Mesut Akyol

A quantitative evaluation of total antioxidant status and oxidative stress markers in preeclampsia and gestational diabetic patients in 24–36 weeks of gestation

OBJECTIVE To assess the plasma and serum maternal total antioxidant status, circulating levels of lipid peroxidation breakdown products (MDA), protein oxidation markers (AOPPs), myeloperoxidase (MPO) and lipid hydroperoxide (LHP) in preeclampsia, gestational diabetes mellitus (GDM) patients and compare them with noncomplicated normal pregnancies between 24 and 36 weeks of gestation. STUDY DESIGN 27 GDM, 27 preeclampsia and 29 noncomplicated singleton pregnancies were included. The blood samples were taken at the diagnosis of disease. RESULTS TAS was decreased in GDM and preeclampsia when compared to normal pregnancies. MDA levels were higher only in GDM group than normal pregnancies. AOPP levels were increased but MPO and LHP levels were not changed both in GDM and preeclampsia when compared to normal pregnancies. CONCLUSIONS We concluded that increased oxidative stress and reduction in antioxidant defense mechanisms may contribute to disease processes both in GDM and preeclampsia.

Comparison of levonorgestrel intrauterine system versus hysterectomy on efficacy and quality of life in patients with adenomyosis

OBJECTIVE To compare the levonorgestrel intrauterine system (LNG-IUS) with hysterectomy in patients with adenomyosis and to study the effects of both treatments on quality of life (QOL). DESIGN Prospective randomized clinical trial. SETTING Womens health teaching and research hospital. PATIENT(S) Eighty-six patients (43 patients for each group) were enrolled, but only 75 women continued the study. INTERVENTION(S) Women interpreted as having adenomyosis on transvaginal ultrasound and magnetic resonance imaging were assigned to receive either LNG-IUS or hysterectomy. MAIN OUTCOME MEASURE(S) Clinical measures of menstrual bleeding as number of used pads/day during menstruation, hemoglobin levels, and health-related QOL variables were assessed. Each woman was followed up for 1 year after treatment. RESULT(S) LNG-IUS increased the hemoglobin levels at the sixth month and first year of the treatment to the comparable levels with hysterectomy. When pretreatment and post-treatment QOL scores of groups were compared, three of the five mean domain scores (physical, environmental, environmental-TR) were increased in patients treated with hysterectomy, while in patients managed with LNG-IUS, all five mean domain scores were increased. CONCLUSION(S) It seems that LNG-IUS demonstrates significant and comparable improvements in hemoglobin levels to hysterectomy in treating adenomyosis-associated menorrhagia during the first year. Although both treatments lead to improvements in health-related QOL, LNG-IUS seems to have superior effects on psychological and social life. It may be a promising alternative therapy to hysterectomy.

Micro push-out bond strengths of 2 fiber post types luted using different adhesive strategies

OBJECTIVE The objective of this study was to evaluate the push-out bond strengths of carbon and glass fiber posts adhesively luted with Panavia F 2.0 and RelyX Unicem luting cements, as well as a modified application procedure using RelyX Unicem cement in combination with a single-bottle total-etch adhesive in 3 segments of teeth. STUDY DESIGN Sixty single-rooted human maxillary central incisors and canines were sectioned below the cementoenamel junction, and the roots were endodontically treated. The roots were divided into 2 fiber-post groups, and then divided into 3 subgroups of 10 specimens each to test different luting strategies. Bonded specimens were cut (1-mm-thick sections) and push-out tests were performed (crosshead-speed, 0.5 mm/min). Failure modes were evaluated using a stereomicroscope at original magnification ×40. RESULTS Micro push-out bond strengths were significantly affected by the type of luting agent and the type of post (P < .05). In all root sections, the push-out bond strength values of glass fiber posts were significantly higher than that of carbon fiber posts (P < .05). Moreover, the highest push-out bond strengths were measured for Panavia F 2.0 and RelyX Unicem cements. These values were significantly higher than that of modified application procedure in the medium section for both glass- and carbon-fiber posts, and in the apical root sections only for glass-fiber post (P < .05). In each region, the modified application procedure showed the lowest bond strength values. Adhesive failure between dentin and cement was the most frequent type of failure. CONCLUSIONS In all root segments, the glass fiber post provided significantly increased post retention compared with the carbon fiber post, regardless of the luting strategy used.

