Long term sexual outcomes of Mayer Rokitansky Küster Hauser Syndrome patients after Uncu-modified Davydov procedure

Background

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome has an incidence of 1 in 4000. The absence of the vagina and uterus results in sexual dysfunction and infertility. The first-line treatment is vaginal dilatation. There exists a number of second-line surgical options including the Uncu-modified Davydov procedure.

Objective

To determine the complication rate, anatomical outcomes, and long-term sexual outcomes of MRKH syndrome patients after Uncu-modified Davydov procedure.

Materials and Methods

Patients with MRKH syndrome who underwent paramesonephric remnant-supported laparoscopic double-layer peritoneal pull-down vaginoplasty (aka Uncu-modified Davydov procedure) between January 2008 and December 2021. The procedure involves laparoscopic circular dissection of the pelvic peritoneum followed by pulling down, through the opened vaginal orifice, and suturing the vaginal cuff with the support of uterine remnants. The long-term complication rate, anatomical outcomes, and sexual function outcomes (as measured by Female Sexual Function Index (FSFI)) were ascertained.

Main outcome measures

Main Outcome Measures: The long-term complication rate, anatomical outcomes and FSFI survey results.

Results

A total of 50 patients with MRKH syndrome underwent the Uncu-modified Davydov procedure between Jan 2008- Dec 2021. There were four perioperative complications: three bladder injuries (6%) and one rectal serosa injury (2%). Four long-term postoperative complications were identified: one vesicovaginal fistula (2%), one recto-vaginal fistula (2%), and two vaginal stenoses (4%). All patients were physically examined at least one year after surgery. The mean vaginal length was 8.4 + 1.9 cm. The mean FSFI score was 31.5 + 3.9 (minimum score of 24, maximum score of 36).

Conclusion

Conclusion: The Uncu-modified Davydov procedure has been demonstrated to be a safe and effective treatment option with high female sexual function index scores for patients with MRKH syndrome.

What is new?

The long-term complication rate, anatomical and sexual outcomes of Uncu-modified laparoscopic peritoneal pull-down vaginoplasty were reported in this study. The results indicated that the surgical approach could be used in selective MRKH patients who failed first-line self-dilatation therapy.

Feasibility and Safety of Personalized, Multi-Target, Adoptive Cell Therapy (IMA101): First-in-Human Clinical Trial in Patients with Advanced Metastatic Cancer

IMA101 is an actively personalized, multi-targeted adoptive cell therapy (ACT), whereby autologous T cells are directed against multiple novel defined peptide-HLA (pHLA) cancer targets. HLA-A*02:01-positive patients with relapsed/refractory solid tumors expressing ≥1 of 8 predefined targets underwent leukapheresis. Endogenous T cells specific for up to 4 targets were primed and expanded in vitro. Patients received lymphodepletion (fludarabine, cyclophosphamide), followed by T-cell infusion and low-dose IL2 (Cohort 1). Patients in Cohort 2 received atezolizumab for up to 1 year (NCT02876510). Overall, 214 patients were screened, 15 received lymphodepletion (13 women, 2 men; median age, 44 years), and 14 were treated with T-cell products. IMA101 treatment was feasible and well tolerated. The most common adverse events were cytokine release syndrome (Grade 1, n = 6; Grade 2, n = 4) and expected cytopenias. No patient died during the first 100 days after T-cell therapy. No neurotoxicity was observed. No objective responses were noted. Prolonged disease stabilization was noted in three patients lasting for 13.7, 12.9, and 7.3 months. High frequencies of target-specific T cells (up to 78.7% of CD8+ cells) were detected in the blood of treated patients, persisted for >1 year, and were detectable in posttreatment tumor tissue. Individual T-cell receptors (TCR) contained in T-cell products exhibited broad variation in TCR avidity, with the majority being low avidity. High-avidity TCRs were identified in some patients' products. This study demonstrates the feasibility and tolerability of an actively personalized ACT directed to multiple defined pHLA cancer targets. Results warrant further evaluation of multi-target ACT approaches using potent high-avidity TCRs. See related Spotlight by Uslu and June, p. 865.

