The novel predictor of metabolic risk in patients with polycystic ovary syndrome: could it be the visceral adiposity index?

OBJECTIVE: Polycystic ovary syndrome (PCOS) is the most common endocrinological disorder in women of reproductive age, often accompanied by high androgen levels, irregular menstrual cycles and polycystic ovaries. In addition, patients with PCOS also present with an increase in abdominal adipose tissue and insulin resistance. Recently, the gender-specific mathematical formulation called visceral adiposity index (VAI) has been widely used in assessing cardiometabolic risk. This study aimed at comparing the VAI values of patients with PCOS, patients with idiopathic hirsutism (IH) and a control group. PATIENTS AND METHODS: We obtained demographic data, laboratory results and anthropometric measurements of patients from the hospital database. We retrospectively grouped all cases included in the study as PCOS (n = 52), IH (n = 57) and control (n = 58) according to the diagnoses. We also took venous samples for hormone and biochemical tests in the early follicular phase of the menstrual cycle, at least 8-10 hours after fasting in the early morning hours. Finally, we evaluated the variables using SPSS 22.0 software (IBM Corp., Armonk, NY, USA). RESULTS: We included 167 female individuals in the study. Of these, 57 (34.1%) were diagnosed with IH, while 52 (31.1%) were diagnosed with PCOS. The control group comprised 58 (34.8%) healthy female individuals. The median age of the study group was 25 years [interquartile range (IQR) = 8 years]. The age, height, weight, body mass index (BMI) and waist circumference values of the groups were similar. We found that the VAI values among the groups were significantly different (p = 0.028). Post-hoc analysis determined that this was due to the difference between the group with PCOS and the control group. In addition, we found significantly high HOMA-IR, fasting insulin and androgen levels in the group with PCOS (p < 0.001). CONCLUSIONS: After comparing data in groups with similar BMI levels, we found significantly high VAI values in patients with PCOS. The results reinforce the idea that VAI is a useful marker easily obtained in daily practice for assessing the cardiometabolic risk of patients with PCOS.

Identification of Schizosaccharomyces pombe ird Mutants Resistant to Glucose Suppression and Oxidative Stress.

Glucose is both the favourite carbon and energy source and acts as a hormone that plays a regulating role in many biological processes. Calorie restriction extends the lifespan in many organisms, including Schizosaccharomyces pombe, while uptake of high glucose leads to undesired results, such as diabetes and aging. In this study, sequence analysis of Schizosaccharomyces pombe ird5 and ird11 mutants was performed using next-generation sequencing techniques and a total of 20 different mutations were detected. ird11 is resistant to oxidative stress without calorie restriction, whereas ird5 displays an adaptive response against oxidative stress. We selected nine candidate mutations located in the non-coding (6) and coding (3) region among a total of 20 different mutations. The nine candidate mutations, which are thought to be responsible for ird5 and ird11 mutant phenotypes, were investigated via forward and backward mutations by using various cloning techniques. The results of this study provide report-like information that will contribute to understanding the relationship between glucose sensing/ signalling and oxidative stress response components.

Cesarean section: requested mode of delivery?.

AIM: To constitute accurate policies for reducing the cesarean section (C/S) the authors evaluated the attitudes and knowledge of health workers and public population towards the mode of delivery, C/S on demand, and delivery complications in a large population. MATERIALS AND METHODS: 1,892 female volunteers in reproductive age were enrolled in the study and 589 of them were health workers. Patients were evaluated with questionnaire about their delivery mode and their answers were analyzed. RESULTS: The overall cesarean rate of the study population was 45.4%. This rate were 51.4% and 28.2%, respectively, for the health workers and public group (p < 0.001). Medical indication ratio ivere 57.7% and 40.1% for the healthcare group and the public population respectively and 20.2% of health workers and 13.9% of the public group had C/S by their preference without any medical indications (p < 0.001). CONCLUSION: C/S rate is high in Turkey and an action plan is needed to decrease the rate. When a patient's preference towards the mode of the delivery is C/S on demand, obstetricians, in their capacity as patient advocate, should help guide their patient through the sophisticated detailed medical information toward a decision that respects both the patient's attitude and the physician's obligation to optimize the health of both the mother and the newborn.

