Subgroup analysis of accreta, increta and percreta cases using acoustic radiation force impulse elastography.

OBJECTIVE: To compare acoustic radiation force impulse (ARFI) elastography values and histopathological diagnoses (accreta, increta, percreta) in patients suspected of having abnormal placental invasion (API). MATERIALS AND METHODS: This prospective study included 54 patients in the third trimester with a history of caesarian section (CS) and API based on gray scale and Doppler ultrasonography (USG) and 35 healthy controls. Patients underwent ARFI elastography preoperatively. Elastography measurements of the fetal and maternal sides of the placenta were compared to histopathology. RESULTS: Patients had higher maternal-side, fetal-side and average elastography values (P = 0.001). Intraoperatively, eight patients (14.8%) showed abnormal cervical canal invasion and 46 (85.2%) bladder and/or parametrial invasion. Eight patients underwent CS + placental-bed suture, 11 CS + excision of the lower segment, and 35 caesarean-hysterectomy. Histopathology of lower segment excision/caesarian-hysterectomy patients determined 10 (21.7%) accreta, 10 (21.7%) increta and 26 (56.6%) percreta cases. ARFI values were highest in the percreta subgroup. The increta subgroup showed higher ARFI values than the accreta subgroup but maternal-side, fetal-side and average ARFI values were not significantly different across the subgroups (P > 0.05). The cut-off values for average, peripheral and central elastography were determined as >0.90, >0.76, >0.98 (m/s) with sensitivities of 98, 64, 98% and specificities of 85, 80, 91%, respectively. CONCLUSION: ARFI elastography can detect API. However, it cannot determine invasion depth reliably. More studies with subgroup analyses are warranted to reveal its usefulness for invasion depth.

Topical Rifampicin versus Povidone-Iodine for the Prevention of Incisional Surgical Site Infections Following Benign Gynecologic Surgery: A Prospective, Randomized, Controlled Trial.

In this prospective, randomized, controlled study we investigated the effect of subcutaneous rifampicin and povidone-iodine irrigation on incisional surgical site infection. Superficial incisional surgical site infection (SSI) following gynecologic surgery is a serious problem for both patient and surgeon in terms of increased morbidity, length of hospital stay, anxiety, and costs. Three hundred patients scheduled for abdominal surgery due to various benign gynecological pathologies were randomly assigned to one of three groups of 100 members each, as follows: the subcutaneous tissue was irrigated with saline in group 1; saline + rifampicin in group 2; saline +10% povidone iodine in group 3. Patients were invited to follow-up once every 10 days in a 30-day period for evaluation. Patients who developed a superficial incisional SSI were recorded. The superficial incisional SSI rate increased significantly with the use of saline alone (p = 0.006). There was no significant difference between saline +10% povidone iodine and saline + rifampicin (p=0.055). The results suggest that the incidence of superficial incisional SSI is significantly reduced when irrigation is performed using rifampicin and povidone-iodine compared with using saline alone.

Comparison of the Kelly's plication and TOT simultaneously with vaginal hysterectomy, on the incontinence, and sexual functions.

