Effects of epidural analgesia on the course of labor.

OBJECTIVE: The aim of this study was to assess the effects of epidural analgesia on the course of labor. SUBJECTS AND METHODS: The material for the study was obtained from the analysis of 300 medical records of patients delivering under epidural analgesia in the period 2015-2019. A questionnaire by the authors was used as the research tool. Statistical analysis was performed using Fisher's test, Pearson's Chi-square test of independence, and Cramer's V-test. RESULTS: The first stage of labor in primiparas usually lasted six to nine hours, and in multiparas under five hours (p = 0.041). The second stage was shorter in multiparas (p < 0.001). Our five-year analysis demonstrated that the second stage of labor was longer from year to year (p = 0.087). The fetal station had an effect on the duration of the first stage of labor (p = 0.057). After administration of epidurals, the majority of the women bore the pain well (p = 0.052). CONCLUSIONS: Epidural analgesia reduces labor pain, but may also disturb the natural rhythm of labor. This happens even if the moment of application of the analgesia is chosen with the guidance of obstetric indications, and may result in the necessity for surgical intervention.

The impact of premenstrual syndrome on women's quality of life - a myth or a fact?

OBJECTIVE: The aim of this study was to assess the quality of life (QoL) of women with premenstrual syndrome (PMS). PATIENTS AND METHODS: The study involved 231 regularly menstruating women aged 18 years and older. The research was carried out from July 2018 to November 2018 at St. Maksymilian Maria Kolbe Catholic Secondary School in Szczecin, Non-Public Healthcare Center "MEDI-PLUS" in Zwierzyno, and by electronic means. The research instruments used in the study were: the author's questionnaire concerning the severity of individual PMS symptoms (based on the APA criteria for PMDD, included in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed.), and the standardized World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. Statistical analysis was performed using the SPSS 24 statistical package. The Kolmogorov-Smirnov test was used. The level of statistical significance was set as p < 0.05. RESULTS: The QoL of women with PMS was at a medium level. Emotional symptoms were the most severe ones (p = 0.010). The highest QoL scores were obtained for the social relationship domain (p = 0.002), and the lowest for the mental health domain (p = 0.006). CONCLUSIONS: PMS involves significant morbidity, and the health burden it causes is still not fully assessed. Young women constitute a group that shows the greatest need for psychological support because they experience the most severe PMS symptoms.

Can personality traits affect the quality of life of women with the BRCA1/BRCA2 mutations before and after prophylactic adnexectomy?

OBJECTIVE: Ovarian, fallopian tube, and peritoneal carcinomas are the most common hereditary gynecological cancers associated with the BRCA1 and BRCA2 mutations. It is recommended to radicalize management, using RRSO. Personality traits are regarded as significant contributors to human QoL and adaptability to the changed conditions of functioning. The aim of this study was to demonstrate the effect of personality on the QoL of women with the BRCA1 and BRCA2 mutations before and after RRSO. PATIENTS AND METHODS: The study involved 62 patients with the BRCA1 and BRCA2 mutations referred to hospital for RRSO. The research instruments were the WHQ, NEO-FFI, and self-developed sociodemographic data collection tool. RESULTS: Highly neurotic patients with the BRCA1 and BRCA2 mutations had lower QoL, especially in the domains of depressed mood, anxiety/fears, and sleep problems. At the same time, higher levels of conscientiousness, openness to experience, extroversion, and agreeableness were associated with better QoL outcomes. CONCLUSIONS: (1) Personality traits can contribute to the QoL of women with the BRCA1 and BRCA2 mutations before and after RRSO. (2) Identification of personality traits may be an important prognostic factor indicating potential changes in the QoL of patients after RRSO.

Oocyte matched follicular fluid anti-Müllerian hormone is an excellent predictor of live birth after fresh single embryo transfer.

