The investigation of cholinergic receptor muscarinic 1 activity in the rat ovary with induced ovarian hyperstimulation.

Objective: We look at the immunoreactivity of cholinergic receptor muscarinic 1 (CHRM1) in the ovarian tissues of rats with ovarian hyperstimulation syndrome (OHSS) considering the possibility that the muscarinic activity may contribute to the pathophysiology of OHSS. Materials and Methods: In this study, 14 immature female Wistar Albino rats were divided into two groups at random. The rats were 22 days old. Rats in the control group (n=7) were 22 days old, while those in the OHSS group (n=7) received 10 IU follicle-stimulating hormone subcutaneously over the course of four days and 30 IU human chorionic gonadotropin (hCG) on the fifth day to induce ovarian hyperstimulation. All the rats were sacrificed after all the groups' ovaries and blood samples were collected at the conclusion of the experiment. The left ovarian tissues were kept in aluminum foil at -80 °C, while the right ovarian tissues were kept in 10% formalin. Tissue vascular endothelial growth factor (VEGF), interleukin (IL)-1ß, IL-6, IL-10, tumor necrosis factor (TNF)-α and malondialdehyde (MDA) levels were measured by The Enzyme Linked Immunosorbent Assay technique in the ovarian tissues. CHRM1 immunoreactivity was scored immunohistochemically. Results: Ovarian weight, tissue IL-10, TNF-α, VEGF and MDA levels, and CHRM1 immunoreactivity were significantly increased in the OHSS group. Conclusion: Increased levels of CHRM1 activity may play a role in the pathophysiology of OHSS. With further studies, the effect of luteinizing hormone and hCG on the ovarian and hypothalamic cholinergic system can be further investigated, and useful information can be obtained in determining OHSS prevention strategies.

Elabela levels in pregnancies with intrauterine growth retardation.

OBJECTIVES: The aim of our study is to examine maternal serum Elabela levels in pregnancy with intrauterine growth retardation (IUGR). IUGR is one of the most important causes of perinatal mortality and morbidity. IUGR is also related future comorobidities such as diabetes mellitus, hyperlipidemia, hypertension and coronary artery disease. MATERIAL AND METHODS: Fifty pregnancies diagnosed as IUGR (Group 1) and fifty healthy pregnancies (Group 2) enrolled into the study. Obstetric and demographic characteristics of the patients, serum elabela levels, ultrasound parameters, cord pH value and APGAR scores of the newborns were recorded. In the study, which was planned as a prospective case-control study, an independent t test was used for the evaluation of continuous data and the Mann Whitney U test was used for the statistical evaluation of ordinal data. p < 0.05 was considered significant. RESULTS: The mean gestational age of the cases at delivery was 36.35 ± 1.29 in Group 1 and 38.16 ± 0.94 weeks in Group 2 (p < 0.05). Mean serum Elabela levels were 15.05 ± 9.03 in Group 1 and 8.96 ± 4.33 ng/mL in Group 2 (p < 0.0001). Mean newborn weights were 2498.20 ± 465.92 in Group 1 and 3179.44 ± 387.99 gr. in Group 2 (p < 0.0001). Systolic and diastolic blood pressure measurements taken on the day of delivery were higher in Group 1, and diastolic blood pressure was 77.0 ± 9.53 in Group 1 and 72.60 ± 13.37 mmHg in Group 2 (p < 0.05). Bilateral uterine artery Pulsatile Index (PI) and umbilical artery PI value were significantly higher in Group 1 (p < 0.05), and middle cerebral artery PI and cerebroplacental ratio were significantly lower in Group 1 compared to Group 2 (p < 0.05). Although the cord pH value, 1st and 5th minute APGAR scores were lower in Group 1 compared to Group 2, no statistically significant difference was found (p > 0.05). CONLUSIONS: In our study, it was found that serum Elabela levels increased significantly in pregnancies complicated by IUGR compared to the control group.

Comparison of a novel isthmic circumferential suture and Bakri balloon technique for the treatment of uterine atony during cesarean section.

