Esra Nur Tola

Intracellular Ca2+ and antioxidant values induced positive effect on fertilisation ratio and oocyte quality of granulosa cells in patients undergoing in vitro fertilisation

Oxidative stress is important for promoting oocyte maturation and ovulation within the follicle through calcium ion (Ca(2+)) influx. The relationship between antioxidant and cytosolic Ca(2+) levels and oocyte quality and fertilisation rate in the granulosa cells of patients undergoing in vitro fertilisation was investigated. Granulosa cells were collected from 33 patients. Cytosolic free Ca(2+) ([Ca(2+)]i) concentration, lipid peroxidation, reduced glutathione, glutathione peroxidase and oocyte quality were measured in the granulosa cells. The relationship between two drug protocols was also examined (gonadotrophin-releasing hormone antagonist and agonist protocols) and the same parameters investigated. The [Ca(2+)]i concentration (P<0.001), glutathione (P<0.05) and oocyte quality (P<0.001) values were significantly higher in the fertilised group than in the non-fertilised group, although glutathione peroxidase activity was significantly (P<0.05) higher in the non-fertilised group than in the fertilised group. The [Ca(2+)]i concentrations were also higher (P<0.001) in the good-quality oocyte groups than in the poor-quality oocyte group. There was no correlation between the two drug protocols and investigated parameters. In conclusion, it was observed that high glutathione and cytosolic Ca(2+) concentrations in granulosa cells of patients undergoing in vitro fertilisation tended to increase the fertilisation potential of oocytes.

Maternal serum AMP-activated protein kinase levels in mild and severe preeclampsia

Abstract Objective: To investigate Phosphorylated adenosine monophosphate activated protein kinase (AMPK) levels in healthy pregnant women and pregnant women with preeclampsia (PE). Methods: Twenty-eight women with mild-PE, 22 with severe-PE, and 30 normotensive controls were included in this cross-sectional study. The serum AMPK levels of these patients were analyzed. The patients were followed up to delivery. Results: No statistically significant difference was found between the groups for age, gravida, parity, and gestational age at the time the blood samples were obtained (p > .05). No significant difference between the group with mild-PE and the control group was found, while in the severe-PE group, serum AMPK levels were significantly higher relative to both the mild-PE and control groups (p < .001 and p < .001, respectively). No correlation was detected between serum AMPK levels and age, body mass index (BMI), and gestational age at the time the blood samples were collected. A negative correlation was found between AMPK levels and gestational week and birthweight at delivery, while a positive correlation was detected between systolic and diastolic blood pressures and AMPK levels. Conclusions: Serum AMPK was higher in patients with severe-PE compared with healthy pregnant women and patients with PE without severe features so it might be a new biomarker for the prediction of disease and its severity.

Increased levels of the novel hepatokine fetuin B in patients with intrahepatic cholestasis of pregnancy

Abstract Objectives: To investigate liver-derived plasma protein fetuin B levels in healthy pregnant women and pregnant women with intrahepatic cholestasis of pregnancy (ICP). Materials and methods: Forty women with ICP and 40 healthy pregnant women were included in this cross-sectional study. The serum fetuin B levels of these patients were analyzed. The patients were followed up to delivery. Results: Maternal age, gravida, parity, BMI at assessment, and gestational age at blood sampling were similar between the ICP and control groups (p > .05). However, the gestational age at delivery and the birth weight were significantly lower in the ICP group (p < .05). Total bile acid (TBA) levels and liver function tests were significantly higher in the ICP group than in the control group (p < .0001 and < .0001, respectively). In addition, serum fetuin B concentrations were significantly higher in the ICP group than in the control group (p < .0001). The best cutoff for fetuin B serum concentration was 5540.2 pg/mL. Serum values greater than this threshold had 80% sensitivity and 65% specificity for the diagnosis of ICP. Conclusions: Serum fetuin B was higher in patients with ICP compared to healthy pregnant women and might be a new biomarker.

