Comparative analysis of thiol-disulfide homeostasis dynamics between elective cesarean section and uncomplicated vaginal delivery: insights into perinatal oxidative balance.

OBJECTIVE: Thiols are organic compounds containing sulfhydryl groups that exert antioxidant effects via dynamic thiol-disulfide homeostasis. The shift towards disulfide indicates the presence of an oxidative environment. Different modes of delivery can affect thiol-disulfide homeostasis. Accordingly, we planned this research to evaluate the effects of the mode of delivery on thiol-disulfide homeostasis in both maternal serum and fetal cord blood samples. PATIENTS AND METHODS: We conducted a prospective case-control study involving two groups: vaginal delivery (n=50) and elective cesarean section (CS) (n=45). The vaginal delivery group exclusively comprised uncomplicated term deliveries, while the CS group included pregnant individuals with scheduled cesarean deliveries due to the absence of spontaneous labor onset. Maternal serum and fetal cord blood samples were collected, and thiol-disulfide exchanges were analyzed using an automated method capable of measuring both aspects of the thiol-disulfide balance. RESULTS: The levels of native thiol (-SH) and total thiol in both maternal serum and fetal cord blood samples were significantly higher in the vaginal delivery group than those in the CS group. An important discovery of our study was that fetal cord disulfide (-SS) level, which may reflect oxidative stress, was higher in newborns born via vaginal delivery when examined alone. However, in both maternal and fetal cord blood, the combined ratios, SS/SH ratio (%), SS/Total thiol ratio (%), and SH/Total thiol ratio (%) were observed to be similar between the groups in both maternal and fetal cord blood. It was observed that as the mother's weight gained during pregnancy increased, SS/SH and SS/total thiol increased (positive correlation), while SH/total thiol decreased (negative correlation). CONCLUSIONS: Our results showed that the dynamic thiol-disulfide homeostasis was greatly influenced by the way of delivery and supported the idea that vaginally-delivered infants may have more oxidative stress.

Predicting adverse perinatal outcomes with fetal modified myocardial performance index and epicardial fat tissue thickness in diabetes-complicated pregnancies.

OBJECTIVE: The aim of this study was to evaluate fetal modified myocardial performance index (mod-MPI) and fetal epicardial fat tissue (EFT) thickness and its association with adverse perinatal outcomes in diabetic pregnant women. PATIENTS AND METHODS: This was a prospective case-control study including 90 gestational diabetes mellitus (GDM) and 45 pregestational diabetes mellitus (PGDM) and 90 healthy pregnant women (control group). Two-dimensional gray-scale and Doppler fetal echocardiography were used to calculate the mod-MPI. EFT thickness was measured in the hypoechogenic area between the myocardium and the visceral pericardium on the right ventricle by distinguishing it from the pericardial fluid by Doppler ultrasound. RESULTS: Both mod-MPI values and EFT thickness were significantly higher in diabetic pregnant women (p<0.001; for both). No significant differences were observed in mod-MPI values and EFT thickness between pregnant women with GDM and PGDM. In addition, there was no significant difference in fetal mod-MPI values and EFT thicknesses among diabetic pregnant women based on their treatment requirements. The receiver operating characteristic (ROC) curve revealed that mod-MPI value (cut-off 0.54, 95% CI: 0.629-0.837, p<0.001, sensitivity 64.6%, specificity 61.7%) and EFT thickness (cut-off 1.85 mm, 95% CI: 0.524-0.750, p=0.014, sensitivity 65.8%, specificity 63.9%) could predict adverse neonatal outcomes in diabetic pregnant women. Multivariate regression analysis revealed that both mod-MPI (p=0.003) and EFT thickness (p=0.008) were independently associated with adverse outcomes. CONCLUSIONS: Fetal mod-MPI values and EFT thickness increase in pregnancies complicated by diabetes, and these measurements may serve as valuable predictors of adverse perinatal outcomes.

Negativity of the electromechanical window: relation to frequent premature ventricular complexes.

