Füsun Varol

Nerve growth factor (NGF) and NGF mRNA change in rat uterus during pregnancy

During pregnancy, the uterus undergoes a profound sympathetic denervation. To explore whether this is associated with changes in neurotrophic factors, we assayed nerve growth factor (NGF) and NGF mRNA in the uterus of non-pregnant and pregnant rats. In the uterine horn, the concentration of NGF and its mRNA decreased during middle and late pregnancy. However, when values were corrected for the increase of uterine weight and total RNA yield during pregnancy, NGF content and mRNA per horn increased during middle and late pregnancy. Similar, but less pronounced, changes were observed in the cervix. By seven days postpartum, both parameters returned to near normal.

IUGR detection by ultrasonographic examinations using neural networks

This article presents a study that supports a computer-based diagnostic approach to detection of intrauterine growth retardation (IUGR). As an aid to clinical decisions, fetuses that are truly growth retarded and at risk for increased morbidity and mortality should be differentiated from those who have reached their genetic growth potential and are not at increased risk. A wide variety of mathematical formulas (or composite tables) have been proposed for the estimation of fetal weight from ultrasonographic measurements. For these formulas, the timing of the examinations to estimate fetal weight has become controversial due to the poor correlation of early results with the outcomes several weeks later, and also the technical difficulty and poor reproduction of late results. Among the attempts to improve accuracy, one may use more accurate estimated fetal-weight formulas or a single biometric parameter to identify growth abnormalities. This study confirms the following results: 1) in the ultrasound examination the prediction using multiple parameters is better than the prediction using a single parameter; 2) the experiments also show that multiple examinations give a better insight for the diagnosis of IUGR than does a single examination; 3) a neural net is a very helpful tool for correlating many variables.

HELLP syndrome and postpartum corticosteroids

Hemolysis, elevated liver enzymes, and low Ž . platelet HELLP syndrome is a type of severe preeclampsia that threatens both mother and fetus. Several treatment strategies have been considered to be beneficial in stabilization of the disease. In previous studies, the patients receiving dexamethasone for postpartum HELLP syndrome experienced a shorter disease course, faster recovery, and less morbidity 1 3 . In this report, benefits of corticosteroids in patients with postpartum HELLP syndrome were reemphasized. Ž . The study group dexamethasone-group consisted of nine postpartum patients with HELLP syndrome who were managed between 1997 and 1999 at the Department of Obstetrics and Gynecology, Trakya University. The retrospectively assigned control group consisted of 11 postpartum patients with HELLP syndrome who were managed without dexamethasone between 1994 and

Evaluation of hepatic venous pulsatility and portal venous velocity with Doppler ultrasonography during the puerperium.

OBJECTIVE The aim of this study is to evaluate pregnancy-induced changes of hepatic venous pulsatility and portal venous velocity in the puerperium and to determine if these changes disappeared by the end of the puerperium. METHODS AND MATERIAL Healthy normal volunteers (90) were examined on the 2nd and 7th days of puerperium and between the 6th and 8th weeks postpartum. Doppler waveform patterns were obtained in the middle hepatic vein and main portal vein. The hepatic venous pulsatility was named as normal, damped or flat. RESULTS On the 2nd day postpartum, the hepatic vein pulsatility was shown as normal in 8 (26%), damped in 11 (37%) and flat in 11 (37%) cases. On the 7th day postpartum, 15 (50%) cases had normal, 9 (30%) cases had dampened, and 6 (20%) cases had still flat pattern. The majority of the cases (60%) displayed normal hepatic venous pulsatility in the 6th and 8th weeks of puerperium, whereas 23% had still dampened and 17% had flat patterns. There was a trend toward normal pulsatility with increasing puerperal age. The mean portal venous velocity was still higher than the non-pregnant levels and did not showed significant alterations during puerperium. CONCLUSION This study emphasised that, since pregnancy-induced alterations in hepatic venous pulsatility and portal venous velocity had not completely returned to normal in most cases until the end of the puerperium, these physiological changes should be considered whenever hepatic and portal systems are interpreted with Doppler sonography during the puerperal period.

