Amplicon-based next-generation sequencing for comparative analysis of root canal microbiome of teeth with primary and persistent/secondary endodontic infections.

OBJECTIVES: To compare the root canal microbiome profiles of primary and persistent/secondary infections using high-throughput sequencing with the help of a reliable bioinformatics algorithm. MATERIALS AND METHODS: Root canal samples of 10 teeth in the primary endodontic infection (PEI) group and 10 teeth in the persistent/secondary endodontic infection (SEI) group were included resulting in a total of 20 samples. After DNA extraction from the samples, sequencing was performed on the Illumina MiSeq platform. Pair-end Illumina reads were imported to QIIME 2; amplicon sequence variants (ASVs) generated by DADA2 were mapped to GreenGenes database. Weighted UniFrac distances were calculated and principal coordinates analysis (PCoA) was used to compare beta diversity patterns. The multiple response permutation procedure (MRPP), the analysis of similarities (ANOSIM), and permutational multivariate analysis of variance (adonis) were conducted for testing group differences. Linear discriminant analysis effect size (LEfSe) analysis was utilized to identify differentially abundant taxa between the groups. The linear discriminant analysis (LDA) score threshold was set to 4.0. RESULTS: Within the Gram-negative facultative anaerobic Gammaproteobacteria class outgroup, two orders (Pasteurellales, Vibrionales) and two families (Pasteurellaceae, Vibrionaceae) were significantly more abundant in the PEI group, whereas Gram-positive bacteria, Actinomycetales order, and Gram-positive anaerobic taxa, one genus (Olsenella) and one species (Olsenella uli), were identified as significantly more abundant in the SEI group. CONCLUSIONS: A few taxa were differentially abundant within either the PEI or SEI group. CLINICAL RELEVANCE: Reliable bioinformatic tools are needed to define microbial profiles of endodontic infections. Based on a limited number of samples, no distinct variation was determined between the bacterial diversity of initial and recurrent endodontic infections.

The importance of invasion and resection of superior mesenteric and portal veins in adenocarcinoma of the pancreas.

BACKGROUND/AIMS: To achieve a negative surgical margin, resection of superior mesenteric/portal vein is necessary in pancreatic cancer. This study is designed to demonstrate the demographic and clinical differences of the patients requiring major vein resection and the incidence of histopathological vein invasion. METHODOLOGY: A retrospective analysis of patients that underwent pancreaticoduodenectomy for adenocarcinoma of the pancreas between January 2000 and September 2011 was performed. Macroscopic adhesion to vein was considered as an invasion and a resection was performed. RESULTS: Twenty three of 100 patients that underwent pancreaticoduodenectomy for adenocarcinoma of the pancreas had vein resection. Although the operation time (p=0.001), blood loss (p<0.001) and perioperative blood transfusion (p<0.001) were higher in the vein resection group, there were no differences in perioperative and hospital mortality, complication rate and hospitalization time. The tumor was larger (p=0.001) and lymphovascular invasion (p=0.030), perineural invasion (p=0.011), median metastatic lymph nodes (p=0.007), rate of R1 resection (p=0.007) were higher in vein resection group. Only 9 patients out of 23 patients had histopathological vein wall invasion. Overall survival was also not significantly different (p=0.14). CONCLUSIONS: Overall survival in vein resected group was also not significantly different than patients with standard pancreaticoduodenectomy and not all macroscopic vein adhesion means histopathological vein wall invasion.

Is there any correlation between amh and obesity in premenopausal women?

