Artur J. Jakimiuk

Leptin messenger ribonucleic acid (mRNA) content in the human placenta at term: relationship to levels of leptin in cord blood and placental weight

During fetal life ,placental tissue represents an additional source of leptin for the mother and conceptus. It has been suggested that feto-placental production of leptin may be involved in placental and fetal growth regulation. The aim of this study was to examine the correlation between leptin mRNA expression in the placenta and the concentrations of leptin in cord blood. A total of 30 healthy ,pregnant women who gave birth to healthy neonates were included in the study. Maternal blood (obtained from the cubital vein) and umbilical cord blood were drawn immediately after birth. Serum leptin concentration was determined by enzyme-linked immunosorbent assay and serum insulin concentration was measured by radioimmunoassay. Leptin mRNA was measured in placental tissue by a reverse transcriptase-polymerase chain reaction. The estimated mean leptin mRNA expression in placenta was 4.65 ± 1.83 pg mRNA/μg DNA. Leptin mRNA correlated with cord serum leptin concentrations (r = 0.3691 ,p = 0.045). Placental weight correlated with placental leptin mRNA (r = 0.3686 ,p = 0.045). The mean leptin concentration in cord serum at birth was slightly lower (3.1 ± 1.9 ng/ml) than that found in maternal serum (3.9 ± 1.2 ng/ml). A positive correlation was observed between cord and maternal serum leptin levels (r = 0.58 ,p = 0.001). The mean insulin concentration in maternal serum was not significantly higher than that in umbilical serum: 22.2 ± 17.8 μIU/ml vs. 6.9 ± 3.6 μIU/ml; r = 0.069 ,p = 0.71). Neither maternal nor umbilical insulin concentrations correlated with leptin concentration in cord or maternal peripheral serum.

A Randomized, Single Blind, Placebo-Controlled Trial for the Pain Reduction During the Outpatient Hysteroscopy After Ketoprofen or Intravaginal Misoprostol

STUDY OBJECTIVE To assess the efficacy of ketoprofen vs intravaginal misoprostol for pain relief during outpatient hysteroscopy. DESIGN Prospective, randomized, single-blind, placebo-controlled clinical trial (Canadian Task Force classification I). SETTING Tertiary medical center. PATIENTS One hundred fifty women referred for hysteroscopy between January and October 2013. INTERVENTIONS Women were randomized to receive vaginal misoprostol, 400 μg, with 100 mL of 5% intravenous glucose (misoprostol arm); intravenous ketoprofen, 50 mg/mL, in 100 mL 5% glucose with intravaginal placebo (ketoprofen arm); or vaginal placebo tablets, 100 mL 5% intravenous glucose (placebo arm) before outpatient hysteroscopy. MEASUREMENTS AND MAIN RESULTS A visual analog scale (VAS) was used for 1-dimensional pain assessment. Patients were asked to mark a VAS score before, during, and at 5 and 15 minutes after the procedure. Median VAS scores during and directly after the anesthesia-free hysteroscopy were significantly lower in the misoprostol group than in the ketoprofen (p = .02) or placebo (p = .006) groups. There were no statistical differences between the 3 arms in median VAS score assessed at 15 minutes after the procedure (p = .16). There were no differences in procedure time between groups (p = .16). CONCLUSION When administrated 4 hours before the procedure, 400 μg vaginal misoprostol seems to reduce the pain during and immediately after hysteroscopy. The effect does not depend on patient age, hormone status, parity, or type of outpatient hysteroscopy (operative or diagnostic).

C-reactive protein as the indicator of severity in ovarian hyperstimulation syndrome

Background. To establish correlations between laboratory findings and clinical symptoms of moderate and severe ovarian hyperstimulation syndrome (OHSS). Design. A retrospective study. Setting. Department of obstetrics and gynecology, public clinical hospital. Patients. Nineteen women admitted to the public hospital with a diagnosis of OHSS. The procedure of controlled ovarian stimulation (COH) was performed in the private assisted reproductive technology centre. Methods. Blood samples were collected, ultrasound examination of ovaries, abdominal circumference measurement were performed, intravenous crystalloids, plasma expanders such colloids and albumin were given. Correlations between mean laboratory results (haematocrit, c-reactive protein (CRP), white blood count, serum protein, serum albumin), ovarian size in ultrasound examination, abdominal circumference, and amount of albumin and hydroxyethyl starch transfused to the patient were assessed. Results. Significant correlation was observed between CRP concentration and abdominal circumference measured when the patient was admitted to the department, between CRP concentration and ovarian size measured during ultrasound examination at admission and between CRP concentration and body weight. Conclusions. CRP can be a potential candidate to an indicator of OHSS severity.

