Reliability, diagnostic value, and diagnostic yield of ultrasound-guided percutaneous core needle biopsy for peritoneal lesions.

INTRODUCTION: Peritoneal lesions cannot be definitively distinguished based on clinical and imaging characteristics alone. This study aimed to evaluate the reliability, diagnostic value, and diagnostic yield of ultrasound-guided percutaneous core needle biopsy (PCNB) for peritoneal lesions. METHODS: A retrospective analysis of 129 patients who underwent PCNB for peritoneal lesions was performed to assessed technical completion and diagnostic yield. RESULTS: The results showed that ultrasound-guided PCNB is a safe and reliable diagnostic tool with high diagnostic yield for peritoneal lesions. Technical feasibility and diagnostic yield rates were 100% and 89.9%, respectively. The diagnostic yield was lower for patients with a known history of cancer and a short anteroposterior diameter of the target lesion. CONCLUSIONS: These findings suggest that ultrasound-guided PCNB could be considered as a first-line diagnostic tool for peritoneal lesions, as it offers a minimally invasive and accurate means of obtaining tissue samples for diagnosis.

2-Arachidonoylglycerol Activity in Over Ischemia Reperfusion Damage: Can Endocannabinoids Protect Ovarian Reserve?

Objective: The present study aimed to demonstrate the possible effects of increased 2-arachidonoylglycerol (2-AG) by applying the monoacylglycerol lipase inhibitor KML-29 on rats with ovarian ischemia-reperfusion (IR) model. Methods: Forty-eight female Wistar albino rats were divided into six groups. Group 1: Sham, Group 2: Ischemia, Group 3: IR, Group 4: IR + KML-29 (2 mg/kg), Group 5: IR + KML-29 (20 mg/kg), and Group 6: IR + vehicle (dimethyl sulfoxide). Three hours of ischemia followed by 3 h of reperfusion. Two different doses of KML-29 (2 and 10 mg/kg) were administered intraperitoneally in Groups 4 and 5, 30 min before reperfusion. Ovarian IR injury and ovarian reserve were evaluated histopathological and by using nuclear factor (NF)-κB, interleukin (IL)-1ß, tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-ß1, superoxide dismutase, glutathione peroxidase pre-/postoperative blood antimullerian hormone, and inhibin B. Results: In the KML-1 and KML-2 groups, this damage was significantly reduced compared to the ischemia group. NF-κB, IL-1ß, TNF-α, and TGF-ß1 immunoreactivities increased statistically significantly in the ischemia group compared to the control group (p<0.001). Immunoreactivities of these proteins were significantly decreased in the KML-1 and KML-2 groups (p<0.001). It was observed that the number of these apoptotic cells decreased significantly in the KML-1 and KML-2 groups compared to the ischemia group (p<0.001). The postoperative inhibin level showed a significant decrease in the ischemia group compared to the sham group, while a significant increase was observed in the KML-1 and KML-2 groups compared to the ischemia group. Conclusion: It was seen that anti-inflammatory, antioxidant, and antiapoptotic activity was formed, and the ovarian reserve was preserved with 2-AG in ovarian IR damage. The protective effect of endocannabinoids on the ovaries may create a promising new treatment strategy for many pathologies that will affect the ovarian reserve.

Is the Anal Component of the Anogenital HPV-Related Disease Overlooked During the Surveillance of Patients Treated for Cervical Intraepithelial Neoplasia?

AIM: To investigate the anal component of the anogenital Human Papillomavirus (HPV) related disease during surveillance of patients treated for cervical intraepithelial neoplasia (CIN). METHODS: Patients were analyzed within two groups according to the histopathological examination of the cervical biopsies: Low-Grade Squamous Intraepithelial Lesion (LSIL) and High-Grade Squamous Intraepithelial Lesion (HSIL) groups. Anal specimens were also collected in the first-year follow-up visit. RESULTS: All patients had cervical high-risk HPV (HR HPV) infection at admission. At the first-year follow-up, positive HR HPVs were found in 47% of cervical samples. Despite this clearance, the anal HPV infection rate after the first year was 42.5% and 39.6% in LSIL and HSIL groups. Amongst the HSIL group, anal HR HPV positivity was observed in 29.6% of cases without any cervical HPV infection. CONCLUSION: A group of women cured of high-grade lesions have ongoing anal HPV infection. It is reasonable to propose that detecting anal HPV could impact the patient's treatment process. Therefore, prospective studies are needed to investigate this group of women's clinical outcomes and define the clearance rate of cervical HPV infection when anal HPV persists.

