Can the neutrophil-to-lymphocyte ratio (NLR) predicts fetal loss in preeclampsia with severe features?

INTRODUCTION

Preeclampsia (PE) is one of the most common causes of major maternal and fetal adverse events including mortality and preterm birth Grill et al. (2009). The neutrophil-to-lymphocyte ratio (NLR) and other hematologic indexes of systemic inflammation have been investigated in patients with PE for the prediction of the severity or presence of the disease. Despite these studies, we found no trials investigating the relationship between NLR and fetal outcomes in PE patients. In this study, we aimed to investigate the relationship between NLR and fetal outcomes.

METHODS

We retrospectively analyzed the demographic data and laboratory tests to determine the NLR of 175 pregnant women with severe PE admitted to our clinic between January 2015 and December 2018.

RESULTS

NLR in the first (2.4 ± 1.1 vs 2.9 ± 1.4, P = 0.18) and second trimesters (3.6 ± 0.7 vs 3.8 ± 1.3, P = 0.25) were not different between the groups, but third trimester NLR was significantly higher in patients with fetal loss (6.5 ± 5.4 vs 4.2 ± 2.7, P = 0.009). The area under the receiver operating characteristic curve for NLR in the third trimester was 0.66 and NLR > 3.9 predicted fetal loss with a sensitivity of 75% and a specificity of 61% (0.684, 95% confidence interval 0.48-0.83, P = 0.05).

CONCLUSION

We demonstrated that third trimester NLR is associated with fetal loss in patients with severe PE.

Responses of oxidative stress and inflammatory cytokines after zearalenone exposure in human kidney cells

Zearalenone is a mycotoxin widely found worldwide that is produced by several fungal species. Due to its similarity to estradiol, it has been shown to have toxic effects on the reproductive system. Although various animal studies have been conducted to investigate the toxic effects of zearalenone, the mechanisms of toxicity have not been fully elucidated. The aim of the study was to investigate the dose-dependent toxic effects of zearalenone exposure in human kidney cells. The half-maximal inhibitory concentration values of zearalenone in HK-2 cells were found to be 133.42 and 101.74 µM in MTT- and NRU-tests, respectively. Zearalenone exposure at concentrations of 1, 10 and 50 µM decreased cell proliferation by 2.1, 11.07 and 24.34%, respectively. Reactive oxygen species levels increased significantly in a dose-dependent manner. A significant increase was observed in the expressions of MGMT, α-GST, Hsp70 and HO-1 genes, which are associated with oxidative damage, while a significant decrease in L-Fabp gene expression was observed. Moreover, zearalenone increased gene expression of inflammatory cytokines, such as IL-6, IL-8, TNFα and MAPK8. Significant increases were observed at the level of global DNA methylation and expression of DNMT1 in all exposure groups. These results indicate that changes in DNA methylation and oxidative damage may play an important role in the toxicity of zearalenone.

Polymorphism of the Oxytocin Receptor (OXTR) Gene Affects the Circulating Oxytocin Receptor Levels in Late-Term Pregnancy in a Turkish Population

INTRODUCTION

Postterm and late-term pregnancies still remain a serious health problem, and underlying exact mechanisms are not fully elucidated. These mechanisms are influenced by many factors.

OBJECTIVE

The aim of this study was to investigate the relationship between plasma oxytocin and oxytocin receptor levels and oxytocin receptor polymorphisms in term and late-term pregnant women.

METHODS

Sixty-eight singleton pregnant women with late-term pregnancy and 83 singleton pregnant women with term parturition were included in this study. A comparison was performed between pregnancies and neonates born at term (37 0/7 and 41 6/7 weeks' gestation). Plasma oxytocin, oxytocin receptor, estradiol, and progesterone levels were measured by using enzyme-linked immunosorbent assay kits. TaqMan® SNP Genotyping Assays and qPCR ProbesMaster were used to investigate the polymorphisms of rs237911, rs2228485, rs53576, and rs2254298.

RESULTS

There was not any difference in gene distributions of 4 common single-nucleotide polymorphisms of oxytocin receptor of rs237911, rs2228485, rs53576, and rs2254298 between subjects in late-term and term pregnancy groups. With rs53576 of the GG genotype, serum oxytocin levels were 21.50 ± 10.69 (ng/L) in the late-term group and 62.71 ± 18.01 (ng/L) in the term group (p = 0.049). Oxytocin receptor levels in the late-term and term pregnancy groups of the GG genotype were 17.92 ± 8.15 (pg/mL) and 45.77 ± 11.66 (pg/mL), respectively (p = 0.046).

CONCLUSION

Our findings suggest that the rs53576 oxytocin receptor single-nucleotide polymorphism is associated with late-term pregnancy through acting by direct modulation of oxytocin and oxytocin receptor levels.

