Influence of Early Versus Delayed Hepatic Artery Perfusion Scan on 90Y Selective Internal Radiation Therapy Planning

Purpose: The aim of this study was to evaluate the effect of an increase in the time interval between hepatic intra-arterial injection of 99mTc-macroaggregated albumin (MAA) and hepatic artery perfusion scintigraphy (HAPS) on the lung shunt fraction (LSF) and perfused volume (PV) calculations in the treatment planning of selective internal radiation therapy (SIRT). Methods: The authors enrolled 51 HAPS sessions from 40 patients diagnosed with primary or metastatic liver malignancy. All patients underwent scan at the first and fourth hour after hepatic arterial injection of 99mTc-MAA. Based on single-photon emission computed tomography images, LSF values were measured from each patient's first and fourth hour images. PV1 and PV4 were also calculated based on three-dimensional images using 5% and 10% cutoff threshold values and compared with each other. Results: The authors found that the median of LSF4 was statistically significantly higher than LSF1 (3.05 vs. 4.14, p ≤ 0.01). There was no statistically significant difference between PV1 and PV4 on the 10% (p = 0.72) thresholds. Conclusions: LSF values can be overestimated in case of delayed HAPS, potentially leading to treatment cancellation due to incorrectly high results in patients who could benefit from SIRT. Threshold-based PV values do not significantly change over time; nevertheless, keeping the short interval time would be safer.

An anthropomorphic body phantom for the determination of calibration factor in radionuclide treatment dosimetry

The aim of this study is to create an inhomogeneous human-like phantom, whose attenuation and scattering effects are similar to the human body, as an alternative to the homogeneous phantoms traditionally used in calibration factor (CF) determination. The phantom was designed to include the thorax, abdomen and upper pelvis regions sized to represent a 75-kg male with a body mass index of 25. Measurements using Lu-177 with 50- and 100-mL lesion volumes were performed using inhomogeneous anthropomorphic body phantom (ABP) and homogeneous NEMA PET body phantom. There was a difference of 5.7% of Calibration Factor including attenuation and scatter effect between ABP and NEMA PET body phantom. Because it better reflects the attenuation and scatter effect, it is recommended to use a human-like inhomogeneous phantom for determination of CF instead of a homogeneous phantom.

P-683 High Serum Progesterone Levels on Day of Embryo Transfer for Pregnancy Outcomes in Patients Undergoing Artificial Frozen-thawed Blastocyst Transfer; Is There a Ceiling Effect?

Study question

Is there a ceiling effect of high serum progesterone levels on day of embryo transfer for pregnancy outcomes in patients undergoing artificial frozen-thawed blastocyst transfer?

Summary answer

There is no ceiling effect of high serum progesterone levels on day of embryo transfer(>40 ng/mL)for pregnancy outcomes in patients undergoing artificial frozen-thawed blastocyst transfer.

What is known already

In recent studies, 10 ng/mL was usually used as the lower threshold value for serum progesterone (P4) level on the day of embryo transfer in patients undergoing artificial frozen-thawed blastocyst transfers and pregnancy outcomes were compared between patients with P4 levels above and below this threshold. The main reason for choosing this threshold in the studies is that it reflects the healthy corpus luteum function. Although many studies have investigated the lower threshold value, there is paucity of data on the high threshold value that can indicate the possible ceiling effect of P4 in the literature.

Study design, size, duration

This was a retrospective cohort study including 595 patients undergoing artificial frozen-thawed blastocyst transfer between 2017 to 2021. In order to eliminate the age-related bias, only patients performed euploid embryo transfer according to preimplantation genetic testing for aneuploidy from patients above aged 35 years were included.

Participants/materials, setting, methods

When we evaluated the percentiles of according to the progesterone levels,40.6 ng/ml corresponded to 90th percentile and 23.9 ng/ml corresponded to 50th percentile. Based on this finding, rounding up the numbers, we determined the progesterone levels cut-off as < 20ng/mL,n=220(37.0%);20-40ng/mL,n=312(52.4%) and ≥40ng/mL,n=63(10.6%). The main outcome measure was pregnancy outcomes as clinical pregnancy and live birth rate. We compared pregnancy outcomes according to age, BMI, blastocyst expansion, trophectoderm and inner cell mass grade and progesterone cut-off levels .

Main results and the role of chance

The median age of the patients was 31 (Range 20-46) and the mean body mass index (BMI) of the patients was 24.5±4.0 kg/m2. The overall clinical pregnancy rate and live birth rate were 61.8% (368/595) and 52.9% (315/595), respectively. Patients were subdivided into two different groups according to clinical pregnancy and live birth rate outcomes as follows; positive and negative. Age and BMI of patients were comparable between groups.

