Effects of obesity on the serum BMP15, GDF9, and kisspeptin concentrations in women of reproductive age.

Background: As BMP15, GDF9, and kisspeptin all play critical roles in folliculogenesis and fertilization, investigating the possible relationship between obesity and these three factors could prove crucial in relation to understanding the role of obesity in infertility. Thus, the present study sought to determine the effects of obesity on the serum BMP15, GDF9, and kisspeptin concentrations in women of reproductive age. Methods: Ninety female participants were equally divided into three groups: class-1 obese (n=30), class-2 obese (n=30), and normal weight (control; n=30). The participants' serum BMP15, GDF9, and AMH concentrations were measured. Moreover, the serum kisspeptin concentrations were evaluated in the class-1 obese and control groups by means of the enzyme-linked immunosorbent assay (ELISA) method while the participants were in their menstrual period. Results: The serum BMP15 and kisspeptin concentrations were found to be much higher in the control group than in both obese groups (p=0.001 and p=0.01, respectively). While the GDF9 concentration exhibited a statistically significant positive correlation with age, the BMP15 concentration exhibited a positive correlation with the kisspeptin and LH concentrations in the control group. In addition, a positive correlation was identified between the BMP15 concentration and both age and the glucose level and a negative correlation with the insulin level in both the obese groups. Conclusions: Obesity appears to reduce the serum BMP15 and kisspeptin concentrations in obese women of reproductive age. This reduction may represent a milestone in reproductive dysfunction and may be used to predict the success of infertility treatment in obese women.

Could maternal serum MFG-E8 level predict adverse first trimester pregnancy outcome? A preliminary study.

BACKGROUND: Milk fat globule-epidermal growth factor 8 (MFG-E8) is expressed in the endometrial epithelium and its expression increases during the implantation process. Due to this knowledge, we aimed to investigate the maternal serum MFG-E8 levels on both healthy pregnant women in the first trimester and pregnant women complicated with missed abortion and threatened abortion in the first trimester. METHODS: This prospective, cross-sectional study was conducted in a tertiary referral hospital, department of obstetrics between July 2020 and February 2021 after ethical committee approval. The study population was consisted of 30 healthy pregnant women (HP) in the first trimester, 30 pregnant women suffering from threatened abortion (TA) in the first trimester and 30 pregnant women suffering from missed abortion (MA) in the first trimester. Maternal serum MFG-E8 levels were analyzed with enzyme linked immunosorbent assay. Delivery and neonatal outcomes of the study population was evaluated. The continuous variables were compared among three groups with variance analysis with post hoc tests. The categorical variables were compared with chi-square and Fisher's exact tests where applicable. RESULTS: The mean age of the study population was 29.36 ± 5.31 years. There was no significant difference among three groups for parameters of age, body mass index, parity number, and gestational week. Despite being within normal ranges, the mean neutrophil and international normalized ratio values of the three groups showed statistically significant difference (p < 0.05). The mean maternal serum MFG-E8 levels of MA, TA, and HP groups were 270 ± 152.3, 414.7 ± 236.7, and 474 ± 222.5 ng/mL, respectively (p = 0.001). It was found that mean of MFG-E8 of the MA group was statistically significantly lower than those of the other two groups (p < 0.05). DISCUSSION: Although maternal serum MFG-E8 level seems to be a parameter that differ between live and nonlive pregnancies, studies with large number of cases are needed to discuss our results and to determine a cut-off value for prediction.

Effect of ondansetron for preventing of ovarian hyperstimulation syndrome: in an experimental rat model.