Functionalized boron nitride porous solids

A demonstration of the chemical functionalization of h-BN flakes and a template free approach for the development of macroscopic porous h-BN solids.

Enhanced field emission properties from CNT arrays synthesized on Inconel superalloy

One of the most promising materials for fabricating cold cathodes for next generation high-performance flat panel devices is carbon nanotubes (CNTs). For this purpose, CNTs grown on metallic substrates are used to minimize contact resistance. In this report, we compare properties and field emission performance of CNTs grown via water assisted chemical vapor deposition using Inconel vs silicon (Si) substrates. Carbon nanotube forests grown on Inconel substrates are superior to the ones grown on silicon; low turn-on fields (∼1.5 V/μm), high current operation (∼100 mA/cm(2)) and very high local field amplification factors (up to ∼7300) were demonstrated, and these parameters are most beneficial for use in vacuum microelectronic applications.

Stabilising the Structure of HDPE by the Use of Highly-dispersed Mixture of Fe/FeO

An oxygen acceptive catalyser Fe/FeO mixture was added to the high density polyethylene (HDPE) at different amounts and the stabilisation effects of this additive on the structure of HDPE was investigated. It was shown that the mechanical behaviour and the temperature stability of HDPE was significantly improved with the application of the additive. The experimental results were found to be in accordance with analytical approaches.

An Assessment of Thermal Stresses in Injection Moulded ABS Copolymer

Thermal residual stresses in injection mouldings result from the non-uniform cooling of the melt in the mould. Normally, compressive stresses develop at the surface and tensile ones within the core of the mouldings. The magnitude of these residual stresses was examined for an acrylonitrile-butadienestyrene copolymer (ABS) under various injection moulding conditions. Although the occurrences of thermal stresses are inevitable, the warpage results only when the residual stresses are out of balance. The imbalance of the residual stresses are caused by the non-uniform temperature distribution through the thickness of the mouldings which may be caused by variation in cross section, part geometry and temperature difference between the two surfaces. The magnitudes of thermal residual stresses in injection moulded ABS flat plaques were determined using a layer removal technique. The development of warpage in a 3D component (an L-shaped bracket) was modelled using the residual stresses obtained for the flat plaques and the predictions were compared with the experimental warpage measurements.

Inhibition of Thermal Oxidation Destruction of PBT/HDPE Blends by Organic Compounds of Five-valent Phosphorus

Polybutylene terephthalate (PBT) and highy density polyethylene (HDPE) were blended and stabilized with four different stabilizers obtained from the organic derivatives of five-valent phosphorus. These stabilizers were cyclohexylphosphonic acid, its metallic salts of cyclohexyl phosponates of bivalent nickel, bivalent iron and trivalent iron. The stabilization improved the thermal stability of the PBT/HDPE blends and increased their mass loss temperature. The blend melts were thermally aged inside a viscometer barrel and the Melt flow Index (MFIs) was measured. All stabilizers increased the melt stability of the blends when used in low rates (< 0.2 % in mass). At higher stabilizer rates, some stabilizers further enhanced the thermal stability, while others decreased it. A melt parameter was introduced to determine the melt stability of the PBT/HDPE blends during extrusion. The best stabilization was obtained with cyclohexylphosphonic acid based on the metallic salts of bivalent nickel. The mechanisms that lead to the inhibition of thermal destruction of the blends were explained in terms of the stabilizers.

Evaluation of the relationship between heart type fatty acid binding protein levels and the risk of maternal cardiac ischemia in low risk obstetric population during delivery

AIM

To investigate the heart type fatty acid binding protein (hFABP) changes during delivery in low-risk obstetric population.

METHODS

Pregnant women who are at term and met the inclusion criteria were included the study. Maternal echocardiography, electrocardiography, arterial blood pressure monitoring, CK-MB, serum heart type fatty acid binding protein and troponin I levels were evaluated before and after delivery. Of the total of 100 pregnant women, mean age was 26.7±5, 51 pregnant had vaginal delivery and the remaining 49 had caesarean section.

RESULTS

The h-FABP positivity was detected in nine (9%) subjects after the delivery as compared to values before the delivery (p=0.0035). Troponin levels were 0.013±0.001 before the delivery and 0.025±0.002 after the delivery (p= 0.0001). In the comparison of vaginal and Cesarean deliveries, h-FABP positivity was detected in five of 51 subjects in the vaginal delivery group and four of 49 subjects in the cesarean delivery group (p=0.95). The changes in troponin levels were 0.01 ng/mL (-0.02 to 0.2) in the vaginal delivery group and 0.01ng/mL (-0.07 to 0.06) in the cesarean delivery group (p= 0.24).

CONCLUSION

Delivery stress is associated with maternal cardiac damage as evaluated by heart type fatty acid binding protein and troponin. There was no difference between the two delivery routes in the risk of maternal cardiac damage.

