Elevated circulating levels of secreted frizzled-related protein 4 in relation to insulin resistance and androgens in women with polycystic ovary syndrome.

PURPOSE: Secreted frizzled-related protein 4 (SFRP4) is an adipokine involving in apoptotic process during ovulation and energy metabolism. Polycystic ovary syndrome (PCOS) is a common reproductive and metabolic disorder associated with insulin resistance and impaired oocyte maturation as well as apoptotic dysfunctions through oocyte development. Our aim was to determine whether there was an alteration in levels of SFRP4 and if there was an association between metabolic or hormonal parameters and SFRP4 in women with PCOS. METHODS: We enrolled 80 subjects with PCOS and 80 age- and body mass index (BMI)-matched subjects with normal menstrual cycle into current case-control study. Metabolic and hormonal parameters of enrolled subjects were determined. Circulating SFRP4 levels were measured with ELISA method. RESULTS: We found that circulating SFRP4 levels were elevated in women with PCOS with respect to controls (5.87 ± 1.91 vs. 3.72 ± 1.29 ng/ml, P < 0.001). We also found a positive association between SFRP4 and insulin resistance, androgens, ovarian follicular number or ovarian volume in women with PCOS. Binary logistic regression analysis revealed that subjects with the highest tertile of SFPR4 levels displayed increased possibility of having PCOS risk compared to those subjects with the lowest tertile of SFRP4 levels. CONCLUSIONS: Increased SFRP4 levels were not only associated with higher possibility of having PCOS but also related to insulin resistance, hyperandrogenism, ovarian follicular number and ovarian volume, suggesting that SFPR4 could be a player in different pathophysiologic pathways of PCOS.

Circulating insulin-like peptide 5 levels and its association with metabolic and hormonal parameters in women with polycystic ovary syndrome.

PURPOSE: Insulin-like peptide 5 (INSL5) is a gut peptide hormone that is a member of relaxin/insulin superfamily. Growing evidence implicates the crucial role of the peptide in some metabolisms including food intake, glucose homeostasis and reproductive system. Polycystic ovary syndrome (PCOS) is involved in both reproductive and metabolic issues. The aim of the study was determination of circulating levels of INSL5 alteration in women with PCOS and evaluation of the relationship between INSL5 and hormonal-metabolic parameters as well as carotid intima media thickness (cIMT). METHODS: A total of 164 subjects were recruited in this cross-sectional study (82 women with PCOS and 82 age- and BMI-matched controls). Circulating INSL5 levels were assessed via ELISA method. High-resolution B-mode ultrasound was used to measure cIMT. The hormonal and metabolic parameters of the recruited subjects were determined. RESULTS: Circulating INSL5 levels were significantly elevated in women with PCOS compared to controls (27.63 ± 7.74 vs. 19.90 ± 5.85 ng/ml, P < 0.001). The mean values of INSL5 were significantly higher in overweight subjects compared to lean weight subjects in both groups. The women with PCOS having insulin resistance have increased INSL5 compared to those of PCOS subjects without insulin resistance. INSL5 is associated with insulin resistance, BMI, luteinizing hormone and free androgen index. Multivariate logistic regression analyses revealed that the odds ratio for having PCOS in the highest tertile of INSL5 was higher than in the lowest tertile. CONCLUSIONS: PCOS subjects exhibited an elevation in circulating INSL5 levels along with a link between INSL5 level induction and metabolic-hormonal parameters.

A possible connection between tumor necrosis factor alpha and adropin levels in polycystic ovary syndrome.