The assessment of LH surge for predicting ovulation time using clinical, hormonal, and ultrasonic indices in infertile women with an ensemble of neural networks.

An ensemble of independently trained neural networks (NN) is proposed for the assessment of luteinizing hormone (LH) surge for predicting ovulation time in infertile but ovulating women. The proposed ensemble involves a number of parallel NN modules. Each pair of the NNs learn specific data that are previously collected for monitoring timing function of LH estradiol (pg ml-1), and follicle diameter (mm) are used to train NN pairs to approximate the function of the LH values. A reasonable and accurate estimation places ovulation approximately 10-12 h after the LH peak. The double-valued (bi-phasic) regions of training data are separated into two single-valued (bi-phasic) regions of training data are separated into two single-valued parts (not exactly preovulatory, postovulatory division) that can be learned by each module of the NN pair. During testing, after the initial decision to have single-valued sides, the assessment is obtained by a linear opinion pool (consensus rule) using the decisions of NNs on the corresponding side without waiting. The network ensemble has various desirable properties: high assessment accuracy of a double-valued multisource data, minimized learning and recall times, and a parallel structure. The ovulation time can be predicted through the assessment of LH peak with a better precision and fewer number of tests.

Third trimester maternal plasma total fibronectin levels in pregnancy-induced hypertension: results of a tertiary center.

The aim of this study was to evaluate maternal plasma total fibronectin values in pregnancy-associated hypertension in women in the third trimester of pregnancy. A total of 125 pregnant women at the 24th week of gestation participated in this study. Nonpregnant normotensive women were included as control group (n = 30). Plasma samples for fibronectin were obtained at the 24th, 28th, and 32nd weeks of gestation from all pregnant patients. From this cohort, 10 patients met the criteria for the diagnosis of gestational hypertension and 15 women met the stringent requirements of preeclampsia, whereas 100 patients were normotensive later in gestation. Plasma total fibronectin levels were determined by radial immunodiffusion technique. Data were analyzed using the SPSS program. The mean plasma fibronectin levels of the pregnant women in whom gestational hypertension and preeclampsia developed were significantly higher at the 24th, 28th, and 32nd weeks in comparison to normotensive pregnant women (p < 0.001). However, throughout the period from the 24th to 32nd weeks of pregnancy, plasma total fibronectin levels did not exhibit a significant change in normotensive pregnant patients or in patients with preeclampsia and gestational hypertension. There was also no correlation between plasma fibronectin levels and gestational age, mean arterial pressure, birth weight, and 5-minute Apgar scores in all groups (p < 0.05). The elevated maternal plasma fibronectin level over 40 mg/dL is capable of predicting preeclampsia with a sensitivity of 73% and a specificity of 92%. These results suggest that serial plasma fibronectin measurements before 24 weeks’ of gestation may be helpful in the early detection of preeclampsia in normotensive gravid women who are destined to become clinically preeclamptic.

The effects of ritodrine and magnesium sulfate on maternal and fetal Doppler blood flow patterns in women with preterm labor.

OBJECTIVE To determine the effects of ritodrine and magnesium sulfate on maternal-fetal blood flows. STUDY DESIGN A total of 85 pregnant women between 26th and 36th weeks with preterm labor, and 83 healthy pregnant women were included. Patients in the study group were randomly assigned to receive either ritodrine (with the addition of verapamil) (n=46) or magnesium sulfate (n=39). Blood flow examinations on the umbilical artery (UA), middle cerebral artery (MCA), bilateral uterine arteries (Ut.A) and ductus venosus (DV) were performed before and 48 h after initiating therapy. RESULTS UA pulsatility index (PI) significantly differed in women receiving tocolysis compared to controls after 48 h. DV PI increased in women receiving MgSO(4), whereas it decreased in the ritodrine and control groups. Ut.A values did not significantly change after 48 h in the groups. In women between the 26th and 32nd weeks, UA, MCA and DV PI did not significantly change after 48 h in the three groups. However, in women between the 32nd and 36th weeks UA and MCA PI significantly differed in the treatment groups compared to controls after 48 h. DV PI increased in women receiving MgSO(4), whereas it decreased in the ritodrine and control groups. CONCLUSIONS MgSO(4) and ritodrine affect blood flow patterns after 48 h in some maternal-fetal vessels. These effects on blood flow are particularly significant in women between 32nd and 36th weeks. The effects of both drugs on fetal and maternal Doppler flows seem similar, except the increased resistance to flow in DV in women receiving MgSO(4).