Assessment of bone mineral density in the jaws and its relationship to radiomorphometric indices

OBJECTIVES

The aim of this study was to evaluate maxillary, mandibular and femoral neck bone mineral density using dual energy X-ray absorptiometry (DXA) and to determine any correlation between the bone mineral density of the jaws and panoramic radiomorphometric indices.

METHODS

49 edentulous patients (18 males and 31 females) aged between 41 and 78 years (mean age 60.2 +/- 11.04) were examined by panoramic radiography. Bone mineral density (BMD) of the jaws and femoral neck was measured with a DXA; bone mineral density was calculated at the anterior, premolar and molar regions of the maxilla and mandible.

RESULTS

The mean maxillary molar BMD (0.45 g cm(-2)) was significantly greater than the maxillary anterior and premolar BMD (0.31 g cm(-2), P < 0.05). Furthermore, the mean mandibular anterior and premolar BMD (1.39 g cm(-2) and 1.28 g cm(-2), respectively) was significantly greater than the mean mandibular molar BMD (1.09 g cm(-2), P < 0.01). Although BMD in the maxillary anterior and premolar regions were correlated, BMD in all the mandibular regions were highly correlated. Maxillary and mandibular BMD were not correlated with femoral BMD. In addition, mandibular cortical index (MCI) classification, mental index (MI) or panoramic mandibular index (PMI) values were not significantly correlated with the maxillary and mandibular BMDs (P > 0.05).

CONCLUSIONS

The BMD in this study was highest in the mandibular anterior region and lowest in the maxillary anterior and premolar regions. The BMD of the jaws was not correlated with either femoral BMD or panoramic radiomorphometric indices.

Comparison of colour Doppler indices of pelvic arteries in women with bilateral hypogastric artery ligation and controls

The aim of this study is to compare the blood flows of bilateral uterine, ovarian and arcuate arteries in patients who underwent bilateral hypogastric ligation (BHL), with the controls having similar characteristics. The S/D, the RI and the PI were measured on uterine, arcuate and ovarian arteries in 7 women with BHL and compared with 10 controls. There were not significant differences between the Doppler indices of the two groups. In conclusion, our study suggests that BHL preserves pelvic function and fertility.

Comparison of the intrapartum analysis of Doppler blood flow velocity waveform of the umbilical artery and fetal heart rate tracing for the prediction of perinatal outcome

This study was performed to determine the value of umbilical artery Doppler flow velocity waveform (FVW) analysis and fetal heart rate (FHR) tracing in the course of labour for predicting poor perinatal outcome. The randomised, controlled and prospective study was carried out on 99 singleton term pregnant women in labour at the Zeynep Kamil Women and Children's Hospital, Istanbul. All patients were evaluated by both methods during the intrapartum period. Blood gases and pH of umbilical venous blood and 1 and 5 minute Apgar scores of the newborn infants were determined immediately after delivery. For the prediction of poor perinatal outcome, the sensitivity, specificity, negative predictive value and positive predictive value of FHR were 72.0%, 85.1%, 60.1% and 90.0%, respectively. FHR was pathological in all four cases with a neonatal death, whereas only two had pathological Doppler FVW. We conclude that FHR is a more sensitive method than umbilical artery Doppler FVW analysis (72.0% versus 36.0%) in the prediction of poor perinatal outcome during the intrapartum period. A combination of the two tests increases the specificity of the prediction of poor perinatal outcome from 89.2% and 85.1% to 94.9%. High negative predictive values of both tests should reassure the clinician when the test results are normal.

Thrombotic thrombocytopenic purpura and pregnancy treated with fresh-frozen plasma infusions after plasmapheresis: a case report

Thrombotic thrombocytopenic purpura is a serious, highly mortal disease that goes with pregnancy. The diagnosis may be difficult due to similar symptoms to other pregnancy-related diseases. Treatment of the patient differs with the clinic. Plasmapheresis continued with fresh-frozen plasma infusion may be a good choice.