Blastocyst morphology grade as expansion, trophectoderm and inner cell mass grade are statistically significantly associated with clinical pregnancy (p<.001 for all) and progesterone level between 20-40ng/mL is associated with higher clinical pregnancy rate (p:0.043). In multivariate analysis; only blastocyst expansion and inner cell mass grade were the independently and significantly factors that are associated with clinical pregnancy rate (p:0.011, OR: 1.6, CI95%: 1.13-2.39 and p:0.007, OR: 1.65, CI95%: 1.14-2.39, respectively). Progesterone level and trophectoderm grade were not fount statistically significant (p: 0.310 and p:0.489, respectively).

In evaluation of the association between factors and live birth rate, only blastocyst expansion grade equal or over 4 and trophectoderm grade A or B were associated with statistically significant live birth rates.

Limitations, reasons for caution

The main limitations of current study were the retrospective design and the limited sample size of the ≥40 ng/mL cohort of serum progesterone levels.

Wider implications of the findings

According to this data, we speculated that if the serum P4 level is above 40 ng/mL on the day of embryo transfer in patients undergoing artificial frozen-thawed blastocyst transfer, there is no need to reduce the dose of progesterone used.

Trial registration number

N/A

Efficacy of pulse steroid therapy in patients critically ill with COVID-19

OBJECTIVES

The aim of this study was to determine the efficacy of pulse steroid therapy administered to patients critically ill with COVID-19 progressing into severe pneumonia.

METHODS

A total of 600 patients included in this retrospective study were divided into three groups. Group 1 (control group): 200 patients who did not receive steroid treatment, Group 2: 200 patients who received dexamethasone 1x8 milligram (mg) or methylprednisolone 1x80 mg, Group 3: (pulse steroid therapy group): 200 patients who received 1 g methylprednisolone followed by 1x80 mg methylprednisolone. Demographic and laboratory data were recorded.

RESULTS

Mortality rates in groups 1, 2 and 3 were 77 %, 53.55 %, and 58.5 %, respectively. The ratios of intubated patients in groups 1, 2 and 3 were 70 %, 45.5 % and 56 %, respectively. The numbers of patients whose D‑dimer values were above 2,250 ng/mL (cut-off value for D-dimer in this study) in groups 2, 1 and 3 were 65, 107, and 105, respectively.

CONCLUSION

Pulse steroid therapy does not shorten the duration of hospital stay, does not reduce the need for intubation and increases the risk of thrombosis by significantly increasing the level of D-dimer among patients critically and severely ill with COVID-19 (Tab. 4, Fig. 3, Ref. 20) Keywords: COVID-19, pulse steroid therapy, thrombosis, d-dimer, corticosteroid.

P–411 Does subcutaneous progesterone (SC-P) administration eliminate the necessity of serum progesterone level monitoring in frozen embryo transfer (FET) cycles?

Study question

Does SC-P provide similar ongoing pregnancy rates (OPRs) as intramuscular progesterone(IM-P) in hormone replacement therapy (HRT)-FET cycles and do serum progesterone (P) levels on FET day effect on pregnancy outcome? Summary answer: SC-P administration had similar OPR compared to IM-P in HRT-FET cycles. In SC-P group embryo transfer(ET) day P found to be insignificant factor for outcome.

What is known already

Different P routes can be used in HRT-FET cycles such as vaginal P, IM-P and recently SC-P. Only retrospective studies evaluated the comparison of SC-P with other routes in HRT-FET cycles. Here, we assessed prospectively whether SC-P is effective for HRT-FET cycles. Previous studies reported that serum P levels on ET day after vaginal P administration clinical outcomes were closely correlated. The correlation between serum P after IM-P administration and clinical outcomes were conflicting. In addition, there is lack of data on the serum P levels after SC-P administration. Serum P levels on ET day were evaluated in this study.

Study design, size, duration

This prospective cohort study was performed between July 1-October 31 2020, enrolled 224 patients scheduled for HRT-FET cycles with SC-P(25 mg twice daily) or IM-P(50 mg once daily). The route of P was decided according to the patient’s eligibility to hospital. First FET cycle was included after freeze-all cycles for each patients. Female age>35, PGT-A cycles, cleavage ET, >1 ET, patients with uterine pathology and hydrosalpinx, FET with surplus embryos, endometrial thickness<7mm were excluded.

Participants/materials, setting, methods

Female age ≤ 35 years old with a triple-layer endometrium >7 mm underwent transfer of single blastocysts after the first ET after freeze-all cycles. The indications for freeze-all were ovarian hyperstimuation syndrome and trigger day P level>1.5 ng/ml. 224 patients were eligible for study; 133 in SC-P group and 91 in IM-P group.The primary endpoint was the ongoing pregnancy rate (OPR) beyond pregnancy week 12.

