Prediction model for residual high-grade cervical intraepithelial lesions.

BACKGROUND: The aim of the study was to evaluate risk factors associated with high-grade cervical intraepithelial lesions (HSIL) in patients undergoing a second cervical excision procedure due to positive surgical margins and to create a prediction model for residual disease. METHODS: This study included patients with HSIL positive surgical margins following loop electrosurgical excision procedures (LEEP) between March 2015 and August 2019. HSIL in the second cervical excision pathology in these patients was accepted as residual disease. For residual disease prediction, a multivariate logistic regression and stepwise elimination analysis of 14 variables including demographic characteristics, clinical characteristics, pathology results and HPV genotypes of the patients was performed. RESULTS: Second cervical excision procedures were performed in 290 patients 85(29.4%) of these patients had CIN 2 (cervical intraepithelial neoplasia) and 205 (70.6%) had CIN 3. In the second excision procedure, 166 patients (57.2%) had ≤CIN 1, 124 patients (42.8%) had ≥CIN2. The prediction model of residual disease includes only 3 variables out of the 14 different clinical characteristics (AUC=0.605 [0.539-0.671]). These variables are gravida (adjusted OR: 1.15 [0.97-1.38], P=0.107), CIN2-3 presence in the endocervical canal in the first LEEP specimen (adjusted OR: 1.52 [0.94-2.47], P=0.091) and the presence of HR-HPV except 16/18 lesions (adjusted OR: 0.64 [0.38-1.06], P=0.083). CONCLUSIONS: A prediction model was designed with our data, from variables reported to be risk factors for residual disease in previous studies. While this model was statistically significant, it was poor at distinguishing residual disease. A prediction model can be designed to guide clinicians with future studies.

Ansiedad y depresión posparto a largo plazo de las madres con COVID-19 durante el embarazo

La pandemia de COVID-19 se asocia con resultados mentales negativos en el período posparto temprano. Objetivo. Evaluar la salud mental posparto a largo plazo de las mujeres infectadas con COVID-19 durante el embarazo. Métodos. Estudio transversal en 101 gestantes que dieron a luz en un centro terciario durante la pandemia de COVID-19, entre el 31 de marzo de 2020 y el 30 de noviembre de 2021. Se clasificó a las gestantes en 2 grupos como COVID-19 positivo (grupo de estudio, n=52) y COVID-19 negativo (grupo control, n=49). Se recogieron datos sociodemográficos y obstétricos mediante un cuestionario en los períodos posparto temprano (≤6 meses) y tardío (6 a 18 meses). Se calculó la puntuación del Inventario de Depresión de Beck (IDB) y del Inventario de Ansiedad de Beck (IAB) mediante el análisis de los datos de las participantes. Resultados. La puntuación media del IDB y la tasa de depresión (puntuación del IDB >13) en las pacientes con COVID-19 positivo fueron mayores en el período posparto temprano que en el tardío. Según el análisis de regresión lineal multivariante, existió una correlación significativa entre la puntuación IDB de las pacientes con COVID-19 y el nivel educativo y la situación laboral. Según el mismo análisis, existió una correlación significativa entre la puntuación del IAB de los pacientes con COVID-19 y el apoyo del cónyuge, la relación marital y las enfermedades relacionadas con el nacimiento. Se encontró que las pacientes con COVID-19 positivo y COVID-19 negativo tenían puntuaciones IDB e IAB similares en los periodos postparto temprano (≤6 meses) y tardío (6-18 meses). Además, las tasas de ansiedad y depresión fueron similares en ambos grupos en los mismos períodos posparto. Conclusión. En nuestro estudio, la infección por COVID-19 en el embarazo no tuvo un impacto adicional significativo en la salud mental materna en el posparto a largo plazo.

