Comparative analysis of the quality of life regarding patients who underwent hip replacement in public versus private hospitals in Hungary.

The study aimed to investigate the impact of hip replacement surgery on the quality of life and to compare the outcomes by sociodemographic and surgical data in Hungarian public and private hospitals. Patients were selected at the Department of Orthopaedics (Clinical Centre, University of Pécs) and at the Da Vinci Private Clinic in Pécs. Patients completed the SF-36 and Oxford Hip Score (OHS) questionnaires before the surgery, 6 weeks and 3 months later. We also evaluated socio-demographic data, disease and surgical conditions. The research involved 128 patients, 60 patients in public, 68 patients in private hospital. Despite the different sociodemographic characteristics and surgical outcomes of public and private healthcare patients, both groups had significantly improved the quality of life 3 months after hip replacement surgery measured by OHS and SF-36 physical health scores (p < 0.001). In the mental health score, only the patients of the private health sector showed a significant improvement (p < 0.001). The extent of improvement did not differ between the two healthcare sectors according to the OHS questionnaire (p = 0.985). While the SF-36 physical health score showed a higher improvement for public patients (p = 0.027), the mental health score showed a higher improvement for private patients (p = 0.015).

[Conservative and surgical treatments performed for symptomatic pelvic organ prolapse and stress urinary incontinence in Hungary.] / A kismedencei szervek süllyedésének és a noi terheléses vizeletvesztésnek a konzervatív és sebészi kezelése Magyarországon.

INTRODUCTION AND OBJECTIVE: As clinical guidelines are available for the treatment of stress urinary incontinence, but not pelvic organ prolapse, in Hungary, the treatment of pelvic organ prolapse varies widely throughout the country and is not standardized. Due to the establishment of the Hungarian Continence and Urogynecological Association, we aimed to determine current conservative and surgical treatment trends and strategies for these conditions in Hungary and compare them with international practice. METHOD: An online questionnaire consisting of 20 multiple-choice, checkbox, multiple-choice grid, and short-answer items was sent to 40 urology and 65 gynecology departments in Hungary in September and October 2021. RESULTS: The overall response rate was 24.76%. Almost all (96.15%) respondents reported that conservative treatment options were offered as first-line therapy to patients with symptomatic pelvic organ prolapse. For symptomatic anterior-wall prolapse, anterior repair, and laparoscopic sacrohysteropexy/sacrocolpopexy were the preferred surgical options (by 28.96% and 27.42% of respondents, respectively). For apical prolapse, laparoscopic sacrofixation was the first-choice treatment (35.88%). For stress urinary incontinence, mid-urethral sling insertion with a transobturator (61.53%) or retropubic (15%) approach was the preferred intervention. CONCLUSION: The low overall response rate in this study alone reflects the current condition of Hungarian urogynecology. Our findings might provide a good basis for the improvement and refinement of diagnosis and therapy for female urinary incontinence and pelvic organ prolapse in the country. As Hungary is a new affiliated partner of the European Urogynecological Association, we hope that this goal can be achieved soon. In addition, a curriculum for urogynecological specialization is needed. Orv Hetil. 2022; 163(52): 2072-2078.

[Participation indicators of organized cervical cancer screening in Hungary]. / A szervezett lakossági méhnyakszurés részvételi mutatói Magyarországon.

The aim of this study was to determine the percentage of women in Hungary who underwent gynecological cytological examinations either as part of a screening test or diagnostic examinations. Data derived from the nationwide financing database of the Hungarian National Health Insurance Fund Management and covered the period 2008-2021. We analyzed both diagnostic and screening cytological tests. The number of diagnostic tests has decreased. The number of patients per 10,000 female inhabitants in 2021 was a national average of 840. The highest rate was observed in the counties of Hajdú-Bihar (1464/10,000 female inhabitants), Tolna (1443) and Baranya (1254). In screening, the number of cytological tests is lower compared to smearing. The annual participation rate decreased from 28% to 17%. The number of patients and the participation rate of diagnostic cytology examinations decreased during the examined period. The added value of screening cytology is moderate, the willingness to participate is low, falling short of the expected value.

[Participation indicators of organized mammography screening in Hungary between 2012-2021]. / A szervezett lakossági mammográfiás emloszurés részvételi mutatói 2012­2021 között Magyarországon.

