Prediction of Preterm Delivery Using Serum Ischemia Modified Albumin, Biglycan, and Decorin Levels in Women with Threatened Preterm Labor / Previsão de parto prematuro usando albumina modificada por isquemia sérica, biglicano e níveis de decorina em mulheres com ameaça de trabalho de parto prematuro

Abstract Objective The serum ischemia modified albumin (IMA), biglycan, and decorin levels of pregnant women who were hospitalized for threatened preterm labor were measured. Methods Fifty-one consecutive pregnant women with a single pregnancy between the 24th and 36th weeks with a diagnosis of threatened preterm labor were included in the present prospective cohort study. Results As a result of multivariate logistic regression analysis for predicting preterm delivery within 24 hours, 48 hours, 7 days, 14 days, ≤ 35 gestational weeks, and ≤ 37 gestational weeks after admission, area under the curve (AUC) (95% confidence interval [CI[) values were 0.95 (0.89-1.00), 0.93 (0.86-0.99), 0.91 (0.83-0.98), 0.92 (0.85-0.99), 0.82 (0.69-0.96), and 0.89 (0.80-0.98), respectively. In the present study, IMA and biglycan levels were found to be higher and decorin levels lower in women admitted to the hospital with threatened preterm labor and who gave preterm birth within 48 hours compared with those who gave birth after 48 hours. Conclusion In pregnant women admitted to the hospital with threatened preterm labor, the prediction preterm delivery of the combined model created by adding IMA, decorin, and biglycan in addition to the TVS CL measurement was higher than the TVS CL measurement alone. Clinical trial registration The present trial was registered at ClinicalTrials.gov, number NCT04451928.

Resumo Objetivo Medir os níveis séricos de albumina modificada por isquemia (IMA), biglicano e decorina de gestantes hospitalizadas por ameaça de parto prematuro. Métodos Cinquenta e uma mulheres grávidas consecutivas com uma única gravidez entre a 24ᵃ e a 36ᵃ semanas com diagnóstico de ameaça de trabalho de parto prematuro foram incluídas no presente estudo de corte prospectivo. Resultados Como resultado da análise de regressão logística multivariada para prever parto prematuro dentro de 24 horas, 48 horas, 7 dias, 14 dias, ≤ 35 semanas gestacionais e ≤ 37 semanas gestacionais após a admissão, área sob a curva (AUC) (95% de confiança os valores de intervalo [CI[) foram 0,95 (0,89-1,00), 0,93 (0,86-0,99), 0,91 (0,83-0,98), 0,92 (0,85-0,99), 0,82 (0,69-0,96) e 0,89 (0,80-0,98), respectivamente. No presente estudo, os níveis de IMA e biglican foram maiores e os níveis de decorin menores em mulheres admitidas no hospital com ameaça de trabalho de parto prematuro e que tiveram parto prematuro em 48 horas em comparação com aquelas que deram à luz após 48 horas. Conclusão Em gestantes admitidas no hospital com ameaça de trabalho de parto prematuro, a predição de parto prematuro do modelo combinado criado pela adição de IMA, decorin e biglican, além da medição do TVS CL, foi maior do que a medição do TVS CL isoladamente. Registro do ensaio clínico O presente ensaio foi registrado em ClinicalTrials.gov, número NCT04451928.

Comparison of the different PCOS phenotypes based on monocyte to HDL cholesterol ratio.

In this study, we aimed to evaluate the degree of inflammation in polycystic ovary syndrome (PCOS) phenotypes by comparing the monocyte-to- High-density lipoprotein (HDL) ratios showing inflammatory and oxidative stress among different phenotypes of PCOS. In this case-control study, we studied 186 women with PCOS and 59 age-matched healthy women. PCOS women were prospectively classified into four phenotypes based on NIH Expert Panel criteria. The degree of inflammation between the non-PCOS control group and four PCOS phenotypes was compared by measuring monocyte-to high-density lipoprotein ratio (MHR). The prevalence of phenotypes A, B, C and D were 29%, 22%, 26% and 23%, respectively. MHR was found to be the highest in phenotype A (13.7 ± 4.9) among the PCOS phenotypes and the lowest level was found in phenotype D (9.0 ± 1.9), which is the non-androgenic phenotype. MHR were significantly different across the four PCOS phenotypes; with the highest value were present with phenotype A. As an easily accessible simple marker, the monocyte/HDL ratio may be promising for detecting at-risk metabolic phenotypes in PCOS.IMPACT STATEMENTWhat is already known on this subject? Polycystic ovary syndrome (PCOS) is a syndrome that progresses with chronic inflammation and has long-term effects such as diabetes and cardiovascular risk. The inflammatory process in PCOS has been demonstrated by many parameters.What do the results of this study add? The level of inflammation among PCOS phenotypes in Turkish women was evaluated by the monocyte-to high-density lipoprotein ratio (MHR). Inflammatory cytokines have been studied extensively in the literature comparing PCOS and non-PCOS patients, but studies of inflammatory levels between PCOS phenotypes are rare.What are the implications of these findings for clinical practice and/or further research? Inflammatory status in PCOS is important in terms of disease severity and long-term complications. It is now important to apply a clinical approach, knowing that PCOS is no longer a single syndrome but a difference in phenotypes. In future studies, it is necessary to investigate the phenotypes of patients with PCOS with different inflammatory markers.