The association of polypoid growth pattern with lymph node involvement in endometrioid type endometrial adenocarcinoma.

Background: Tumor size is an independent predictor of lymph node metastasis and survival in the endometrioid type endometrial adenocarcinoma (EC). However, some of the ECs tend to grow towards the cavity in the polypoid pattern, which can reach very large sizes. In this study, we aimed to analyze the association of growing in the polypoid pattern of the tumor with the proportion of lymph node metastasis and extrauterine tumor spread. Methods: Four hundred seven patients were analyzed retrospectively. The effect of tumor size, tumor growing pattern, myometrial invasion, grade, and lymphovascular space invasion on the lymph node metastasis and extrauterine tumor spread were investigated. Statistical analysis consisted of unpaired t-tests for parametric data and Mann Whitney-U test for non-parametric data, whereas the Chi-square test for categorical variables. Logistic Regression, Cox Regression and multivariate analysis were used to estimate the risk predictors. Results: No association was found between the growing in polypoid pattern and lymph node metastasis (P > 0.05). In the analysis of endometrioid type EC patients who had myometrial invasion less than ½ as a subgroup, no association was found between the growing pattern and lymph node metastasis and extrauterine disease. Tumor size was found to be a statistically significant predictor of lymph node metastasis and extrauterine disease (P < 0.05). Conclusions: Lymphovascular space invasion, grade, and myometrial invasion are associated with a higher proportion of lymph node metastasis. The polypoid growth pattern of the tumor does not correlate with any histopathological parameters.

The relationship of immunohistochemical SOX-2 staining with histopathological diagnosis in patients with abnormal colposcopic findings.

This study aimed to analyze immunohistochemical staining and pathological data in cervical intraepithelial neoplasia (CIN) and squamous cell cervical carcinoma (SCC) with abnormal colposcopic findings. A histopathological evaluation of 45 low-grade squamous lesions (LSILs), 177 high-grade squamous lesions (HSILs) and 16 SCC biopsy materials from existing slides was obtained from blocks obtained from the archive. In addition, SOX-2 immunohistochemical staining was evaluated. The mean age of the HSIL group was 43.20 ± 8.97 years, younger than the mean age of the LSIL group of 51.62 ± 9.64 years (p = 0.000). There was no difference between the groups regarding the method of biopsy (p > 0.05). Endocervical gland involvement was not observed in the LSIL group, but was observed in 66 (37.3%) biopsy materials in the HSIL group (p = 0.000). There was a difference between the groups in terms of the level of CIN at the surgical margin (p = 0.000). Ki-67, SOX-2 staining percentage and p16INK4a positivity were higher in the HSIL group than in the LSIL group (respectively, 67.57 ± 19.10 vs. 14.62 ± 7.11, p = 0.000; 27.72 ± 31.56 vs. 10.09 ± 15.38, p = 0.003; 66 (82.5%) vs. 8 (44.4%), p = 0.001). While there was no difference in SOX-2 intensity between the HSIL and LSIL groups (p > 0.05), it was statistically significantly higher in the SCC group (p = 0.000), as was the percentage of SOX-2 (p = 0.000). We have shown that p16INK4a and SOX-2 staining is useful, in addition to Ki-67 immunostaining, which is widely used for SCC, which is one of the preventable cancer types. In addition, SOX-2 may provide a glimmer of hope in the development of SCC treatment modalities, especially since it is aggressively elevated in SCC rather than CIN lesions.

Microarray expression results of VEGF, YAP1 and PTEN immunostains in preeclampsia cases.