Serum leptin concentrations in women taking oral contraceptives

OBJECTIVES To investigate serum leptin concentrations in women taking oral contraceptives containing the same gestagen and different doses of ethinyl estradiol. STUDY DESIGN 30 women received tablets containing 20 microg of ethinyl estradiol (EE) and 150 microg of desogestrel (DSG) (Mercilon) whereas another group of 30 women received 30 microg of EE and 150 microg of DSG (Marvelon). Serum leptin concentrations were estimated using a Leptin RIA kit (Linco Research USA) after an overnight fast on the first day of the cycle prior to the onset of therapy as well as after the 3rd and 6th treated cycles. RESULTS In both groups a positive correlation between serum leptin and body mass index (BMI) was found (r=0.56; P<0.001 and r=0.67; P<0.001). The initial serum leptin concentration in the Mercilon group was 7.62+/-8.46 ng/ml. This value was not statistically different from values after 3 months (9.31 8.23 ng/ml) and after 6 months (10.53+/-8.03 ng/ml) of treatment. Very similar results were found in patients receiving Marvelon: 8.81+/-6.56 ng/ml initially; 11.62+/-11.16 ng/ml at 3 months, and 10.38+/-7.32 ng/ml at 6 months. The statistical analysis did not reveal any significant difference at each investigated time point in either study group. CONCLUSIONS Modern low dose OC containing third generation gestagen and low dose of ethinyl estradiol, does not have any influence on serum leptin or BMI, and therefore does not exert a significant influence on body energy metabolism.

Bilateral ectopic tubal pregnancy, following in vitro fertilisation (IVF).

This is a case report of a 33 year-old-woman who underwent in vitro fertilization, because of primary infertility caused by fallopian tube factor. The patient underwent three trials of frozen embryo transfers (ET-CRYO). On the 26th day after the third probe of ET-CRYO she suffered from pelvic pain and vaginal bleeding. Transvaginal ultrasonographic scan revealed bilateral tubal ectopic pregnancy without fluid in the Douglas pouch and no gestational sac in the uterus. Laparoscopic bilateral salpingectomy was performed on the next day after admission. The postoperative course was uneventful.

PCOS and cancer risk.

Polycystic ovary syndrome (PCOS) affects approximately 5 to 10% of women of reproductive age. It is the most common reason of anovulation in infertile women. PCOS is accompanied by such conditions as oligo- or anovulation, hipertestosteronism, lower cell sensitivity to insulin, type II diabetes, hyperlipidemia and obesity. Each of the above-mentioned conditions is an approved risk factor proved to predispose towards cancer. However, PCOS is also a disease entity which differs in its clinical manifestation. For example not all patients suffer from obesity or hipertestosteronism related symptoms. From the analysis of literature it is possible to draw conclusions, that there is a possible correlation between PCOS and endometrial cancer, which emerges from clinical trials or research focused on molecular changes in endometrium patients with PCOS. On the other hand, correlation between PCOS and breast or ovary cancer is not so strong, in spite of single papers which are showing the link. The main problem in researching the correlation between PCOS and any cancer risk, is there is a very small group of women or the trial is imperfect (e.g. no control group). There is no meta-analysis focused on this correlation in literature. The change of criteria of PCOS in the past is also a big problem, because there was a number of definitions of PCOS, which results in inconsistent PCOS diagnoses over time. In this paper we would like to provide a description of studies that aimed at showing correlation between PCOS and cancer risk and underlying theoretical assumptions.

Transfusion-related acute lung injury in a young woman with ectopic pregnancy - case report and literature review.

BACKGROUND Transfusion-related acute lung injury (TRALI) is a major cause of death associated with transfusion. Nevertheless it is still misdiagnosed and underreported. We present a case of this serious complication in order to make it more familiar to clinicians and indicate proper medical management, which is significant not only for the patients presenting TRALI symptoms but also for future recipients of blood components. CASE PRESENTATION A 32-year-old white woman with in-vitro fertilization in anamnesis was admitted to Department of Obstetrics and Gynecology because of abdominal pain. Ultrasonography examination revealed pathological mass in left adnexa. The patient underwent laparoscopic left salpingectomy. The following day she reported progressive pain in lower abdomen with signs of peritoneal irritation. Emergency laparotomy was performed and active bleeding from fallopian tube was stopped. Four units of red blood cells concentrate and six units of fresh frozen plasma were transfused. Within two hours of surgery acute respiratory distress symptoms occurred, bilateral infiltrates were found on chest X-ray. The patient responded to supportive treatment (oxygen therapy, dexamethasone, diuretics) and her state improved within 12 hours. Serological diagnostics revealed anti-HLA antibodies in one donor which reacted with patients granulocytes. Clinical picture and anti-leukocyte antibodies detected in blood component allowed to identify the immune-mediated TRALI. CONCLUSIONS Transfusion-related acute lung injury is a life-threatening complication of transfusion which manifests as non-cardiogenic pulmonary edema. Each suspected case of this syndrome should be reported to blood center in order to confirm the diagnosis and implement preventive measures (exclusion of implicated donor from further blood donation).