BACKGROUND: Postpartum bleeding is a life-threatening obstetric complication. The most common cause is uterine atony. There is no method that can treat PPH with 100% effectiveness and therefore, efforts for the development of more effective conservative treatment methods continue. The aim of the study is to compare the effectiveness of the isthmic circumferential suture technique and the Bakri balloon tamponade in the treatment of postpartum bleeding due to uterine atony during cesarean operation. METHODS: This study was conducted by retrospectively evaluating the cases who developed uterine atony during cesarean section. Group 1 (n = 15) consisted of the patients who had undergone the isthmic circumferential suture technique, and Group 2 (n = 15) comprised patients who had undergone the Bakri balloon tamponade. The two groups were compared with regard to obstetric characteristics, operative time, preoperative and postoperative features, and neonatal outcomes. RESULTS: The groups were similar with regard to age, obstetric characteristics, preoperative complete blood count, neonatal outcomes and there was no statistically significant difference between groups. The operative time was significantly shorter in Group 1 (61.86 ± 6.7 vs. 69.53 ± 3.2 min; p < .05). The amount of intraoperative bleeding was lower in Group 1, although there was no statistically significant difference (1793.66 ± 323.96 versus 1886.33 ± 343.23 ml; p > .05). The postoperative blood loss was significantly less in Group 1 compared to Group 2 (101.37 ± 64.6 versus 169.32 ± 50.0 ml; p < .05). The postoperative 24-hour Htc values were significantly higher in Group 1 (28.83 ± 2.1 versus 27.08 ± 2.1 g/dl; p < .05). CONCLUSION: Both methods are effective in the uterine atony during cesarean section. However, due to the shorter operative time and less pre-operative blood loss, the isthmic circumferential suture technique may be a better alternative.

Fetal epicardial fat thickness in fetal growth restriction; effects on fetal heart function and relationship with the severity of disease.

OBJECTIVE: To investigate fetal epicardial fat thickness (EFT) value in fetal growth restriction (FGR) and its relationship with clinical parameters, fetal modified myocardial index (Mod-MPI), and the Doppler parameters. MATERIAL METHODS: Eighty-five pregnant women, with 30 diagnosed with FGR and 55 healthy pregnant women as control group participated in this prospective case-control study. FGR group was divided into 2 subgroups as early (n = 9) and late FGR (n = 21) groups. Demographic data were taken from the medical records. Amnion fluid value, fetal biometric measurements, and Doppler parameters were obtained. Fetal EFT and fetal Mod-MPI were measured by using the echocardiographic methods. The correlation tests were performed to assess the association between EFT and clinical and ultrasonographic parameters. p < .05 was interpreted as statistically significant. RESULTS: EFT value was found statistically lower in the early and late FGR groups than the control group (p = .003). Higher umbilical artery pulsatility index (PI) and lower cerebroplacental ratio (CPR) values were found in the early and late FGR (p < .001, p = .001). The optimal EFT cutoff level to predict FGR disease was measured as 1.25 with 63.3% specificity and 77.4% sensitivity. Lower ejection time (ET) and higher Mod-MPI and isovolumetric contraction time (ICT) values were found in the group FGR with absent UAEDF than in the group FGR with no absent UAEDF (p = .001, p < .000, p < .000, respectively). Correlation tests showed statistically negative and weak correlations among EFT, umbilical artery PI, and mean Ut A-PI (p = .019, p = .019). Positive correlations were found in regard to gestational age, EFW, and EFT (p = .002, p < .000). CONCLUSION: Our study showed that the measurement of EFT may contribute to predicting the diagnosis of FGR. Moreover, lower EFT values can be related to the severity of FGR. Future randomized control studies are needed to understand the effects and pathways of fetal EFT on fetal cardiac function.

Fetal intracranial structures: differences in size according to sex.