We aimed to evaluate the expression of YAP1, PTEN, VEGF in the placentas of patients with preeclampsia and placentas of healthy pregnant women for trophoblast invasion, which is similar to cancer etiopathogenesis. The placentas of 70 women who gave birth, including 30 preeclampsia and 40 healthy controls, were evaluated. YAP1, PTEN and VEGF immunohistochemical staining were performed using the microarray method on placental tissue. The mean ± standard deviation for YAP1, PTEN and VEGF intensity were; 1.57 ± 0.71,2.59 ± 0.80, 1.61 ± 0.59, respectively. PTEN intensity was statistically significantly lower in the preeclampsia group than in the control group (2.37 ± 0.99 vs 2.75 ± 0.58, p = .049). There was no difference between the groups in terms of YAP1 and VEGF staining (p > .05). The etiopathogenesis of preeclampsia is still unclear. However, since trophoblast invasion and endothelial repair have similar aspects with cancer mechanisms, both preeclampsia and cancer studies are progressing by supporting each other. Our study is a prototype study showing that large-participation studies can be carried out easily by using the microarray method as an economic model.

The effect of buzzy and cold spray on pain, anxiety, and fear of children during venipuncture in pediatric emergency department in Turkey; A randomized controlled study.

PURPOSE: It was aimed to evaluate the efficacy of Buzzy and cold spray in reducing pain, anxiety, and fear of children during venipuncture in the emergency department (ED). METHODS: This study is an experimental, parallel-group (intervention-control), randomized controlled, single-blind design. The study was conducted with 161 children aged 5-12 years in pediatric ED. Data were collected by the 'Personal Information Form', 'Wong Baker-Facial Expression Rating Scale', 'Child Anxiety Statement Scale', and 'Child Fear Inventory'. Data were analyzed with descriptive statistics, Mann Whitney U test, Kruskal Wallis H test, and Intraclass Correlation. RESULTS: Descriptive features of the children were homogeneous. 'Wong Baker-Facial Expression Rating Scale', 'Child Anxiety Statement Scale', and 'Child Fear Scale' score averages of the children in the control group were higher than the children in the Buzzy group and the cold spray group (p < 0.001). The pain scores of the Buzzy group were higher than those in the cold spray group (p < 0.001). The anxiety and fear mean scores of the children in the Buzzy and cold spray groups were similar (p > 0.05). CONCLUSION: It was determined that Buzzy and cold spray were more effective than standard care in reducing the level of pain, anxiety, and fear in children ages 5-12 years during venipuncture in the pediatric emergency. The cold spray was more effective in reducing pain than Buzzy. PRACTICE IMPLICATIONS: Nurses can use Buzzy and cold sprays to manage the fear, anxiety, and pain associated with venipuncture.

A Decrease in Lactobacilli in the Vaginal Microbiota Is Independently Associated With HPV Persistence in Women With High-Risk HPV Infection.

Background Vaginal dysbiosis, an imbalance between species, can initiate some local changes in immune and metabolic signaling causing chronic inflammation. The mechanism of the clearance or progression of the HPV infection has not been uncovered yet. We hypothesized that vaginal dysbiosis may contribute to the persistence of the cervical HPV infection. Therefore we aimed to determine the association of lactobacillus dominancy index with cervical HR-HPV persistence. Methods A total of 100 women who were followed up because of high-risk HPV infection were defined as the target study group. The patients were evaluated in two groups; HPV positive (group with HPV persistence, n=43) and HPV negative (group with HPV clearance, n=57). Cervicovaginal swab samples and blood samples were evaluated for Nugent score, lactobacillus dominance, and white blood cell count. Statistical tests were performed by the IBM Statistical Product and Service Solutions (version 22, IBM SPSS Statistics for Windows, Armonk, NY) program. The continuous variables were presented using the mean±standard deviation (SD), and the categorical variables were presented as the number of cases and their percentage. A p value less than 0.05 (<0.05) was set as statistically significant. Results HPV persistence was observed in 43 (43%) patients. Univariate analysis revealed that age, menopausal status, and lactobacillus reduction were associated with HPV persistence (p<0.05). The median value of the Nugent score was similar among groups. After logistic regression analysis, lactobacillus reduction continued to be associated with HPV persistence, independent of age and menopause (OR: 2.668, 96% CI: 1.069-6.662, p<0.05) Conclusions A decrease in lactobacilli in the cervicovaginal microbiota is associated with the persistence of HPV, regardless of age and menopausal status in this study.

