Association between metabolic syndrome and pelvic organ prolapse severity.

INTRODUCTION AND HYPOTHESIS: As in the case of cardiovascular and metabolic diseases, the prevalence of pelvic organ prolapse (POP) has been rising with the increasing proportion of elderly women in the population. The purpose of the present cross-sectional study was to evaluate the components of metabolic syndrome (MS) in urogynecological patients with a variable POP severity. METHODS: The MS risk factors (elevated waist circumference, elevated triglycerides, decreased high-density lipoprotein cholesterol, elevated blood pressure, hyperglycemia) were assessed in 100 women who were referred to our urogynecological center with pelvic floor disorders (PFD). POP was evaluated with the Pelvic Organ Prolapse Quantification system (POP-Q). RESULTS: The χ (2) test revealed that the diagnosis of MS and the presence of elevated triglycerides increased with the overall POP-Q stage. The other MS risk factors were not significantly associated with the overall POP-Q stage. MS and elevated triglycerides were predictors of the POP-Q stage ≥III [odds ratio (OR) 3.5, 95 % confidence interval (CI) 1.5-8.2 for MS and OR 3.4, 95 % CI 1.4-8.2 for elevated triglycerides, p < 0.01]. CONCLUSIONS: The diagnosis of MS and the presence of elevated triglycerides may be associated with the severity of POP in urogynecological patients. Longitudinal studies are required to assess whether the MS risk factors might predict the progression of POP and whether elimination of the risk factors might improve the prognosis in POP patients.

Mesh retraction correlates with vaginal pain and overactive bladder symptoms after anterior vaginal mesh repair.

INTRODUCTION AND HYPOTHESIS: The aim of the present study was to determine possible correlations between mesh retraction after anterior vaginal mesh repair and de novo stress urinary incontinence (SUI), overactive bladder (OAB), and vaginal pain symptoms. METHODS: One hundred and three women with symptomatic prolapse of the anterior vaginal wall, stages 3 and 4 based on the Pelvic Organ Prolapse Quantification (POP-Q) system, underwent Prolift anterior™ implantation. At a 6-month follow-up, the patients were interviewed for de novo SUI, OAB, and vaginal pain, and underwent an introital/transvaginal ultrasound examination to measure the mesh length in the midsagittal plane. RESULTS: Mesh retraction was significantly larger in a subgroup of patients (n = 20; 19.4 %) presenting de novo OAB symptoms on the follow-up assessment compared with those without this complication (5.0 cm vs. 4.3 cm; p < 0.05). Mesh retraction was also significantly larger in a subgroup of patients (n = 23; 22.3 %) reporting postoperative vaginal pain compared with the women who did not report any postoperative vaginal pain (5.3 cm vs. 4.2 cm; p < 0.01). A significant correlation was found between mesh retraction and the severity of vaginal pain (R = 0.4, p < 0.01). Mesh retraction did not differ between patients with de novo SUI symptoms and those without this complication. CONCLUSIONS: Mesh retraction assessed on ultrasound examination after anterior vaginal mesh repair may correlate with de novo OAB symptoms and vaginal pain.

Serum TRAIL levels in patients with epithelial ovarian cancer or primary peritoneal cancer treated with neoadjuvant chemotherapy. A pilot study.

