The Effect of Flower Printing Activities on the Anxiety Levels of Elderly Nursing Home Residents: Randomized Controlled Study.

Introduction: Gardening activities are an activity that contributes positively to the mental health of the elderly. Flower printing is a gardening activity that the elderly can easily implement. This study was conducted to determine the effect of flower printing activities on anxiety levels among elderly individuals in nursing homes. Material and Method: This was a single blind randomized controlled experimental study. The research was conducted between January 1, 2023, and May 1, 2023. The study population consisted of 60 elderly nursing home residents, and the sample consisted of 42 elderly individuals who met the research criteria and agreed to participate. In the study, participants were assigned to the experimental and control groups by simple randomization method. The data were collected with the "Elderly Introduction Form," "Standardized Mini Mental Test," and "Geriatric Anxiety Scale." In this study, the elderly in the experimental group participated in flower printing activities for an average of 60 min once a week for 1 month. No intervention was administered to elderly participants in the control group during the study period. Institutional permission and ethics committee approval were obtained for the research. Results: There was no statistically significant difference between the pretest anxiety scores of the experimental and control groups (P = .880). A statistically significant difference was found between the post-test anxiety scores of the experimental and control groups (P < .001). A statistically significant difference was found between the pre-and post-test anxiety scores of the elderly in the experimental group (P < .001). There was no statistically significant difference between the pre-and post-test anxiety scores in the control group (P = .680). Conclusion: Flower printing activities reduced anxiety levels in the experimental group. In accordance with this result, it is recommended that the elderly in nursing homes be exposed to flower printing activities as leisure activities, and similar studies should be carried out on those staying in different nursing homes. Elderly people's removal from routine through these activities and their increased social interactions with other people may be effective in reducing their anxiety levels. ClinicalTrials.gov: (NCT05834439).

Effects of metformin and ganirelix on subcutaneous endometriosis in a mouse model of autophagy-related cell death.

Objective: This study aimed to investigate the efficacy of metformin and ganirelix on subcutaneous endometriotic tissues created in an experimental mouse model. Materials and Methods: Five groups were formed with eight animals in each group. One of the groups was set as the control group. Endometriotic lesions were created by transplanting 40 mouse autologous endomyometrial tissues into the mouse subcutaneous tissue to a highly vascular surface. Gene expression analyzes of tissues were performed as HIF-1α, ATG5, ATG12, Beclin2, Beclin1, LC3BII, CateninB, GSK3b, TCF, WNT2, WNT7α, and WNT10α gene analyzes. Drug effects were examined by histological examination. HIF1a and WNT2 protein expressions were examined immunohistochemically. Gene expression coefficients of control, metformin day 1 (Met1g), metformin day 7 (Met7g), ganirelix day 1 (Gnx1g), and ganirelix day 7 (Gnx7g) groups are shown in tables. Data are presented as mean and standard error. Results: Beclin2 gene expression coefficients of metformin 1st day, metformin 7th day, ganirelix 1st day, and general 7th day groups were found to have significantly decreased compared with the control group coefficient. Beclin1 gene expression coefficients of metformin 1st day, metformin 7th day, ganirelix 1st day, and genirelix 7th day groups were found to have significantly decreased compared with the control group coefficient. LC3BII gene expression coefficients of metformin 1st day and metformin 7th day groups were found to have significantly decreased compared with LC3BII gene expression coefficients of control, genirelix 1st day, and genirelix 7th day groups. These findings were supported by histological and immunohistochemical staining. Conclusion: These genes are actively involved in the autophagy pathway, and we think that the use of metformin in endometriosis might create an autophagy-based suppression mechanism.

Serum Bcl-2, caspase-9 and soluble FasL levels as perinatal markers in late preterm pregnancies with intrauterine growth restriction.