Relationship Between Immunohistochemical CD3, CD4, CD5, CD8, and PD1 Staining and Histopathological Diagnosis of Cervical Lesions in Patients With Abnormal Colposcopic Findings.

INTRODUCTION: This study aimed to analyse the relationship between clinicopathological factors in cervical intraepithelial lesions and abnormal colposcopic findings. MATERIAL AND METHODS: Thirty high-grade squamous intraepithelial lesion (HSIL) and thirty low-grade squamous intraepithelial lesion (LSIL) patients who underwent biopsy due to abnormal colposcopic findings were included in the study. The immunoreactivity of CD3, CD4, CD5, CD8, and PD-1 was analysed immunohistochemically in tumor-infiltrating lymphocytes (TILs) and stromal lymphocytes. RESULTS: In TILs, CD3, CD4, CD5, CD8, and PD-1 were highly stained in 20/30 (66.6%), 16/30 (53.3%), 15/30 (50.0%), 24/30 (80.0%), and 13/30 (43.3%) of the cases for the HSIL group, while 7/30 (23.3%), 4/30 (13.3%), 5/30 (16.6%), 9/30 (30.0%), and 5/30 (16.6%) were in the LSIL group, respectively. CD3, CD4, CD5, CD8, and PD-1 immunostainings for TILs were higher in the HSIL group (p=0.001, p=0.001, p=0.006, p˂0.001, p=0.024, respectively). Only PD-1 was significantly higher in lymphocytes in the stroma (p=0.001). CONCLUSIONS: CD3, CD4, and CD8 also show a positive correlation with the Ki-67 proliferation index. CD3, CD4, CD5, and CD8 may contribute to PD-1-mediated tumour control. Immunohistochemical staining plays a key role in evaluating the tumour microenvironment.

Attitude and Practice Toward Use of Cigarettes and Electronic Cigarettes Among Pregnant Women: A Questionnaire-Based Survey.

OBJECTIVE: This study aimed to evaluate attitude and practice toward use of regular tobacco cigarettes and electronic cigarettes among pregnant women. MATERIAL AND METHODS: A total of 1123 pregnant women participated on a voluntary basis in this questionnaire survey. Maternal characteristics, cigarette consumption parameters, and personal opinions regarding the adverse effects of smoking during pregnancy were evaluated. RESULTS: Active smokers composed 12.4% (9.4%: regular tobacco cigarettes, 3.0%: electronic cigarettes) of the study population. Smoking during the current pregnancy, particularly via regular tobacco cigarettes, was more likely for women with smoking during previous pregnancies (56.0% vs. 7.8%, P < .001), previous history of low birth weight infant delivery (16.1% vs. 8.6%, P = .013), premature delivery (16.7% vs. 7.0%, P < .001), and stillbirth (22.8% vs. 11.7%, P = .002). The presence versus absence of smoking during pregnancy was associated with a lower likelihood of being a housewife (70.5% vs. 80.5%, P = .010) and a higher likelihood of having an actively smoking mother (25.9% vs. 11.2%, P < .001) or partner (65.7% vs. 46.9%, P < .001). Regular tobacco cigarette users considered electronic cigarettes to have a higher risk of adverse impacts (11.1% vs. 2.9%, P = .012), while electronic cigarette users considered regular cigarettes to have a higher risk of nicotine exposure (55.9% vs. 13.0%, P < .001). CONCLUSION: Our findings indicate being employed, having an actively smoking mother or partner, as well as smoking in previous pregnancies, to be the risk factors for increased likelihood of smoking during pregnancy.

The impact of uterine adenomyosis on the histopathological risk factors and survival in patients with endometrial adenocarcinoma.

