include patients with increased risk for OHSS and contraindication for hyperestrogenism. Aromatase inhibitors can be used to preserve the fertility of patients with estrogen-sensitive cancers. Letrozole priming appears to be an efficient approach in patients who undergo IVM, with likely less cost than FSH priming.

Quantitative measurements of celeration times and indexes in the ductus venosus spectral Doppler waveforms in normal fetuses

Background Ductus venosus spectral waveform has two peaks and two nadirs: S, v, D and a velocities, which are obtained after to some extent of accelerations or decelerations throughout a cardiac cycle. It is aimed to define the actual celeration times and indexes and their relationships with the fetal heart rate (FHR). Methods The acceleration times and indexes were measured in 357 patients between 11 and 40 weeks of pregnancies with low risk. Results The FHR has a gradual increasing negative correlation from time for S to time for a with each of the cardiac times of phases according to the statistical analysis (correlations were minus 190, 269, 407 and 541 for S, v, D and a phase times, respectively). The acceleration aS and the deceleration Da have positive correlations with the FHR; however, the deceleration Sv and the acceleration vD do not correlate with the FHR. Conclusion The deceleration Da time and index are the main components for determining the FHR in fetuses. Therefore, the atrial contraction is the strongest component for determining the FHR in fetuses.

Noninvasive determination of the fetal cardiac interatrial pressure gradients by Doppler ultrasonography: preliminary results

Objective: In 2000, Johnson et al. measured the atrial pressures puncturing the atria invasively in 19 fetuses that will be terminated. In this study, it is aimed to define the fetal cardiac interatrial pressure gradient noninvasively. The pressure gradients were calculated using the ductus venosus (DV) and pulmonary vein (PV) blood flow velocities and Bernoulli equation for flowing fluids.Methods: "S," "a," and the time-averaged maximum velocities in both veins of 246 fetuses were used in the simplified Bernoulli equation; Δp=4 ([Formula: see text]). Additionally, the umbilical vein maximum velocity is measured in order to calculate ducto-umbilical pressure gradient.Results: The average interatrial pressure gradient was biggest in the ventricular systole and the least gradient was in the atrial systole of a cardiac cycle. The pressure gradient changes throughout the second and the third trimester have four periods with two increases and two decreases.Conclusions: The interatrial and ducto-umbilical pressure gradients can be measured noninvasively in order to follow the hemodynamic of the fetal circulatory system.

Circulating SCUBE1 levels in women with polycystic ovary syndrome

Objective:

Polycystic ovary syndrome (PCOS) is thought to represent an early manifestation of metabolic syndrome, which is associated with cardiovascular disease. Signal peptide-CUB (complement C1r/C1s, Uegf, and Bmp1)-epidermal growth factor domain-containing protein 1 (SCUBE1) is a platelet activation marker that plays important roles in vascular biology and has been closely linked to cardiovascular events. In the present study, we investigated SCUBE1 levels in lean glucose-tolerant women with PCOS and assessed the possible association between SCUBE1 levels and hormonal and metabolic features of women with PCOS.

Materials and Methods:

The study population consisted of 90 lean [body mass index (BMI) <25 kg/m²] women who were diagnosed as having PCOS using the Rotterdam criteria and 100 age- and BMI-matched healthy controls with no clinical or biochemical feature of hyperandrogenism. Glucose tolerance was evaluated in all subjects before recruitment using the 2 h 75 g oral glucose tolerance test, and only those exhibiting normal glucose tolerance were enrolled. Hormonal and metabolic parameters, and serum SCUBE1 levels were evaluated.

Results:

Circulating SCUBE1 levels were significantly higher in women with PCOS than in controls (5.9±3.9 vs. 4.2±1.4 ng/mL, p=0.022). No association between SCUBE1 level and clinical or biochemical parameters was found in the control or PCOS group.

Conclusion:

SCUBE1 levels are elevated in women with PCOS compared with those in healthy controls; thus, this protein may be an early biomarker of cardiovascular disease later in life.

Increased serum ghrelin in preeclampsia: is ghrelin a friend or a foe?

OBJECTIVES

To investigate maternal serum ghrelin levels in pregnancies complicated by preeclampsia and to explore the relationship between ghrelin level and disease severity.

MATERIALS AND METHODS

This case-control study included 40 healthy pregnant women, 42 women with mild preeclampsia, and 40 women with severe preeclampsia. The groups were matched in terms of maternal and gestational age and body mass index. Serum ghrelin levels were measured via enzyme immunoassay.

RESULTS

Serum ghrelin levels were significantly higher in women with mild and severe preeclampsia than in healthy controls (p < 0.001). Although serum ghrelin levels were somewhat higher in the severe compared to the mild preeclampsia group, the difference was not statistically significant (p > 0.05). In the control group, no significant correlation was observed between ghrelin level and any other parameter, but in the preeclampsia group, serum ghrelin levels were negatively correlated with uterine artery Doppler index values and both systolic and diastolic blood pressure (all p-values < 0.05). Multivariate stepwise linear regression analysis revealed that systolic blood pressure (β = 0.493, p = 0.023) was independently associated with serum ghrelin level.