T cell receptor dynamic and transcriptional determinants of T cell expansion in glioma-infiltrating T cells

Background

Glioblastoma (GBM) is characterized by low numbers of glioma-infiltrating lymphocytes (GIL) with a dysfunctional phenotype. Whether this dysfunctional phenotype is fixed or can be reversed upon ex vivo culturing is poorly understood. The aim of this study was to assess T cell receptor (TCR)-dynamics and -specificities as well as determinants of in vitro GIL expansion by sequencing-based technologies and functional assays to explore the use of GIL for cell therapy.

Methods

By means of flow cytometry, T cell functionality in GIL cultures was assessed from 9 GBM patients. TCR beta sequencing (TCRB-seq) was used for TCR repertoire profiling before and after in vitro expansion. Microarrays or RNA sequencing (RNA-seq) were performed from 6 micro-dissected GBM tissues and healthy brain RNA to assess the individual expression of GBM-associated antigens (GAA). GIL reactivity against in silico predicted tumor-associated antigens (TAA) and patient-individual GAA was assessed by ELISpot assay. Combined ex vivo single cell (sc)TCR-/RNA-seq and post-expansion TCRB-seq were used to evaluate transcriptional signatures that determine GIL expansion.

Results

Human GIL regains cellular fitness upon in vitro expansion. Profound TCR dynamics were observed during in vitro expansion and only in one of six GIL cultures, reactivity against GAA was observed. Paired ex vivo scTCR/RNA-seq and TCRB-seq revealed predictive transcriptional signatures that determine GIL expansion.

Conclusions

Profound TCR repertoire dynamics occur during GIL expansion. Ex vivo transcriptional T cell states determine expansion capacity in gliomas. Our observation has important implications for the use of GIL for cell therapy including genetic manipulation to maintain both antigen specificity and expansion capacity.

P-320 The Effects of Endometriosis on Oocyte Morphology and Embryo Development

Study question

What is the effect of the endometriosis on oocytes morphological abnormalities in intracytoplasmic sperm injection cycles.?

Summary answer

An increase in the detection rate of refractile body and polar body fragmentation was observed in the morphology of oocytes obtained from endometriosis patient.

What is known already

The quality of the oocyte is suspected for the lower clinical success in endometriosis patients compared to other patient groups. The oocyte quality is determined by its morphological, cellular, and molecular evaluations. However, there are limited studies on the association between endometriosis and oocyte morphology.

Study design, size, duration

This was a retrospective cohort study, conducted between January 2020 and August 2021, at a tertiary care hospital. The women aged 24-35 years and BMI 19-30 kg/m2 ranges who underwent fresh GnRH antagonist cycles and stimulated with 150-300 IU dose of recombinant FSH (rFSH) and then trigerred with 250 micrograms/0.5 ml of rhCG were included.

Participants/materials, setting, methods

The patients who were cycled with the etiology of endometriosis (n = 46 cycles, Group 1) and those who were cycled with the etiology of male infertility (n = 64 cycles, Group 2) were included in this study. In addition to the comparison of intracytoplasmic and extracytoplasmic (polar body, perivitelline space, zona pellisuda) anomalies observed in oocyte morphology between groups, morphology anomalies that affect fertilization and blastocyst development within the group were evaluated.

Main results and the role of chance

The patient age, BMI, antral follicle counts, duration of infertility, and basal endocrine parameters among patients who were cycled with the etiology of endometriosis (n = 46 cycles, Group 1) and those who were cycled with the etiology of male infertility (n = 64 cycles, Group 2) were not different (p>0.05). As a result of the comparison of intracytoplasmic anomalies of 800 oocytes in total (n = 263 Group 1; n = 537 Group 2) between the groups; the refractile body determination (OR:1.23; 95% CI 1.08 -1.4, p <0.00) was higher in the endometriosis group compared to the other group. As a result of the comparison of extracytoplasmic anomalies between the groups; the polar body fragmentation (OR:1.3; 95% CI 1.01 - 1.85, p> =0.03) determination was higher in the endometriosis group compared to the other group. When the effect of oocyte morphology anomalies on fertilization and blastocyst development within the groups was evaluated by logistic regression analysis, it was found that granulation of the perivitelline space had a negative effect on blastocyst development only in the endometriosis group (β  = -0.69; p> =0.31).