OBJECTIVE: The electromechanical window (EMW) was investigated as a new predictor of arrhythmia in the presence of long QT. However, the use of EMW to predict idiopathic frequent ventricular premature complexes (PVCs) in those with normal QT intervals has not been clarified. PATIENTS AND METHODS: This single-center study included consecutive patients who presented to the Cardiology Clinic with palpitations and were found to have idiopathic PVC on 24-hour Holter monitoring. Those with a PVC/24-hour frequency of < 1% were defined as group 1, 1-10% as group 2, and > 10% as group 3. The EMW was defined as the time difference (in ms) between the aortic valve closure and the end of the QT interval, measured from an ECG on the concurrent echocardiogram. RESULTS: A total of 148 patients were included in the study, 64% (n = 94) of which were female. The patients' mean age was 50.11 ± 14.7. The groups were similar in terms of the patients' age, BMI, and comorbidities. There was a statistically significant difference between the three groups in terms of the EMW measurements (group 1: 3.78 ± 19.6, group 2: -7 ± 30.9, group 3: -34.83 ± 55.2 ms: p < 0.001). In the multivariate regression analysis, the EMW (OR 0.971, p = 0.007) and every 10-ms decrease in the EMW (OR 1.254, p = 0.011) were thus determined to be independent predictors of PVC > 10%. An EMW value of ≤ -15 ms was associated with the frequency of 24-h PVC > 10%, with a sensitivity of 70% and a specificity of 70% (AUC 0.716, 95% CI: 0.636-0.787 p < 0.001). CONCLUSIONS: The results showed that a negative increase in the EMW may be associated with frequent idiopathic PVCs.

Does detection of a large for gestational age (LGA) fetus in fetal anomaly scan (FAS) require an early oral glucose screening test (OGTT) and can LGA fetus be detected at birth?

OBJECTIVE: Gestational diabetes mellitus (GDM) complications increase with late diagnosis and late treatment, so early diagnosis and treatment is one of the most important factors in preventing complications. We tried to find an answer to the question of whether the detection of large for gestational age (LGA) fetus in fetal anomaly scan (FAS) requires earlier oral glucose screening test (OGTT) and predicts LGA fetus at birth. PATIENTS AND METHODS: Pregnant women who underwent fetal anomaly scan and gestational diabetes screening at the Department of Obstetrics and Gynecology, University of Health Sciences, Tepecik Training and Research Hospital between 2018 and 2020 were included in this large retrospective cohort study. FAS was routinely performed between 18-22 weeks in our hospital. 75 grams of OGTT was used for gestational diabetes screening and it was performed between 24-28 weeks. RESULTS: This large retrospective cohort study was performed on 3,180 fetuses, 2,904 appropriate for gestational age (AGA) and 276 LGA, in the second trimester. The prevalence of GDM was significantly higher in the LGA group (OR 2.44, 95% CI 1.66-3.58; p < 0.001). Insulin requirement for blood glucose regulation was significantly higher in the LGA group (OR 3.6, 95% CI 1.68-7.7; p = 0.001). Fasting and 1st hour OGTT values were similar between the groups, but 2nd hour OGTT values were significantly higher in the second trimester LGA group (p = 0.041). The prevalence of LGA newborns at birth was higher in second trimester LGA fetuses than in fetuses with AGA (21.1% vs. 7.1%, p < 0.001). CONCLUSIONS: The fact that the estimated fetal weight (EFW) measured in the second trimester FAS is LGA may be related to GDM in the future and LGA fetus at birth. A more detailed GDM risk questioning should be performed to these mothers and OGTT should be considered when additional risk factors are detected. In addition to all these, glucose regulation may not be possible with diet alone in mothers who have LGA in the second trimester ultrasound and who may have GDM in the future. These mothers should be monitored more closely and more carefully.

Polymicrobial anaerobic meningitis caused by Bacteroides fragilis, Bacteroides thetaiotaomicron, Fusobacterium necrophorum and Slackia exigua in a patient with mastoiditis following otitis media.

We have reported a case of mastoiditis which progressed to meningitis in a 16-year old male patient. CSF (cerebrospinal fluid) anaerobic culture revealed four species of isolated anaerobic bacteria. This is the first case in the literature in which a patient survived childhood polymicrobial anaerobic meningitis diagnosed by MALDI-TOF MS (Matrix Assisted Laser Desorption Ionization - Time of Flight Mass Spectrometry).