Outcome of prophylactic cranial radiotherapy in children with ALL

17532

Background: The aim of this study was to evaluate influence of prophylactic cranial radiotherapy (RT) and prognostic factors on overall survival (OS) in patients with acute lymphoblastic leukemia (ALL), retrospectively. Methods: Forty nine children referred to Dr. Lutfi Kirdar Kartal Education and Research Hospital to undergo prophylactic cranial RT for the diagnosis of ALL between years 1997–2003 were analyzed retrospectively to determine cranial recurrence rate. Eleven patients were considered as loss due to loss of contact. Survival analyses were carried out by Kaplan Meier. Results: Median follow-up time was 49 months. Of the 49 cases, 30 (61,2%) were male, and 19 (38,8%) were female. Median age was 6 years (2–18). Moderate to high risk patients who revealed remission after chemotherapy (CT) had been referred to our clinic for RT. At the time of presentation, 5 patients had CNS involvement, and one patient had mass in his right eye. Craniospinal RT was performed to 4 patients while others received total cranial RT including C1–2 vertebra. RT was given with Co 60 in various dose and fractionation schedules (120–200cGy/fx) to total doses ranging from 11,4 to 24 Gy in 7–16 fractions. There was a statistically significant survival difference between cases treated at doses <18 Gy (n:15) and those treated at doses >18 Gy (n:23) in favor of higher RT doses (OS: 35,5 vs. . 44,1 months, p=0.01). Cases with no CNS involvement at presentation revealed a significant overall and disease free survival (DFS) advantage over cases with involvement (OS: 44,2 vs. 22,5 months, DFS:40,7 vs. 19,5 months, p=0.001). OS analyses of 24 cases whose leukocyte counts (LC) were determined at the time of diagnosis revealed OS of 57,5, 35,6, 36,2 months for those with LC of <10000 (n:9), 10000–50000 (n:5) and >50000 (n:10), respectively (p=0,01). There was no notable influence of sex or age on survival. CNS recurrence was seen in only 2 male patients. No morbidity related to RT was experienced in any of the patients that are still alive. Conclusions: Prophylactic cranial RT of 18 Gy is a well-tolerated treatment option for children with the diagnosis of ALL, and optimal dose for better outcome should be identified.

No significant financial relationships to disclose.

An extremely rare cause of acute abdomen in pregnancy: ruptured pancreatic mucinous cystadenocarcinoma

Pancreatic cystadenocarcinoma is an extremely rare neoplasm in pregnancy. To our knowledge, there have been 2 published cases of pancreatic mucinous cystadenocarcinoma (PMC) during pregnancy in the literature; one of which was reported to have ruptured into the abdominal cavity. We present a second case of ruptured PMC resulting in acute abdomen in 36 weeks of pregnancy. Rupture of mucinous cystic neoplasms of pancreas including PMC should be remembered in acute abdomen during pregnancy.

Concomitant administration of uracil-tegafur and leucovorin during adjuvant radiotherapy for locally advanced rectal cancer

PURPOSE

We report the feasibility and toxicity profile, and the impact on local control, disease-free survival and overall survival rates of our study which consisted of postoperative concurrent chemoradiotherapy, followed by adjuvant chemotherapy using uracil-tegafur (UFT)/leukovorin (LV) in locally advanced rectal cancer patients.

PATIENTS AND METHODS

Thirty-one patients operated for rectal adenocarcinoma (pT3/4 or N+) were enrolled onto the study. Twenty-three patients were males and 8 females with median age 62 years (range 21-85). Radiotherapy (RT) to the pelvis with conformal technique and individual blocks was delivered within 8 weeks following surgery. Total RT dose was 50.4 Gy and was given in a conventional single fraction of 1.8 Gy per day. Chemotherapy was administered concomitantly and consisted of UFT (300 mg/m(2)/day) and LV (30 mg/day) during RT-days. Following chemoradiotherapy, chemotherapy alone was administered for 4 cycles in the same dose for 28 days every 35 days.

RESULTS

No lethal toxicity occurred. All patients completed the scheduled RT. Concurrent chemotherapy continued in 22 (70.9%) patients until the end of RT. Seventeen (54.8%) patients completed the whole concurrent chemoradiotherapy and adjuvant chemotherapy as planned. No grade 3-4 stomatitis/mucositis or haematological toxicities were observed during the whole treatment period. During concomitant therapy grade 1-2 toxicities were: nausea/vomiting 60%, dyspepsia/gastric pain 39%, diarrhea 39% and dysuria 10%, whereas grade 3 nausea and diarrhea occurred in 6% and 19%, respectively. Median follow-up was 22 months. Two-year local control, disease-free survival and overall survival rates were 96.3%, 72.3% and 83.2%, respectively.

CONCLUSION

The acute toxicity profile of UFT/LV, local control, disease-free survival and overall survival in the concurrent chemoradiotherapy setting for operated, locally advanced rectal cancer seem comparable with the standard 5-fluorouracil (5-FU)-based therapies.

Tolerability assessment of urasil-tegafur (UFT)/folinic acid (FA) as concurrent chemoradiation (CRT) in adjuvant rectal cancer treatment

