Identification of historical Veziragasi aqueduct using the operational modal analysis.

This paper describes the results of a model updating study conducted on a historical aqueduct, called Veziragasi, in Turkey. The output-only modal identification results obtained from ambient vibration measurements of the structure were used to update a finite element model of the structure. For the purposes of developing a solid model of the structure, the dimensions of the structure, defects, and material degradations in the structure were determined in detail by making a measurement survey. For evaluation of the material properties of the structure, nondestructive and destructive testing methods were applied. The modal analysis of the structure was calculated by FEM. Then, a nondestructive dynamic test as well as operational modal analysis was carried out and dynamic properties were extracted. The natural frequencies and corresponding mode shapes were determined from both theoretical and experimental modal analyses and compared with each other. A good harmony was attained between mode shapes, but there were some differences between natural frequencies. The sources of the differences were introduced and the FEM model was updated by changing material parameters and boundary conditions. Finally, the real analytical model of the aqueduct was put forward and the results were discussed.

Successful preimplantation genetic aneuploidy screening in Turkish patients.

Preimplantation genetic diagnosis is a preventive approach for identifying genetic abnormalities in early stages of reproduction. We used preimplantation genetic aneuploidy screening in 230 cycles of patients with indications of advanced maternal age, recurrent implantation failure, recurrent spontaneous abortions, or severe male factor. Biopsied blastomeres from embryos with six to eight blastomeres on day 3 were fixed and fluorescence in situ hybridization was utilized on chromosomes 13, 16, 18, 21, 22, X, and Y. Among 945 morphologically normal embryos, 314 were diagnosed as chromosomally normal. Trisomy and monosomy were observed in 36% of the cases (18% each). Embryo transfer was used in 144 cycles, resulting in 41 pregnancies. Thirty-seven healthy babies were delivered, with a take-home baby rate of 24.2% and an implantation rate of 22%. We recommend preimplantation genetic aneuploidy screening as a valuable technique to select normal chromosome embryos in order to avoid multiple pregnancies due to the multiple embryo transfers that are normally necessary to ensure pregnancy in poor prognosis in vitro fertilization patients.

Analgesic effects of skin-to-skin contact and breastfeeding in procedural pain in healthy term neonates.

OBJECTIVES: The effectiveness of skin-to-skin contact to decrease pain from heel-lancing in healthy term neonates and whether breastfeeding in addition to skin-to-skin contact provided a more effective analgesia than skin-to-skin contact alone were investigated. METHODS: A randomised, controlled trial was conducted in 107 neonates undergoing heel-lance. Infants were randomly assigned to three groups: (i) being breastfed with skin-to-skin contact (group 1, n=35), (ii) being held in their mother's arms with skin-to-skin contact but no breastfeeding (group 2, n=36), or (iii) lying on the table before, during and after painful stimulus (group 3, n=36). Physiological responses to pain were measured by heart rate and oxygen saturation changes and behavioural responses were measured by duration of crying and grimacing. RESULTS: Infants had a mean (SD) birthweight of 3355 (270) g and gestational age of 39.5 (0.6) weeks; at the time of the procedure, mean (SD) postnatal age was 33.1 (5) hours. There was no significant difference between the groups in clinical characteristics and time spent squeezing the heel. Heart rate, oxygen saturation changes and length of crying were significantly reduced in groups 1 and 2 compared with group 3 (p<0.001). No difference was found between group 1 and group 2. Grimacing was less in group 2 than in group 3 (p<0.001). CONCLUSIONS: In healthy term neonates, skin-to-skin contact with the mother and breastfeeding with skin-to-skin contact reduce both physiological and behavioural pain response. Breastfeeding in the 1st 2 postnatal days with skin-to-skin contact did not increase the analgesic effect of skin-to-skin contact alone.

A case of Seckel syndrome with Tetralogy of Fallot.

Seckel syndrome, also known as Harper's Syndrome and Virchow-Seckel-Syndrome, was first described by Seckel in 1960, and is a rare (<1:10,000 live births) autosomal recessive trait. The syndrome (OMIM 210600) is a form of primordial dwarfism, characterized by severe intrauterine growth restriction, postnatal dwarfism, severe microcephaly with variable mental retardation, facial anomalies and skeletal abnormalities. Cardiac anomalies have been described in only five case. We report a male newborn with typical findings of Seckel sydrome associated with Tetrology of Fallot. This is the first case reported in concomitance with Tetralogy of Fallot, and might be a new finding of the syndrome. We would like to emphasize that clinicians should perform diagnostic interventions for congenital cardiac defects in Seckel Syndrome.

Bacillus Calmette-Guerin vaccination in preterm infants.