Objective: Ovarian hyperstimulation syndrome is an iatrogenic condition that occurs in the treatment of infertility. There is no specific treatment available for OHSS. Cabergoline is a dopamine receptor 2 agonist and VEGF-VEGF2 receptor antagonist . Recently, cabergoline has been widely used to prevent the development of OHSS and reduce its severity Serotonin is known as a neurotransmitter and thought to have a role in the mechanism of angiogenesis and in signaling in endothelial cells. Serotonin is said to have similar effects to VEGF . Ondansetron is Selective Serotonin (5-HT3) Receptor Antagonist . It works by blocking the action of serotonin, a natural substance that may cause nausea and vomiting. In the clinical practice today, there is no choice other than cabergoline, to prevent occurrence and reduce severity of OHSS, and sometimes its effects are limited. Methods: In our study, we compared the effect of cabergoline and ondansetron. 32 immature rats were used and the OHSS model was created. Parameters such as hematocrit value , ovarian size, the number of follicles in the ovary, endometrial capillary congestion and thickness values were evaluated and compared. Results: As a result, in our study, it was seen that ondansetron was effective on OHSS in many parameters. It is thought to be as effective as cabergoline. When we look at the literature, this is the first study in which ondansetron was evaluated for this purpose. It would be good to show this effect of ondansetron with other studies.

Serum kisspeptin, leptin, neuropeptide Y, and neurokinin B levels in adolescents with polycystic ovary syndrome.

OBJECTIVES: Polycystic ovary syndrome (PCOS) is characterized by ovarian dysfunction, clinical and/or biochemical hyperandrogenism, and polycystic ovaries. Its pathogenesis is still unclear. This study aimed to investigate the relationship between kisspeptin, leptin, neuropeptide Y (NPY), and neurokinin B (NKB) levels for evaluating the pathogenesis of PCOS. METHODS: Levels of these parameters were analyzed in 20 patients with PCOS, and 16 healthy adolescents. RESULTS: Serum NPY levels were significantly higher in the obese and non-obese PCOS group (p<0.01). There was a negative correlation between the kisspeptin and the NKB levels (p<0.01) in the PCOS group but not in the control group. This negative correlation was also found in both PCOS groups (p<0.01). In the obese PCOS group, serum kisspeptin levels were significantly lower than the control and non-obese PCOS groups (p<0.05) although serum leptin and NPY levels were significantly higher in the obese PCOS group (p<0.01). CONCLUSIONS: The high NPY levels in both obese and non-obese patients with PCOS indicate that NPY plays a role in the pathogenesis independently from obesity. Significantly high leptin and low kisspeptin levels in the obese PCOS group suggested that they may be associated with obesity rather than PCOS.

Mature cystic teratoma mimicking meningomyelocele.

Teratomas are benign germ cell tumors originating from at least two germ layers, mostly of ectodermal and mesodermal origin. Mature teratomas are the most common subtype and develop from well-differentiated germ cells. Although the location is extragonadal in infants and young children, gonadal involvement occurs in adults. Midline defects can be diagnosed on prenatal imaging. In this case report, a newborn with mature cystic teratoma and a prenatal lumbar midline closure defect was presented. The perinatal preliminary diagnosis was meningomyelocele. However, a cystic sac containing exophytic solid tumoral tissues approximately 5 × 5 × 3 cm in size was seen macroscopically in the lumbar region after the birth, and this tumor was totally resected. After tumor excision, spina bifida aperta and vertebral exophytic bony tissue compatible with diastematomyelia were observed at the bottom of the surgical field and were totally resected. In the short-term follow-up, no additional problem occurred. The histopathological diagnosis was "mature cystic teratoma." In conclusion, extragonadal teratoma accompanying diastematomyelia could easily be mistaken for meningomyelocele or other common malformations. Perinatal diagnosis should be provided using radiodiagnostic methods, and total surgical excision and accurate pathological diagnosis are essential to avoid the risk of recurrence.

Comparison of Serum Ykl-40 and Ischemia Modified Albulmin Levels Between Pregnant Women with Hyperemesis Gravidarum and Normal Pregnant Women.