PURPOSE: To evaluate the correlation between the levels of anti-mullerian hormone and body mass index between obese and non-obese premenopausal women. METHODS: Serum anti-mullerian hormone levels of women younger than 45 years admitted to our reproductive endocrinology clinic for investigation of infertility were examined in this cross-sectional study. Body mass indices were lower than 30 kg/m(2) in 222 patients and equal to or higher than 30 kg/m(2) in 37 patients. Levels of antimullerian hormone were analyzed in each group. Blood samples obtained from study subjects were assayed for levels of anti-mullerian hormone, follicle-stimulating hormone, luteinizing hormone, estradiol, prolactin and thyroid stimulating hormone. RESULTS: There was no significant difference in terms of mean age between the two groups. There was no statistically significant difference between these two groups in terms of FSH, LH, estradiol and prolactin levels. Anti-mullerian hormone levels were 3.46 ± 2.79 ng/ml and 3.79 ± 2.93 ng/ml in non-obese and obese participants, respectively. No statistically significant correlation was found between Anti Müllerian Hormone (AMH) levels and BMI levels in either group (P > 0.05). CONCLUSIONS: Body mass index does not have an effect on serum AMH levels in women of reproductive age. Obesity has no association with levels of serum follicle stimulating hormone, luteinizing hormone, estradiol, prolactin and thyroid stimulating hormone. Obesity is unlikely to affect ovarian reserve in the premenopausal age group.

Serum anti-müllerian hormone concentrations in reproductive age women with and without polycystic ovary syndrome: the influence of body mass index.

PURPOSE: To evaluate the correlation between anti-müllerian hormone (AMH) and body mass index (BMI) in patients with and without polycystic ovarian syndrome (PCOS). METHODS: Serum AMH levels of 332 women in their reproductive period and below 45 years of age who were admitted to our reproductive endocrinology clinic with infertility were investigated in a cross-sectional study. Patients were divided into two groups as BMI under and equal or over 25 kg/m2. Both groups were divided into two subgroups as PCOS and non-PCOS. AMH levels of patients were analyzed for each group. RESULTS: Mean AMH values of BMI <25 and ≥25 kg/m2 groups were 3.87 ± 2.95 and 3.58 ± 2.93 ng/mL, respectively (P > 0.05) in all patients. Means of AMH were not significantly different in BMI quartiles (r = -0.008401, P = 0.96). Among 107 patients with PCOS, means of AMH were 6.85 ± 2.95 ng/mL in 56 patients with BMI <25 kg/m2 and 6.66 ± 3.18 ng/mL in 51 patients with BMI ≥25 kg/m2 (P > 0.05). In the group of 225 non-PCOS patients, means of AMH were 2.27 ± 1.12 ng/mL in 104 patients with BMI <25 kg/m2 and 2.28 ± 1.49 ng/mL in 121 patients with BMI ≥25 kg/m2 (P > 0.05). CONCLUSIONS: Body mass index does not seem to have an effect on serum AMH levels in reproductive age women both with and without PCOS.

The frequency of vitamin B12, iron, and folic acid deficiency in the neonatal period and infancy, and the relationship with maternal levels.

AIM: The most important function of vitamin B12 is to accomplish DNA synthesis, which is necessary for cell division and proliferation. Deficiency of vitamin B12 causes megaloblastic anemia, retardation of growth, and delay in neuromotor maturation. Newborns whose mothers have vitamin B12 deficiency are born with low vitamin B12 storages, and are at risk in terms of vitamin B12 deficiency symptoms during infancy. The aim of our study was to investigate the frequency of anemia and deficiency of vitamin B12, folic acid, and iron in pregnant women living in our region, in their newborn babies, and during the infancy period of these babies. Another aim of our study was to investigate the correlation between the levels of these vitamins in newborns and in their mothers. MATERIAL AND METHODS: In our study, 250 pregnant women at 38-42 gestational weeks, who were admitted for delivery to Gynecology and Obstetrics Clinic and their babies with a birth weight over 2500 g were included in the study. RESULTS: We determined that 24.8% of the pregnant women had anemia, 28% had low ferritin levels, 90.4% had vitamin B 12 deficiency, and 22.4% had folic acid deficiency. Some 3.2% of the newborns had anemia, 2.8% had low ferritin levels, and 72.4% had vitamin B12 deficiency. Among the infants who presented for a follow-up visit at 6 months of age, 22.3% had anemia, 14.9% had low ferritin levels, 40.4% had vitamin B12 deficiency, and 1.06% had folic acid deficiency. In addition, we found that the levels of vitamin B12 and folic acid in newborns were related to the levels of vitamin B12 and folic acid in their mothers. CONCLUSION: Development of low vitamin B12 stores in newborns and the development of vitamin B12 deficiency during infancy, which may result in irreversible complications including neurologic complications, can be prevented by preventing vitamin B12 deficiency during pregnancy.