OBJECTIVE: To evaluate the tuberculin response after bacille Calmette-Guérin (BCG) vaccination in preterm infants. METHODS: Thirty-five infants born at <35 weeks gestation were included in the study. An intradermal injection of 0.05 ml BCG vaccine was given to each infant at postnatal months 2-3. Tuberculin skin tests (TSTs) were done 8-12 weeks after vaccination using 0.1 ml of 5 TU purified protein derivative (PPD). The diameter of induration was measured 72 h later and > or =5 mm induration was taken as a positive response. RESULTS: The babies had a mean birth weight (SD) of 1650 (424) g, and a gestational age of 32.4 (2.1) weeks. The TST was positive in 20 (57%) of the infants. The mean body weight of the tuberculin-positive babies was significantly higher than the others at both vaccination and TST. No difference was found between groups concerning sex, birth weight, gestational age, intrauterine growth and postnatal age at BCG vaccination and TST. CONCLUSION: BCG vaccination in preterm infants at months 2-3 of postnatal life results in a high percentage of BCG scarring and 57% TST conversion. A positive tuberculin response was significantly related to the postnatal weight gain of the preterm infants.

Comparing two embryo transfer catheters. Use of a trial transfer to determine the catheter applied.

OBJECTIVE: To analyze the performance of two different embryo transfer catheters (Wallace and Frydman) in an in vitro fertilization (IVF)-intracytoplasmic sperm injection (ICSI) program. STUDY DESIGN: Four hundred twenty-eight IVF or ICSI embryo transfer cycles were analyzed. A trial transfer was performed before the initiation of controlled ovarian hyperstimulation to determine the choice of embryo transfer catheter, Wallace or Frydman. Actual transfer was undertaken with the catheter chosen from the trial transfer. RESULTS: During actual embryo transfer, 214 (93.5%) of the intended 229 Wallace transfers were successful, and in 15 transfers the Frydman catheter was used. Of the intended 199 Frydman transfers, all were successful. Clinical pregnancy rate, implantation rate per embryo and ectopic pregnancy rate per transfer for the Wallace catheter were 41.6%, 16% and 0.9%, respectively. Respective rates for the Frydman catheter were 36.0%, 14.4% and 0.9% (P > .05 for all variables). Trial catheterization prevented most of the unanticipated procedural difficulties during the actual transfer. CONCLUSION: Both Wallace and Frydman catheters performed similarly, although there was a slight but nonsignificant increase in clinical pregnancy rates with the Wallace catheter.

Hypoglycemia in small-for-gestational-age neonates'.

In this prospective study, we investigated the frequency of hypoglycemia and the proper intervals for screening in small-for-gestational-age (SGA) neonates. We determined test-strip blood glucose values at two, three, six, 12, 24 and 48 hours of age in 25 SGA and 16 appropriate-for-gestational-age (AGA) infants who were born after 37 completed gestational weeks at the Obstetrics Clinics of Sisli Etfal Hospital. Serum glucose determination was immediately done if a test-strip value was less than 40 mg/dl. The frequency of hypoglycemia in SGA neonates was significantly higher (p:0097) than in AGA neonates. The first three hours, the sixth hour and the 48th hour postnatally were the most common hours for encountering hypoglycemia. Clinical signs were not true indicators of hypoglycemia. These data suggest that screening for hypoglycemia in SGA neonates should continue for 48 hours.

The effect of low-dose heparin on maintaining peripherally inserted percutaneous central venous catheters in neonates.

OBJECTIVE: To evaluate the effect of low-dose heparin on duration of peripherally inserted percutaneous central venous catheter (PCVC) patency and catheter occlusion. STUDY DESIGN: Our research was a prospective, randomized, controlled, double-blind clinical study including 246 eligible neonates with PCVCs. It was conducted at the neonatal intensive care unit (NICU) of Diyarbakir Children's Hospital between 1 February 2007 and 31 October 2008. In the heparin group (n=118), the total parenteral nutrition (TPN) solutions contained heparin, which was infused at a rate of 0.5 IU kg⁻¹ h⁻¹ . The no-heparin group (n=121) received TPN fluids without heparin. RESULT: In the heparin group, the duration of catheter patency was longer than that of the no-heparin group reaching a statistically significant difference (12.4 ± 4.5 vs 9.7 ± 4.0, P<0.0001). In the heparin group, the proportion of patients completing the TPN therapy successfully was higher than in the no-heparin group (P=0.0001; relative risk (RR): 3.32 (95% confidence interval (CI): 1.92 to 5.73)) also demonstrating a statistically significant difference. The rate of catheter occlusion among infants in the heparin group was smaller (P=0.0001; RR: 3.44 (95% CI: 1.92 to 6.44)). There were no statistically significant differences between the two groups in the incidence of other catheter-related problems. The length of the occluded catheter outside the skin, TPN infusion rate and catheter duration time were found to be the factors associated with catheter occlusion. Heparin prevented catheter occlusion with a mechanism unrelated to these factors. CONCLUSION: In neonates with PCVCs, low-dose continuous infusion of heparin (0.5 IU kg ⁻¹h⁻¹ within TPN fluids is an effective measure in terms of reducing catheter occlusion, allowing successful completion of the therapy, without increasing adverse effects. Furthermore, this effect of heparin may occur independently via occlusion-related factors that we evaluated in the study.

Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers.

BACKGROUND/OBJECTIVES: There are other benefits of vitamin D than those for bone health. To determine the association of serum 25-hydroxy vitamin D (25(OH)D) concentrations in newborns with acute lower respiratory infection (ALRI) and without clinical signs of rickets, and their mothers. The design comprises a hospital-based case-control study. SUBJECTS/METHODS: The study group consisted of 25 newborns with ALRI who were admitted to neonatal intensive care unit and their mothers. Controls were 15 healthy newborns of the same age as the study group and their mothers. A commercial radioimmunoassay was used to measure 25(OH)D concentrations in serum for assessing vitamin D status. RESULTS: The two groups were similar in gestational week, birth weight, birth height, head circumference, age and gender. The mean serum 25(OH)D concentrations in the study group newborns were lower than those of the control group (9.12+/-8.88 ng/ml and 16.33+/-13.42 ng/ml, respectively) (P=0.011). Also, mean serum 25(OH)D concentrations in the mothers of the study group were lower than those in the mothers of the control group (13.38+/-16.81 ng/ml and 22.79+/-16.93 ng/ml respectively) (P=0.012). In 87.5% of all newborns and 67.5% of all mothers, serum 25(OH)D concentrations were lower than 20 ng/ml. The 25(OH)D concentrations of newborns were highly correlated with mothers' serum 25(OH)D concentrations. CONCLUSIONS: Our findings suggest that newborns with subclinical vitamin D deficiency may have an increased risk of suffering from ALRI. The strong positive correlation between newborns' and mothers' 25(OH)D concentrations shows that adequate vitamin D supplementation of mothers should be emphasized during pregnancy especially in winter months.

Simultaneous bilateral tubal pregnancy after intracytoplasmic sperm injection.

Since the advent of assisted reproductive technology, the concern about ectopic implantation of embryos has increased dramatically. Simultaneous bilateral tubal pregnancy is the least common type of ectopic implantation of two embryos. In this report we present the first case of simultaneous bilateral tubal pregnancy after intracytoplasmic sperm injection (ICSI) and embryo transfer treatment. The present case had no risk factor for ectopic pregnancy. Therefore, for early diagnosis and management of such cases, close clinical follow-up and routine ultrasonography following ICSI are necessary.

Evaluation of uterine cavity by sonohysterography in women scheduled for intracytoplasmic sperm injection.

A prospective study was performed to determine the feasibility of evaluating the uterine cavity by sonohysterography (SHG) in women who were scheduled for intracytoplasmic sperm injection (ICSI) due to severe male factor infertility and who had not had a previous hysterosalpingography (HSG). Sonohysterography was performed in 80 women scheduled for ICSI. A subsequent hysteroscopy was undertaken in patients with intracavitary lesions. The outcome of ICSI for the women undergoing SHG was compared with that of 240 cycles performed (during the same time period) in patients who had a normal HSG before admission to the clinic. There were no complications attributable to the SHG procedure. Hysteroscopy correctly identified all lesions depicted by SHG. SHG and HSG groups were comparable with regard to female age and duration of infertility. Clinical pregnancy rates per transfer were 40.2% and 42.5% in the SHG and HSG groups, respectively. Abortion rates in the two groups were also similar (14.8 and 11.0%, respectively). In conclusion, sonohysterography appears to be a simple, inexpensive, and safe alternative to HSG for evaluation of the uterine cavity in women scheduled for ICSI.

Progression of excess embryos to the blastocyst stage predicts pregnancy and implantation rates after intracytoplasmic sperm injection.

Excess embryos from patients undergoing intracytoplasmic sperm injection and embryo transfer for male infertility were cultured to determine the rate and timing of their progression to the blastocyst stage. In 194 embryo transfer cycles, four embryos with the morphologically best grading were transferred and at least two embryos were cultured. The cycles were classified as: group 1: no excess embryos reached blastocyst stage, group 2: >50% of embryos reached blastocyst stage by days 4-5, group 3: <50% of embryos reached the blastocyst stage by days 4-5, group 4: >50% of the embryos reached blastocyst stage by days 6-7, group 5: <50% of the embryos reached blastocyst stage by days 6-7. All groups were similar regarding female age, duration of infertility, and parameters of ovarian stimulation. In group 1, clinical pregnancy and implantation rates were 14 and 11% respectively, and were similar to those of group 4. In group 2, clinical pregnancy and implantation rates were 75 and 33%. Multiple implantations occurred in 81% of group 2 or 3 cycles, compared to none in group 1 cycles. The results suggest that the development potential of the embryo is intrinsic, and that embryos which carry a high potential for development yield a high clinical pregnancy rate and multiple implantations.

