Changes of miR-139-5p, TGFB1, and COL1A1 in the placental tissue of cases with gestational diabetes mellitus.

There are structural changes in the placenta of cases with Gestational Diabetes Mellitus (GDM). TGF-ß and collagen pathways have crucial roles in tissue remodeling and TGF-ß1 and COL1A1 are important genes in these signalling respectively. Also, lncRNA NEAT1, and miRNA hsa-miR-139-5p and hsa-miR-129-5p have regulatory effects on TGF-ß1 and COL1A1. Here we aimed to assess their expressions in the placenta tissue of GDM cases. 30 patients with GDM and 30 healthy pregnant women participated in the study. Placental tissues taken during normal or cesarean delivery were used and total RNA was isolated from the tissues. mRNA levels were determined by qPCR and protein levels were determined by ELISA methods. An in silico analysis was done to elucidate the possible relation of TGF-ß1 and COL1A1 gene networks with GDM. We determined that NEAT1 and miR-129-5p expression levels did not differ between GDM and healthy control groups (p = 0.697 and 0.412, respectively). But, miR-139-5p mRNA level, TGFB1 and COL1A1 protein levels significantly differ between the GDM and control groups (p = 0.000, p = 0.000 and p = 0.001, respectively). The in silico analysis revealed that TGFB1 and COL1A1 genes network may have important role in the GDM with their variety of members and regulatory molecules NEAT1, hsa-miR-139-5p, and hsa-miR-129-5p can control their functions. The expression of TGFB1, COL1A1 and miR-139-5p is changed in placenta tissue of GDM cases and many genes in the interacting networks of TGFB1 and COL1A1 could contribute to the pathogenicity of GDM.

Anatomical and symptomatic outcomes in patients with Le Fort colpocleisis with or without hysterectomy.

BACKGROUND: We aimed to evaluate the short-term anatomical and clinical outcomes of elderly patients who underwent the Le Fort colpocleisis operation due to pelvic organ prolapse (POP) in our clinic. METHODS: The medical records of fifty-nine sexually inactive females, with stage 2 or higher vaginal or uterine prolapse who underwent Le Fort colpocleisis operations were prospectively analysed. Preoperative and 12th month postoperative data were recorded. Lower urinary tract symptoms (LUTS) was also evaluated preoperatively and 12 months postoperatively in all patients. Anatomical success was determined as no prolapse of any POP-Q point at or below 1 cm above vaginal introitus. RESULTS: A total of 59 patients were included in this study. The average age of the patients was 71.67 ± 7.01 (years). The mean BMI was 27.1 ± 9.52 kg/m2. POP-Q point, C (6.70 ± 2.44 vs. - 2.66 ± 1.21) measurements were significantly deeper, as well as Gh (4.83 ± 0.94 vs. 4.26 ± 0.94) and TVL (3.51 ± 1.24 vs. 8.93 ± 1.73) measurements were significantly higher after surgery than during the preoperative period (p < 0.01, p < 0.01, p < 0.01, respectively). There were no cases of recurrence. The evaluation of LUTS at the 12-months postoperative follow-up revealed significant differences for SUI, urinary frequency, nocturia, and pelvic pain symptoms (p = 0.007, p < 0.001, p = 0.01, p < 0.001, respectively). CONCLUSIONS: Le Fort colpocleisis is a simple and effective procedure that provides successful anatomical and clinical outcomes in sexually inactive and elderly women with POP. However, the long-term results of this procedure need further investigation.

Analysis of prognostic factors in Grade 3 endometrioid type endometrial carcinoma.