Main results and the role of chance

The demographic, cycle, embryologic characteristics were similar between groups. The median circulating P levels on the day of ET were 19.92(15.195–27.255)ng/
ml and 21(16.48–28)ng/ml in the SC-P and IM-P groups,(p = 0.786). The clinical pregnancy rates [86/133(64.7%) vs 57/91(62.6%);p=0.757], miscarriage rates [21/86(24.4%) vs 10/57(17.5%) ;p=0.329], and OPR [65/133 (48.9%) vs 47/91(51.6%); p = 0.683] were comparable between the SC-P and IM-P. Binary logistic regression was performed for ongoing pregnancy as the dependent factor blastocyst morphology was found to be the only significant independent prognostic factor (p = 0.006), whereas the route of P was insignificant. In the SC-P and IM-P 
groups, the effect of ET day P levels were divided into quartiles(Q) to evaluate the effect on ongoing pregnancy. In SC-P group OPR were similar in four Q [Q1:33.3%(11/33),Q2:50%(17/34),Q3:60.6%(20/33),Q4:51.5%(17/33) (p = 0.1)].For IM-P group; Q1 had a significantly reduced OPR than Q2, Q3, Q4. [26.1%(6/23),65.2%(15/23),54.5%(12/22) and 60.9%(14/23), p = 0.031]. Logistic regression analysis for OP was performed separately in SC-P group and IM-P group. Although in SC-P group, ET day P levels was not found to be a significant factor, in IM-P ET day P level was found to be an independent factor for OP in IM-P group (Q1vs Q2+Q3+Q4; OR: 8,178 95% CI: [1.387–48.223] p:0.02).

.

Limitations, reasons for caution

Although this study has the advantage of being prospective and in a homogenous study population, randomized controlled trials are warranted to evaluate the effectiveness of SC-P to other routes of P. Extrapolation to unselected populations of this study is needed.

Wider implications of the findings: Assignment of threshold of serum P on the day of ET for HRT-FET cycles to optimize outcomes is critical for every route of P. Regarding these results, individual luteal phase for HRT-FET cycles can improve IVF outcome.

Trial registration number

None

An Analysis for Therapeutic Doses of Patients with Neuroendocrine Tumor Treated with Lutetium-177-DOTATATE

Background: The aim of this study is to clarify the critical organs that limit treatment scheme and also evaluate the validity of currently used critical organ threshold values in neuroendocrine tumor (NET) patients, receiving peptide receptor radionuclide therapy (PRRT) with Lutetium-177 (¹⁷⁷Lu)-DOTATATE. Thirty-six NET patients (ages 16-73 years) who received ¹⁷⁷Lu-DOTATATE treatment were evaluated retrospectively in this study. Dosimetric calculations were made using medical internal radionuclide dose method. For calculation of organ doses, Internal Dose Assessment at Organ Level/Exponential Modelling 1.1 software program was used. Follow-up data were used to determine the organ failure. Results: A total of 141 cycles and mean of 3.91 (±1.33) cycles were applied to the patients. A mean of 691 mCi (±257 mCi) ¹⁷⁷Lu-DOTATATE infusion in total and a dose between 70 and 200 mCi per treatment was applied to patients. Seven of 36 patients reached 23 Gy renal dose limit. In these patients, although kidney doses were between 23 and 29 Gy, there was no diminution in renal functions during follow-up. Two of 36 patients reached total bone marrow dose of 2 Gy limit. Bone marrow suppression did not develop in these patients. Conclusion: The critical organs that seem to affect the treatment scheme in PRRT with ¹⁷⁷Lu-DOTATATE are kidney and bone marrow. Although there are established threshold levels, derived from radiotherapy experience, more studies are needed to clarify these dose limits in systemic radionuclide therapies such as PRRT.

Assessment of nail findings in children with atopic dermatitis

BACKGROUND

Cutaneous findings are well known in atopic dermatitis (AD), but nail changes have not received as much attention.

AIM

To determine the clinical and disease-related capillaroscopic findings of nail findings in paediatric patients with AD.

METHODS

In total, 100 participants aged 2-16 years were sourced from the dermatology outpatient clinic: 50 of these had been diagnosed with AD according to the Hanifin-Rajka criteria, and the others were 50 healthy controls (HCs) without AD. The AD severity score (SCORing Atopic Dermatitis; SCORAD) was calculated for all patients with AD. A digital epiluminescence device was used for nailfold capillaroscopy.