Genç SÖ, Karakus S, Çetin A, Çetin M, Dogan HO, Ünver Korgali E. Serum Bcl-2, caspase-9 and soluble FasL levels as perinatal markers in late preterm pregnancies with intrauterine growth restriction. Turk J Pediatr 2019; 61: 686-696. Intrauterine growth restriction (IUGR) is the inability of the fetus to grow and develop in the expected pattern. It occurs in about 5% of pregnancies and is associated with severe fetal mortality and morbidity. Affected infants are also highly vulnerable to diseases such as perinatal asphyxia, cerebral palsy, meconium aspiration syndrome, coagulation disorders, and immune system disorders that require long-term treatment. Apoptosis is thought to play a key role in the etiopathogenesis of IUGR. In conclusion, fetal complications are thought to be related to the severity of apoptosis in pregnancies complicated with IUGR. The aim of the study was to test the measurability of the severity of apoptosis using Bcl-2, caspase-9, soluble Fas ligand (sFasL) markers and the maternal blood sample in addition to the diagnostic methods commonly used to diagnose IUGR; and to decrease the rates of adverse perinatal outcomes due to IUGR and to evaluate the fetal well-being status without feeling a need for invasive procedures. One hundred and fifty-nine late preterm pregnancies were included in the study. Eighty were diagnosed with IUGR and the others were the control group. During delivery, maternal and umbilical cord blood samples were taken. Bcl-2, caspase-9, sFasL marker levels in maternal and umbilical cord sera were determined using ELISA method. Bcl-2 levels were found to be significantly high in the maternal and umbilical cord sera in the IUGR group. There was also no significant difference between umbilical cord sera of the two groups in terms of sFasL and caspase-9 levels. The results suggest that maternal serum Bcl-2 levels may also be helpful in the diagnosis of IUGR when used besides the ultrasonographic findings. Multicenter studies with large patient groups will increase knowledge in this area.

Evaluation of ovarian reserve using anti-müllerian hormone and antral follicle count in Sjögren's syndrome: Preliminary study.

AIM: The aim of this study was to determine ovarian reserve status using anti-müllerian hormone (AMH) level and antral follicle count (AFC) in patients with Sjögren's syndrome (SS). METHODS: Twenty-four women with SS diagnosed according to the classification criteria proposed by the American-European Consensus Group and 25 healthy women as controls were enrolled in this study. Ovarian reserve was assessed on clinical findings, AFC, and serum AMH and reproductive hormone levels. RESULTS: Compared with the healthy controls, in the SS patients, the duration of menstrual cycle was significantly shorter (P = 0.043); serum AMH (P = 0.001) and AFC (P = 0.001) were significantly lower, and serum luteinizing hormone (LH) was significantly higher (P = 0.019). The right (P = 0.555) and left ovarian (P = 0.386) volumes were also lower but this did not reach statistical significance. Serum follicle-stimulating hormone (P = 0.327), estradiol (P = 0.241), and prolactin (P = 0.55) were similar between the two groups. CONCLUSIONS: Ovarian reserve may be reduced in SS patients. For the assessment of ovarian reserve, serum AMH and ovarian AFC with serum LH may be useful. Further studies with long-term follow-up are required to determine the course of ovarian reserve abnormalities and best possible biomarkers of reduced ovarian reserve in SS patients.

Pelvimetry by Three-Dimensional Computed Tomography in Non-Pregnant Multiparous Women Who Delivered Vaginally.

BACKGROUND: We assessed retrospectively the reference values of pelvic dimensions by 3D CT performed for non-obstetrical indications in non-pregnant multiparous women with a successful vaginal delivery. We further aimed to evaluate the impact of maternal short stature on these parameters. MATERIAL/METHODS: The 3D CT pelvimetry was performed retrospectively in 203 non-pregnant women selected consecutively if they had at least one singleton term delivery with head presentation and if there was no history of maternal or fetal birth trauma or cerebral palsy after childbirth. With standard sagittal and reformatted axial-oblique views, anteroposterior including three conjugates of pelvic inlet, transverse, posterior sagittal diameters of pelvic inlet, the plane of greatest diameter, the plane of least diameter, and pelvic outlet were measured. Selected obstetric parameters were collected. RESULTS: Overall, the pelvises had transverse oval appearance in inlet and size of the female pelvis. The diagonal conjugate was at least 15 mm longer than the obstetric conjugate. Women with short stature had lower maximal birth weight, and this was in accordance with their somewhat lower pelvic diameters. CONCLUSIONS: The findings of this study present the reference values of the main planes of the true pelvis by 3D CT pelvimetry in a relatively large group of multiparous women who passed a trial of labor successfully. Overall, the pelvises had features of female pelvic bony structure although pelvic diameters were somewhat lower in multiparous women with short stature. The 3D pelvimetry with CT applications may be used as an adjunct to clinical and ultrasonographic examinations to rule out cephalopelvic dystocia in selected cases.