T-Cadherin, E-Cadherin, PR-A, and ER-α Levels in Deep Infiltrating Endometriosis.

The goal of this study was to compare the T-cadherin, E-cadherin, progesterone receptor (PR), and estrogen receptor (ER) staining levels of deep infiltrating endometriosis (DIE) tissue, ovarian endometriomas and normal endometrial tissues in the same individuals. The tissue sections of both DIE nodule(s) and endometrioma(s) of 15 cases were examined. As a control group, normal endometrial tissue sections of 23 cases were examined. T-cadherin, E-cadherin, ER-α, and PR-A staining levels of DIE, endometrioma tissues, and endometrial tissues were compared immunohistochemically. H -score was calculated to compare the expression of T-cadherin, E-cadherin, ER-α, and PR-A in immunohistochemical staining based on the percentage of cells stained at each intensity level. T-cadherin, E-cadherin, ER, and PR H -score were lowest in DIE tissue and highest in endometrial tissue ( P <0.0001, <0.0001, <0.0001, and <0.0001, respectively). In correlation analysis, a positive correlation was found between T-cadherin, E-cadherin, PR, and ER H -score ( P <0.0001 for each). T-cadherin, E-cadherin, ER, and PR H -score were lowest in DIE tissue and highest in endometrium tissue. We think that examination of DIE tissue and endometrioma tissue from the same individual excludes the possibility of an effect due to different genetic and environmental factors from different individuals. With the help of this exclusion we showed that DIE and endometrioma have different biological properties.

The deep infiltrating endometriosis tissue has lower T-cadherin, E-cadherin, progesterone receptor and oestrogen receptor than endometrioma tissue.

OBJECTIVE: To compare the T-cadherin, E-cadherin, PR and ER staining levels of deep infiltrating endometriosis (DIE) tissue, ovarian endometriomas and normal endometrial tissues. MATERIALS AND METHODS: DIE tissue of 24 cases, endometrioma of 30 cases and normal endometrial tissues of 30 cases were examined. T-cadherin, E-cadherin, ER-α and PR-α staining levels of DIE, endometrioma tissues and endometrial tissues were compared immunohistochemically. H-score was calculated to compare the expression of T-cadherin, E-cadherin, ER-α, PR-α in IHC staining based on the percentage of cells stained at each intensity level. RESULTS: T-cadherin, E-cadherin, ER and PR H-score were found lowest in DIE tissue and the highest in endometrial tissue (p < 0.0001, <0.0001, <0.0001 and < 0.0001, respectively). In correlation analysis, a positive correlation was found between T-cadherin, E-cadherin, PR and ER H-score (p < 0.0001 for each). No correlation was found between age, body mass index (BMI), visual analog scale (VAS) score, CA125, endometrioma size and the severity of dysmenorrhea, dyspareunia and dystonia (p > 0.05). CONCLUSION: T-cadherin, E-cadherin, ER and PR H-score were found lowest in DIE tissue, the highest in endometrium tissue. The finding of lower expression of PR-α in endometriotic nodule in our study may be related to decrease in progesterone effect which could not inhibit the decrease in the expression of T-cadherin and E-cadherin, thus the invasiveness of DIE tissue. These findings suggest that DIE tissue and ovarian endometrioma tissues have a different biology.

Cisplatin decreases HOXA13 and alphaVBeta3 integrin levels in the uterus.