13559

Background: The objective of the present phase II study was to evaluate the feasibility of UFT and FA as a concomittant CRT administration for rectal cancer in the adjuvant setting. Methods: Between October 2003 and December 2005 thirty-one (10 female; 21 male) patients were treated. All the patients were locally advanced (T2N1–2M0 (2), T3N0M0 (12), T3–4N1M0 (9), T3–4N2M0 (7)) and median age was 62 (range, 21–85). Inclusion criteria were WHO 0–1, age ≥ 18, complete tumor resection, stage T3/4 or N+, adequate CBC, liver function tests and signed informed consent form. RT was performed in 8 weeks following the surgery and the dose was 50.4 Gy given at 1.8 Gy daily. Chemotherapy consisted of UFT (300 mg/m2/day) and FA (30 mg/day) during week-days of radiotherapy and continued 4 cycles with same dose (D1–28/35days) after CRT. Acute toxicity was assessed according to CTC 2.0 criteria. Results: Median follow-up for all patients was 12 months (between 3–27 months). No toxic death occurred. CRT related side effects were diarrhea Gr 2 (25%) and Gr 3 (25%); emesis Gr 2 (29%) and Gr 3 (10%); dysuria Gr 2 (10%) and Gr 3 (10%). All patients completed radiotherapy but 21 out of 31 (67%) continued with UFT/LV until the end of concurrent treatment. The full compliance to the adjuvant CT part was 63%. During the adjuvant CT period there were diarrhea Gr 3–4 (10%), emesis Gr 3 (10%) and no Gr 3–4 hematological toxicity observed during the whole treatment. During the study period none of the patients failed locally, 3 patients developed distant metastases (2 liver, 1 bone), and 3 patients died (1 with disease, 2 without). Two-year disease-free and overall survival rates were 84% and 71%, respectively. Conclusion: The acute and subacute toxicity of CRT with UFT/LV is acceptable and seems comparable to infusional 5-FU based combined modality treatments.

No significant financial relationships to disclose.

Protective effects of antithrombin III on retinal ischemia/reperfusion injury in rats: a histopathologic study

PURPOSE

To investigate the effect of antithrombin III (AT III) on retinal ischemia/reperfusion (I/R) injury in rats.

METHODS

The study was carried out on 10 Wistar albino rats (20 eyes) and four-vessel occlusion method was employed to induce retinal ischemia in this study. Rats were divided into two groups: Group I (control group, 10 eyes) and Group II (AT III, 10 eyes). In both groups, vertebral arteries were occluded bilaterally an electric needle coagulator under an operating microscope. A total of 48 hours after the initial procedure, the rats were re-anesthetized and both common carotid arteries were clamped to interrupt blood flow. In Group II, rats were injected intravenously with 250 U/kg of AT III 5 minutes before the induction of ischemia. Duration of ischemia was 30 minutes. At the end of this period, clamp was removed for the reperfusion of the eye for 4 hours. Following the reperfusion period, the animals were killed by decapitation. Retinal sections were evaluated under light and electron microscope. The signs of I/R injury at the microscopic level, i.e., cellular degeneration, vacuolization between retinal layers, increase in the retinal thickness due to edema, mononuclear cell infiltration, and apoptotic cells, were recorded for each group.

RESULTS

Retinal sections obtained from the rats in the AT III group revealed a well preserved retinal structure. When average thickness values of the two groups were compared to each other, the difference was significant with respect to inner nuclear and inner plexiform layers indicating increased retinal thickness values in Group I due to tissue edema resulting from I/R injury. Similarly, mononuclear cell infiltration and apoptotic cell counts were found to be significantly higher in control group compared to AT III group showing the inhibitory effect of AT III on leukocyte infiltration and apoptotic cell death in rat retina.

CONCLUSIONS

Antithrombin III attenuated I/R injury in rat retina.

Predictive value of transvaginal ultrasonography for determining the response to tocolytic therapy in cases with preterm labour

This study was performed prospectively on 144 randomly selected women carrying singleton uncomplicated pregnancies of 20 to 36 gestational weeks and 60 women with preterm labour matched for gestational age to determine the predictive value of transvaginal cervical measurements for evaluation of the response to tocolytic therapy. Cervical length and width and width of the cervical canal were measured and funnelling of internal os of the cervical canal was evaluated by transvaginal ultrasonography in each case. These measurements did not reveal any change depending on the gestational age in the control group. The mean values for cervical length and width, and width of cervical canal were 45.05+/-6.52 mm, 38.75+/-4.11 mm, 7.01+/-2.76 mm, respectively. Mean cervical length+/-standard deviations of the control group were used as cut-off values for the prediction of preterm delivery in the preterm labour group. When the cut-off value of the cervical length was accepted as 38.53 mm (-1 SD of the control group), the sensitivity, specificity, positive and negative predictive values for prediction of preterm delivery were 80.9%, 72.2%, 87.2%, 61.9%, respectively; whereas when this cut-off value was used in combination with the funnelling of the internal cervical os, the sensitivity and negative predictive value decreased to 40.5% and 41.9%, respectively; but the positive predictive value and specificity became 100.0% and 100.0%, respectively.

High basal estradiol level and FSH/LH ratio in unexplained recurrent pregnancy loss

BACKGROUND

The potential role of diminished ovarian reserve in unexplained recurrent pregnancy loss (RPL) in a retrospective comparative analysis.