The COVID-19 pandemic is associated with negative mental outcomes in the early postpartum period. Objective: To assess the long-term postpartum mental health of women infected with COVID-19 during pregnancy. Methods: Cross-sectional study in 101 pregnant women who gave birth in a tertiary center during the COVID-19 pandemic, between March 31, 2020, and November 30, 2021. The pregnant women were classified into 2 groups as COVID-19 positive (study group, n=52) and COVID-19 negative (control group, n=49). Sociodemographic and obstetric data were collected by questionnaire in the early (≤6 months) and late (6-18 months) postpartum periods. Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) scores were calculated by analysis of the participants' data. Results: The mean BDI score and the rate of depression (BDI score >13) in COVID-19 positive patients were higher in the early postpartum period than in the late postpartum period. According to multivariate linear regression analysis, there was a significant correlation between the BDI score of COVID-19 patients and educational level and employment status. According to the same analysis, there was a significant correlation between the BAI score of COVID-19 patients and spousal support, marital relationship, and birthrelated diseases. We found that COVID-19 positive and COVID-19 negative patients had similar BDI and BAI scores in the early (≤6 months) and late (6-18 months) postpartum periods. In addition, rates of anxiety and depression were similar in both groups at the same postpartum periods. Conclusion: In our study, COVID-19 infection in pregnancy had no significant additional impact on long-term postpartum maternal mental health.

Asociación entre el hipotiroidismo subclínico de anticuerpos antiperoxidasa tiroidea negativos y los resultados perinatales adversos diagnosticados con diferentes criterios en el tercer trimestre del embarazo

Antecedentes. El efecto del hipotiroidismo subclínico (HSC) en los resultados perinatales adversos no está claro, y los valores de referencia de la hormona tiroestimulante (TSH) en el embarazo son controvertidos. Objetivo. Evaluar los efectos del HSC negativo para los anticuerpos de la peroxidasa tiroidea (TPOAbs) sobre los resultados perinatales según los diferentes valores de referencia de la TSH. Métodos. Un total de 554 mujeres embarazadas, incluyendo 509 eutiroideas y 45 gestantes hipotiroideas subclínicas (TSH > 3 mIU/L), fueron incluidas en este estudio prospectivo de casos y controles. Todas las gestantes estaban en el tercer trimestre y eran negativas a los TPOAbs. Las funciones tiroideas fueron evaluadas utilizando los valores de referencia específicos para el trimestre recomendados por el Colegio Americano de Obstetricia y Ginecología (ACOG) (TSH > 3 mIU/L) y la Asociación Americana de Tiroides (ATA) (TSH > 4 mIU/L). Resultados. La mortalidad neonatal en el hipotiroidismo subclínico con un límite superior de TSH de 4 mIU/L fue significativamente menor que en el grupo eutiroideo (2 (0,4%) frente a 1 (4,5%); p=0,009). No hubo diferencias significativas en resultados maternos y perinatales adversos en las gestantes con HSC y eutiroideas en ambos valores de referencia de la TSH. No hubo correlación significativa entre los valores de TSH y las semanas de parto de las gestantes con parto prematuro (r=0,169, p=0,146). Conclusiones. En este estudio, utilizando los diferentes valores basales de TSH recomendados por las directrices del ACOG de 2020 y de la ATA de 2017 en el tercer trimestre del embarazo para el diagnóstico de hipotiroidismo subclínico, no hubo una relación significativa entre los casos de hipotiroidismo subclínico con TPOAbs negativos y los resultados perinatales adversos.

Background: The effect of subclinical hypothyroidism (SCH) on adverse perinatal outcomes is unclear, and thyroid-stimulating hormone (TSH) reference values in pregnancy are controversial. Objective: To evaluate the effects of thyroid peroxidase antibody (TPOAbs) negative SCH on perinatal outcomes according to the different TSH reference values. Methods: A total of 554 pregnant women, including 509 euthyroid and 45 subclinical hypothyroid (TSH > 3 mIU/L) pregnant women, were included in this prospective case-controlled study. All pregnant women were in the third trimester and were TPOAbs negative. Thyroid functions were evaluated using trimester-specific reference values recommended by the American College of Obstetrics and Gynecology (ACOG) (TSH > 3 mIU/L) and the American Thyroid Association (ATA) (TSH > 4 mIU/L) guidelines. Results: Neonatal mortality in subclinical hypothyroidism with a TSH upper limit of 4 mIU/L was significantly lower than in the euthyroid group (2 (0.4%) vs 1 (4.5%); p=0.009). There was no significant difference in terms of adverse maternal and perinatal outcomes in SCH and euthyroid pregnant women in both TSH reference values. There was no significant correlation between TSH values and delivery weeks of pregnant women with preterm delivery (r=0.169, p=0.146). Conclusions: In this study, using different baseline TSH values recommended by the 2020 ACOG and 2017 ATA guidelines in the third trimester of pregnancy for the diagnosis of subclinical hypothyroidism, it was shown that there was no significant relationship between cases of subclinical hypothyroidism with negative TPOAbs and adverse perinatal outcomes.

