Birol Vural

EFFECTS OF GRANULOCYTE-MACROPHAGE COLONY -STIMULATING FACTOR ON INCISIONAL WOUND HEALING IN AN EXPERIMENTAL DIABETIC RAT MODEL

The exact nature of poor wound healing in diabetes is uncertain. Neutrophils play a critical role in the host defense mechanism, and it is suggested that impaired neutrophil functions cause healing difficulties with or without infections in diabetic patients. Granulocyte-macrophage colony-stimulating factor (GM-CSF) is used clinically when given systematically to increase the circulating neutrophils, but its wound-healing effects have not been systematically studied. This study was undertaken to examine the effects of GM-CSF on incisional wound healing in an experimental diabetic rat model. Forty rats were randomly divided into three groups, group I receiving saline as control, diabetes-induced group II receiving saline and diabetes-induced group III receiving GM-CSF. The anesthetized rats in all groups were wounded 21 days after diabetes induction by streptozotocin. Blood neutrophil counts and neutrophil fractions were also determined three days after wounding. Tensile strengths of wounded skin and the hydroxyproline (hyp) level of the wound were determined and wound healing processes were evaluated by light and electron microscopy, fourteen days after wounding. Neutrophil counts and phagocytosis were significantly increased in group III and neutrophil counts decreased in group II (p < 0.05). Although the hydroxyproline level of wound tissue significantly decreased in group II as compared with group III (p < 0.05), there was no differences of tensile strength between group II and III (p < 0.05). Wound score in group II was less than that in groups I and III (p < 0.05). It is concluded that PMN may have a role in modulating wound healing. GM-CSF may be useful for creating better wound healing healing. GM-CSF may be useful for creating better wound healing in risky patients such as diabetics.

The Relationship between Neutrophils and Incisional Wound Healing

The systemic administration of granulocyte-macrophage colony-stimulating factor (GM-CSF) is used clinically to increase circulating neutrophils, but its wound healing effects after intraperitoneal treatment have not been studied yet. We planned to investigate the effect of neutrophils on wound healing under cyclophosphamide and GM-CSF treatment. Forty rats were divided into three groups: control group (group I, n = 12) receiving saline, group II (n = 14) receiving cyclophosphamide and group III (n = 14) receiving GM- CSF. The rats in all groups underwent incisional wounding and were euthanized after 7 days. Blood neutrophil counts and functions, tensile strengths and the hydroxyproline level of skin were determined, and a histopathological evaluation of healing was made. Neutrophil counts and phagocytosis significantly increased in group III and decreased in group II. Although the skin hydroxyproline level did not differ, there was a difference in tensile strength of the wounded skin between group II and group III. The wound score in group II was lower than that in groups III and I. As a result we suggest that systemically given GM-CSF – by increasing the neutrophil count and neutrophil phagocytosis index – can enhance the tensile strength of surgical incisions.

Expression of insulin-like growth factor in the placenta of intrauterine growth-retarded human fetuses

Many cases of intrauterine growth retardation (IUGR) are the result of placental and fetal tissue insufficiency. Insulin-like growth factor-I (IGF-I) is known to play a role in placental and fetal growth. An immunocytochemical study was performed to localize IGF-I peptides in human placenta and umbilical cords of normal (n = 3) and IUGR (n = 3) fetuses. The peripartum fetal conditions were evaluated as well. Immunoreactive IGF-I was detected in the cytotrophoblast, syncytiotrophoblast, amnion, endothelial cells of fetal capillaries and in the decidua in both normal and IUGR placental tissue. A more robust immunostaining and increased numbers of positively stained cells were found in the decidua of IUGR placenta (p < 0.001). Intense immunostaining was also found in endothelial cells, smooth muscle cells and fibroblasts of the umbilical vein. IGF-I immunoreactivity was also present in stroma (Hofbauer cells and/or fibroblasts) of IUGR villi. Our results indicate that expression of IGF-I is high in specific sites in placenta and umbilical cords, which indicates a paracrine and/or endocrine function. The increased expression of IGF-I in placenta of IUGR fetuses indicates its involvement in restoring normal growth by means of a positive feed-back mechanism.