The aim of our study is to analyze the participation indicators of screening rounds Nr. 6-10 (2012-2021) of the organized nationwide mammography screening program. Data derived from the nationwide financing database of the Hungarian National Health Insurance Fund Management and covered the period 2012-2021. We analyzed both diagnostic and screening mammography examinations. Between 2012 and 2019 the coverage (screening and diagnostic mammography) varied between 48.1-51.5, which decreased to 31.8% in 2020-2021. Within total coverage, the organized screening rate declined from 30.3-31.2 to 20.0, while the diagnostic mammography rate decreased from 17.7-20.7% to 11.8%. We can conclude that the number of both the diagnostic and screening mammography declined. In order to reduce the mortality of breast cancer, participation rate of mammography screening program should be increased.

[Participation indicators of colorectal screenings in Hungary between 2008-2021]. / A kolorektális szurések részvételi mutatói Magyarországon 2008­2021 között.

The aim of our study is to analyse the participation indicators of colorectal cancer screening between 2008-2021. Data derived from the nationwide financing database of the Hungarian National Health Insurance Fund Management. We analysed both diagnostic and screening examinations. According to our results, the screening rate was low, varying between 5.1-6.8% in the years examined. Between 2008 and 2019, the number of participating patients increased slightly. The highest number of patients can be observed in 2019 (178,568 people). In 2020 and 2021, we see a significant decrease, which is a consequence of the COVID-19 pandemic. In the number of patients of the entire examined period (2,233,963 people, 938,223 men, 1,295,740 women), the largest proportion was fecal blood detection by immunochemical method (OENO code: 22631). In 2021, at the county level, the highest number of patients can be seen in Csongrád-Csanád county (994 patients/10,000 people), and the least in Békés county (218 patients/10,000 people). The participation rate of women is higher than that of men in all counties. Participation in colorectal screening is very low. In order to prevent colorectal cancer death, it is necessary to increase the participation rate.

Cross-sectional study of female pelvic floor dysfunction in a Hungarian population / Noi kismedencei funkciózavarok keresztmetszeti vizsgálata magyarországi populáción.

Összefoglaló. Bevezetés és célkituzés: A noi kismedencei funkciózavarok változatos tünetekkel jelentkezhetnek, és jelentosen befolyásolják az érintettek életminoségét. Vizsgálatunk célja volt felmérni a medencefenék-diszfunkciós tüneteket és azok hatását az egyén életminoségére. Módszer: Vizsgálatunkba 203 not vontunk be. Az adatgyujtést két kérdoív, egy általunk összeállított és az Australian Pelvic Floor Questionnaire segítségével végeztük. Az adatok statisztikai elemzéséhez SPSS 20.0 rendszert használtunk. Spearman-korrelációt, khi-négyzet-próbát, Mann-Whitney-féle U-tesztet, Kruskal-Wallis-próbát és többváltozós lineáris regressziót alkalmaztunk. A szignifikanciaszintet p≤0,05 határnál állapítottuk meg. Eredmények: A hólyagdiszfunkciók gyakorisága (56,2%) szignifikáns kapcsolatot mutatott az életkor növekedésével (p<0,001), az obesitassal (p<0,001), a szülésszámmal és -móddal (p<0,001; p<0,001), az episiotomiával (p<0,001) és a prolapsusmutétekkel (p = 0,010). A süllyedéses kismedencei kórképek gyakorisága (27,1%) szignifikáns kapcsolatot mutatott az életkor növekedésével (p = 0,002), a szülésszámmal és -móddal (p<0,001; p<0,001) és a korábbi episiotomiával (p<0,001). Az analis incontinentia gyakorisága (58,9%) a magasabb testtömegindexszel (p = 0,029) volt szignifikáns kapcsolatban. Szexuális diszfunkciót (53,2%) allergia és tüdobetegségek (p = 0,048) jelenlétével kapcsolatban találtunk. A többes diszfunkció elofordulási gyakorisága az életkor növekedésével (p<0,001), az obesitassal (p = 0,043), a korábbi hysterectomiával (p = 0,046) és prolapsusmutétekkel (p<0,001) mutatott szignifikáns kapcsolatot. Minden diszfunkció esetén kimutatható volt az életminoség-romlás (hólyagfunkciók: p<0,001; bél- és székletürítési funkciók: p<0,001, hüvelyfali süllyedés: p<0,001, szexuális funkciók: p<0,001). Következtetés: Az általunk vizsgált noi populációban nagy arányban találtunk kismedencei funkciózavarokat, melyek kedvezotlen hatással voltak az érintettek életminoségére. Orv Hetil. 2021; 162(43): 1724-1731. INTRODUCTION AND OBJECTIVE: Pelvic floor dysfunction (PFD) can cause several complaints in women and has an adverse effect on the quality of life (Qol). The aim of our study was to evaluate the prevalence of pelvic floor dysfunction and its effect on Qol. METHOD: 203 women were included. We used two questionnaires, a self-constructed and the Australian Pelvic Floor Questionnaire. Statistical analysis was performed by SPSS 20.0. Spearman's correlation, chi-square, Mann-Whitney U, Kruskal-Wallis tests and multivariate linear regression were used. Statistical significance was set at p≤0.05. RESULTS: There was a significant association between the prevalence of urinary incontinence (56.2%) and age (p<0.001), obesity (p<0.001), number and mode of deliveries (p<0.001; p<0.001), episiotomy (p<0.001) and pelvic organ prolapse (POP) surgery (p = 0.010); between the occurrence of POP (27.1%) and age (p = 0.002), the number and mode of deliveries (p<0.001; p<0.001) and episiotomy (p<0.001); between the prevalence of anal incontinence (58.9%) and obesity (p = 0.029); between sexual dysfunction (SD) (53.2%) and respiratory disease and allergy (p = 0.048). Multiple PFD was significantly associated with age (p<0.001), obesity (p = 0.043), hysterectomy (p = 0.046) and POP surgery (p = 0.010). There was a significant difference between women having more severe PFD than milder complaints regarding Qol (bladder p<0.001; bowel p<0.001; SD p<0.001 and POP p<0.001). CONCLUSION: Pelvic floor dysfunction was common in our study population and had a great adverse effect on Qol. Orv Hetil. 2021; 162(43): 1724-1731.

