O-257 The effect of the presence of intramural myomas smaller than 6 cm on reproductive outcome in IVF treatment: a systematic review and meta-analysis

Study question

What is the effect of small intramural myomas on the reproductive outcome of in vitro fertilization (IVF) treatment?

Summary answer

Non-cavity-distorting intramural myomas with the size of < 6 cm have a significant adverse effect on reproductive outcomes in IVF treatment.

What is known already

There is a consensus that submucous myomas have a significant unfavorable impact on reproductive outcomes, whereas subserosal myomas do not seem to have any adverse effects. Women with large (≥6 cm) non-cavity-distorting intramural myomas should be evaluated individually, considering their reproductive history. However, there is scarce data on the effect of relatively smaller intramural myomas (<6 cm) on reproductive outcomes and how to manage them before IVF treatment.

Study design, size, duration

This study is a systematic review and meta-analysis according to PRISMA guidelines. We performed a comprehensive search of PubMed, Web of Science, and Cochrane Library databases to identify relevant studies from inception until 31 November 2021. Search terms were used as “intramural fibroid*” [tw] OR “intramural leiomyom*” [tw] OR “intramural myom*” [tw]. English language and human subjects were applied to search filters.

Participants/materials, setting, methods

The target population was infertile women undergoing IVF treatment with non-cavity-distorting intramural myomas <6 cm in diameter. History of myomectomy and the presence of predominant subserous myomas, submucous myomas, or other cavity distorting pathologies were exclusion criteria. The primary outcome measures were live birth rate (LBR) and miscarriage rate (MR). Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of included studies. All statistical analyses were performed using RevMan 5.4.1.

Main results and the role of chance

The initial search strategy yielded 378 studies. After adopting exclusion criteria, eight studies were included in the final analysis. Six of these studies had a NOS score of 8 out of 10, and the remaining two studies had 9 out of 10. Three studies had a prospective design, and five studies had a retrospective design. Two of eight studies did not report LBR as an outcome. In pooling data analysis of six studies including 2058 cycles (1980 women), 41% relative reduction in LBR was observed in women with non-cavity-distorting intramural myomas with the size of < 6 cm compared to women without myomas (RR = 0.59, 95%CI: 0.49–0.71, I2=0%, p<0.00001). A sub-group analysis for smaller intramural myomas (<3 cm) was also performed and concordantly 27% decrease in the LBR (RR = 0.73, 95% CI: 0.57–0.93, I2=0%, p=0.01) was found. Regarding the MR, for women with non-cavity-distorting intramural myomas with the size of < 6 cm, 50% relative increase in MR was found when compared with women without myomas (RR = 1.50, 95%CI: 1.11–2.04, I2=0%, 8 studies, p=0.009).

Limitations, reasons for caution

Lack of information regarding the distance of myomas from endometrium and the number of myomas in most of the included studies is a limitation. Differences in IVF treatment and uterine cavity evaluation methods among studies may limit generalizability of the findings. Future RCTs are warranted to confirm our findings.

Wider implications of the findings

This study is the first meta-analysis with overall moderate-quality evidence from observational studies to demonstrate the adverse effect of the presence of small (<6 cm) intramural myomas on reproductive outcomes in IVF treatment. Surgical removal of such small myomas should be considered before IVF treatment.

Trial registration number

not applicable

P-679 Comparison of hormone replacement treatment (HRT) and true-natural cycle (t-NC) protocols for endometrial priming: An analysis of 1,815 warmed blastocyst transfer cycles

Study question

Does the ongoing pregnancy rate (OPR) of HRT with or without GnRH-agonist suppression and t-NC protocols differ in patients undergoing warmed blastocyst transfer?

Summary answer

HRT, with or without GnRH-agonist suppression, and t-NC protocols are associated with comparable OPRs in patients undergoing warmed blastocyst transfer.

What is known already

Despite the worldwide increase in frozen embryo transfer cycles, the most optimal protocol for priming of the endometrium is debated. Although HRT offers flexibility, recent evidence points tot-NC being superior to HRT regarding safety, i.e., maternal, obstetric, and neonatal outcomes.However, there are still conflicting data regarding pre-clinical losses and reproductive outcomes when comparing the two protocols.

Study design, size, duration

In this longitudinal prospective study, 1,815 consecutive patients undergoing 1,815 warmed blastocyst transfer cycles at the Anatolia IVF Centre, Ankara, between 2015-2021, were included. HRT with pituitary suppression was the protocol of choice during 2015- 2017, whereas HRT without suppression and t-NC were more commonly employed during the latter part of the period.