OBJECTIVE: To examine the effects of cisplatin on uterine histology and implantation molecules and the possible protective role of recombinant Klotho administration on uterine histology and uterine receptivity in mice exposed to cisplatin. MATERIALS AND METHODS: This study was conducted using thirty-two adult female mice assigned to four groups with 8 mice in each group. Saline was given to the 1st group, cisplatin to the 2nd group, recombinant mouse Klotho to the 3rd group and recombinant mouse Klotho plus cisplatin to the 4th group. Uterine tissues were examined for damage histologically and immunobiologically for the uterine receptivity markers HOXA13 and alphaVBeta3 integrin. RESULTS: Apoptosis, degeneration, decrease in uterine thickness and uterine absence of gland scores were higher in the cisplatin group (3rd group) compared to the saline group (1st group) (cisplatin vs. saline p < 0.0001 for all parameters). In the recombinant Klotho plus cisplatin group (4th group), scores of apoptosis, degeneration, reduction in uterine thickness and uterine absence of gland were lower than the group receiving only cisplatin (cisplatin plus recombinant Klotho vs cisplatin, p = 0.006 for apoptosis; p = 0.017 for degeneration; p = 0.011 for the reduction in uterine thickness; p = 0.002 for the absence of gland). However, HOXA13 and alphaVBeta3 integrin staining levels were not different between the cisplatin group (group 3) and the cisplatin plus recombinant Klotho group (group 4) (p = 0.980 and p = 0.762, respectively.) CONCLUSION: Cisplatin has adverse effects on the uterus. Administration of recombinant Klotho was found to attenuate the cisplatin-induced damage but failed to preserve levels of the implantation molecules HOXA13 and alphaVbeta3. Further studies examining the effect of cisplatin toxicity using other implantation markers along with functional studies are needed.

Comparison of serum human Klotho levels and thiol/disulfide homeostasis in women with polycystic ovary syndrome and in healthy women.

OBJECTIVES: Women with polycystic ovary syndrome (PCOS) have an increased cardiometabolic risk. Similarly, it was previously shown that atherosclerotic and cardiovascular risk is increased in the general population with lower serum Klotho levels. The aim of this study was to investigate the lotho and thiol/disulfide levels in women with non-obese PCOS compared to healthy controls and also to investigate the relationship of serum Klotho and thiol/disulfide homeostasis with cardiometabolic risk factors. MATERIALS AND METHODS: In this prospective case control study, human serum alpha Klotho levels and thiol/disulfide homeostasis of women with PCOS aged between 19-33 were compared to their age and BMI matched non - PCOS healthy controls. In addition, the correlation of these molecules with other metabolic markers/measurements were also investigated. RESULTS: Metabolic parameters such as mean waist circumference, lipid accumulation product, visceral adiposity index, fasting insulin, homeostasis model assessment of insulin resistance and triglyceride values were higher in the PCOS group (p = 0.038, p = 0.008, p = 0.001, p = 0.001, p = 0.002 and p = 0.002, respectively) compared to controls. However, mean serum Klotho and native thiol levels (respectively p < 0.0001 and p = 0.038) were lower compared to controls. Correlation analysis revealed that serum Klotho levels were negatively correlated with BMI, waist circumference, disulphide/total thiol, disulphide/native thiol, HOMA-IR and LAP-index. CONCLUSIONS: Findings of decreased serum Klotho and native thiol values of the PCOS group compared to controls and the negative correlation of serum Klotho levels with metabolic markers supports the idea that decreased Klotho may be another mechanism by which cardiovascular risk is increased in women with PCOS.

Evaluation of the consistency ratios of cervical smear, cervical biopsy and conization results.

OBJECTIVES: Possible discrepancies between the cervical smear, biopsy histology and loop electrosurgical excision procedure (LEEP) results of the same patient is a matter of debate in the literature. In this study, we investigate the degree to which these results differ, and the clinical reasons for these differences. MATERIAL AND METHODS: With a retrospective design, cervical smear, cervical biopsy and LEEP results of patients were compared in terms of consistency. One hundred sixty-four patients who underwent till LEEP procedure due to pathologic initial smear and biopsy results between January 2015 and March 2020 were included in the study. RESULTS: Exact diagnosis discrepancy and high grade squamous intraepithelial lesion (HSIL) discrepancy were 78.9% and 50.0% between smear and cervical biopsy, 64.6% and 31.7% between cervical smear and LEEP and 43.8% and 28.1% between cervical biopsy and LEEP results, respectively. Age did not affect the consistency rates of pathologic results between smear-biopsy (p = 0.408) and biopsy-LEEP (p = 0.590). However, the probability of the consistency of smear and LEEP results exhibited a statistically significant linear relation with age (OR = 1.043, p = 0.015). HPV infections did not affect the discrepancy between smear-biopsy (p = 0.533), smear-LEEP (p = 1.000) and biopsy-LEEP (p = 0.529). CONCLUSIONS: Smear technique has a serious discrepancy and under-diagnosis problem when its results are compared with biopsy and LEEP. The consistency between smear and LEEP results appears to improve with age. When HSIL is evaluated in terms of detection, this discrepancy decreases. A smear test can detect HSIL and carcinoma with a higher accuracy than low-grade lesions.