RESULTS

The nail findings detected in patients with AD were pitting, punctate leuconychia, trachyonychia, onycholysis and onychomadesis. Pitting was significantly (P < 0.01) more frequent in the patient group (26%) than in the HC group (6%). Similarly, the patient group had significantly higher rates for capillary density decrease (P < 0.01), capillary array irregularity (P < 0.001), capillary dilatation increase (P < 0.001), tortuosity (P = 0.04), ramification increase (P = 0.02), bush-like appearance (P = 0.02) and avascular areas (P < 0.01). Significant correlations were determined between pitting and trachyonychia (P < 0.05, r = 0.21), capillary density decrease (P < 0.05, r = 0.25), avascular areas (P < 0.001; r = 0.29) and SCORAD (P < 0.05, r = 0.35).

CONCLUSION

The nailfold capillaroscopic images of children with AD were similar to those of scleroderma spectrum disorder. Thus, we believe it would be beneficial to support detailed clinical examination of patients with a capillaroscopic examination.

Efficacy of balloon Eustachian tuboplasty as a first line treatment for otitis media with effusion in children

OBJECTIVE

This study aimed to compare the outcomes of ventilation tube insertion and balloon Eustachian tuboplasty as a first line treatment for otitis media with effusion in children.

METHOD

This was a retrospective evaluation of 62 children, 30 cases that underwent balloon Eustachian tuboplasty (group 1) and 32 cases that underwent ventilation tube insertion (group 2), from July 2016 to April 2018.

RESULTS

The pre-operative air-bone gap of patients who underwent balloon Eustachian tuboplasty was 15-35 dB (mean: 27.6 ± 8.2 dB). The mean pre-operative air-bone gap decreased to 9.6 dB after a mean of 14.4 months (p < 0.05). The air-bone gap decreased from 25.6 dB to 17.6 dB in the ventilation tube group. There was a significant improvement in the air-bone gap values in both groups; however, this decrease was significantly higher in the balloon Eustachian tuboplasty group (p = 0.043).

CONCLUSION

Balloon Eustachian tuboplasty may be an effective and safe method for use as a first-line treatment of otitis media with effusion in children.

Deformity correction with total knee arthroplasty for severe knee osteoarthritis accompanying extra-articular femoral deformity: the results are promising

PURPOSE

This study aimed to evaluate patients with severe degenerative osteoarthritis of the knee and extra-articular femoral deformities treated with total knee arthroplasty (TKA) and acute deformity correction.

METHODS

Ten patients with severe degenerative osteoarthritis of the knee and extra-articular femoral deformities were included, and the median age was 63 years (range 38-67). The etiology was post-traumatic malunion in four patients, rickets sequelae in four patients, and surgical sequelae due to multiple epiphyseal dysplasia in two patients. The severity of degenerative osteoarthritis and deformity analyses were assessed according to the Kellgren-Lawrence and Paley criteria, respectively. The median number of previous operations the patients had undergone was two (range 0-3), and the median Oxford Knee Society score was 9 (range 5-13) before treatment. All patients were treated with primary TKA and deformity correction in the same surgery. The TKA was completed first, followed by an osteotomy at the apex of the deformity. Finally, a retrograde intramedullary nail was inserted.

RESULTS

The median follow-up period was 44 (31-60) months. A stable and functional knee joint, a physiological mechanical axis, and solid osseous union were achieved in all patients. Late prosthetic failure was seen in one patient due to deep infection. The median Oxford Knee Society score was 42 (range 37-47) at the final follow-up.

CONCLUSIONS

Combining several procedures in single setting for the treatment of severe knee osteoarthritis accompanied by extra-articular deformity may eliminate the need for multiple surgeries. Furthermore, a proper physiological mechanical axis can be obtained without causing substantial bone loss.

LEVEL OF EVIDENCE

IV.

Elliptic Fourier based analysis and multivariate approaches for size and shape distinctions of walnut (

Size and shape data of agricultural crops provide great sources for food processing technologies. The physical attributes of different fruits should be known for the design, developing and innovation of food technologies. In this study, the size and shape distinctions of fifteen national and international walnut cultivars (Midland, Sütyemez-1, Serr, Maraş-18, Maraş-12, Sütyemez-2, Kaman-1, Kaman-5, Pedro, Howard, Chandler, Şebin, Şen-2, Bilecik and KR-1) were determined using elliptic Fourier and multivariate approaches. Firstly, the gravitational features of walnut cultivars were determined, and their dimensional, area and shape attributes were revealed by image processing. Cluster analysis was used to designate the walnut cultivars. Elliptic Fourier descriptors obtained from walnut outlines provided the comparisons among walnut cultivars in shape. The shape index indicated that Serr, Sütyemez-2, Midland and Şen-2 cultivars were oval-shaped, and the others were spherical. The cluster analysis divided the walnut cultivars into four subgroups. Elliptic Fourier descriptors perfectly distinguished the walnut cultivars according to shape.