STUDY QUESTION: What is the relationship between the anti-Müllerian hormone (AMH), gonadotropin and androgen concentrations within a single follicle and live birth after ICSI and a transfer of an embryo developed from the matched oocyte? SUMMARY ANSWER: Among the analysed markers on the day of oocyte retrieval, AMH concentration in follicular fluid (FF) is a predictor of live birth after single embryo transfer (SET). WHAT IS KNOWN ALREADY: High serum concentrations of AMH and low FSH concentrations have been associated with a high chance of pregnancy after ART. Whether there are differences in the hormonal milieu for individual follicles and whether this impacts the laboratory and clinical outcomes for the individual oocyte developing within that follicle are unknown. STUDY DESIGN, SIZE, DURATION: This prospective cohort study included 322 individual FF samples from 199 infertile women scheduled for ICSI/SET over an 18-month period. Of these women, 76 provided a single FF sample, while 123 women contributed two FF samples taken from two different follicles. PARTICIPANTS/MATERIALS, SETTING, METHODS: The first follicle aspirated in each ovary on the day of oocyte retrieval had the FF aspirated; the individual cumulus-oocyte complex (COC) was tracked, and the associated FF was stored at -80°C. FF AMH, FSH, LH, testosterone (T) and androstenedione (A2) levels were measured by mass spectrometry (androgens) and immunoassays. The laboratory and clinical outcomes for each individual oocyte were related to their unique follicle hormone concentrations. MAIN RESULTS AND THE ROLE OF CHANCE: Of the 322 oocytes with paired FF samples, 70 (21.7%) oocytes did not fertilise. From the remaining 252 2PN embryos, 88 (34.9%) were transferred as single embryos on Day 3; of the remaining 164, 78 developed into blastocysts, and 18 single blastocyst transfers were performed. Thus, a total of 106 transferred embryos had matching FF samples. An analysis of these individual FF concentrations revealed that AMH concentrations were higher in follicles in which the oocyte developed into a top quality (TQ) blastocyst (6.33 ± 5.52 ng/ml) and whose transfer led to live birth (7.49 ± 5.03 ng/ml) than those in which there was a failure of fertilisation (3.34 ± 2.21 ng/ml). In contrast, follicular FSH concentrations were the lower for oocytes that resulted in a TQ blastocyst (5.36 ± 2.20 mIU/ml) and live birth (5.60 ± 1.41 mIU/ml) than for oocytes that failed to fertilise (9.06 ± 3.36 mIU/ml). FF AMH was the only studied marker that increased the chance of live birth (odds ratio: 1.93 [95% CI: 1.40-2.67], P < 0.001). The receiver operating characteristic analysis showed that FF AMH levels predicted live birth with a very high sensitivity (91.2%), specificity (91.7%) and an excellent AUC value of 0.954, whereas serum AMH level only had a fair (AUC = 0.711) significance as a predictor for live birth after ICSI/SET. The predictive capabilities of the interfollicular markers were not limited to the TQ embryos or blastocysts; they applied to all SET cycles. LIMITATIONS, REASONS FOR CAUTION: Whether an altered intrafollicular hormonal environment reflects the developmental capacity of the oocyte or defines cannot be determined from this cross-sectional analysis. Inclusion of 21 subjects with polycystic ovary syndrome (PCOS) may have biased the findings due to a unique intrafollicular milieu associated with PCOS. WIDER IMPLICATIONS OF THE FINDINGS: Our results suggest that highly competent human oocytes have an FF composition of AMH, FSH, T and A2 that is close to that in a natural cycle. Also, the relationships between intrafollicular AMH, gonadotropin and androgen levels in the same follicle support the hypothesis that FF AMH concentration may reflect granulosa cell proliferation during gonadotropin-stimulated follicle growth. Finally, the serum AMH concentration is markedly lower than the FF AMH concentration, with a moderate correlation between serum and FF AMH, implying ovarian follicle autonomy with regards to its secretory products. STUDY FUNDING/COMPETING INTEREST(S): The National Science Centre of Poland supported this work (grant number: N N407 217 040). The authors declare that there is no conflict of interest regarding the publication of this article.