Relationships between meconium concentrations of acute phase proteins

Meconium concentrations of naturally accumulated ceruloplasmin (CER), lactoferrin (LF), and neutrophil gelatinase‐associated lipocalin (NGAL) and their relationships considered as a panel of acute phase proteins could be used for the assessment of fetal homeostasis. CER, LF and NGAL concentrations were measured using enzyme‐linked immunosorbent assay kits in meconium portions (n = 80) collected from 19 healthy neonates. The coefficients of variation (CV) of the meconium LF (1.77) and NGAL (1.26) were about two‐fold higher than that of CER (0.73) with significant (P < 0.05) correlations between all three parameters. The LF to NGAL ratio (CV = 0.67) correlated strongly with the CER concentrations (r = 0.39, P < 0.01). These correlations between CER, LF and NGAL concentrations suggest their combined involvement in the metabolic processes in the developing fetus.

Variations in serum concentrations of C-reactive protein, ceruloplasmin, lactoferrin and myeloperoxidase and their interactions during normal human pregnancy and postpartum period

BACKGROUND Serum proteins may provide information about homeostasis of redox status and inflammatory processes also during pregnancy. The aim of the study was to assess the dynamics of changes in serum concentrations of C-reactive protein (CRP), ceruloplasmin (CP), lactoferrin (LF) and myeloperoxidase (MPO) and their interactions during normal pregnancy and the postpartum period. METHODS The concentrations of proteins were measured in serum (n=113) from pregnant in consecutive trimesters and in postpartum period (n=28) and in non-pregnant women (n=17), using immunoturbidimetric assays (CRP, CP) and ELISA Kits (LF, MPO). RESULTS The concentrations [mg/dl] CP and CRP (mean±SD respectively): second trimester (43.1±6.2; 0.49±0.57), third trimester (44.5±5.8; 0.41±0.37), postpartum (42.39±6.4; 4.15±3.6) were higher than in the first trimester (33.0.5±8.7; 0.31±0.36) or non-pregnant women (24.12±7.4; 0.12±0.13). The increases in concentrations of CP and CRP between the first and the second trimesters were by approximately 35% and 50% respectively and the correlation coefficients in the first trimester and in non-pregnant women were twice higher than in the second trimester and the postpartum period. The concentrations [μg/ml] LF and MPO were no significant differences (mean±SD respectively): first (6.19±4.54; 0.17±0.12), second (5.68±4.4; 0.14±0.08), third (6.34±6.98; 0.17±0.14), the postpartum (4.86±3.64; 0.25±0.4), and non-pregnant (3.9±2.56; 3.2; 0.14±0.05). However, significant correlations were established (p<0.05) between MPO and LF in all groups and between the following ratios CRP/LF vs CP/MPO and CRP/MPO vs CP/LF. CONCLUSIONS The concentrations of proteins synthesized by the liver (CP, CRP) dynamically increase during consecutive trimesters of pregnancy unlike neutrophil-derived proteins (LF, MPO). Statistically significant correlations between the proportions of the serum proteins may suggest their combined role for the maintenance of homeostasis during pregnancy.

Cumulative summation test for learning curve (LC-CUSUM) in outpatient hysteroscopy

OBJECTIVES Outpatient hysteroscopy has become an integral part of postgraduate training in gynecology. It is an operator-dependent procedure, however there are no recommendations regarding total number of performed procedures to reach proficiency. MATERIAL AND METHODS This study aimed to assess the learning curve (LC) using cumulative summation test for learning curve (LC-CUSUM). RESULTS A success rate of 97% a failure rate ≥ 10% were established to denote an adequate and an inadequate performance. A third-year trainee needed 56 procedures to reach the predefined level of performance. CONCLUSIONS As the length of the LC for outpatient hysteroscopy seems highly variable, it is reasonable to provide tailored monitoring while training.