Innate Immunity in Autoimmune Thyroid Disease during Pregnancy.

Autoimmune thyroid disease (AITD) is the most common organ-specific autoimmune disorder clinically presented as Hashimoto thyroiditis (HT) and Graves' disease (GD). The pathogenesis of AITD is caused by an inappropriate immune response related to genetic, non-genetic, and environmental factors. Pregnancy is one of the factors that have a great influence on the function of the thyroid gland because of the increased metabolic demand and the effects of hormones related to pregnancy. During pregnancy, an adaptation of the maternal immune system occurs, especially of the innate immune system engaged in maintaining adaptive immunity in the tolerant state, preventing the rejection of the fetus. Pregnancy-related hormonal changes (estrogen, progesterone, hCG) may modulate the activity of innate immune cells, potentially worsening the course of AITD during pregnancy. This especially applies to NK cells, which are associated with exacerbation of HD and GD. On the other hand, previous thyroid disorders can affect fertility and cause adverse outcomes of pregnancy, such as placental abruption, spontaneous abortion, and premature delivery. Additionally, it can cause fetal growth retardation and may contribute to impaired neuropsychological development of the fetus. Therefore, maintaining the thyroid equilibrium in women of reproductive age and in pregnant women is of the highest importance.

THE RELIABILITY OF URODYNAMIC ASSESSMENT IN CONFIRMATION OF STRESS URINARY INCONTINENCE IN RELATION TO BONNEY TEST.

According to the International Continence Society, stress (static) urinary incontinence is defined as any involuntary loss of urine on effort or physical exertion, due to which intravesical pressure overcomes urethral pressure, with no detrusor activity. Urodynamic testing accurately assesses the function of the bladder and urethra. The urodynamic assessment includes three tests: cystometry, uroflowmetry and profilometry (determination of urethral pressure profile). Prior to urodynamic assessment, it is mandatory to rule out urinary tract infection since it is an invasive test. Urethral profilometry is a technique that measures pressure in the urethra and bladder at rest, during stressful actions, and during the act of miction. Its main purpose is to evaluate the sphincter mechanism. During the examination, a special catheter is used, which is being slowly pulled out from the bladder neck throughout the urethra, with continuous recording of intraurethral pressure. In addition to measuring urethral pressures, stress urinary incontinence is also very successfully proven by the cough test and Bonney test. If, on forced cough, the urine escapes uncontrollably, and continence is restored by finger lifting the neck of the bladder, the diagnosis of static incontinence is confirmed. At our urogynecologic clinic, urodynamic examination is being routinely performed. In the present study, we included patients previously treated for urinary stress incontinence and compared their results of urodynamic assessment to the results of Bonney test. Of the 43 subjects in whom stress incontinence was proven with Bonney test, we recorded an appropriate profilometry result in 13 cases.

[THE INCIDENCE OF PERIPARTUM HYSTERECTOMY IN FIVE CROATIAN HOSPITALS DURING A SIXTEEN-YEAR PERIOD]. / UCESTALOST PERIPARTALNIH HISTEREKTOMIJA U PET HRVATSKIH BOLNICA TIJEKOM SESNAESTOGODISNJEG RAZDOBLJA.

INTRODUCTION: Peripartal hysterectomy (PPH) is a life saving surgical procedure that is performed when conservative measures fail to control bleeding. According to literature data there is an increase in incidence among developed countries. AIM: To define the rate of PPH during two eight-year periods in five Croatian hospitals in respect to mode of delivery. METHODS: Patients data were collected retrospectively from the medical records of the five Croatian hospitals. We analyzed data from 1998 to 2013, and divided them in two eight-year periods. RESULTS: In 70 cases out of 153,302 deliveries urgent PPH was performed. PPH after vaginal deliveries was found in 0.21%o and 0.16%o and PPH after caesarean section was 1.91 %o and 2.04%o in the first and second period, respectively. DISCUSSION AND CONCLUSION: There is no increase of PPH rate in the two analyzed periods, although there is a statistically significant increase of caesarean section rate. Caesarean section presents higher risk for PPH.

Role of tumor-associated glycoprotein-72 in the progression of endometrial adenocarcinoma: a proposed study.

