Reconstruction of Bilateral Upper and Lower Eyelid Ectropion Caused by a Liquid Unblocker Chemical Burn.

Liquid drain unblockers, although meant to be used by professionals with protective equipment, are sometimes used in the household without any precautions. This could lead to severe chemical burns, as in the case we present with severe eyelid ectropion. This study aims to stress the need for preventive measures regarding the use of chemicals and for close observation and timely surgical intervention in chemical burn patients to prevent and limit disfigurement. A 45-year-old woman was injured while using an unblocker (90% sulfuric acid) at home. Accidentally, a quantity of the liquid was spilled on her face. She was initially examined in ophthalmology emergencies because of the obvious ocular involvement, and the cutaneous component was underestimated. On the third post-burn day, she was referred as an outpatient to our clinic, and because of the soft consistency and patchy pattern of the burn, she was asked to revisit in a week. Unfortunately, she reappeared two months post-burn with severe ectropion of all four eyelids and a high risk of corneal abrasion, desiccation, and further damage to the already injured left eye as well as the right eye. She underwent three operations in six months and a fourth 15 months after the accident, with the release of the scarred eyelids with full-thickness skin grafts, Z-plasties, and V-Y plasties. After four operations and sessions of triamcinolone acetonide intralesional injection, the patient has a satisfactory eyelid position and function with adequate closure and scar maturation. Domestic use of strong industrial chemicals is dangerous, and public education for prevention is urgently needed. On the other hand, it is mandatory to follow up very closely with chemical burn patients to prevent severe sequelae, especially in the delicate and contraction-prone periocular and perioral areas. Reconstruction, in these cases, is a complex task. Often, several surgeries are needed to restore acceptable function and appearance. Burn disfigurement and self-stigma will follow the patients to some extent throughout their lives.

Giant Pilomatrix Carcinoma of the Thorax: An Uncommon and Clinically Misdiagnosed Tumor.

Pilomatrix carcinoma is an unusual and aggressive malignant tumor deriving from follicular matrix cells and exhibiting a metastatic potential to lungs and regional lymph nodes in 10% of cases. We report the case of a 54-year-old male patient who presented with a biopsy-proven malignant pilomatrixoma of the thoracic region, which recurred multiple times after previous excisions. Due to the size of the tumor (28 by 22 cm), wide excision and axillary lymphadenectomy of levels I and II were performed, followed by reconstruction with a free deep inferior epigastric artery perforator flap and adjuvant radiotherapy. Owing to its rarity, this tumor can initially be misdiagnosed, resulting in delayed treatment and recurrences if inadequately excised. Also, large tumor size is correlated with a higher incidence of metastasis. High index of clinical suspicion and wide excision are recommended, along with the need of establishing oncological guidelines for better prognosis.

Increasing Muscle Mass in Elders through Diet and Exercise: A Literature Review of Recent RCTs.

This study aimed to review the current evidence on the independent and combined effects of diet and exercise and their impact on skeletal muscle mass in the elderly population. Skeletal muscle makes up approximately 40% of total body weight and is essential for performing daily activities. The combination of exercise and diet is known to be a potent anabolic stimulus through stimulation of muscle protein synthesis from amino acids. Aging is strongly associated with a generalized deterioration of physiological function, including a progressive reduction in skeletal muscle mass and strength, which in turn leads to a gradual functional impairment and an increased rate of disability resulting in falls, frailty, or even death. The term sarcopenia, which is an age-related syndrome, is primarily used to describe the gradual and generalized loss of skeletal muscle mass (mainly in type II muscle fibers) and function. Multimodal training is emerging as a popular training method that combines a wide range of physical dimensions. On the other hand, nutrition and especially protein intake provide amino acids, which are essential for muscle protein synthesis. According to ESPEN, protein intake in older people should be at least 1 g/kgbw/day. Essential amino acids, such as leucine, arginine, cysteine, and glutamine, are of particular importance for the regulation of muscle protein synthesis. For instance, a leucine intake of 3 g administered alongside each main meal has been suggested to prevent muscle loss in the elderly. In addition, studies have shown that vitamin D and other micronutrients can have a protective role and may modulate muscle growth; nevertheless, further research is needed to validate these claims. Resistance-based exercise combined with a higher intake of dietary protein, amino acids, and/or vitamin D are currently recognized as the most effective interventions to promote skeletal muscle growth. However, the results are quite controversial and contradictory, which could be explained by the high heterogeneity among studies. It is therefore necessary to further assess the impact of each individual exercise and nutritional approach, particularly protein and amino acids, on human muscle turnover so that more efficient strategies can be implemented for the augmentation of muscle mass in the elderly.