METHODS

Eighty women with RPL underwent routine work-up to exclude known associations of RPL. Serum FSH, LH and E(2) levels were assessed on the 3rd day of the menstrual cycle. Following investigation, 58 women failed to reveal an identifiable cause and are therefore classified as unexplained RPL. Control group consisted of women in whom the cause of abortions was known such as uterine septum and parental chromosomal abnormalities. Mean age, gravidity, parity, presence of infertility, previous number of miscarriages, duration of marriage were similar in both groups. Day 3 serum levels of FSH, E(2) and FSH: LH ratios were compared in the two groups.

RESULTS

Elevated FSH concentrations were equally distributed in the unexplained RPL and control groups. Both day 3 E(2) and FSH:LH ratio were elevated in the unexplained RPL group compared with the control group ( p=0.0066 and p=0.0187 respectively). The percentage of women with elevated FSH and/or E(2) levels on day 3 were significantly higher in the unexplained RPL group than in controls ( p=0.0045).

CONCLUSIONS

Unexplained RPL may be associated with diminished ovarian reserve and should be considered in the workup of RPL.

The prenatal diagnosis of cloacal dysgenesis sequence in six cases: can the termination of pregnancy always be the first choice?

OBJECTIVE

Cloacal dysgenesis sequence is a lethal malformation, which usually requires termination. In this study, our aim was to evaluate the prenatal and postnatal diagnostic features of cloacal dysgenesis sequence and review the management of the patients.

MATERIAL AND METHODS

The data of six cases of cloacal dysgenesis sequences were collected from the ultrasonography and neonatal records. The findings were evaluated in prenatal and postnatal periods. Chromosomal analysis was performed in all the cases. The evaluation of primary and secondary malformations was done. Coexisting anomalies were searched for by radiology and histopathology.

RESULTS

Malformations in six cases (two females and four males) were described. The absence of anal, genital, and urinary openings with intact perineum covered by smooth skin were common findings. These features were considered as primary malformations for cloacal dysgenesis sequence. Secondary anomalies (urinary and gastrointestinal system malformations, pulmonary hypoplasia, and other coexisting anomalies) were evaluated.

CONCLUSION

The prenatal differential diagnosis of cloacal dysgenesis sequence from other urinary obstructive diseases was essential regarding fetal prognosis, prenatal, and neonatal management. The bladder outlet obstruction and pulmonary hypoplasia due to reduced amniotic fluid and/or kidney disease were considered prognostic factors for neonatal death. Termination of pregnancy is almost always recommended instead of intrauterine shunt procedures; but if we take into consideration one of our cases and a few reported cases who survived in the neonatal period, the prenatal management of these pregnancies needs to be reevaluated.

Basal hormone levels in women with recurrent pregnancy loss

The potential role of endocrine abnormalities during the follicular phase in women with unexplained recurrent pregnancy loss was investigated in a retrospective study. Eighty women with recurrent pregnancy loss underwent routine work-up to exclude known associations with the condition. Following investigation, 58 women failed to reveal an identifiable cause, and were therefore classified as having unexplained recurrent pregnancy loss. The control group consisted of women with known causes of abortions, such as uterine septum and parental chromosomal abnormalities. Mean age, gravidity, parity, presence of infertility, previous number of miscarriages and duration of marriage were similar in both groups. Day-3 serum levels of follicle stimulating hormone (FSH), estradiol, luteinizing hormone (LH) prolactin, total testosterone, dehydroepiandrosterone sulfate (DHEAS) and thyroid stimulating hormone (TSH) were compared in the two groups. FSH, estradiol, LH, prolactin and DHEAS concentrations were significantly higher in the unexplained recurrent pregnancy loss group than in the explained recurrent pregnancy loss group, although serum concentrations of all hormones were within the normal range (p < 0.01). TSH and total testosterone levels were similar in the two groups (p > 0.05). There were no differences in the frequency of abnormal levels of hormones between the two groups (p > 0.05). We conclude that endocrine abnormalities in the follicular phase are not associated with recurrent pregnancy loss.

Effects of hormone replacement therapy on mammographic findings

To evaluate the effects of different hormone replacement therapy (HRT) protocols on mammographic findings. One-hundred-eighty-two women in menopause were recruited for this prospective study. Breast examination was performed and four basal mammograms were obtained in all cases. Eighty of the cases received HRT by estrogen only; 40 used combined pills of estrogen plus progestagen sequentially; 44 used combined pills of estrogen plus progestagen continuously; 18 used tibolone. Breast examination and mammography were repeated after 11.6+/-2.1 months of HRT. Mammographic parenchymal density was found to be increased in all cases (17.6%). This finding was most prominent in the continuous combined estrogen plus progestagen group (25%) and the lowest in the tibolone group (5.5%). The use of estradiol resulted in more increased density than conjugated estrogen. The increase in the mammographic density is related directly with breast tenderness. Hormone replacement therapy is not contraindicated in the cases of breast disease without atypia. The increase in mammographic density was found to be higher in obese women.