PURPOSE: To compare the effect of vaginal hysterectomy-anterior/posterior colporrhaphy with Kelly's plication(VH-KP), versus vaginal hysterectomy-anterior/posterior colporrhaphy-transobturator tape(VH-TOT) surgeries on incontinence, quality of life, and sexual functions in patients with pelvic organ prolapse(POP), and concurrent obvious stress urinary incontinence(SUI). MATERIALS AND METHODS: Between 2013 and 2017, fifty patients treated with VH-KP(n = 25), and VH-TOT(n = 25) due to POP and SUI, were evaluated prospective consecutively. Age, parity, duration of urinary incontinence,and the daily pad use were recorded. Patients were filled "rinary Distress Inventory-6(UDI-6)", "Incontinence Impact Questionnaire 7(IIQ-7)" and "Index of Female Sexual Function(IFSI)" questionnaire forms at preoperatively,and postoperative 6th month. No usage of pads was accepted as subjective cure rate.Intraoperative,and postoperative complications were noted. RESULTS: There was no statistically significant difference between two groups, for the mean age of the patients, parity, duration of SUI, and the daily pad use, preoperatively (p > 0.05). Decreased UDI-6 scores, IIQ-7 scores and daily pad usage, and increased IFSF scores were found statistical significantly in each group, at the postoperative 6 th month (p < 0.05). However, VH-TOT group had higher improvement rates, on UDI-6 scores (69.5% vs 63.0%, p = 0.04). In addition, it was notable that the the rates of the patients had IFSF scores ≥ 25 was higher in VH-KP group (p = 0.05). Four (16%) patients had recurrent SUI in the VH-KP group (p = 0.039) and vaginal extrusion occurred in 2 (8%) patients in the VH-TOT group (p = 0.153), postoperatively. CONCLUSIONS: Although the effects of VH-TOT surgery are superior to conventional methods for incontinence and quality of life; negative effects on sexual functions are notable. In addition, although recurrence rates of TOT are low, complications such as vaginal extrusion are accompanied by drawbacks of mesh usage.

Assessment of total sialic acid levels in patients with hyperemesis gravidarum: a preliminary study.

To determine the levels of serum total sialic acid (TSA) in patients with hyperemesis gravidarum (HG) and their gestational age-matched controls. Thirty pregnant women with HG, and 30 healthy pregnant women at up to 14 weeks of gestation were enrolled in this preliminary study. Total sialic acid levels in maternal serum were measured using the quantitative sandwich ELISA method. We observed statistically significant difference in TSA levels between HG and the control groups (p = .003). The identification of the role of SA in the prediction, diagnosis and follow-up of HG warrants more comprehensive studies in the future. Impact Statement What is already known on this subject? The derivatives of neuraminic acid are collectively referred to as sialic acid (SA). Changes in SA levels are known to trigger various conditions and disorders, including inflammatory, cardiovascular, neurological and endocrine diseases. Although a sensitive test capable of identifying hyperemesis gravidarum (HG) would be useful for diagnosis purposes, such a test is currently not available. Studies focussing on identifying new potential indicators and biomarkers for HG - as well as identifying their relevance in establishing diagnosis and assessing disease severity - would not only assist in elucidating the underlying causes of this condition but would also contribute to the development of new diagnostic tests for HG. What the results of this study add? Total sialic acid levels are significantly higher in sera of the patients with HG. The present study is the first in the literature to assess total sialic acid levels in patients with HG and healthy pregnant women before 14 weeks of gestation. What the implications are of these findings for clinical practice and/or further research? Total sialic acid levels could give an idea to clinicians in the etiopathogenesis of HG. The identification of the role of sialic acid in the prediction, diagnosis and follow-up of HG warrants more comprehensive studies in the future.

Differences in geographical distribution and risk factors for urinary incontinence in Turkey: analysis of 6,473 women.

OBJECTIVE: To assess the prevalence, types and risk factors for urinary incontinence (UI) and to evaluate the impact of incontinence on quality of life by using validated and objective questionnaires in the western and eastern parts of Turkey. METHODS: In this multicenter observational study, 6,473 women from 38 cities in the western and eastern parts of Turkey were included. UI was assessed by ICIQ-SF (International Consultation on Incontinence Questionnaire Short Form) and IIQ-7 (Incontinence Impact Questionnaire). RESULTS: The UI rate was 20.9% (10% for stress, 8.3% overactive bladder and 2.6% for mixed type). In all, stress incontinence was the most common type. The rate of UI in women residing in the west was higher than in women living in the east (p < 0.001). ICIQ scores were comparable in the two groups but women in the west scored higher in each item of the IIQ. Age >40 years (p < 0.001), number of siblings >5 (p < 0.001) and low educational status (p < 0.001) increased the rate of incontinence. In binary logistic regression analysis menopausal status, age >40 years, number of siblings >5, being overweight, region of residence, and educational status were associated with UI. CONCLUSION: The rate of UI in women residing in the western part of Turkey was higher than women living in the east. Residing in a different geographical region (in our case living either in the western or eastern part of Turkey) seemed to be an independent risk factor for UI. Moreover, UI deteriorates quality of life and more attention should be paid to this vulnerable population.