Effects of sildenafil and tadalafil on ischemia/reperfusion injury in fetal rat brain

Objective. The aim of the present study was to evaluate the effects of phosphodiesterase type 5 (PDE5) inhibitory drugs, sildenafil and tadalafil, in ischemia/reperfusion (I/R)-induced oxidative injury in fetal rat brain. Methods. Timed pregnant adult Wistar rats were randomly assigned to the following groups (n = 6 for each group): saline + none I/R (1), saline + I/R (2), sildenafil + none I/R (3); sildenafil + I/R (4), tadalafil + none I/R (5) and tadalafil + I/R (6). Fetal ischemia was induced by clamping the utero-ovarian artery bilaterally. Fetuses were delivered and 268 fetal rats were decapitated. Malondialdehyde (MDA) levels and, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities were assessed in fetal brain tissue homogenates by spectrophotometric methods. Results. In saline + I/R group, MDA levels were increased and, SOD and GSH-Px activities were decreased significantly comparing with saline + none I/R group. Both tadalafil and sildenafil treatment decreased the MDA levels significantly in ischemia/reperfusion groups, whereas this effect was significantly more potent with tadalafil. SOD levels were significantly decreased in all groups after I/R. Tadalafil seems to be more effective than sildenafil by means of increasing GSH-Px activity significantly after I/R. Conclusion. Our results indicate some beneficial effects of PDE5 inhibitory drugs, especially tadalafil, on oxidative I/R injury in fetal rat brains.

Repeatability and reproducibility of Galilei measurements in normal keratoconic and postrefractive corneas.

OBJECTIVE To assess the repeatability and reproducibility of the anterior segment measurements performed with a dual Scheimpflug analyzer (Galilei) in normal, keratoconic and post-refractive surgery corneas. METHODS To evaluate the repeatability, two additional measurements were performed by the first examiner. To assess reproducibility, this was later followed by a single reading by the second examiner. The following parameters were recorded and evaluated in this study; central corneal thickness (CCT), thinnest corneal thickness (TCT), mean total corneal power (TCP) in central (0-4mm), mean posterior corneal power (PCP) in central (0.5-2mm), anterior and posterior elevation (best fit sphere [BFS]) in central 8mm anterior and posterior eccentricity (ɛ(2)) in central 8mm. Repeatability and reproducibility for each corneal parameter was assessed using the Bland-Altman analysis. RESULTS Each of the three groups was consisted of 20 subjects (totally 60 patients, 30 men and 30 women). The 95% LoA for repeatability was very small, indicating small discrepancies between measurements related to CCT. Acceptable repeatability was also achieved for the other parameters in each group. However, the 95% LoA for value TCP was larger in keratoconic eyes. The 95% LoA for reproducibility was also very small, and acceptable for all measured parameters in each group. In addition, the 95% LoA was larger for the measurement of CCT and TCT for postrefractive corneas. CONCLUSIONS The anterior segment measurements provided by Galilei showed good repeatability and reproducibility for normal, keratoconic and postrefractive corneas.

The relationship between meiotic spindle imaging and outcome of intracytoplasmic sperm injection: a retrospective study

Meiotic spindle analysis with a non-invasive technique, the PolScope, is used to protect the meiotic spindle from damage during microinjection. To evaluate the predictive feature of PolScope, we have designed a retrospective study to analyse the correlation between the meiotic spindle visualisation with regard to spindle location and outcomes of assisted reproductive technologies (ART), including patient age, previous cycles, the number of the collected oocytes, fertilisation rates (FR), pronuclear scoring (PNS) and embryo scoring of the days from two to five. All of the data belonging to 1496 oocytes from 190 patients were statistically analysed. We found that the oocytes having PolScope visualised spindle have higher FR, and also observed that when the spindle located at 0°–30° according to the first polar body, gave the highest FR. PNS gave higher scores in the spindle visualised group, but spindle angle did not affect PNS outcomes. Although a correlation was found between spindle visualisation and developed embryo qualities, particularly at day 2 and 3, spindle angles did not affect embryo quality. We conclude that PolScope microscopy has an efficiency to estimate FR, and cleavage stage embryo development.

Can serum oestradiol be a predictor of quality of oocytes and embryos, maturation of oocytes and pregnancy rate in ICSI cycles?

Our aim was to assess the influence of ratios of oestradiol (E2) to either number of follicles ≥14 mm on the day of human chorionic gonadotropin administration (E2/fol) or the number of oocytes retrieved (E2/o) during oocyte pick up and total serum E2 levels on the day of embryo transfer (ETE2) on the outcome of ICSI cycles. The assessed outcomes were number of oocytes retrieved (NRO), number of mature oocytes (NMO), number of fertilised oocytes (NFO), number of transferred embryos (NTE), qualities of oocytes (OQS), qualities of embryos (EQS) and pregnancy rates (PR). Two hundred and twenty-seven ICSI-ET cycles admitted to our IVF clinic during a 2-year period with normal ovarian reserve receiving long luteal GnRH agonist protocol were included. The E2/fol levels correlated positively with NRO (r = 0.202, p = 0.002), NMO (r = 0.199, p = 0.003) and NFO (r = 0.159, p = 0.018). However, we observed negative correlations between E2/o and NMO (r = −0.329, p <0.001), NFO (r = −0.219, p = 0.001), EQ5 (r = −0.203, p = 0.040). Oocyte quality scores were not affected from either E2/fol or E2/o levels. Implantation, clinical and ongoing PRs were comparable between groups categorised due to E2/fol, E2/o and ETE2. It seems that high E2/fol ratio may have beneficial effects on NRO, NMO and NFO while E2/o may adversely affect these parameters. Neither of the E2 levels is associated with pregnancy rates in women with normal ovarian reserve.