INTRODUCTION: The etiopathogenesis of HG is still unclear. AIM: The aim of this study was to investigate the levels of YKL-40 protein as an inflammatory marker and evaluate the levels of IMA as an oxidative marker in hyperemesis gravidarum women. MATERIALS AND METHODS: Totally 35 patients with hyperemesis gravidarum and 35 healthy pregnants were included in the study. Singleton pregnancies between 6+0 week and 13+6 weeks of gestation, with normal fetal anatomy were included in the study. Complete blood count, complete urine analyze, biochemical tests and thyroid function tests were done. RESULTS: There was no significant difference between groups for demographical features (age, gravidity, gestational age, body mass index). Also, there was no statistically significant difference between groups for IMA levels (p>0.05). The median level of YKL-40 was higher in pregnants with hyperemesis gravidarum than normal pregnants but the difference was not statistically significance (p>0.05). CONCLUSION: Further comprehensive studies with more number of patients are needed to show the efficacy of YKL-40 and IMA levels for predicting hyperemesis gravidarum and even monitoring of the treatment.

What is the protective effect of krill oil on rat ovary against ischemia-reperfusion injury?

AIM: In this study, we aimed to investigate the protective effect of krill oil (KO) against ischemia-reperfusion (I/R) injury on rat ovary. METHODS: This study was conducted with 32 Wistar Albino rats. Rats were divided into four groups, with eight rats in each group-as follows: Sham group, I/R group, I/R + low dose KO group (50 mg) and I/R + high dose KO group (500 mg). The histopathological and follicle counts were performed on the right ovary. The total antioxidant status, total oxidant status and oxidative stress index were evaluated on the left ovary. And also serum N-thiol level, serum T-thiol level, serum disulfide (SDS) level, serum disulfide/N-thiol and serum disulfide/T-thiol ratios were evaluated too. RESULTS: A statistically significant difference was determined between the I/R group and all the other groups for all parameters. There was significant difference between KO groups and the Sham group for the parameters of serum N-thiol, serum T-thiol, SDS, serum disulfide/N-thiol and serum disulfide/T-thiol. SDS, total oxidant status and oxidative stress index were determined to be the highest in the I/R group and the lowest in the low dose KO group. The total antioxidant status values were found to be the highest in the high dose KO group and the lowest in the I/R group. Follicle counts and histological injury scores showed no significant difference between Sham and KO groups. CONCLUSION: This study demonstrated that KO has beneficial effects on decreasing the injury after I/R on rat ovary.

Sigmoid Colon Perforation Mimics a Tuboovarian Absces.

INTRODUCTION: An adnexal mass may be diagnosed after a routine pelvic ultrasonographic examination or an emergent hospital admission due to rupture of ectopic pregnancy, adnexal torsion or rupture of tuboovarian abscess. It is necessary to evaluate the origin of the mass initially and to classify patients who need further evaluation and treatment for an urgent condition. CASE PRESENTATION: We report a case of sigmoid colon rupture due to sigmoid colon adenocarcinoma presenting as acute abdomen with left adnexal mass in a 28 years old woman. Abdominopelvic computed tomography revealed a left adnexal mass with suspicion of tuboovarian abscess. In laparatomy, rupture of sigmoid colon was observed and resection of sigmoid colon was performed. Histological examination of resection part revealed diagnosis of sigmoid colon adenocarcinoma due to familial adenomatous polyposis. CONCLUSION: This case may be interesting for clinicians because pelvic pain, fever, increased infection markers in the laboratory and mass at ultrasonography or other screening methods could cause a misdiagnosis of tubaovarian abscess especially in reproductive age women. Before the operation of the pelvic mass of all age women with the diagnosis of tuboovarian abscess other causes of the pelvic abscess should come into mine and necessary preparation for operation must be done.

Association of body mass index and weight gain patterns with albumin excretion in pregnancy.