Limitations, reasons for caution

The main limitation of our study was its retrospective design, which precludes us from reaching a more definitive conclusion on the relation between oocyte morphology of endometriosis an fertility outcomes.

Wider implications of the findings

The previous studies indicate that PVS and PBI abnormalities may be ascribed to over-mature oocytes and also be negatively correlated with fertilization rate and embryo quality. Our study suggest that endometriosis seems to negatively affect oocyte quality and maturation process.

Trial registration number

not applicable

P-678 Does gonadotropin dose adjustment in inadequate ovarian response during controlled ovarian hyperstimulation improve the live birth rates of patients with diminished ovarian reserve?

Study question

Does gonadotropin dose adjustment in inadequate ovarian response during controlled ovarian hyperstimulation improve the live birth rates of patients with diminished ovarian reserve?

Summary answer

The increasing dose adjustment of the gonadotropin according to the ovarian response during COH in DOR provides similar live birth rates to the fixed-dose group.

What is known already

Since the poor ovarian response is associated with low pregnancy rates and high cycle cancellation rates, the ovarian response should be predicted, especially for stimulation protocol and gonadotropin dose adjustment before COH is initiated. On the other hand, the predicted gonadotropin dose may not be enough for the ovarian response, and the dose adjustment may be required. Nevertheless, the literature has conflicting results on whether dose adjustment during COH improves the pregnancy results.

Study design, size, duration

This retrospective cohort study was conducted at a tertiary university hospital's ART (assisted reproductive technologies) center. The electronic database of the ART center was screened between the years 2012-2021, and the DOR patients who underwent ICSI-ET (intra-cytoplasmic sperm injection – embryo transfer) were selected. Bologna criteria were used to determine the diminished ovarian reserve. Patients were divided into two groups depending on the presence of dose adjustment on the first ultrasound control during COH.

Participants/materials, setting, methods

Women who underwent single–fresh good quality (Gardner A or B) blastocyst transfer and aged between 18-40 years, without male infertility and endometrial pathology were included in, and after exclusion, 498 patients were enrolled in the study. Flexible antagonist protocol was used for COH. A vaginal micronized progesterone capsule (3x200 mg) was prescribed for luteal phase support after oocyte retrieval. Live birth rate was determined as the singleton live birth after the 24th week of pregnancy.

Main results and the role of chance

There were 188 patients in the dose adjustment (DA) group and 310 patients in the fixed-dose (FD) group. The demographic parameters were similar between the groups (Age, Body Mass Index, Ovarian Reserve Parameters). The mean women age was 33.8+4 in the DA group and 33.6+4.1 in the FD group (p = 0.6). The started gonadotropin dose was similar in both groups (300 IU). The type of gonadotropin was mostly HMG in the DA group (67% in DA vs. 48% in the FD group, p = 0.01). The median dose adjustment on the first control was +75 IU in the DA group, and as expected, the total gonadotropin consumption was significantly higher in the DA group (Median values; 3900 vs. 3000 IU, p < 0.01). The follicle output rates, follicle to oocyte indexes, and the embryology parameters were comparable between the groups (number of picked up oocytes, metaphase-2 oocytes, and 2PN embryos). The positive pregnancy rate was 19.7% (36/188) in the DA group vs. 19.1% (61/310) in the FD Group (p = 0.4). The primary outcome of the study; live birth rates were 12% in the DA group vs. 9% in the FD group, and the results were statistically similar (p = 0.3).

Limitations, reasons for caution

Retrospective design and the sample size limit the power of the study.

Wider implications of the findings

Our study showed that the gonadotropin dose adjustment in inadequate ovarian response during COH provides similar live birth rates to the fixed-dose group. In patients with inadequate response, dose adjustment may be a necessary action.