Serum levels of ET-1, M30, and angiopoietins-1 and -2 in HELLP syndrome and preeclampsia compared to controls.

PURPOSE: We aimed to compare the serum levels of ET-1, M30, and Angs-1 and -2 in patients with preeclampsia or HELLP syndrome, and normal controls. METHODS: In this cross-sectional study of 74 pregnant women, serum levels of ET-1, M30, and Angs-1 and -2 were measured in preeclamptic patients with or without HELLP syndrome. 74 pregnant women; 37 had healthy pregnancies, 25 had preeclampsia (PE), and 12 had HELLP syndrome. RESULTS: The age, body mass index, gravidity, and parity of patients with normal pregnancy, PE, and HELLP syndrome were comparable (p > 0.05). In HELLP syndrome, compared to healthy or preeclamptic pregnancies, platelet count was lower (p < 0.05) and the values of hepatic function tests were higher (p < 0.05). In HELLP syndrome, ET-1, M30, and Ang-2 were higher compared to healthy or preeclamptic pregnancies (p < 0.05); however, they increased in preeclamptic pregnancies compared to healthy pregnancies though not significant (p > 0.05). In PE or HELLP syndrome, Ang-1 was higher compared to a healthy pregnancy (p < 0.05); however, in HELLP syndrome, it was also higher than in PE though not significant (p > 0.05). We found no significant correlation among these biomarkers and hematological and biochemical parameters (p > 0.05). CONCLUSION: For the diagnosis of HELLP syndrome, increased levels of ET-1, M30, and Angs-1 and -2 appear as promising biomarkers after determination of their standardized threshold levels after further studies. As an apoptosis-related biomarker, serum M30 level has a merit to be the most promising test for prediction or differential diagnosis of HELLP syndrome in PE patients.

Determining the Incidence of Gynecoid Pelvis Using Three-Dimensional Computed Tomography in Nonpregnant Multiparous Women.

OBJECTIVES: To determine the incidence of gynecoid pelvis by using classical criteria and measured parameters obtained from three-dimensional computed tomography (3D CT) pelvimetry in nonpregnant multiparous women who delivered vaginally. SUBJECTS AND METHODS: Our hospital's picture archiving and communication system was reviewed retrospectively. All adult women who had undergone CT examination with routine abdominal protocols were identified. In the pelvic inlet, midpelvis, and pelvic outlet, classical criteria and measured parameters, both alone and in combination, were used to determine the presence of gynecoid pelvis. RESULTS: 3D CT pelvimetry was performed on 226 women aged 23-65 years without any history of cephalopelvic disproportion and who had at least one delivery of an average fetal size (>2,500 g). The median parity was 4, and the mean (±SD) birth weight was 3,700 ± 498 g. Compared to the classical criteria, measured parameters and their combined use with the classical criteria significantly reduced the frequency of gynecoid pelvis (51.3 and 47.8%, respectively, vs. 71.6%; p = 0.001); however, there was no significant difference between the measured parameters and their combined use with classical criteria with regard to the frequencies of gynecoid pelvis (p > 0.05). CONCLUSIONS: With the use of measured parameters of 3D CT pelvimetry, the incidence of gynecoid pelvis reduces to a more acceptable level (51.3%) in accordance with obstetric knowledge. Since there is no considerable decrease with the addition of classical criteria, 3D CT pelvimetry alone has merit for determining a woman's pelvic capacity for obstetric needs after the improvement and standardization of measured parameters.

Comparison of Effectiveness of Laminaria versus Vaginal Misoprostol for Cervical Preparation Before Operative Hysteroscopy in Women of Reproductive Age: A Prospective Randomized Trial.