AIM: We examined body mass index (BMI) and gestational weight gain (GWG) patterns of pregnant women and investigated the impact of these factors on the urinary albumin-creatinine ratio (ACR) during pregnancy. METHODS: The data of 163 women whose basal BMI and ACR were measured during the first trimester were used in this study. Body weight alone between 12-16 weeks and body weight together with ACR after 37 weeks of gestation were measured. RESULTS: Overall, 46% of women were overweight or obese, 60.7% had excessive weight gain and 16.6% had inadequate weight gain. Only 22.7% of women gained weight within the recommended range. There was no difference in weight gain patterns with respect to BMI. ACR during the third trimester was significantly higher than during the first trimester (7.08 [0.00-1180.90] mg/g vs 4.73 [0.00-275.00] mg/g, respectively; P = 0.001). The ACR of obese women was higher than in normal weight subjects during the third trimester (16.79 mg/g [0.01-1180.90] vs 8.07 mg/g [0.10-402.14] respectively; adjusted P = 0.015). Both ACR change and third trimester ACR were weakly but significantly correlated with basal BMI (r: 0.228 P: 0.003 and r: 0.301 P < 0.001, respectively) but not with GWG or GWG rate. Basal BMI was not associated with first-trimester ACR. CONCLUSION: Obesity is associated with an increase in urinary albumin excretion during the course of pregnancy. Distinction of this relationship during pregnancy offers an opportunity for further research on pathophysiological mechanisms. The alarmingly high rate of non-compliance with IOM guidelines in pregnant women is a concern. Prompt measures for counseling of women before and during pregnancy in order to maintain healthy weight are needed.

Plasma lipocalin-2 levels in pregnancy.

UNLABELLED: OBJECTIVE. To evaluate plasma levels of lipocalin-2, which is a novel adipokine associated with obesity and insulin resistance, in pregnant women. DESIGN: Prospective case-control study. SETTING: University hospital. POPULATION: Pregnant women with pre-pregnancy body mass index >25kg/m(2) (overweight; n=29) and body mass index <25kg/m(2) (n=27), whose gestational ages were between 24 and 28 weeks, as study groups and nonpregnant control women with body mass index <25kg/m(2) (n=29). METHODS: Plasma lipocalin-2 levels, fasting plasma glucose and fasting plasma insulin levels; homeostasis model assessment insulin resistance index and fasting plasma glucose/fasting plasma insulin ratio were measured for each subject. MAIN OUTCOME MEASURES: Comparisons among the groups and correlations for lipocalin-2 and the parameters of insulin resistance. RESULTS: Plasma lipocalin-2 levels among the pregnant women were significantly higher than those of the control group (p<0.001 for both group comparisons). Lipocalin-2 levels were significantly higher in the group with pre-pregnancy body mass index >25kg/m(2) compared with the group with pre-pregnancy body mass index <25kg/m(2) (p=0.003). Lipocalin-2 levels were positively correlated with homeostasis model assessment insulin resistance index and fasting plasma insulin and negatively correlated with fasting plasma glucose/fasting plasma insulin ratio in both pregnant groups. CONCLUSIONS: Lipocalin-2 was found to be higher in pregnant women, especially when pre-pregnancy body mass index was >25kg/m(2) , and it was correlated with markers of insulin resistance.

Total and lipid bound sialic acid levels in patients with polycystic ovary syndrome.

OBJECTIVE: To evaluate serum total and lipid bound sialic acid (TSA&LBSA) levels in patients with polycystic ovary syndrome (PCOS). MATERIAL AND METHODS: Forty women with PCOS and 35 healthy controls were enrolled in the study. Serum TSA, LBSA, follicle stimulating hormone, lutenizing hormone, estradiol, thyroid stimulating hormone, prolactin, dehydroepiandrosterone sulphate, androstenedione, free testosterone, total testosterone, 17-OH progesterone, sex hormone binding globulin, cortisol, total cholesterol, triglyceride, high density lipoprotein and low density lipoprotein were measured in each subject. Insulin resistance was estimated by fasting insulin level, fasting glucose: insulin ratio and 75-g glucose tolerance test for 2 hours. RESULTS: Serum TSA levels were not significantly different between the groups. Serum LBSA levels were higher in patients with PCOS compared to the control group. TSA was correlated with androstenedione and HOMA-IR in the PCOS group. Positive correlations were found between LBSA and dehydroepiandrosterone sulphate in patients with PCOS. After correction for BMI, the only existing significant correlation was between LBSA and follicle stimulating hormone. CONCLUSION: Serum LBSA levels, which has previously been found to be higher in cardiovascular diseases and diabetes mellitus, are elevated in PCOS.