Endometrial adenocarcinoma is on the basis of the molecular, immunohistological and clinicopathologic features broadly divided into two groups, referred as type I and type II. Type I appears more frequently and in principle patients have a good prognosis; however a significant number of patients develop local recurrences. We hypothesize that TAG-72, expressed on endometrial carcinoma binds and internalizes endocytic pattern recognition receptors on surrounding tissue antigen presenting cells (dendritic cells and macrophages), powers their anti-inflammatory maturation program and make them capable to elicit or modulated tolerogenic immune response mediated by local T and NK effectors. This could support uncontrolled local tumor growth, deeper tumor invasion into surrounding tissues, frequent local recurrences and/or lymph node metastasis. To test this hypothesis, we propose a semi-quantitative immunohistochemical analysis of TAG-72 expression in endometrial adenocarcinoma samples and to correlate the results with clinical and pathological parameters (age, type and histological grade of the tumor, estrogen and progesterone receptor expression, invasion into the myometrium and capillaries, presence of lymph node metastases, FIGO stage, and TNM classification). It would be worthwhile to investigate the local tissue immune response in the tumor environment using tissue samples removed during surgery. These studies could elucidate the underlying immunopathological mechanisms that govern the early recurrence and possibly distant metastases of TAG-72-expressing adenocarcinomas and might help in deciding the type of treatment to be applied in a selected group of cancer patients including application of biological therapy with anti-TAG-72 antibodies, according the principle of personalized oncology treatments.

Gabapentin-induced changes of plasma cortisol level and immune status in hysterectomized women.

AIM: We have examined the effects of gabapentin (GBP) on stress-related changes of cortisol and catecholamines in patients who underwent hysterectomy because of uterine fibrinoids. Additionally, we have observed the effect of GBP on the immune status in the acute stress response to surgery. METHODS: Sixty patients scheduled for an abdominal hysterectomy were randomly assigned to the GBP administration 1h before surgery (n=30 pts), or to the placebo group (n=30 pts). Blood samples were collected before and 24h after the surgery. The intensity of pain was assessed by a visual analogue scale (VAS) every 8h at rest. Immunomodulatory effects of GBP were determined by flow cytometry. We followed the total proportion of CD3(+) lymphocytes, CD3(+)CD4(+), CD3(+)CD8(+), CD19(+) B lymphocytes, CD16(+)CD56(+)CD3(-)NK cells and CD16(+)CD56(+)CD3(+) NKT cells before and 24h after hysterectomy. The plasma cortisol and catecholamines concentration was used to estimate the level of the stress response. RESULTS: VAS pain score at rest was significantly lower in the GBP group than in the placebo group (P=0.003). Application of GBP significantly decreased the plasma cortisol level 24h after the operation in comparison to the placebo group (P<0,001). We found significant positive correlation between the VAS pain score and concentration of cortisol in all patients (P=0.025). GBP reduced the concentration of catecholamines (p<0.05). The proportion of CD3(+) (P=0.027) and CD3(+)CD4(+)cells (P=0.006) was significantly lower in the GBP group 24h after operation, while the contribution of CD19(+) (P=0.033) was significantly higher. CONCLUSION: Preoperative administration of GBP reduced the pain scores at rest in patients at 0, 16 and 24h after abdominal hysterectomy. Additionally, GBP reduced the stress response and changed immune parameters in the reaction to surgery.

Age- and region-dependent changes in human lumbar vertebral bone: a histomorphometric study.

STUDY DESIGN: Histomorphometric evaluation of autopsy material. OBJECTIVES: To explore region-dependent changes that occur with aging in trabecular and cortical bone of the human vertebral body. SUMMARY OF BACKGROUND DATA: Human vertebral bone is continuously subjected to external forces (loads) that promote changes in inner architecture. This functional adaptability is limited, however, and when lost, vertebral bone progressively deteriorates and becomes subject to injury with increases in mechanical loading. METHODS: Bone cylinders were drilled with a trephine from three regions (central anterior, central posterior, and lateral) of the third lumbar vertebral bodies of 48 autopsy cases 31 to 76 years old. Two consecutive 5-microm sections obtained 150 microm apart were stained with toluidine blue and Masson trichrome and photographed at x40. Differences in numerous morphometric factors were evaluated by age and region of the vertebra using repeated-measures analysis of variance and Tukey's Honestly Significant Difference test. RESULTS: Starting at about 50 years of age, significant, linearly progressive decreases occurred in trabecular and cortical bone volume (P < 0.005), trabecular surface area (P < 0.001), number of trabeculae (P < 0.001), and thickness of trabeculae (P < 0.001). Space between trabeculae increased from ages 31 to 70 years and then decreased (P < 0.001). Trabecular deterioration was significantly more pronounced in central versus lateral regions (P < 0.001). Cortical bone thickness decreased significantly with aging in central regions but increased in lateral regions between ages 61 and 70 years (P < 0.001). CONCLUSIONS: The balance between cortical and trabecular bone maintains the strength of the vertebral body until about the age of 50 years, when irreversible deterioration begins in central regions and subsequently involves lateral regions.