OBJECTIVES: We aimed to compare gender difference on sizes of some structures in the brain of normal male and female fetuses between 20 and 22 week gestations. METHODS: A total of 300 female and 300 male singleton pregnancies with low risk were included in the study. Biparietal diameter, head circumference, transcerebellar diameter, cisterna magna, nuchal fold thickness, anterior and posterior horn of lateral ventricles, length and width of cavum septum pellucidum were measured transabdominally. Mean±SD values were calculated and comparison of measurements were done between male and female fetuses. Kolmogorov-Smirnov and independent samples t-test were used for statistical analysis. A value of p<0.05 were accepted as statistically significant. RESULTS: We determined statistically significant difference in sizes of some structures of the brain of male and female fetuses. Mean±SD value of cavum septi pellucidi width was 3.38±0.61 and 3.85±0.96 in female and males, respectively (p<0.05). Male fetuses were also found to have larger anterior (1.92±0.30 vs. 1.58±0.26, p<0.0001) and posterior horn of lateral ventricles (6.00±0.87 vs. 5.53±1.17, p<0.05). CONCLUSIONS: Difference in sizes of some structures of the brain starts in fetal life. This finding may be important in evaluating the intracranial structures more precisely. These results may also give a contribution to the understanding physiological and pathologic differences between males and females.

Transient receptor potential melastatin 2 ion channel activity in ovarian hyperstimulation syndrome physiopathology

Background/aim: Ovarian hyperstimulation syndrome (OHSS) is a complication of ovarian stimulation with increased vascular endothelial growth factor (VEGF) and vascular permeability in the ovarian tissue. Transient receptor potential melastatin 2 (TRPM2) is known to be associated with angiogenesis and vascular permeability. In this experimental study, we aimed to investigate the activity of TRPM2 in the development of OHSS. Materials and methods: Fourteen immature female rats were divided into two groups. Group 1 was the control group, and Group 2 was the OHSS group that was exposed to 10 IU of subcutaneous application of FSH for four days and 30 IU of human chorionic gonadotropin (hCG) on the 5th day. At the end of the experiment, the ovaries were removed. The right ovarian tissues were stored in 10% formol for histopathological and immunohistochemical examination. The left ovarian tissues were stored at ­80 °C for biochemical examinations. VEGF, tumor necrosis factor-alpha (TNF­α) and malondialdehyde (MDA) levels were measured in the ovarian tissue. Congestion, edema, apoptosis and TRPM2 immunoreactivity were evaluated. Results: There was a significant increase in ovarian weight in the OHSS group compared to the control group. There was a significant increase in congestion, edema, apoptosis and TRPM2 immunoreactivity in the OHSS group. A significant increase in tissue levels of VEGF, TNF­α and MDA was also found in the OHSS group compared to the control group. Conclusion: As a result of our experiment, it was found that increased TRPM2 immunoreactivity on hyperstimulated rat ovary may be the reason or result of edema and congestion. Further studies are needed to discuss our results.

Comparison of the efficacy between bilateral proximal tubal occlusion and total salpingectomy on ovarian reserve and the cholinergic system: an experimental study

Background and aim: To compare the effects of bilateral proximal tubal occlusion and bilateral total salpingectomy on ovarian reserve and the cholinergic system via rat experiment. Materials and methods: Twenty-one adult female rats were randomly divided into the following three groups:G1 (n = 7), sham group;G2 (n = 7), bilateral total salpingectomy group; and G3 (n = 7), bilateral proximal tubal occlusion group. Four weeks later, the abdomen of the rats was opened. The right ovarian tissues were stored in 10% formaldehyde, whereas the left ovarian tissues were stored at ­80 °C in aluminum foil. Serum samples were evaluated for antimullerian hormone. The right ovary was used for histological and immunoreactive examination, and the left ovary was used for tissue MDA analysis. Tissue samples were analyzed for MDA levels with spectrophotometric measurement, apoptosis with TUNEL staining, fibrosis score with Mason trichrome staining, ovarian reserve with HE staining, and cholinergic receptor muscarinic 1 (CHRM1) level with immunoreactivity method. Results: Compared to G1 and G3, the number of corpus luteum with secondary follicles was significantly lower in G2, whereas the number of ovarian cysts and fibrosis and apoptosis scores increased significantly. The CHRM1 immunoreactivity was significantly lower in G2 than in G1 and G3. Conclusions: Compared to the bilateral proximal tubal occlusion performed by using bipolar cautery, bilateral total salpingectomy in rats leads to a significant damage in ovarian histopathology and the cholinergic system.