Structural and Physiological Traits of Compound Leaves of Ceratonia siliqua Trees Grown in Urban and Suburban Ambient Conditions.

Ceratonia siliqua L. (carob tree) is an endemic plant to the eastern Mediterranean region. In the present study, anatomical and physiological traits of successively grown compound leaves (i.e., the first, third, fifth and seventh leaves) of C. siliqua were investigated in an attempt to evaluate their growth under urban and suburban environmental conditions. Chlorophyll and phenolic content, as well as the specific leaf area of the compound leaves were determined. Structural traits of leaflets (i.e., thickness of palisade and spongy parenchyma, abaxial and adaxial epidermis, as well as abaxial and adaxial periclinal wall) were also investigated in expanding and fully expanded leaflets. Fully expanded leaflets from urban sites exhibited increased thickness of the lamina and the palisade parenchyma, while the thickness of the spongy parenchyma was thicker in suburban specimens. The palisade tissue was less extended than the spongy tissue in expanding leaflets, while the opposite held true for the expanded leaflets. Moreover, the thickness of the adaxial and the abaxial epidermises, as well as the adaxial and abaxial periclinal wall were higher in suburban leaflets. The chlorophyll content increased concomitantly with the specific leaf area (SLA) of both expanding and expanded leaflets, and strong positive correlations were detected, while the phenolic content declined with the increased SLA of expanding and expanded leaflets. It is noteworthy that the SLA of expanding leaflets in the suburban site was comparable to the SLA of expanded leaflets experiencing air pollution in urban sites; the size and the mass of leaf blades of C. siliqua possess adaptive features to air pollution. These results, linked to the functional structure of expanding and expanded successive foliar tissues, provide valuable assessment information coordinated with an adaptive process and yield of carob trees exposed to the considered ambient conditions, which have not hitherto been published.

From Biodiversity to Musketry: Detection of Plant Diversity in Pre-Industrial Peloponnese during the Flora Graeca Expedition.

As the interest in natural, sustainable ecosystems arises in many fields, wild plant diversity is reconsidered. The present study is based on extant literature evidence from the journey of John Sibthorp (Professor of Botany, Oxford University) to Peloponnese (Greece) in pre-industrial time. In the year 1795, Peloponnese was a botanically unknown region, very dangerous for travellers and under civil unrest, in conjuncture with a pre-rebellion period. Our study reveals approximately 200 wild plant taxa that were collected from Peloponnese localities in 1795, transported to Oxford University (UK), and quoted in the magnificent edition Flora Graeca Sibthorpiana of the 19th century. Moreover, these plants currently constitute a living collection in Peloponnese, confirmed according to updated data on the vascular Flora of Greece. The presented lists constitute a source of information for plant biologists, linking the past to the present, shedding light on the study of adaptive traits of wild Mediterranean plants and revealing the temporal dimension of natural history. Nowadays, increasing and thorough understanding of the considered plants' functionality to abiotic and biotic environmental stimuli provides a new framework of sustainability and management options.

Sedation With Dexmedetomidine in Critically Ill Burn Patients Reduced Delirium During Weaning From Mechanical Ventilation.