CONTEXT: Adropin is a peptide hormone implicated in the regulation of insulin sensitivity and energy homeostasis. Polycystic ovary syndrome (PCOS) is a metabolic and reproductive disease associated with insulin resistance. It has been demonstrated that various inflammatory markers increased in PCOS including TNF-α. TNF-α regulates the secretion of certain peptides which play a crucial role in glucose and lipid homeostasis. There is also some evidence of a link between TNF-α and adropin. OBJECTIVE: To ascertain whether there is an association between circulating adropin levels and TNF-α in PCOS. PATIENTS AND DESIGN: 152 women with PCOS and 152 age- and body mass index-matched controls without PCOS were recruited for this cross-sectional study. MAIN OUTCOME MEASURES: Adropin and TNF-α levels were measured using ELISA. RESULTS: Adropin levels were lower in the PCOS group compared with the control group (7.43 ± 0.79 vs. 9.42 ± 0.76 ng/ml, P < 0.001), whereas TNF-α levels were higher (49.93 ± 3.39 vs. 35.83 ± 2.47 pg/ml, P < 0.001). A strongly negative correlation was found between circulating adropin levels and TNF-α levels in women with PCOS (r = -0.407, P < 0.001). Binary logistic regression analysis revealed that decreased adropin levels were significantly associated with high odds of having PCOS, although, after adjustment for TNF-α, this link vanished. Additionally, multiple linear regression analysis showed that HOMA-IR and TFN-α independently predicted adropin levels. CONCLUSIONS: Serum adropin levels are significantly decreased in PCOS and are inversely associated with TNF-α. Further dissection of the nature of this association can open new therapeutic options for metabolic diseases.

Using the LigaSure vessel sealing device in the large uterus at laparoscopic hysterectomy.

OBJECTIVE: To compare intraoperative hemorrhage and other operative parameters between patients with large and small weighted uterus who underwent laparoscopic hysterectomy (LH). MATERIALS AND METHODS: Forty-six patients intending to have LH were divided into two groups according to uterine weight (group 1 > 300 grams vs. group 2 < 299 grams). Intraoperative blood loss, operating time, periopera- tive complications, and duration of hospitalization were compared. RESULTS: Intraoperative blood loss was significantly higher in the large uterus group (group 1); 350 (227-454) ml vs. 250 (182-320) ml (p < 0.001). However, it was not significantly different between the groups in the laparoscopy step. Mean operating time was 90 (77-103) minutes and 80 (62-98) minutes in groups 1 and 2, respectively (p < 0.001) revealing ten-minute delay in group 1. Similarly, this was also not significantly different in the laparoscopy step. No significant differences were found between two groups; in terms of hemoglobin concentration decrease, major and minor complications, and hospitalization duration. CONCLUSION: The authors conclude that LigaSure can be safely used for LH in patients with a large uterus.

Acupuncture relieves symptoms in chronic prostatitis/chronic pelvic pain syndrome: a randomized, sham-controlled trial.

BACKGROUND: There are multiple approaches to the management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS); and lately the data suggesting the ability of acupuncture treatment to decrease pain, positively impact quality of life and potentially modulate inflammation has suggested it as a potential therapeutic option for men with CP/CPPS. We conducted this study to determine whether acupuncture is really an effective therapeutic modality for CP/CPPS in terms of >50% decrease in total National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score from baseline compared with sham. METHODS: One hundred patients with CP/CPPS (category III B) in an outpatient urology clinic were randomized to receive acupuncture at either seven acupoints bilaterally or sham points adjacent to these points. NIH-CPSI was completed by each patient before and 6, 8, 16, 24 weeks after the treatment. Mean values of total CPSI score and subscores after the treatment and on follow-up following the treatment were compared. RESULTS: Of the acupuncture participants, 92% were NIH-CPSI responders (>50% decrease in total NIH-CPSI score from baseline) compared with 48% of sham participants, 8 weeks after the end of the therapy. Both groups experienced significant decrease in CPSI subscores throughout the whole follow-up period; however, the decline remained significantly greater in the active acupuncture group as compared with the sham group. CONCLUSIONS: Our results show that the use of acupuncture in treatment of men with CP/CPPS symptoms resulted in a significant decrease in total NIH-CPSI scores.

Selenium prevents lipid peroxidation in liver and lung tissues of rats in acute swimming exercise.

BACKGROUND: Selenium, which is critical for human health, is necessary for various metabolic processes, including thyroid hormone metabolism, protection against oxidative stress, and immune function. OBJECTIVE: The present study aims to examine how selenium administration affects lipid peroxidation in liver and lung tissues of rats subjected to acute swimming exercise. METHODS: The study included 32 Spraque-Dawley adult male rats divided into Group 1 (general control), Group 2 (selenium-administered), Group 3 (swimming), and Group 4 (selenium-administered swimming). MDA and GSH levels were determined in liver and lung tissues. RESULTS: The highest MDA values in the liver and lung tissues were found in group 3 in the study. MDA value in group 4 was higher than those in groups 1 and 2. Group 4 had the highest liver and lung GSH levels. GSH levels in Group 3 were higher than those in groups 1 and 2. CONCLUSION: Results of the study indicate that acute swimming exercise causes lipid peroxidation in liver and lung tissues, while selenium administration prevents free radical formation by increasing antioxidant activity (Tab. 2, Ref. 26).