CONCLUSION

Elevated blood ghrelin levels were correlated with disease severity in pregnancies complicated by preeclampsia.

The impact of electromagnetic radiation (2.45 GHz, Wi-Fi) on the female reproductive system: The role of vitamin C

The present study investigated the effects of applied continuous 2.45 GHz electromagnetic radiation (EMR), which might cause physiopathological or morphological changes in the ovarian, fallopian tubal, and uterine tissues of rats. We proposed that the addition of vitamin C (Vit C) may reduce these severe effects. Eighteen female Sprague Dawley rats were randomly divided into three groups with six animals in each: Sham, EMR (EMR, 1 h/day for 30 days), and EMR + Vit C (EMR, 1 h/day for 30 days 250 mg/kg/daily). Total oxidant status (TOS) and oxidative stress index (OSI) levels increased ( p = 0.011 and p = 0.002, respectively) in the EMR-only group in ovarian tissues. In all tissues, TOS and OSI levels significantly decreased in the Vit C-treated group in ovarian, fallopian tubal, and uterine tissues ( p < 0.05). Anti-müllerian hormone levels significantly increased in the EMR group ( p < 0.05) and decreased in the Vit C-treated groups. Estrogen (E2) levels were unchanged in the EMR group, as the differences were not statistically significant. Immunohistochemical examination of the ovaries revealed significant increases in Caspase-3 expressions in the epithelial cells of the EMR group ( p < 0.05). In the EMR group, hyperemia was observed in uterine tissues. Also, Caspase-3 and Caspase-8 were significantly increased in the EMR group ( p < 0.001). Caspase-3 was significantly diminished with Vit C application in the ovarian and uterine tissues ( p < 0.05). Caspase-8 was significantly diminished only in uterine tissues ( p < 0.05). These results indicate that prolonged EMR exposure induced physiopathological changes in the ovarian, fallopian tubal, and uterine tissues due to oxidative damage. Under the conditions of this study, Vit C may have protective effects on female reproductive system against oxidative damage.

Pathology of cigarettes on the reproductive system and ameliorative effects of alpha lipoic acid: A rat model study

Cigarette smoking (CS) has some detrimental effects that occur via oxidative stress (OS). The aim of this work was to demonstrate the pathological and immunohistochemical effects of CS and the protective effects of a strong antioxidant alpha lipoic acid (ALA) on CS-induced genital system changes in a rat model. Twenty-eight female rats were randomly allocated to three groups as control, CS-exposed, and CS-exposed and ALA-treated. Reproductive tract organs were collected for biochemical and pathological examinations. In the CS group, OS markers increased in the tissues of both the ovary and fallopian tubes. Decreased follicle numbers in the ovary, marked cilial loss in the fallopian tubes, and pathologic changes in the uterus were observed in the CS group. Positive calcitonin gene–related peptide (CGRP), caspase 3α, hypoxia-inducible factor 1α (HIF-1α), tumor necrosis factor-α (TNF-α) immunoreactions were observed in uterine tissues and HIF-1α immunoreactions in tubal and uterine epithelial cells of the CS group. ALA reversed all these findings effectively. CS has negative effects on the female reproductive system via HIF-1α in tuba uterina and HIF-1α, HIF-2α, TNF-α, caspase 3, and CGRP in the uterus, and ALA could protect against the negative effects of CS on the female reproductive system.

The Impact of Surgical Staging on the Prognosis of Mucinous Borderline Tumors of the Ovaries: A Multicenter Study

BACKGROUND/AIM

The purpose of this study was to prove the effect of complete surgical staging of patients with mucinous borderline ovarian tumors (mBOTs) especially appendectomy on progression-free survival (PFS) and overall survival (OS).

PATIENTS AND METHODS

The database of 14 gynecological oncology departments from Turkey and Germany were comprehensively searched for women who underwent primary surgery for an ovarian tumor between January 1, 1998, and December 31, 2015, and whose final diagnosis was mBOT.

RESULTS

A total of 364 patients with mBOT with a median age of 43.1 years were included in this analysis. The median OS of all patients was 53.1 months. The majority of cases had Stage IA (78.6%). In univariate and multivariate analyses, radical surgery, omentectomy, appendectomy, lymphadenectomy, and adding adjuvant chemotherapy were not independent prognostic factors for PFS and OS. Furthermore, FIGO stage (≥IC vs. <IC), radical surgery, and staging surgery were not independent risk factors for recurrence of mBOTs. Finally, abnormal macroscopic appendix and FIGO stage (≥IC vs. <IC) were independent risk factors for appendiceal involvement (p=0.032).

CONCLUSION

Patients with conservative surgery do not have higher recurrence rates. Fertility-sparing surgery should be considered in the reproductive age group. Detailed surgical staging including lymphadenectomy, appendectomy, and omentectomy does not have an impact on survival rates.

