Kisspeptin Variations in Patients with Polycystic Ovary Syndrome-A Prospective Case Control Study

Background and objectives: Kisspeptin, also named metastin, showed important roles in initiating the secretion of gonadotropin-releasing hormone (GnRH) and is an essential factor in the development of polycystic ovaries syndrome (PCOS). Several research studies noticed associations between kisspeptin levels and patients with anovulatory cycles due to PCOS with an increased LH/FSH ratio. The aim of our study was to bring scientific evidence regarding the correlation between high kisspeptin and luteinizing hormone values in subfertile women due to PCOS. Materials and Methods: A prospective case-control study was conducted in “Elena Doamna” Hospital of Obstetrics and Gynecology between 4 January 2021 and 1 March 2022. All patients agreed to participate in our study, had ages between 18 and 45 years old, and had a body mass index between 18.5 and 30 kg/m². The study group consisted of subfertile patients with PCOS and menstrual disturbances, including amenorrhea or oligomenorrhea. The control group consisted of healthy patients with ovulatory cycles and no other reproductive or endocrinology pathologies. During the follicular phase of their menstrual cycle, patients had blood samples taken with the dosage of kisspeptin, LH, FSH, estradiol, insulin, glycemic levels, testosterone, and prolactin. Pelvic ultrasounds and clinical examinations were performed as well. Results: Significant differences were observed in kisspeptin, LH, FSH, and estradiol levels between patients with PCOS and the control group. After the univariate analysis, PCOS was significantly associated with increased kisspeptin, increased LH, and decreased FSH. There was no significant association between PCOS, estradiol, prolactin, and insulin. Conclusions: kisspeptin serum values are higher in subfertile PCOS patients, supporting the hypothesis that an over-stimulation of the KISS1 system might cause the hyper-stimulation of the HPG-axis.

Surgical versus Transvalvular Aortic Valve Replacement in Elderly Patients-The Impact of Frailty

(1) Background: The aging process leads to an increased number of patients with cardiovascular diseases that require surgical treatment. One of the most common heart diseases with an increased prevalence in the elderly is aortic stenosis (AS). Recently, transcatheter aortic valve implantation (TAVI) has become the preferred technique for frail patients with high surgical risk. Currently, there is no gold standard method for assessing frailty. The available scores are objective, but limited by the lack of prospective information, especially from patients undergoing cardiac surgery or interventional procedures. Moreover, the current frailty scores record only certain aspects of the frailty identified in some system and organs. The aims of this study were to evaluate the different profile patients treated with TAVI or with surgical aortic valve replacement (SAVR) and to analyze the risk factors of unfavorable outcomes in the two groups to identify potential factors for frailty that could be included in the new scoring system. (2) Methods: This study included patients over 65 years old evaluated with severe, symptomatic AS treated with TAVI or SAVR admitted to the Cardiovascular Diseases Institute, Iasi. (3) Results: The group included 88 patients treated with TAVI compared with 218 patients undergoing SAVR. Most of the TAVI patients (84.09%) were over 70 years compared to 30.09% of the SAVR group. The TAVI patients had an increased surgical risk assessed by EuroSCORE II (15 vs. 4%) and severe heart failure (NYHA IV, 36.36 vs. 6.48%). The only residual symptom was dyspnea, in a significantly lower prevalence compared to preoperative evaluation. (4) Conclusions: TAVI improves the general status with results comparable to SAVR in elderly patients with increased severity of the disease and higher prevalence of comorbidities.

Morphological aspects of the vasculogenesis and angiogenesis during prenatal edification of the circle of Willis: a review

In the literature, there are many articles reporting anatomical variations of circle of Willis (CoW), defined as those changes that lead to the inability of this anastomotic structure to maintain adequate brain flow. Because there is such a wide variation in the configuration of the CoW, its anatomical variations affect the hemodynamics of blood flow, thus contributing to the development of aneurysms or stroke. As such, we consider that a good knowledge of the embryological development of the constituent arteries of the CoW can shed some light on the causes of the appearance of its anatomical variants. Reviewing literature, we will present the embryological development of the constituting arteries of the CoW and will begin with vasculogenesis and angiogenesis of the vascular system as a whole. Then, we will focus on the embryological development of the internal carotid artery (ICA) and its branches because, starting with the embryological day 24, these arteries are the first vessels that begin to develop to provide the necessary blood for the primitive brain. As the hindbrain increases its volume, a larger amount of nutrients is needed. Because a larger amount of blood is required to be provided by the primitive ICAs, there is a need for arterial capacity development and thus the posterior circulation begin to take shape. At this stage, the posterior circulation consists of a plexiform arterial network that receives blood from the carotid artery through the carotid–vertebrobasilar anastomoses. At the 5–8 mm embryonic stage, these anastomoses begin to regress, and the basilar artery and vertebral arteries become independent of the ICA. We are pointing out on the process of regression of these primitive vessels, emphasizing the fact that their persistence represents the starting point for the appearance of anatomic anomalies of the CoW, which are identified in the adult individuals. In this review, we also present and illustrate some developmental abnormalities of the anterior and posterior parts of the CoW.