Angular deformity development after the distal tibial physeal fractures

Several clinical and radiological factors can be prognostic in the development of angular deformity following physeal injuries of the distal tibia. One of the radiological parameters, premature physeal closure (PPC), can be detected during postoperative follow-ups. Aim of our study was to identify the prognostic factors in development of angular deformity and its relationship with PPC. One hundred and four patients treated due to physeal injuries of the distal tibia were included in our study. Patients were divided into three groups based on Salter-Harris (SH) classification. The intergroup relationships between sex, age, the amount of energy sustained during injury, premature physeal closure, the amount of residual gap, and deformity were analyzed. Angular deformity developed in 25% (3/12) of SH Type 2, in 60% (9/15) of Type 3 and 30% (3/10) of Type 4 patients with PPC. A residual displacement of more than 2 mm, age and premature physeal closure were specified as significant risk factors for development of angular deformity. 2 mm limit for residual displacement and findings of premature physeal closure in the radiological evaluations during follow-ups are prognostic factors in avoiding malalignment of the distal tibia.

LEVEL OF EVIDENCE

Level 3.

Reproductive performance after hysteroscopic metroplasty in infertile women: complete versus partial uterine septum

OBJECTIVE

To investigate the impact of hysteroscopic metroplasty on pregnancy outcome in women with complete or incomplete uterine septum (US) accompanying infertility.

MATERIALS AND METHODS

Seventy-three patients who had hysteroscopic metroplasty for complete and incomplete US with primary and secondary infertility were reviewed. Obstetric outcomes (number of pregnancies, live births, and miscarriages) up to 36 months follow up period were investigated.

RESULTS

Twenty-five patients in complete US and 28 patients in incomplete US became pregnant in 36 months follow up. Postoperative miscarriage rate was significantly lower in patients with complete US (p = 0.0001,p = 0.0001, respectively). The mean gestational week at the time of birth and mean birth weight of the in- fants were significantly lower in patients with complete US compared to the incomplete US cases (p = 0.026, p = 0.049, respectively). Postoperative pregnancy rate was significantly lower in incomplete US patients with primary infertility compared with secondary in- fertility (p = 0.037).

CONCLUSION

Hysteroscopic metroplasty improves fertility and pregnancy performance. This improvement is more prominent in patients with complete US, and incomplete US patients with secondary infertility.

Production cross–section calculations of medical 32P, 117Sn, 153Sm and 186,188Re radionuclides used in bone pain palliation treatment

In this study, production cross–section calculations of 32P, 117Sn, 153Sm and 186,188Re radionuclides used in bone pain palliation treatment produced by 30Si(d,γ)32P, 118Sn(γ,n)117Sn, 116Sn(n,γ)117Sn, 150Nd(α,n)153Sm, 154Sm(n,2n)153Sm, 152Sm(n,γ)153Sm, 186W(d,2n)186Re, 187Re(γ,n)186Re, 185Re(n,γ)186Re and 187Re(n,γ)188Re reactions have been investigated in the different incident energy range of 0.003–34 MeV. Two-component exciton and generalised superfluid models of the TALYS 1.6 and exciton and generalised superfluid models of the EMPIRE 3.1 computer codes have been used to pre-equilibrium (PEQ) reaction calculations. The calculated production cross–section results have been compared with available experimental results existing in the experimental nuclear reaction database (EXFOR). Except the 118Sn(γ,n)117Sn, 150Nd(α,n)153Sm and 185Re(n,γ)186Re reactions, the two-component exciton model calculations of TALYS 1.6 code exhibit generally good agreement with the experimental measurements for all reactions used in this present study.

Reattachment of dehydrated tooth fragments: two case reports

Anterior crown fractures are the most common type of injury in dental trauma. The ideal treatment is to reattach the fragments as quickly as possible following intraoral and radiographic examination, but sometimes delayed treatment appointments are necessary because of uninformed patients/parents or multidisciplinary cases included endodontically and periodontically. Delayed reattachment may lead to unesthetic results because of the dehydration of fragments. The purpose of this study was to present 1-year follow-ups of reattachment of dehydrated fragments using dentin bondings and flowable composites in two different cases. The color of the dehydrated fragments was natural in the control appointments and 1-year follow-ups show harmonious integration of color, form and texture after the reattachment of the original piece of tooth. Restoration of the tooth by reattaching the original fragment is the best way of treatment in esthetic, conservative and economic point of view.