Trial registration number

Not applicable

P-419 Does adjuvant usage in the luteal phase improve live birth rates of ICSI - ET patients with previous implantation failure?

Study question

Does adjuvant usage in the luteal phase improve live birth rates of ICSI-ET (intracytoplasmic sperm injection - embryo transfer) patients with previous implantation failure?

Summary answer

Combination of low molecular weight heparin, aspirin, and prednisolone in the luteal phase doesn't improve live birth rates of ICSI-ET patients with previous implantation failure.

What is known already

RIF affects around 10% of patients undergoing IVF worldwide. The exact pathology of implantation failure, although transferring a good quality embryo, is still unknown. There are numerous treatment options, However, there is no conclusive evidence that prophylactic treatment improves the pregnancy rate in infertile women during IVF.

Study design, size, duration

This retrospective study included 1095 patients with > 2 failed either fresh or frozen embryo transfer cycles between 2014 Jan – 2021 Jan.

Participants/materials, setting, methods

Patients were divided into two groups. Group-A consisted of patients with only vaginal progesterone for luteal phase support. Group-B consisted of patients with triple (daily subcutaneous low molecular weight heparin, daily p.o. 150 mg aspirin, and daily p.o. 16 mg prednisolone) luteal phase supplementation to vaginal progesterone. Demographic parameters, cycle characteristics, embryology, and pregnancy outcomes were compared, and the live birth rate was the study's primary outcome.

Main results and the role of chance

There were 5910 ICSI&ET cycles between the years Jan 2014 and Jan 2021. A total of 3853 Patients with single day5-6 good quality blastocyst transfer was selected from the database, and appropriate patients for inclusion criteria with at least two previous failure implantation history were included. As a result, a total of 1095 fresh or frozen-thawed ET cycles were included in the study. There were 617 patients without (Group A) and 478 patients with adjuvant use (Group B). Demographic parameters were similar between groups. Although higher embryology outcomes (Group A vs. B, No.of oocyte; 11 (7-17) vs. 13 (8-19), No. of MII; 9(5-14) vs. 10 (6-15), No. of 2PN; 5 (3-9) vs. 6 (4-10), p < 0.01), positive b-hCG rates, miscarriage rates, live birth rates were similar between groups (Group A vs. B, positive b-hCG; 30.8% (190/617) vs. 35.4% (169/478), Miscarriage rates; 4.4% (27/617) vs. 6.7%  (32/478), Live Birth Rates; 20.4% (126/617) vs. 23.8% (114/478)). When the live birth rates were stratified depending on the number of previous failed transferred cycles, the live birth rates were still comparable between the groups.

Limitations, reasons for caution

The study's retrospective design limits the power of the results. The study's main limitation is the lack of the euploidy information of transferred embryos.

Wider implications of the findings

Our findings suggest that empirical usage of adjuvants such as low molecular weight heparin, aspirin, and prednisolone does not improve live birth rates in patients with previous implantation failure. These results support the present literature.

Trial registration number

Not applicable

Phase I/II multicenter trial of a novel therapeutic cancer vaccine, HepaVac-101, for hepatocellular carcinoma

PURPOSE

Immunotherapy for hepatocellular carcinoma (HCC) shows considerable promise in improving clinical outcomes. HepaVac-101 represents a single-arm, first-in-man Phase I/II multicenter cancer vaccine trial for HCC (NCT03203005). It combines multi-peptide antigens (IMA970A) with the TLR7/8/RIG I agonist CV8102. IMA970A includes 5 HLA-A*24 and 7 HLA-A*02 as well as 4 HLA-DR restricted peptides selected after mass spectrometric identification in human HCC tissues or cell lines. CV8102 is an RNA-based immunostimulator inducing a balanced Th1/Th2 immune response.