The Effect of Thyroid-Stimulating Hormone on Tumor Size in Differentiated Thyroid Carcinoma.

We evaluated the correlation between serum thyroid-stimulating hormone (TSH) levels and tumor size and other invasiveness parameters of tumor in patients with differentiated thyroid carcinoma (DTC). Several clinical studies have reported that TSH may also have a role as a regulator of the development and function of the thyroid gland. It is currently not clear whether TSH is involved in the existence of thyroid cancer or progression of thyroid cancer or both. Patients with DTC who underwent thyroid surgery between 2003 and 2008 were included this study. Preoperative serum T3, T4, and TSH levels were compared with the size and invasiveness of cancer, retrospectively. DTC was observed in 110 patients over the 5-year period. Seventy-seven (70 %) of them were euthyroid and classified as the "normal-TSH group" (NTG), and 33 (30 %) have an overt or subclinical hyperthyroidism, classified as the "low-TSH group" (LTG). The mean tumor diameter in the LTG was found to be 8.91 ± 8.03 mm; however, it was found to be 18.19 ± 16.24 mm in the NTG. There were significantly differences among the groups related to the diameter of tumor (p = 0.001). Microcarcinoma was determined in 36 patients (46.8 %) in the NTG and 23 patients (69.7 %) in the LTG (p = 0.027). Although there were no significant differences, tumor capsule invasion (33.8 vs. 18.2 %, p = 0.099) and lymphovascular invasion (16.9 vs. 6.1 %, p = 0.130) rates were higher in the NTG. These findings suggest that TSH has effects on growing and proliferation of not only normal thyroid cells but also cancer cells in DTC. This study revealed that serum TSH level can be explored as an important factor that affects the size and invasiveness of tumor in DTC.

Comparison of manual mycobacteria growth indicator tube and epsilometer test with agar proportion method for susceptibility testing of Mycobacterium tuberculosis.

BACKGROUND AND OBJECTIVES: Antimycobacterial susceptibility tests take weeks, and delayed therapy can lead to spread of Mycobacterium tuberculosis. Therefore, rapid, accurate and cost-effective methods are required for proper therapy selection. In this study, the Mycobacteria growth indicator tube (MGIT) and epsilometer test (Etest) methods were compared to the agar proportion method for susceptibility testing of Mycobacterium tuberculosis. MATERIALS AND METHODS: The susceptibility tests against isoniazid (INH), rifampin (RIF), streptomycin (STM) and ethambutol (ETM) of 51 M. tuberculosis complex isolates were analyzed by the MGIT, Etest and agar proportion methods. RESULTS: The concordance between MGIT/Etest and agar proportion methods was 98% for INH and 100% for RIF, STM, ETM. There were not statistically significant differences in results of the susceptibility tests between MGIT/Etest and the reference agar proportion method. CONCLUSION: The results have shown that MGIT and Etest methods can be used instead of the agar proportion method, because these two methods are more rapid and easier than the agar proportion method.

GNB3 gene c.825C>T polymorphism and performance parameters in professional basketball players.

UNLABELLED: This study has been conducted to determine whether mean values of peak oxygen consumption (VO(2peak)), anaerobic test parameters and knee isokinetic test measurements are different among guanine nucleotide-binding protein, beta-3 (GNB3) genotype groups in a group of basketball players. METHODS: Seventy-two healthy male (mean age, 22.9 ± 5.3 years) basketball players from the first division of national league participated. We studied GNB3 gene c.825C>T (rs5443) polymorphism, then divided the subjects into three groups as CC (n = 21), CT (n = 35), and TT (n =1 6). Mean VO(2peak), Wingate anaerobic test results, and isokinetic knee muscle strength measurements were compared among the genotype groups. RESULTS: Mean VO(2peak) (60.1 ± 3.9; 56.7 ± 3.6; and 57.8 ± 3.3, respectively, p < 0.01), mean anaerobic minimum power (5.1 ± 0.4; 5.3 ± 0.5; and 4.4 v 0.5 W/kg, respectively, p < 0.001), mean anaerobic power drop (57.0 ± 6.2; 54.2 ± 6.9; and 62.9 ± 5.3%, respectively, p < 0.001) were significantly different among the study groups, CC, CT, and TT. Individuals with TT genotype exerted lower performance in terms of isokinetic knee muscle strength. CONCLUSION: The presence of 825T-allele may impair athletic performance and may serve as a genetic marker of low capacity for athletic performance in male basketball players.