Key to Life: Physiological Role and Clinical Implications of Progesterone.

The most recent studies of progesterone research provide remarkable insights into the physiological role and clinical importance of this hormone. Although the name progesterone itself means "promoting gestation", this steroid hormone is far more than a gestational agent. Progesterone is recognized as a key physiological component of not only the menstrual cycle and pregnancy but also as an essential steroidogenic precursor of other gonadal and non-gonadal hormones such as aldosterone, cortisol, estradiol, and testosterone. Based on current findings, progesterone and novel progesterone-based drugs have many important functions, including contraception, treatment of dysfunctional uterine bleeding, immune response, and prevention of cancer. Considering the above, reproduction and life are not possible without progesterone; thus, a better understanding of this essential molecule could enable safe and effective use of this hormone in many clinical conditions.

Annual epidemiological and health insurance burden of cervical cancer in Hungary / A méhnyakrák okozta éves epidemiológiai és egészségbiztosítási betegségteher Magyarországon.

Összefoglaló. Bevezetés: A méhnyakdaganatok kérdése kiemelten fontos, megoldatlan népegészségügyi probléma. A betegség terhe magas, ami elsosorban az alacsony és közepes jövedelmu országokban éloknél jelentkezik. Célkituzés: Elemzésünk célja volt meghatározni a méhnyakdaganatok epidemiológiai és egészségbiztosítási betegségterhét Magyarországon a 2018-as évre vonatkoztatva. Adatok és módszerek: Elemzésünket a Nemzeti Egészségbiztosítási Alapkezelo (NEAK) finanszírozási adatbázisának 2018. évi adatai alapján végeztük az in situ (D06), a jóindulatú (D26.0) és a malignus (C53) méhnyakdaganatokra vonatkozóan. Az elemzés a NEAK által finanszírozott összes szolgáltatóra és ellátási formára kiterjed. Meghatároztuk az éves betegszámokat, a prevalenciát 100 000 lakosra, továbbá az éves egészségbiztosítási kiadásokat betegségcsoportonként és korcsoportos bontásban, valamennyi egészségbiztosítási ellátás tekintetében. Eredmények: A NEAK 2018-ban 1,276 milliárd Ft-ot (4,7 millió USD; 4,0 millió EUR) költött a méhnyakdaganatok kezelésére. A betegek és a finanszírozás dönto többsége a méhnyak rosszindulatú daganatához kapcsolható. A finanszírozásból a malignus méhnyakdaganatok részesedése 97%. Ellátási típusonként vizsgálva a legnagyobb kiadási tétel az aktívfekvobeteg-szakellátásban jelenik meg, éves szinten 763,9 millió Ft, ami az összköltség 59,9%-a. A 100 000 lakosra jutó prevalencia az aktívfekvobeteg-szakellátás igénybevételi adatai alapján 26/100 000 lakos. Következtetés: A méhnyakdaganatok kezelésének meghatározó költségeleme az aktívfekvobeteg-szakellátás. Hazánkban a szervezett méhnyakszurés korszerusítéseként az új szurési stratégiát megfelelo finanszírozási támogatással célszeru bevezetni, a szurovizsgálatoknak, a hozzájuk kapcsolódó további diagnosztikus kivizsgálásnak és terápiának a teljesítményvolumen-korlát alóli mentesítésével. Orv Hetil. 