Gene Expression Profiles of Tumor Necrosis Factor-α and Endothelin-1 in Obstructive Sleep Apnea.

BACKGROUND/AIMS: The aim of this study was to observe the relationship between the gene expression profiles of tumor necrosis factor (TNF)-α and endothelin (EDN)-1 and obstructive sleep apnea (OSA). METHODS: A prospective, cross-sectional study performed at a tertiary-care academic center; 108 patients with snoring and day-time sleeplessness were included in this study carried out in the Otolaryngology Department. All patients were evaluated with 1-night polysomnography (PSG). There were 63 patients with OSA and 45 patients without OSA. In the OSA group, the median apnea hypopnea index (AHI) was 29.1; in the non-OSA group, the median AHI was 2.1. Blood samples were obtained from all 108 patients for the genetic analysis of the expression of TNF-α and EDN-1. PSG findings and gene expression levels were evaluated in both groups. RESULTS: The median (range) age was 46 (20-81) years, BMI 24.9 (15-49), EDN-1 gene expression 0.45 (0.02-67.88) pg/µL, and TNF-α gene expression 1.71 (0.08-59.52) pg/µL. We found that EDN-1 and TNF-α gene expression levels were significantly higher in the OSA group than in the control group (p = 0.009 vs. p < 0.001). CONCLUSION: EDN-1 and TNF-α gene expression levels were associated with the occurrence of OSA.

Can fetal abdominal visceral adipose tissue and subcutaneous fat thickness be used for correct estimation of fetal weight? A preliminary study.

The aim of this study was to assess the accuracy of a new formula for the calculation of an estimated fetal weight (EFW) and to evaluate value of fetal visceral adipose tissue (VAT) and abdominal subcutaneous fat (SF) thickness on the prediction of birth weight. In this prospective study, fetal biometry, EFW, fetal VAT and SF thickness were measured in low-risk 37-41 gestational weeks pregnant women by ultrasonography. The linear regression analysis was performed to investigate the relationship between birth weight and obstetric measurements. It was found that the most important factors in the prediction of a birth weight were the abdominal circumference (AC), SF and VAT. The new formula for EFW was EFW=-2748.622+13.811*AC+56.795*SF+17.913*VAT According to the Hadlock 3 and the new formula, 92% and 95% of all fetal weight estimations were within 10% of actual birth weight, respectively. Measurement of VAT and SF thickness in prediction of fetal weight could reduce a weight estimation error. Impact statement What is already known on this subject? An accurate prediction of fetal weight during gestation provides useful information for assessing the fetal and newborn health status. As the detection of growth abnormalities is vital, there is a need for a reliable method of assessing birth weight during labour. Unfortunately, although different methods are available, a simple, quick and reliable method of assessing birth weight is still in debate. Fetal visceral adipose (VAT) tissue measurement is a new method which could be used for the correct estimation of fetal weight. Like adults, the VAT and subcutaneous fat tissue (SF) thickness could be correlated with the weight and body-mass index. What do the results of this study add? It was found that SF and VAT are important factors in the prediction of birth weight, like the abdominal circumference (AC). What are the implications of these findings for clinical practice and/or further research? The measurement of VAT and SF thickness in prediction of fetal weight could reduce a weight estimation error.

Ischemia-Modified Albumin May Be a Novel Marker for Predicting Neonatal Neurologic Injury in Small-For-Gestational-Age Infants in Addition to Neuron-Specific Enolase.

Aim This study aims to evaluate hypoxia/ischemia and oxidant stress, and negative neurodevelopmental outcomes in small-for-gestational-age (SGA) infants. Material and Methods Two study groups were established as SGA and appropriate-for-gestational-age (AGA) infants. SGA infants were allocated asymmetric and symmetric SGA infants. Serum levels of neuron-specific enolase (NSE), ischemia-modified albumin (IMA), malondialdehyde (MDA), total antioxidant capacity (TAC), and total oxidant status (TOS) were determined and oxidative stress indexes (OSI) were calculated in all groups. Results Overall, 83 infants were diagnosed SGA, and 85 infants were determined AGA. TOS and OSI levels were significantly higher and TAC levels were significantly lower in SGA group (p < 0.05). MDA and IMA levels were significantly higher in SGA group (p < 0.05). NSE levels in SGA infants were significantly higher (p < 0.05). NSE and IMA were significantly higher in symmetric SGA infants (p < 0.05). TOS, OSI, MDA, TAC levels were not significantly different in SGA infants with abnormal neurological findings (p > 0.05); NSE and IMA levels were significantly higher in SGA group with abnormal neurological findings (p < 0.05). Conclusion SGA infants expose to hypoxia and oxidative stress led to neuronal damage. We suggest that in addition to NSE, IMA blood levels might be a sensitive novel marker for predicting the severity of neuronal damage.