OBJECTIVE: To investigate the prognostic factors of patients with Grade 3 endometrioid endometrial cancer (G3EEC). METHODS: This four-center, retrospective study included a total of 129 women with G3EEC. Demographic, clinicopathologic, and survival data were collected. Kaplan-Meier method was used for survival analysis. Predictors of outcome were analyzed using Cox proportional hazards models. RESULTS: Median age at the time of diagnosis was 63 (range 39-87) years and median follow up was 37 (range 6-126) months. For the entire cohort, the 5-year disease-free survival (DFS) and overall survival (OS) were 54.3% and 63.6%, respectively. The 5-year DFS rates for lymphovascular space invasion (LVSI) -positive and -negative patients were 41.6% and 88.3%, respectively (P < 0.001). The 5-year OS rates for LVSI-positive and -negative patients were 54.7% and 88.3%, respectively (P = 0.001). Positive LVSI status was identified as the independent prognostic factor for decreased DFS and OS (hazard ratio [HR] 5.5, 95% confidence interval [CI] 1.65-18.86; P = 0.006 versus HR 4.4, 95% CI 1.33-14.58; P = 0.013, respectively). CONCLUSION: LVSI seems to be an independent prognostic factor for decreased DFS and OS in G3EEC patients.

Can the application of a temporary uterine tourniquet during an abdominal myomectomy reduce bleeding?

Objective: Uterine fibroids are common, benign uterine tumours. The three most common surgical treatment approaches for uterine fibroids are laparoscopic, robotic and abdominal myomectomies. Bleeding is a risk with all three approaches. The present study compared post-operative and pregnancy outcomes in patients with bilateral uterine artery occlusion who underwent an abdominal myomectomy, with or without a temporary uterine tourniquet. Material and Methods: This retrospective study included patients with intra-mural fibroids (≥5 cm) who underwent an abdominal myomectomy. The patients were divided into two groups according to the use or non-use of a temporary uterine tourniquet. Post-operative and pregnancy outcomes in the tourniquet use and non-use groups were compared. The association of the number of uterine fibroids removed (≤3 vs >3) with laboratory parameters was also evaluated. Results: A total of 84 patients were included, divided into use (n=36) and non-use (n=48) of the temporary tourniquet. There was a statistically significant difference between the groups with >3 myomas removed and with a uterine tourniquet applied and not applied in terms of reduction in hemoglobin and hematocrit, transfusion amounts, operation times and lengths of hospitalization in favour of the uterine tourniquet use group (p=0.019, p=0.023, p=0.012, p=0.044 and p=0.036, respectively). Bilateral uterine arterial occlusion using a temporary uterine tourniquet had no negative effects on pregnancy outcomes. Conclusion: A temporary uterine tourniquet may be an effective method for reducing the amount of perioperative bleeding in patients with multiple, large-sized myomas located close to vascular structures.

Evaluation of dynamic thiol-disulfide balance in preinvasive lesions of the cervix.

PURPOSE: This study aimed to determine the potential clinical use of dynamic thiol-disulfide balance in cases with preinvasive lesions of the cervix. METHODS: One hundred and sixteen patients with high-grade squamous intraepithelial lesion, 100 patients with low-grade squamous intraepithelial lesion, and 110 healthy controls were enrolled in the study. A fully automated colorimetric system was used to determine the levels of thiol-disulfide parameters. The ischemia-modified albumin, total oxidant-antioxidant capacity, and oxidative stress index of the retrieved cases were further analyzed. RESULTS: Native thiol and total thiol levels are significantly lower in the high-grade squamous intraepithelial lesion group according to control group (p: 0.004 and 0.015, respectively). Disulfide level is significantly increased in the high-grade squamous intraepithelial lesion group compared to control group (p: 0.004). Oxidative stress index levels in high-grade squamous intraepithelial lesion group were observed as significantly higher according to the control group (p: 0.014). Ischemia-modified albumin levels in the high-grade squamous intraepithelial lesion group were observed as significantly higher compared to the control group (p: 0.020). Disulfide levels are positively correlated with risk type of Human papillomavirus (r: 0.420, p < 0.001). CONCLUSION: The analysis of dynamic thiol-disulfide balance revealed considerable oxidative damage in patients with Human papillomavirus-related cervical precursor lesions compared to women with ordinary cytology specimens. Therefore, investigation of thiol-disulfide balance with presented method represents a new promising test for early diagnosis and management of women at high risk for cervical cancer.