Short rib-polydactyly syndrome in twins: Beemer-Langer type with polydactyly.

We present premature female twin fetuses with concordant extremely shortened ribs, short limbs, macrocephaly, median cleft upper lip and facial dysmorphism. Based on radiological criteria and the pattern of associated abnormalities, a lethal short rib-polydactyly syndrome (Beemer-Langer type) was diagnosed. The differential diagnosis of this entity is discussed.

Low-dose aspirin does not increase implantation rates in patients undergoing intracytoplasmic sperm injection: a prospective randomized study.

PURPOSE: The aim was to evaluate the effect of aspirin on pregnancy and implantation rates in an unselected group of patients undergoing intracytoplasmic sperm injection (ICSI). METHODS: Two hundred and seventy-nine patients were randomized to receive 80 mg of aspirin (n = 139) or no treatment (r = 136) starting from the first day of controlled ovarian hyperstimulation. RESULTS: Duration of stimulation, gonadotropin consumption, peak estradiol, number of oocytes retrieved, fertilization rate, cleavage rate, and number of embryos transferred were similar in the two groups. Implantation and clinical pregnancy rates were 15.6% and 39.6% versus 15.1% and 43.4% in aspirin treated and untreated groups, respectively (P > 0.05). CONCLUSIONS: Low-dose aspirin administration does not improve implantation and pregnancy rates in an unselected group of patients undergoing ICSI.

Blastocyst transfer following intracytoplasmic injection of ejaculated, epididymal or testicular spermatozoa.

Recent studies indicate a strong paternal influence on embryo development and progression of the embryo to the blastocyst stage. The aim of this study was to compare, during extended culture, the in-vitro development of embryos resulting from intracytoplasmic sperm injection (ICSI) of ejaculated spermatozoa (group 1, n = 347), epididymal (group 2, n = 22) or testicular (group 3, n = 18) spermatozoa from obstructive azoospermic and testicular spermatozoa from non-obstructive azoospermic (group 4, n = 31) subjects. Fertilization and blastocyst formation rates were significantly lower in group 4 (P < 0.05). The incidence of expanded and hatching blastocysts was significantly lower in group 4 (P < 0.05). Overall in 93.2% ejaculate ICSI cycles, blastocysts were transferred on day 5. This was significantly higher than the 62% day 5 transfers in the non-obstructive azoospermic group (P < 0.05). Implantation rate per embryo was significantly higher in the ejaculate ICSI group compared with the other groups (P < 0.05). Clinical pregnancy per transfer was similar between groups; however, significantly fewer multiple pregnancies were encountered in the non-obstructive azoospermic group (P < 0.01). In conclusion, the source of the spermatozoa, most likely to be indicative of the severity of spermatogenic disorder, affects the rate of blastocyst formation and blastocyst implantation. Spermatozoa from non-obstructive azoospermic subjects, when utilized for ICSI, result in embryos that progress to the blastocyst stage at a lower and slower rate and implant less efficiently.

Performing testicular or epididymal sperm retrieval prior to the injection of hCG.

PURPOSE: Our purpose was to determine the feasibility and efficacy of performing testicular or epididymal sperm retrieval prior to the injection of human chorionic gonadotropin (hCG). METHODS: This report deals with 87 sperm-positive percutaneous epididymal sperm aspiration (PESA), percutaneous testicular sperm aspiration (PTSA), or testicular sperm extraction (TESE) cycles. All sperm retrieval procedures were performed prior to administration of hCG to the women. Retrieved spermatozoa were cultured in vitro in simple medium for approximately 40 hr prior to intracytoplasmic sperm injection. RESULTS: In all but one cycle in which TESE was performed for nonobstructive azoospermia, motile sperm were available for ICSI. The overall fertilization rate was 53%. Pregnancy rate per transfer and implantation rate per embryo were 41.2 and 15.7%, respectively. CONCLUSIONS: Satisfactory fertilization and pregnancy rates can be achieved when PESA, PTSA, or TESE is performed prior to the injection of hCG followed by in vitro culture of spermatozoa approximately 40 hr before ICSI. Scheduling of testicular or epididymal sperm retrieval cases in this way appears to ease the workload on laboratory and operating room personnel. Furthermore, withholding hCG when sperm is absent may obviate the unnecessary risk of ovarian hyperstimulation when spermatozoa cannot be retrieved.