AIMS: The study attempted to evaluate the kinetics of changes in serum TRAIL levels as a potential predictive and prognostic factor in patients with epithelial ovarian cancer (EOC) or primary peritoneal carcinoma (PPC), eligible for an interval debulking surgery (IDS). MATERIAL AND METHODS: 17 patients with primary inoperable EOC or PPC in FIGO Stage IIIC or IV who underwent an exploratory operation were enrolled to the study. Serum TRAIL levels were determined by ELISA method (DIACLONE, Besancon Cedex, France) before and after two courses of neoadjuvant chemotherapy (NAC) based on paclitaxel and platinum analogue (cisplatin or carboplatin). The control group consisted of six healthy volunteers. The median difference in concentration of TRAIL (dTRAIL) between the initial marking and after two courses of NAC in each patient was 192 pg/ml and it was used for dichotomization of the test group. RESULTS: Suboptimal interval debulking surgery (IDS) was performed in 23.5% (4/17) and optimal IDS in 76.5% (13/17) patients. TRAIL concentration before chemotherapy did not differ significantly between patients with EOC or PPC [1426.96 +/- 321.06 pg/ml (mean +/- SD) (U = 26, p = 0.08)] and the control group [1160.40 +/- 256.39 pg/ml (mean +/- SD. After two courses of NAC serum TRAIL concentration level was 1247.49 +/- 378.46 pg/ml (mean +/- SD). The difference was significant (Z = 2.44, p = 0.0147). Statistical analysis showed that dTRAIL did not significantly influence either extent of IDS (U = 35, p = 0.0962) or time to progression (log-rank test, p = 0.1185), overall survival (log-rank test, p = 0.1973) and response to treatment according to RECIST criteria (U = 35.5, p = 0.9616). CONCLUSIONS: Serum TRAIL concentration levels changed significantly during NAC. However, it seems that the concentration of this protein has no critical value as a predictive or prognostic factor in patients with EOC or PPC.

[Immunological aspects of recurrent spontaneous abortion]. / Immunologiczne aspekty poronien nawykowych.

Recent studies emphasise an important role of immunological mechanisms in pregnancy maintenance. Therefore, unravelling mechanisms regulating placentogenesis are critical to understanding the pathogenesis of recurrent spontaneous abortion (RSA). Author gives review concerning about auto- and alloimmunological aspects of RSA.

[Pregnancy outcome in the woman with antiphospholipid antibodies: a case report]. / Przebieg ciazy u pacjentki z zespolem antyfosfolipidowym--opis przypadku.

Recent studies emphasise an important role of immunological mechanisms in pregnancy maintenance. Antiphospholipid antibody syndrome is responsible for 5-15% of recurrent pregnancy loss. Authors describe a successful pregnancy outcome after aspirin and heparin therapy in 26 years old woman with three previous pregnancy losses, with positive anticardiolipin antibodies and increased number of NK cells.

[The evaluation of expression of T-lymphocytes and NK cell surface receptors in women with threatened miscarriage]. / Ocena ekspresji antygenów powierzchniowych limfocytów T i komórek NK u pacjentek w ciazy zagrozonej poronieniem.

OBJECTIVES: Recent studies emphasise an important role of immunological mechanisms in pregnancy maintenance. Therefore, unravelling mechanisms regulating placentogenesis are critical to understanding the pathogenesis of recurrent spontaneous abortion. MATERIALS AND METHODS: We studied 49 women with threatened abortion and 24 healthy pregnant women. In addition, we studied 17 women with the history of recurrent spontaneous abortion and 10 healthy nonpregnant women in reproductive age with the previous successful pregnancy outcome. CD3, CD45 RO, CD4, CD8, CD16 expression on peripheral blood lymphocytes were studied using flow cytometry. RESULTS: We determined that there is significantly higher CD4 expression in pregnant recurrent aborters compared to control (p < 0.05). Pregnant recurrent spontaneous aborters, with the successful pregnancy outcome have significantly lower CD16 expression compared to those, who abort (p < 0.05). CONCLUSION: Our studies may indicate that T cell and NK cell can be involved in the pathogenesis of pregnancy loss.

Influence of antisperm antibodies on T cell adhesion to extracellular matrix proteins in women with a history of unexplained infertility.

beta 1 integrins, receptors responsible for the binding of extracellular matrix proteins, mediate activation, adhesion, migration and differentiation in different tissue compartments. It has been recently demonstrated that integrins are distributed on sperm surface and on T cells, as well. The aim of this study was to establish influence of antisperm antibodies on T cell adhesion to extracellular matrix proteins in women with a history of unexplained infertility.