Participants/materials, setting, methods

All patients with an available day-5/6 vitrified blastocyst(s) were included. Each patient was included only once. The three protocols were t-NC and HRT - with or without suppression. The prerequisites for t-NC was being a local patient with regular menstrual cycles. For t-NC, neither human chorionic gonadotropin (hCG) nor luteal phase support was administered. The primary outcome measure was OPR, defined as pregnancy >12 weeks of gestation.

Main results and the role of chance

Of the 1,815 cycles,124 were t-NC, 477 were HRT with suppression, and 1,214 were HRT without suppression. For the stimulated cycles leading to FET, no difference was seen among the three groups regarding female age, body mass index, duration of infertility, number of previous embryo transfer attempts, ovarian stimulation protocol, estradiol levels on the day of hCG trigger, number of oocytes retrieved, number of preimplantation genetic testing-aneuploidy, freeze-all cycles and number of embryos transferred. The positive pregnancy test rates of the HRT protocol with or without suppression were higher when compared with that of t-NC (63.7%, 66.6%, and 58.1%,respectively; p = 0.05). The respective figure for clinical pregnancy rates were 56.6%, 60.8% and 55.6% (p = 0.07). However, the pre-clinical (biochemical) loss rates (11.9%, 10.9%, and 4.9%, respectively; p = 0.05), as well as the miscarriage rates (11.9%, 10.9%, and 4.9%, respectively; p = 0.04), were higher in the HRT groups with or without suppression compared to those of t-NC. The OPRs of t-NC, HRT with or without suppression were comparable (53.2%, 45.1%, and 49.0%, respectively; p = 0.73). The protocol for endometrial priming was not an independent predictor of ongoing pregnancy at logistic regression analysis when potential confounders were used as covariates (OR = 0.998; 95%CI 0.669-1.490, p = 0.99).

Limitations, reasons for caution

The longitudinal study design and the lack of obstetric and perinatal outcome data are limitations.

Wider implications of the findings

Compared with t-NC, the HRT protocol with/without suppression is associated with higher positive pregnancy test rates albeit increased pre-clinical and clinical loss rates, resulting incomparable OPRs. When compared with t-NC, the HRT protocol could be associated with enhanced endometrial receptivity at the expense of decreased selectivity.

Trial registration number

not applicable

P-406 Ongoing pregnancy rates (OPRs) after warmed blastocyst transfer (WBT) in a true-natural cycle (t-NC) are similar using six different luteinizing hormone (LH) surge criteria

Study question

Does timing of WBT in t-NC differ according to six different commonly definitions for LH surge, and if so, do differences in timing impact OPRs?

Summary answer

Performing WBT on follicular collapse+5 days is equivalent to LH surge +7/+8 /+9 days in terms of OPRs, using six different definitions of LH surge.

What is known already

Pinpointing the day of ovulation, usually by documentation of the LH surge, and less commonly by transvaginal-ultrasonography is crucial for timing WBT in t-NC to maximize reproductive success. However, there is no consensus on the definition of the LH surge, and the most commonly used six LH-surge definitions are LH ≥ 10, ≥15, ≥17, ≥20 IU/L, ≥1.8-fold, and ≥2-fold increase from baseline. The usual practice is to schedule warmed blastocyst transfer on LH-surge +6 days.

Study design, size, duration

Prospective monitoring of 115 WBT cycles performed during January 2017-October 2021. The goals of the study were i)to assess how frequently and to what extent there would be a change in WBT related to the day of the LH surge, using the six different definitions of LH surge, compared to follicular collapse +5 days; ii)for each definition of the LH surge to compare OPRs of different WBT timings related to the day of LH surge.

Participants/materials, setting, methods

Staying locally and having regular menstrual cycles were the main criteria to perform t-NC. For t-NC, serial serum endocrine (LH, estradiol, and progesterone) and transvaginal ultrasonographic monitoring started on cycle days 8-10. Following precise documentation of follicular collapse by ultrasound, WBT was performed on follicular collapse +5 days. All included cycles were t-NC without human chorionic gonadotropin trigger or luteal phase support administration.