Intravaginal misoprostol vs. expectant management in premature rupture of membranes with low Bishop scores at term

OBJECTIVES

To evaluate the efficacy of vaginal misoprostol for cervical ripening and labor induction in premature rupture of membranes (PROM) cases with low Bishop scores at term.

METHODS

Sixty-two PROM cases who fulfilled the criteria of 36 weeks of completed gestation, not in active labor, singleton pregnancy with vertex presentation, normal fetal heart rate reactivity, amniotic fluid index >5 cm and Bishop score <5, consented to participate in the study. Thirty-one of the cases were included in study group and a 50-microg misoprostol tablet was placed in the posterior vaginal fornix. Another 31 cases were included in control group and managed expectantly. Treatment success was defined as an interval from membrane rupture to delivery of <24 h.

RESULTS

The mean admittance-delivery interval was significantly shorter in the study group (8.68+/-4.40 h) compared with the control group (26.22+/-18.98 h, P=0.001) and the mean interval from membrane rupture to delivery were also significantly shorter in the study group (19.37+/-7.20 h) than the control group (33.05+/-20.85 h, P=0.001). Oxytocin necessity was significantly lower in the study group than the control group (45.2% vs. 100%, P=0.00051). Tachysystole occurred more frequently in the study group (8 cases, 25.8% vs. 2 cases, 6.5%, P=0.038). There were no difference between two groups with regard to birth weights, 1- and 5-min Apgar scores and the need for neonatal intensive care unit.

CONCLUSIONS

It is effective, safe and economic to use misoprostol vaginally in PROM cases with low Bishop scores at term.

The effects of vaginal delivery and cesarean section on bladder neck mobility and stress urinary incontinence

We investigated the effects of vaginal delivery (VD) and cesarean section (CS) on bladder neck (BN) mobility and genuine stress incontinence (GSI). Of the 230 patients included in the study, 95 had CS, 95 had VD and the remaining 40 continent nulliparous women served as controls. In both the CS and the VD groups 40 women had delivered once, 35 women twice and 20 women three times. Perineal ultrasonography was performed in all patients. Vaginal delivery affects BN mobility and its position more negatively than does CS, and increases its mobility in two directions. The CS group also has similar findings after the third delivery. The GSI rate was not significantly different between the CS and the VD groups, but the VD group had a higher percentage. Our study also shows that BN mobility is associated with GSI compared to the continent controls.

Effect of trimetazidine on retinal ischemia/reperfusion injury in rats

PURPOSE

To investigate the effect of trimetazidine (TMZ), an antioxidant agent, on the ischemia/reperfusion (I/R) injury in rat retina histopathologically.

METHODS

The retinal I/R model was carried out by the 4-vessel occlusion method on Wistar albino rats. Twenty-one rats were divided into 7 groups, each comprising 3 rats. The animals in groups 1, 2 and 3 underwent 30 min of ischemia + 4 h of reperfusion and were treated by the administration of saline, TMZ before reperfusion and TMZ before ischemia, respectively. The animals in groups 4, 5 and 6 underwent 90 min of ischemia + 4 h of reperfusion and were treated in the same way as those in groups 1, 2 and 3, respectively. The 7th group was sham operated.

RESULTS

Thirty and 90 min of ischemia followed by 4 h of reperfusion induced retinal injury in the rat retina. Histopathologically, the inner plexiform and inner nuclear layers were the most affected parts. TMZ was able to reduce almost all retinal I/R damage when administered before ischemia. A cytoprotective effect of TMZ was partly observed in those animals which were treated before reperfusion.

CONCLUSION

TMZ seemed to have a protective effect against retinal I/R injury in rats.

The effects of hormone replacement therapy on lipid peroxidation and antioxidant status

OBJECTIVE

A number of studies have consistently shown a lower cardiovascular risk in women who received postmenopausal hormone replacement therapy (HRT). The aim of our study was to examine the effects of HRT on lipid peroxidation and antioxidant status, which were likely to be involved in the pathophysiology of atherosclerosis.

METHODS

We measured erythrocyte and plasma thiobarbituric acid reactive substances (TBARS) levels as expression of lipid peroxidation-end product malondialdehyde, and also erythrocyte reduced glutathione (GSH) level and glutathione peroxidase (GSH-Px) activity as indicators of the antioxidant status of the 35 postmenopausal women with HRT (mean age: 51.81 +/- 4.57 yr; body mass index (BMI): 26.56 +/- 3.78 kg/m(2)) and 35 postmenopausal women without HRT (mean age: 47.50 +/- 3.64; BMI: 27.42 +/-3.43 kg/m2).