MMP2, MMP9 and TIMP2 polymorphisms affect sperm parameters but not fertility in Polish males.

Proper function of the blood-testis barrier is pivotal to spermatogenesis. Synchronised action of matrix metalloproteinases (MMP) and their inhibitors (TIMP) is mandatory to maintain dynamic balance of the barrier. Therefore, the association of functional genetic variants of MMP-2, MMP-9 and TIMP-2 and male infertility was studied. A total of 416 infertile males and 421 healthy subjects were genotyped for 7 SNPs within MMP2, MMP9 and TIMP2 genes, along with the assessment of semen parameters (concentration, motility and morphology of spermatozoa). No association was observed between the studied genotypes and male infertility. However, higher sperm concentration was associated with TIMP2 rs8080623 C and rs2277698 T variants among infertile men, and with MMP9 rs17576 A minor allele in controls (p < .05). TIMP2 rs9900972 T and rs2277698 T allele were associated with higher percentage of morphologically normal spermatozoa among controls. MMP2 rs2285053 TT homozygous infertile patients presented higher percentage of spermatozoa displaying nonprogressive motility. Haplotype analysis revealed strong linkage disequilibrium between the studied loci (5 of 8 possible TIMP2 haplotypes, and 3 of 4 possible MMP2 and MMP9 were found). None of the haplotypes showed association with infertility. This study results suggest an association between MMP9 and TIMP2 SNPs with sperm parameters, but not infertility.

Evidence for clinical safety, efficacy, and parent and physician perceptions of levocetirizine for the treatment of children with allergic disease.

Allergic rhinitis (AR) and chronic idiopathic urticaria (CIU) are highly burdensome diseases, which are increasing in prevalence, especially in the paediatric population. Despite the availability of a large number of medications for treatment of AR and CIU, their use in children has primarily been based on data obtained from a limited number of clinical trials in children and/or testing in adults. The H(1)-antihistamines have traditionally been used as first-line treatment for the relief of both AR and CIU symptoms in children. The first-generation H(1)-antihistamines are associated with marked adverse effects such as sedation, sleepiness/drowsiness as well as difficulties in learning and cognitive processing; thus, they are recommended for limited or discontinued use in children with AR or CIU. In contrast, second-generation H(1)-antihistamines are more adapted for the use in children with AR and CIU due to better safety profiles. However, only a limited number of trials with these agents have been conducted and generally, data from well-designed trials in children are lacking. Levocetirizine is one of the most extensively investigated H(1)-antihistamines for its pharmacologic properties, safety, efficacy as well as overall global satisfaction in children aged 2-12 years. Levocetirizine is the only H(1)-antihistamine launched in the 21st century shown to lack clinically relevant adverse effects on physical and psychomotor development or routine laboratory tests over a long-term period of 18 months in 1- to 3-year-old children predisposed to development of allergic disease. Available data suggest that levocetirizine is a suitable treatment option for AR and CIU in children aged 6 months to 12 years.

HLA-G polymorphism and in vitro fertilization failure in a Polish population.