EXPERIMENTAL DESIGN

82 patients with very early to intermediate stage HCCs were enrolled and screened for suitable HLA haplotypes and 22 put on study treatment. This consisted in a single infusion of low-dose cyclophosphamide followed by 9 intradermal coadministrations of IMA970A and CV8102. Only patients with no disease relapse after standard of care treatments were vaccinated. Primary endpoints of HepaVac-101 clinical trial were safety, tolerability and antigen-specific T-cell responses. Secondary or exploratory endpoints included additional immunological parameters and survival endpoints.

RESULTS

The vaccination showed a good safety profile. Transient mild-to-moderate injection-site reactions were the most frequent IMA970A/CV8102-related side effects. Immune responses against {greater than or equal to}1 vaccinated HLA class I tumor-associated peptide (TAA) and {greater than or equal to}1 vaccinated HLA class II TAA were respectively induced in 37% and 53% of the vaccinees.

CONCLUSION

Immunotherapy may provide a great improvement in treatment options for HCC. HepaVac-101 is a first-in-man clinical vaccine trial with multiple novel HLA class I- and class II-restricted TAAs against HCC. The results are initial evidence for safety and immunogenicity of the vaccine. Further clinical evaluations are warranted.

Comparative evaluation of T-cell receptors in experimental glioma-draining lymph nodes

Background

Glioblastomas, the most common primary malignant brain tumors, are considered immunologically cold malignancies due to growth in an immune sanctuary site. While peptide vaccines have shown to generate intra-tumoral antigen-specific T cells, the identification of these tumor-specific T cells is challenging and requires detailed analyses of tumor tissue. Several studies have shown that CNS antigens may be transported via lymphatic drainage to cervical lymph nodes, where antigen-specific T-cell responses can be generated. Therefore, we investigated whether glioma-draining lymph nodes (TDLN) may constitute a reservoir of tumor-reactive T cells.

Methods

We addressed our hypothesis by flow cytometric analyses of chicken ovalbumin (OVA)-specific CD8⁺ T cells as well as T-cell receptor beta (TCRβ) next-generation-sequencing (TCRβ-NGS) of T cells from tumor tissue, TDLN, spleen, and inguinal lymph nodes harvested from experimental mouse GL261 glioma models.

Results

Longitudinal dextramer-based assessment of specific CD8⁺ T cells from TDLN did not show tumor model antigen reactivity. Unbiased immunogenomic analysis revealed a low overlap of TCRβ sequences from glioma-infiltrating CD8⁺ T cells between mice. Enrichment scores, calculated by the ratio of productive frequencies of the different TCRβ-CDR3 amino-acid (aa) rearrangements of CD8⁺ T cells derived from tumor, TDLN, inguinal lymph nodes, and spleen demonstrated a higher proportion of tumor-associated TCR in the spleen compared to TDLN.

Conclusions

In experimental glioblastoma, our data did not provide evidence that glioma-draining cervical lymph nodes are a robust reservoir for spontaneous glioma-specific T cells highlighting the requirement for detailed analyses of glioma-infiltrating T cells for the discovery of tumor-specific TCR.

Macroanatomical and histological study of the structure of intercornual gland in Abaza (Capra Aegagrus) and Gurcu (Capra Falconeri) goats breeds

BACKGROUND

The anatomical localisation of the odour glands, which increase activity during the reproduction period and help goat species to find each other, varies.

MATERIALS AND METHODS

In our study, the anatomical and histological structures of the glands around the horn were examined in the Gurcu and Abaza goats, which are native breeds. In this study a total of 12 Abaza and Gurcu goat heads were used.

RESULTS

The area between the two horns and area at the back of the horns were shaved to remove all hair. The distance between the horns of both goat breeds was measured using an electronic calliper. The mean distance between the horns of the Abaza goats was determined as 36.80 ± 8.62 mm while this distance was 39.63 ± 4.10 mm for the Gurcu goats. Gland tissue that could not be seen anatomically under the skin was examined histologically. For the histological examination, skin samples were taken from the anterior, middle, right posterior and left posterior of the area between the two horns of both breeds. Crossman triple staining and haematoxylin and eosin staining were applied to the samples.

CONCLUSIONS

Glandula intercornualis was found to be slightly caudal between the horns in both breeds and normal sebaceous glands were almost absent in the areas where these glands were found. Lobes and branched alveolar glands were located around the hair follicles.