Antenatal fetal risk assessment by blood-flow velocity waveforms

The purpose of this article is to study a system for antepartum fetal evaluation. The task is to investigate the Doppler ultrasound measurements of the umbilical artery and the cerebral artery to relate the health status of a fetus by using discriminant functions of pattern recognition. The authors then analyze the individual effects of various blood-flow velocity waveforms using principal component analysis.

VEGFR-1, Bcl-2, and HO-1 Ratios in Pregnant Women With Hypertension.

Backgound/Aim: Preeclampsia (PE) is a multisystem disease resulting in high maternal–fetal morbidity and mortality. The aim of the study was to investigate antiangiogenesis-associated alterations in antiapoptotic and antioxidative proteins in PE. Method: Of the 46 patients with PE, 25 (54.3%) were with gestational hypertension (GH), 12 (26%) were with mild, and 9 (19.5%) were with severe PE. The serum levels of vascular endothelial growth factor receptor 1 (VEGFR-1), heme oxygenase 1 (HO-1), and B-cell lymphoma/leukemia (Bcl-2) levels were measured by enzyme-linked immunosorbent assay. Results: In the severe PE group, the VEGFR-1 serum levels (27.3 ± 16.8 vs 13.3 ± 10.7 ng/mL, P = .023) were higher, but the Bcl-2 levels (1.5 ± 0.2 vs 2.1 ± 1.7 ng/mL, P = .047) were lower than the levels in the GH-mild PE group (P = .047). Also, VEGFR-1/Bcl-2 ratio in the severe PE group was significantly higher (P = .003) than the ratio in the GH-mild PE group. Conclusion: The Bcl-2 and HO-1 proteins seem to have important roles in the antiangiogenic environment of preeclampsia.

The investigation of tumoral angiogenesis with HIF-1 alpha and microvessel density in women with endometrium cancer

OBJECTIVE Hypoxia inducible factor 1 alpha (HIF-1α) is a nuclear protein upregulated in response to reduced cellular oxygen concentration which therefore acts as a marker for hypoxia. The aim of this study was to determine tumoral angiogenesis with immunohistochemical markers in endometrium cancer and its relation with stage, grade, survival rates and other prognostic factors. MATERIAL AND METHODS Using the database in our Gynecologic Oncology clinic, we selected 94 patients who were diagnosed with endometrial cancer and underwent primary surgery at our institution between 2001 and 2010. Tissue microarrays believed to demonstrate the optimum part of the tumor were reprepared from the paraffin blocks. Angiogenesis and microvessel density (MVD) were investigated with the aid of HIF-1α and CD34 antibodies. RESULTS High expression of HIF-1α was significantly more frequent in advanced grade endometrial cancers (p=0.044). HIF-1α expression was highly correlated with CD34 expression in the tumor cells (p<0.001). However lack of relation among stage, overall survival rates and histological types were analyzed with HIF-1α. When we compared HIF-1α positive and negative cases with cervical, adnexial, lymphovascular and myometrial invasion, there was no difference between these groups. MVD was evaluated with CD34 and it was remarkable and significantly different on advanced grade tumors (r=0.268; p=0.009). A similar significant difference was observed between the high expression of CD34 and type II endometrial cancer histology (p<0.001). However, there was no relationship between the MVD and stage or survival rates. CONCLUSION High expression of HIF-1α is associated with tumoral angiogenesis in endometrial adenocarcinomas. Further studies targeting HIF-1α for disrupting mechanisms essential for tumor growth in endometrium cancer will be significant investigations in the future.