2021; 162(Suppl 1): 22-29. INTRODUCTION: Cervical cancer is a particularly important, unresolved public health problem. The burden of the disease is high, primarily in those living in low- and middle-income countries. OBJECTIVE: Our aim was to determine the annual epidemiological disease burden and health insurance cost of cervical cancer in Hungary in 2018. DATA AND METHODS: Our analysis was made according to the financial database of the National Health Insurance Fund Administration (NHIFA) of Hungary for the year 2018, which covers all service providers and maintenance forms financed by NHIFA. We analysed the in situ (D06), the benignant (D26.0) and the malignant (C53) cervical tumours. The data analysed included annual patient numbers and prevalence of care utilisation per 100 000 population furthermore annual health insurance costs calculated for disease and age groups. RESULTS: In 2018, NHIFA spent 1.276 billion HUF (4.7 million USD, 4.0 million EUR) on the treatment of patients with cervical cancer. The majority of patients and funding can be linked to malignant cervical cancer (97%). Acute inpatient care was the major cost driver: 763.9 million HUF (59.9% of the total health insurance expenditures) annually. The prevalence is 26 per 100 000 population based on acute inpatient care data. CONCLUSION: Acute inpatient care was the major cost driver. In Hungary, as a modernization of organized cervical screening, it is appropriate to introduce a new screening strategy with appropriate financial support, by exempting screening tests, associated additional diagnostic testing, and therapy from the performance volume limit. Orv Hetil. 2021; 162(Suppl 1): 22-29.

Comparative analysis of abdominal fluid cytokine levels in ovarian hyperstimulation syndrome (OHSS).

BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is a rare, yet severe, iatrogenic complication of ovulation induction therapy during assisted reproductive procedures. Our group previously detected atypical cells in the ascitic fluid of OHSS patients, although no malignancy developed during follow up. Here, the aim was to perform a comparative analysis of the cytokines present in the abdominal fluid of patients affected by OHSS versus patients with advanced ovarian cancer, a benign adnexal mass, or ovarian endometriosis. METHODS: This prospective, non-randomized study was conducted at the Clinical Center of the University of Pecs Department of Obstetrics and Gynecology/Reproductive Center between October 2016 and March 2018. Abdominal fluid samples were obtained from 76 patients and subjected to Luminex analysis. The samples were collected from patients with OHSS (OHSS; n = 16), advanced ovarian cancer (OC; n = 22), a benign adnexal mass (BAM; n = 21), or ovarian endometriosis (EM; n = 17). Data were subjected to the non-parametric Kruskal-Wallis test and Spearman's rank correlation coefficient to identify statistical differences between the four study groups. RESULTS: Leukocytosis and hemoconcentration were detected in the peripheral blood of OHSS patients. Abdominal fluid analysis further revealed significantly higher levels of interleukin (IL)-6, IL-8, IL-10, and transforming growth factor (TGF)-ß in both the OHSS and OC groups compared to the BAM and EM groups. The highest concentration of vascular endothelial growth factor (VEGF) was detected in the OC group, while a significantly lower level was detected in the OHSS group. Moreover, VEGF levels in OC and OHSS groups were significantly elevated compared to the levels in the BAM and EM groups. CONCLUSIONS: Vasoactive and hematogenic cytokines were present at higher levels in both the OHSS and OC abdominal fluid samples compared to the fluid samples obtained from the peritoneal cavity of the BAM patients. It is possible that these cytokines play an important role in the formation of ascites.