To investigate whether human leukocyte antigen-G (HLA-G) gene polymorphism is associated with in vitro fertilization (IVF) failure, we sequenced exons 2-4 of the HLA-G gene in 50 couples with three or more IVFs (including 10 couples with five or more IVFs) and 58 control fertile couples from a Polish population. Of the 10 different HLA-G alleles identified in our study subjects, neither allele was found to be associated with IVF. We also genotyped 50 couples with IVF and 71 control couples for the -725C>G variant in the promoter region and the 14 bp insertion or deletion polymorphism in the 3' untranslated region of the HLA-G gene. The frequency of -725GG or GC genotype in women with IVF and in control fertile women was similar [26% vs 25.3%; odds ratio (OR) = 1.0; P = 1.0]. The 14 bp ins/ins or ins/del genotype was more common in women with IVF than in control women (76.9% vs 59.1%; OR 2.4; P = 0.03), but the difference was not significant after Bonferroni correction for multiple comparisons. The frequency of the ins/ins or ins/del genotype was particularly high (90%) in women who experienced five or more IVFs (OR = 6.2; P = 0.08), but again, the excess was not statistically significant, possibly because of small sample sizes. These results are in line with functional studies that show lower levels of HLA-G mRNA and protein related to the HLA-G allele including the 14 bp sequence and suggest that the insertion allele may be associated with an increased risk of IVF.

Diagnostic evaluation of oxidoreductive capability of sperm mitochondria.

In the present paper, morphological and functional features of human sperm midpiece, contributing to the assessment of sperm fertility potential, have been described. The NADH-dependent NBT screening assay was used to identify and visualise: 1/ morphological defects of sperm midpiece, 2/ immature sperm forms with extensive cytoplasmic retention, reflecting developmental failure in spermatogenic remodelling process, 3/ cytoplasmic sperm conglomerates, related to apoptotic bodies and 4/ sperm NADH-dependent oxidoreductase system at the mitochondrial level, related to the reaction intensity. The used assay is an adequate marker of sperm mitochondrial activity and sperm maturity. It can also help discover sperm defects that result in asthenozoospermia and can be used as an additional indicator in the evaluation of the sperm midpiece, as well as in routine morphological examination of spermatozoa, having a considerable predictive value for in vivo and in vitro fertilization.

Evaluation of mouse preimplantation embryos cultured in media enriched with insulin-like growth factors I and II, epidermal growth factor and tumor necrosis factor alpha.

Culture of preimplantation embryos is complex and requires strictly defined culture media to sustain their viability and quality. In the current study, an effort was made to evaluate comprehensively the quality of mice embryos, grown in media enriched with IGF I, IGF II, EGF and TNFalpha. For that purpose, critically chosen and thoroughly described, complex morphological methods based on contrast-phase, fluorescent and confocal microscopy were used. The study evaluated blastulation and hatching rates, total blastocyst cells, inner cell mass cell numbers (differential staining) as well as identified embryo cells with positive reactions for necrosis or apoptosis (TUNEL). The critical evaluation of the effects of the studied cytokines allowed for simultaneous, meticulous assessment of the applied study methods. Significantly more blastocysts were found in culture media enriched with IGF-I, IGF II and EGF. Significantly more hatched blastocysts were found in media with IGF-I and IGF II. Additionally, IGF I and II increased inner cell mass and total blastocyst cell numbers. Very few cells with necrosis and apoptosis were found in the culture media enriched with IGF I, IGF II and EGF. TNFalpha produced negative effects. The observed effects were dose-dependent.

Confocal microscopy: principles and applications to the field of reproductive biology.

Confocal microscopy allows analysis of fluorescent labeled thick specimens without physical sectioning. Optical sections are generated by eliminating out-of-focus fluorescence and displayed as digitalized images. It allows 3-dimensional reconstruction (XYZ) and time-analysis (XYT), thus providing unique chance to link morphology with cell function. Since images are obtained by scanning, excess illumination of the specimen and quick decrease of the fluorescent signal are avoided. Resolution obtained with a Laser Scanning Confocal Microscopy (LSCM) is theoretically better than that of a conventional microscope. The preparation of the specimen may be based on standard techniques, such as immunocytochemistry applied to fixed cells, or on staining of living cells, following the use of different fluorescent probes at the same time (colocalization). In our laboratory, we use the LSCM system Fluoview version 2.1 (Olympus) to study reproductive biology of animals and humans. We work on stainings of oocytes and blastocysts (mouse, bovine, human), and human ovarian tissues. We study mitochondrial distribution, cortical granule migration, calcium oscillations and spindle quality to link culture conditions and oocyte quality. Staining of F-actin is used to check transzonal projections (in zona pellucida) or to detect abnormalities following experimental treatment. Blastocyst quality is analyzed in sequential optical sections for microfilament organization and counting of total cell number (staining with phalloidin (actin) and picogreen (DNA). Trophectoderm and inner cell mass distribution (differential staining), apoptotic cells (TUNEL method) and viable cells (live/dead test) are also evaluated. Confocal imaging can be helpful for rapid determination of follicle density (staining with AM Calcein) and follicle morphology (picogreen) in ovarian cortical biopsies. The current review describes the principles of confocal microscopy and illustrates its applications to the field of reproductive biology by a large collection of pictures.