INTRODUCTION: Weaning of mechanical ventilation while maintaining appropriate pain control and preventing delirium is one of the most challenging aspects of burn care. Dexmedetomidine, an α2-adrenergic receptor agonist used for sedation may improve intensive care unit (ICU) patients' arousal status and enhance patient comfort. OBJECTIVES: To determine the efficacy of dexmedetomidine vs. standardized usual care (midazolam or propofol) in maintaining sedation and reducing delirium in burn patients while weaning off mechanical ventilation. MATERIAL AND METHODS: A total of 56 mechanically ventilated patients who fulfilled the criteria for weaning were enrolled in the study. Group 1 (26 patients) received dexmedetomidine 1 mcg/kg over 15 minutes as a loading dose, followed by 0.4-0.1 mcg/kg/h. Group 2 (30 patients) received usual sedation with midazolam 0.08 mg/kg/h or propofol 15- 30 mcg /kg/min). RESULTS:  Dexmedetomidine was not associated with a significantly shorter duration of mechanical ventilation (Mean {IQR}: 9.3 {4,12} versus 7.5 {4,10}, p=0.3). Patients who received dexmedetomidine had a lower delirium rate (38,4% on Day 1 to 7,7% on Day 5) in comparison with patients from the usual care group (53,3% on Day 1 to 20% on Day 5) during the five days after the onset of weaning process (p=0.02) and had less need for supplemental use of analgesia (23.1% versus 53.3%, p=0.045) and antipsychotic agents (15.4% versus 53.3%, p=0.01). The most notable adverse effect of dexmedetomidine was bradycardia. CONCLUSIONS: Dexmedetomidine may provide effective light sedation and is associated with fewer sedation-related adverse effects in burn patients. Sedation with dexmedetomidine during the weaning process in adult burn patients was associated with lower delirium rates, a trend towards the earlier withdrawal of mechanical ventilation but did not seem to improve the total duration of mechanical ventilation.

An Endoscopic-Assisted Open Removal of a Retained Foreign Body From Frontal Sinus.

Facial penetrating injuries can cause retention of foreign bodies in the frontal sinus. This rare condition can remain underdiagnosed for years, since non-specific symptoms, such as headaches and nasal obstruction, can be developed. So far, removal by an endoscopic approach is the most preferred treatment option because it is less invasive with a short recovery time. However, removal by an open surgical approach remains the method of choice for large foreign bodies, especially in cases of coexistent non-reducible fractures of the anterior table of the frontal bone. We present a case where a combined approach - open and endoscopic - was necessary to successfully remove a retained foreign body from a frontal sinus. With the assistance of a transnasal endoscope, the retained stone was mobilized and removed from the open frontal sinus followed by osteosynthesis of the anterior table. Therefore, in special circumstances, a combination of both techniques should be considered for the optimal outcome.

Reconstruction of a massive defect of the neck after a scorpion sting: A case report.

Introduction: Cutaneous traumas from scorpion sting envenomation are rare in European countries. Regarding Greece, Euscorpius sicanus' complex is the most widespread scorpion species. The venom of these small dark brown arthropods, which shelter in woods, usually provokes local cutaneous symptoms: erythema, edema, cellulitis, urticarial plaques, ulcers and rarely skin necrosis. We present a case of a massive soft tissue defect of the neck due to a scorpion sting managed by a Plastic Surgery Department in Greece. Case report: In March 2020, a 60 year-old lumberjack was referred to our Clinic due to a neck wound resulting from Euscorpius cf. sicanus sting. After multiple surgical debridements in combination with negative pressure wound therapy healthy tissue was achieved. Reconstruction followed using a 7cmX15cm vertical island trapezius musculocutaneous flap based on the dorsal scapular artery and rotated to cover the defect. The trapezius flap, donor site and graft healed well and resulted in satisfying contouring at the one-year follow-up. Conclusion: This case report is the first presenting Plastic Surgery reconstructive techniques for a massive neck defect after a Euscorpius cf. sicanus scorpion sting. Major complications of such stings need to be managed drastically for the optimum patient's outcome.