Main results and the role of chance

A total of 115 t-NC cycles were included for the first part of the study, determining the impact of different definitions of the LH-surge for the day of WBT. Our reference timing of follicular collapse +5 days would be equivalent to LH-surge +6 days in only 5.2%-41.2% of the cycles employing the six different LH-surge definitions. In contrast, the reference timing was comparable to LH surge +7 days in the majority of cycles (46.1%-70.8%) and less commonly to LH-surge +8 days (1.8%-38.3%) and +9 days (0%-10.4%). For the second part of the study, a total of 94 cycles were analyzed; 15 cycles were excluded as these cycles constituted 2nd or 3rd t-NC cycles; four cycles due to low serum progesterone (<7 ng/ml) on WBT-1 day and two cycles due to failure of survival after warming. For each LH-surge definition, OPRs were comparable among the different WBT timings related to the LH-surge (+6/+7/+8/+9 days). When logistic regression analysis was performed, taking LH-surge + 6 days as the reference, a change in timing was not an independent predictor of OPR for all six different definitions of the LH-surge.

Limitations, reasons for caution

Assignment of WBT timings related to LH-surge by our standard policy (follicular collapse +5 days), rather than by randomization, is a limitation. Other limitations include single daily measurements of serum LH and limited sample size.

Wider implications of the findings

Differences in warmed blastocyst timing related to the LH surge (LH surge +6/+7/+8/+9) are associated with comparable reproductive outcomes in t-NC, reflecting the flexibility of the window of implantation. Further, trials are warranted to delineate the best tool and timing of FET for warmed blastocyst transfer in t-NC.

Trial registration number

Not applicable

Can cystic lesions of the jaws be considered as the cause of mandibular asymmetry?

BACKGROUND

The aim of this study is to investigate the presence of condylar and ramal asymmetry in patients with a cyst larger than 10 mm in the maxilla or mandible.

MATERIAL AND METHODS

Condylar and ramal asymmetry index measurements of 47 patients (mean age: 28.85 ± 15.348) in the study group and 40 patients in the control group (mean age: 33.73 ± 13.095) were performed using panoramic radiographs. The study group consists of patients with cysts larger than 10 mm in diameter in the maxilla or mandible. The control group consisted of patients with no radiolucent lesions and no history of trauma. The possible statistical difference between the groups was evaluated by the Mann-Whitney U test.

RESULTS

No statistically significant difference was observed in asymmetry indices according to gender and the jaw (maxilla or mandible) in which the cyst was located. However, it was determined that CAI and RAI values were statistically significantly different between the study and control groups (p = 0.047 and p = 0.016, respectively).

CONCLUSIONS

The presence of intraosseous cysts larger than 10 mm in the jaws was found to be associated with condylar and ramal asymmetry.

Clinical characteristics, quality of life and risk factors for severity in palmoplantar pustulosis: a cross-sectional, multicentre study of 263 patients

BACKGROUND

Palmoplantar pustulosis (PPP) is a rare, chronic, inflammatory skin disease characterized by sterile pustules on palmar or plantar areas. Data on PPP are scarce.

AIM

To investigate the clinical characteristics and risk factors for disease severity in a large cohort of Turkish patients with PPP.

METHODS

We conducted a cross-sectional, multicentre study of patients with PPP recruited from 21 tertiary centres across Turkey.

RESULTS

In total, 263 patients (165 women, 98 men) were evaluated. Most patients (75.6%) were former or current smokers. The mean Palmoplantar Pustulosis Area and Severity Index (PPPASI) was 8.70 ± 8.06 and the mean Dermatology Life Quality Index (DLQI) score was 6.87 ± 6.08, and these scores were significantly correlated (r = 0.52, P < 0.001). Regression analysis showed that current smoking was significantly associated with increased PPPASI (P = 0.03). Coexisting psoriasis vulgaris (PsV) was reported by 70 (26.6%) patients. Male sex prevalence, PPP onset incidence, disease duration, DLQI, and prevalence of nail involvement and psoriatic arthritis (PsA) were significantly increased among patients with PPP with PsV. Of the 263 patients, 18 (6.8%) had paradoxical PPP induced by biologic therapy, and these patients had significantly increased mean DLQI and prevalence of PsA (r = 0.03, P = 0.001).

CONCLUSION

Our data suggest that smoking is a risk factor for both PPP development and disease severity. Patients with PPP with PsV present distinct clinical features and patients with biologic therapy-induced paradoxical PPP have reduced quality of life and are more likely to have PsA.

Clinical and demographic features of hidradenitis suppurativa: a multicentre study of 1221 patients with an analysis of risk factors associated with disease severity

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic, relapsing and debilitating inflammatory disease associated with profound morbidity.

AIM

In this multicentre study, we investigated the demographic and clinical features of HS, and determined risk factors of disease severity.