Vitamin D Deficiency in Pregnant Women and Their Infants.

OBJECTIVE: Vitamin D deficiency is a serious health problem despite a general improvement in socio-economic status in Turkey. The aim of this study was to evaluate maternal vitamin D status and its effect on neonatal vitamin D concentrations after a support programme for pregnant women was introduced. A second aim was to identify risk factors for vitamin D deficiency in a district of Istanbul. METHODS: A total of 97 pregnant women and 90 infants were included in this study, conducted between January and October 2016. The demographic data, risk factors and daily vitamin intake were recorded. Serum levels of vitamin D, calcium, phosphorus and alkaline phosphatase in all subjects were measured. The mothers and newborns were divided into groups based on their vitamin D levels. The relationship between vitamin D levels and risk factors was analyzed. RESULTS: Mean ± standard deviation vitamin D levels for the women and their infants were found to be 14.82±11.45 and 13.16±7.16 ng/mL, respectively. The number of mothers and infants was significantly higher in the deficient group, and their mean vitamin D levels significantly lower (9.02±1.34 and 8.80±1.06 ng/mL, respectively) (p<0.001, p<0.001). Only 14.4% of pregnant women took 1000-1200 IU/day of vitamin D. When the mother groups were evaluated in terms of risk factors, there were significant differences in daily vitamin intake and clothing style (p<0.001 and p<0.001 respectively). CONCLUSION: Vitamin D deficiency in pregnant women and their infants is still a serious health problem in Turkey, although a vitamin D support programme during pregnancy has been launched by the department of health.

Intrauterine instillation of trichloroacetic acid is effective for the treatment of dysfunctional uterine bleeding.

OBJECTIVE: To evaluate the effectiveness of trichloroacetic acid (TCA) instillation into uterine cavity for the treatment of dysfunctional uterine bleeding (DUB). DESIGN: Prospective clinical study. SETTING: A university research hospital. PATIENT(S): Ninety women participated who had dysfunctional uterine bleeding. INTERVENTION(S): Ninety-five percent of TCA was instilled into uterine cavity for endometrial ablation in women with dysfunctional uterine bleeding who want conservative treatment. Participants in group 1 received only TCA; participants in group 2 received a single dose of gonadotropin-releasing hormone analogue 1 month before the procedure. MAIN OUTCOME MEASURE(S): All participants underwent an evaluation that included cycle history, body mass index measurement, and transvaginal ultrasonography of pelvis, diagnostic hysteroscopy and endometrial biopsy. RESULT(S): At the end of 12 months of the treatment, amenorrhea rates in group 1 and group 2 were 26.7% vs. 31.1%, with pooled amenorrhea, hypomenorrhea, and eumenorrhea rates of 95.6% vs. 97.8%, respectively. There was no significant difference between the groups vis-a-vis postprocedure results. More than 90% of women who have this procedure are satisfied with the results. There were no observed negative effects or related complications with this treatment. CONCLUSION(S): An instillation of TCA into uterine cavity produces acceptable results and provides conservative management of DUB.

The effects of antihypertensive agents on endometrial thickness in asymptomatic, hypertensive, postmenopausal women.