Effect of melatonin on element distribution in the liver tissue of diabetic rats subjected to forced exercise.

The objective of the present study was to investigate the effects of melatonin supplementation on elements in the liver of diabetic rats subjected to acute swimming exercise. Eighty adult male rats were equally divided into eight groups. Group 1, general control. Group 2, melatonin-supplemented control. Group 3, melatonin-supplemented diabetic control. Group 4, swimming control. Group 5, melatonin-supplemented swimming. Group 6, melatonin-supplemented diabetic swimming. Group 7, diabetic swimming. Group 8, diabetic control. Liver tissue samples were analyzed for lead, cobalt, molybdenum, chrome, sulphur, magnesium, manganese, sodium, potassium, phosphorus, copper, iron, calcium, zinc, selenium. The highest cobalt, chrome values were found in the groups 7, 8 and the groups 5, 6 respectively. Groups 3 and 7 had the highest copper values. Iron and potassium values were higher in the groups 1 and 4. Group 6 had increased magnesium value, and groups 6, 7, 8 were found to have the highest manganese levels. The highest lead values were found in the groups 5 and 6. Group 6 had the highest selenium levels. The highest zinc levels were established in 1 and 2. Groups 1, 2, 5 and 6 were found to have the highest calcium values. The results of our study indicate that melatonin supplementation in diabetes and forced exercise significantly alters the element metabolism in the liver (Tab. 3,Ref. 33).

The effect of selenium supplementation on elements distribution in liver of rats subject to strenuous swimming.

The present study aims to explore how selenium supplementation affects the element distribution in the liver tissue of rats subjected to strenuous swimming exercise. Thirty-two Spraque-Dawley male rats were equally divided into the four groups: Group 1, normal control group. Group 2, selenium-supplemented, non-swimming (0.6 mg/kg/day sodium selenite) group. Group 3, swimming, no supplementation group. Group 4, swimming, selenium-supplemented (0.6 mg/kg/day sodium selenite) group. After one month, the animals were decapitated and liver tissue samples were collected to determine the levels of lead, cobalt, boron, molybdenum, chromium, sulfur, magnesium, sodium, potassium, phosphorus, copper, iron, zinc and selenium. The chromium, molybdenum, iron, sodium and potassium values were higher in the swimming groups, relative to controls. Group 3 had significantly lower lead levels (p<0.001). The highest cobalt levels were obtained in the Group 1 and that of the Group 2 was higher than in the Groups 3 and 4. The boron values in the Group 3 were higher than those in all other groups. The copper and magnesium levels were higher in the Groups 3 and 4, compared to the Groups 1 and 2. The highest phosphorus levels were found in the Group 1. The highest selenium and zinc values were obtained in the Group 2 and those of the Group 4 were higher than in the Groups 1 and 3. Group 1 had higher selenium and zinc levels than the Group 3. The results of the present study demonstrated that selenium-supplemented rats subjected to strenuous swimming exercise had distinct elements distribution in liver tissue. Also, selenium supplementation offsets the decrease in zinc levels in rats subjected to vigorous swimming (Tab. 3, Ref. 20).

Protective effect of melatonin on lipid peroxidation in various tissues of diabetic rats subjected to an acute swimming exercise.

BACKGROUND: The present study aimed to explore the effect of melatonin administration on lipid peroxidation in various tissues of rats with streptozocin induced diabetes and subjected to an acute swimming exercise. METHODS: The study used 80 adult male rats, which were equally allocated to 8 groups: Group 1, general control; Group 2, melatonin-administered control; Group 3, melatonin-administered diabetic control; Group 4, swimming control; Group 5, melatonin-administered swimming; Group 6, melatonin-administered diabetic swimming; Group 7, diabetic swimming; Group 8, diabetic control. Diabetic rats were administered 3 mg/kg/day ip melatonin for 4 weeks. At the end of the study, the animals were decapitated to collect samples from liver, lung and spleen tissues, which were then analyzed to determine levels of liver MDA (nmol/gram/protein) and GSH (mg/g/protein). RESULTS: The highest MDA values in liver, lung and spleen tissues were obtained in the Group 7. The values in the Group 8 were lower than those in the Group 7, but higher than in all other groups. The Group 5 and 6 had the highest liver, lung and spleen GSH values. CONCLUSION: Results obtained from the study indicate that the increase in free radical production and the inhibition of antioxidant activity in diabetes and acute exercise are both prevented by melatonin administration (Tab. 2, Ref. 30).