Assessment of circulating betatrophin concentrations in lean glucose-tolerant women with polycystic ovary syndrome

The aims of the current study were to investigate the betatrophin levels in lean glucose-tolerant women with polycystic ovary syndrome (PCOS), and to explore the relationships between these levels and antropometric, hormonal and metabolic parameters. The study population consisted of 50 lean (body mass index [BMI] < 25 kg/m²) women diagnosed with PCOS using the Rotterdam criteria, and 60 age- and BMI-matched healthy controls without any features of clinical or biochemical hyperandrogenism. Before recruitment, glucose tolerance was evaluated in all of the subjects using the 2-h 75 g oral glucose-tolerance test, and only those exhibiting normal glucose tolerance were enrolled. Serum betatrophin levels were significantly higher in women with PCOS (median 322.3; range 44.7-1989.3 ng/L) compared to the controls (median 199.9; range 6.2-1912.9 ng/L; p = .005). In the control group, no significant correlation was evident between betatrophin levels and clinical or biochemical parameters. In the PCOS group, betatrophin levels were positively correlated with prolactin levels (r = .286, p = .046) and negatively correlated with BMI (r = -.283, p = .049), waist/hip ratio (r = -.324, p = .023), and low-density lipoprotein cholesterol levels (r = -.385, p = .006). Impact statement What is already known on this subject: Several studies have suggested that primary alteration in beta-cell function is a pathophysiological feature of PCOS, and insulin resistance is the most significant predictor of beta-cell dysfunction independent of obesity. Betatrophin is a circulating protein that is primarily expressed in the liver in humans. Early experimental investigations demonstrated that overexpression of betatrophin significantly promoted pancreatic beta-cell proliferation, insulin production and improved glucose tolerance. Few studies have investigated the association between PCOS and betatrophin. However, in contrast to our study, the authors included overweight/obese patients and glucose tolerance was not evaluated before recruitment. What the results of this study add: Our results showed that serum betatrophin levels were significantly higher in lean glucose-tolerant PCOS women than in age- and BMI-matched healthy controls. What are the implications of these findings for clinical practice and/or further research: Elevated betatrophin levels in PCOS women, in the absence of obesity and glucose intolerance, may reflect a compensatory mechanism in order to counteract metabolic syndrome-related risk factors.

Comparison of thyroid function tests and blood count in pregnant women with versus without gestational diabetes mellitus

AIM

The aim of this study was to compare thyroid function and complete blood count parameters in pregnant women with versus without gestational diabetes mellitus (GDM).

METHODS

A total of 269 pregnant women patients with (n = 110, GDM group) or without (n = 159, non-GDM group) GDM were included in this study. Data on age, rate of cesarean section, birthweight of neonate, hemogram, and thyroid function tests were collected. Multivariate analysis was performed to determine factors predicting increased risk of GDM.

RESULTS

Rate of cesarean section (70.9 vs 57.2%, P = 0.022), median (max-min) age (33.0 [26.0] vs 26.0 [20.0] years, P < 0.001), platelet count (246.7 ± 68.3 vs 227.8 ± 64.2 ×10³ /μL, P = 0.021) and thyroid-stimulating hormone (1.3 [97.6] vs 1.0 [4.1] μIU/mL, P = 0.028) were significantly higher in the GDM than in the non-GDM group; whereas mean platelet volume (10.4 [5.3] vs 10.6 [5.6] fL, P = 0.031) and free triiodothyronine (FT3) (2.9 [3.6] vs 3.1 [3.0] pg/mL, P < 0.001) levels were significantly lower in the GDM than in the non-GDM group. Older age (odds ratio, 1.281; 95% confidence interval, 1.182-1.389, P < 0.001) and lower FT3 levels (odds ratio, 0.295; 95% confidence interval, 0.149-0.586, P < 0.001) were independently associated with increased risk of GDM.

CONCLUSION

Our findings revealed that lower FT3 levels and older age predict the likelihood of developing GDM in euthyroid pregnant women, with no influence of other thyroid hormones or blood counts on the risk of GDM.

The association between serum ghrelin levels and large-for-gestational-age fetuses in patients with gestational diabetes mellitus

We aimed to determine the relationship between serum ghrelin levels and large-for-gestational-age (LGA) fetuses in patients with gestational diabetes mellitus (GDM). A case-control study was conducted in 32 women with GDM and LGA fetuses (GDM + LGA group), 35 women with GDM and appropriate-for-gestational-age (AGA) fetuses (GDM + AGA group), 32 women with normal glucose tolerance (NGT) and LGA fetuses (NGT + LGA group), and 31 women with NGT and AGA fetuses (NGT + AGA group). All participants were recruited at the time of GDM diagnosis between 24 and 30 weeks of pregnancy. Participants also underwent ultrasonographic examinations. Serum ghrelin levels were significantly higher in GDM + LGA and GDM + AGA groups than in the NGT + AGA group. In the univariate model, biparietal diameter, head circumference, abdominal circumference (AC), femur length and ghrelin values were significant predictors of LGA fetuses. In the multivariate model, only AC remained as a predictor of LGA fetuses.

Perinatal outcomes of sonographically detected nuchal cord in southeastern Turkey

PURPOSE

To investigate the outcomes of pregnancies with a sonographically detected nuchal cord (NC) from a single center in south-eastern Turkey.