Plasma apelin levels in patients with polycystic ovary syndrome.

OBJECTIVE: The aim of the study was to evaluate plasma apelin levels in patients with polycystic ovary syndrome (PCOS) and healthy controls. MATERIAL AND METHODS: Plasma apelin levels, serum lipid levels, serum hormone levels, and homeostasis model assessment-insulin resistance (HOMA-IR) values of 32 patients with PCOS and 31 healthy women forming the control group were checked. RESULTS: Plasma apelin levels of the PCOS group (0.350±0.083 ng/ml) were significantly higher than those of the control group (0.246±0.045 ng/ml) (p<0.001). No significant correlation was detected between apelin levels and biochemical or clinical data in PCOS group. CONCLUSION: Plasma apelin levels were significantly higher in PCOS patients.

Serum paraoxonase 1 activity, asymmetric dimethylarginine levels, and brachial artery flow-mediated dilatation in women with polycystic ovary syndrome.

OBJECTIVE: To evaluate endothelial function via serum asymmetric dimethylarginine (ADMA) levels, paraoxonase 1 (PON1) activity, and brachial artery flow-mediated dilatation (FMD) in women with polycystic ovary syndrome (PCOS). DESIGN: Prospective case-control study. SETTING: University hospital. PATIENT(S): Thirty patients with PCOS with a mean age of 24.33 ± 4.50 years and 30 healthy controls matched for body mass index (BMI) and age. INTERVENTION(S): Endothelial function was assessed biochemically with serum ADMA levels and serum PON1 activity and functionally with brachial artery FMD by ultrasonography. MAIN OUTCOME MEASURE(S): Serum ADMA levels, serum PON1 activity, brachial artery FMD, hormonal and biochemical parameters. RESULT(S): Patients with PCOS had higher levels of free testosterone and insulin, and higher waist-hip ratio and Ferriman Gallwey scores when compared with the controls. Fasting glucose and homeostasis model assessment of insulin resistance were not different between the groups. There was no statistically significant difference in ADMA levels between two groups. Serum PON1 activity and brachial artery FMD were statistically significantly lower in women with PCOS. There was negative correlation between ADMA and PON1 in patients with PCOS. CONCLUSION(S): Serum PON1 activity and brachial artery FMD, as markers of endothelial dysfunction and cardiovascular risk, were statistically significantly lower in women with PCOS compared with healthy controls matched for age and BMI. Endothelial dysfunction may be seen at earlier ages in patients with PCOS.

The effects of oral contraceptives including low-dose estrogen and drospirenone on the concentration of leptin and ghrelin in polycystic ovary syndrome.

OBJECTIVE: To evaluate short-term leptin and ghrelin concentrations in women with polycystic ovary syndrome (PCOS) who use low-dose oral contraceptives containing drospirenone. DESIGN: Prospective study. SETTING: Department of obstetrics and gynaecology in a university hospital. PATIENT(S): Twenty women with PCOS were enrolled in the study. INTERVENTION(S): A low-dose oral contraceptive containing ethinyl estradiol and drospirenone was given for three cycles. MAIN OUTCOME MEASURE(S): Serum androstenedione, free T, T, dehydroepiandrosterone sulphate, sex hormone-binding globulin, FSH, LH, E(2), lipid profiles, leptin, and ghrelin levels were measured in each subject. Insulin resistance was estimated by the homeostasis model assessment-insulin resistance (HOMA-IR). RESULT(S): While leptin concentrations did not change with therapy, ghrelin levels increased statistically. Baseline leptin concentrations were correlated positively with body mass index, waist-to-hip ratio, insulin, and HOMA-IR and negatively with ghrelin. After controlling for body mass index and waist-to-hip ratio in a partial correlation analysis, leptin levels were not correlated with these parameters. Ghrelin was inversely correlated with body mass index, waist-to-hip ratio, insulin, HOMA-IR, and free T. CONCLUSION(S): In patients with PCOS, an oral contraceptive containing ethinyl estradiol and drospirenone increases ghrelin levels but not leptin levels in a 3-month period. Ghrelin might be related to the metabolic and androgenic changes in patients with PCOS.