A Comparative Multicentric Study on Serosal and Endometrial Myomectomy During Cesarean Section: Surgical Outcomes.

OBJECTIVE: This multi-center study aims to determine the efficiency and safety of endometrial myomectomy (EM) for the removal of uterine fibroids during cesarean section (CS). METHODS: Retrospective review of 360 women diagnosed for fibroids during pregnancy. They all delivered by CS between 2014 and 2019. The study groups included 118 women who only underwent EM, 120 women who only had subserosal myomectomy by traditional technique and 122 women with fibroids who decided to avoid cesarean myomectomy, as control group. They were analyzed and compared the surgical outcomes. RESULTS: The EM, subserosal myomectomy and control groups were statistically (p > 0.05) similar for to age, body mass index (BMI), gravidity, parity, gestational age at delivery, indications for CS, number of excised fibroids, size of the largest myoma. Postoperative hemoglobin values and ? (?) hemoglobin concentrations were lower in SM group (10.39gr/dl vs 9.98 gr/dl vs 10.19 - 1.44 gr/dl vs 1.90 gr/dl vs 1.35; p = 0.047, p = 0.021; respectively) Hybrid fibroids were significantly more frequent in the EM group than subserosal myomectomy and control groups (respectively, 33.1% vs 23.3% vs 27.0%, p = 0.002). Surgery time was significantly longer in the subserosal myomectomy group than EM and control groups (respectively, 46.53 min vs 37.88 min vs 33.86 min, p = 0.001). Myomectomy took significantly longer time in the subserosal myomectomy than EM group (13.75 min vs 8.17 min, p = 0.001). CONCLUSIONS: Endometrial myomectomy is a feasible choice for treatment of fibroids during CS, and, basing on our results could be an alternative to traditional cesarean subserosal myomectomy.

Effect of health literacy on help-seeking behavior: A comparison of patients accepting surgery and refusing surgery for urinary incontinence.

OBJECTIVE(S): To compare the health literacy (HL) of the adult females with SUI complaints in terms of their acceptance or non-acceptance of surgery. METHODS: In this cohort study, the European Health Literacy Survey Questionnaire (HLS-EU- Q47) scores as a measure of health literacy were compared among the two groups of patients who accepted to undergo surgery for SUI and the ones who did not. Demographic features, weight and BMI values, comorbidity, menopausal status, duration and type of UI, socioeconomic characteristics (marital status, educational level, level of income) and HLS-EU- Q47 survey results of the two groups were compared. We also investigated the reasons regarding the acceptance or refusal of SUI surgery. RESULTS: Among the patients who were offered surgery 474% accepted to undergo operation. Total HLS-EU-Q47 score was 30.04 in the group of patients who accepted surgery and 23.46 in the group who refused surgery. The patients that refused surgery had more often insufficient health literacy level (p=0.001). An excellent health literacy level was higher for patients who agreed to anti-incontinence surgery (p=0.021). CONCLUSIONS: Health literacy score of patients with urinary incontinence (UI) who refused surgery was lower than those who accepted surgery. Acceptance of surgery may be increased by providing more understandable and clear information, especially for women with lower HL levels.

Platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in missed abortion

Abstract Objective Missed abortion occurs in ~ 15% of all clinical pregnancies. The pathogenesis is not clearly known. However, defective placentation resulting in maternal systemic inflammatory response is considered responsible for missed abortion. Platelet lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) are increasingly cited parameters of inflammation in the literature. However, no study evaluated the PLR and NLR rates in missed abortions so far. The aim of the present study is to investigate whether complete blood count (CBC) inflammatory parameters such as NLR and PLR are increased in patients with missed abortion. Methods Medical records of 40 pregnant women whose gestation ended in missed abortion at between 6 and14 weeks of gestation and of 40 healthy pregnant women were collected and compared retrospectively. The groups were compared regarding hemoglobin, hematocrit, platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), PLR and NLR. Results Platelet distribution width, NLR and PLR values were higher in the missed abortion group compared with the healthy pregnant women group (rates are p = 0.043; p = 0.038; and p = 0.010, respectively). Hematocrit, MPV, and lymphocyte values were found to be lower in the missed abortion group compared with the healthy pregnant women group (p = 0.027, p = 0.044 and p = 0.025, respectively). Conclusion The PDW, NLR and PLR values of the missed abortion group were reported high; and MPV values were reported low in the present study. These findings may help to speculate a defective placentation in the pathogenesis of missed abortion.

Is there any association between rs1303 (Pi*M3) variant of alpha-1 antitrypsin gene and atrial septal aneurysm development?

AIM: Atrial septal aneurysm (ASA) is one of the congenital heart defects. The underlying pathophysiology of ASA has not been fully understood yet. Alpha-1 antitrypsin (A1AT) is a serine protease inhibitor glycoprotein, which is held responsible from tissue wall proteolysis if it is deficient in the body. The aim of this study was to investigate A1AT serum levels and the rs1303 (Pi*M3) variant in A1AT gene in patients with ASA. MATERIAL AND METHODS: Thirty patients (7 male and 23 female) with isolated ASA and 33 patients (11 male and 22 female) with normal atrial septum on echocardiography were included in this study. A1AT serum levels of study patients were measured quantitatively by the enzyme-linked immune sorbent assay (ELISA) method. The A1AT gene mutation rs1303 was analyzed by genotyping, which is performed on genomic DNA extracted from circulating mononuclear blood cells. Single-nucleotide polymorphism was evaluated on polymerase chain reaction using commercial kits. RESULTS: A1AT serum levels were not statistically different among patients with and without ASA (9.52 ± 4.33 µg/mL vs 9.83 ± 5.27 µg/mL, respectively, P = .80). A1AT homozygote mutation (PiM3M3) was significantly higher in the ASA group than the control group (21 vs 11, OR (95% CI): 6.68 [2.09-21.40], P = .001). A1AT serum levels were similar among patients with normal A1AT allele (PiMM), homozygote variant (PiM3M3), and heterozygote variant (PiMM3) (P = .79). CONCLUSION: This preliminary study revealed that homozygote A1AT rs1303 (PiM3M3) variant is significantly higher in patients with isolated ASA and may be associated with ASA development. Large scale comprehensive studies are needed to validate these results.

Conservative Surgical Treatment of a Case of Placenta Accreta.

Placenta accreta syndromes are associated with increased maternal mortality and morbidity. Cesarean hysterectomy is usually performed in cases of placenta accreta syndrome. Fertility sparing methods can be applied. In the present study, we report a successful segmental uterine resection method for placenta accreta in the anterior uterine wall in a cesarean section case. A 39-year-old woman underwent an elective cesarean section at 38 + 2 weeks. A placental tissue with an area of 10 cm was observed extending from the anterior uterine wall to the serosa, 2 cm above the uterine incision line. The placental tissue was removed with the help of monopolar electrocautery. The uterine incision was continuously sutured. The patient was discharged on the second postoperative day. The placental pathology was reported as placenta accreta. The American College of Obstetricians and Gynecologists (ACOG) generally recommends cesarean section hysterectomy in cases of placenta accreta because removal of placenta associated with significant hemorrhage. Conservative and fertility sparing methods include placenta left in situ, cervical inversion technique and triple-P procedure. There are several studies reporting that segmental uterine resection is performed with and without balloon placement or artery ligation. Segmental uterine resection may be an alternative to cesarean hysterectomy to preserve fertility or to protect the uterus in cases of placenta accreta when there is no placenta previa.