MATERIALS AND METHODS

A retrospective study was carried out at Maternity and Child Health Hospital Diyarbakir, Turkey, between 2011 and 2013. A-total of 477 pregnancies with sonographically detected NC during the second and third trimesteri of gestation (20-40 weeks) were included. The control group consisted of 1,043 randomly selected pregnancies without NC matched for gestational age at the time of ultrasound examination. Outcome variables, including maternal age, parity, gestational age at delivery, mnode of delivery, intrapartum fetal heart abnormalities, meconium-stained amniotic fluid, birth weight, and one- and five-minute Apgar scores, were compared between the two groups.

RESULTS

There were no statistically significant differences in any of the outcome variables between patients with sonographically detected NC and controls.

CONCLUSIONS

The presence of NC indicates a need for increased care but is not associated with adverse perinatal outcomes.

Borderline ovarian tumors: clinical characteristics, management, and outcomes - a multicenter study

Background

The optimal surgical management and staging of borderline ovarian tumors (BOTs) are controversial. Institutions have different surgical approaches for the treatment of BOTs. Here, we performed a retrospective review of clinical characteristics, surgical management and surgical outcomes, and sought to identify variables affecting disease-free survival (DFS) and overall survival (OS) in patients with BOTs.

Methods

A retrospective review of ten gynecological oncology department databases in Turkey was conducted to identify patients diagnosed with BOTs. The effects of type of surgery, age, stage, surgical staging, complete versus incomplete staging, and adjuvant chemotherapy were examined on DFS and OS.

Results

In total, 733 patients with BOTs were included in the analysis. Most of the staged cases were in stage IA (70.4 %). In total, 345 patients underwent conservative surgeries. Recurrence rates were similar between the conservative and radical surgery groups (10.5 % vs. 8.7 %). Furthermore we did not find any difference between DFS (HR = 0.96; 95 % confidence interval, CI = 0.7–1.2; p = 0.576) or OS (HR = 0.9; 95 % CI = 0.8–1.1; p = 0.328) between patients who underwent conservative versus radical surgeries. There was also no difference in DFS (HR = 0.74; 95 % CI = 0.8–1.1; p = 0.080) or OS (HR = 0.8; 95 % CI = 0.7–1.0; p = 0.091) between complete, incomplete, and unstaged patients. Furthermore, receiving adjuvant chemotherapy (CT) for tumor stage ≥ IC was not an independent prognostic factor for DFS or OS.

Conclusions

Patients undergoing conservative surgery did not show higher recurrence rates; furthermore, survival time was not shortened. Detailed surgical staging, including lymph node sampling or dissection, appendectomy, and hysterectomy, were not beneficial in the surgical management oF BOTs.

Comparison of p57, c-erbB-2, CD117, and Bcl-2 expression in the differential diagnosis of hydatidiform mole and hydropic abortion

PURPOSE

To explore the utility of p57, c-erbB-2, CD 117, and Bel-2 immunostaining in the differential diagnosis of complete hydatidiform mole (CHM), partial hydatidiform mole (PHM), and hydropic abortion (HA).

MATERIALS AND METHODS

Immunohistochemical expression of the p57, c-erbB-2, CD117, and Bel-2 proteins were investigated semi-quantitatively using paraffin-embedded tissue sections from histologically unequivocal cases of CHM (n = 20), PHM (n = 23), and HA (n = 17).

RESULTS

All cases of CHM exhibited a striking absence of p57 expression. The percentage of positive p57 staining was similar between PHMs (73.9%) and HAs (76.5%) (p >0.05). The comparison of c-erbB-2 expression revealed a significantly higher percentage of positive c-erbB-2 staining in CHMs (45%) compared with that in PHMs (8.7%) and HAs (5.9%) (p = 0.006 and 0.01, respectively). The CD 117 expression pattern (immunoreactivity score, percentage of positive cells, and staining intensity) was significantly lower in HAs compared with that in PHMs and CHMs (p < 0.05 for all). A significantly increased Bel-2 expression pattern was observed in HAs compared with that in PHMs and CHMs (p < 0.05 for all).

CONCLUSION

Immunohistochemical examination of p57, c-erbB-2, CD 117, and Bel-2 expression represents a relatively simple, reliable, and cost-efficient procedure to definitively distinguish among CHM, PHM, and HA.

Relationship between thioredoxin and thioredoxin-binding protein in patients with gestational diabetes mellitus

OBJECTIVE

This study examined the clinical and biological significance of thioredoxin (Trx) and thioredoxin-binding protein (TrxBP), which are redox-active proteins that control multiple biological functions, in gestational diabetes.

METHODS

We measured serum concentrations of Trx, TrxBP, insulin and other blood parameters, as well as insulin resistance and glucose tolerance in pregnant women with or without gestational dieabetes mellitus (GDM) (34/34) at the early second trimester.

RESULTS

Contrary to diabetes patients, serum TrxBP levels were lower in women with GDM than healthy pregnant controls. The serum insulin concentrations were higher in GDM, but the difference was not statistically significant. Furthermore, the intracellular redox potential ratio (Trx/TrxBP) of GDM patients was higher than that of the control group.

CONCLUSION

During pregnancy, the mother is potentially subjected to glucotoxicity as well as oxidative stress (OS) to help the foetus absorb more nutrients. Our results suggest that the Trx/TrxBP system may mediate a compensating mechanism. Reduced TrxBP levels and consequent enhanced Trx activity may alleviate OS and protect the foetus from hypoglycaemia. We hypothesise that the decrease in TrxBP levels is not a consequence of GDM, but rather is an instance of the active functional role of TrxBP in maternal development, unifying redox regulation and glucose metabolism.