Classification of bacterial contamination using image processing and distributed computing.

Disease outbreaks due to contaminated food are a major concern not only for the food-processing industry but also for the public at large. Techniques for automated detection and classification of microorganisms can be a great help in preventing outbreaks and maintaining the safety of the nations food supply. Identification and classification of foodborne pathogens using colony scatter patterns is a promising new label-free technique that utilizes image-analysis and machine-learning tools. However, the feature-extraction tools employed for this approach are computationally complex, and choosing the right combination of scatter-related features requires extensive testing with different feature combinations. In the presented work we used computer clusters to speed up the feature-extraction process, which enables us to analyze the contribution of different scatter-based features to the overall classification accuracy. A set of 1000 scatter patterns representing ten different bacterial strains was used. Zernike and Chebyshev moments as well as Haralick texture features were computed from the available light-scatter patterns. The most promising features were first selected using Fishers discriminant analysis, and subsequently a support-vector-machine (SVM) classifier with a linear kernel was used. With extensive testing we were able to identify a small subset of features that produced the desired results in terms of classification accuracy and execution speed. The use of distributed computing for scatter-pattern analysis, feature extraction, and selection provides a feasible mechanism for large-scale deployment of a light scatter-based approach to bacterial classification.

Distribution of HLA antigens in breast cancer.

Investigation of various tumor-specific markers has a critical role in early diagnosis and treatment of breast cancer. The aim of the this study is to investigate the Human Leukocyte Antigen (HLA) alleles, the molecules that play an important role in immunity and tumor response of the body, and its relationship with breast cancer. In this prospective clinical study, after obtaining approval from the ethics committee of Istanbul University Experimental Medical Research Institute, 22 female patients who have been hospitalized in Istanbul University Cerrahpasa Faculty of Medicine the Department of General Surgery with a diagnosis of breast cancer were selected. In the control group, there were 22 healthy women who had no relationship and were donor candidates for renal transplantation. After collecting blood in 5 ml tubes with EDTA, HLA A, B and DR groups were measured with SSP method using the GenoVision Olerup SSP (Olerup SSP, Stockholm, Sweden) kit in Istanbul University Cerrahpasa Faculty of Medicine Blood Center Tissue Type Determination Laboratory. In patient and control group, totally 53 alleles; 17 alleles of HLA-A gene, 22 alleles of B gene, 14 alleles of DR gene were detected. A statistically significant relationship was determined between HLA-B55:01 and HLA-DRb1*18:01 alleles and the development of breast cancer (p<0.05). HLA-B13:01 antigen is determined only in the control group. It was concluded that HLA-B13:01 antigen, determined only in the control group, may be protective for breast cancer and HLA-B55:01 and HLA-DRb1*18:01 antigens, determined only in the patient group, may be a risk factor for breast cancer (Tab. 5, Ref. 22).

Giant seminoma in an undescended testis presenting as an abdominal wall mass.

Seminomas in undescended testes may present as abdominal wall tumours. A unilateral testis tumour in a 29 year old man with ipsilateral undescended testis is presented and relevant literature is reviewed. A 29 year old man presenting with a tender left lower abdominal mass was admitted to our clinic and initial diagnostic tests followed by abdominal computerized tomography (CT) and positron emission tomography/computerized tomography (PET/CT) were performed. Abdominal CT clearly demonstrated the tumour location between the lower left abdominal subcutaneous layer and the external oblique fascia. He underwent surgery and the tumour was resected via en-bloc excision. Pathological diagnosis of the resected specimen was consistent with classical seminoma and no distant metastasis was detected with PET/CT. He was referred to oncology clinic after discharge. Tumours of undescended testis can present as an abdominal wall mass and clinicians must be aware of their existence.

Surgical anatomic evaluation of cervical uncinate process for ventral and ventrolateral subaxial decompression.