OBJECTIVE: The aim of this study was to investigate, by using transvaginal ultrasonography, the possible effects on endometrial thickness of antihypertensive agents in asymptomatic postmenopausal women. DESIGN: A prospective study in an outpatient menopause clinic of a university hospital. We included 288 postmenopausal women in this study, and we compared three groups of postmenopausal women as follows: (1) normotensive postmenopausal women, (2) hypertensive women treated with an antihypertensive drug (beta-blocker, non-beta-blocker, or beta-blocker plus non-beta-blocker), and (3) untreated hypertensive women who had had hypertension for at least 1 year. Hypertensive women treated with a drug had been receiving treatment for 1 year. All women were interviewed and examined. Measurements of endometrial thickness were carried out by vaginal ultrasonography. RESULTS: Sixty-two women (22%) were normotensive, and 226 (78%) of 288 women were hypertensive. Of the 226 women, 122 (54%) were receiving an antihypertensive drug. The mean (+/- SD) endometrial thicknesses in groups A, B, and C were 4.5 (+/- 1.3), 5.4 (+/- 1.5), and 6.4 (+/- 1.7) mm, respectively. Significant difference was obtained among the groups (P = 0.004). CONCLUSIONS: Our data indicate that the mean endometrial thickness is significantly greater in asymptomatic, hypertensive women receiving antihypertensive drugs than among untreated hypertensive and normotensive women.

Comparison of the effects of letrozole and clomiphene citrate on ovarian follicles, endometrium, and hormone levels in the rat.

OBJECTIVE: To compare the effects of letrozole and clomiphene citrate in the rat in terms of number of ovarian follicles; endometrial thickness; and serum levels of E2, FSH, LH, and T. DESIGN: Controlled prospective study. SETTING: University research laboratory. ANIMAL(S): Thirty sexually mature female Wistar-Albino rats that were 20 weeks of age. INTERVENTION(S): Letrozole, 5 mg/kg of body weight daily (10 rats); clomiphene citrate, 100 microg/kg daily (10 rats); or saline solution, 2 mL/d (10 rats). After 2 days, rats were euthanized and ovariectomized. MAIN OUTCOME MEASURE(S): Number of mature follicles, endometrial thickness, and serum levels of hormones. RESULT(S): Mean levels of FSH, LH, E2, and T; number of mature follicles; and ovary size differed among the groups, whereas the mean endometrial thickness did not differ. CONCLUSION(S): In rats, the effect of letrozole on follicular maturation is similar to that of clomiphene citrate.

Laparoscopic management of fallopian tube prolapse masquerading as adenocarcinoma of the vagina in a hysterectomized woman.

BACKGROUND: Fallopian tube prolapse as a complication of abdominal hysterectomy is a rare occurrence. A case with fallopian tube prolapse was managed by a combined vaginal and laparoscopic approach and description of the operative technique is presented. CASE PRESENTATION: A 39-year-old woman with vaginal prolapse of the fallopian tube after total abdominal hysterectomy presented with an incorrect diagnosis of adenocarcinoma of the vaginal apex. The prolapsed tube and cystic ovary were removed by vaginal and laparoscopic approach. The postoperative course went well. CONCLUSIONS: Early or late fallopian tube prolapse can occur after total abdominal hysterectomy and vaginal hysterectomy. Symptoms consist of persistent blood loss or leukorrhea, dyspareunia and chronic pelvic pain. Vaginal removal of prolapsed tube with laparoscopic surgery may be a suitable treatment. The abdominal or vaginal approach used in surgical correction of prolapsed tubes must be decided in each case according to the patient's individual characteristics.

Elevated serum TNF-alpha levels in normal-weight women with polycystic ovaries or the polycystic ovary syndrome.