METHODS

In total, 1221 patients diagnosed with HS from 29 centres were enrolled, and the medical records of each patient were reviewed.

RESULTS

The mean age of disease onset was 26.2 ± 10.4 years, and almost 70% (n = 849) of patients were current or former smokers. Mean disease duration was 8.9 ± 8.4 years with a delay in diagnosis of 5.8 ± 3.91 years. Just over a fifth (21%; n = 256) of patients had a family history of HS. The axillary, genital and neck regions were more frequently affected in men than in women, and the inframammary region was more frequently affected in women than in men (P < 0.05 for all). Acne (40.8%), pilonidal sinus (23.6%) and diabetes mellitus (12.6%) were the most prevalent associated diseases. Of the various therapies used, antibiotics (76.4%) were most common followed by retinoids (41.7%), surgical interventions (32.0%) and biologic agents (15.4%). Logistic regression analysis revealed that the most important determinants of disease severity were male sex (OR = 2.21) and involvement of the genitals (OR = 3.39) and inguinal region (OR = 2.25). More severe disease was associated with comorbidity, longer disease duration, longer diagnosis delay and a higher number of smoking pack-years.

CONCLUSIONS

Our nationwide cohort study found demographic and clinical variation in HS, which may help broaden the understanding of HS and factors associated with disease severity.

The Association of Interleukin-6 (IL-6) -572G/C and Transforming Growth Factor Beta 1 (TGFB1) 29C/T Single Nucleotide Polymorphisms (SNPs) with Developmental Dysplasia of the Hip: a Case Control Study

PURPOSE OF THE STUDY The aim of the present study was to determine the potential effects of single nucleotide polymorphisms (SNPs) of TGFB1 and IL-6 on the development and severity of the disease in patients with DDH and investigate the relationship of these two gene polymorphisms. MATERIAL AND METHODS This case control study was conducted on 105 patients diagnosed with DDH and 119 healthy control subjects of any age. The DDH patients were classified according to the Hartofilakidis and IHDI classifications for adult and pediatric patients, respectively. Genomic DNA was isolated from peripheral blood samples using the Salting-out method. TGFB1 gene p.Pro10Leu (c.29C>T) (rs1800470) and IL-6 572G>C (rs1800796) polymorphisms were analyzed using Sanger DNA sequencing. RESULTS There was no statistically significant relationship of TGFB1 and IL-6 SNPs for DDH. When the rs1800470 and rs1800796 polymorphisms were compared according to family history, the homozygous mutation rate of TGFB1 gene was found to be significantly higher in patients with a positive family history than in patients with a negative family history. No significant relationship was found between rs1800796 polymorphisms and family history. TGFB1 homozygous mutation rate was determined to be statistically higher in the positive family history group than control group. No similar relationship was found between the negative family history group and the control group. No statistically significant relationship was determined between rs1800470 and rs1800796 and the severity of DDH. CONCLUSIONS rs1800796 and rs1800470 polymorphisms do not appear to be major responsible genetic factors for DDH. However, the determination of a correlation between a positive family history and homozygous mutation rate of the TGFB1 gene indicates that this gene may have a greater effect on DDH development. Key words: developmental dysplasia of the hip, interleukin-6, transforming growth factor beta 1, case control study.

Effects of arthrocentesis and low-level laser therapy on patients with osteoarthritis of the temporomandibular joint

This retrospective study examined whether arthrocentesis combined with 10 sessions of low-level laser therapy (LLLT) improved the clinical outcomes of patients with temporomandibular joint osteoarthritis (TMJ-OA) compared with arthrocentesis alone. Data from two groups of patients (total: n=36) with unilateral TMJ-OA were evaluated. The groups were established according to their treatment regimens: Group 1 (arthrocentesis alone; n=19) and Group 2 (arthrocentesis plus LLLT; n=17). All patients had been diagnosed in accordance with the Research Diagnostic Criteria for Temporomandibular Joint Disorders (RDC/TMD) (Axis I Group IIIb) protocol. They all underwent the same arthrocentesis protocol, but those in Group 2 also received 10 sessions of LLLT immediately afterwards. The outcome variables were the visual analogue scale scores (VAS 1, VAS 2) for various treatment outcomes and millimetric measurements of mandibular movements over both the short and long term. Intra-group comparisons showed significant short and long-term improvements for both groups, but outcomes were better over the long term than the short term in both. In addition, greater improvements in muscle palpation scores and mandibular movements were achieved in Group 2 than in Group 1. In conclusion, although both techniques improved joint pain and function, a combination with LLLT seemed to have an additional benefit for myofascial components.