An anatomical study was designed to investigate the cervical uncinate processes morphology and their variations. Linear and angular measurements were performed on 145 vertebrae (29 spines) from C3 to C7. The dimensions and variations of the uncinate processes were measured to obtain some morphologic data for an effective neurovacular decompression via the ventral and ventrolateral approaches. Four researchers performed the linear and angular measurements including uncinate process height, width, length, sagittal angle with the superior margin of the vertebral body, inter-uncinate process distance, vertebral body anteroposterior dimeter and width measurements. The data were presented as mean value, standard deviation and range values. These data provide a three-dimensional orientation and anatomical knowledge, and contribute to perform more effective neurovascular decompression with minimizing the surgical complications.

Surgical anatomy and morphometric analysis of the optico-chiasmatic apparatus, optic canal and sphenoid ridge.

An anatomical study was performed in order to obtain help for orientation regarding the cranial base approaches to the anterior cranial base. Cranial base approaches were studied in 8 adult cadaver heads, and morphometric measurements critical in these approaches were achieved in 76 dry skulls. Importance of the surgical anatomy of the opticochiasmatic apparatus, optic canal, sphenoid ridge, and anterior clinoid was emphasised in this study. Observations from the dissections and operative approaches, and measurements between various points were recorded in a specifically designed software, and these data helped both to understand the local anatomy and the relationship to the intimate structures better and to decide the head position, the degree and direction of safe bony removal, and the direction of the operative approach during the surgery. Considerations important in the selection of these structures, anatomical landmarks and distances were discussed.

Importance of the mitral subvalvular apparatus for left ventricular functional anatomy.

The mitral subvalvular apparatus is so important to attain the integrity of the left ventricular geometric model and systolic pump function of the heart. We conducted a detailed dissection of the anatomic structure of mitral valve complex and left ventricle of 10 adult hearts from fixed human cadavers (eight male and two female) at Department of Anatomy. Faculty of Medicine of Istanbul University and Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital. The distribution of chordae tendinea and classification of musculus papillaris were recorded. The distribution of chordae tendinea varied slightly both anterior and posterior groups. Musculus papillaris was not simetrical in all subjects. Four type of musculus papillaris were distinguished. The insertio angulus of musculus papillaris varied between 20 degrees and 55 degrees. The left ventricular distances (inflow-outflow) and axes (short-long) were determined as the criteria, together with the mitral subvalvular apparatus, to gain the architecture of the left ventricle. We believe that the goal a more precise data collection and developed model will influence our understanding of functional anatomy of left ventricular subvalvular apparatus, and concept of changes in left ventricular configuration after mitral valve surgery.

Surgical anatomy and morphometric analysis of the occipital condyles and foramen magnum.

Surgical anatomy that provides the basis for dealing with lesions arising in the lower clivus and ventral foramen magnum was reviewed in 8 adult cadaver heads and 76 dry skulls. The extreme lateral transcondylar approach was performed in cadavers; the morphometric analysis was studied in both the cadavers and the skulls. The landmarks, distances and structures were selected in order to guide the surgical operations in this area. In the paper, surgical approaches to this region are reviewed, and the results are discussed from the standpoint of surgical importance.

Surgical anatomy of the temporal bone and measurements of the skull base for transpetrosal approaches.

Transtemporal approaches exposing the petroclival region require extensive drilling of the petrous bone. This is only possible with an understanding of the three dimensional anatomy of the temporal bone and the cranial base. The purpose of this study is to review the topographic anatomy of the petrous bone and peripetrous region, with emphasis on the relationships critical to the lateral approaches for posterior and lateral skull base. To understand the surgical anatomy and the cranial base approaches to this area, 8 cadaveric heads and 76 dry skulls were studied. Cadaveric dissections were performed, and morphometric data from measurements of the relationships of the surface landmarks in the petroclival region were provided. The results and the observations could be useful to understand the anatomy better, and to estimate the degree and direction of a safe bony removal for the most radical transpetrosal surgery.

A case report; trilobular spleen?

During dissection course a spleen with a pyramidal extremity was noted. Literature reviewed and this rare case has been presented.