The role of adropin, salusin-α, netrin-1, and nesfatin-1 in endometriosis and their association with insulin resistance

Objective: The pathogenesis of endometriosis has not been clearly explained. Inflammatory factors of ectopic implantation and the growth of ectopic endometrial cells have been subjects of major interest. The number of studies evaluating salusin-α and nesfatin-1 markers in patients with endometriosis is limited. No studies have evaluated the levels of anti-inflammatory markers for adropin and netrin-1 in patients with endometriosis. This study investigates how some important inflammatory regulatory markers in the inflammatory process affect the pathogenesis of endometriosis and determines whether any relationship exists between serum levels of these parameters and endometriosis and insulin resistance. Materials and Methods: This prospective study included 73 patients with endometriosis diagnosed histopathologically after laparoscopic surgery and 75 healthy controls. Serum adropin, salusin-α, netrin-1, and nesfatin-1 levels and homeostatic model assessment of insulin resistance (HOMA-IR) values of the participants were measured. Results: The endometriosis group had significantly lower nesfatin-1 levels than the control group (3.0±0.53 vs 9.5±0.94, p=0.005). Between the patient and control groups, there was no difference regarding serum adropin, salusin-α, and netrin-1 levels (p=0.36, p=0.34, p=0.75, respectively). Nesfatin-1 had a significant positive correlation with adropin, salusin-α, and netrin-1 (r=0.563, p<0.01; r=0.738, p<0.01; r=0.700, p<0.01, respectively), but had a negative correlation with fasting blood glucose (r=-0.343, p<0.05). HOMA-IR values were comparable between both groups. Conclusion: The lower nesfatin-1 levels leading to increased inflammatory pathway activity in patients with endometriosis might play a role in endometriosis pathogenesis. Without causing systemic insulin resistance, decreased nesfatin-1 might contribute to endometriosis pathogenesis locally by leading to the reduced insulin susceptibility of endometriosis cells.

Modified laparoscopic lateral suspension with a five-arm mesh in pelvic organ prolapse surgery.

BACKGROUND: Laparoscopic lateral suspension (LLS) is a laparoscopic technique used to treat pelvic organ prolapse (POP) in apical and anterior compartment defect with the use of a synthetic T-shaped mesh graft. The posterior compartment is repaired using a second mesh or a procedure along with LLS, such as posterior colporrhaphy. The aim of this study was to evaluate the clinical results of LLS for POP using a five-arm mesh instead of a T-shaped mesh graft to repair the defect of the posterior compartment in addition to the apical and anterior compartments. METHODS: Data from 37 patients with a diagnosis of advanced-stage (≥ 3) POP undergoing LLS with the use of a five-arm mesh were retrospectively analysed. Pre-operative and post-operative examinations and, surgical outcomes were determined. The results of measurements and examinations, reoperation rates, erosion rates, lower urinary tract symptoms, and complications were analysed. The Prolapse Quality of Life Questionnaire (P-QOL) was also used. RESULTS: The median post-operative follow-up was 20 (13-34) months. There was a significant improvement in POP-Q scores in all treated compartments, with overall objective cure rates of 94.5% for the apical compartment, 86.4% for the anterior compartment, and 91.8% for the posterior compartment. The median operative time was 96 (76-112) minutes. The median length of hospitalization was 2 (1-3) days. A significant improvement in vaginal bulge, urinary urgency, incomplete voiding, urinary frequency, and constipation was observed after surgery. The sexuality among patients increased from 13 (35.1%) preoperatively to 22 (59.4%) post-operatively. De novo stress urinary incontinence developed in 7 (18.9%) patients. The P-QOL scores improved significantly after surgery. CONCLUSIONS: In advanced-stage POP patients, the posterior compartment damage can also be repaired in LLS with the use of a single five-arm mesh without the need for an additional procedure, and the recurrence rate can be reduced.

Laparoscopic removal of the cervical stump for a cervical solid mass in a patient with previous supracervical hysterectomy

The aim of this video article is to demonstrate a surgical tutorial in which a cervical mass was resected with laparoscopic removal of the cervical stump after supracervical hysterectomy (SCH). First, the dense adhesions due to previous operation were dissected. Then the dissection was continued carefully in order to identify bilateral ureters and iliac arteries. A cervical mass of nearly 4 cm was identified at the posterosuperior aspect. The mass was separated from surrounding tissue and removal of the cervical stump was performed. This is an exciting case, illustrating that minimally invasive procedures, such as laparoscopic removal of the cervical stump after SCH, can be used in the management of benign cervical tumor. The main feature of this operation was to check the relationship of tumor with adjacent structures, including ureters, bowel and vascular structures at every step to prevent unwanted injuries.

