ARE THE FACTORS AFFECTING ADVERSE PREGNANCY OUTCOMES DIFFERENT IN OBESE GESTATIONAL DIABETES PREGNANT WOMEN RECEIVING DIET OR INSULIN TREATMENT?

CONTEXT: We aimed to examine the factors affecting adverse gestational outcome in gestational diabetes (GDM) patients, who were grouped as obese and normal- weight, having only-diet, or insulin treatments. SUBJECTS AND METHODS: The study included 373 patients, treated with diet or insulin. These patients were sub-grouped as obese and non-obese, and examined retrospectively. The variables affecting adverse gestational outcome in obese GDM patients having dietary and/ or insulin treatments were detected with multiple regression analysis. RESULTS: The weight gained during pregnancy in the GDM group having insulin treatment was more than the one in only-diet treated GDM group (p=0.004). Pre-pregnancy body mass index, the weight gained during pregnancy, hemoglobin A1C levels in the second and third trimesters, caesarian rates were higher in the insulin-treated obese patients than in the other groups (p<0.001). The odds ratio for fasting blood glucose level in insulin-treated obese GDM group was 1.081 (95% CI =1.004 - 1.163) (p=0.039); and it was 0.982 (95% CI =0.924 - 1.002) (p=0.048) for the weight gained during pregnancy, in only-diet treated obese GDM patients. CONCLUSION: The control of weight gained during pregnancy, and of fasting blood glucose levels in obese patients having GDM, is important to decrease adverse gestational outcome.

The role of ADAMTS4 and ADAMTS9 in cardiovascular disease in premature ovarian insufficiency and idiopathic hypogonadotropic hypogonadism.

PURPOSE: We aimed to determine the relation of a disintegrin and metalloproteinase with thrombospondin motifs-4 (ADAMTS4), and a disintegrin and metalloproteinase with thrombospondin motifs-9 (ADAMTS9) with cardiovascular disease (CVD) risk, in ovarian dysfunction patients with premature ovarian insufficiency (POI), and idiopathic hypogonadotropic hypogonadism (IHH). METHODS: 43 IHH and 44 POI patients were enrolled to this case-control study. Serum hormonal parameters, lipid profiles, ADAMTS4 and ADAMTS9 levels were measured. Lipid accumulation product (LAP) index, visceral adiposity index (VAI), and homeostasis model assessment of insulin resistance (HOMA-IR) were calculated. The patients with at least two out of the four following criteria were accepted to have increased CVD risk; waist-to-hip ratio (WHR) ≥ 0.8, waist circumference (WC) ≥ 79 cm, triglycerides (TG) ≥ 150 mg/dL, high-density lipoprotein cholesterol (HDL-C) < 50 mg/dL. Serum ADAMTS4 and ADAMTS9 levels were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: ADAMTS4 and ADAMTS9 levels were significantly higher in the IHH group than the POI group (p = 0.002, and p = 0.013, respectively). IHH group had significantly higher levels of insulin, HOMA-IR index, and LAP index (p = 0.006, p = 0.005, and p = 0.013, respectively). The mean age of patients in the IHH group (23.60 ± 5.64 years) was significantly lower than the POI group (31.05 ± 6.03 years), (p < 0.001). Odds ratios (OR) were 1.236 (95% CI 1.055-1.447) and 1.002 (95% CI 1.000-1.004) for LAP index and ADAMTS4, respectively, in the IHH group. These two parameters found to have high predictivity for CVD risk in the IHH group (p = 0.009 and p = 0.028, respectively). CONCLUSION: The lower levels of ADAMTS4 in the POI group, when compared with the IHH patients pointed out that even limited hormone secretion and ovulation in the POI group, may have protective effect on cardiovascular system. The higher levels of ADAMTS4 and LAP index in the IHH group demonstrated the increased risk of these patients for CVD.