Conservative surgical treatment of a case of placenta accreta

Abstract Placenta accreta syndromes are associated with increased maternal mortality and morbidity. Cesarean hysterectomy is usually performed in cases of placenta accreta syndrome. Fertility sparing methods can be applied. In the present study, we report a successful segmental uterine resection method for placenta accreta in the anterior uterine wall in a cesarean section case. A 39-year-old woman underwent an elective cesarean section at 38 + 2 weeks. A placental tissue with an area of 10 cm was observed extending fromthe anterior uterine wall to the serosa, 2 cm above the uterine incision line. The placental tissue was removed with the help of monopolar electrocautery. The uterine incision was continuously sutured. The patient was discharged on the second postoperative day. The placental pathology was reported as placenta accreta. The American College of Obstetricians and Gynecologists (ACOG) generally recommends cesarean section hysterectomy in cases of placenta accreta because removal of placenta associated with significant hemorrhage. Conservative and fertility sparing methods include placenta left in situ, cervical inversion technique and triple-P procedure. There are several studies reporting that segmental uterine resection is performed with and without balloon placement or artery ligation. Segmental uterine resection may be an alternative to cesarean hysterectomy to preserve fertility or to protect the uterus in cases of placenta accreta when there is no placenta previa. received

The correlation between plasma human neutrophil peptide 1-3 levels and severity of coronary artery disease.

INTRODUCTION: Inflammation plays a key role in atherosclerosis, and discovering new biomarkers of inflammation is becoming important in order to uncover the pathogenesis of atherosclerotic coronary artery disease (CAD). Recent studies have focused on polymorphonuclear neutrophils. It has been suggested that human neutrophil peptide 1-3 (HNP1-3) is proatherogenic. In this study, we aimed to investigate the associations between plasma HNP1-3 levels and the severity of atherosclerosis via a generally accepted scoring system. MATERIAL AND METHODS: This cross-sectional, observational study included 107 consecutive patients suffering from stable angina pectoris and undergoing coronary angiography (CAG). Patients were divided into two groups according to the Gensini scoring (GS) system evaluating disease severity. Group 1 was composed of mild CAD patients with GS < 20 and group 2 consisted of severe CAD patients with GS ≥ 20. Plasma HNP1-3 levels were assessed by the ELISA method. RESULTS: The mean HNP1-3 levels were found to be lower in group 1 than group 2 (134.7 ng/ml vs. 147.5 ng/ml). HNP1-3 levels were significantly higher in the severe CAD group than the mild CAD group according to GS (p < 0.001). The results of multivariate logistic regression analysis revealed that only age > 62 years and HNP1-3 > 134 ng/ml were independent predictors of the severity of CAD after adjusting for gender, smoking, hypertension, hyperlipidemia, diabetes, family history of CAD and white blood cell count. In predicting the severity of CAD, the sensitivity and specificity of HNP1-3 were 83.9% (p < 0.001) and 58.8% (p < 0.001), respectively. CONCLUSIONS: This study revealed that the plasma levels of HNP1-3 were significantly higher in severe CAD than mild CAD.

Associations of fibroblast growth factor 23 and fetuin-A with coronary plaque burden and plaque composition in young adults.

OBJECTIVE: The total burden of subclinical coronary artery disease (CAD) is significant among young adults. Serum fibroblast growth factor 23 (FGF-23) and fetuin-A are established predictors of morbidity and mortality because of cardiovascular disease. The objective of the study was to evaluate the relationship between subclinical CAD and serum FGF-23 and fetuin-A concentrations among a population of young adults. METHODS: A total of 241 subjects younger than 45 years who had undergone coronary computed tomographic angiography (CCTA) were included in the study. In 117 patients, the CCTA detected subclinical CAD; the rest of the patients had no CAD detected on CCTA. RESULTS: Serum FGF-23 and fetuin-A levels were significantly increased in the CAD patients as compared with the non-CAD patients (26.7 [interquartile range, 22.4-31.9] vs 15.7 [interquartile range, 13.2-18.1] pg/mL and 904.7 [interquartile range, 695.5-1021.6] vs 469.6 [331.4-660.5] mg/L, respectively; P < 0.001 for both). Furthermore, a positive correlation was identified between FGF-23 and fetuin-A levels and the total number of plaques (r = 0.21 and r = 0.28, respectively; P < 0.001 for both). In multivariate logistic regression analysis, age, smoking status, uric acid, FGF-23, and fetuin-A levels were found to be independently associated with the presence of CAD. CONCLUSIONS: The presence of subclinical CAD is independently associated with FGF-23 and fetuin-A and could be used as novel risk markers of cardiovascular disease in the asymptomatic young adult population.

Does varicocele correction lead to normalization of preoperatively elevated mean platelet volume levels?