STUDY OBJECTIVE: To compare the effectiveness and safety of intracervical laminaria dilator versus intravaginal misoprostol administered before surgery to facilitate cervical dilation before operative hysteroscopy. DESIGN: A prospective randomized study (Canadian Task Force classification 1). SETTING: A university hospital. PATIENTS: A total of 150 women were assigned at random to the following groups: laminaria dilation (n = 50), misoprostol dilation (n = 50), and mechanical dilation (n = 50). INTERVENTIONS: Hysteroscopic surgery of intrauterine lesions. MEASUREMENTS AND MAIN RESULTS: In this study, 150 women were assigned at random to receive cervical priming with an intracervical laminaria dilator, 200 µg of intravaginal misoprostol, or a mechanical dilator before operative hysteroscopy. Cervical response, surgical outcome, and complications of operative hysteroscopy were assessed. Visual analog scale (VAS) pain scores were recorded in the misoprostol and laminaria dilation groups. Demographic variables of the study groups were comparable (p = .278-.988). The duration of cervical pretreatment was similar with the intracervical laminaria dilator and intravaginal misoprostol (p = .803); however, intravaginal misoprostol was associated with more adverse effects (p = .031). Compared with the misoprostol dilation group, in which all patients required additional cervical dilation, notably fewer patients in the laminaria dilation group required additional cervical dilation after cervical preparation (p = .001). VAS pain scores were significantly higher in the laminaria dilation group, however (p = .001). CONCLUSION: Cervical priming with an intracervical laminaria dilator before operative hysteroscopy reduces the need for cervical dilation and better facilitates hysteroscopic surgery compared with intravaginal misoprostol. Oral analgesic use may be required before the use of this device.

Immunohistochemistry with apoptotic-antiapoptotic proteins (p53, p21, bax, bcl-2), c-kit, telomerase, and metallothionein as a diagnostic aid in benign, borderline, and malignant serous and mucinous ovarian tumors.

BACKGROUND: In many tumors including ovarian cancer, cell proliferation and apoptosis are important in pathogenesis and there are many alterations in most of the genes related to the cell cycle. This study was designed to evaluate immunohistochemistry with apoptotic-antiapoptotic proteins (p53, p21, bax, and bcl-2), c-kit, telomerase, and metallothionein as a diagnostic aid in typing of benign, borderline, and malignant serous and mucinous ovarian tumors. METHODS: Total of 68 ovarian tumors, 25 benign [13 (19.1%) serous and 12 (17.6%) mucinous], 16 borderline [9 (13.2%) serous and 7(10.3%) mucinous], and 27 malignant ovarian tumors [24 (35.3%) serous and 3 (4.4%) mucinous tumors] were included in the study. Immunohistochemical expression of p53, p21, bax, bcl-2, telomerase, c-kit, and metallothionein were evaluated. RESULTS: When all 68 cases were evaluated as benign, borderline, and malignant ovarian tumors without considering histopathological subtypes, the p53, p21, bax and metallothionein showed significantly higher staining scores in the borderline and malignant ones (p < 0.05). After evaluation of all 68 cases, the serous tumors showed significantly higher staining scores of p53, p21, c-kit, and metallothionein compared to the mucinous ones (p < 0.05). For differentiation of benign and borderline and malignant tumors combined, p53 was not used because all benign tumors has no staining, and p21, bax, and metallothionein was determined the significant predictors for borderline and malignant tumors combined (p < 0.05). For differentiation of borderline and malignant tumors, only p53 was determined the significant predictor for malignant tumors (p < 0.05). CONCLUSIONS: In conclusion, p53, p21, bax, c-kit, and metallothionein may be helpful for the typing of ovarian tumors as benign, borderline and malignant or serous and mucinous. p53, p21, bax, c-kit, and metallothionein may have different roles in the pathogenesis of ovarian tumor types. p53 and metallothionein may be helpful in the typing of borderline and malignant ovarian tumors. The immunohistochemical staining with bcl-2 and telomerase may not provide meaningful contribution for the typing of ovarian tumors. VIRTUAL SLIDE: The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2013030833768498.

Serum anti-Müllerian hormone and antral follicle count as predictive markers of OHSS in ART cycles.

OBJECTIVE: To evaluate predictive role of day-3 serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) in ovarian hyperstimulation syndrome (OHSS) in patients undergoing IVF/ICSI cycles. MATERIALS AND METHODS: Forty-one women with moderate/severe OHSS and 41 age matched women without OHSS were compared to evaluate the predictive value of certain risk factors for OHSS. AFC, and E(2), FSH, LH, AMH, inhibin-B levels measured on day 3 of the menstrual cycle before controlled ovarian hyperstimulation. RESULTS: Mean FSH was significantly lower (p < 0.0001); and mean LH, AFC and AMH were significantly higher in women with OHSS compared to women without OHSS (p = 0.049, p < 0.0001 and p < 0.0001, respectively). There was no significant difference in inhibin B (p = 0.112) and estradiol (p = 0.706) between the groups. The ROC area under curve (AUC) for AMH presented the largest AUC among the listed risk factors. AMH (AUC = 0.87) and AFC (AUC = 0.74) had moderate accuracy for predicting OHSS while Inhibin B (AUC = 0.58) and LH (AUC = 0.61) had low accuracy. The cut-off value for AMH 3.3 ng/mL provided the highest sensitivity (90%) and specificity (71%) for predicting OHSS. It's positive (PPV) and negative predictive values (NPV) were 61% and 94%, respectively. The cut-off value for AFC was 8 with 78% sensitivity, 65% specificity, 52% PPV and 86% NPV. CONCLUSION: Measurement of basal serum AMH and AFC can be used to determine the women with high risk for OHSS.