The predictive effect of inflammatory markers and lipid accumulation product index on clinical symptoms associated with polycystic ovary syndrome in nonobese adolescents and younger aged women

OBJECTIVE(S) The aim of our study is to analyse the inflammatory markers and lipid accumulation product (LAP) index in nonobese adolescents and younger aged women with polycystic ovary syndrome (PCOS) compared with age and body mass index (BMI)-matched healthy controls and to determine whether the investigated parameters are potential markers for the etiopathogenesis of PCOS. We also aim to determine whether these inflammatory markers are predictive for developing some clinical implications, such as cardiovascular disease (CVD) and insulin resistance (IR), associated with PCOS. STUDY DESIGN A total of 34 adolescents and younger aged females with PCOS, and 33 age and BMI-matched healthy controls were recruited for our study. All participants were nonobese (BMI<25). Neopterin (NEO), C-reactive protein (CRP) levels and complete blood parameters were assessed. LAP index and homeostasis model assessment of IR (HOMA-IR) were calculated; anthropometric, clinical and biochemical parameters were also recorded. RESULTS Serum NEO, CRP levels and LAP index were significantly increased in nonobese adolescents and younger aged females with PCOS compared to healthy controls. We could not found any predictive effect of investigated inflammatory markers and LAP index on CVD risk among PCOS patients after adjustment for abdominal obesity. We also found a positive predictive effect of WBC and a negative predictive effect of lymphocytes on IR in PCOS patients after adjustment for abdominal obesity. We did not find any predictor effect of NEO on IR, but it was a positive predictive marker for an elevated HOMA-IR index. CONCLUSION(S) Elevated NEO, CRP levels and LAP index could have potential roles in the etiopathogenesis of PCOS in nonobese adolescents and younger aged females,NEO could be a predictive marker for elevated HOMA-IR index, and WBC and lymphocytes could be predictive for the development of IR among nonobese adolescents and younger aged females with PCOS.

Uygun Olmayan Servikste Doğum İndüksiyonunda Çift Balonlu Kateter ve Vajinal Dinoprostonu Karşılaştıran Kontrollü Randomize Çalışmanın Ön Sonuçları

Objective: To compare a double-balloon transcervical catheter and dinoprostone vaginal insert for induction of labor in women with an unfavorable cervix. Material and Methods: Patients with a Bishop score of 6 requiring labor induction due to maternal or fetal indications at term received either a double-balloon catheter or a dinoprostone vaginal insert from November 2016 through February 2017 at the Perinatology Department. The primary outcome was vaginal delivery rate within 24 hours. Results: A total of 74 women were included; 37 received induction with a double-balloon catheter and 37 with the dinoprostone vaginal insert. The groups were similar with respect to maternal age, gravidity, parity, baseline Bishop score, gestational age at induction and indications for induction. There was no difference in the vaginal delivery rate within 24 h (52.5% vs. 47.5%, P=0.551) or the vaginal delivery rate (47.8% vs. 52.2%, p=0.860) between the groups. Maternal and neonatal outcomes were similar between the groups. Conclusion: Doubleballoon catheter and dinoprostone vaginal insert are associated with similar vaginal delivery and cesarean section rates and neonatal outcomes and safe and effective at induction.

Pathology of cigarettes on the reproductive system and ameliorative effects of alpha lipoic acid: A rat model study

Cigarette smoking (CS) has some detrimental effects that occur via oxidative stress (OS). The aim of this work was to demonstrate the pathological and immunohistochemical effects of CS and the protective effects of a strong antioxidant alpha lipoic acid (ALA) on CS-induced genital system changes in a rat model. Twenty-eight female rats were randomly allocated to three groups as control, CS-exposed, and CS-exposed and ALA-treated. Reproductive tract organs were collected for biochemical and pathological examinations. In the CS group, OS markers increased in the tissues of both the ovary and fallopian tubes. Decreased follicle numbers in the ovary, marked cilial loss in the fallopian tubes, and pathologic changes in the uterus were observed in the CS group. Positive calcitonin gene–related peptide (CGRP), caspase 3α, hypoxia-inducible factor 1α (HIF-1α), tumor necrosis factor-α (TNF-α) immunoreactions were observed in uterine tissues and HIF-1α immunoreactions in tubal and uterine epithelial cells of the CS group. ALA reversed all these findings effectively. CS has negative effects on the female reproductive system via HIF-1α in tuba uterina and HIF-1α, HIF-2α, TNF-α, caspase 3, and CGRP in the uterus, and ALA could protect against the negative effects of CS on the female reproductive system.