A multi-functional fluorescent scaffold as a multi-colour probe: design and application in targeted cell imaging

A new scaffold material based on a novel targeting strategy has been developed, benefiting from recent progress in the development of tailor-made fluorescent bioprobes for cellular imaging and opening a new viewpoint for further improvements in in vitro and in vivo imaging.

The relationship between ischemia modified albumin and oxidative stress parameters in patients with cardiac syndrome X

BACKGROUND

The objective of this study was to evaluate the serum levels of ischemia modified albumin and oxidative stress parameters in patients with cardiac syndrome X.

METHODS

A total of 61 patients, composed of 32 consecutive patients (24 female, 8 male, average age: 47.63 +/- 9.49 years) diagnosed with cardiac syndrome X by coronary angiography (initially performed following the identification of ischemia by exercise stress test or myocardial perfusion scintigraphy) and a control group of 29 consecutive patients (15 female, 14 male, average age: 49.59 +/- 11.68 years) with similar features without cardiac syndrome X were included in the study. The levels of the ischemia modified albumin (IMA), ferric reducing antioxidant power (FRAP), prooxidant-antioxidant balance (PAB), and advanced protein oxidation products (AOPP) were determined by colorimetric methods.

RESULTS

Patients have significantly higher PAB, AOPP, and IMA levels in the patient group than in the control group (p < 0.01, p < 0.001, and p < 0.02, respectively). Also, serum triglyceride (p < 0.005) and hs-CRP (p < 0.0001) levels were significantly higher in the patient group (p < 0.01, p < 0.001, and p < 0.02, respectively). We found that there was a significant correlation between hs-CRP, plasma PAB (r: 0.258; p < 0.05), AOPP (r: 0.459; p < 0.001), and triglyceride levels (r: 0.404; p < 0.01). Plasma AOPP levels were also significantly positive correlated with triglyceride levels (r: 0.463; p < 0.001). In addition, during the correlation analysis performed on the patient group, a positive correlation was observed between the levels of IMA with the levels of plasma PAB and plasma AOPP (r: 0,994; p < 0.01 and r: 0.857; p < 0.05, respectively) In a multiple linear regression analysis, AOPP levels were significantly related with hs-CRP and triglyceride (R2: 0.380, p < 0.0001 and p < 0.05). Simple linear regression analysis was performed between plasma PAB (as dependent variable) and hs-CRP levels. Plasma PAB levels were related with hs-CRP (R2: 0.258, p < 0.05). Using the receiver-operator characteristic (ROC) curve, the best cut-off values for predicting cardiac syndrome X of PAD, AOPP, IMA, and hs-CRP levels were 88.1 arbitrary units, 68.5 kloramin T micromol/L, 7.17 U/mL, and 1.09 mg/dL, respectively.

CONCLUSIONS

Based on the results of our study, the increase in oxidative stress during cardiac syndrome X appears to be related to elevated levels of IMA. Treatment modalities that decrease oxidative stress might be beneficial for the treatment of cardiac syndrome X.

Gold nanoparticle loaded phytosomal systems: synthesis, characterization and in vitro investigations

A novel liposomal formulation was synthesized by encapsulating both gold nanoparticles (AuNPs) andCalendula officinalisextract as AuNP-phytosomes and AuNP-phytosomes were characterized and used atin vitroinvestigations.

Folic acid modified clay/polymer nanocomposites for selective cell adhesion

A promising material, a folic acid modified poly(epsilon-caprolactone)/clay nanocomposite that allows selective cell adhesion and proliferation, was synthesized and characterized as a cell culture and biosensing platform.

Correlation of myocardial performance index assessed by different echocardiographic methods in patients with acute myocard infarction receiving different reperfusion treatment

AIM

Myocardial performance index (MPI) is a well known prognostic parameter in acute myocardial infarction (AMI) patients, which has been used to assess global cardiac functions. In this study, we aimed to evaluate the corelation between the MPI levels obtained by PW doppler and Tissue doppler ultrasonography with reperfusion in AMI patients.

METHODS

Fifty-four consecutive acute ST elevatation myocardial infarction patients, 26 treated with primary percutaneous coronary intervention (PCI) and 28 with thrombolytic therapy (TT); and 15 consecutive healthy controls were included in the study. MPI levels were measured with pulsed-wave (PW) doppler and tissue Doppler ultrasonography in all patients. The isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT) and ejection time (ET) values used to measure MPI levels were determined. Corelation between the time intervals obtained with both methods were evaluated. MPI variations were evaluated in patients treated with PCI and TT. A significant corelation was observed in MPI levels obtained with PW doppler and tissue doppler ultrasonography (P<0.001) as well as between IRT, ICT and ET values (for all parameters; P<0.001). No significant corelation was observed between the MPI levels obtained with PW doppler and tissue doppler ultrasonography in patients treated with primary PTCA and TT (P=0.128, P=0.991, respectively). A significant corelation was observed between the MPI values obtained by PW doppler and tissue doppler ultrasonography with reperfusion interval (P=0.002, P<0.001, respectively).