[Umbilical cord blood cytokines: a new diagnostic parameter? A preliminary report]. / Cytokiny krwi pepowinowej--nowy parametr rokowniczy? Doniesienie wstepne.

The aim of neonatologist is to anticipate clinical status of newborn immediately after delivery. Important are all parameters helpful in determining perinatal outcome. Particular attention is paid to proinflammatory cytokines: IL-1 alpha, IL-1 beta, IL-6, IL-8 and TNF alpha. The aim was to verify a relationships between umbilical cord blood cytokines and way of delivery, umbilical factor and clinical status of newborn in perinatal period. Newborns with lower 10 min Apgar score had higher levels of umbilical blood cytokines. Elevated IL-6 and IL-8 levels were found in newborns with subsequently diagnosed bacterial infection. Higher levels of cytokines were found in umbilical blood of newborns who passed meconium into the amniotic sac and who required an incubator. Proinflammatory cytokines, especially IL-6 and IL-8 may indicate the newborn clinical status in perinatal period.

Diurnal variations of respiratory system resistance and compliance derived from input impedance in asthmatic children.

The forced oscillation technique is more and more often used in the evaluation of the results of bronchomotor tests and in assessing respiratory mechanics in children. There is little information available concerning diurnal variability of indices of respiratory mechanics derived from input impedance (Z(rsin)). In 29 asthmatic children, aged 8-13 years we have studied diurnal changes of respiratory system resistance (R(rs)) and compliance (C(rs)) by measuring input impedance with the head generator every hour from 08:00 to 21:00 h. Diurnal coefficient of variation for zero frequency resistance (R(0)), mean resistance in the range 4-32 Hz (R(avg)) and C(rs) were 10.6+/-4.9, 11.2+/-4.5 and 8.9+/-3.3%, respectively. Significant circadian rhythm on R(0) was detected in 11 children, on R(avg) in nine children and on C(rs) in seven children. Only three children had all the three rhythms significant. We conclude, that diurnal variability of input impedance derived indices of respiratory mechanics is rather small, and circadian variability is present in about one third of the examined children. Diurnal variations of respiratory mechanics in children with significant circadian rhythm do not exceed 20%.

[Predictive values of peak expiratory flow measured with mechanical meters for Polish children and adolescents between 7-19 years of age]. / Wartosci nalezne szczytowego przeplywu wydechowego mierzonego miernikami mechanicznymi dla polskiej populacji dzieci i mlodziezy w wieku 7-19 LAT.

The aim of this study was to evaluate the predicted values of pack expiratory flow for the Polish children and youth by means of measures Mini Wright and Personal Best. The accounts were based on a group of 86 boys and 110 girls. It was established that it was necessary to state different predicted values for different measures and that an optimum model of regression for counting of predicted values of PEFR in relation to body height for the Polish children and youth was an exponential model. Model indices for both measures were set up separately for boys and girls.

[The effect of umbilical cord blood cytokines on clonogenicity of hemopoietic stem cells isolated from umbilical cord blood]. / Badania nad wplywem wybranych endogennych cytokin prozapalnych krwi pepowinowej na potencjal klonogenny macierzystych komórek krwiotworzenia izolowanych z krwi pepowinowej.