Magnetically responsive, sorafenib loaded alginate microspheres for hepatocellular carcinoma treatment.

This study aimed to develop sorafenib loaded magnetic microspheres for the treatment of hepatocellular carcinoma. To achieve this goal, superparamagnetic iron oxide nanoparticles (SPIONs) were synthesised and encapsulated in alginate microspheres together with an antineoplastic agent, sorafenib. In the study, firstly SPIONs were synthesised and characterised by dynamic light scattering, energy-dispersive X-ray spectroscopy, and scanning electron microscopy. Then, alginate-SPIONs microspheres were developed, and further characterised by electron spin resonance spectrometer and vibrating sample magnetometer. Besides the magnetic properties of SPIONs, alginate microspheres with SPIONs were also found to have magnetic properties. The potential use of microspheres in hyperthermia treatment was then investigated and an increase of about 4°C in the environment was found out. Drug release studies and cytotoxicity tests were performed after sorafenib was encapsulated into the magnetic microspheres. According to release studies, sorafenib has been released from microspheres for 8 h. Cytotoxicity tests showed that alginate-SPION-sorafenib microspheres were highly effective against cancerous cells and promising for cancer therapy.

Development of Titania Nanotube-based Electrochemical Immunosensor and Determination of Prostate Specific Antigen.

Early diagnosis of cancer is the most important factor that increases the success of treatment. Therefore, the development of new diagnostic tools is a necessity. In this study, a new electrode surface was developed via modification of a disposable titanium electrode with anodic oxidation and coating of gold nanoparticle and chitosan. Titanium electrodes were anodized by several anodization parameters to obtain a nanoporous surface and characterized by scanning electron microscopy. Electrodes anodized in optimum conditions were modified with gold nanoparticles and chitosan for enhancing conductivity and functionalizing the surface of electrode, respectively. To detect prostate specific antigen (PSA), anti-PSA was bound onto the functional electrode surface. Modified electrodes were characterized with scanning electron microscopy and cyclic voltammetry and used for chronoamperometric detection of PSA. Limit of detection (LOD) of the designed electrode was found to be 7.8 ng mL-1 for PSA in a linear range of 0 - 100 ng mL-1.

Electrochemical immunoassay for detection of prostate specific antigen based on peptide nanotube-gold nanoparticle-polyaniline immobilized pencil graphite electrode.

In this work, we developed a disposable amperometric sandwich-type immunoassay to detect prostate specific antigen (PSA). A self-assembled peptide nanotube (PNT), gold nanoparticle (AuNP) and polyaniline (PANI) composite (PANI/AuNP-PNT) were used to modify a pencil graphite electrode (PGE). Anti-PSA (Ab1) was immobilized on the modified electrode (PANI/AuNP-PNT/PGE) to capture PSA. Horseradish peroxidase (HRP) labeled anti-PSA (HRP-Ab2) was used as a tracer antibody. The modified electrodes were characterized with scanning electron microscopy (SEM), thermogravimetric analysis (TGA), energy dispersive X-ray spectroscopy (EDS), transmission electron microscopy (TEM), cyclic voltammetry (CV), and electrochemical impedance spectroscopy (EIS). PSA concentration in phosphate buffer (pH=7.4) was determined with electro-catalytic reduction of H2O2 on the modified working electrode by using the chronoamperometric method. Limit of detection was found out to be 0.68ng/mL in a linear range of 1-100ng/mL with a high regression (R2=0.990). To show the practicality of the modified biosensor in real matrixes, it was successfully applied for the detection of PSA in blood serum samples. The proposed method was also compared with enzyme-linked immunosorbent assay (ELISA) and compatible results were obtained. The developed immunoassay exhibited good reproducibility together with high stability and provides an efficient approach to detect PSA cost-effectively compared to traditional methods.