Multiple sclerosis patients with and without sexual dysfunction: are there any differences?

Objective Sexual dysfunction (SD) severely affects the quality of life in patients with multiple sclerosis (MS). The aim of this study is to investigate the type and frequency of sexual complaints in MS patients, to analyse their relationship to various clinical and psychosocial variables and to clarify the differences between MS patients with and without SD.

Methods Thirty-five relapsing-remitting (RR), nine secondary progressive and seven primary progressive MS patients were included in this study. A structured face-to-face interview regarding sexual function and other physical problems which may interfere with sexual functioning was administered to each patient. They also filled out Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19), which includes items for primary (direct physical), secondary (indirect physical) and tertiary (psychosocial) causes of SD. Disability, cognitive functions and psychological functioning were also evaluated.

Results Forty-one patients (80.4%) reported primary SD; decreased libido was the most frequent complaint (80.5%). These patients were older and more disabled, however 39% had low disability scores. SD was a common problem for both men and women. Patients with RRMS were affected less in all items of primary SD. Several items of secondary SD-problems with memory and concentration, bladder symptoms, bowel symptoms-showed correlation with different items of primary SD; these were altered genital sensation, decreased libido, increased time for arousal, decreased lubrication/difficulties with erection. Total MSISQ-19 scores were correlated with disease duration, age, disability, disease course, Beck depression scale, temporary and long-standing anxiety and low level of education.

Conclusion SD is an underestimated, common symptom of MS. It may occur in MS even in the absence of severe disability. Physicians’ awareness of this problem may help to bring about appropriate treatments and management, and improve the quality of life for these patients.

Clinical importance of placental membrane microscopic chorionic pseudocysts in preeclampsia

OBJECTIVE

To determine the importance of placental membrane microscopic chorionic pseudocysts (MCP) in preeclamptic and normal placentas and evaluate the association between MCP and neonatal complications in preeclamptic patients.

MATERIALS AND METHODS

In this prospective case-control study, microscopic examination of placentas was performed, including MCP count, in 33 preeclamptic and 35 normal control pregnant women from December 2008 to May 2009. The MCP were counted in placentas for each patient and modeled as a continuous variable to assess the difference between the two groups.

RESULTS

The mean MCP count was similar for preeclamptic (7 ± 2) and control patients (7 ± 2; not significant). A weak positive correlation was noted between placental weight and MCP (r = 0.253; p ≤ 0.04). In the preeclamptic patients, mean MCP count was significantly higher for neonates that did not have neonatal respiratory distress syndrome (NRDS) (p ≤ 0.05) and who did not admitted to neonatal intensive care unit (NICU) than admitted to NICU (P ≤ .03). The risk for developing NRDS was 20.3-fold greater in neonates of preeclamptic patients who did not have than had MCP (odds ratio, 20.3 95% confidence interval, 1.0 to 48; P ≤ .05). The MCP count cutoff value was ≤ 1 for developing NRDS (sensitivity 83%; specificity, 70%).

CONCLUSION

The absence of MCP was significantly associated with the development of NRDS in neonates. The MCP count was inversely associated with the risk of NRDS in newborns of high-risk pregnancies caused by preeclampsia.

Bacterial translocation and intestinal injury in experimental necrotizing enterocolitis model

OBJECTIVE

To study the occurrence of bacterial translocation and to assess the impact of breastfeeding on bacterial translocation in the animal model of necrotizing enterocolitis.

METHODS

A total of 20 neonate Sprague-Dawley rats were enrolled in the study. Rats were randomly allocated into either control or study group just after birth. Ten newborn rats in the control group were left with their mother to be breast-fed. In contrary, necrotizing enterocolitis group consisted of neonates that were separated from their mothers, housed in an incubator and were gavaged with a special rodent formula three times daily. Survival rates, weight changes, and morphologic scoring obtained after microscopic evaluation were determined as microbiologic evaluation criteria.