Serum and follicular fluid levels of serotonin, kisspeptin, and brain-derived neurotrophic factor in patients undergoing in vitro fertilization: an observational study : Neurohormones in patients receiving IVF.

OBJECTIVE: This study aimed to examine the effect of interactions between serotonin (5-HT), brain-derived neurotrophic factor (BDNF), and kisspeptin on the reproductive potential in women receiving in vitro fertilization (IVF). METHODS: Paired serum and follicular fluid (FF) samples were obtained from 30 consecutive patients receiving IVF. Primary and secondary outcome measures were the rate of chemical/clinical pregnancy and the number of mature oocytes and embryos, respectively. Serum and FF 5-HT, BDNF, kisspeptin, and platelet-activating factor (PAF) levels were measured by enzyme-linked immunosorbent assay. RESULTS: In response to ovarian hyperstimulation, serum 5-HT and kisspeptin levels significantly increased, whereas serum BDNF and PAF levels remained unchanged. These factors were detected in FF, but they were unrelated to serum levels. FF 5-HT and BDNF levels were positively correlated. Serum kisspeptin levels were negatively correlated with FF BDNF and serum and FF PAF levels. Women who were pregnant had significantly lower FF BDNF levels compared with women who were not pregnant (21.96±12.75 vs 47.63±52.90 µg/mL). Multivariate stepwise linear regression and logistic regression analyses showed that only 5-HT and kisspeptin improved IVF outcome. CONCLUSIONS: This study indicates a role of serotoninergic mechanisms in success of IVF, but the contribution of interacting neuropeptides requires additional investigation.

Follicular fluid progesterone concentration is associated with fertilization outcome after IVF: a systematic review and meta-analysis.

Follicular fluid is a key biochemical environment for oocyte development. The potential effect of follicular progesterone level on successful fertilization is a subject of debate, and so the aim of this study was to provide a summary of the currently available evidence on the association between follicular fluid progesterone level and fertilization outcome. To do so, a systematic review and a meta-analysis were performed, with the literature searches being conducted in three databases (PubMed, Embase and the Cochrane Library) to identify all relevant studies published up to 19 August 2017. Data were available from 13 studies (four intracytoplasmic sperm injection [ICSI] and nine conventional IVF) and 1009 individually aspirated follicular fluid samples were included in the analysis. The progesterone levels in follicular fluid were significantly higher in normal fertilization than in failed fertilization, both in conventional IVF (33% difference, P < 0.001) and ICSI (34% difference, P = 0.004). Although these data show that fertilized oocytes are derived from follicles with higher levels of progesterone, the results must be interpreted with caution, because of various progesterone measurement methods and different treatment protocols and it is too early to state that follicular fluid progesterone level could be considered as a marker for oocyte quality.

[Multimodal treatment of malignant mixed Müllerian tumor]. / Malignus kevert Müller-cso-eredetu tumor komplex kezelése.

INTRODUCTION AND AIM: The aim of our study was to evaluate the prognostic factors and treatment options of a very rare and highly aggressive type of uterine neoplasms, the malignant mixed Müllerian tumor, known as carcinosarcoma. METHOD: Between 2009 and 2017, 29 patients were treated with malignant mixed Müllerian tumor. At stage I, surgery and postoperative radiotherapy were performed. At stages II-IV, trimodal treatment (surgery, chemotherapy and radiotherapy) was administered. RESULTS: The average age of patients was 68.51 (49-90) years, mean body mass index was 30.22 (20.90-37.22). We have experienced recurrence of disease after complete resection in 6 cases (4 of 6 patients did not accept radiation therapy). Local recurrence has occurred after an average 15.52 (6-36) months, distant metastasis with an average 19.2 (8-32) months. Overall survival was 11.92 (1-75) months. Six patients are free of tumours at the moment. CONCLUSIONS: As overall survival has not increased in recent decades by using combined chemotherapy, there is no congruent consensus associated with the optimal treatment. The standard surgical treatment is total abdominal hysterectomy with bilateral oophorectomy, although due to high rates of recurrence and metastases, the necessity of lymphadenectomy and postoperative treatment is in the focus of recent studies. Though postoperative irradiation improves local control, the beneficial effect on overall survival is still not proven. Adjuvant chemotherapy decreases the rate of both pelvic and extrapelvic recurrence at the same time, although there is no recommendation for the optimal chemoterapeutic agent. Multimodal therapy should lead to better outcomes. Recently there are many ongoing studies with biologic and target therapies to improve efficiency, however, the relevant results will be disclosed in many years only, due to the small number of patients. Orv Hetil. 2018; 159(19): 741-7747.