OBJECTIVE: To compare the serum tumor necrosis factor-alpha (TNF-alpha) levels in nonobese women with those in women with polycystic ovaries (PCO) and polycystic ovary syndrome (PCOS) and healthy controls. STUDY DESIGN: Twenty-one sonographically and biochemically diagnosed women with PCOS, 19 with PCO and 14 healthy women were recruited for the study. Serum TNF-alpha levels were measured in all three groups. Insulin and glucose serum concentrations were analyzed before and after a 75-g oral glucose tolerance test in all samples. The serum TNF-alpha, glucose and insulin levels were compared in PCOS, PCO and controls. RESULTS: Serum TNF-alpha levels were similar in the PCOS and PCO groups (23.67 +/- 5.58 and 13.58 +/- 1.34 pg/mL, respectively) and significantly higher than in the control group. Serum TNF-alpha levels did not significantly correlated with body mass index, serum total testosterone, LH, DHEAS, fasting glucose and fasting insulin levels or glucose and insulin area under the curve values in the three groups. CONCLUSION: We found similar TNF-alpha levels in patients with PCOS and with PCO; however, there was no correlation between the TNF-alpha and insulin, glucose and androgen levels in the study.

Ramsay Hunt syndrome with atypical progress in a renal transplant recipient: a case report.

Ramsay Hunt syndrome is a rare complication of herpes zoster disease in which reactivation of latent varicella zoster virus infection occurs in the geniculate ganglion causing otalgia, unilateral vesicular eruption in a restricted dermatomal distribution, and peripheral facial paralysis. Dermal infections caused by human pathogenic herpes viruses are common in organ transplant recipients. For a transplant surgeon, it is imperative to remember that viral prophylaxis is essential in the follow-up of the transplant patients. Here, we presented a case of renal transplant and Ramsay Hunt syndrome with multiple cranial nerve involvement, with an atypical course. Management and differential diagnosis of this particular case are discussed with a review of the literature.

Effects of strontium ranelate, raloxifene and misoprostol on bone mineral density in ovariectomized rats.

OBJECTIVES: To investigate the effects of strontium ranelate, raloxifene and misoprostol on bone mineral density (BMD) in ovariectomized rats to contribute to the individualization of the treatment of postmenopausal osteoporosis. STUDY DESIGN: Sixty sexually mature female Sprague-Dawley rats weighing 250 g were used. The 60 rats were divided into six groups of 10 rats each: SR, MISO, RAL, SHAM, DW and OVX. All except the SHAM rats were subjected to bilateral ovariectomy. Three days after surgery, rats were administered strontium ranelate (Protelos, 2 g, Servier, Istanbul), 1800 mg/kg/day; misoprostol (Cytotec, 200 mcg, Ali Raif, Istanbul), 200 mcg/kg/day; raloxifene (Evista, 60 mg, Lily and Company, Istanbul), 3 mg/kg/day and 1 cc of distilled water by gavage for 8 weeks. Bone mineral density measurements were then performed. RESULTS: The strontium ranelate (SR) group had significantly higher vertebral BMD than all other groups. Femoral density in the SR group was also significantly higher than in other groups and there was no difference between femoral density in the strontium ranelate and sham groups. CONCLUSIONS: Strontium ranelate, raloxifene and misoprostol can prevent bone loss in the vertebrae, whereas strontium ranelate can also prevent bone loss in the femur of ovariectomized rats. Strontium ranelate increases greater than raloxifene and misoprostol BMD in the vertebrae. CONDENSATION: Strontium ranelate may increase both vertebral and femur BMD in ovariectomized rats while raloxifene and misoprostol may only increase lumbar spine BMD.

The only effects of recombinant follicle-stimulating hormone for ovulation induction in the pre-implantation period of rats.