Red blood cell distribution width: can it be a predictive marker for long-term valvular involvement in children with acute rheumatic carditis?

INTRODUCTION: In this study, we aimed to evaluate Red blood cell distribution width (RDW) in patients with acute rheumatic carditis during the acute phase and after anti-inflammatory therapy. METHODS: Pediatric patients diagnosed with acute rheumatic carditis (ARC) between 2006 and 2014 and age- and sex-matched controls were retrospectively analyzed. At the time of diagnosis and after 2 months of medical therapy, we reviewed the obtained demographic features; echocardiographic data; complete blood count reports, including RDW; acute phase reactants, including C-reactive protein; and erythrocyte sedimentation rate values. RESULTS: The number of the cases with ARC and age- and sex-matched controls were 100 and 110, respectively. The mean age of patients was 11.6 ± 2.5 years. WBC and platelet counts, RDW were found to be significantly higher in patient group compared with controls at the time of diagnosis, prior to the onset of treatment. RDW, platelet count, CRP, and ESR levels significantly decreased after an 8 weeks of medical treatment. RDW values after the medical treatment were still significantly higher compared with controls. RDW values were significantly higher in patients with multiple valvular involvement both prior to and after the treatment. Moreover, we found a significant and positive correlation between the RDW and the severity of mitral regurgitation in our patients (r: 0.46, P < 0.001). CONCLUSIONS: High levels of RDW after initial medical treatment may indicate an ongoing subtle inflammatory process that leads to future stenotic valvular lesions. However, long-term follow-up studies are needed involving adulthood period to support this hypothesis.

Hypertrophic Cardiomyopathy as a Clinical Component of Congenital Cytomegalovirus Infection.

We report hypertrophic cardiomyopathy in a newborn with congenital cytomegalovirus infection. The neonate had distinct signs of congenital cytomegalovirus infection including petechiae, jaundice, intracranial calcifications, cerebral ventriculomegaly and chorioretinitis together with hypertrophic cardiomyopathy. Following determination of anti-cytomegalovirus IgM, viral DNA was also isolated from the plasma of the patient by polymerase chain reaction. Although cytomegalovirus is a relatively frequent cause of myocarditis in childhood, it was rarely reported to be associated with cardiac abnormalities such as structural heart disease, atrioventricular block, or dilated cardiomyopathy. To our knowledge, this is the first case with congenital cytomegalovirus infection and hypertrophic cardiomyopathy.

In contrast to leptin, serum concentrations of ghrelin are not related to premenstrual syndrome.

OBJECTIVE: Premenstrual syndrome (PMS) is a disorder related to mood and appetite changes during the premenstrual phase. Unfortunately, the understanding of the pathophysiology of PMS is quite poor. Though, ghrelin and leptin play important roles in the control of food intake. The aim of this study was to evaluate leptin and ghrelin serum concentrations in PMS patients. PATIENTS AND METHODS: Forty-five PMS patients diagnosed according to ICD-10 diagnostic criteria and 45 healthy women as a control group, were included in the study. These groups were matched for age, body mass index and duration of menstrual cycle. Symptoms of the patients were evaluated using "Menstrual Distress Questionnaires". Serum leptin and ghrelin serum concentrations were measured using ELISA in the postmenstrual phase (5-9 days) and 2-3 days before menstruation. Mann-Whitney U test, independent sample t-test and Wilcoxon test were used for statistical analyses. RESULTS: In the PMS group, there was no difference in the serum concentrations of ghrelin; however, leptin serum concentrations were 31.05 (± 14.16) and 16.42 (± 15.81) ng/ml during the premenstrual and postmenstrual periods, respectively (p < 0.05). Ghrelin serum concentrations in the premenstrual period were 6.9 (± 9.3) ng/ml in the PMS group and 8.8 (± 9.3) ng/ml in the control group, but this difference was not statistically significant (p = 0.79). CONCLUSIONS: Ghrelin serum concentrations were not associated with PMS, while leptin serum concentrations were found to be higher in the premenstrual period in PMS patients. Though, these two hormones work antagonistically to control the food intake and body weight, we suggest that this function is not relevant to PMS.

Perinatal outcomes of borderline diabetic pregnant women.