Local upregulation of transient receptor potential ankyrin 1 and transient receptor potential vanilloid 1 ion channels in rectosigmoid deep infiltrating endometriosis.

Transient Receptor Potential Vanilloid 1 (TRPV1) and Transient Receptor Potential Ankyrin 1 (TRPA1) expressed mainly by primary sensory neurons function as major nociceptive integrators. They are also present on the rat endometrium in an oestrogen-regulated manner. TRPV1 is upregulated in peritoneal and ovarian endometriosis patients, but there is no information about TRPA1 and their pathophysiological significances. In this study, patients undergoing laparoscopic surgery were investigated: severe dysmenorrhoea due to rectosigmoid deep infiltrating endometriosis ( n = 15), uterine fibroid-induced moderate dysmenorrhoea ( n = 7) and tubal infertility with no pain ( n = 6). TRPA1 and TRPV1 mRNA and protein expressions were determined by quantitative polymerase chain reaction and semi-quantitative immunohistochemistry from the endometrium samples taken by curettage. Results were correlated with the clinical characteristics including pain intensity. TRPA1 and TRPV1 receptors were expressed in the healthy human endometrium at mRNA and protein levels. Sparse, scattered cytoplasmic TRPA1 and TRPV1 immunopositivities were found in the stroma and epithelial layers. We detected upregulated mRNA levels in deep infiltrating endometriosis lesions, and TRPV1 gene expression was also elevated in autocontrol endometrium of deep infiltrating endometriosis patients. Histological scoring revealed significant TRPA1 and TRPV1 difference between deep infiltrating endometriosis stroma and epithelium, and in deep infiltrating endometriosis epithelium compared to control samples. Besides, we measured elevated stromal TRPV1 immunopositivity in deep infiltrating endometriosis. Stromal TRPA1 and TRPV1 immunoreactivities strongly correlated with dysmenorrhoea severity, as well TRPV1 expression on ectopic epithelial cells and macrophages with dyspareunia. Epithelial TRPA1 and stromal TRPV1 immunopositivity also positively correlated with dyschezia severity. We provide the first evidence for the presence of non-neuronal TRPA1 receptor in the healthy human endometrium and confirm the expression of TRPV1 channels. Their upregulations in rectosigmoid deep infiltrating endometriosis lesions and correlations with pain intensity suggest potential roles in pathophysiological mechanisms of the disease.

Noninvasive embryo viability assessment by quantitation of human haptoglobin alpha-1 fragment in the in vitro fertilization culture medium: an additional tool to increase success rate.

OBJECTIVE: To find new candidate molecules to assess embryo viability in a noninvasive manner. DESIGN: Prospective, blinded study with randomized sample collection. SETTING: University research center. PATIENTS(S): Ninety embryos implanted in 53 randomly selected patients (mean ± SD age, 32.3 ± 5.1 years) were analyzed. INTERVENTION(S): Superovulation treatment was initiated by the administration of the GnRh agonist triptorelin and individual dosages of recombinant FSH. Ovulation was induced by the injection of hCG. Oocytes were fertilized by intracytoplasmic sperm injection. MAIN OUTCOME MEASURE(S): Liquid chromatography coupled mass spectrometric quantification of the α-1 fragment of human haptoglobin in the culture medium. RESULT(S): A novel polypeptide marker was found that might be helpful to differentiate between potentially viable and nonviable embryos. This molecule was identified with tandem mass spectrometry as the α-1 fragment of human haptoglobin. Significant correlation was found in the amount of the peptide fragment and the outcome of pregnancy. In the culture media of embryos that were assigned in the biochemical assay as nonviable (according to the amount of the haptoglobin fragment), there were no pregnancies detected; this assay revealed a 100% successful selection of the nonviable embryos. In the group assigned as viable, the rate of pregnancy was 54.7%. CONCLUSION(S): Viability of the embryo during the IVF process is assessed by microscopic inspection, resulting in a pregnancy rate of 25%-30%. Detection and quantitation of the α-1 haptoglobin fragment of the culture medium proved to be a useful additional method for identifying nonviable embryos, increasing the success rate to 50%.