Irisin as an early marker for predicting gestational diabetes mellitus: a prospective study

OBJECTIVE

The objective of this study is to evaluate maternal serum irisin levels in the first and second trimesters of pregnancy in women diagnosed with and without gestational diabetes mellitus (GDM).

METHODS

We performed a prospective, nested case-control study in 258 pregnant women who were enrolled at the time of the first prenatal visit (6-11th weeks of gestation) and followed until delivery. Among the entire population, we selected 20 women who subsequently developed GDM and 30 women with uneventful pregnancies. Blood samples were collected once from each participant at 6-11th weeks of gestation during the fetal viability scan and at 24-28th weeks of gestation during screening for GDM.

RESULTS

In the first trimester, irisin levels were significantly lower in women who later developed GDM (median = 453 ng/mL, range: 257-811 ng/mL) than in controls (median = 721 ng/mL, range: 700-786 ng/mL). In the second trimester, the difference in irisin levels between the GDM group (median = 749 ng/mL; range: 456-910 ng/mL) and controls (median = 757 ng/mL; range: 703-898 ng/mL) was not statistically significant.

CONCLUSIONS

Irisin may be a useful biomarker in early pregnancy to predict the development of GDM.

Serum level and placental expression of resistin in pregnancies complicated by preeclampsia: relationship with disease severity

The authors aimed to compare the maternal serum level and placental expression of resistin in pregnancies complicated by preeclampsia and clarify their relationship with disease severity. This cross-sectional study included 50 healthy pregnant women, 50 women with mild preeclampsia, and 48 women with severe preeclampsia. Serum resistin levels were measured by enzyme immunoassay and placental resistin expression was determined by immunohistochemistry. Resistin levels were significantly higher in women with mild and severe preeclampsia than in the healthy controls (p = 0.012 andp < 0.001, respectively). Placental resistin expression was significantly higher in women with severe preeclampsia compared to women with mild preeclampsia (p = 0.003) and healthy controls (p < 0.001). Serum resistin levels were positively correlated with gestational age and umbilical and uterine artery Doppler indices, as well as systolic and diastolic blood pressure, but negatively correlated with birth weight (p < 0.05). On the other hand, placental resistin expression was positively correlated with systolic blood pressure and uterine artery indices, but negatively correlated with birth weight (p < 0.05). In conclusion, increased cir- culating levels and placental expression of resistin in pregnancies complicated by preeclampsia were correlated with disease severity.

Pycnogenol prevents peritoneal adhesions

PURPOSE

This study tested the ability of pycnogenol, an extract from the bark of the French maritime pine (Pinus pinaster), to prevent intra-abdominal adhesions.

METHODS

Thirty female Wistar albino rats were separated randomly into three equal groups: Group (1) the control group, which underwent surgery, but was given no drug; Group (2) given 10 mg/kg of pycnogenol dissolved in normal saline intraperitoneally for 10 days after surgery; and Group (3) given 0.1 mL of normal saline for 10 days intraperitoneally after surgery. On post-operative day 10, all of the animals were killed and any adhesions were evaluated macroscopically and histopathologically.

RESULTS

The macroscopic adhesion scores (mean ± SD) for Groups 1, 2, and 3 were 2.5 ± 0.53, 0.60 ± 0.70, and 2.0 ± 0.82, respectively. The macroscopic adhesion score was significantly lower in Group 2 than in Groups 1 and 3 (p < 0.001). All three components of the histopathological evaluation (inflammation, fibrosis, and neovascularization) were significantly lower in Group 2 than in Groups 1 or 3 (p < 0.001, p < 0.001, and p = 0.004, respectively).

CONCLUSIONS

Pycnogenol was found to be effective at preventing surgery-related adhesions in an animal model.

Ultrasonography for the prediction of extension of trophoblastic infiltration into the tubal wall in ampullary pregnancy

OBJECTIVE

Predictive factors of damage to the Fallopian tube may guide the treatment for patients with tubal pregnancy. The purpose of this study was to evaluate the predictive value of ultrasonographic findings in patients affected by ampullary pregnancy for the determination of the depth of trophoblastic infiltration into the tubal wall on histological examination.

MATERIAL AND METHODS

38 patients with ampullary pregnancy undergoing salpingectomy were enrolled into the study. The patients were divided into two subgroups depending on their transvaginal sonography (TVS) findings; either an ectopic gestational sac containing an embryo with cardiac activity or those with a tubal ring. The ampullary pregnancies were histologically classified according to the depth of infiltration of trophoblastic tissue into the tubal wall as follows: stage I: limited to mucosa; stage II: extension to the muscularis layer; stage III: complete infiltration of the tubal wall with or without rupture of the serosa. The association between findings on TVS and stage of trophoblastic invasion, serum beta-human chorionic gonodatropin (β-hCG) levels was evaluated.