LEFT ATRIAL, LEFT ATRIAL APPENDAGE AND PULMONARY VEINS ANATOMICAL VARIANTS IN PATIENTS WITH ATRIAL FIBRILLATION VERSUS PATIENTS IN SINUS RHYTHM

The aim of the study is to evaluate by multidetector computed tomography (MDCT) the prevalence, location and size of LA (left atrial) diverticula and accessory appendages, the prevalence of PVs anatomical variants and LAA (left atrial appendage) shapes in patients with atrial fibrillation (AF) compared to patients in sinus rhythm (SR). Images obtained by MDCT in a group of 100 patients with <1 year paroxysmal or persistent AF prior to radiofrequency catheter ablation and in a group of 100 patients in SR with unconfirmed or insignificant (<50%) coronary arteries stenoses were compared. The prevalence of LA diverticula (22% in AF group, 19% in SR group) and accessory appendages (6% in AF group, 5% in SR group) was not significantly different between the two groups. Similar sizes of LA diverticula and accessory appendages were registered in patients with AF and in SR. The prevalence of a common left venous trunk was significantly higher in patients with AF (30%) compared to patients in SR (18%) (p=0.047) and proved to be an independent predictor for AF (odds ratio (OR) 1.32; 95% confidence interval (CI) 0.93-1.51; p=0.002) at multivariate logistic regression. LAA had a complex shape but no significant differences concerning the prevalence of the 4 major types were registered between the groups. In conclusion, the only parameter associated with AF was the presence of a left common trunk suggesting that it is either a consequence or a predisposing factor for the development of AF.

Trigeminal nerve: MRI anatomy and case presentation of trigeminal neuralgia due to arterial compression

Trigeminal neuralgia (TN), also known as tic douloureux is a chronic neuropathic pain disorder characterized by sporadic episodes of extreme, sudden burning or shock-like face pain that last from a few seconds to 2 minutes. Trigeminal neuralgia has a reported incidence of 5.9/100,000 women and 3.4/100,000 men in USA. The exact pathophysiology is still unclear, but demyelization leading to abnormal discharge in fibers of the trigeminal nerve is a probable cause. In the majority of cases, no structural lesion is detected but in almost 15% of patients medical imaging methods like MRI, CT or angiography can identify a vein or artery that compresses the nerve which results in focal demyelization. The authors present a case of trigeminal neuralgia investigated by MRI, which identified a vascular compression of the nerve 9 mm after emerging the pons by the superior cerebellar artery (SCA) and one of its branches. The authors also realize a review of the MRI anatomy of the trigeminal nerve.

Considerations associated with computer forensic facial reconstructions the limits of soft tissues' thickness determination

Revolutionary progresses in computer technology are of great use during forensic investigations in terms of facial identification based on reconstructions.

AIM

The purpose of the current study is to evaluate the use and limits of facial reconstruction by considering soft tissues' thickness determination.

MATERIAL AND METHOD

The authors investigated the limits of three methods used for soft tissues' thickness determination on a sample group consisting of 9 cadavers, 30 ultrasound investigations and 27 cranial X-rays. The measurements were performed at standard anthropological landmarks following methods previously described in literature.

RESULTS

Measurement values for each soft tissue landmark overlapped between sexes, females having greater soft tissue thickness at two sites: infraorbital and supraorbital notches. US measurements demonstrate a much larger dependence of the soft tissue thickness according to different body posture and imply compressing soft tissues with the transducer. X-rays determinations revealed more accurate values than US, but are nocive to the subjects and can only be performed in standard radiographic positions. For cadavers, different postmortem stages and supine position generated inadequate results.

CONCLUSION

In order to increase the degree of accuracy of craniofacial approximation it is necessary to obtain a validated data set specific for the Romanian population. This will allow a better determination of facial measurements opening new perspectives in understanding the relation between physical properties and facial soft tissue.