3Ds: decorin, discordance, and diamniotic dichorionic twins.

aullimary Investigation: The cause of discordance in dichorionic diamniotic (DD) twins is still unknown. The authors aimed to compare decorin (DCN) and oxidative/antioxidative state levels between the placentas of discordant and concordant twins. MATERIALS AND METHODS: Prospective study of 43 spontaneous DD twin pregnancies included and placentas samples taken from each twin and prepared for homogenization. Total oxidant/antioxidant status levels in placental tissue were determined by automated colorimetric method. Decorin levels were detected by using ELISA method; 23 of these were discordant and 20 of them were concordant. RESULTS: DCN levels in the placentas of the low birth-weight twins were significantly lower than the levels of the placentas of appropriate gestational age twins (p = 0.006). There were no statistically significant differences in total antioxidant status (TAS), total oxidant status (TOS), or arylesterase (ARES) levels in discordant (p = 0.631, p = 0.370, and p = 0.079, respectively) and in the placental DCN, TAS, TOS, or ARES levels of the concordant twins (p = 0.407, p = 0.035, p = 0.194, and p = 0.979, respectively). When the authors compared the twins of similar birth weight, the DCN, TAS, and TOS levels were significantly lower in the discordant twins (p < 0.001, p < 0.001, and p = 0.002, respectively). CONCLUSIONS: Decreased levels of DCN in discordant twin fetuses compared to the same birth weight-concordant twins shows that it contributes to disease pathogenesis.

Influence of oval and circular post placement using different resin cements on push-out bond strength and void volume analysed by micro-CT.

AIM: To evaluate the percentage volume of voids within cement layers, to determine the push-out bond strength of circular and oval fibre posts luted with different commercial resin cements in oval cross-sectional root canals, and to correlate push-out bond strength values and volume of voids of circular and oval fibre posts. METHODOLOGY: Seventy-two mandibular premolars with oval-shaped root canals were selected. The specimens were divided into two main groups according to the post type (oval and circular). Groups were further divided into three subgroups (n = 24) according to resin cement type: Maxcem Elite, Rely-X Unicem and Duo-Link. The volumes of voids within the cements were analysed by micro-computed tomography (micro-CT). The bond strength was then measured using a push-out test with an Instron universal testing machine. The failure modes were evaluated. Statistical analyses were performed using a three-way anova, Tukey's post hoc, Pearson's correlation and chi-square test (P = 0.05). RESULTS: The push-out bond strength values were significantly affected by root canal region, post type and cement type (P < 0.001). Root canal region, post type and cement type also significantly affected void volume (P < 0.001). There was a significant interaction between post type and cement type (P < 0.001). The most frequent failure type was adhesive failure in all the groups. There was no significant correlation between the push-out bond strength and void volume (P > 0.05). CONCLUSIONS: Void volume did not affect push-out bond strength of oval and circular posts luted in oval canals.

Apical extrusion of debris using reciprocating files and rotary instrumentation systems.

BACKGROUND: To compare the preparation time and amount of apically extruded debris after the preparation of root canals in extracted human teeth using the reciprocating files and rotary nickel-titanium systems. PROCEDURE: Sixty extracted human mandibular premolars were used. The root canals were instrumented using reciprocating (WaveOne, Reciproc, SafeSider) or rotary motion (Typhoon, ProTaper Universal, Mtwo), and the debris produced was collected in glass vials. The remaining debris was assessed using a microbalance and statistically analyzed using the one-way ANOVA and Duncan multiple range tests at a significance level of P < 0.05. The time required to prepare the canals with different instruments was also recorded. RESULTS: The Reciproc group produced significantly less debris when compared to the Typhoon group (P < 0.05), and instrumentation with the single-file systems was significantly faster than in the multi-file systems (P < 0.05). The WaveOne group extruded significantly more debris per unit of time than the other groups, with the exception of the Typhoon group (P < 0.05). CONCLUSION: According to our study, all systems caused apical debris extrusion. However, the Reciproc group was associated with less debris extrusion when compared to the other groups.

Long-term intensive care unit outbreak of carbapenemase-producing organisms associated with contaminated sink drains.

BACKGROUND: Between 2018 and 2022, a Belgian tertiary care hospital faced a growing issue with acquiring carbapenemase-producing organisms (CPO), mainly VIM-producing P. aeruginosa (PA-VIM) and NDM-producing Enterobacterales (CPE-NDM) among hospitalized patients in the adult intensive care unit (ICU). AIM: To investigate this ICU long-term CPO outbreak involving multiple species and a persistent environmental reservoir. METHODS: Active case finding, environmental sampling, whole-genome sequencing (WGS) analysis of patient and environmental strains, and implemented control strategies were described in this study. FINDINGS: From 2018 to 2022, 37 patients became colonized or infected with PA-VIM and/or CPE-NDM during their ICU stay. WGS confirmed the epidemiological link between clinical and environmental strains collected from the sink drains with clonal strain dissemination and horizontal gene transfer mediated by plasmid conjugation and/or transposon jumps. Environmental disinfection by quaternary ammonium-based disinfectant and replacement of contaminated equipment failed to eradicate environmental sources. Interestingly, efflux pump genes conferring resistance to quaternary ammonium compounds were widespread in the isolates. As removing sinks was not feasible, a combination of a foaming product degrading the biofilm and foaming disinfectant based on peracetic acid and hydrogen peroxide has been evaluated and has so far prevented recolonization of the proximal sink drain by CPO. CONCLUSION: The persistence in the hospital environment of antibiotic- and disinfectant-resistant bacteria with the ability to transfer mobile genetic elements poses a serious threat to ICU patients with a risk of shifting towards an endemicity scenario. Innovative strategies are needed to address persistent environmental reservoirs and prevent CPO transmission.