Evaluation of Adipose Cell-Based Therapies for the Treatment of Thumb Carpometacarpal Joint Osteoarthritis.

Adipose tissue and its regenerative products which are isolated with enzymatic or mechanical processing of the harvested fat have been studied in a wide range of degenerative diseases, including osteoarthritis of the knee and hip. Intra-articular injection of these products can provide symptomatic relief of pain and postpone surgery. However, their use in the treatment of thumb carpometacarpal joint (CMCJ) osteoarthritis is limited and just a few studies have been published on that topic. For this reason, a review of the literature was performed by a thorough search of eight terms using the Pubmed database. In total, seven human studies met the selection criteria, including case-control studies, case-series and one case report. In all studies, intra-articular injection of autologous fat in osteoarthritic thumb CMCJ provided reduction in pain and improvement in hand function. Grip and pinch strength showed variable results, from no change to significant improvement. Fat-processing techniques were based on centrifugation and mechanical homogenization but biological characterization of the injected cells was not performed in any study. Although the results are encouraging, a uniformly standardized method of fat processing and the conduction of randomized controlled trials in the future could better evaluate the effectiveness of this procedure for thumb CMCJ osteoarthritis.

Differences in Technical Development and Playing Space in Three UEFA Champions Leagues.

The analysis of football grows exponentially, with many researchers adopting it as an object of study. The thematic range that addresses it, as well as the different methodologies used, are of a very different nature-physical, psychological, technical, tactical-enriching every day the knowledge, and understanding of the game itself. The objective of this study has been to identify the differences between the different styles of play that lead to becoming the champion of the UEFA Champions League in the last 3 years of the pre-COVID stage, by analyzing the spatial performance developed, the association between the players that make up the different lines of the game system and the analysis of the various technical actions that are developed to carry out the offensive phase of each team. For this, the Observational Methodology and two types of analysis have been used: quantitative, by calculating X 2, and qualitative, by applying the Polar Coordinates technique. The results obtained show the relationship that is established between the different lines that make up the offensive systems of the champion teams of this competition, as well as the relationship of significance that is established between the use of space-width and depth-and the technical means used to achieve success, the goal.

Subcutaneous Adipose Tissue in Female Volleyball Players: Is It Related with Performance Indices?

The aim of the present study was to examine subcutaneous adipose tissue distribution in female volleyball players with regards to (a) variation by anatomical site, (b) differences among age groups and playing positions, and (c) physiological characteristics associated with performance. Participants were adolescent (n = 89, age 15.6 ± 0.9 years, mean ± standard deviation) and adult female volleyball players (n = 78, 24.8 ± 5.3 years), who performed a series of anthropometric and performance tests including skinfold thickness in 10 sites, Abalakov jump (AJ) and handgrip test (HG). Chin had the smallest thickness, and iliac crest and abdomen the largest. The largest correlations of skinfold thickness were shown with regards to AJ ad HG. Coefficient of variations in skinfold thickness correlated with performance indices with small magnitude. Triceps and chin were the most frequent predictors of performance indices. The anatomical site of skinfold was near the active muscle groups related to performance in HG. In conclusion, performance indices such AJ and HG were related with thickness of specific skinfolds and with the variation of thickness by anatomical site (i.e., the less the variation, the better the performance). Considering the relevance of specific skinfolds (e.g., triceps and chin) for performance, their further use would be recommended for purposes of training monitoring, volleyball players' selection and talent identification.

Relative Age Effect on Youth Female Volleyball Players: A Pilot Study on Its Prevalence and Relationship With Anthropometric and Physiological Characteristics.