We examined the perinatal outcomes of borderline diabetic pregnant women who had impaired 50 g oral glucose challenge test (OGCT) results, but normal 100 g oral glucose tolerance test (OGTT) results. Our study group included 70 pregnant women who had increased 50 g OGCT results, but normal 100 g OGTT results, and a control group of 122 pregnant women with normal 50 g OGCT results. Polyhydramnios, macrosomia and neonatal birth weight were significantly higher in the study group. After adjusting the results for possibly affecting variables, the risk of polyhydramnios remained significant, while the risk of macrosomia and neonatal birth weight was not significant between the groups. The results from the study group were similar to the control group, when adjusted for other risk factors. Increased 50 g OGCT results in pregnant women can be accepted as a benign state if the 100 g OGTT results are normal.

The effects of ischaemic preconditioning on ovarian apoptosis and p53 expression during laparoscopy.

We aimed to explore the effects of ischaemic preconditioning (IP) used to reduce ischaemic injury during laparoscopy on ovarian apoptosis and p53 expression. A total of 32 rats were randomly allocated into four groups consisting of eight in each as follows: Group I was subjected to a sham operation without pneumoperitoneum (Pp). Group II was subjected to 5 min of Pp with 15 mmHg pressure of CO(2) followed immediately by 5 min of deflation, after that, 60 min of Pp and deflation. Group III was subjected to 10 min of Pp and deflation. Group IV was subjected to 60 min of Pp and deflation. The ovarian tissues were histologically and immunohistochemically processed. The number of apoptotic and p53(+) cells were measured. All the data revealed that ovarian apoptosis and p53 expression were highest in group IV. Apoptotic cells and p53(+) cells were lower in IP groups. Additionally, group II had significantly lower p53(+) cells compared with group III. Pp induces higher amount of apoptosis and p53 expression in ovary but preconditioning may have protective effects during laparoscopy. Furthermore, 5 min of preconditioning may be more effective. Therefore, the effects of Pp and preconditioning should be considered for the ovary during laparoscopy.

Squamous cell carcinoma arising in a mature cystic teratoma of the ovary in young patient with elevated carbohydrate antigen 19-9.

Squamous cell carcinoma is the most common type of malignant transformation in mature cystic teratomas. It mainly effects postmenopausal women but is rarely seen in young patients. Carbohydrate antigen 19-9 (CA19-9) tumor marker is a high-molecular-weight glycoprotein, frequently elevated in gastrointestinal adenocarcinomas. CA19-9 levels can increase in both dermoid cysts and in malignant transformation of dermoid cysts. Herein we report a case of squamous cell carcinoma originating from a dermoid cyst in a 31-year-old, gravida 0, para 0, single woman with high levels of CA19-9 and normal levels of CEA. Preoperative CA19-9 was 1000 U/ml (normal range below 27 U/ml). The patient underwent unilateral salpingo-oophorectomy, omentectomy, appendectomy, pelvic and paraaortic lymphadenectomy. After the pathologic analysis of the material, the patient was categorized as FIGO Stage IIa due to metastasis to the left tube. She received six cycles of cisplatin and paclitaxel at 21-day intervals. The postoperative first day, second month, and sixth month CA19-9 values were 602 U/ml, 33.5 U/ml and 22.3 U/ml, respectively. She is now doing well without recurrence of disease six months after the surgery. Squamous cell carcinomas originating from dermoid cysts are rare tumors especially seen in elderly patients with high levels of tumor markers (like CEA, SCCA). Every case may not have the same characteristics and management should be individualized.

Laparoscopic management following ultrasonographic-guided drainage in a patient with giant paraovarian cyst.

BACKGROUND: Giant and paraovarian cysts are unusual masses that are usually treated by laparotomy. The safety of laparoscopic management of benign paraovarian cysts has been demonstrated, but it is believed that the size of benign paraovarian cysts is a limiting factor for laparoscopic surgery. METHODS: We describe a new technique for the laparoscopic removal of a giant and benign paraovarian cyst in a 40-year-old woman. A paraovarian cystic mass was detected on the right part of her body that extended to the liver. It was confirmed on both ultrasonography and computed tomography scans. After ultrasound-guided aspiration of the cyst, the mass was resected laparoscopically. RESULTS: No complications were noted during or after the surgical procedure. The patient was discharged on postoperative day 2. CONCLUSIONS: Laparoscopic surgery can be safely applied in patients with giant and benign paraovarian cysts.