Vascular effect of levonorgestrel intrauterine system on heavy menstrual bleeding: is it associated with hemodynamic changes in uterine, radial, and spiral arteries?

The aim of this study was to evaluate the clinical and blood flow changes associated with the use of a levonorgestrel-releasing intrauterine device (LNG-IUD) in patients with idiopathic heavy menstrual bleeding (HMB). LNG-IUD was inserted into a total of 91 patients (39.5 ± 5.4 years) who were diagnosed with HMB. Uterine volume, ovarian volume, uterine, radial and spiral artery blood flow, Pictorial Blood Loss Assessment Chart (PBAC) scores, and other clinical and laboratory parameters were evaluated before and 12 months after insertion of LNG-IUD. Compared to pre-insertion values, LNG-IUD dramatically improved haemoglobin, PBAC scores, and endometrial thickness. Mean resistance indices of radial and spiral arteries significantly increased 12 months after insertion. Our study results suggest that a significant increase in the resistance indices of the intra-myometrial arteries in LNG-IUD users one year after insertion may be due to its local progestational effects, indicating a possible mechanism of LNG-IUD in reducing menstrual blood flow.Impact StatementsWhat is already known on this subject? The mechanisms of action of LNG-IUD on heavy menstrual bleeding include atrophy, decidualization and vascular changes of in the endometrium, resulting endometrial suppression. However, the exact mechanism to stop bleeding is not clear.What do the results of this study add? The present study suggests that one of the effects of the LNG-IUD on heavy menstrual bleeding is its ability to increase the resistance indexes of the intra-myometrial arteries.What are the implications of these findings for clinical practice and/or further research? These results will foster further studies on the effects of LNG-IUD on intra-myometrial arteries and will further assure clinicians on the vascular effect of LNG-IUD during management of heavy menstrual bleeding which includes hysterectomy as a final step.

Thiol-disulfide status of patients with cervical cancer.

AIM: The evaluation of dynamic thiol-disulfide homeostasis among patients with the cancer of the uterine cervix. METHODS: The study was conducted in 62 cervical cancer patients and 61 healthy women who had been followed up in an obstetrics and gynecology clinic between September 2018 and April 2020. Serum disulfide, native thiol, total thiol, ischemia modified-albumin, total antioxidant and oxidant capacities, and oxidative stress index values were measured in all participants. RESULTS: The mean plasma disulfide levels of the cervical cancer group was statistically significantly higher than that of the control group (25.79 ± 6.90 µmol/L, 22.31 ± 6.11 µmol/L, respectively) (P = 0.004). Plasma native thiol and total thiol levels were lower in cervical cancer patients (299.27 ± 99.05 µmol/L and 350.86 ± 102.72 µmol/L, respectively) compared to controls, but no statistically significant difference was observed (318.00 ± 93.75 µmol/L and 376.44 ± 98.51 µmol/L, respectively) (P = 0.284, P = 0.161). With respect to the ischemia modified-albumin level, no statistically significant difference was observed between two groups. There were statistically significant positive association between disulfide level and both the stage of cervical cancer (r = 0.278, P = 0.029) and total oxidant capacity level (r = 0.256, P = 0.046). CONCLUSION: Dynamic thiol-disulfide homeostasis may participate in the pathophysiological mechanisms of cervical cancer and may be a potential biomarker for early identification of cervical cancer in future.

Assessment of thiol disulfide balance in early-stage endometrial cancer.