Different serum anti-Müllerian hormone concentrations are associated with oocyte quality, embryo development parameters and IVF-ICSI outcomes.

OBJECTIVE: To evaluate the association between different basal serum levels of anti-Müllerian hormone (AMH) and oocyte-embryo quality and IVF outcomes. MATERIALS AND METHODS: Two hundred and nine infertile women who underwent in vitro fertilization treatment with intracytoplasmic sperm injection (ICSI) between January 2009 and February 2011 were included in the study. Mean age, BMI, FSH, E(2), inhibin B, duration of infertility, total gonadotropin dose, antral follicle count, morphology of all oocytes, percentage of MII, early cleavage rate, the number of good quality embryos in transfer and ongoing pregnancy (>12 weeks) rates were evaluated. RESULTS: Six groups were formed according to the percentiles as <10% (≤0.89 ng/ml; n = 21), 10-25% (0.89-1.40 ng/ml; n = 31), 25-50% (1.40-2.89 ng/ml; n = 53), 50-75% (2.89-4.83 ng/ml; n = 28), 75-90% (4.83-8.06 ng/ml; n = 55), >90% (>8.06 ng/ml; n = 21). Central granulation, cytoplasmic granulation, oocyte postmaturity, percentage of embryos, early cleavage and percentage of transferred good quality embryos were significantly different in five groups (ANOVA test). Ongoing pregnancy rate (PR) was the lowest in <10% (9.5%), and the highest in 50-75% group (39.3%). (P = 0.040) CONCLUSION: Different AMH levels may predict the quality of oocytes, presence of postmaturity and nucleoli Z score, early cleavage and ICSI outcomes.

Serum anti-Müllerian hormone level as a predictor of poor ovarian response in in vitro fertilization patients.

PURPOSE: To evaluate the clinical value of day 3 serum anti-Müllerian hormone (AMH) compared with day 3 serum follicle-stimulating hormone (FSH) and human chorionic gonadotropin (hCG) day estradiol (E2) levels and antral follicle count (AFC) in the prediction of poor ovarian response in controlled ovarian hyperstimulation (COH). METHODS: AMH, FSH and AFC on day 3 as well as hCG day E2 levels were determined in 164 subjects. Receiver operating curve analyses and area under curves (AUC) of the study parameters were performed. Predictive values of the levels of day 3 AMH, FSH, AFC, and hCG day E2 as clinical parameters of ovarian response to COH were studied. RESULTS: Thirty-eight women were defined as poor responders. The day 3 AMH and hCG day E2 levels and AFC of normal responders were significantly higher than those of the poor responders. In predicting poor response, the AUC of day 3 AMH level was significantly higher than that of day 3 FSH level but was similar to the hCG day E2 level. Day 3 AMH, FSH and hCG day E2 levels and AFC were found to predict a poor response. Day 3 AMH and hCG day E2 levels were more predictive compared with day 3 FSH level and AFC. The cut-off level of AMH was ≤2 with a sensitivity of 78.9% and a specificity of 73.8%. CONCLUSION: Day 3 AMH has the ability to predict a poor response to COH and it is more predictive than day 3 FSH and AFC.

Spontaneous twin cervico-isthmic pregnancy in a grand multiparous woman.

Cervico-isthmic pregnancy is a rare form of ectopic pregnancy and is defined as the implantation of a fertilized ovum in the cervico-isthmic portion. The cause is unknown; local pathology related to previous cervical or uterine surgery may play a role, given an apparent association with a prior history of curettage or cesarean delivery. Transvaginal ultrasonography and ß-human chorionic gonadotrophin assays are useful for diagnosis. Here we report a case of spontaneous twin cervico-isthmic pregnancy in a grand multiparous patient who was diagnosed early in the first trimester with transvaginal ultrasonography. The pregnancy was terminated successfully with methotrexate. Methotrexate seems to be most successful at early gestational ages.