Assessment of oxidative stress markers in recurrent pregnancy loss: a prospective study.

OBJECTIVE: To determine the levels of oxidative stress markers in recurrent pregnancy loss using a novel automated method. MATERIALS AND METHODS: 30 pregnant women in their first trimester with a history of recurrent pregnancy loss (RPL) and 30 healthy pregnant women were enrolled in this prospective controlled study. Total antioxidant capacity (TAC), total oxidant level (TOL) and oxidative stress index (OSI) in maternal serum were measured using the more recently designated Erel method. RESULTS: We observed statistically significant increased TOL and OSI levels in patient group (p = 0.032, p = 0.007, respectively). We also demonstrated statistically significant decreased TAC in pregnant women who had a history of RPL (p = 0.013). CONCLUSION: Our results support the concept that oxidative stress plays a central role in the etiopathogenesis of RPL. Further studies to evaluate the predictive role of TAC, TOL, OSI levels using Erel method are needed.

Intraoperative frozen section is essential for assessment of myometrial invasion but not for histologic grade confirmation in endometrial cancer: a ten-year experience.

PURPOSE: To evaluate the accuracy of endometrial biopsy (EB), transvaginal ultrasonography (TVS) and intraoperative frozen section (FS) for assessment of myometrial invasion and histologic grade to predict more conservative surgery in endometrial carcinoma. METHODS: Demographic and clinical data of 220 patients with endometrial carcinoma were retrospectively reviewed. Preoperatively, the subjects were evaluated by EB and TVS. Intraoperatively, FS was also performed to evaluate histological grading and myometrial invasion. All patients underwent surgical-pathological staging after removal of the uterus, adnexa and pelvic lymph nodes. Sensitivity and specificity values were calculated for EB, TVS and FS with regard to detection of histological grading and neoplastic invasion of the myometrium according to the final histopathologic examination. RESULTS: Bilateral pelvic and common iliac lymphadenectomy was performed in 80 patients without performing intraoperative biopsy because of preoperative high risk. Evaluation of the tumor grade by preoperative EB showed a sensitivity, specificity and accuracy of 73, 97 and 91%, respectively. Evaluation of the tumor grade by intraoperative biopsy showed a sensitivity, specificity and accuracy of 73, 96 and 90%, respectively. Evaluation of the depth of myometrial invasion with TVS showed a sensitivity, specificity and accuracy of 52, 91 and 79%, respectively. Evaluation of the depth of myometrial invasion with intraoperative biopsy showed a sensitivity, specificity and accuracy of 86, 94 and 92%, respectively. CONCLUSIONS: Evaluation of the histologic grade by EB and of the depth of myometrial invasion by intraoperative biopsy is a good option for deciding the necessity of lymphadenectomy.

Assessment of maternal serum sialic acid levels in preterm versus term labor: a prospective-controlled clinical study.

PURPOSE: To compare total serum sialic acid (SA) levels between singleton pregnant women diagnosed with preterm labor between 24th and 36th weeks of pregnancy, singleton pregnant women at term, and their gestational age-matched controls. METHODS: Thirty pregnants diagnosed with preterm labor (group I), 30 gestational age-matched control pregnants (group II), 30 pregnants with labor at term (group III), and 30 gestational age-matched control pregnants (group IV) were enrolled. Detailed history, demographic data (age, gravidity, parity, abortion), ultrasound parameters, cervical dilatation and effacement, fetal tococardiography, routine laboratory tests, and total SA levels were assessed. RESULTS: There was no statistically significant difference between the parameters other than SA. SA levels of the preterm labor group (group I) were significantly higher than the other three groups. CONCLUSIONS: We may suggest that pathways including SA or molecules containing SA in subclinical infection without the clinical manifestations of apparent infection may be involved in the pathogenesis of preterm birth. Future longitudinal studies are needed to investigate prediction performance and to better understand the role of SA in molecular mechanisms leading to preterm labor.