INTRODUCTION: There are several studies on the relationship between increased mean platelet volume (MPV) and varicocele. We investigated the relationship between preoperative and 6-month postoperative MPV values in patients whose varicocele was corrected with surgery. METHODS: A total of 282 patients underwent surgery at our urology clinic between December 2011 and December 2013 for primary varicocele. We retrospectively examined the records of 61 patients who came to the 6-month postoperative follow-up. The preoperative varicocele diagnosis was made with physical examination findings and supported with colour Doppler ultrasonography. RESULTS: The varicocele was grade I in 12 patients, grade II in 34 patients and grade III in 11 patients. When the preoperative and 6-month postoperative haemoglobin (Hb), MPV, mean corpuscular volume, platelet, and platelet distribution width (PDW) values were compared, there was a significant decrease in MPV (p = 0.019), and a significant increase in Hb (p < 0.001). A noticeable increase was also present in PDW, but it was not statistically significant (p = 0.058). CONCLUSION: We found that MPV increased in patients with varicocele and tended to decrease again after the varicocele was surgically corrected. However, we feel larger prospective series are needed.

Urethral caruncle: Case report of a rare acute urinary retension cause.

A urethral caruncle is a benign vascular tumour usually originating from the rear lip of the external urethral mea and often observed in postmenopausal women. Urethral caruncle is not included within the list of bladder overdistension causes in women. We present urethral caruncle as a rare cause of acute urinary obstruction in a 41-year-old woman. The case was evaluated with physical examination and the bladder was evacuated with a 12-Fr urethral catheter. A pressure flow study was performed. The caruncle was excised under spinal anesthesia. There were no complications. The urethral catheter was withdrawn on the sixth day and she was discharged with local estrogen.

Efficacy of gabapentin versus diclofenac in the treatment of chest pain and paresthesia in patients with sternotomy.

OBJECTIVE: Chronic post-sternotomy chest pain and paresthesia (PCPP) are frequently seen and reduce the quality of life. We aimed to demonstrate the efficacy and safety of gabapentin compared with diclofenac in the treatment of PCPP and to elucidate the similarities of PCPP to neuropathic pain syndromes. METHODS: The prospective, randomized, open-label, blinded end-point design of study was used. One hundred and ten patients having PCPP lasting three months or more were randomized to receive 800 mg/daily gabapentin (n=55) and 75 mg/daily diclofenac (n=55) for thirty days. All patients have undergone cardiac surgery and median sternotomy. The perception of pain or paresthesia was evaluated as 0--Normal (no pain or paresthesia), 1--Mild, 2--Moderate, 3--Severe at baseline and after thirty days of treatment. Recurrences were questioned after three months. Statistical analyses were performed using independent samples t, Chi-square, continuity correction, Fisher's exact, Mann Whitney U and Kruskal Wallis tests. RESULTS: In gabapentin group, mean pain and paresthesia scores regressed from 2.12+/- 0.76 to 0.54+/- 0.83 (p<0.001) and from 1.72+/- 0.74 to 0.49+/- 0.62 (p<0.001), respectively. Mean pain and paresthesia scores regressed in diclofenac group from 1.93+/- 0.8 to 1.0+/- 1.13 (p<0.001) and from 1.76+/- 0.74 to 1.24+/- 0.96 (p=0.002), respectively. Although, both gabapentin and diclofenac were found to be effective without obvious side effects in the treatment of PCPP (p<0.001), gabapentin was found to be superior to diclofenac (p=0.001 and p<0.001, respectively). Adverse effects were seen in 7% of patients on gabapentin and 4% of patients on diclofenac. Results also showed that symptomatic relief with gabapentin lasts longer than diclofenac (p<0.001). CONCLUSION: Both gabapentin and diclofenac are effective in the treatment of chronic PCPP, without obvious side effects. However, gabapentin is found to be superior to diclofenac and its effects sustain longer. The results show that there may be some evidence in PCPP as a kind of neuropathic pain.

Left atrial mobile hydatid cyst mimicking left atrial myxoma and mitral stenosis and causing heart failure and arrhythmia.

Cardiac hydatid cysts are very rare in hydatid cyst disease. We report herein a case of hydatid cyst mimicking left atrial myxoma. A 78-year-old woman was admitted to our hospital with complaint of dyspnea and signs pulmonary edema and mitral stenosis. Echocardiography showed left atrial mobile, mostly solid mass with wall calcifications moving towards the orifice of the mitral valve. We also found loculated giant hepatic and right pulmonary cysts. We aimed to report this case because of mimicking mitral stenosis and left atrial myxoma and causing heart failure.