Patient perceptions and clinical efficacy of labial frenectomies using diode laser versus conventional techniques.

INTRODUCTION: The aim of present study was to compare the keratinized gingival tissue measurements, degree of subjective complaints and functional complications of using an 980nm diode laser versus a scalpel for labial frenectomies. MATERIAL AND METHODS: Thirty-six patients requiring labial frenectomies, between 14 and 51 years old, were randomly assigned to either scalpel or diode laser treatments. The soft tissue measurements, including the keratinized gingiva width (KGW), attached gingiva width (AGW) and attached gingiva thickness (AGT), were recorded before surgery, immediately after, one week later and one, three and six months after surgery. In addition, the functional complications and the morbidity (level of pain, swelling and redness) were evaluated during the first postoperative week using a visual analog scale (VAS). RESULTS: We determined statistically significant gains in the KGW, AGW and AGT after surgery in both groups; however, there was no significant difference between the study groups. The VAS scores indicated that the patients treated with a diode laser had less discomfort and functional complications compare with scalpel surgery. DISCUSSION: The results described above show that diode laser surgery offers a safe, impressive alternative for labial frenectomies that are comfortable for the patients.

The diagnostic ability of core needle biopsy in nodular thyroid disease.

INTRODUCTION Non-diagnostic results of fine needle aspiration biopsy (FNAB) remain an important limitation of this technqiue. The aim of our study was to evaluate the results of core needle biopsy (CNB) of thyroid nodules and its effectiveness in non-diagnostic FNAB cases. METHODS CNBs were performed in 1,000 patients (154 male, 846 female; mean age: 50.2 years, range: 18-86 years) with a spring loaded 20G needle. Of these, 143 had initially had FNABs that were insufficient for evaluation. The CNB reports were reviewed. Patients with suspicious or malignant CNB results underwent total thyroidectomy. RESULTS When considering all 1,000 CNBs, the non-diagnostic rate was 1.5% (15/1,000). However, when the first 100 cases were eliminated as a learning curve, this reduced to 0.9% (8/900). Of the 143 cases with initial FNABs that were non-diagnostic, 0.7% (1/143) were also non-diagnostic on CNB. Twelve patients underwent surgery because of malignant CNB reports and all of these cases were confirmed as malignant by the postoperative pathology specimen results (100% accuracy). There were no major complications although three self-limiting minor complications were observed. CONCLUSIONS CNB is a safe and accurate method. It is more diagnostic than FNAB for nodular thyroid disease.

Measurements of axial length and radius of corneal curvature in the rabbit eye.

The axial length of the eye, the radius of the anterior corneal surface, and the diameter of the cornea were measured on 40 eyes of 20 New Zealand White rabbits. The ultrasonographic measurements of the axial length of the eye showed a mean value of 15.12 +/- 0.51 mm (15.33 +/- 0.50 mm in males, 14.96 +/- 0.46 mm in females). The mean corneal radius was 7.26 +/- 0.26 mm (7.18 +/- 0.9 mm in males, 7.32 +/- 0.33 mm in females); the mean value of the difference in corneal curvature between two principle meridians was 0.21 +/- 0.12 mm; and the mean horizontal and vertical diameters of the cornea were 13.41 +/- 0.34 mm and 13.02 +/- 0.30 mm, respectively. Although the diameter of the cornea of rabbits was bigger than that of humans (average, horizontal 11.75 mm, vertical 10.55 mm), the axial length of the eye was 0.7 times that of humans (23-24 mm), and the radius of corneal curvature was relatively smaller than that in humans (7.7-7.8 mm).