The relative age effect (RAE) on human performance has been well studied in many sports, especially in soccer; however, little information has been available about the prevalence of RAE in volleyball, and its role on anthropometric and physiological characteristics. The aim of the present study was to examine (a) the prevalence of RAE in selected (i.e., to be considered for the national team) and non-selected youth female volleyball players, and (b) the relationship of birth quarter (BQ) with anthropometric and physiological characteristics. Selected (n = 72, age 13.3 ± 0.7 years, weight 62.0 ± 7.2 kg, height 1.72 ± 0.06 m) and non-selected female volleyball players (n = 53, age 13.9 ± 1.1 years, weight 56.4 ± 7.3 kg, height 1.66 ± 0.06 m) performed a series of anthropometric and physiological tests. Twenty-six selected participants were born in the first quarter of the year, 19 in the second, 14 in the third, and 13 in the forth. The corresponding frequency by BQ in non-selected participants was 12, 12, 17, and 12. No association was observed between the number of participants and their frequency by BQ neither in the selected (χ 2 = 2.79, p = 0.425) nor in the non-selected group (χ 2 = 0.64, p = 0.886). Anthropometric and physiological characteristics did not vary by BQ (p > 0.05). The absence of RAE in female volleyball players and the similarities of anthropometric and physiological characteristics among BQ might be due to technical-tactical character of this sport. These findings would be of great practical value for coaches and fitness trainers working with young volleyball players.

Validity of Prediction Equations of Maximal Heart Rate in Physically Active Female Adolescents and the Role of Maturation.

Background and objectives: Maximal heart rate (HRmax) is an important training and testing tool, especially in the context of evaluating intensity in exercise prescription; however, few studies have examined the validity of prediction equations of HRmax in physically active female adolescents and the role of maturation level. Therefore, the aim of the present study was to examine the differences between measured and predicted HRmax in a sample of physically active female adolescents. Materials and Methods: Seventy-one selected volleyball players (age 13.3 ± 0.7 years, body mass 62.0 ± 7.2 kg, height 1.72 ± 0.06 m) performed a 20 m shuttle run endurance test, and the actual HRmax was compared with Tanaka HRmax ('208 - 0.7 × age') and Fox HRmax ('220 - age'). Results: A large main effect of assessment method on HRmax was found (p < 0.001, η2 = 0.486) with Fox overestimating actual HRmax by 6.8 bpm (95% confidence intervals, CI; 4.2, 9.3) and Tanaka underestimating actual HRmax by -2.6 bpm (95% CI; -5.1, -0.1). The more matured participants had similar actual HRmax (mean difference -2.4 bpm; 95% CI; -6.5, 1.7; p = 0.242, d = -0.28), difference Fox - actual HRmax (1.5 bpm; 95% CI; -2.6, 5.6, p = 0.466, d = 0.17), and difference Tanaka - actual HRmax (1.7 bpm; 95% CI; -2.4, 5.8; p = 0.414, d = 0.19) to the less matured participants. Conclusions: These findings suggest that age-based prediction equations of HRmax developed in adult populations should be applied with caution in physically active female adolescents, and Tanaka should be preferred instead of the Fox equation.

The Effect of Static and Dynamic Stretching Exercises on Sprint Ability of Recreational Male Volleyball Players.

The aim of the present trial was to investigate the effect of two stretching programs, a dynamic and a static one, on the sprint ability of recreational volleyball players. The sample consisted of 27 male recreational volleyball players (age 21.6 ± 2.1 years, mean ± standard deviation, body mass 80.3 ± 8.9 kg, height 1.82 ± 0.06 m, body mass index 24.3 ± 2.5 kg.m-2, volleyball experience 7.7 ± 2.9 years). Participants were randomly divided into three groups: (a) the first performing dynamic stretching exercises three times per week, (b) the second following a static stretching protocol on the same frequency, and (c) the third being the control group, abstaining from any stretching protocol. The duration of the stretching exercise intervention period was 6 weeks, with all groups performing baseline and final field sprinting tests at 4.5 and 9 m. The post-test sprint times were faster in both the 4.5 (p = 0.027, η2 = 0.188) and 9 m tests (p < 0.001, η2 = 0.605) compared to the pre-test values. A large time × group interaction was shown in both the 4.5 (p = 0.007, η2 = 0.341) and 9 m tests (p = 0.004, η2 = 0.363) with the static and dynamic stretching groups being faster in the post-test than in the pre-test, whereas no change was found in the control group. The percentage change in the 4.5 m sprint time correlated with volleyball experience (r = -0.38, p = 0.050), i.e., the longer the volleyball experience, the larger the improvement in the 4.5 m sprint. Thus, it is concluded that both stretching techniques have a positive effect on the velocity of recreational male volleyball players, when performed at a frequency of three times per week for 6 weeks under the same conditions as defined in the study protocol.