Comparison of effects of low-flow sevoflurane and desflurane anesthesia on neutrophil and T-cell populations.

BACKGROUND: Numerous transient effects of anesthesia on postoperative immune status have been documented in the literature. OBJECTIVE: This study was performed to test the hypothesis that the effects on neutrophil and T-cell populations differ with use of low-flow sevoflurane- and desflurane-induced anesthesia during abdominal surgery. METHODS: Fifty adult patients (American Society of Anesthesiologists physical status I or II) aged 20 to 60 years were recruited for the study. Patients were randomly assigned to one of two study groups. Anesthesia was induced using fentanyl, propofol, and vecuronium. After intubation, patients in group 1 received sevoflurane, oxygen, and nitrous oxide at a flow rate of 6 L/min, and those in group 2 received desflurane, oxygen, and nitrous oxide at a flow rate of 6 L/min. Ten minutes after induction of anesthesia, the flow rate was decreased to 1 L/min in both groups. Total leukocyte, lymphocyte, and neutrophil counts, percentage of T helper lymphocytes (CD4), cytotoxic T lymphocytes (CD8), natural killer lymphocytes, and active T lymphocyte, CD4/CD8 ratio, and plasma cortisol values were assessed before and at 2 and 24 hours after induction of anesthesia. RESULTS: In the desflurane group, at 2 hours after induction of anesthesia, a significant decrease was observed in the lymphocyte count, percentage of CD4 cells, and CD4/CD8 ratio, and a significant increase was noted in the neutrophil count and percentage of CD8 cells (P < 0.05). At 24 hours after induction of anesthesia, a significant increase was observed in the leukocyte and neutrophil counts, percentage of CD4 cells, and CD4/CD8 ratio (P < 0.05). There was no change in the other parameters studied. In the sevoflurane group, a significant decrease was observed in the lymphocyte count and percentage of natural killer cells. In addition, a significant increase was noted in the leukocyte and neutrophil counts at 24 hours after induction of anesthesia (P < 0.01). The increase in the neutrophil count in the desflurane group compared with that in the sevoflurane group was statistically significant (P < 0.05). CONCLUSIONS: With use of the low-flow anesthesia technique, compared with desflurane, sevoflurane exerts minimal effects on neutrophil and T-cell populations, which supports our hypothesis.

Comparison of MED 12 gene mutation and microRNA-124 expression in leiomyoma and myometrium of Turkish patients.

OBJECTIVES: It is believed that there are still unclear areas in the formation mechanism of leiomyomas. In our study, it was aimed to investigate the formation mechanisms of leiomyomas due to local MED 12 gene exon 2 mutation and local microRNA-124 expression in a Turkish population. MATERIAL AND METHODS: Thirty patients who underwent hysterectomy for leiomyoma uteri at Gaziantep University between January 2013 and January 2016 were included in our study. In the pathology specimens of these patients, the patient's myometrium tissue and her own leiomyoma tissue were analysed via quantitative Realtime PCR in association with MED 12 exon 2 mutation and microRNA-124 expression. RESULTS: The average age of the 30 patients included in our study is 46.67 ± 5.42 and 13 patients had single leiomyoma; 17 patients had more than one leiomyoma. There were significantly higher c.130G> T (p.G44C) mutation and c.131G> A (p.G44A) mutation of MED 12 gene exon in leiomyoma tissues than healthy myometrium tissues of same patients. There was a 3.7-fold decrease in the expression of microRNA-124 in leiomyoma tissues compared to intact eutopic myometrium tissues, but this difference was not statistically significant. CONCLUSIONS: In recent studies, it has been suggested that MED 12 gene may play an active role in the formation of fibroids. MED12 and ß-catenin / Wnt pathway were emphasized, and alternative genetic pathways are sought in fibroid formation. Also, tumour suppressor and oncogenesis effects of microRNAs have been demonstrated in many different studies. Since it is involved in the Wnt pathway, microRNA-124 has been blamed by some previous studies for the formation of fibroids. This study demonstrates that MED12 exon 2 mutations and probably microRNA-124 gene expressions might contribute to uterine leiomyoma pathology.