The relationship between consumption of animal products and expenditure levels with Quality of Life Scores (SF-36) by veterinary students in Turkey

ABSTRACT The present study aimed to calculate the quality of life scores (Short Form-36) of veterinary students in Turkey and review their scores with regards to different socio-demographic characteristics. A total of 1211 students studying veterinary medicine in 26 different faculties in Turkey were selected by stratified sampling method and were asked questions concerning their consumption of and expenditures on foods of animal origin using the SF-36 questionnaire between October and December 2018. Significant differences were found between SF-36 components in terms of year level, gender, accommodation status, income level, and level of expenditures on foods and foods of animal origin (P<0.01). With the increase in the size of the budget set aside for animal products, the scores in the domains of physical functioning, vitality, mental health, pain, and general health perception also enhanced, and statistically significant differences were found (P<0.01). The low quality of life scores of the veterinary students can be improved by increasing their income level and consumption of foods of animal origin. This will ensure that they are energetic and have the desired level of mental and general health perceptions.

Dermatological aspects of tularaemia: a study of 168 cases

BACKGROUND

Tularaemia is a zoonotic infectious disease caused by Francisella tularensis, an aerobic, uncapsulated, gram-negative coccobacillus. Several case reports have appeared on the dermatological manifestations of tularaemia, but relatively few longer-term studies are available.

AIM

To identify skin features of tularaemia that aid in its diagnosis.

METHODS

In total, 168 patients (68 male, 100 female) diagnosed with tularaemia were retrospectively examined. All dermatological data for these patients were evaluated.

RESULTS

Of the 168 patients, 149 (88.69%) had tularaemia of the oropharyngeal type, 12 (7.73%) had the ulceroglandular type, 5 (2.9%) had the oculoglandular type and 2 (0.59%) had the pulmonary type. Secondary skin manifestations were found in 26 patients (15.47%). Sweet syndrome (SS) was found in 11 patients (6.54%), most of whom presented with the oropharyngeal form, while erythema nodosum (EN) was found in 7 patients (4.16%), dermatitis in 2 (1.19%), urticaria in 2 (1.19%), acneiform eruptions in 1 (0.59%), vasculitis-like eruptions in 1 (0.59%) and SS + EN in 1 (0.59%). Patients with the oropharyngeal form had a statistically significant (P < 0.001) higher number of skin findings than patients with the other forms.

CONCLUSIONS

In clinical practice, tularaemia may present with various cutaneous manifestations, and dermatologists who work in endemic regions must be aware of the possibility of this disease.

Effect of Vitamin E Therapy on Sexual Functions of Uremic Patients in Hemodialysis

Twenty-four uremic patients on hemodialysis who had never been treated with vitamin E or related drugs and 12 control patients with normal renal function were studied. Hemodialysis patients were randomly divided into two groups; 12 were treated with oral vitamin E (300 mg/day) for eight weeks and 12 uremic patients and 12 controls were given placebo. Serum vitamin E, prolactin, FSH, LH, and free testosterone levels were measured in all patients before and after treatment. After the vitamin E treatment serum prolactin levels were significantly decreased (50.8 vs 15.4 ng/ml, p<0.01). Vitamin E levels were significantly increased (1.11 vs 1.22 mg/dl, p<0.05). Serum FSH, LH and free testosterone were not affected. In the other two groups there were no significant changes. These results show that vitamin E treatment lowers prolactin levels in uremic hemodialysis patients. This might be due to inhibition of central prolactin secretion. Vitamin E inhibits pituitary gland hypertrophy in vitamin E-deficient rats.

The evaluation of hormonal and psychological parameters that affect bone mineral density in postmenopausal women

OBJECTIVE

In this study we aimed to investigate the relationships between serum levels of DHEAS, reproductive hormones and low bone mineral density (BMD) in postmenopausal women. We also examined the relationship between psychological status of patients and their BMD results.

PATIENTS AND METHODS

This study included postmenopausal female patients. BMD measurements were performed with dual-energy X-ray absorptiometry (DEXA). Psychological assessments of all cases were performed using the Hamilton Anxiety and Hamilton Depression scales. All patients provided fasting venous blood samples in order to determine serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and DHEAS.

RESULTS

There were 33 cases (45.2%) with normal BMD levels and 40 cases (54.8%) with abnormal BMD levels (osteopenia and osteoporosis). DHEAS levels did not show any statistically significant difference according to BMD results (p = 0.431). The Hamilton Anxiety and Depression scores also did not show statistically significant differences in accordance with the BMD results (p = 0.889 and p = 0.706, respectively).