A retrospective cohort study was performed on patients diagnosed with endometrial adenocarcinoma (EC) during a 9-year period to investigate the impact of co-existing adenomyosis on patients with EC. Group A included women with EC and adenomyosis and Group B EC cases without the presence of adenomyosis. Group A was more likely to have early-stage disease, tumours without deep myometrial invasion, low-grade tumours and tumours with negative lymphovascular space invasion when compared to Group B (p = 0.012, p = 0.004, p < 0.001, p = 0.02). There were no statistically significant difference between Group A and Group B for lymph node metastasis (p = 0.064). There was no significant relation between the adenomyosis and survival outcomes in the multivariant analysis (p = 0.437). As a conclusion, patients with adenomyosis were more likely to accompany good histopathologic prognostic factors. Multivariate analysis showed no significant effect of adenomyosis on recurrence and survival parameters.IMPACT STATEMENTWhat is already known on this subject? Adenomyosis is one of the most common accompanying benign histopathological findings of type 1 endometrial carcinomas (EC). Adenomyosis comprises some characteristics similar to malignant tumours, such as invasion, abnormal tissue growth and angiogenesis. Despite concerns have arisen due to both their high incidence and similar molecular links, the possible relation between EC and adenomyosis is still not well grounded.What the results of this study add? We presented a 9-year period retrospective cohort of a tertiary referring single centre and evaluated the prognostic effect of adenomyosis in patients with EC as well as the survival outcomes of these patients. The co-occurrence of adenomyosis was more likely to accompany early-stage (stages 1-2) disease, low-grade tumours (grades 1-2) and tumours with negative LVSI in patients with EC. However, multivariate and survival analysis showed no significant effect of adenomyosis on recurrence and survival parameters.What the implications are of these findings for clinical practice and/or further research? Based on these findings, we suggest that the presence of adenomyosis should not be considered as a prognostic factor in EC. Our results support the overriding opinion about the prognostic value of co-occurrence of adenomyosis and EC. However, further studies exploring the molecular and genomic markers in these two groups are needed to uncover the exact relation of adenomyosis on the prognosis of EC.

Severe Preeclampsia is Associated with Functional and Structural Cardiac Alterations: A Case-control Study.

BACKGROUND: The aim of the current study is to compare electrocardiographic and echocardiographic changes in patients with severe preeclampsia (PE) and those with uncomplicated pregnancies. METHODS: This is a case-controlled prospective study consisting of 21 pregnant women with severe preeclampsia and a control group consisting of age- and gestational age-matched 24 healthy pregnant women. All patients underwent electrocardiographic and echocardiographic investigation. RESULTS: QRS intervals were shorter and PR intervals were longer in the PE group (QRS duration: 80 (60-120) ms and 80 (40-110) ms, p=0.035; PR duration: 160 (100-240) ms and 120 (80-200) ms, respectively; p=0.046). The left ventricular end-systolic diameters of the patients with severe PE group were significantly larger than the control group (31 (24-36) mm and 30 (24-33) mm, respectively; p=0.05). Similarly, posterior wall thickness values of the PE group were significantly higher compared to the control group (9 (7-11) mm vs. 8 (6-10) mm, respectively; p=0.020). Left ventricular mass (146.63±27.73 g and 128.69±23.25 g, respectively; p=0.033) and relative wall thickness values (0.385±0.054 and 0.349±0.046, respectively; p=0.030) were also higher in the PE group. In addition, patients with early-onset severe PE had significantly a higher left ventricular end-diastolic diameter and volume compared with late-onset PE patients. CONCLUSIONS: The structural changes detected in the severe PE group suggest a chronic process rather than an acute effect. In addition, diastolic dysfunction and left ventricular remodeling are most marked in patients with severe early-onset PE.

EFFECTS OF ISOLATED POSTERIOR VAGINAL WALL PROLAPSE ON LOWER URINARY TRACT SYMPTOMS.