Prevalence and genotype distribution of human papillomavirus in non-neoplastic cervical tissue lesion: cervical erosion.

Human papillomavirus (HPV) infection is the commonest sexually transmitted infection, which is associated with various clinical conditions, ranging from asymptomatic infection to malignant disease of the cervix. The aim of this study was to evaluate the prevalence and genotypic distribution of HPV in women with cervical erosion and to compare the results with those in women with a clinically normal cervix. A further aim was to establish the association between HPV infection and cervical cytology results in women with and without cervical erosion. Cervical samples were collected by liquid-based method and consecutively evaluated for the presence of HPV DNA and for cervical cytology. HPV DNA was tested by a nested polymerase chain reaction (PCR) and typed by reverse dot blot genotyping. Cytological classification was made according to Bethesda 2001 criteria. The overall HPV prevalence was 16.9%; HPV DNA was positive in 20.2% of women with cervical erosion and 12.8% in women with normal cervix (P < 0.05). Multiple infections were found in 34.1% of the HPV-positive women. Commonest types were HPV 18 (32.9%), HPV 16 (29.5%), HPV 54 (20.5%), and HPV 6 (17%). Cervical cytology results were abnormal for 5.2% of women with cervical erosion and for 1.3% with clinically normal cervix (P < 0.05). This study detected a high prevalence of HPV infection in women with cervical erosion compared to women with a normal cervix. This data may contribute to the HPV epidemiology in the southeastern Turkey. It is recommended that women with cervical erosion should be given priority in HPV screening programs.

No association between serum paraoxonase, arylesterase activities, and hydatidiform mole.

BACKGROUND: In this study, we aimed to evaluate the association between hydatidiform mole (HM) and paraoxonase 1 (PON1) activity and phenotyping in comparison with healthy subjects (both pregnant and nonpregnant women). METHODS: Eighty women were enrolled in this study. Of these, 26 had HM (group 1). Twenty-seven healthy women in the first trimester of pregnancy with a single viable fetus were included in the study as control subjects (group 2). The remaining 27 subjects were healthy nonpregnant women who also participated as control subjects (group 3). Paraoxonase and arylesterase activities were measured using commercially available kits (Relassay, Gaziantep, Turkey). Paraoxonase activity measurements were performed both in the absence (basal activity) and presence of NaCl (salt-stimulated activity). The phenotype distribution of PON1 activity was determined by the double-substrate method. RESULTS: Basal and salt-stimulated paraoxonase and arylesterase activities were not significantly different between the HM, healthy pregnant control, and healthy nonpregnant control groups. Hence, PON1 phenotype distribution of the subjects was not significantly different between these 3 groups. CONCLUSIONS: We determined no association between HM (complete or partial) and PON1 activity and phenotyping in comparison with pregnant and nonpregnant healthy subjects. Further studies including metastatic or invasive HM are needed.

Effect of Ramadan fasting on maternal oxidative stress during the second trimester: a preliminary study.

AIM: To evaluate whether fasting during Ramadan has any significant effects on maternal oxidative stress or fetal health in healthy, pregnant women with an uncomplicated, second-trimester, singleton pregnancy. METHODS: During the month of Ramadan, 1-29 September 2008, 42 fasting and 30 non-fasting pregnant women were enrolled in this prospective controlled study. Total antioxidant status (TAS), total oxidant status (TOS) and the oxidative stress index (OSI) were measured from maternal serum samples taken on a fasting day during Ramadan. The two groups underwent routine follow-up examinations. At the end of the pregnancy, maternal complications, birth weight and maternal weight gain during the entire pregnancy were noted. To evaluate whether the duration of fasting days (≥10 or ≥15 days) had any significant effects on maternal oxidative stress, pregnant women who observed Ramadan for more than nine days or those who fasted for more than 14 days were compared with the control group in terms of TAS, TOS and OSI. RESULTS: No significant differences were observed between the groups studied in terms of TAS, TOS, OSI, maternal age, gestational age, parity, birth weight or weight gain during the pregnancy. The TAS level was evaluated as significantly higher (P = 0.027) in the ≥10 fasting days group compared to the non-fasting control group, while there were no significant differences between the groups with respect to TOS and OSI. CONCLUSION: Maternal fasting during Ramadan during the second trimester does not have a significant effect on maternal oxidative stress, fetal development or fetal birth weight.