Additional effect of pulsed electromagnetic field therapy on knee osteoarthritis treatment: a randomized, placebo-controlled study.

The aim of this study was to evaluate if pulsed electromagnetic field therapy (PEMF) has additional effect on the classical physical treatment of knee osteoarthritis (OA) composed of hot pack, therapeutic ultrasound, and terminal isometric exercises. Forty patients (29 women and 11 men), ages 44 to 78 (mean age was 61.3 +/- 7.8 years) were included in our study. Patients with knee osteoarthritis [Kellgren-Lawrence criteria grade 2 and above and an average pain intensity of 40 or more on a 100-mm visual analog scale (VAS)] recruited from outpatient physical medicine and rehabilitation clinic were randomly assigned to receive PEMF or sham PEMF treatment in addition to their physical therapy. Both the PEMF and sham PEMF treatments being evaluated were 55 min/session, five sessions per week for 2 weeks. Each session comprise 20-min hot pack, 5-min therapeutic ultrasound, and 30-min PEMF or sham PEMF treatment applied to the knee of the patients. Patients were evaluated by the Western Ontario and McMasters Universities Osteoarthritis (WOMAC) Index and VAS at the baseline and at the end of treatment. Both PEMF and sham PEMF treatment groups showed statistically significant improvement in WOMAC pain and functional scores at the end of treatment (p < 0.001 in both groups). There were no statistically significant differences between groups in WOMAC pain, stiffness, and physical function scores after treatment (p = 0.906, p = 0.855, p = 0.809, respectively). There was neither difference in concomitant used acetaminophen dose in both groups (p = 0.289). The results of this study show that PEMF does not have additional effect on the classical physical treatment in reducing symptoms of knee OA.

A prospective case-control study analyzes 12 thrombophilic gene mutations in Turkish couples with recurrent pregnancy loss.

PROBLEM: Recurrent pregnancy loss (RPL) is a heterogeneous disorder. The contribution of specific thrombophilic genes to the pathophysiology of RPL has remained controversial. We evaluated the prevalences of 12 thrombophilic gene mutations among homogenous Caucasian couples with RPL and fertiles. METHOD: of study This was a prospective case-control study evaluating 272 women with RPL and 152 of their male partners, and a control group of 56 fertile couples. We investigated mutations including FV Leiden, factor V H1299R, factor II prothrombin G20210A, F XIII V34L, beta-fibrinogen -455G>A, plasminogen activator inhibitor-1, GPIIIa L33P (HPA-1 a/b L33P), MTHFR C677T, MTHFR A1298C, ACE I/D, Apo B R3500Q, and Apo E. RESULTS: Overall, heterozygous mutations of FV Leiden, FXIII V34L, GPIIIa L33P, Apo E4, and prothrombin G20210A and homozygous mutations of PAI-1and MTHFR C677T were associated with RPL. There was no meaningful association between RPL and other studied genes. CONCLUSION: In contrast to the other mutations and polymorphisms, FV Leiden, FXIII V34L, GPIIIa L33P, Apo E, prothrombin G20210A, PAI-1 and MTHFR C677T gene mutations may help to identify the couples at risk for recurrent pregnancy loss.

Effects of different postmenopausal hormone therapy regimens on cerebral blood flow and cognitive functions.

INTRODUCTION: The purpose of this study was to compare the effects of different postmenopausal hormone therapy regimens, namely conjugated equine estrogens (CEE), CEE plus medroxyprogesterone acetate (MPA), tibolone, and raloxifene on cerebral blood flow and cognitive functions. METHODS: A total of 64 healthy postmenopausal women admitted to the Department of Obstetrics and Gynecology, Cumhuriyet University, Turkey were included in this study. Patients were divided into five groups with respect to the treatment protocols: CEE 0.625 mg/day (n=13); CEE 0.625 mg/day + MPA 2.5 mg/day (n=14); tibolone 2.5 mg/day (n=11); raloxifene 60 mg/day (n=9); and control (n=17). The CEE group included only women with surgical menopause. Those who were on hormonal therapy, who had previously used hormonal therapy, who had neurological disorders, or who did not accept the longterm follow-up were excluded from the study. Demographic and clinic characteristics were recorded. Before starting the therapy regimens, cerebral blood flow was evaluated by internal carotid artery and middle cerebral artery peak systolic velocity, and pulsatility index measurements via Doppler ultrasonography. Cognitive functions were evaluated by the Standardized Mini-Mental Test. The mean follow-up period was 10.9+/-2.4 months, ranging between 8 and 16 months. After the follow-up period, the cerebral blood flow, and cognitive function of each woman was re-evaluated. RESULTS: Demographic and clinical characteristics of the women were not significantly different between the study groups (P>0.05). There were no significant differences between the pretreatment and posttreatment values for cerebral blood flow indices and cognitive function scores in any of the study groups (P>0.05). CONCLUSION: Different postmenopausal hormone therapy regimens have not revealed any significant effects on either cerebral blood flow or cognitive function.