AIM: To investigate the effects of isolated posterior vaginal compartment prolapse to lower urinary tract symptoms (LUTS). MATERIALS-METHODS: Patients who were admitted with any kind of LUTS and diagnosed with posterior compartment defects were retrospectively analyzed at urogynecology units of 2 different tertiary referral centers. Patients were included in the analysis if they had isolated posterior vaginal compartment defects with no clinically significant anterior and apical compartment defects. The control group consisted of patients with no pelvic organ prolapse (POP). All pelvic examinations were performed by the same 2 specialists. The responses to a detailed LUTS questionnaire in the unit were assessed. RESULTS: Of the 340 women with posterior POP, 280 were excluded from the analysis due to combined anterior and/or apical POP with posterior POP and stage 4 POP. When we compared the symptoms between the control group and the remaining 60 patients with isolated posterior POP, there was a statistically significant difference in urge, frequency, nocturia, abnormal emptying, vaginal winding, difficult stool passage (p = 0.031, p < 0.001, p < 0.001, p = 0.022, p = 0.041, and p = 0.039, respectively). CONCLUSION: Women with posterior POP should be carefully examined not only for anorectal or bulging symptoms but also for LUTS.

Association between endometriosis and increased arterial stiffness.

BACKGROUND: Endometriosis is a common gynecologic disease associated with systemic inflammation and atherogenic risk factors. Therefore, women with endometriosis may have increased cardiovascular risk. AIMS: We aimed to evaluate arterial stiffness using cardio-ankle vascular index (CAVI) in women with and without endometriosis. METHODS: We enrolled 44 patients with endometriosis and 76 age­matched controls without endometriosis.Endometriosis was diagnosed based on histopathologic examination or magnetic resonance imaging. Arterial stiffness was evaluated using CAVI in all study participants. RESULTS: No differences were observed between patients and controls in terms of age (median [interquartile range, IQR], 30 [24.25-5] years and 26 years [24-35] years, respectively), body mass index (median [IQR], 23.31 [20.82-24.98] kg/m2 and 23.74 [21.13-26.78] kg/m2, respectively), or waist circumference (median [IQR], 69 [64-75] cm and 72 [65-81.25] cm, respectively). C­reactive protein levels were higher in women with endometriosis than in controls (median [IQR], 0.27 [0.14-0.68] mg/dl vs 0.12 [0.06-0.24] mg/dl; P <0.001). Left ventricular ejection fraction, left ventricular mass index (LVMI), relative wall thickness, as well as systolic and diastolic blood pressures were similar in both groups. Women with endometriosis had higher CAVI than controls (mean [SD], 5.961 [0.644] vs 5.554 [0.654]; P = 0.001). Elevated arterial stiffness was observed in the endometriosis group also after adjustment for age and LVMI. CONCLUSIONS: Our results indicate increased arterial stiffness measured by CAVI in women with endometriosis. Therefore,clinicians should be aware that these patients may be at increased cardiovascular risk.

An alternative technique in surgical correction of anterior compartment prolapse; Iliococcygeal fixation of the pubocervical fascia by native tissue repair.

AIM: To present 'bilateral iliococcygeal fixation of the pubocervical fascia' as an alternative vaginal surgical technique for anterior compartment repair with native tissue and the surgical outcomes of 30 cases. MATERIALS-METHODS: The consecutive 30 cases who admitted to urogynecology clinic with anterior vaginal prolapse/cystocele and underwent anterior compartment repair by bilateral iliococcgeal fixation of the pubocervical fascia by native tissue were included to the study. All cases attended to the postoperative follow-up visits at the sixth and the twelfth months. RESULTS: There were no major or minor intraoperative complications. Overall, in 28 (93.3 %) patients surgical success was achieved at the postoperative 12th month when it was defined as the maximum descent of the anterior segment was proximal to the hymen. During the study period, none of the patients requested or admitted for re-treatment for anterior compartment prolapse. Subjective cure that was assessed by the absence of bulge symptoms was achieved in 29 cases (96.7 %) at first year follow-up. Lower urinary tract symptoms (LUTS) were found to be significantly lower at the first-year postoperative visit compared to pre-operative evaluation. A clinically significant improvement in the quality of life parameters were also noted (mean PFIQ-7 scores = 8.5, 5.6 and 50.8, respectively). CONCLUSION: Bilateral iliococcygeal fixation of the pubocervical fascia seems to be effective in surgical correction of anterior vaginal prolapse according to our post-operative follow-up results. It is an easy to learn procedure with low complication rates and associated with high patient satisfaction.