Endothelial nitric oxide synthase gene polymorphisms in preeclampsia with or without eclampsia in a Turkish population.

AIM: To evaluate endothelial nitric oxide synthase (eNOS) gene polymorphisms in preeclampsia with or without eclampsia in a Turkish population. MATERIAL AND METHODS: Fifty-seven preeclamptic and 60 normotensive women were enrolled in the present study. The study focused on two functional variants: a variant in exon 7-G to T conversion at nucleotide position 894 resulting in the replacement of glutamic acid with aspartic acid at codon 298 (Glu298Asp) and a variant variable number of 27 bp tandem repeats in intron 4 (VNTR intron 4). Two polymorphisms in the maternal eNOS gene were characterized by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) method. Preeclamptic pregnant women were evaluated into two subgroups according to the presence of eclampsia. RESULTS: We demonstrated a significant difference in patients with preeclampsia in terms of Glu298Asp/eNOS genotype frequency. G/G homozygotes of Glu298Asp among healthy pregnancies were significantly frequent when T/T homozygotes were significantly frequent among preeclamptic pregnancies. We showed that G/T heterozygotes of Glu298Asp/eNOS gene were significantly frequent among preeclamptic pregnant women who did not develop eclampsia than in preeclamptic pregnant women with eclampsia. CONCLUSION: Glu298Asp polymorphism in the eNOS gene could be an individual's risk factor and may modulate progression to an eclampsia complication of preeclampsia in the Turkish population.

Identification of autophagy-associated miRNA signature for the cervical squamous cell cancer and high-grade cervical intraepithelial lesions.

Cervical cancer markedly threatens women's health worldwide and currently ranks fourth leading cause of cancer mortality in women according to recent global cancer statistics. Recent advances have proven that not only tumor suppressor and oncogenes but also non-coding RNAs including micro RNAs (miRNAs) have significant impact in the development and progression of cervical cancers. Previous studies have identified many cancer-specific miRNAs for the early detection of cervical cancers. However, the diagnostic and prognostic use of autophagy-associated miRNAs for the cervical squamous cell cancer (SCC) cases and high-grade squamous intraepithelial lesion (HSIL) have not been uncovered. In the present study, we revealed that miRNAs are differentially expressed in both cervical SCC and HSIL. A total of 35 HSIL, 35 cervical SCC and 30 healthy controls were enrolled for the present study. Total RNA including miRNAs were isolated from the FFPE tissue samples and miRNA expression levels were quantified by quantitative PCR. Predicted miRNA targets of autophagy related genes were determined using miRNA-target prediction algorithms. MiR-143, miR-372, miR-375 and miR-30c were markedly downregulated in HSIL and cervical SCC. MiR-130a was significantly upregulated in the cervical SCC group compared to HSIL and control groups. MiR-30a, miR-520e, miR-548c and miR-372 were significantly associated with the overall survival of cervical SCC patients and these miRNAs were determined to be significant diagnostic markers as revealed by ROC analysis. Together, these results indicate that autophagy-associated miRNAs are potentially valuable for the differential diagnosis and targeted therapy to cervical cancer.

Spinal versus general anesthesia in gynecologic laparoscopy: A prospective, randomized study.