CONCLUSION

As a result, tissue Doppler ultrasonography may be used as an alternative to PW doppler to evaluate MPI, which is a well known prognostic factor in AMI. No relation has been observed between MPI values in early phases of AMI with reperfusion pattern, while a connection has been observed between MPI and reperfusion interval.

Human spermatozoa antigens in unexplained infertility

OBJECTIVE

To determine and compare the immunolocalization of functionally important antigens in human spermatozoa in an unexplained infertility (UI) group.

MATERIALS AND METHODS

In this study, the sperm samples of 20 patients undergoing evaluation belonging to normozoospermic group, whose primary reason of infertility was under investigation for this purpose, were screened. CD46, CD55 and CD52, CD69, CD98, fMLP, HI307, and 80280 were stained on the spermatozoa through indirect immunofluorescence technique.

RESULTS

In addition to CD46, CD55, and CD52 antigens, which are known to be localized on human spermatozoa, significant immunolocalization of several novel antigens including: CD52, CD69, CD98, fMLP, HI307, and 80280 were determined on the spermatozoa of the unexplained infertility group, possibly reflecting important roles in the pathophysiology of such unresolved clinical situations.

CONCLUSION

Identification and characterization of antigens present on sperm cells is crucial for understanding of the diagnosis and treatment of unexplained infertility. Further studies were conducted to evaluate a possible correlation between the expression of these antigens and clinical outcomes in different well-defined infertility groups.

The role of homocysteine, asymmetric dimethylarginine and nitric oxide in pre-eclampsia

Nitric oxide (NO) contributes to vasodilatation that is observed during normal pregnancy. Hyperhomocysteinaemia (HHcy) is a vascular risk factor associated with placental microvascular diseases and pre-eclampsia. Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of endothelial nitric oxide synthase (NOS) has been linked to endothelial dysfunction. Maternal ADMA has been reported to be higher in women with pre-eclampsia and HHcy leads to accumulation of ADMA. The aim of this presented study is to evaluate the alterations of plasma homocysteine, ADMA and NO levels in mild pre-eclampsia. A total of 40 pre-eclamptic women and 40 healthy controls were included into the study. Mean systolic and diastolic blood pressure, mean serum homocysteine and ADMA levels were significantly higher and NO level was lower in patients. Serum homocysteine, ADMA and NO levels found to be correlated among them and with blood pressure. In conclusion, we found that homocysteine and ADMA levels were increased and NO levels decreased in pre-eclampsia.

Serum levels of lipids, lipoproteins and paraoxonase activity in pre-eclampsia

Serum paraoxonase 1 (PON1) activity and the oxidation of lipoproteins were investigated in 35 women with pre-eclampsia and in 35 healthy control women with normal pregnancies. Blood pressure, body mass index (BMI), serum levels of total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB) and lipoprotein (a) (Lp[a]), and PON1 activity were assessed. There were no significant between-group differences in subject age, gestational age at diagnosis of pre-eclampsia, BMI, serum total cholesterol, triglycerides, LDL and ApoB levels. Mean systolic and diastolic blood pressures and serum Lp(a) were significantly higher in subjects with pre-eclampsia than in controls. Mean serum HDL, ApoA1 and PON1 activity were significantly lower in subjects with pre-eclampsia compared with controls. In conclusion, lipids and oxidized lipoproteins may play important roles in the pathogenesis of pre-eclampsia.

ICSI outcome of patients with severe oligospermia vs. non-obstructive azoospermia

OBJECTIVE

To compare the results of intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) cycles in men with severe oligoospermia and non-obstructive azoospermia.

MATERIALS AND METHODS

This study included 91 ICSI cycles performed due to male factor infertility. Patients are divided into two groups according to source of spermatozoa. Group 1 consisted of 38 cycles in which sperm was obtained from testicles (cases with non-obstructive azoospermia). In Group 2, 53 consecutive cycles were included in which ejaculated sperm was available for ICSI in spite of severe oligospermia (< 100,000/ml). Fertilization, embryo quality and clinical pregnancy rates were compared between the groups.

RESULTS

Although, the female age and mean number of oocytes retrieved were similar among the two groups, fertilization rate was significantly lower in the non-obstructive azoospermia (34.6%) group compared to group in which patients underwent ICSI with ejaculate spermatozoa (55.3%) (p < 0.05). However, there were no differences regarding mean number of available grade 1 embryos on day 3 and pregnancy rate between the two groups.