AIM: We carried out this research to assess thiol disulfide balance in patients with early-stage endometrial cancer. METHODS: Fifty-seven endometrial cancer patients and 60 age-matched healthy subjects volunteered for this study. Thiol disulfide parameters and the ratios of these parameters were examined using a colorimetric system. We also evaluated total antioxidant capacity, total oxidant capacity and oxidative stress index. RESULTS: Subjects with endometrial cancer had statistically significantly lower serum native thiol and total thiol levels (224.2 [122.8-267.5] and 270.5 [171.6-323.2], respectively) than healthy subjects (281.35 [213.45-358.9] and 339.55 [274.1-425.95], respectively) (P = 0.001, P < 0.001). Subjects with endometrial cancer had statistically significantly higher serum disulfide/native thiol and disulfide/total thiol ratios (12.22 [8.77-17.61] and 9.82 [7.46-13.02], respectively) than healthy subjects (8.9 [6.79-16.35] and 7.36 [5.9-12.32], respectively) (P = 0.038, P = 0.028). Disulfide/native thiol ratio appeared to be strongly and positively correlated with the stage of endometrial cancer (r = 0.827, P < 0.001). CONCLUSION: This is an initial report related to thiol disulfide balance in endometrial cancer patients. We believe that oxidative stress contributes both to the evolution and to the progression of the disease. We conclude that deterioration of thiol disulfide balance due to oxidative stress is likely to contribute to the etiopathogenesis of endometrial cancer.

Bilateral uterine artery coagulation in laparoscopic hysterectomy for benign disease in uteri more than 1000 g.

AIM: We aimed to evaluate the efficacy of bipolar uterine artery coagulation in laparoscopic hysterectomy for uteri larger than 1000 g. METHODS: Data from 674 patients who underwent laparoscopic hysterectomy were retrospectively analyzed. Among those, 75 patients with uteri weighing more than 1000 g were included. The clinical and surgical outcomes of patients with large uteri were compared according to bipolar uterine artery coagulation performance status. RESULTS: The mean difference in intraoperative blood loss between the groups of patients with uterine artery occlusion and without uterine artery occlusion was statistically significant (89.26 ± 65.52 vs 227.94 ± 124.65 mL; P < 0.001). The hemoglobin decrease was also significantly lower in the patients with uterine artery occlusion (0.46 ± 0.23 vs 1.21 ± 0.79 g/dL; P < 0.001). CONCLUSION: When performing laparoscopic hysterectomy of uteri weighing over 1000 g, the occlusion of the bilateral uterine arteries at the point of exit from the internal iliac arteries using bipolar coagulation at the beginning of the operation reduces intraoperative hemorrhage and hemoglobin decrease.

Evaluation of serum M30 and M65 activity in patients with stage-I endometrial cancer.

We aimed to analyse the prognostic value of serum oxidative stress parameters and apoptotic markers of serum M30/65 levels in endometrial cancer patients. Serum M30/65 levels and oxidative stress parameters were evaluated in 52 women with stage I endometrial cancer (n = 26) and a control group of healthy females (n = 26). The total antioxidant status (p = .002), oxidative stress index (p = .003) and serum M30/65 levels (p < .001) were significantly higher in women with stage-I endometrial cancer in comparison to the control group. Furthermore, serum M30/65 levels were significantly lower on postoperative day 8, compared to preoperative levels (p = .001 and p < .001, respectively), in the endometrial cancer group. Although impaired apoptotic activity plays a crucial role in the aetiopathogenesis of endometrial cancer, oxidative stress may be instrumental in malignant transformation. We concluded that measurement of M30/65 levels would be beneficial in the follow-up of women with endometrial cancer. Impact Statement What is already known on this subject: Although M30 has been evaluated as a marker of apoptosis in tissue samples from women with endometrial cancer (EC), no previous studies have simultaneously analysed serum M30 and M65 levels and oxidative stress in patients with stage-I EC. What the results of this study add: Total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI) and serum M30/65 levels were significantly higher in women with stage I EC in comparison to the control group. Furthermore, serum M30/65 levels were significantly lower on postoperative day 8, compared to preoperative levels, in the EC group. The fact that pre-operative M30/M65 levels were higher than the post-operative levels may be very important in early-stage EC What the implications are of these findings for clinical practice and/or further research: Although impaired apoptotic activity plays a crucial role in the aetiopathogenesis of EC, oxidative stress may be instrumental in malignant transformation. The fact that serum M30/M65 levels decreased in accordance with the reduction of post-operative tumour burden led us to conclude that measurement of M30/65 levels would be beneficial in the follow-up of women with EC.