Effect of Topical and Intravenously Applied Tranexamic Acid Compared to Control Group on Bleeding in Primary Unilateral Total Knee Arthroplasty

&NA; We aimed to answer the following three questions in this study: (1) Does tranexamic acid (TA) reduce the amount of bleeding in total knee arthroplasty (TKA)? (2) Does TA reduce requirement for blood transfusion? (3) Is there any difference on reliability and efficacy between topical and intravenous (IV) applications of TA? Patients were allocated into three groups randomly by a software program as topical, IV, and control group. TA was applied as 20 mg/kg to the IV group and as 3 g/100 mL saline to the topical group. The hemoglobin values were recorded preoperatively and postoperatively on the same day and on day 1 and day 2. Removal of the drain postoperatively and length of hospital stay, as well as any complications such as pulmonary embolism or deep venous thrombosis, were also noted. The study comprised 40 patients in the IV group, 42 in the topical group, and 41 in the control group. The drain output values were similar in the IV and topical groups (p = 0.161), while those of the control group were significantly higher than both the IV and topical groups (p < 0.001 and < 0.001). Transfusion was applied to 19.5% of cases in the control group, 4.8% in the topical group, and 5.1% of the IV group (χ2 = 6.522; p = 0.038). The results of the study showed that 20 mg/kg single‐dose IV bolus or 3 g topical TA application reduced blood loss and transfusion requirement without increasing the rate of thromboembolic complications in unilateral primary TKA.

Horizontal migration of pre- and postnatal mental foramen: An anatomic study

OBJECTIVE To evaluate the horizontal migration of the human mental foramen before and after birth. METHODS 54 formalin-fixed fetuses between 17 and 32 weeks of gestation, and 94 panoramic radiographs of children aged between 4 and 12 years were investigated. The distances between the mental foramen and mental symphysis, and the distances between the posterior border of the mandibular ramus and mental foramen were determined according to development periods. RESULTS Our results confirm that the mental foramen moves in a posterior direction during the development of the mandible. CONCLUSION The horizontal location of the pre- and postnatal mental foramen changes in a posterior direction as the development progresses, however, prenatal mental foramen features an irregular behavior, while the postnatal mental foramen gradually migrates posteriorly in a regular pattern.

Reliability of the 34βE12, keratin 5/6, p63, bcl-2, and AMACR in the diagnosis of prostate carcinoma.

OBJECTIVE In this study, we aimed to investigate which basal cell marker should be used with α-methylacyl coenzyme A racemase (AMACR) to increase diagnostic accuracy in the diagnosis of prostate carcinoma. MATERIALS AND METHODS A total of 98 cases of prostate biopsy, comprising 65 cases with prostate adenocarcinoma and 33 cases without adenocarcinoma, were included in this study. Prostate-specific antigen (PSA) serum levels before biopsies were obtained. The number of cores with malignant glands and Gleason scores for each case were determined. Paraffin sections were stained immunohistochemically with 34βE12, keratin 5/6, p63, bcl-2, and AMACR. RESULTS According to staining pattern, extensiveness, and intensity of basal cell markers in benign glands, 34βE12 gave the best results. As negative markers for prostate adenocarcinoma, the best markers were p63 and 34βE12. According to the AUC values in ROC curves for both extensiveness and intensity, the arrangement from the best to the worst was 34βE12, p63, bcl-2, and keratin 5/6. The 34βE12 had the best sensitivity and specificity values (95% and 98%, respectively). Staining extensiveness and intensity of keratin 5/6 in malignant glands, and those of bcl-2 in benign glands had statistically significant positive correlation with serum PSA levels. Even though AMACR is a negative marker for benignity, some of the benign glands also had positive immune reaction with AMACR. However, AMACR positivity was usually focal and weak. Nevertheless, intensively stained subjects were also present. No correlation was present between AMACR and basal cell markers. CONCLUSIONS As a result, we suggest that keratin 5/6 and bcl-2 should not be used to identify benign glands in prostate biopsy since they show high positivity in malignant glands and high negativity in benign glands. 34βE12 should be the first choice as a basal cell marker. p63 can be used together with 34βE12, but it may not give additional diagnostic information. When we evaluated the correlation of basal cell markers, we did not find any complementary staining results among basal cell markers. Our study showed that 34βE12 is the most appropriate negative marker to combine with AMACR as a positive marker for the diagnosis of prostate adenocarcinoma.