Comparison of epidural ropivacaine 0.2% and ropivacaine 0.2% in combination with sufentanil 0.75 microg mL-1 for postcaesarean analgesia.

Analgesic techniques after c-section must be effective producing early mobilisation to enable mothers to care effort their babies. In this study, the comparison of ropivacaine 0.2% alone, with ropivacaine 0.2%+sufentanil 0.75 microg mL-1 for patient controlled epidural analgesia (PCEA) was aimed. Fifty women (ASA-I) were enrolled in the study. All patients had combined spinal-epidural anaesthesia. Infusion of analgesic solutions was started when sensory level decreased by two dermatome levels. The patients randomly assigned, into two groups (n=25). In Group-I, ropivacaine 0.2% and sufentanil 0.75 microg mL-1, in Group-II, ropivacaine 0.2% alone were applied (bolus 1.25 mL, lockout 30 min, with 2.5 mL h-1 background infusion). Pain (Visual Analog Scale), motor blockage (Bromage scale) and sedation (Four point scale) were evaluated during 24 hours after Caesarean, using the scales of visual analogue, bromage, and four-point, respectively. Haemodynamic and respiratory parameters, side effects, total drug consumption and additional analgesic need, were recorded. Statistical analysis included student-t, chi-square, and Mann Whitney U tests. There was no difference in demographic data, sedation scores, haemodynamic and respiratory parameters, between the groups. Motor block and pain scores were significantly higher in Group-II than in Group-I at 2 and 4. h. Total drug consumption was 65.24+/-4.20 mL for Group-I and 81.1+/-6.44 mL for Group-II, (P<0.05). Four patients in Group-I and 21 patients in Group-II received additional analgesic. Pruritus was observed more frequently in Group-I. The addition of sufentanil 0.75 microg mL-1 to ropivacaine 0.2% for PCEA after Caesarean led to more effective analgesia and less motor weakness when compared to ropivacaine 0.2% alone, especially during early postoperative period.

Plasma adrenomedullin levels in patients with polycystic ovary syndrome.

OBJECTIVE: To evaluate adrenomedullin levels in patients with polycystic ovary syndrome (PCOS). DESIGN: Prospective study. SETTING: Department of obstetrics and gynecology in a university hospital. PATIENT(S): Thirty-eight women with PCOS and 29 healthy control subjects were enrolled in the study. INTERVENTION(S): Plasma adrenomedullin, serum androstenedione, free T, T, DHEAS, SHBG, thyrotropin, PRL, FSH, LH, and E2 were measured in each subject. Insulin resistance was estimated by fasting insulin level, fasting glucose:insulin ratio and 75-g glucose tolerance test for 2 hours. MAIN OUTCOME MEASURE(S): Plasma adrenomedullin levels and correlations among adrenomedullin and gonadotropins, female sex steroids, androgens, and insulin resistance. RESULT(S): There was no significant difference concerning plasma adrenomedullin concentrations between the groups. In patients with PCOS, fasting glucose, fasting insulin, body mass index, and free T were inversely correlated with the plasma adrenomedullin. Plasma adrenomedullin was significantly correlated with glucose:insulin ratio. After controlling for body mass index, there were no significant correlations between the above-mentioned parameters. CONCLUSION(S): Adrenomedullin may play a role in regulating the insulin metabolism in patients with PCOS.

The association of serum androgens and insulin resistance with fat distribution in polycystic ovary syndrome.