RESULTS

Although there was no significant difference among two groups in terms of histological stage of trophoblastic infiltration (p = 0.257), patients in whom an embryo with cardiac activity had been identified were found to have higher percentage of stage II (47.8%) or stage III (8.7%) invasion. However, there was a significant difference in serum β-hCG levels on the day of surgery among the two groups (p = 0.028).

CONCLUSIONS

Ultrasonographic aspect of ampullary pregnancy is associated with depth of trophoblastic infiltration into the tubal wall and serum β-hCG levels.

Significance of trophoblastic infiltration into the tubal wall in ampullary pregnancy

A total of 81 patients with an ampullary ectopic pregnancy undergoing salpingectomy were enrolled in the study. The ampullary pregnancies were classified according to the depth of trophoblastic infiltration into tubal wall as follows: Stage I, limited to mucosa; Stage II, extension to the tubal muscularis; Stage III, complete tubal wall infiltration up to the serosa. An association was observed between serum β-human chorionic gonadotropin (β-hCG) levels and the depth of trophoblastic infiltration. Significantly higher severe ischemic changes and rupture of tubal wall were observed in patients with stage III infiltration compared with the other groups. A significant association was found between the absolute depth of trophoblastic invasion and severe ischemic changes, and also rupture of serosa. In conclusion, serum β-hCG levels are associated with depth of trophoblastic invasion into the tubal wall, severe ischemic changes, and rupture of the tubal wall.

Evaluation of circulating betatrophin levels in gestational diabetes mellitus

Experimental data indicate that betatrophin plays a significant role in the regulation of lipid metabolism and glucose homeostasis. In recent years, considerable attention has focused on the relationship between betatrophin and diabetes mellitus in humans. This case-control study included 45 women diagnosed with gestational diabetes mellitus (GDM) and 45 pregnant healthy controls. The groups were matched for maternal and gestational age and body mass index. Serum betatrophin levels were significantly higher in women with GDM (median = 635.8 ng/L; range: 290-1841.6 ng/L) compared to control subjects (median = 320.1 ng/L; range: 94.6-936.8 ng/L; p = 0.001). No significant correlations were observed between serum betatrophin levels and clinical or biochemical parameters in the control group. However, in the GDM group, serum betatrophin levels were positively correlated with weight gain during pregnancy (r = 0.304, p = 0.042), systolic blood pressure (r = 0.394, p = 0.007), fasting insulin level (r = 0.348, p = 0.019), and homeostatic model assessment insulin resistance (HOMA-IR; r = 0.311, p = 0.038). Multivariate stepwise linear regression analysis revealed that fasting insulin levels (β = 0.342, p = 0.022) and HOMA-IR (β = 0.312, p = 0.037) were independently associated with serum betatrophin levels.

Core/shell-structured, covalently bonded TiO2/poly(3,4-ethylenedioxythiophene) dispersions and their electrorheological response: the effect of anisotropy

Higher surface area, rod-to-rod interactions and conducting thin shell induced covalently-bonded core/shell nanorod-TiO₂/PEDOT nanocomposite to show stronger ER activity and higher recovery after stress loading compared to particulate one.

Natural history of prenatal isolated muscular ventricular septal defects

OBJECTIVE

To evaluate the natural history of isolated muscular ventricular septal (m-VSD) defects during gestation and up to 1 year postnatally, as well as the association with chromosomal anomalies.

MATERIAL AND METHODS

Between August 2007 and July 2012, 76 fetuses with isolated m-VSDs represented the study population. The following variables were evaluated: site and size of the m-VSDs, presence of chromosomal anomalies, pregnancy outcome, and spontaneous closure rate from diagnosis up to 1 year postnatally.

RESULTS

Of the 76 cases with m-VSD, 1 fetus died after birth and 31 cases were lost to follow-up after birth. Thus, a total of 44 fetuses reached their first year of postnatal life, and these cases were available for analysis. Three (6.8%) of 44 defects closed spontaneously in utero, 33 (75%) closed within 1 year, and 8 (18.2%) remained patent. Overall, spontaneous closure occurred more frequently in the apical defects, but no significant difference was found for spontaneous closure between the mid-muscular and apical defects (p>0.05). Also, 83.8% (36 of 44) of defects ≤3 mm closed during gestation or the first year of life.

CONCLUSION

We infer that m-VSDs have a high spontaneous closure rate during the first year of life. Also, small m-VSDs frequently close spontaneously.

Association with isokinetic ankle strength measurements and normal clinical muscle testing in sciatica patients

BACKGROUND

Sensitive muscle strength tests are needed to measure muscle strength in the diagnosis and management of sciatica patients.

OBJECTIVE

The aim of this study was to assess the isokinetic muscle strength in sciatica patients' and control subjects' ankles that exhibited normal ankle muscle strength when measured clinically.

METHODS

Forty-six patients with L5 and/or S1 nerve compression, and whose age, sex, weight, and height matched 36 healthy volunteers, were recruited to the study. Heel-walking, toe-walking, and manual muscle testing were used to perform ankle dorsiflexion and plantar flexion strengths in clinical examination. Patients with normal ankle dorsiflexion and plantar flexion strengths assessed by manual muscle testing and heel-and toe-walking tests were included in the study. Bilateral isokinetic (concentric/concentric) ankle plantar-flexion-dorsiflexion measurements of the patients and controls were performed within the protocol of 30°/sec (5 repetitions). Peak torque and peak torque/body weight were obtained for each ankle motion of the involved limb at 30°/s speed.