[The role of antiphospholipid antibodies in placental immunopathology]. / Rola przeciwcial antyfosfolipidowych w immunopatologii lozyska.

The review highlights recent studies investigating the impact of antiphospholipid antibodies (aPS) on placental tissue destruction. These data suggest that aPS may influence pregnancy outcome. Possible mechanisms of aPS action are analysed.

Intravenous immunoglobulin therapy influences T cell adhesion to extracellular matrix in women with a history of recurrent spontaneous abortions.

PROBLEM: To determine activated T cell adhesion level to extracellular matrix (ECM) in non-pregnant women with a history of recurrent spontaneous abortions (RSA). In addition, to evaluate a small-dose intravenous immunoglobulin (IVIG) therapy influences on T cell adhesion to ECM. METHOD OF STUDY: Phytohemaglutinin (PHA) or phorbol myristate acetate (PMA) activated T cell adhesion to the following extracellular matrix proteins: collagen IV, fibronectin and elastin were studied in women with the history of RSA. In addition, IVIG immunotherapy influence on T cell adhesion was studied. Normal T cells adhesion values were established in non-pregnant healthy women with the previous successful pregnancy outcome and in normal healthy pregnant women. RESULTS: PHA activated T cell adhesion to collagen IV (P = 0.04), fibronectin (P = 0.0003) nad elastin (P = 0.02) were significantly higher in women with the history of RSA when compared to non-pregnant healthy women wit the previous successful pregancy outcome. IVIG immunotherapy normalized the T cell adhesion level and favored a successful pregnancy. CONCLUSIONS: Increased T cell adhesion to collagen IV, fibronectin and elastin characterize women with the history of RSA. Decreased T cell adhesion to the main extracellular matrix components of human placenta may underlie possible effect of IVIG action.

[The role of components of peritoneal fluid in the immunopathogenesis of endometriosis]. / Znaczenie skladników plynu otrzewnowego w immunopatogenezie endometriozy.

Endometriosis is characterised by the presence of abnormally located tissue resembling the endometrium with glands and stroma. The abnormal endometrium of women affected by endometriosis could be able to protect itself from harmful effects of immune cells by expressing specific antigens, by harbouring a different population and by synthesizing and secreting immunosuppressive factors. This disturbance may be regulated by factors in peritoneal fluid which is a specific microenvironment.

Apoptosis of T cells in the first trimester human decidua.

PROBLEM: Apoptosis has been accepted as a mechanism for maintaining tolerance in the immune system. The induction of apoptotic cell death can also be a possible outcome of the lymphocyte activation. Expression of Fas ligand (FasL) by the human trophoblast has been proposed as a mechanism providing protection against the lytic action of decidual immune cells. The aim of this study was to determine whether decidual T cells undergo apoptosis during abortion. METHOD OF STUDY: We studied apoptosis of T cells isolated from the first-trimester decidua in 12 women after spontaneous or elective abortion. We used gel electrophoresis to detect DNA fragmentation. Cells undergoing DNA fragmentation also were identified by DNA analysis using flow cytometry. This method was based on the accumulation of ethanol-fixed apoptotic cells in the sub-G0/G1 peak of the DNA content as a result of the loss of DNA fragments from the cells and because of a reduced DNA ability to be stained by propidium iodide. In addition, the expression of Fas antigen on the surface of decidual T cells (CD3+) also was determined. RESULTS: We did not detect apoptosis by the "ladder" technique. However, the apoptotic index (the percentage of positive cells per total number of cells) ranged from 2% to 24% using flow cytometry. CONCLUSIONS: Trophoblast cells usually fail to stimulate alloantigen-specific T cells, but they may express nonclassical major histocompatibility complex alloantigens to which mothers can produce immunoglobulin G alloantibody, which requires T helper cell activation. The apoptosis of T cells in the human decidua, probably through Fas-FasL signaling, may be a defense mechanism against rejection of the fetal allograft by the maternal immune system.