RESULTS

All the rats in the control group survived, while 1 (10 %) rat died in the necrotizing enterocolitis group. Mortality rates of the two groups were similar. All the formula-fed animals in the necrotizing enterocolitis group had significant weight loss compared to the breast milk-fed rats in the control group (p<0.05). A total of 7 (70 %) and 2 (20 %) E. coli growths were identified in the bowel lumen, liver, and spleen of necrotizing enterocolitis and control groups, respectively. This difference was statistically significant. In peritoneal smear cultures, a total of 3 (30 %) growths were detected in the necrotizing enterocolitis group and 1 (10 %) growth in the control group.

CONCLUSION

As the result of a disturbance in the intestinal flora and impairment of the intestinal barrier in necrotizing enterocolitis, microrganisms in the bowel pass through the intestinal barrier and reach the liver and the spleen via the hematogenous route. This condition is closely related to the impairment of physiological and functional features of the intestinal barrier and is independent from the degree of intestinal injury. Bacterial translocation should be remembered in cases suspected of necrotizing enterocolitis, and a rapid and effective treatment algorithm should be applied in such circumstances (Tab. 3, Fig. 3, Ref. 21). Full Text in PDF www.elis.sk.

The Central Retinal Artery and Regression of the Hyaloid Artery in Perinatal Cattle

The arterial supply to the retina and lens of 10 fetal, 10 neonatal and four adult Zavot-bred cattle of both sexes was studied macroscopically and by stereoscopic microscopy by means of vascular perfusion with latex, giving special emphasis on the hyaloid artery. The central retinal artery ramified in four major retinal arterioles, which formed a compact network throughout the retina (holangiotic or euangiotic pattern). The hyaloid artery was patent in all fetal stages and extended through the vitreous cavity of the eye to the caudal surface of the capsule of the lens. Atrophy of the hyaloid artery began immediately after birth and was completed on day 17 after parturition. No remnant of the hyaloid artery in the vitreous cavity was observed in the adult cattle examined at stereoscopic microscopic level.

Morphometric Characteristics of the Ophthalmic Rete in the Goose Living at High Altitudes and Cold Climate Conditions

This study has aimed at observing in detail the degree of complexity in the formation of the ophthalmic rete in geese living at high altitudes and very cold climate conditions in Kars and its province of Turkey. The 15 adult geese were injected with red and blue coloured latex, dissection was performed, the rete was examined, and the vessels were counted macroscopically and by stereoscopic microscopy. The size and the afferent and efferent vessels of the rete were mostly in parallel with the literature. The numbers of the vessels in the rete of the male and female geese were between 8.3 +/- 1.1 and 9.3 +/- 1.1 in arteries, and 8.6 +/- 1.4 and 10.5 +/- 1.3 in veins respectively. The results suggest that the ophthalmic rete in the goose living at high altitudes and very cold conditions may tend to be less complex, which might be the result of the relatively less cooling needs of the brain at cold conditions.

Arterial Vascularization of the Uropygial Glands (Gl. Uropygialis) in the Rock Partridge (Alectoris graeca) Living in Turkey

This study aims to observe the morphological characteristics of the uropygial gland (Glandula uropygialis), specifically the arterial vascularization, in rock partridges (Alectoris graeca) living in Turkey. Coloured-latex-injected animals were dissected and the gland and related arteries were observed. Mostly, the fourth paired caudal segmental arteries (Aa. segmentales caudales) arising from the median caudal artery (A. mediana caudae) were specified as the uropygial gland arteries. These arteries, in turn, gave the following rami: the muscular ramus (Ramus muscularis) to the levator coccygeus and lateral caudal muscles, the lateral ramus (Ramus lateralis) to the lateral coccygeus muscle and a small ventro-lateral division of the caudal component of the gland, and the medial rami (Ramus medialis) to the dorsal surface of the gland.