RESULTS

In the group with HRT, erythrocyte and plasma TBARS levels were significantly lower than in the group without HRT (P < 0.003 and P < 0.001, respectively). Erythrocyte GSH level and GSH-Px activity was found to be increased significantly in the group with HRT in comparison with the group without HRT (P < 0.001 and P < 0.001, respectively). There was not any correlation between the erythrocyte and plasma TBARS and erythrocyte GSH levels and GSH-Px activity with duration of HRT (mean 3.5+/-1.3 yr).

CONCLUSION

Our results show that HRT is beneficial in the protection against oxidative damage and can prevent atherosclerotic complications.

Sporadic inclusion body myositis in a patient with human T cell leukemia virus type 1-associated myelopathy

Sporadic inclusion body myositis is a disease of unknown pathogenesis in which a viral etiology has long been suspected. We report a case that occurred in a patient with human T cell leukemia virus type 1-associated myelopathy. The diagnosis was confirmed by histopathological studies of the deltoid muscle. Nucleic acids amplification and in situ hybridization indicated the presence of integrated proviral DNA and viral mRNA transcripts in the lesions.

Synthesis and antimicrobial activity of some new 4-hydroxy-2H- 1,4-benzoxazin-3(4H)-ones

Some 4-hydroxy-2H-1,4-benzoxazin-3(4H)-ones were synthesized and evaluated for their antimicrobial activities against Staphylococcus aureus, Escherichia coli and Candida albicans. Compounds 9, and 10 exhibited the best activity against Candida albicans.

Interactions between brain endothelial cells and human T-cell leukemia virus type 1-infected lymphocytes: mechanisms of viral entry into the central nervous system

Human T-cell leukemia virus type 1 (HTLV-1) is associated with a variety of clinical manifestations, including tropical spastic paraparesis or HTLV-1-associated myelopathy (TSP/HAM). Viral detection in the central nervous system (CNS) of TSP/HAM patients demonstrates the ability of HTLV-1 to cross the blood-brain barrier (BBB). To investigate viral entry into the CNS, rat brain capillary endothelial cells were exposed to human lymphocytes chronically infected by HTLV-1 (MT2), to lymphocytes isolated from a seropositive patient, or to a control lymphoblastoid cell line (CEM). An enhanced adhesion to and migration through brain endothelial cells in vitro was observed with HTLV-1-infected lymphocytes. HTLV-1-infected lymphocytes also induced a twofold increase in the paracellular permeability of the endothelial monolayer. These effects were associated with an increased production of tumor necrosis factor alpha by HTLV-1-infected lymphocytes in the presence of brain endothelial cells. Ultrastructural analysis showed that contact between endothelial cells and HTLV-1-infected lymphocytes resulted in a massive and rapid budding of virions from lymphocytes, followed by their internalization into vesicles by brain endothelial cells and apparent release onto the basolateral side, suggesting that viral particles may cross the BBB using the transcytotic pathway. Our study also demonstrates that cell-cell fusion occurs between HTLV-1-infected lymphocytes and brain endothelial cells, with the latter being susceptible to transient HTLV-1 infection. These aspects may help us to understand the pathogenic mechanisms associated with neurological diseases induced by HTLV-1 infection.

Lymphoid organs as a major reservoir for human T-cell leukemia virus type 1 in experimentally infected squirrel monkeys (Saimiri sciureus): provirus expression, persistence, and humoral and cellular immune responses

The aim of this study was to investigate the distribution of human T-cell leukemia virus type 1 (HTLV-1) in various organs of serially sacrificed squirrel monkeys (Saimiri sciureus) in order to localize the reservoir of the virus and to evaluate the relationship between viral expression and the humoral or cellular immune response during infection. Six squirrel monkeys infected with HTLV-1 were sacrificed 6, 12, and 35 days and 3, 6, and 26 months after inoculation, and 20 organs and tissues were collected from each animal. PCR and reverse transcription-PCR (RT-PCR) were performed with gag and tax primers. Proviral DNA was detected by PCR in peripheral blood mononuclear cells (PBMCs) of monkeys sacrificed 6 days after inoculation and in PBMCs, spleens, and lymph nodes of monkeys sacrificed 12 and 35 days and 3, 6, and 26 months after inoculation. Furthermore, tax/rex mRNA was detected by RT-PCR in the PBMCs of two monkeys 8 to 12 days after inoculation and in the spleens and lymph nodes of the monkey sacrificed on day 12. In this animal, scattered HTLV-1 tax/rex mRNA-positive lymphocytes were detected by in situ hybridization in frozen sections of the spleen, around the germinal centers and close to the arterial capillaries. Anti-HTLV-1 cell-mediated immunity was evaluated at various times after inoculation. Anti-p40(Tax) and anti-Env cytolytic T-cell responses were detected 2 months after infection and remained detectable thereafter. When Tax peptides were used, this response appeared to be directed against various Tax epitopes. Our results indicate that squirrel monkeys represent a promising animal model for studying the early events of HTLV-1 infection and for evaluating candidate vaccines against HTLV-1.