OBJECTIVE: The aim of this study was to evaluate the changes in follicular development, serum hormonal levels, and endometrium in the pre-implantation period of rats by using recombinant FSH (rFSH) without human chorionic gonadotropin (hCG). METHODS: Thirty female rats were studied in six groups of five specimens. Two groups determined as controls (groups 1 and 2). Two groups received constant doses of rFSH (groups 3 and 4) and other two decreasing doses (groups 5 and 6). One of the paired groups was mated. Uterus, ovaries, and blood samples were taken from non-mated groups (groups 1, 3, and 5) at the proestrus period and from mated groups (groups 2, 4, and 6) in the pre-implantation period. RESULTS: In non-mated groups antral follicles and corpus luteum periodicum and in mated groups antral follicles, corpus luteum periodicum, and corpus luteum graviditatis were increased in rFSH groups, especially in decreasing dose groups. Estradiol (E2) levels were increased and progesterone (P)/E2 ratio was significantly decreased in decreasing dose groups. Endometrium surface epithelium was columnar, irregular, and folded in rFSH groups. Endometrium glandular epithelium was cuboidal in all groups. In decreasing dose groups endometrial stroma was smooth and fibroblastic. Mitotic indices of endometrium surface, glandular epithelium, and stroma were significantly decreased in rFSH groups. Primary follicles and P levels showed no change. CONCLUSION: It seems likely that decreasing doses of rFSH might be used in order to improve follicular development, although it has negative effects with E2 on endometrium in the pre-implantation period of rats.

Hormone profiles and clinical outcome after laparoscopic ovarian drilling in women with polycystic ovary syndrome.

BACKGROUND: The aim of our study was to evaluate the results of laparoscopic treatment in women with polycystic ovary syndrome, and to compare their response with ovulation, homocysteine levels, hormone profiles and clinical outcome before and after drilling. MATERIAL/METHODS: We studied twenty-two nulliparous oligomenorrheic women with polycystic ovaries, complaining of infertility refractory to clomiphene-citrate treatment and subsequently underwent laparoscopic ovarian drilling (LOD) with a needle electrocautery. Endocrine assays, lipoproteins, homocysteine determinations and ultrasound evaluation were performed in all women before and after the procedure. Ovulatory and pregnancy rates and clinical outcome were assessed. RESULTS: After the procedure, serum T, LH, homocysteine levels and LH-FSH ratio were significantly lower than at baseline (0.93 +/- 0.15 vs 0.67 +/- 0.11 ng/ml, p < 0.001; 12.72 +/- 1.13 vs 7.36 +/- 0.57 mlU/ml, p < 0.001; 9.77 +/- 1.06 vs 7.13 +/- 0.99 micromol/L, p < 0.001; 2.16 +/- 0.22 vs 1.29 +/- 0.13, p < 0.001, respectively). In addition, SHBG levels were higher than at baseline (370.7 +/- 19.08 vs 404.7 +/- 16.71 nmol/L, p < 0.001) No reduction in high-density lipoprotein cholesterol was observed after the procedure. Similarly, no differences were observed between treating women with LOD and their baseline measurements in E2, FSH, DHEAS, and PRL concentrations (p = 0.255, p = 0.140, p = 0.250, p = 0.137, respectively). Ovulation occurred spontaneously in 77% of women after the procedure. The chance of conception at 12 months after surgery was 54%. CONCLUSIONS: LOD appears to be a promising alternative treatment for patients with PCOS. Our results show that LOD may cause a significant reduction in serum concentration of homocysteine in patients with PCOS.

Relationship between homocysteine and insulin resistance in women with polycystic ovary syndrome.

Hyperhomocysteinemia is a risk factor for atherosclerotic vascular diseases. It is known that plasma homocysteine levels are higher in polycystic ovary syndrome (PCOS) patients than in healthy subjects. The aim of our study was to determine the relationship between plasma homocysteine level and insulin resistance in women with PCOS. Twenty-nine patients (age, 23.90 +/- 5.86 years) and twenty-five healthy subjects (age, 25.24 +/- 4.28 years) were involved in the study. Plasma levels of fasting insulin, glucose, homocysteine, FSH, and LH levels were measured. A statistically significant difference in plasma concentrations of HOMA index, homocysteine, basal insulin levels and LH/FSH ratios was observed between groups (P = 0.001, P = 0.001, P = 0.001, and P = 0.01, respectively). There was no relationship between Hcy and the other variables. In multiple logistic regression analysis, age, BMI and insulin resistance were not predictors of Hcy.