Factors affecting the rates of caesarean sections in cases with premature rupture of membranes (PROM) at term.

The aim of this retrospective study was to investigate the factors affecting the rates of caesarean section in cases with premature rupture of membranes (PROM) in term pregnancies. Eighty-two term PROM patients who presented to Turgut Ozal University and Erzurum Nene Hatun Hospitals between 2012 and 2014 were included. The effects of demographics, nulliparity, active-latent phase durations, presence of meconium and chorioamnionitis, requirement of oxytocin and cervical dilation at the initial examination on C/S rates were assessed. The C/S rates were changed with the duration of active period and the duration of latent period. It was found that the presence of cervical dilation at the initial examination significantly reduced the risk for progress to C/S at a rate of 87.5%. C/S rates did not change with other variables. We conclude that the factors increasing the risk for C/S in PROM at term group are not different from the non-term PROM. Impact statement The aim of this retrospective study was to investigate the factors affecting the rates of caesarean section (C/S) in cases with premature rupture of membranes (PROM) in term pregnancies. The C/S rates were changed with the duration of active period and the duration of latent period. It was found that the presence of cervical dilation at the initial examination significantly reduced the risk for progress to C/S at a rate of 87.5%. We conclude that the factors increasing the risk for C/S in PROM at term group, are not different from the non-term PROM groups. Currently, the PROM is considered the start of a pathological process in both term and preterm pregnancies and also considered to increase the rates of caesarean sections. Studies on the management of PROM at term have concentrated rather on whether to intervene for accelerating the labour or spontaneous monitorisation. As found by the studies like this one in the literature, the factors having an impact on C/S rates in the cases of PROM at term are similar to those of non-PROM patients at term, may prevent clinicians from taking an invasive or aggressive approach towards the cases of PROM at term.

Galectin-3: A biochemical marker to detect paroxysmal atrial fibrillation?

PURPOSE: Atrial fibrillation (AF) is the most common form of arrhythmia. AF leads to electrical remodelling and fibrosis of the atria; however, the mechanism(s) remain poorly understood. Galectin-3 is a potential mediator of cardiac fibrosis. The present study aimed to examine the relationship between serum galectin-3 levels and paroxysmal AF. METHODS: Forty-six patients with paroxysmal AF and preserved left ventricular systolic function, and 38 age- and gender-matched control subjects, were involved in the study. Serum galectin-3 levels were analyzed with an enzyme-linked immunosorbent assay (ELISA). RESULTS: Serum galectin-3 levels (median 1.38 ng/mL; 1.21 ng/mL-1.87 ng/mL; p< 0.001) were significantly elevated in patients with paroxysmal AF compared with the control. Left atrial diameter was significantly higher in patients with paroxysmal AF (41.2±3.0 mm vs. 39.6±3.3 mm). Left atrial diameter was found to be significantly correlated with serum galectin-3 levels in patients with paroxysmal AF (r= 0.378, p= 0.001). CONCLUSION: Serum galectin-3 levels are significantly elevated and significantly correlated with left atrial diameter in patients with paroxysmal AF.

Effect of combined oral contraceptive use on serum 25-hydroxy vitamin D levels and ultrasound parameters in patients with polycystic ovary syndrome.

PURPOSE: To investigate if there is an effect of combined oral contraceptive (COC) use on serum 25-hydroxy vitamin D [25(OH)D] levels in patients with polycystic ovary syndrome (PCOS). METHODS: PCOS was defined by the 2003 Rotterdam criteria. All patients with PCOS were treated with a COC containing 0.035 mg ethinylestradiol and 2 mg cyproterone acetate for 6 months. Serum 25(OH)D levels, HOMA-IR, ovarian volume and antral follicule count were measured before and after the treatment. RESULTS: The median 25(OH)D levels were 9.40 (range 4.40-24.50) µg/l and 7.00 (5.00-13.50) µg/l before and after COC use, respectively. Serum 25(OH)D levels decreased after the treatment; however, the difference was not statistically significant (p = 0.055). CONCLUSION: This study seems to be the first prospective trial revealing the effect of COC use on serum 25(OH)D levels in women with PCOS. Although the decrease in serum 25(OH)D levels in patients with PCOS with the use of COC alone, did not reach to statistically significance level after 6 months treatment with COC.