Is it safe to have multiple repeat cesarean sections? A high volume tertiary care center experience.

OBJECTIVE: To compare the obstetric outcomes of cesarean section in women who had a history of four or more previous cesarean sections with those who had a history of two or three previous cesarean sections. METHODS: Total 1318 women who underwent repeat cesarean section between January 2013 and January 2016 were retrospectively reviewed. Of these, 244 (18.5%) had previously had four or more cesarean sections (multiple repeat cesarean section group) and 1074 (81.5%) had previously had two or three cesarean sections (control group). Demographic characteristics and obstetric outcomes were compared using the Independent t and chi-square tests. RESULTS: The adhesion rate (p < 0.001), number of blood transfusion (p = 0.044), operation time (p = 0.012), length of hospital stay (p < 0.001) and tubal ligation surgery (p < 0.001) were significantly higher in multiple repeat cesarean section group compared to control group. CONCLUSION: Although multiple repeat cesarean section are asscociated with adhesion occurrence, higher number of blood transfusion, increased operation time and length of hospital stay, there is no remarkable difference in serious morbidity associated with multiple repeat cesarean section.

Comparison of protein- and polysaccharide-based nanoparticles for cancer therapy: synthesis, characterization, drug release, and interaction with a breast cancer cell line.

In this study, human serum albumin (HSA) was used as a protein-based material and poly (3-hydroxybutyrate) (PHB)-carboxymethyl chitosan (CMCh) as a polysaccharide-based material for the production of nanoparticles to be used as nanocarriers in cancer therapy. HSA and PHB-CMCh nanoparticles were prepared and characterized with a Zeta Sizer, Fourier transform infrared spectroscopy, scanning electron microscopy, and atomic force microscope. The effects of the pH value of the suspending medium and the amounts of crosslinker and polymer concentration on nanoparticle size and size distribution were investigated. The anticancer-agent etoposide was used as a model drug and encapsulated in nanoparticles to obtain drug release profiles. The entrapment efficiency of HSA nanoparticles was found to be greater than that of PHB-CMCh nanoparticles. To achieve "active" targeting of cancer cells, the nanoparticles were modified with concanavalin A. In the final step of the study, the interaction of nanoparticles with cancer cells was investigated in cytotoxicity and cellular uptake studies.

In vitro S. epidermidis and S. aureus adherence to composite and lightweight polypropylene grafts.

BACKGROUND: Despite the significant risk of infection, prosthetic graft materials have become indispensable for incisional hernia repair. Composite and lightweight grafts have been developed to overcome adhesion and rigidity. The aim of this study was to evaluate in vitro S. epidermidis and S. aureus adherence to these new generation grafts, which have modified composition and textile properties. MATERIALS AND METHODS: In this experimental study, sterile samples of multifilament polypropylene, multifilament lightweight composite, monofilament composite, and monofilament polypropylene grafts were incubated with slime positive S. epidermidis and S. aureus strains for 24 h. The grafts were washed and vortexed in saline. The saline was passaged to blood agar and incubated for 24 h. The colonies were counted. Naïve and incubated graft materials were examined by scanning electron microscopy to reveal both textile properties and biofilm formation. Physicochemical properties were evaluated. Wilcoxon signed ranks test and Friedman test were used for statistical analysis. RESULTS: S. epidermidis showed a significantly decreased adherence to monofilament polypropylene graft, and increased adherence to multifilament polypropylene graft (P<0.05). S. aureus showed a significant affinity for monofilament composite graft (P<0.05). SEM studies showed that biofilm formation was present on multifilament polypropylene graft. CONCLUSIONS: Both S. epidermidis and S. aureus had significantly less adherence to multifilament lightweight composite than multifilament polypropylene graft. S. epidermidis showed a greater affinity to monofilament composite graft compared with monofilament polypropylene graft. Overall S. epidermidis adherence for multifilament lightweight composite and monofilament composite was less than multifilament polypropylene and higher than monofilament polypropylene. S. epidermidis and S. aureus showed different adherence for each graft. Changes in material composition and textile properties may well influence bacterial adherence.