The Role of Follicular Fluid Thiol/Disulphide Homeostasis in Polycystic Ovary Syndrome

Background: Oxidative stress has been proposed as a potential trigger in the etiopathogenesis of polycystic ovary syndrome-related infertility. Thiol/disulphide homeostasis, a recently identified oxidative stress marker, is one of the antioxidant mechanism in humans with critical roles in folliculogenesis and ovulation. Aims: To investigate follicular fluid thiol/disulphide homeostasis in the etiopathogenesis of polycystic ovary syndrome and to determine its association with in vitro fertilization outcome. The study procedures were approved by the local ethics committee. Study Design: Cross-sectional study. Methods: Follicular fluid from 22 women with polycystic ovary syndrome and 20 ovulatory controls undergoing in vitro fertilization treatment was sampled. Thiol/disulphide homeostasis was analyzed via a novel spectrophotometric method. Results: Follicular native thiol levels, as well as the native thiol/total thiol ratio, were lower in the polycystic ovary syndrome group than in the non-polycystic ovary syndrome group (p=0.041 and p<0.0001, respectively). Disulphide levels, disulphide/native thiol, and disulphide/total thiol ratios were increased in the polycystic ovary syndrome group (p<0.0001). A positive correlation between the fertilization rate and native thiol (p=0.01, r=0.53) and total thiol (p=0.01, r=0.052) among polycystic ovary syndrome patients was found. A positive predictive effect of native thiol level on the fertilization rate in the polycystic ovary syndrome group was also found (p=0.03, β=0.45, 95% CI= 0.031-0.643) Conclusion: Deterioration of thiol/disulphide homeostasis, especially elevated disulphide levels, could be one of the etiopathogenetic mechanisms in polycystic ovary syndrome. Increased native thiol levels are related to the fertilization rate among polycystic ovary syndrome patients and are positive predictors of the fertilization rate among polycystic ovary syndrome patients. Improvement of thiol/disulphide homeostasis could be important in the treatment of polycystic ovary syndrome to increase in vitro fertilization success.

Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, mean platelet volume and plateletcrit in isolated intrauterine growth restriction and prediction of being born small for gestational age

Introduction: Mean platelet volume (MPV), plateletcrit (PCT), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are accepted as inflammatory markers. In this study, we aimed to investigate the changes occurring in these parameters in pregnancies complicated with intrauterine growth restriction (IUGR) and the role of these parameters in the prediction of being born small for gestational age (SGA). Material and methods: The study concerned a group of 200 patients with isolated IUGR and a control group of 200 patients without IUGR. Changes in MPV, PCT, NLR, and PLR were analyzed in patients with IUGR and prediction of SGA. Results: Gravida, parity, gestational week at birth, and birth weight were significantly lower in the IUGR group. The PCT and MPV values were similar in both groups. Lymphocyte count was significantly higher and the PLR and NLR values were significantly lower in the IUGR group. In the ROC curve analysis, the area under the curve (AUC) values for NLR, PLR, and lymphocyte count were statistically significant (p = 0.005, 0.0001, 0.0001, respectively). Conclusions: The NLR, PLR, and lymphocyte count appear to be useful markers for the prediction of SGA newborns. However, their low sensitivity and specificity values restrict their use in clinical practice.

Conventional 22- and 20-gauge needle for second trimester amniocentesis: A comparison of short term outcomes

Objective: To compare the short-term outcomes of two different-sized needles for genetic amniocentesis. Materials and Methods: A total of 271 amniocentesis were retrospectively evaluated in 2 groups concerning the size of the needles used during the procedure: Conventional 20-gauge (G) (n=164) and 22G (n=107). Periprocedural complications and cost-effectiveness were compared across the groups. Results: There were no differences between groups concerning complications within 15 days after the procedure (fetal loss, 0.6% versus 0.9%, and amniotic fluid leak 1.2% versus 1.8%, p=0.99 for each). The 22G needle was significantly more cost efficient (p<0.0001). Conclusion: The 22 G spinal needle is convenient for second trimester amniocentesis with similar complication rate and has a favorable cost profile.

A 27-kg mucinous cystadenoma of the ovary presenting with deep vein thrombosis

Giant ovarian adenomas are rarely observed today because of early diagnosis and treatment. Mucinous cystadenomas is a kind of tumor that mostly causes the ovary to enlarge. Theu can present with various and non-specific clinical manifestations such as deep vein thrombosis. The primary symptoms of giant ovarian tumors are abdominal enlargement and distension. Therefore, making the correct preoperative diagnosis is sometimes difficult. The appropriate treatment must include oncologic procedures and a multidisciplinary approach to minimalize complications and save the patient’s life. Herein, we report a woman aged 53 years with a 27-kg ovarian mucinous cystadenoma that presented as a left popliteal vein thrombosis.