OBJECTIVE: To compare spinal anesthesia (SA) with general anesthesia (GA) in gynecologic laparoscopic surgery regarding anesthetic parameters and patient satisfaction together with an assessment of total oxidant, antioxidant levels, and Oxidative Stress index (OSI). MATERIALS AND METHODS: Sixty patients who were planned to undergo gynecologic laparoscopy were randomized into group G (GA) and group S (SA). Demographics, adverse events and anesthetic parameters were recorded before induction, after induction, and at the 5th, 10th, 15th, 30th, 60th, 90th, and 120th minutes. Patients and surgeons completed questionnaires. Total antioxidant capacity (TAC), total oxidant level (TOL), and OSI were measured. RESULTS: There was no difference between the groups in terms of hemodynamic parameters except heart rate at 30th minute and mean arteral pressure at 10th, 15th, 30th, and 60th minute (p<0.05). The postoperative arterial blood pH value was lower in group S (p=0.021). Intraoperative hypotension was lower in group S (p=0.038). There was more intraoperative hypotension in group S when compared with group G (p=0.038). Postoperative analgesic consumption was higher and onset of postoperative pain was shorter in group G (p=0.001 for both). There was no difference between the groups in terms of patient and surgeon satisfaction. There was no difference in terms of TAC, TOL, and OSI between the groups (p=0.862, p=0.940, and p=0.728, respectively). CONCLUSION: SA may become a reliable alternative to GA in gynecologic laparoscopy when hemodynamic and respiratory parameters, patient and surgeon satisfaction, as well as total oxidant, antioxidant levels, and OSI are considered.

Comparison of the efficiency of partial versus subtotal mesh removal on urogenital distress and sexual functions after stress urinary incontinence surgery.

OBJECTIVE: To compare the efficiency of the partial mesh removal (PMR) versus subtotal mesh removal (SMR) on urogenital distress and sexual functions in patients who experienced vaginal mesh extrusion. MATERIAL AND METHODS: Between June 2014 and January 2018, 45 patients who experienced vaginal mesh extrusion following midurethral sling surgeries and therefore underwent mesh excision were evaluated retrospectively. The effectiveness of PMR and SMR was compared using the "Urinary Distress Inventory-6 (UDI-6)" and "Female Sexual Function Index (FSFI)" forms, at the 6th month postoperatively. RESULTS: Fourteen PMR-patients and 21 SMR-patients who met the study criteria were evaluated for the study. There was a significant improvement in UDI-6 scores and FSFI scores in both PMR and SMR groups at the 6th month postoperatively (p=0.001, p=0.001, p=0.001, and p=0.001, respectively). When the two groups were compared in terms of improvement rates, there was no significant difference in UDI-6 scores [(-)30.21±6.56% vs. (-)26.33±9.01%, p=0.222]. However, there was a statistically significant improvement in the FSFI scores in the SMR group [(+)83.71±14.81% vs. (+)124.42±36.82%, p=0.001]. There was no significant difference in overactive bladder symptoms between the two groups, with a decrease of 75% in the PMR group and 71.42% in the SMR group (p=0.721). Recurrent stress urinary incontinence was observed in two (14.2%) patients in the PMR group and four (19.1%) patients in the SMR group at the 6th month postoperatively (p=0.544). CONCLUSION: In cases where extrusion is developed, subtotal/total mesh removal provides a significant improvement in patients' complaints of sexual dysfunction related to extrusion.

Is pregnancy loss after amniocentesis related to the volume of amniotic fluid obtained?

OBJECTIVE: The objective was to determine whether pregnancy loss after amniocentesis is related to the amount of amniotic fluid obtained during the procedure. STUDY DESIGN: The study enrolled 2,400 women, all in their sixteenth to twentieth week of pregnancy. A 22G spinal needle was inserted for amniocentesis. The amount of amniotic fluid obtained from 1,200 patients in Group 1 was 4 ml and from 1,200 patients in Group 2 was 20 ml. In Group 1, the amniotic fluid was analyzed with a quantitative fluorescent polymerase chain reaction technique, whereas in Group 2, conventional cytogenetic analysis was used. SPSS 16.0 (chi-square and t tests) was used for statistical analyses. RESULTS: In Group 1, postamniocentesis premature rupture of membranes (PROM) occurred in four patients (0.3%). There was one unintended fetal loss and postamniocentesis miscarriage rate was 0.08%. In Group 2, postamniocentesis PROM occurred in 12 patients (1%). Eight of these patients experienced fetal loss (0.67%). Fetal loss rates were higher in Group 2 compared with Group 1. These results did not show statistical differences between the groups according to chi-square test (P>0.05). CONCLUSION: Although statistical analysis denies the positive effect of obtaining small amounts of amniotic fluid to reduce fetal loss rates in patients after amniocentesis, six to eight times lower fetal loss rates based on the amount of fluid obtained cannot be undervalued.