Is prostate-specific antigen a potential new marker of androgen excess in polycystic ovary syndrome?

Aim:  To determine whether serum prostate‐specific antigen (PSA) levels are increased in polycystic ovary syndrome (PCOS) and the possibility of PSA to be used as a diagnostic marker of hyperandrogenism in females.

Hormonal and functional biomarkers in ovarian response

PurposeSuccess rates of any artificial reproduction techniques depend on a correct protocol for ovarian stimulation. This can be decided only by proper assessment of ovarian reserve before commencing ovarian stimulation. This study has been conducted to investigate the role of hormonal and functional biomarkers in the prediction of ovarian response.MethodsA total of 689 women between July 2012 and July 2013 undergoing IVF at Kocaeli University have been enrolled in the study. Patients have been categorized into three groups according to the number of oocytes retrieved: 0–3 oocytes (poor responders), 4–15 oocytes (normoresponders), and >16 oocytes (hyperresponders). Groups have been compared according to follicle-stimulating hormone (FSH), E2, luteinizing hormone (LH) levels, antral follicle counts, and E2 levels on hCG days. Furthermore, regression analysis has been performed with parameters such as age, FSH, LH, E2, anti-mullerian hormone (AMH) and antral follicle counts (AFC) that can affect the total number of oocytes retrieved and pregnancy rates and their interactions with each other have been investigated.ResultsFSH, age, hCG day LH level, cycle cancellation rate, total gonadotropin dose were significantly higher in the poor responder group, but in this group, AFC, AMH, hCG day E2 level, and the number of MII oocytes were significantly lower. Cut-off values of normal responders for FSH, AMH, and AFC were 8.43 area under curve [AUC: 0.541 (0.491–0.590)], 0.62 [AUC: 0.704 (0.638–0.764)], and 6 [AUC: 0.715 (0.667–0.760)], respectively. Cut-off values for the absolute poor response group (cycle cancellation) were 12.75 for FSH [AUC: 0.533 (0.49–0.57)], 0.23 for AMH [AUC: 0.678 (0.618–0.733)], and 6 for AFC [AUC: 0.576 (0.531–0.613)]. AMH and AFC were the best markers for the prediction of total oocyte count, independent of age, FSH, and LH levels.ConclusionsAMH and AFC were found to be the best ovarian reserve tests that can determine the total oocyte count retrieved, without any significant effects on pregnancy rates.

The role of L-arginine and neutrophils on incisional wound healing.

Although arginine plays an important role in many aspects of inflammation and wound healing, the mechanism is not clear. We aimed to evaluate the effect of L-arginine administration on wound healing and neutrophil activity and on the interaction of these effects. Sixteen rats were divided into two groups: control group and L-arginine group. L-arginine was given intraperitoneally. The rats underwent incisional wounding and were killed on the 7th day of wounding. Blood neutrophil counts, neutrophil adhesivity index, tensile strengths and hydroxyproline level of skin were determined, histopathological and electron microscopical evaluation of healing was performed. Wound scores in the control group were significantly lower (p  < 0.05). Hydroxyproline and collagen levels of skin were significantly increased in the L-arginine group (p  < 0.05). Blood neutrophil counts and neutrophil adhesivity index in the L-arginine group were significantly increased (p  < 0.05), as were the inflammatory cells in the skin. L-arginine may be used during the first phase of healing to induce inflammation in high risk patients.

Is sildenafil citrate affect endometrial receptivity? An immunohistochemical study.

The authors aimed to investigate the effect of sildenafil citrate (Sc) on expressions of β3 integrin and vascular endothelial growth factor (VEGF), which is taking part in endometrium receptivity in implantation window period in controlled ovarian hyperstimulation (COH) performed rats. In this study, Wistar albino female rats were used and were divided into four groups as control, COH, Sc, and COH + Sc groups. They were sacrificed on the third, fourth, and fifth day of pregnancy, uteruses were resected, and uteri sections were stained with immunohistochemical method and evaluated. β3 integrin immunoreactivity was most intensely observed in the endometrial glandular epithelium (GE) and stromal cells in the Sc group on the third day, whereas immunoreactivity was most intensely detected in the luminal epithelium (LE), GE, and stromal cells in the Sc group on the fourth day. VEGF immunoreactivity was most intensely observed in the endometrial LE in the Sc group on the third day, in the Sc and COH + Sc groups on the fourth day, and in the COH + Sc group on the fifth day. Our results indicated that Sc plays a role in both implantation and decidualization by affecting β3 integrin and VEGF expressions in implantation window period in rats.