The efficacy of dinoprostone vaginal insert for active management of premature rupture of membranes at term: a randomized controlled trial.

PURPOSE: To evaluate the efficacy and safety of the vaginal insertion of dinoprostone in terms of achieving cervical ripening, shortening the length of labor, and lowering the cesarean delivery rate for term pregnancies complicated with premature rupture of membranes. METHODS: A prospective, randomized, controlled trial enrolled 100 women with term pregnancies complicated with premature rupture of membranes. Each had a normal non stress test, unscarred uterus, a singleton pregnancy with cephalic presentation, and a Bishop score of less than 4. Patients were randomized to receive a 10 mg dinoprostone vaginal insert single dose or no medication. After cervical ripening, oxytocin induction was performed during labor for both the study and control group. Cervical ripening in the 12th hour, total delivery time and delivery mode were compared between the two groups. RESULTS: More often cervical ripening was obtained in the study group women who used dinoprostone vaginal inserts compared to the control group (p: 0.001). Latent phase of labor and total delivery time was shorter in the study group women than the control group (p: 0.022 and p: 0.026). There was no difference in terms of delivery mode and indication of section between study and control groups. CONCLUSION: The use of dinoprostone vaginal inserts in patients with term pregnancy of premature rupture of membranes reduced both the latent phase of labor and total delivery time without increasing the rate of cesarean section.

Effect of zinc supplementation on lipid peroxidation and lactate levels in rats with diabetes induced by streptozotocin and subjected to acute swimming exercise.

OBJECTIVE: The present study aims to explore the effect of zinc supplementation on lipid peroxidation and lactate levels in rats having diabetes induced by streptozotocin and subjected to acute swimming exercise. METHOD: A total of 80 adult male rats of Sprague-Dawley type were equally allocated to 8 groups: Group 1, general control. Group 2, zinc-supplemented group. Group 3, zinc-supplemented, diabetic group. Group 4, swimming control group. Group 5, zinc-supplemented swimming group. Group 6, zinc-supplemented diabetic swimming group. Group 7, diabetic swimming group. Group 8, diabetic group. At the end of the 4-week study, blood samples were collected to determine MDA, GSH, GPx, SOD, lactate and zinc levels. RESULTS: The highest MDA values were found in group 7 and 8 (p<0.001). GSH values in groups 5 and 6 were higher (p<0.001). The highest GPx values were established in groups 2, 5 and 6 (p<0.001). SOD values were the highest in groups 5 and 6 (p<0.001) and lowest in groups 2, 3 and 8 (p<0.001). The highest plasma lactate levels were found in group 7 (p<0.001). The highest zinc levels were obtained in groups 1, 2 and 5 (p<0.001), and the lowest zinc levels were found in groups 7 and 8 (p<0.001). CONCLUSION: Results of the study reveal that zinc supplementation prevents the increase of free radical formation, suppression of antioxidant activity and muscle exhaustion, all of which result from diabetes and acute exercise. Zinc supplementation may contribute to health performance in diabetes and acute exercise (Tab. 2, Fig. 1 Ref. 47). Full Text in PDF www.elis.sk.

Validity and reliability of VEINES-QOL/Sym questionnaire in chronic venous disorders.