Radicals, Oxidative/Nitrosative Stress and Preeclampsia.

Preeclampsia (PE) has a profound effect in increasing both maternal and fetal morbidity and mortality especially in third World. Disturbances of extravillous trophoblast migration toward uterine spiral arteries is characteristic feature of PE, which, in turn, leads to increased uteroplacental vascular resistance and by vascular dysfunction resulting in reduced systemic vasodilatory properties. Underlying pathogenesis appeared to be an altered bioavailability of nitric oxide (NO•) and tissue damage caused by increased levels of reactive oxygen species (ROS) and reactive nitrogen species (RNS). The increase in ROS and RNS production or the decrease in antioxidant mechanisms generates a condition called oxidative and nitrosative stress, respectively, defined as the imbalance between pro- and antioxidants in favor of the oxidants. Additionally, ROS might trigger platelet adhesion and aggregation leading to intravascular coagulopathy. ROS-induced coagulopathy causes placental infarction and impairs the uteroplacental blood flow in PE. As a consequence of these disorders could result in deficiencies in oxygen and nutrients required for normal fetal development resulting in fetal growth restriction. On the one hand, enzymatic and nonenzymatic antioxidants scavenge ROS and protect tissues against oxidative damage. More specifically, placental antioxidant enzymes including catalase, superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) protect the vasculature from ROS, maintaining the vascular function. On the other hand, ischemia in placenta in PE reduces the antioxidant activity. Collectively, the extent of oxidative stress would increase and therefore leads to the development of the pathological findings of PE including hypertension and proteinuria. Our goal in this article is to review current literature about researches demonstrating the interplay between oxidative, nitrosative stresses and PE, about their roles in the pathophysiology of PE and also about the outcomes of current clinical trials aiming to prevent PE with antioxidant supplementation.

Paraoxonase-1 Polymorphisms (L55M/Q192R) and Activities (PONase/AREase) in Patients with Idiopathic Recurrent Early Pregnancy Loss: A Preliminary Study.

Aim: To evaluate the associations between idiopathic recurrent early pregnancy loss (REPL) and paraoxonase-1 (PON1) polymorphisms and the activities of its encoded enzymes. Materials and Methods: Ninety-eight women were enrolled in this study, including 21 currently pregnant multiparous women without a history of miscarriage; 18 multiparous women who were not pregnant during the study; 30 women with a history of idiopathic REPL who were pregnant; and 29 who were not. Paraoxonase (PONase) and arylesterase (AREase) activities, two activities of the PON1 enzyme, were measured through commercially available kits (Relassay, Gaziantep, Turkey). PON1 genotypes were determined by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) analysis. Data were analyzed using SPSS for Windows version 19.0 (SPSS). Results: There was no association between idiopathic REPL and PON1 polymorphisms or PONase activity. The AREase activity of the PON1 enzyme trended higher in the healthy pregnant group than in the healthy nonpregnant group (p = 0.067), and was higher in the pregnant group with a history of idiopathic REPL than in the nonpregnant group with a history of idiopathic REPL (p = 0.041). Conclusions: Despite there being no detected association between PON1 activities or genotype and idiopathic REPL, we showed that AREase activity increased during early gestation. New studies, including longitudinal changes in serum AREase activity throughout normal pregnancy, should be carried out to further evaluate the association between PON encoded enzymatic activities and early gestational pathophysiology.