CONCLUSIONS

According to our results, anxiety, depression and circulating DHEAS levels are not significantly associated with low levels of BMD, particularly at osteopenic levels. So these parameters are not useful for clinical practice in patients with low BMD in the middle-aged postmenopausal women.

Obstetric outcomes of intramural leiomyomas in pregnancy

AIM

The authors aimed to study larger intramural leiomyoma with a size of ≥ three cm on pregnancy outcome of singleton pregnancies compared with control group.

MATERIALS AND METHODS

The hospital records of all pregnancies followed between years of 2009 and 2013 were searched for the diagnosis of intramural leiomyoma in the second trimester ultrasonographic screening, past medical history, demographics, pregnancy follow up, and pregnancy outcomes of pregnant women. In the data analyses, 112 singleton pregnant women with intramural leiomyoma were included in the study group and 168 singleton pregnant women without leiomyoma were included in the control group.

RESULTS

The presence of pregnancy associated leiomyoma was found to be a risk factor for abortion (odds ratio (OR):12.6, 95% confidence interval (CI) 2.5-63.6) hospitalization for pain (OR: 19.6, 95% CI 5.8-66.5), premature rupture of mem- branes (OR: 6.7, 95% CI 1.4-32.4), oligohydramniosis (OR: 5.3, 95% CI 1.4-20.0), preterm birth (OR: 4.7, 95% CI 1.9-11.6), and breech presentation and other abnormal presentations (OR: 9.7, 95% CI 2.8-34.2) and neonatal intensive care need (OR: 3.0, 95% CI 1.2-7.5). No correlation with the rate of intrauterine growth restriction, intrauterine fetal death, placenta previa, abruption of placenta, and cesarean section was found.

CONCLUSIONS

Pregnancy associated intramural leiomyoma is a risk factor for some perinatal complications and these results may be useful for prenatal counseling.

Primary vaginal endometrial stromal sarcoma associated with endometriosis: a case report with a review of the literature

Extrauterine endometrial stromal sarcomas (ESSs) are quite rare tumors, and vagina is an unusual site for these tumors. This paper presents a very rare pathological entity of primary vaginal ESS. A 46-year-old woman with a complaint of postcoital vaginal bleeding, low abdominal pain, and constipation was admitted to the clinic. She had a mass of seven cm in size, located in the posterior fornix detected on physical examination. The preoperative biopsy showed ESS, surgical material, and evaluation of an endometrium confirmed the diagnosis of primary vaginal ESS. She underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and partial vaginectomy. The diagnosis of ESS performed by pathologic and immunohistochemical evaluation was: caldesmon (-), actin (-), desmin (-). CDIO (+), ER (+), PR (+), and vimentin (+). There was no ESS lesion in the endometrium. The patient was free of tumor for 22 months after the surgery without any additional therapy. In this study, the authors report the sixth case of primary vaginal ESS in the literature and aim to discuss diagnostic criteria and management protocols in the light of the literature.

Tear function alterations in patients with polycystic ovary syndrome

OBJECTIVE

Complaints of dry eye are prevalent worldwide and are known to be associated with insulin resistance (IR) and hyperandrogenism. However, dry eye is often overlooked in the context of polycystic ovary syndrome (PCOS). The aim of the present study was to evaluate whether or not there is any relation between tear functions and PCOS, which is a multifaceted disorder associated with IR or hyperandrogenism.

PATIENTS AND METHODS

A total of 35 women with polycystic ovary syndrome (PCOS) were enrolled in this study, along with 27 healthy controls. Body mass index (BMI), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and free testosterone levels on the third day of menstruation were recorded, as well as hirsutism score (using the Ferriman Gallwey scoring system), insulin resistance (homeostasis model assessment), neutrophil-to- lymphocyte ratios (NLR), platelet-to-lymphocyte ratios (PLR), and mean platelet volumes (MPV). A complete ocular examination was followed by administration of the ocular surface disease index (OSDI) questionnaire and Schirmer and tear break-up time (TBUT) tests.

RESULTS

Schirmer and OSDI results were similar between groups, but TBUT was significantly lower in the PCOS group (p = 0.002). There were negative correlations between FG score and TBUT test (r = -0.406, p = 0.001) and between NLR and Schirmer test (r = -0.294, p = 0.025).

CONCLUSIONS

Although subjective dry eye symptoms do not present in all patients, these results confirm that tear reduction, which can cause further complications in patients with PCOS, can be detected by careful examination and sensitive tests.