Hyperemesis gravidarum and its relation with maternal body fat composition.

The objective of this study was to determine if maternal body fat composition and body mass index were associated with hyperemesis gravidarum (HG) in the first trimester of pregnancy. Healthy pregnant women (n = 30) without nausea and vomiting (control group) and women with HG (n = 54; study group), all with singleton pregnancy at 6-14 weeks gestational age, were included. Body mass index was measured before and during pregnancy. Visceral adipose tissue (VAT) and subcutaneous fat thickness were measured during pregnancy. Comparison of the groups revealed that VAT and pre-pregnancy body mass index but not subcutaneous fat thickness were significantly higher in the HG group versus controls. VAT and pre-pregnancy body mass index predicted 83.8% and 67.1% of HG cases, respectively. VAT and pre-pregnancy body mass index were correlated with the development of hyperemesis gravidrum and hence could be considered as predictive markers for HG.

Gut satiety hormones and hyperemesis gravidarum.

UNLABELLED: Hyperemesis gravidarum (HG) is described as unexplained excessive nausea and vomiting during pregnancy. Some gut hormones that regulate appetite may have important role in etiopathogenesis of HG and weight changes during pregnancy. In this study, levels of gut satiety hormones were evaluated in pregnant women with HG. METHODS: This prospective case-control study was conducted in 30 women with HG and 30 healthy pregnant women without symptoms of HG. Fasting venous blood samples were taken from all subjects for measurement of plasma gut hormone levels; obestatin (pg/mL), peptide YY (PYY), pancreatic polypeptide (PP) and cholecystokinin (CCK). RESULTS: Plasma PYY and PP levels were significantly higher in HG group. The most important parameter in diagnosis of HG was plasma PP level. Simple use of PP level led to the diagnosis 91.1 % of HG cases correctly. The single most important parameter in the prediction of HG was also PP level. CONCLUSION: Anorexigenic gut hormones might have important role in etiopathogenesis of hyperemesis gravidarum and weight changes during pregnancy.

Ischemia-modified albumin may be a novel marker for the diagnosis and follow-up of necrotizing enterocolitis.

AIM: We investigate the efficacy of serial ischemia-modified albumin (IMA) measurements in diagnosis and follow-up of necrotizing enterocolitis (NEC), and compare its effectiveness with C-reactive protein (CRP), interleukin-6 (IL-6), in NEC. METHODS: Preterm infants, whose gestational age and weight matched each other, were grouped as control (n = 36) and NEC (n = 37). IMA, CRP, IL-6 levels were measured on the third day of life for the control group and on the day of diagnosis (first day), third, and seventh days of NEC. RESULTS: IMA, CRP, and IL-6 levels were significantly increased in NEC patients compared to the control group (P < 0.001) on the follow-up. IMA levels were significantly higher in infants with stage-III NEC than those in infants with stage-II NEC on the first, third, and seventh days (P < 0.001). The area under curve for IMA (0.815 at diagnosis, 0.933 at the third day, 0.935 at the seventh day) were significantly higher than CRP and IL-6 at all days for predicting perforation in infants with NEC (P < 0.001). Similarly, the area under curve for IMA (0.952 at diagnosis, 0.929 at the third day, 0.971 at the seventh day) was significantly higher than CRP and IL-6 at all consequent days of diagnosis for predicting mortality in infants with NEC (P < 0.001). CONCLUSION: Ischemia-modified albumin was found to be superior to CRP and IL-6 in both diagnosis and follow-up of NEC.

Effect of underlying infertility factors on second trimester serum screening results.