A comparison of the benefits of sonography and electrophysiologic measurements as predictors of symptom severity and functional status in patients with carpal tunnel syndrome.

OBJECTIVES: To clarify whether sonography or electrophysiologic testing is a better predictor of symptom severity and functional status in carpal tunnel syndrome (CTS) and to assess the diagnostic value of sonography in patients with idiopathic CTS. DESIGN: Cross-sectional. SETTING: University hospital physical medicine and rehabilitation clinic. PARTICIPANTS: Thirty-four hands with CTS and 38 normative hands were evaluated. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Boston Carpal Tunnel Questionnaire, which comprised symptom severity and functional status scale, was applied to CTS patients. Bilateral upper-extremity nerve conduction studies of median and ulnar nerves and sonographic imaging of the median nerve were performed in all participants. Sonographic evaluation was performed by a physician blinded to the physical and electrophysiologic findings of the subjects. RESULTS: Cross-sectional areas (CSAs) of the median nerve at the carpal tunnel entrance and proximal carpal tunnel were 12.5+/-2.6 and 10.6+/-2.6 versus 15.6+/-4.2 and 11.5+/-3.2 in CTS patients versus controls, respectively. Increased CSA of the median nerve at the carpal tunnel entrance (P<.002) and at the proximal carpal tunnel (P<.000) were detected in the hands with CTS. Flattening ratios did not differ in a statistically significant manner between the groups (P>.05). The best predictor of symptom severity was median nerve sensory distal latency and that of functional status was median nerve motor distal latency. The optimum cutoff value for median nerve CSA was 11.2mm(2) at the carpal tunnel entrance and 11.9mm(2) at the proximal carpal tunnel. Sensitivity, specificity, and positive and negative predictive values at the proximal carpal tunnel (88%, 66%, 71%, 80%, respectively) were higher than those at the carpal tunnel entrance (68%, 62%, 65%, 66%, respectively). CONCLUSIONS: The best predictors of symptom severity and functional status in idiopathic CTS seem to be the electrophysiologic assessments rather than sonographic measurements. On the other hand, sonography may be helpful in the diagnosis of idiopathic CTS.

Aromatase expression in uterine leiomyomata is regulated primarily by proximal promoters I.3/II.

CONTEXT: Uterine leiomyomata are common tumors that cause irregular uterine bleeding and pregnancy loss and depend on estrogen for growth. Aromatase catalyzes the conversion of androgens to estrogens. Aromatase expression is regulated via alternatively used promoters in the placenta (I.1 and I.2a), fat (I.4, I.3, and II), bone (I.6), and gonads (II). A prostaglandin E(2)/cAMP-dependent pathway regulates coordinately the proximal promoters I.3/II, whereas glucocorticoids and cytokines regulate the distal promoter I.4. Use of each promoter gives rise to a population of aromatase mRNA species with unique 5'-untranslated regions (5'-UTRs). Uterine leiomyoma tissue, but not normal myometrium, overexpresses aromatase leading to estrogen-stimulated cell proliferation. Aromatase inhibitor treatment shrank uterine leiomyomata in a few women. OBJECTIVE AND DESIGN: Promoter I.4 was reported to regulate aromatase expression in uterine leiomyomata from a group of Japanese women. Here, we used two independent techniques to identify the promoters that regulate aromatase expression in uterine leiomyomata (n = 30) from 23 African-American, Hispanic, and white women. RESULTS: Rapid amplification of 5'-cDNA ends of aromatase mRNA species revealed the following distribution of promoter usage in leiomyomata: promoters I.3/II, 61.5%; I.2a, 15.4%; I.6, 15.4%; and I.4, 7.7%. Real-time PCR, which quantifies mRNA species with promoter-specific 5'-UTRs, revealed the following distribution for each 5'-UTR as a fraction of total aromatase mRNA: I.3/II, 69.6%; I.4, 7.3%; and other promoters, 23.1%. CONCLUSIONS: The primary in vivo aromatase promoter in leiomyoma tissues in non-Asian U.S. women is the prostaglandin E(2)/cAMP-responsive I.3/II region. Alternative signals may stimulate aromatase expression that is a common biological phenotype in uterine leiomyomata.