The diversity of major histocompatibility complex class II DRB1 gene in sheep breeds from Xinjiang, China

Exon 2 of the ovine leukocyte antigen OLA-DRB1 locus was examined in sheep from the Xinjiang Karakul Ram and Bashibai populations, and three generations of hybrids were derived from a cross between Bashibai and Altai Argali wild sheep. This identified 12 novel alleles and 30 previously reported alleles. A neighbor-joining tree of the amino acid sequences of these 42 alleles revealed allelic clusters shared across the study populations. There were significant differences in allelic frequency between Karakul Ram and Bashibai sheep. DRB1*K18cC was the most frequent allele in Kararul Ram with a frequency of 21.2%, while DRB1*2F10c8 (13.2%) and DRB1*0803 (13.2%) were the most frequent alleles found in Bashibai sheep; the alleles DRB1*2F16c2, DRB1*1601, and DRB1*0803 occurred most frequently in F1, F2, and F3 populations, with frequencies of 17.6%, 14.3%, and 20%, respectively. Although many alleles were shared by Bashibai and hybrid sheep, some alleles differed between them, especially in the F1 generation of the Bashibai × Altai Argali cross. The hybrid-specific alleles indicated the introgression of Altai Argali alleles into hybrid flocks. A population tree based on the OLA-DRB1 allelic frequency in each population indicated that the Bashibai sheep and three hybrid populations were similar, with Karakul Ram being genetically distinct.

B-cell subsets in patients with transient hypogammaglobulinemia of infancy, partial IgA deficiency, and selective IgM deficiency

BACKGROUND

The pathogenesis of some primary humoral immunodeficiencies, such as transient hypogammaglobulinemia of infancy (THI) and immunoglobulin (Ig) A deficiency, remains unknown and can render diagnosis problematic.

OBJECTIVE

In the present study, we used flow cytometry to analyze peripheral blood B-cell subsets in patients with THI and unclassified hypogammaglobulinemia (UCH), partial IgA deficiency, and selective IgM deficiency.

METHODS

The study population comprised 41 patients with hypogammaglobulinemia (THI, 18; UCH, 23), 16 patients with partial IgA deficiency, and 16 patients with selective IgM deficiency who were admitted to Ankara University Department of Pediatric Immunology-Allergy between January 2010 and April 2011, as well as 29 healthy controls. B-cell subsets were examined according to the EUROclass classification.

RESULTS

Age at diagnosis in the hypogammaglobulinemia group ranged between-14 months and 13 years (median, 26 months). Naive B-cell percentages were significantly higher and activated B-cell values lower in the THI patients than in the UCH patients and age-matched healthy controls. Nonswitched (IgM+CD27+IgD+) memory B-cell values were found to be significantly lower in patients with selective IgM deficiency than in healthy controls. No significant differences in B-cell subsets were found in patients with partial IgA deficiency.

CONCLUSIONS

Previous reports show that reduced class-switched memory B cell values are associated with CVID, THI, and selective IgA deficiency. Our findings did not support these reports. Furthermore, we observed that naive B cell values were higher in patients with THI. A maturation defect could play a role in the pathogenesis of THI.

Effect of mannan oligosaccharide addition to whole milk on growth and health of Holstein calves

Abstract. The purpose of this study was to investigate the effect of mannan oligosaccharide (MOS) mixed in the whole milk on the growth and health of calves. Forty Holstein calves (20 male, 20 female) were randomly assigned, within sex, to one of two groups at 5 d of age. Calves were fed fresh, warm whole milk (control) or fresh, warm whole milk supplemented with MOS (4 g of Bio-Mos per calf daily at a.m. feeding). Calves were fed 4 L of whole milk per day in two equal feedings for 6 weeks. Pelleted calf starter and fresh water were available ad libitum during the experiment. No hay was fed. Body weights (BW) were measured at the beginning of the experiment and then weekly till the end of the experiment. Height at withers, heart girth, withers to pins, and point of shoulder to pins were measured at the beginning and at the end of the experiment. Fecal fluidity scores and respiratory condition were monitored daily. Intake of whole milk was similar between the groups (P>0.10). Although there was no significant difference in starter intakes (P>0.10), calves in MOS treatment consumed 19.9 % more calf starter than calves in control diet (499.2 vs. 416.5 g/d) for 26 to 46 d of age. BW gains for various age periods were unaffected by treatment (P>0.10). However, calves in MOS treatment gained 11.2 % more BW than calves in control diet (627.4 vs. 564.2 g/d) from 26 to 46 d of age. Skeletal growth and feed efficiencies were similar for calves in both groups. No respiratory problems in calves in both groups occurred during the experiment. Fecal fluidity scores, percent calf days with scours and percent calf days treated for scours were unaffected by treatment (P>0.10). However, calf scours was a common problem especially during the first 3 weeks of the experiment. The reason for this may have been that calf scours had been a common problem at the location of the experiment for many years. This suggests that there must have been a significant enteric challenge for calves at this location. Even under these stressful conditions, MOS in whole milk did not elicit an improvement in enteric health in the circumstances of this location. Although there were no significant differences between the groups, the results suggest that starter intake and consequently BW gain from 26 to 46 d of age tended to be improved in calves in MOS group compared with calves in control group.