RESULTS

L5 and/or S1 nerve compression was evident in 46 patients (76 injured limbs). Mean disease duration was two years. The plantar flexion muscle strength of the patients was found to be lower than that of the controls (p=0.036). The dorsiflexion muscle strength of the patients was found to be the same as that of the controls (p=0.211).

CONCLUSIONS

Isokinetic testing is superior to clinical muscle testing when evaluating ankle plantar flexion torque in sciatica patients. Therefore, isokinetic muscle testing may be helpful when deciding whether to place a patient into a focused rehabilitation program.

The impact of copper-containing and levonorgestrel-releasing intrauterine contraceptives on cervicovaginal cytology and microbiological flora: a prospective study

OBJECTIVE

To compare vaginal microflora and cervical cytology before and after insertion of a copper-containing intrauterine device (Cu-IUD) or a levonorgestrel releasing-intrauterine system (LNG-IUS).

METHODS

Between April 2009 and February 2011, all women requesting insertion of an intrauterine contraceptive for family planning or noncontraceptive indications were enrolled. One hundred and eight Cu-IUDs and 42 LNG-IUSs were placed. Cervical cytological and vaginal microbiological findings before insertion and after 12 months were recorded.

RESULTS

With regard to cervical cytology, nonspecific inflammatory changes became more frequent (but not significantly so; p = 0.062) after one year of use of a Cu-IUD, whereas their prevalence remained unchanged among women fitted with a LNG-IUS. Colonisation by Candida spp. and mycoplasma infections were diagnosed significantly more often after one year of use of the Cu-IUD than at baseline. During the study period, women wearing a Cu-IUD complained significantly more frequently of vaginal discharge, pelvic pain, and increased menstrual flow.

CONCLUSION

Use of a Cu-IUD - but not that of a LNG-IUS - was associated with an alteration of the vaginal flora and showed a trend towards a higher frequency of nonspecific inflammatory changes affecting cervical cytology.

Complete chorioamniotic separation and persistence of a yolk sac associated with triploidy

BACKGROUND

Triploidy is a highly lethal condition, and is thus very rarely observed in live births. It may result in significant medical risk to the pregnant woman.

CASE

A 32-year-old multigravid woman presented for prenatal care. Ultrasound examination at 14+3 weeks of gestation revealed a viable fetus with appropriate fetal biometry, but with evidence of chorioamniotic separation (CAS) and persistence of the yolk sac. Two weeks later, repeat ultrasound showed a large multicystic placenta and early fetal symmetrical growth restriction with persistence of CAS and yolk sac, raising the suspicion of fetal aneuploidy. Amniocentesis showed a fetal karyotype of 69,XXX. The histology of the placental tissue was a partial hydatidiform mole.

CONCLUSION

Persistence of chorioamniotic separation and yolk sac during the early second trimester cannot be considered a reassuring finding. In such cases, fetal karyotyping should be considered, especially when an additional abnormality is found.

Awareness and use of folic acid among reproductive age and pregnant women

OBJECTIVE

Folic acid supplementation during the pre-conception period and first trimester of pregnancy reduces the incidence of neural tube defects (NTDs). In this study, our aim is to investigate knowledge and use of folic acid among women attending our clinic.

MATERIAL AND METHODS

Between January 2012 and June 2012, 817 participants, consisting of 345 pregnant and 472 non-pregnant women, were enrolled in this survey. A questionnaire including socio-demographic information, knowledge and use of folic acid was applied.

RESULTS

48.2% of participants were aware of folic acid for the prevention of congenital anomalies. Knowledge and use of folic acid increase with socio-economic status and educational level. Participants who were already knowledgeable about folic acid cited health care professionals as common sources of information. Although 88.2% of the pregnancies were planned among the currently pregnant women, only 14.2% of them stated that they had used folic acid in the pre-conception period. The use of folic acid during the first trimester among pregnant women was 48.6%. Furthermore, 18.4% of participants had not used folic acid and 29.3% of them had not remembered whether they had or not. Even though 94.4% of health care professionals had heard about folic acid, 28.3% reported that they had used folic acid before pregnancy.

CONCLUSION

It is thought that there is a relatively high incidence of NTD in Turkey, which is due to inadequate information about NTDs and the use of folic acid. Primarily health care professionals such as midwives, nurses and family physicians should aim to inform all reproductive age women about folic acid for the prevention of NTDs, who should be encouraged to take the supplement when planning pregnancy.

Prenatal diagnosis of fetal ovarian cyst: case report and review of the literature

Foetal ovarian cysts are the most frequently encountered intra-abdominal cystic masses diagnosed prenatally. The aetiology of foetal ovarian cysts is still unknown, but hormonal stimulation is generally considered to be responsible for the disease. The diagnosis is made by the exclusion of other cystic lesions confined to the foetal abdomen. In this article we report antenatally-detected foetal ovarian cyst with a review of the available literature. Antenatal ultrasonography (USG) revealed an abdominal cystic mass 41×33 mm in diameter in a 33-week gestation female foetus. The normal anatomy of other foetal abdominal organs suggested that an ovarian cyst was the most likely diagnosis. In the antenatal follow-up period, the cyst diameter increased with time. After delivery, USG scan confirmed the antenatal findings. Due to abdominal distension and respiratory distress, ovarian cystectomy was performed on the second postnatal day. The histopathological evaluation of the surgical material reported a serous cystadenoma of the ovary with non-malignant properties.