AIM: The aim of this study was to translate the VEINES-QOL/Sym questionnaire into Turkish, which is used mainly in Western European countries, and to study its reliability and validity. METHODS: Standard "forward-backward" translation method was used to translate the questionnaire. The internal consistency was assessed with Cronbach's α, test-retest reliability was assessed with the intraclass correlation and Spearman-Brown coefficients. Validity was examined by correlation of VEINES-QOL/Sym with SF-36, Venous Clinical Severity (VCSS), and Venous Disability Scores (VDS). RESULTS: Out of 100 patients included (mean age 41.9 ± 12.5 years; 32% male, 68% female), 30 were given the questionnaire twice with 24-hour intervals for test-retest; a final completion rate of 99.2% was achieved. The Cronbach's α was 0.914. The Spearman-Brown coefficients and the intraclass correlation coefficients were 0.994, 0.988 and 0.966, 0.933 for VQOL and VSym scores, respectively. For the total quality of life and for several domains the correlations between VEINES-QOL/Sym and SF-36 were high, and significant. Inverse and significant correlations were observed with VCSS. CONCLUSION: Conclusively, the Turkish version of VEINSES-QOL/Sym questionnaire is reliable and valid; thus, it is highly recommended to use Turkish version of VEINSES-QOL/Sym to evaluate the quality of life and symptoms of patients with venous insufficiency in Turkey.

Selenium supplementation prevents lipid peroxidation caused by arduous exercise in rat brain tissue.

BACKGROUND: The objective of the present study is to examine how selenium supplementation affects lipid peroxidation in the brain tissue of rats subjected to acute swimming exercise. METHODS: The study was carried out on 32 Spraque-Dawley adult male rats, which were allocated equally to four groups, namely general control (Group 1), selenium-supplemented control (0.6 mg/kg/day sodium selenite) (Group 2), swimming control (Group 3), and selenium-supplemented swimming group (6 mg/kg/day sodium selenite) (Group 4). Selenium supplementations were carried out by intraperitoneal (i.p.) route for four weeks. At the end of supplementation, animals in groups 3 and 4 were subjected to acute swimming. Brain tissue samples were collected from decapitated animals to determine malondialdehyde (MDA) levels using a spectrophotometer according to "Schimadzu-1601, Japan" Uchiyama and Mihara and GSH levels using a spectrophotometer according to Ellmann. RESULTS: The highest MDA values in the brain tissue were obtained in Group 3 (p < 0.001). MDA values in Group 4 were higher than those in Groups 1 and 2 (p < 0.001). Brain tissue MDA values in Groups 1 and 2 did not differ. Group 4 had the highest brain GSH levels (p < 0.001). Brain tissue glutathione (GSH) levels in Group 3 were higher than those in Groups 1 and 2 (p < 0.001). CONCLUSION: Results of the study indicate that acute swimming exercise in rats increased the lipid peroxidation in the brain tissue of rats, while selenium supplementation prevented the free-radical formation by enhancing the antioxidant activity (Tab. 1, Ref. 24).

Development of secondary ovarian lesions after hysterectomy without oophorectomy versus unilateral oophorectomy for benign conditions: a retrospective analysis of patients during a nine-year period of observation.

PURPOSE: The effect of retained one or both ovaries on the de novo ovarian pathologies required re-operation after hysterectomy due to benign gynecologic conditions were investigated retrospectively. This study was done to determine the occurrence of disease in retained ovaries after hysterectomy. METHODS: A retrospective analysis of patient charts was performed, comparing the patient reports of women who had secondary ovarian lesions those whose previously undergone total abdominal hysterectomy with unilateral oophorectomy or without oophorectomy in our Department during the nine year period of observation (2000-2009). The study included 1242 women with at least one ovary saved after hysterectomy for benign indications. RESULTS: De novo ovarian disease was established in 5.1% of patients of hysterectomy without oophorectomy and in 17.6% of patients of at least one ovary saved after hysterectomy for benign indications (p = 0.005). Ovarian pathology requiring re-operation developed in 3.8% of patients who underwent hysterectomy without oophorectomy and in 5.9% of patients who underwent hysterectomy with unilateral oophorectomy (p = 0.536). CONCLUSION: Women with unilateral oophorectomy at the time of hysterectomy had more than twice the risk of secondary ovarian lesions, compared with those without oophorectomy at hysterectomy. Determinants, such as age, parity and gravidity must be considered when deciding whether or not to perform oophorectomy at hysterectomy.

Vena cava resection with venous-venous shunt for hemangioma.

Mediastinal hemangiomas are rare neoplasms among mediastinal tumors. We report a rare case of hemangioma of the vena cava that was detected incidentally in a 30-year-old female patient.