Complete duplication of left and right external iliac vein: two case reports and review of the literature.

The femoral vein is named as external iliac vein as it progresses in the cranial direction. In the current case report, a rare variation of the left external iliac vein that was found incidentally during pelvic lymph node dissection in a 36-year-old woman is presented. We also found the same variation at the right side in a 55-year-old woman during laparoscopic pelvic lymph node dissection. Duplication of left external iliac vein throughout its entire length was detected during the operation of the patient with diagnosis of malignant ovarian serous tumor. The other patient with duplication of the right external iliac vein was diagnosed as stage IA, grade 3 endometrial cancer. These rare variations of external iliac veins are of great importance in gynecologic oncologic surgery and other operations requiring pelvic lymph node dissection. Here, we presented and discussed the importance of this variation with the photographs taken during the operation.

Laparoscopic Resection of An Extragastrointestinal Stromal Tumor in the Presacral Area.

STUDY OBJECTIVE: To show a surgical video in which a retroperitoneal extragastrointestinal stromal tumor was resected with the laparoscopic approach in the presacral area. DESIGN: A case report (Canadian Task Force classification III). The local ethics committee waived the requirement for approval. SETTING: A very small proportion of extragastrointestinal stromal tumors (EGISTs) is located in the retroperitoneal region. There are insufficient data on the clinical and pathologic features and the long-term follow-up of these tumors [1]. There are a few cases reported in the presacral region in the literature. The gold standard treatment for EGISTs is complete surgical excision of the mass. If it is possible, en bloc excision with its surrounding tissue is very important [2]. PATIENT: A 53-year-old woman. The patient provided informed consent to use images and videos of the procedure. INTERVENTIONS: This is a step-by-step illustration for resection of a retroperitoneal EGIST in the presacral area. The patient was a 53-year-old, gravida 3, para 3 white woman. She presented with abdominal pain for 5 months. Magnetic resonance imaging showed a 4-cm diameter solid mass localized at the presacral area. Laboratory test results for tumor biomarkers were as follows: cancer antigen (CA) 125 = 40 U/mL (normal values <35 U/mL), CA 19-9 = 29 U/mL (normal values <37 U/mL), carcinoembryonic antigen = 2.1 ng/mL (normal values <3 ng/mL), and CA 15.3 = 18 U/mL (normal values <35 U/mL). Because of malignancy suspicion, gastroscopy and colonoscopy were performed and revealed no abnormality. The Papanicolaou smear and endometrial biopsy results were negative. After preparation of the patient, laparoscopy was performed. After placement of an 11-mm umbilical port and three 5-mm abdominal ports, the pelvis and abdomen were explored and revealed a 4-cm retroperitoneal mass in the presacral area. The peritoneum overlying the presacral mass was incised and the retroperitoneum explored. Given the proximity to the mass, left ureterolysis was performed. The mass was located on the left internal iliac vein and dissected carefully. The retroperitoneal attachments were resected, and the presacral mass was removed without any complications. In order not to widen the abdominal incisions, a posterior colpotomy was performed in the cul-de-sac at equal distances from the uterosacral ligaments. An Endobag (Covidien, Dublin, Ireland) was introduced through the 5-mm port site at the posterior colpotomy. The specimen was removed in the Endobag through posterior colpotomy. MEASUREMENTS AND MAIN RESULTS: The procedure was performed without any complications. The patient had an uneventful postoperative course and was discharged home on postoperative day 2. Pathology revealed a 4-cm retroperitoneal EGIST with negative margins. Immunohistochemistry measurements revealed hematoxylin-eosin; CD117; S100 positivity; and CD34, CD68, desmin, and DOG1 negativity. The cell type was mixed (spindle and epithelioid type). The mitotic rate was 1 to 2/50 high-power fields. The patient has been disease free since the completion of surgery. CONCLUSION: Laparoscopic complete resection of the retroperitoneal EGIST in the presacral area is successfully performed in this patient. The patient presented by us is an example showing that minimally invasive procedures can be used in the treatment of this type of tumor in the presacral area. The key point in this operation is to control the relationship of vascular structures and a ureter with a tumor in every step to avoid any injury.