OBJECTIVE: To determine whether assisted reproductive technologies (ART) alone or an underlying cause of infertility has any effect on second trimester serum screening results. STUDY DESIGN: Second trimester serum screening results of ART pregnancies of women with polycystic ovary syndrome (IVF-P group) were compared with those of women who underwent ART due to malefactor infertility (IVF-M group) and of women who conceived spontaneously. RESULTS: Comparison of the groups for a-fetoprotein, beta-hCG, and beta-hCG multiples of the median (MoM) revealed a significant difference between the IVF-M and control groups. Comparison of groups for unconjugated estriol (uE3) and uE3 MoM levels revealed a statistically significant difference between the IVF-P versus the control groups. CONCLUSION: It seems advisable to use a population of ART pregnancies, preferably divided by type of treatment and the etiology of the infertility, when establishing median curves for second trimester serum screening markers.

Effect of number of abnormal oral glucose tolerance test (OGTT) values on birthweight in women with gestational diabetes.

BACKGROUND & OBJECTIVES: To examine the effect of abnormal oral glucose loading (OGL) and number of abnormal oral glucose tolerance test (OGTT) values on foetal weight in Turkish pregnant women. METHODS: This retrospective study included 810 pregnant women between 24 and 28 wk of gestation who were screened for gestational diabetes mellitus (GDM). Women were grouped according to degree of glucose intolerance and compared for clinical, biochemical parameters. Women who delivered macrosomic infants were compared with those who delivered normal infants. RESULTS: GDM was detected in 70 (8.6%) women. Median age and infant birthweight of GDM cases were higher than the other groups. Infants of women with GDM weighted 200 g more than infants of non-GDM cases. No difference was found in terms of birthweight between diabetes cases with 2, 3 or 4 OGTT values abnormality. INTERPRETATION & CONCLUSIONS: The number of abnormal OGTT values in GDM cases had no effect on foetal weight. Macrosomia was observed more in GDM cases than in non-GDM cases. Birthweight was significantly higher in women with GDM despite the therapy used for regulation of blood glucose. This may be related to ethnical, dietary, nutritional differences, and treatment compliance in our study population.

Antiadhesive role of human amniotic fluid on peritoneal adhesion formation in a rat model. Experimental study.

OBJECTIVE: To determine the role of human amniotic fluid (HAF) in preventing or reducing postoperative adhesions. STUDY DESIGN: Uterine horn adhesion model was carried out in 24 female Wistar rats. The animals were randomized into 4 groups: (1) control, (2) Ringer's lactate, (3) whole HAF, and (4) HAF depleted from cells and proteins. Adhesion grade and histologic findings of adhesion-carrying tissues were evaluated and groups were compared according to these parameters. RESULTS: Rats treated with whole HAF had less adhesion grade when compared to the control group, but the difference was not statistically significant. On the other hand, centrifuged amniotic fluid treatment significantly reduced peritoneal adhesion grade, fibrosis and inflammation (p < 0.05). CONCLUSION: Whole HAF seems to have no beneficial effect on peritoneal adhesion formation, but HAF depleted of protein and cells does have a positive effect on reducing adhesion formation.

Impact of adrenal versus ovarian androgen ratio on signs and symptoms of polycystic ovarian syndrome.

The aim of this study was to examine the effect of adrenal versus ovarian androgen (dehydroepiandrosterone sulfate/total testosterone [DHEAS/TT]) on clinical presentation and related metabolic disturbances in Turkish women with polycystic ovarian syndrome (PCOS). Two hundred eighty PCOS cases were taken into the study. For all cases, the DHEAS/TT ratio was calculated. The median value of this ratio was 4.40. Patients with an androgen ratio lower than 4.40 were included in Group 1 and cases with a ratio higher than 4.40 were Group 2. The two groups were compared in terms of hormonal, biochemical and clinical parameters. Body mass index and waist circumference were lower, the Ferriman-Gallwey score was higher and the cycle length was shorter in Group 2. High DHEAS level was associated with better lipid profiles and lower levels of inflammatory markers, meaning good metabolic control in these women, in spite of increased hirsutism rates. In patients with PCOS, both androgens are usually high in proportion to each other. Therefore, it would be more meaningful to use the DHEAS/TT ratio for an assessment of the metabolic and phenotypic effects of PCOS.

First-trimester reference ranges for decidual thickness and its relation to progesterone levels.