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AIM: We aimed to report our postoperative results in elderly patients that had off-pump coronary bypass grafting. METHOD: Data of 173 patients with isolated coronary bypass 70 years of age or older were retrospectively evaluated. One month follow-up data were evaluated in all patients. After getting verbal informed consent a total of 91 patients were included in the quality of life assessment via EuroQoL form. The data of patients with age of 70-74 and 75 or older were compared. RESULTS: The mean ages of patients at age of 70-74 and ≥75 were 71.69±0.16 and 76.81±0.23 years; respectively. Eleven cases had in-hospital mortality (%6 of 173 patients). The mean follow-up period for the group that were reached for EuroQoL assessment was 46,3 ± 20,8 months. The percent of cases among the whole study group that had participated in the quality of life questionnaire were in good condition in terms of mobility, self-care, usual activities, pain/discomfort, anxiety/depression were %75, %87, %81, %92 and %89; respectively. DISCUSSION: Off-pump coronary bypass operation may be safely used in elderly patients with high quality of life and low morbidity and mortality.

Assessment of the efficacy of bio-absorbable oxidized regenerated cellulose for prevention of post-operative pericardial adhesion in the rabbit model.

Pericardial adhesions complicate re-operative cardiac surgery and several attempts have been made to reduce adhesion formation. The efficacy of bio-absorbable oxidized regenerated cellulose in preventing post-operative pericardial adhesions was evaluated in the present study. Forty New Zealand white rabbits were divided into four groups of 10. In all rabbits an area of pericardium (2 x 2 cm) was excised. The wound was left open in groups 1 and 2 but replaced with bio-absorbable oxidized regenerated cellulose in groups 3 and 4. Rabbits in groups 1 and 3 were killed 3 weeks after surgery and those in groups 2 and 4 were killed at 6 weeks. Groups 1 and 2 showed more severe pericardial adhesions, more fibrous reaction and increased visibility of coronary vessels than groups 3 and 4, although there was no difference in inflammation. Light microscopy showed a mesothelium-like cell layer in groups 3 and 4. It is concluded that bio-absorbable oxidized regenerated cellulose may be suitable in patients receiving staged cardiac surgery and in those with a high probability of re-operation.

Idiopathic spontaneous coronary artery dissection: a case report.

Spontaneous coronary artery dissection frequently causes death, and most cases are diagnosed at autopsy. In most cases the affected persons are young pregnant females or women in the early postpartum period. We report a case of a female aged 36. She complained of acute chest pain and had ventricular fibrillation. She recovered after successful defibrillation. The coronary angiogram revealed dissection in the proximal left anterior descending artery. ST segment elevation was demonstrated on the electrocardiogram and the patient continued to have chest pains and underwent a coronary bypass operation. The etiology of spontaneous coronary artery dissection is still obscure and is mostly seen in young females. Early surgical intervention and stenting may save lives.

Long-term outcomes of basilic vein transposition fistula for hemodialysis.

BACKGROUND: There has been a dramatic increase in both the availability of hemodialysis and long-term survival of patients with chronic renal failure. Patients who require long-term hemodialysis need long-term vascular access. The transposed autologous basilic vein to brachial artery arteriovenous fistula provides vascular access in the absence of adequate superficial vein. PATIENTS AND METHODS: We follow an aggressive "all-autogenous" policy with regard to dialysis access and recommend prosthetic graft when autogenous options are exhausted. A retrospective analysis was performed of consecutive patients who underwent basilic vein transposition for hemodialysis access between January 2000 and March 2004. Mean follow-up was 21 months (range, 4 to 32 months). RESULTS: A retrospective review of 42 patients undergoing basilic vein transposition was performed. 18 of the patients were men and 24 patients were women. The mean age was 34.6 +/- 12.9 (mean +/- SD) years. Most of the patients were already receiving hemodialysis (92%), with a mean of 2.2 (range, 1 to 4) previous access attempts. Maturation rate was 85.7%. Primary patency rates were 71.4%, 54.7% and secondary (overall) patency rates were 88.0%, 64.2% at the end of the first and second years, respectively. Complications developed in 23 (54.7%) cases, and included arm edema, thrombosis, hematoma, infection, steal syndrome, poor flow and aneurysm formation. CONCLUSION: Transposed brachial-basilic fistula have a good long-term patency rate and should be considered early, before prosthetic grafting, in the absence of a suitable superficial vein.