A clinical study to assess the efficacy of belly dancing as a tool for rehabilitation in female patients with malignancies.

PURPOSE: This prospective, non-randomised follow-up study was designed to compare the health-related quality of life (HRQoL), perceived social support (PSS) and overall life satisfaction (OLS) in female patients receiving standard medical care for malignant diseases with or without additional belly dancing. METHOD: The patients were recruited in the Outpatient Department of the National Institute of Oncology, Budapest, Hungary during the period of 2008-2009. 55 patients joined the one-year-long rehabilitation program (research group, RG) while 59 age-matched patients who received only standard medical care volunteered for clinical assessment (control group, CG). HRQoL, PSS and OLS were assessed using validated questionnaires: EORTC QLQ-C30, F-SozU-K14, and Campbell's OLS, respectively. The scores obtained in RG and CG were controlled for baseline socio-demographic characteristics and evaluated by ANCOVA analysis. RESULTS: It was found that patients of the RG scored better at both the baseline and follow-up than the CG, and the differences between the two groups' measured parameters increased further during the course of the study. The respective baseline values in RG and CG were 56.6 ± 10.3 vs 63.5 ± 12 for HRQoL, 65.2 ± 5.5 vs 57.4 ± 8.8 for PSS and 57.4 ± 8.1 vs 48.4 ± 10.7 for OLS. The corresponding follow-up scores were 51.9 ± 4.4 vs 59.9 ± 11.2 (F = 10.637, p = 0.001) for HRQoL, 67.5 ± 2.7 vs 53.9 ± 10.5 (F = 2.646, p = 0.000) for PSS and 59.5 ± 9.6 vs 45.0 ± 11.5 (F = 2.402, p = 0.001) for OLS. CONCLUSIONS: Belly dance intervention can be applied as a complementary rehabilitation method to improve HRQoL, PSS and OLS in female patients treated for malignant diseases.

"Platelet-associated regulatory system (PARS)" with particular reference to female reproduction.

BACKGROUND: Blood platelets play an essential role in hemostasis, thrombosis and coagulation of blood. Beyond these classic functions their involvement in inflammatory, neoplastic and immune processes was also investigated. It is well known, that platelets have an armament of soluble molecules, factors, mediators, chemokines, cytokines and neurotransmitters in their granules, and have multiple adhesion molecules and receptors on their surface. METHODS: Selected relevant literature and own views and experiences as clinical observations have been used. RESULTS: Considering that platelets are indispensable in numerous homeostatic endocrine functions, it is reasonable to suppose that a platelet-associated regulatory system (PARS) may exist; internal or external triggers and/or stimuli may complement and connect regulatory pathways aimed towards target tissues and/or cells. The signal (PAF, or other tissue/cell specific factors) comes from the stimulated (by the e.g., hypophyseal hormones, bacteria, external factors, etc.) organs or cells, and activates platelets. Platelet activation means their aggregation, sludge formation, furthermore the release of the for-mentioned biologically very powerful factors, which can locally amplify and deepen the tissue specific cell reactions. If this process is impaired or inhibited for any reason, the specifically stimulated organ shows hypofunction. When PARS is upregulated, organ hyperfunction may occur that culminate in severe diseases. CONCLUSION: Based on clinical and experimental evidences we propose that platelets modulate the function of hypothalamo-hypophyseal-ovarian system. Specifically, hypothalamic GnRH releases FSH from the anterior pituitary, which induces and stimulates follicular and oocyte maturation and steroid hormone secretion in the ovary. At the same time follicular cells enhance PAF production. Through these pathways activated platelets are accumulated in the follicular vessels surrounding the follicle and due to its released soluble molecules (factors, mediators, chemokines, cytokines, neurotransmitters) locally increase oocyte maturation and hormone secretion. Therefore we suggest that platelets are not only a small participant but may be the conductor or active mediator of this complex regulatory system which has several unrevealed mechanisms. In other words platelets are corpuscular messengers, or are more than a member of the family providing hemostasis.

Serum and follicular fluid fetuin-A in women undergoing in vitro fertilization.