In Search for Volleyball Entertainment: Impact of New Game Rules on Score and Time-Related Variables.

The aim of this research was to analyse the impact of various game structures on score and time-related variables in elite volleyball. A total of 114 male matches and 76 female matches (38 matches for each tournament) were analysed in under-23 world championships. An observational design was implemented to measure match duration, points scored per match and set, set point differences, tournament phase, match balance, and set tendencies in various game structures (set to 21, to 25 or to 15 points) in male and female categories. Standardised differences in mean values showed that a 15-point set game structure led to shortest matches and smallest time variability in match duration, the largest number of points per match, and greatest equality in terms of set score differences in both the male and the female category. The use of various game structures in training may be useful to coaches and conditioning specialists when planning training schemes and sessions, by introducing different game structures to manage volume and intensity in training more effectively. These results may also be useful to local and/or national volleyball federations willing to attract new young players, to promote learning and to render volleyball a fun activity, by implementing S15 at initial stages. In addition, they could be useful to international federations or committees, so as to attract larger audiences and sponsors interested in more appealing matches with high levels of competitiveness and entertainment.

Association between ratio of sodium to potassium in random urine samples and renal dysfunction and mortality in patients with decompensated cirrhosis.

BACKGROUND & AIMS: Estimates of glomerular filtration rate (GFR) are used to assess renal function and are an independent prognostic factor for patients with decompensated cirrhosis, but are impractical for routine use. We investigated whether the ratio of sodium to potassium in randomly collected urine samples (UNa/K) is associated with mortality and renal dysfunction in patients with decompensated cirrhosis and ascites. METHODS: We assessed data from 126 consecutive patients with decompensated cirrhosis and ascites (93 men; age, 56 ± 12 y; 55% with viral-related disease) admitted to the Hippokration General Hospital of Thessaloniki, Greece, from September 2010 through January 2012. At admission, clinical and laboratory variables were recorded, including GFR, measured with (51)Cr-EDTA. Urine samples were collected, and UNa/K was determined. We evaluated the association between UNa/K and patient mortality using the area under the receiver operating characteristic curve analysis. RESULTS: Forty-one patients (32%; group 1) had a GFR less than 60 mL/min, and 85 patients (68%; group 2) had a GFR of 60 mL/min or greater. In the multivariable analysis, 3 variables were associated independently with the presence of severe renal dysfunction (GFR, <60 mL/min): age (odds ratio [OR], 0.93; P = .008), systolic blood pressure (OR, 1.05; P = .022), and UNa/K (OR, 1.5; P = .025). A UNa/K less than 1.0 had high sensitivity and a negative predictive value for the presence of GFR less than 60 mL/min (79% and 87%, respectively) and mortality (68% and 91%, respectively). CONCLUSIONS: In patients with decompensated cirrhosis and ascites, a ratio of sodium to potassium of less than 1 in randomly collected urine samples was associated with renal dysfunction and short-term mortality. These findings require confirmation in additional studies.

The effect of dropping height on jumping performance in trained and untrained prepubertal boys and girls.