Arterial stiffness measured by cardio-ankle vascular index is greater in non-obese young women with polycystic ovarian syndrome.

AIM: The association of metabolic abnormalities and polycystic ovarian syndrome (PCOS) has been documented, but few studies have focused on cardiovascular risk in these women. The aim of this study was to compare arterial stiffness by using the cardio-ankle vascular index (CAVI) in PCOS women with controls, and to evaluate whether any clinical or laboratory variables had independent associations with it. METHODS: A group of 160 women, matched for age and body mass index were recruited. Diagnosis of PCOS was made according to the Rotterdam criteria. Arterial stiffness using CAVI was evaluated in non-obese young woman, with and without PCOS. RESULTS: In the PCOS group (n = 80), 60 cases (75%) had findings of hyperandrogenism, 59 (73.8%) had ovulatory dysfunction, and 70 (87.5%) had an ultrasonographic appearance of polycystic ovaries. Women with PCOS had significantly higher mean CAVI values when compared to subjects without PCOS (5.78 ± 0.64 vs 5.28 ± 0.77, P < 0.001). Multiple regression analysis revealed that androgen excess was associated with increased arterial stiffness, independent of ovulatory dysfunction, polycystic ovaries, body mass index and age. CONCLUSION: This data suggests that vascular compliance is decreased in young women with PCOS. Androgen excess is independently associated with increased arterial stiffness.

Does apical prolapse in addition to early stage anterior prolapse have any effect on lower urinary tract symptoms?

OBJECTIVE: To investigate whether apical prolapse in addition to early-stage anterior prolapse has any effect on lower urinary tract symptoms (LUTS). METHODS: Patients with early-stage pelvic organ prolapse (POP) were retrospectively analyzed at the urogynecology unit of a tertiary referral center. Cases with posterior POP were excluded, and the remaining women were distributed across four main groups: (1) no determinable anterior and/or apical POP (control); (2) isolated anterior POP; (3) anterior + apical POP; and (4) isolated apical POP. Each LUTS symptom in these groups was recorded. Women with isolated anterior POP and women with anterior + apical POP were then compared to define the additional effects of apical prolapse on LUTS. In order to asses; symptoms of urgency, urinary incontinence, stress urinary incontinence, frequency, abnormal emptying, hesitancy, interrupted stream, nocturia, post-micturition dribble, and dysuria were noted and Incontinence Impact Questionnaire (IIQ-7), and domains of Urinary Distress Inventory (UDI-6) were compared between the groups. RESULTS: Of the 225 patients, 66 were excluded from the analysis due to accompanying posterior compartment defect. There was no statistically significant difference for age, systemic disease history, or smoking status between the groups (p > 0.05). However, history of traumatic vaginal delivery was significantly lower in the control group than in the other groups (p = 0.039). The prevalence of hesitancy and interrupted stream were found to be significantly higher in the anterior + apical POP group than in the isolated POP group (p<0.05). Obstructive subscale of the Urinary Distress Inventory was higher both in the isolated anterior POP and anterior + apical POP groups than the control group (p<0.05). CONCLUSION: The current study demonstrates that even minimal loss of apical support accompanying anterior prolapse exacerbates LUTS.

Predictors of Human papillomavirus (HPV) persistence after treatment of high grade cervical lesions; does cervical cytology have any prognostic value in primary HPV screening?