Identification of a U2HR gene mutation in Turkish families with Marie Unna hereditary hypotrichosis

Marie Unna hereditary hypotrichosis (MUHH) is an autosomal dominant form of isolated alopecia. The disorder is characterized by the absence or scarcity of scalp hair, eyebrows and eyelashes at birth. Coarse wiry hair begins to grow during childhood, but this is followed by progressive hair loss, which usually begins around puberty. A recent study identified mutations in U2HR, an inhibitory upstream open reading frame in the 5'-untranslated region of the human hairless gene. We investigated three reportedly unrelated Turkish multigeneration families with MUHH. Using direct sequencing of U2HR we were able to identify the c. 2T>A (p.M1K) mutation in one index patient of each family. The mutation cosegregates perfectly with the disease in all members of the families. To our knowledge, this is the first time that a mutation in U2HR has been identified in families from the Middle East. The observation of a common mutation is suggestive of a possible founder effect.

Encapsulating fly ash and acidic process waste water in brick structure

Fly ash contains metals such as cadmium, iron, lead, aluminum and zinc in its structure in appreciable amounts. These metals can leach out into surface and ground waters if fly ash is not properly disposed of. A similar problem also exists for acidic process waste waters discharged by numerous industries. The purpose of this study was to utilize such wastes as additives in the production of construction quality bricks for the purpose of waste elimination. The bricks produced were subjected to flexural strength and water retention capacity tests along with heavy metal leaching experiments in order to determine the applicability of the procedure and the best possible recipes. This paper summarizes the results obtained in these tests along with the possible mechanisms involved in stabilizing the two wastes in the brick structure.

Analytical solution of Poisson-Boltzmann equation for interacting plates of arbitrary potentials and same sign

Efficient calculation of electrostatic interactions in colloidal systems is becoming more important with the advent of such probing techniques as atomic force microscopy. Such practice requires solving the nonlinear Poisson-Boltzmann equation (PBE). Unfortunately, explicit analytical solutions are available only for the weakly charged surfaces. Analysis of arbitrarily charged surfaces is possible only through cumbersome numerical computations. A compact analytical solution of the one-dimensional PBE is presented for two plates interacting in symmetrical electrolytes. The plates can have arbitrary surface potentials at infinite separation as long they have the same sign. Such a condition covers a majority of the colloidal systems encountered. The solution leads to a simple relationship which permits determination of surface potentials, surface charge densities, and electrostatic pressures as a function of plate separation H for different charging scenarios. An analytical expression is also presented for the potential profile between the plates for a given separation. Comparison of these potential profiles with those obtained by numerical analysis shows the validity of the proposed solution.

Classifying patients with Behçet's disease for disease severity, using a discriminating analysis method

BACKGROUND

Interleukin (IL)-8 has been shown to correlate with the activity of Behçet's disease (BD). The aim of this study was to develop tools as reliable as IL-8 levels in defining BD severity.

METHODS

In total, 32 patients with BD and 16 healthy controls were included in the study. Medical history, physical examination, routine laboratory investigations and measurement of serum IL-8 levels were performed. The patients were classified as groups I and II based on the serum IL-8 levels. The patients were then reassigned to groups based on the predictions through discriminating analysis.

RESULTS

In addition to the differences between patient and control groups, the differences between groups I and II, group I and controls, and group II and controls were statistically significant. The discriminating analysis results showed that the patients had been assigned to groups I and II with 100% accuracy.

CONCLUSION

Discriminating analysis using clinical and routine laboratory findings indicated that 100% of the patients were accurately assigned to the same groups as their IL-8 levels indicated. This suggests that the classification made according to discriminating analysis using these routine variables is a reliable method in determination of the disease severity.