The Role of Overweight and Obesity in In Vitro Fertilization Outcomes of Poor Ovarian Responders.

Objective. Obesity is a worldwide concern with detrimental health effects including decreased fecundity. However, obesitys impact on in vitro fertilization (IVF) is inconclusive and there is little data concerning poor ovarian responders (POR). This study explored the effects of overweight and obesity on IVF outcomes of POR. Design. We retrospectively evaluated 188 POR undergoing IVF cycles. Methods. Patients were categorized into three groups. Group 1 was normal weight POR (18.5–24.9 kg/m2, n = 96); Group 2 was overweight POR (25.0–29.9 kg/m2, n = 52); and Group 3 was obese POR (≥30.0 kg/m2, n = 40). Main measured outcomes included IVF outcomes. Results. The oocyte maturity, total gonadotropin dose-duration, and cycle cancellation rates were similar. Obese women had significantly decreased LH levels. LH < 4 mIU/mL had a sensitivity (62%) and a specificity (86%) for IVF failure (AUC: 0.71). Fertilization rates of obese subjects were significantly lower than normal and overweight subjects (p = 0.04). Obese womens clinical pregnancy rates were significantly lower (15%) than normal weight women (33.3%, p = 0.01). Conclusions. Despite similar counts of recruited mature oocytes, obese POR women had decreased fertilization and clinical pregnancy rates. Obesity rather than overweight significantly decreased IVF outcomes in POR.

An Abdominal Wall Desmoid Tumour Mimicking Cesarean Scar Endometriomas: A Case Report and Review of the Literature.

Abdominal wall desmoid tumours (DT) are rare, slow-growing benign muscular-aponeurotic fibrous tumours with the tendency to locally invade and recur. They constitute 0.03% of all neoplasms and high infiltration and recurrence rate, but there is no metastatic potential. Although surgery is the primary treatment modality, the optimal treatment remains unclear. Abdominal wall endometriosis is also an unusual disease, and preoperative clinical diagnosis is not always easy. The preoperative radiologic imaging modalities may not aid all the time. Herein, we report an abdominal mass presenting as cyclic pain. Forty-two years old woman who gave birth by cesarean section admitted the complaints of painful abdominal mass (78x45 mm in size) under her cesarean incision scar. She had severe pain, particularly during menstruation. The clinical and radiological imaging findings mimicking endometrioma. We performed wide surgical excision of mass with a 1 cm tumor-free margin with the diagnosis of a benign mesenchymal tumor in the frozen section. The postoperative course was uneventful and recovered without any complication and recurrence three years after surgery. This report presents a case of abdominal wall desmoid tumor mimicking endometrioma. In this paper, shortcomings in diagnosis, abdominal wall endometriomas, and DTs were discussed in the view of literature.

Does the intrauterine device carry the risk of immunity to sperm

Intrauterine devices (IUDs) are the second most commonly used contraceptive method in the world. A number of mechanisms have been proposed by which IUDs could interfere with reproductive processes. In this study, the relationship between intrauterine devices and the risk of antisperm antibody (ASA) production in the absence of prior sensitization was investigated. Sixty-two IUD users (group 1) and 42 women with no contraceptive use as a control group (group 2) were included in the study. Six months after the IUD insertion, 4 women in group 1 and 2 women in group 2 with lower genital tract infections were excluded from the study. The sera of the remaining 58 women in group 1 and 40 women in group 2 were evaluated again for the presence of ASA. Twelve patients (20.7%) in group 1 and 12 patients (30.0%) in group 2 had ASA positivity. When we compared the ASA levels in the IUD group with those in the control group, there was no statistically significant difference (p>0.05). In summary, our data proved that copper-containing intrauterine devices in the absence of prior sensitization do not significantly affect immunity to sperm in sera of women.