OBJECTIVE: This study aimed to determine the factors associated with Human Papillomavirus (HPV) persistence in women undergoing cervical excision for pre-invasive lesions, after they have been referred from a primary HPV screening program. METHODS: A retrospective study design involving patients who were treated at a Cervical Disease Screening and Treatment Unit, in a university hospital setting. After initial treatment, cervical HPV infection status was analyzed at the sixth month, first year and then subsequently after the second year. RESULTS: Totally, 395 patients who were diagnosed with pre-invasive cervical lesions and who subsequently undergone cervical excision were identified. In the first-year visit after cervical excision, HPV 18 was cleared in almost all (95.8%) cases, followed by HPV 16 (69.9%) and other hrHPV types (65.6%). Available data documented that 88.6% of women reached clearance after the two-year follow-up. Univariate analysis revealed a significantly higher proportion of HPV clearance among women who were younger (p = 0.019), premenopausal (p = 0.002), and who had been found to have a negative cytology result on their initial Pap test (p = 0.018). However, only cervical cytology result remained as the independent predictor of HPV persistence on a multivariate logistic regression (OR 0.43; 95% CI 0.21-0.87; p = 0.019). CONCLUSIONS: A low risk of HPV persistence was found among every HPV genotype in women undergoing cervical excision for pre-invasive cervical lesions. Initial cervical cytology result was the only independent predictor of HPV clearance during surveillance, which indicates the prognostic value of Pap test in primary HPV screening.

Comparison of serum adiponectin and osteopontin levels along with metabolic risk factors between obese and lean women with and without PCOS.

INTRODUCTION: The objective of this study was to investigate the possible relation between serum adiponectin and osteopontin levels as metabolic risk markers among women with different polycystic ovary syndrome (PCOS) phenotypes. MATERIAL AND METHODS: In a University Hospital setting PCOS patients diagnosed according to Rotterdam Consensus Conference criteria with body mass index (BMI) between 18 and 35 were recruited. RESULTS: Overall, 57 PCOS patients and 57 age- and BMI-matched healthy controls were included in the study. Luteinising hormone (LH) to follicle-stimulating hormone FSH ratio (LH/FSH), free androgen index (FAI), and dehydroepiandrosterone sulphate (DHEAS-S) was found to be significantly higher in women with PCOS. There was significant interaction between PCOS status and obesity for serum adiponectin levels. Although mean adiponectin and osteopontin levels were similar among cases and controls, a further two-way ANOVA comparison within lean and obese subgroups revealed adiponectin to be significantly lower in lean PCOS women than in lean controls. LH/FSH ratio and adiponectin levels were all found to differ between lean counterparts; however, they did not show any correlation with metabolic markers [cholesterol, homeostatic model assessment (HOMA) or C-reactive protein (CRP) levels] in overall lean women or in the lean PCOS subgroup. CONCLUSION: Serum adiponectin levels in lean PCOS women were significantly lower than those in lean controls. On the other hand, mean adiponectin and osteopontin levels were similar in PCOS cases and controls overall.

Does cervicovaginal cytology have a role in the diagnosis and surveillance of endometrial adenocarcinoma?

OBJECTIVE: To examine the role of cervicovaginal cytology in diagnoses and surveillance of the patients with endometrial carcinoma (EC). METHODS: Patients who underwent EC surgery that included a follow-up were reviewed retrospectively. The cohort was limited to the patients who had an available cervical cytology result within 12 months before the primary surgery took place. The glandular abnormalities were classified in the following subclassifications: "atypical glandular cells" (AGC)-not otherwise specified (NOS), AGC-favor neoplasia, endocervical AIS, and adenocarcinoma. RESULTS: A total of 411 patients were eligible for the study. The cervical cytology was found to be normal and recorded as negative for intraepithelial lesion or malignancy in 368 (89.5%) patients. In 43 (10.5%) patients, cervical cytology was interpreted as: AGC-NOS (n = 11), AGC-FN (n = 7), adenocarcinoma (n = 20), malignant epithelial tumor (n = 3), and squamous carcinoma (n = 2). During the follow-up, recurrence was observed in 53 (12.9%) patients. Among six isolated vaginal cuff recurrences, two of the cases presented with malignant cytology, and the additional four cases were suspected during clinical examination. Among women with recurrence (n = 53), there were malignant cytological findings in four of the patients. In the whole population (n = 411), there were four other abnormal cytological findings detected within the surveillance. These four cytology results were nonmalignant and no recurrence was identified. CONCLUSION: There is no significant clinical advantage of cervicovaginal cytology testing before diagnosis or during the surveillance of EC.