Morphology of the Air Sacs (Sacci Pneumatici) in the Rock Partridge (Alectoris graeca)

The aim of the study was to describe the air sacs of the rock partridge. The sacs of 15 adult birds were cast by injection of latex via the trachea and then corroded with 30% KOH at 40 degrees C. The morphology of the sacs was in general similar to that of other avian species described in the literature. There were, however, significant characteristics such as an additional subcutaneous diverticulum of the cranial thoracic sac and a caudally pointing diverticulum of the cervical sac located between the lungs.

Arterial vascularization of the pineal gland in the fetus of Zavot-bred cattle

This study aimed at revealing arterial vascularization of the pineal gland of the Zavot-bred foetus. Twenty foetuses, regardless of their sex, at the age of 2-7 months were used. Coloured-latex was injected by way of both the right and left common carotid arteries. Then, dissection was performed and vessels nourishing the pineal gland were documented. The pineal gland is vascularized by a number of 2-5 central rami. A small vessel arising from each of the central rami in two foetuses (10%) was shown anastomosing with a branch of the cranial cerebral artery, which advances in cranio-caudal direction in the callosal groove. Hence, anastomoses were observed between several sub-branches of each caudal cerebral and cranial cerebellar arteries.

Preoperative emotional states in patients with breast cancer and postoperative pain

BACKGROUND

The present study examined the relationship between psychological variables, including anxiety, depression, and patient-controlled analgesia (PCA) use in patients who underwent radical mastectomy.

METHODS

Ninety-nine ASA I-II women with breast cancer between 18 and 60 years scheduled for modified radical mastectomy completed the state scale of the state-trait anxiety inventory and the Beck depression inventory before the day of surgery. Standard general anesthesia, surgery, and IV-PCA therapy was conducted. Postoperative ratings of pain intensity, opioid consumption and satisfaction with PCA were recorded for the first 24 h on the ward. The degree of pain intensity was evaluated by a visual analog scale (VAS, 1-10). Satisfaction with pain control was reported using an five-point scale from 1 (very dissatisfied) to 5 (very satisfied).

RESULTS

The pain intensity, total analgesic consumption and dose/demand ratio were significantly related to preoperative anxiety and depression (P<0.05). Degree of dissatisfaction with PCA was significantly correlated with preoperative anxiety and depression (P<0.01).

CONCLUSION

Patients with higher anxiety and depression levels had higher postoperative pain and analgesic requirements in this study.

Arterial vascularization of the uropygial glands (Gl. uropygialis) in geese (Anser anser) and ducks (Anas platyrhynches)

In the present study, arterial vascularization of the uropygial glands (Gl. uropygialis) of 10 adult geese (Anser anser) and 10 adult ducks (Anas platyrhynches) were studied. Takilon was injected into the median coccygeal arteries of six specimens from each species, and Latex (a natural rubber with ammonia) into those of four specimens. Takilon-injected specimens were corrosion casted, and arteries nourishing the gland were revealed via dissection. Vascularization of the uropygial glands of both the goose and the duck was observed to be the right (a. gl. uropygii dextra), left (a. gl. uropygi sinistra) and ventral (a. gl. uropygi ventralis) glandular uropygial arteries, arising from the median coccygeal (a. coccygea media) artery. Both the right and left glandular uropygial arteries were observed, divided into four branches as follows; muscular ramus (ramus muscularis), medial ramus (ramus medialis), ventral ramus (ramus ventralis) and lateral ramus (ramus lateralis). Of these, as the lateral, medial and ventral branches feed the gland, the muscular branch provides blood for the lateral coccygeal (m. coccygealis lateralis) and levator coccygeal (m. levator coccygealis) muscles, and the skin. Among the arteries mentioned above, anastomosis between the first and the second branches of the right ventral uropygial arteries in the five geese and five ducks was found.

A quantitative study on the retial arteries in the bovine fetus

The rostral epidural rete mirabile was injected with latex and the retial arteries were studied quantitatively in three groups of bovine fetuses. It was seen that the differences between the diameters of the right and left retial arteries were not significant. An interesting observation was that the diameter of the internal carotid artery decreased gradually with an increase in the gestational age, but this reduction was made up for the maxillary artery via the rostral rete branches. The proportion of the blood supply to the rete was also determined in three groups of fetuses.