Plyometric training in children, including different types of jumps, has become common practice during the last few years in different sports, although there is limited information about the adaptability of children with respect to different loads and the differences in performance between various jump types. The purpose of this study was to examine the effect of gender and training background on the optimal drop jump height of 9- to 11-year-old children. Sixty prepubertal (untrained and track and field athletes, boys and girls, equally distributed in each group [n = 15]), performed the following in random order: 3 squat jumps, 3 countermovement jumps (CMJs) and 3 drop jumps from heights of 10, 20, 30, 40, and 50 cm. The trial with the best performance in jump height of each test was used for further analysis. The jump type significantly affected the jump height. The jump height during the CMJ was the highest among all other jump types, resulting in advanced performance for both trained and untrained prepubertal boys and girls. However, increasing the dropping height did not change the jumping height or contact time during the drop jump. This possibly indicates an inability of prepubertal children to use their stored elastic energy to increase jumping height during drop jumps, irrespective of their gender or training status. This indicates that children, independent of gender and training status, have no performance gain during drop jumps from heights up to 50 cm, and therefore, it is recommended that only low drop jump heights be included in plyometric training to limit the probability of sustaining injuries.

Evidence for association of the G1733A polymorphism of the androgen receptor gene with recurrent spontaneous abortions.

OBJECTIVE: To determine whether the G1733A polymorphism of the androgen receptor gene is associated with an increased risk for recurrent spontaneous abortion (RSA). DESIGN: Case-control study. SETTING: Division of Genetics and Biotechnology, Department of Biology, University of Athens. PATIENT(S): A total of 131 women with at least three unexplained spontaneous abortions before 20 weeks' gestation, with the same partner, composed the study group. INTERVENTION(S): Subjects were genotyped by the polymerase chain reaction-restriction fragment length polymorphism method. MAIN OUTCOME MEASURE(S): G1733A polymorphism genotypes and allele frequencies. RESULT(S): The observed frequencies of GG, GA, and AA genotypes of the G1733A polymorphism were 0.57, 0.27, and 0.16, respectively, for the patient group and 0.76, 0.15, and 0.09, respectively, for the control group. Allele frequencies were 0.70 and 0.84, respectively, for the patient and control groups for the G allele (wild type) and 0.30 and 0.16, respectively, for the patient and control groups for the A allele (mutant). Statistical analysis of these results indicated significant differences between the two groups. CONCLUSION(S): These results indicated for the first time that the androgen receptor G1733A polymorphism is strongly associated with increased risk for RSA.

Endothelial nitric oxide synthase gene polymorphisms in recurrent spontaneous abortions.

OBJECTIVE: The risk of miscarriage is enhanced by a variety of genetic and environmental factors. Previous studies indicated an association between endothelial nitric oxide synthase (eNOS) activity, and implantation and maintenance of pregnancy, but it is rather controversial whether polymorphisms of the gene encoding for eNOS are associated with recurrent spontaneous abortions (RSA). The aim of our study was to determine whether the 27 bp intron 4 repeat polymorphism (4VNTR) and a Glu298Asp missense mutation encoded by exon 7 of the eNOS gene are associated with an increased risk for recurrent spontaneous abortions (RSA), in the Greek population. METHODS: A total of 126 women who had at least three unexplained spontaneous abortions before 20 weeks of gestation, with the same partner, were included in the study group. The control group consistent of 130 women with at least two live childbirths and without history of abortions. All patients and controls were investigated for the two polymorphisms. To genotype the cohorts we used the PCR-RFLPs method. RESULTS: The observed frequencies of bb, ba, aa genotypes of the VNTR, in intron 4, polymorphism were 0.75, 0.24, 0.01, respectively, for the patient group and 0.73, 0.24, 0.03, respectively, for the control group. The observed frequencies of GG, GT, TT of the Glu298Asp polymorphism were 0.42, 0.45, 0.13, respectively, for the patient group and 0.47, 0.45, 0.08, respectively, for the control group. Statistical analysis of the results indicates no significant difference between the two groups, for both the two studied polymorphisms. CONCLUSION: Our results do not show any influence of the two polymorphisms, VNTR in intron 4 and Glu298Asp of the eNOS gene, on early pregnancy.