BACKGROUNDS: This case-control study was designed to assess the possible role of fetuin-A, a multifunctional protein, in reproductive processes of women undergoing in vitro fertilization (IVF). METHODS: Paired serum and follicular fluid (FF) samples were obtained from 35 unselected patients who received IVF treatment. Their main clinical chartacteristics: age 35.2±5.4 years, BMI 22.9±2.8, duration of infertility 3.2±2.0 years, gonadotropin administered 1199.4±202.3 IU, and estradiol level on day 6 of stimulation 1827±1342 pmol/L. In total 25 healthy women of similar age admitted for minor elective surgery served as controls for serum analysis. Fetuin-A and high-sensitivity C-reactive protein (hsCRP) were measured in serum and FF by using commercially available ELISA kits and turbidimetric immunoassay, respectively. RESULTS: Serum fetuin-A levels of patients participating IVF are markedly elevated when compared to those of healthy women (1.30±0.58 g/L vs. 0.55±0.09 g/L, p<0.000). Fetuin-A in FF proved to be comparable to its serum levels (1.17±0.45 g/L) and no relationship could be detected between the respective individual values. Moreover, markers of reproductive potential (number of oocytes and embryos) appeared to be independent of serum and FF fetuin-A. hsCRP in serum and FF was not related to fetuin-A and did not influence the number of oocytes and embryos. CONCLUSIONS: Fetuin-A concentration is high in FF of patients undergoing IVF, however, it can not be used as an estimate of fertilization success.

Metabolic hormones in follicular fluid in women undergoing in vitro fertilization.

OBJECTIVE: To determine the concentrations of metabolic hormones in follicular fluid (FF) and to find clinical correlates of these biochemical parameters. STUDY DESIGN: FF was obtained from 108 women by ultrasonography-guided transvaginal puncture following controlled ovarian hyperstimulation. FF insulin, leptin, adiponectin and resistin levels were measured by enzyme-linked immunosorbent assay, and ghrelin was analyzed with radioimmunoassay. RESULTS: It was demonstrated that oocyte number correlated negatively with FF leptin (r = -0.190, p < 0.050) and insulin (r = -0.209, p < 0.031) and positively with resistin (r = 0.236, p < 0.014). After adjustments for confounding hormone parameters, resistin remained a positive (p < 0.000) predictor and insulin (p < 0.039) and adiponectin (p < 0.033), negative predictors of oocyte number. When the embryo number was considered, FF leptin proved to be a strong negative (p < 0.012) whereas resistin proved to be a positive outcome predictor (p < 0.004). CONCLUSION: In women undergoing in vitro fertilization (IVF), FF metabolic hormones may be involved in regulating ovarian function and in determining fertilization outcome. Resistin appears to have beneficial effects on the outcome of IVF, while leptin, insulin, adiponectin and ghrelin appear to have adverse or no effects.

Acylcarnitine esters profiling of serum and follicular fluid in patients undergoing in vitro fertilization.

BACKGROUND: L-carnitine-mediated beta-oxidation of fatty acids has a well established role in energy supply of oocytes and embryos. Disturbed carnitine metabolism may impair the reproductive potential in IVF and can serve as a biomarker of pregnancy outcome. METHODS: Our study was performed between March 24, 2011 and May 9, 2011. We performed 44 unselected IVF cycles, (aged 23-40 years (mean: 32.3+/-5.1 years) and had BMI of 17.3-34.7 (mean: 23.80+/-4.9). Samples were also obtained from 18 healthy women of similar age admitted for minor elective surgery to serve as control for plasma carnitine profile. Serum and follicular fluid (FF) free carnitine (FC) and 20 major acylcarnitines (ACs) were measured by ESI/MS/MS method. RESULTS: Serum FC and AC levels in IVF patients were comparable to those in healthy control women. In FF FC and short-chain AC concentrations were similar to those in maternal serum, however, the levels of medium-chain, and long-chain AC esters were markedly reduced (p<0.05). The serum to FF ratio of individual carnitine compounds increased progressively with increasing carbon chain length of AC esters (p<0.05). There was a marked reduction in total carnitine, FC and AC levels of serum and FF in patients with oocyte number of >9 and/or with embryo number of >6 as compared to the respective values of <9 and/or <6 (p<0.05). CONCLUSIONS: In IVF patients with better reproductive potential the carnitine/AC pathway appears to be upregulated that may result in excess carintine consumption and relative depletion of carnitine pool. Consequently, IVF patients may benefit from carnitine supplementation.