OBJECTIVE: The aim of the study was to compare the body fat distribution of women with polycystic ovary syndrome (PCOS) with age and body mass index matched healthy controls and to investigate if androgens and insulin resistance associated with fat distribution. STUDY DESIGN: Thirty-three PCOS and 21 age and body mass index (BMI) matched healthy control women were evaluated in terms of body fat distribution with dual X-ray absorpsiometry (DEXA). Blood samples were obtained for follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, thyroid stimulating hormone (TSH), dehydroepiandrosterone-sulfate (DHEA-S), free testosterone, sex hormone binding globulin (SHBG), insulin and glucose levels. A 75 g 2 h glucose tolerance test was performed for each woman. Insulin resistance was estimated by fasting insulin level, fasting glucose/insulin ratio and 75 g 2 h glucose tolerance test. The Student's t-test and Mann-Whitney U-test were used to compare the groups. Pearson and Spearman rank correlation coefficients were calculated for normally and nonnormally distributed variables, respectively. Partial correlation coefficients were calculated using age and BMI as covariates. RESULTS: Fat mass in trunk and arms were significantly higher in patients with PCOS (p < 0.043 and 0.036, respectively). The ratio of fat mass in trunk to fat mass in legs were significantly higher in patients with PCOS (p < 0.011). Free testosterone was found to be positively correlated with fat mass in arms (r = 0.401, p < 0.05). There was still significant correlation between free testosterone and fat mass in arms (r = 0.5964, p < 0.05) after controlling for age and BMI. CONCLUSION: Free testosterone level is positively correlated with the fat mass in arms in women with PCOS.

The effects of hormone therapy, estrogen therapy and tibolone on apoptosis and cyclin D1 expression in postmenopausal vaginal epithelium.

OBJECTIVE: To investigate the effects of hormone therapy, estrogen therapy and tibolone on markers of apoptosis including bcl-2, and bax and cyclin D(1) expression in postmenopausal vaginal epithelium. STUDY DESIGN: Thirty postmenopausal women were randomized to the treatment protocols (0.625 mg conjugated equine estrogen (CEE) + 2.5 mg medroxyprogesterone acetate (MPA); 2mg estradiol valerate; 2.5mg tibolone). After baseline vaginal biopsy, control biopsies were performed after 70 days following the initiation of the therapy. Bcl-2, bax, Bcl-2/bax ratio, cyclin D(1) measurements were performed immunohistochemically. Data were analyzed by Kruskal-Wallis, Mann-Whitney U and Wilcoxon tests. RESULTS: After the treatment period the above-mentioned parameters were not different among the groups except for cyclin D(1) levels. Cyclin D(1) expression was found to be strong in patients with treated estradiol valerate. CONCLUSIONS: The effects of estrogen on cyclin D(1) expression were not detected with tibolone or with the addition of progesterone to estrogen in the vaginal epithelium. Cyclin D(1) appeared to have stronger effects on the estrogen related proliferation compared to apoptotic markers in vaginal epithelial cells.

Urinary neopterin levels in the different stages of pregnancy.

BACKGROUND/AIMS: Neopterin is a biochemical marker of activated cell-mediated immune response which increases in pathological conditions associated with cellular immune activation as well as in pregnancy where cellular immune response is predominant. The aim of this study was to determine the urinary neopterin level in each trimester of pregnancy and to determine if it can be used as a marker. METHODS: 104 healthy pregnant women (mean age 22.10 +/- 4.39 years; 36 in the first, 30 in the second and 38 in the third trimester) and 16 non-pregnant healthy women (mean age 20.94 +/- 4.48 year) were included. RESULTS: The mean urinary neopterin concentration of all pregnant women was higher than that of non-pregnant women (166.4 +/- 31.7 and 103.1 +/- 27.5 micromol/mol creatinine respectively, p < 0.01). The mean urinary neopterin levels in each trimester and non-pregnant women were 139.8 +/- 49.6, 131 +/- 40.2, 227.9 +/- 86.5 and 103.1 +/- 27.5 micromol/mol creatinine, respectively. Urinary neopterin levels were not significantly different between non-pregnant, first and second trimester groups, but were significantly higher in the third trimester than each of these groups (p < 0.05, p < 0.01 and p < 0.01 respectively). CONCLUSION: Urinary neopterin levels increase significantly in the third trimester probably due to more predominated cellular immunity. The pathologies causing cellular immune activation, especially in the first two trimesters can be predicted with urinary neopterin levels.