AIMS: The present study aimed to provide normal reference ranges for decidual thickness measured ultrasonographically in healthy first-trimester pregnancies and to evaluate whether there was a relationship between decidual thickness and serum progesterone levels. METHODS: Decidual thickness of 173 women with a healthy gestation between 6+0 and 9+6 weeks was measured ultrasonographically and serum progesterone concentration was determined. Distribution of decidual thickness at each gestational week and its relation with serum progesterone levels was evaluated. RESULTS: Mean decidual thickness was 6.8, 5.7, 5.5, and 6.1 mm at 6th, 7th, 8th, and 9th gestational weeks, respectively. Decidual thickness showed a mild negative correlation with gestational week (ρ=-0.207, P=0.006) and a mild positive correlation with serum progesterone concentrations (ρ=0.191, P=0.021). CONCLUSION: The present study provided normal reference ranges for decidual thickness in healthy pregnancies in the first trimester. The association found between decidual thickness and progesterone levels might shed light on further studies investigating the predictive factors of pregnancy loss and might lead to changes in the management of threatened miscarriage.

Does assisted reproductive technology itself or polycystic ovary syndrome as a cause of infertility have any effect on first trimester serum screening results?

OBJECTIVE: To determine whether assisted reproductive technology (ART) itself or polycystic ovary syndrome (PCOS) as a cause of infertility has any effect on first trimester serum screening results. STUDY DESIGN: First trimester serum screening results of ART pregnancies of women with PCOS (IVF-P group) were compared with those of women who underwent ART due to malefactor infertility (IVF-H group) and women who conceived spontaneously. RESULTS: Comparison of the groups for crown-rump length (CRL) and nuchal translucency revealed no significance. There was significant difference between the IVF-H and IVF-P groups in terms of free beta-human chorionic gonadotropin (beta-hCG) levels. Although comparison of groups revealed no significance, pregnancy-associated plasma protein A (PAPP-A) values were higher in the IVF-P group than in the IVF-H group. CONCLUSION: CRL and nuchal translucency measurements were not affected by in vitro fertilization procedures or the presence of maternal PCOS. Use of ART decreased PAPP-A and increased free beta-hCG levels. Although not significant, PAPP-A was higher in PCOS patients who conceived with ART, which may in turn increase false negative rates in these cases.

First trimester volumetric measurements: relation with hormone levels and fetal heart rate.

PURPOSE: This study aimed to examine two-dimensional ultrasound (2D US) volumetric measurements of 1st trimester structures and their relationship with ß-hCG, progesterone, and fetal heart rate (FHR) in 6-10 weeks healthy pregnant women. METHODS: Using conventional 2D transvaginal ultrasound imaging, the crown rump length (CRL), yolk sac (YS) and gestational sac (GS) were measured in 80 women. Volumetric measurements were done in 32 cases that were selected among 80 women, using a simplified formula for the volume of a prolate ellipsoid: V = 0.523 × length × height × width. The ß-hCG and progesterone levels were recorded. The heart rate was determined from M-mode tracings using electronic calipers. RESULTS: Moderately positive correlation was found between FHR versus CRL, embryo volume and GS volume. FHR increased linearly with CRL value, till CRL became 15 mm, after which it formed a plateau. ß-hCG increased linearly till CRL was 15 mm, and then it formed a plateau. Progesterone level was stable till CRL became 20 mm, embryo volume 2 cm(3), after which it increased linearly. CONCLUSION: Various ranges of relations are observed between FHR, obstetric, and hormonal measurements. The relationship between these parameters might be used for determination of abnormal growth and adverse outcomes in early pregnancy.

Effect of liquid-based gel application during speculum examination on satisfactory level of smear examination.

PURPOSE: The aim was to evaluate the use of liquid-based gel during cytologic follow-up and the effect of liquid-based gel application during speculum examination on satisfactory level of smear. METHODS: A total of 1,999 patients were taken into the study. Patients were divided into two groups as gel-applied group and control group. Age and menopausal status of patients, and the physicians taking the smear (resident or specialist) were recorded. In control group, dry speculum was used for the collection of smear sample. All specimens were evaluated for correlation of the cytopathology, the number of "unsatisfactory" samples, and any secondary diagnoses. RESULTS: Assessment of smear satisfactoriness revealed that 2.2% (43) of them were unsatisfactory. Unsatisfactory smear ratio was significantly high in gel-applied group. Screening done by residents increased unsatisfactory result risk for about 5.5 times. Evaluation of effect of menopausal status on smear adequency revealed no difference between premenopausal and postmenopausal women. CONCLUSION: Cervical smear seems to be more accurate without gel application. Experience of the physician is also important. Water-based gel can be used in some women who experience overt pain during speculum examination, but these patients must be warned about unsatisfactory results and the need of repeat test.