CONCLUSION

Testicular sperm from non-obstructive azoospermia patients had significantly lower fertilization rates than the ejaculated spermatozoa from severe oligospermia patients in ICSI cycles. However, it did not bring about improved pregnancy rate.

Outcomes of pregnancies in women with parity ten or more: a case control study

PURPOSE

To determine the outcomes of pregnancies in women with parity ten and more.

MATERIALS AND METHODS

We designed this study in a government hospital in rural Turkey. Pregnant women with parity of ten or more (n=126) were evaluated and compared with pregnant women with parity lower than ten (n=90). The risk factors recorded were maternal age, parity, gestational age (weeks), delivery mode, fetal birth weight and Apgar scores. Statistical analyses were carried out using the statistical packages for SPSS 15.0 for Windows (SPSS Inc., Chicago, IL, U.S.A.).

RESULTS

During the study period, a total of 12,551 deliveries were delivered at the current clinic. One hundred and twenty-six mothers were delivered with parity ten or more with a ratio of 1.01%. There was a statistically significant difference between the study and control group by means of maternal age, parity, fetal birth weight and 1- and 5-min Apgar scores (p < 0.05). There was no difference in delivery mode between the groups.

CONCLUSION

According to this study, pregnant women with parity ten or more showed no adverse clinical characteristics when compared with pregnant women with parity lower than ten.

Effect of sperm morphology on clinical outcome parameters in ICSI cycles

OBJECTIVE

To assess the effect of isolated teratozoospermia with a normal sperm count and total motility by means of the fertilization rates, embryo quality and clinical pregnancy rate only in ICSI cycles.

MATERIALS AND METHODS

We retrospectively analyzed the records of patients who underwent ICSI at Hacettepe University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Fertility and Reproductive Endocrinology between July 2001 and January 2010. Only patients with normal sperm count and total motility were recruited. The remaining cycles were further divided into two groups according to their sperm morphology with respect to Kruger's strict criteria. In Group 1, 537 consecutive cycles were enrolled whose sperm morphology was <4%. In Group 2, 118 cycles were identified with a morphology of > or = 4%.

RESULTS

A total of 655 ICSI cycles were included in the final analysis. The fertilization rates were 72.0% and 70.8% in Groups 1 and 2, respectively. There were no differences regarding embryo quality, clinical pregnancy and implantation rates between the two groups.

CONCLUSION

Our data suggest that detection of morphology defect has no value in the prediction of fertilization, embryo quality and clinical pregnancy in ICSI cycles.

ICSI cycle outcomes in oligozoospermia

AIM

The aim of this study was to evaluate the sole effect of sperm concentration on fertilization, embryo quality and pregnancy rates in patients undergoing ICSI cycles.

MATERIALS AND METHODS

560 ICSI cycles performed for male factor infertility were divided into four groups according to sperm concentration retrospectively. Group 1 consisted of 86 couples whose sperm concentration was less than 1x10(6), group 2 consisted of 169 couples whose sperm concentration ranged between 1x10(6) and 5x10(6), group 3 consisted of 95 couples whose sperm concentration ranged between 5x10(6) and 10x10(6) and group 4 consisted of 210 couples whose sperm concentration ranged between 10x10(6) and 20x10(6).

RESULTS

Fertilization rate was significantly lower in the first three groups compared to the last group (p<0.05). The first three groups were comparable with each other. There were no differences according to ovarian response to stimulation, embryo quality and clinical pregnancy rates between the four groups.

CONCLUSION

Lower sperm concentration has detrimental effects on the outcomes of ICSI cycles. This situation is more evident in men with severe and extremely severe oligozoospermia.

Radiation protection for accompanying person and radiation workers in PET/CT

The purposes of the present study are to measure the total radiation doses for the radiation workers and for the accompanying person to the patients in positron emission tomography (PET)/computed tomography (CT) imaging. Urines samples from the patients were collected at 43, 62, 87, 117, 238, 362 min after the 555-MBq (18)flour-fluorodeoxyglucose ((18)F-FDG) injection and activities were measured. Dose rates were recorded using a Geiger-Muller counter and the total radiation doses were measured with using an electronic personnel dosemeter. According to the results here, 18.4 % of (18)F-FDG was excreted in the urine in 117 min after injection. At 117th min after injection, dose rates were determined as 345, 220, 140, 50 and 15 µSv h(-1), at proposed distances. The radiation doses after 117 min were measured as 3.92 mSv at 0.1 m, 2.11 mSv at 0.25 m and 1.08 mSv at 0.5 m. In conclusion, radiation protection will be sufficient within 2 h after (18)F-FDG injection for PET/CT imaging in daily practice.