Examining the Behaviour subscale of the Hypoglycaemia Fear Survey: an international study

AIMS

The Hypoglycemia Fear Survey (HFS)-II Behaviour and Worry subscales were developed to measure behaviours and anxiety related to hypoglycaemia in diabetes. However, previous studies found lower reliability in the HFS Behaviour subscale and inconsistent relationships with glucose control. The purpose of this study was to conduct extensive analyses of the internal structure of the HFS Behaviour subscale's internal structure and its relationships with diabetes outcomes, including HbA1c and episodes of severe hypoglycaemia.

METHODS

HFS-II survey data from 1460 adults with Type 1 diabetes were collected from five countries. This aggregated sample underwent exploratory factor analysis and item analysis to determine the internal structure of the survey and subscales.

RESULTS

A three-factor solution showed the best fit for the HFS, with two subscales emerging from the HFS Behaviour representing tendencies towards (1) maintenance of high blood glucose and (2) avoidance of hypoglycaemic risks by other behaviours, and a third single HFS Worry subscale. Subscale item analysis showed excellent fit, separation and good point-measure correlations. All subscales demonstrated acceptable (0.75) to excellent (0.94) internal reliability. HbA(1c) correlated with Maintain High Blood Glucose subscale scores, r = 0.14, P < 0.001, and severe hypoglycaemia frequency correlated with all subscales.

CONCLUSIONS

The HFS Worry subscale measures one construct of anxiety about various aspects of hypoglycaemia. In contrast, the HFS Behaviour subscale appears to measure two distinct aspects of behavioural avoidance to prevent hypoglycaemia, actions which maintain high blood glucose and other behaviours to avoid hypoglycaemic risk. These results demonstrate the clinical importance of the HFS Behaviour subscales and their differential relationships with measures of diabetes outcome such as HbA1c .

Comparison of preoperative endometrial biopsy grade and final pathologic diagnosis in patients with endometrioid endometrial cancer

OBJECTIVE

To compare preoperative grading in endometrioid endometrial cancer with the final pathologic assessment of the hysterectomy specimen. The second objective of the study was to determine a high risk group who will be upgraded in the postoperative evaluation.

MATERIAL AND METHODS

A total of 335 patients with endometrioid endometrial cancer were retrospectively reviewed between June 2000 and January 2011. All pathology results were pre- and postoperatively reviewed at two institutions, and all patients underwent surgical therapy. Sensitivity, specificity, positive and negative predictive values and accuracy rates were calculated for all grades in the preoperative assessment.

RESULTS

The mean age of the patients was 56.2±9.6 and the vast majority of the patients were postmenopausal (n=239, 71.3%). FIGO grade was determined to be greater in 75 patients in the final hysterectomy specimen. Fifty-five (32.9%) of the patients with preoperative grade 1 were found to be grade 2 and 3.6% of them were upgraded to grade 3. Fourteen of the patients with grade 2 (11.4%) were found to be grade 3. The accuracy rates of the preoperative grade assessment with endometrial sampling were 75.5%, 66.2% and 88.3% for grades 1, 2 and 3, respectively. There were no statistically significant differences in the preoperative demographic characteristics between patients with or without upgraded tumors.

CONCLUSION

A high percentage of preoperatively diagnosed grade 1 tumors were upgraded in the postoperative evaluation. The patients who would have been upgraded after hysterectomy could not have been predicted preoperatively using the characteristic features.

Geomorphic reconstructions in the environs of ancient troy

Sea level rise, deltaic progradation, and floodplain aggradation have changed the landscape in the vicinity of ancient Troy during the past 10,000 years. With the waning of the last major world glaciation and resultant sea level rise and fluctuation, a marine embayment protruded nearly 10 kilometers south of the site of Troy at Hisarlik in the Troad of northwest Turkey. As the sea approached its present level approximately 6000 years ago, fluvial and marine deposition caused a northerly migration of the delta and floodplain of the Scamander and Simois Rivers past the site of Troy toward the present-day coast about 6 kilometers north of the site. In view of these major changes in morphology, interpretations of ancient geographies related to historical or historical-mythological settings must be changed. A number of paleogeographic maps have been reconstructed with the use of subsurface data that records the continuing landscape change since the first occupancy of the site at Troy 5000 years ago. These show that ancient Troy was located on an embayment of the sea. If the Trojan War occurred, then the axis of the battlefield and associated events must be relocated to the south and west of Troy.

A reappraisal on the management of lumbosacral plexopathies in gynecological malignancies: where do the physiatrists stand?

Two patients are reported here with gynecological malignancies--an ovarian and a cervical carcinoma--who had suffered from lumbar plexopathies during their follow-up. Their management is discussed with an emphasis on the collaboration of the gynecologists and the rehabilitation physicians.