Effect of dose and duration of micronized progesterone treatment during the first trimester on incidence of glucose intolerance and on birth weight.

OBJECTIVE: The aim was to investigate the potential effect of oral progesterone therapy during the first trimester on glucose metabolism and on birth weight, and to assess the existence of dose-related differences. METHODS: One hundred and fifty women with a history of imminent abortion and who used micronized progesterone (MicP) (200-600 µg/day for 4-6 weeks), and 150 healthy pregnant women as a control group, were included in the study. Fasting blood glucose (FBG), hemoglobin A1c (HbA1c) and OGL were measured between 24 and 28 weeks of gestation. Patients were followed up to term and birth weight was recorded. RESULTS: Risk of abnormal FBG and OGL was increased by 4.5- and 9.4-fold, respectively, in patients receiving MicP (p < 0.001). Median birth weight and gestational age were 3,599 g (500) and 39.0 weeks (1.3) for the MicP exposed group and 3,120 g (210) and 39.4 weeks (1.5) for the control group, respectively. Median birth weight was significantly higher in the MicP-exposed group for a similar gestational age (p < 0.001). There were no dose-related differences between groups. CONCLUSION: MicP therapy during the first trimester of pregnancy might have undesirable effects on glucose metabolism, which stresses the need of larger studies to confirm this association.

Is there any relation between umbilical artery and vein diameter and estimated fetal weight in healthy pregnant women?

PURPOSE: The aim of this study was to investigate the relation between umbilical vessel diameter and estimated fetal weight (EFW) and other fetal biometric parameters, and to assess the role of umbilical vessel diameter in prediction of EFW. Umbilical vein/umbilical artery (UV/UA) ratio and its relation to EFW were also examined. METHODS: A prospective study was designed to assess the sonographic diameter of UA and UV in 720 low-risk pregnant women at 20-40 weeks' gestation. Fetal biometry, EFW, and umbilical vessel measurements were performed. RESULTS: There were strong correlations between umbilical vessel diameter versus gestational age and EFW. Umbilical vessel diameters increased linearly up to 34 weeks, after which they plateaued. No relation was found between EFW versus UV/UA ratio and gestational age versus UV/UA. CONCLUSION: Based on these findings, it is not possible at present to recommend the use of umbilical vessel diameters for prediction of EFW after 34 weeks, but it may be helpful under 34 weeks. UV/UA ratio is not useful for prediction and management of complicated pregnancies.

Protective effects of caffeic acid phenethyl ester (CAPE) on intestinal damage in necrotizing enterocolitis.

OBJECTIVE: To determine the preventative effect of caffeic acid phenethyl ester (CAPE) in necrotizing enterocolitis (NEC) in an experimental rat model of NEC. MATERIALS AND METHODS: Thirty newborn Sprague-Dawley rats were randomly divided into three groups; as NEC, NEC + CAPE and control. NEC was induced by enteral formula feeding, subjected to hypoxia-hyperoxia and cold stress. Pups in the NEC + CAPE group were treated with CAPE at a dose of 30 mg/kg daily by intraperitoneal route from the first day to the end of the study. All pups were executed on the fourth day. Proximal colon and ileum were allocated for histopathologic and biochemical evaluation, including xanthine oxidase (XO), total antioxidant status (TAS), total oxidant status (TOS), malonaldehyde (MDA) and myeloperoxidase (MPO) activities. RESULTS: The pups in the NEC + CAPE group had better histopathologic and apoptosis evaluations (TUNEL and caspase-9) and the severity of bowel damage was significantly lower in the NEC + CAPE group compared to the NEC group (P < 0.01). The clinical sickness scores and body weight in the NEC + CAPE group was significantly better compared to the NEC group (P < 0.05). Tissue MDA, MPO, XO levels and TOS were remarkably reduced in the NEC + CAPE group, however, TAS was significantly increased in the NEC + CAPE group (P < 0.05). CONCLUSION: Treatment with CAPE reduces the intestinal damage in NEC.