In vitro glucuronidation of xanthohumol, a flavonoid in hop and beer, by rat and human liver microsomes.

Xanthohumol (XN) is the major prenylated flavonoid of hop plants and has been detected in beer. Previous studies suggest a variety of potential cancer chemopreventive effects for XN, but there is no information on its metabolism. The aim of this study was to investigate in vitro glucuronidation of XN by rat and human liver microsomes. Using high-performance liquid chromatography, two major glucuronides of XN were found with either rat or human liver microsomes. Release of the aglycone by enzymatic hydrolysis with beta-glucuronidase followed by liquid chromatography/mass spectrometry and nuclear magnetic resonance analysis revealed that these were C-4' and C-4 monoglucuronides of XN.

In vitro biotransformation of xanthohumol, a flavonoid from hops (Humulus lupulus), by rat liver microsomes.

Xanthohumol (XN) is the major prenylated flavonoid of the female inflorescences (cones) of the hop plant (Humulus lupulus). It is also a constituent of beer, the major dietary source of prenylated flavonoids. Recent studies have suggested that XN may have potential cancer-chemopreventive activity, but little is known about its metabolism. We investigated the biotransformation of XN by rat liver microsomes. Three major polar metabolites were produced by liver microsomes from either untreated rats or phenobarbital-pretreated rats as detected by reverse-phase high-performance liquid chromatography analysis. Liver microsomes from isosafrole- and beta-naphthoflavone-pretreated rats formed another major nonpolar metabolite in addition to the three polar metabolites. As determined by liquid chromatography/mass spectrometry and (1)H NMR analyses, the three major polar microsomal metabolites of XN were tentatively identified as 1) 5"-isopropyl-5"-hydroxydihydrofurano[2",3":3',4']-2',4-dihydroxy-6'-methoxychalcone; 2) 5"-(2"'-hydroxyisopropyl)-dihydrofurano[2",3":3',4']-2',4-dihydroxy-6'-methoxychalcone; and 3) a derivative of XN with an additional hydroxyl function at the B ring. The nonpolar XN metabolite was identified as dehydrocycloxanthohumol.

Evaluation of genotoxic potential of styrene in furniture workers using unsaturated polyester resins.

Styrene is a widely used chemical, mostly in making synthetic rubber, resins, polyesters, plastics and insulators. Increasing attention has been focused on this compound since experiments using cytogenetic end-points have implicated styrene as a potential carcinogen and mutagen. In order to perform biological monitoring of genotoxic exposure to styrene monomer, we evaluated the urinary thioether (UT) excretion, and sister chromatid exchanges (SCEs) and micronuclei (MN) in peripheral lymphocytes from 53 furniture workers employed in small workplaces where polyester resin lamination processings were done and from 41 matched control subjects. The mean air concentration of styrene in the breathing zone of workers was 30.3 ppm. As a metabolic marker for styrene exposure, mandelic acid + phenylglyoxylic acid was measured in the urine and the mean value was 207 mg/g creatinine. The mean +/- SD value of UT excretions of workers was 4.43 +/- 3.42 mmol SH-/mol creatinine and also mean UT for controls was found to be a 2.75 +/- 1.78 mmol SH-/mol creatinine. The mean +/- SD/cell values of SCE frequency in peripheral lymphocytes from the workers and controls were 6.20 +/- 1.56 and 5.23 +/- 1.23, respectively. The mean +/- SD frequencies (%o) of MN in the exposed and control groups were 1.98 +/- 0.50 and 2.09 +/- 0.35, respectively. Significant effects of work-related exposure were detected in the UT excretion and SCEs analyzed in peripheral blood lymphocytes (p < 0.05 and p < 0.01, respectively). The MN frequency in lymphocytes from the styrene-exposed group did not differ from that in the controls (p > 0.05). Effect of smoking, age and duration of exposure on the genotoxicity parameters analyzed were also evaluated. In conclusion, although our data do not demonstrate a dose-response relationship, they do suggest that styrene exposure was evident and that this styrene exposure may contribute to the observed genotoxic damage in furniture workers.