Effects of formoterol and BRL 37344 on human umbilical arteries in vitro in normotensive and pre-eclamptic pregnancy.

Alterations in vascular responses to beta-adrenoceptor agonists in normotensive pregnancy and pre-eclampsia are not fully understood. Thus, we studied changes in vasodilator responses to beta(2)-adrenoceptor agonist formoterol and beta(3)-adrenoceptor agonist BRL 37344 on umbilical arteries isolated from normotensive (n=12) and pre-eclamptic (n=12) pregnant women. Changes in the relaxant effect of formoterol and BRL 37344 were investigated by measuring isometric tensions in endothelium-denuded strips of umbilical arteries in the presence or absence of metoprolol, ICI 118.551 and SR 59230A (beta(1), beta(2), beta(3)-adrenoceptor antagonists, respectively, 10(-6) mol/L). Effects of formoterol and BRL 37344 on cAMP levels of umbilical arteries were evaluated by radioimmunoassay kits. Formoterol (10(-10)-10(-4) mol/L) and BRL 37344 (10(-10)-10(-4) mol/L) caused concentration-dependent relaxation of the contraction induced by phenylephrine (10(-5) mol/L) in umbilical artery strips isolated from both groups. E(max) values of formoterol and BRL 37344 (for normotensive pregnant women: 87.33+/-0.87 and 53.25+/-1.17 vs. for pre-eclampsia: 73.68+/-1.58 and 43.64+/-1.19, n=12, P>0.05, respectively) were significantly smaller in strips from pre-eclamptic women (P<0.05), with no significant change in pD(2) values. E(max) values of formoterol were significantly higher than those of BRL 37344 in both tissue (P<0.05). ICI 118.551 and SR 59230A, but not metoprolol, antagonized the relaxant effects of formoterol and of BRL 37344 on umbilical artery strips isolated from normotensive and pre-eclamptic pregnant women. Formoterol and BRL 37344 increased cAMP levels in both groups, but less significant in pre-eclamptic strips (P<0.05). These results suggest that the relaxation caused in human umbilical arteries by formoterol and BRL 37344 is mediated by a mixed population of beta(2)- and beta(3)-adrenoceptor subtypes, with contribution of cAMP. Umbilical arteries from subjects with pre-eclampsia showed a weaker beta(2)- and beta(3)-receptor-mediated relaxation to formoterol and BRL 37344, suggesting that the reduced action of formoterol and BRL 37344 may be partly due to a decreased effect of cAMP.

Association of microsomal epoxide hydrolase gene polymorphism and pre-eclampsia in Turkish women.

AIM: To assess the association between human epoxide hydrolase exon 3 and 4 polymorphisms and pre-eclampsia by carrying out a case-control study in Turkish women. METHODS: DNA was extracted from peripheral blood leukocytes, and genotype distribution of exon 3 and exon 4 of epoxide hydrolase gene (EPHX) was carried out in 271 patients and 155 controls. RESULTS: There was no statistically significant difference in the distribution of genotypes between pre-eclampsia without HELLP and pre-eclampsia plus HELLP cases and controls for the exon 3 and 4 polymorphism of EPHX. However, we found a significant association between the predicted enzyme activity level and pre-eclampsia (P = 0.018). The distribution of subjects with predicted high, intermediate and low microsomal epoxide hydrolase enzyme (EPHX) activity were 23.2, 38.8 and 38% in cases and 12, 47.3 and 40.7% in controls, respectively. CONCLUSION: Although we could not find any association between genetic variability in exon 3 and 4 of EPHX and pre-eclampsia, genetic variability in these two exons jointly modifies the predicted enzyme activity and may be a risk factor for pre-eclampsia.