Human umbilical cord blood contains haematopoietic stem cells, which are a potential source of cells for hematopoietic transplants. Early cord blood hematopoietic cells are influenced by so called proinflammatory cytokines, which are present in cord blood serum. In this study we tried to correlate the concentration of these cytokines with the number, viability and clonogenicity of cord blood mononuclear cells. Accordingly, cord blood samples were harvested by employing an "open" collection method. Subsequently, we measured in those samples the concentration of selected pro inflammatory cytokines (Il-1 alpha, Il-1 beta, Il-6, Il-8 and TNF alpha), number of mononuclear cells and evaluated in vitro clonogenicity of myeloid progenitors (CFU-GM). We found the negative correlation between number of mononuclear cells and concentration of TNF alpha, and between number of detectable CFU-GM and concentration of IL-1 beta. Other cytokines, which were studied in this report did not correlate with evaluated parameters.

[Clinical efficacy and safety of levocarbastine++ in the therapy in children suffering from seasonal allergic rhinitis and conjunctivitis who are less than 12 year of age]. / Ocena skutecznosci klinicznej i bezpieczenstwa lewokabastyny w leczeniu pylkowicy u dzieci ponizej 12. roku zycia.

Levocabastine is an antihistaminic agent for topical application. It is without not advisable general side-effects and since many years is widely used for the treatment of pollinosis in adults and children more than 12 years of age. The group of 32 children aged from 5 to 11 years suffering from seasonal allergic rhinitis and conjunctivitis were treated by means of levocabastine applied topically by 20 days during the period of natural exposition to grass pollen. The clinical efficacy and tolerability including potential side-effects, were evaluated on the basis of clinical-laryngological investigations, visual analogs scales and diary cards filed in by parents of examined children. Levocabastine has been demonstrated to have rapid onset of action in children with SAR and the topical application of the drug does not irritate the mucosa of conjunctivas and nasal cavities.

[Some clinical symptoms and allergens on asthma-prurigo syndrome]. / Niektóre objawy kliniczne oraz alergeny w zespole asthma-prurigo.

The group of 146 patients suffering from asthma-prurigo syndrome (85 adults and 64 children) have been inquired in many various clinical centers. It was established that in 79.6% of the patients the first symptoms of illness appeared already in infancy and only 28.2% of the patients had negative familiar anamnesis on the allergy. In 73.2% of the patients with asthma-prurigo syndrome the symptoms of atopic dermatitis persisted longer than asthma symptoms and in 89.9% of them asthma-prurigo symptoms accompanied other form of allergic diseases. The most important causal allergens provoking asthma-prurigo symptoms were: house dust (in 64.4% of the patients), chocolate (in 42.2%), cat epithelia (in 40.2%) and cow milk proteins (in 29.5% of the patients).

[Changeability of respiratory tract and skin symptoms in patients with asthma-prurigo syndrome under the influence of emotional and environmental factors]. / Zmiennosc nasilenia objawów ze strony dróg oddechowych i skóry u chorych z zespolem asthma-prurigo pod wplywem czynników emocjonalnych i srodowiskowych.

In a group of 228 patients suffering from asthma-prurigo syndrome the influence of emotional state, permanent residence and season time on dynamic of the clinical symptoms were studied. The evaluation of emotional state in 80 adult patients was carried-out by means of Eysenck Personality Inventory. The emotional state had less negative influence on the exacerbation of the symptoms upon children then in adults (especially on their skin symptoms). It was confirmed that the patients with high level of neurotic symptoms revealed easier the exacerbation of asthma and skin disorders under the influence of emotional stress. The climatic treatment on the sea-side was more efficient for them than any mountain climatic cure, especially in the treatment of airways symptoms. Similarly, the summer season brought the relief of their symptoms from both the respiratory and skin symptoms.

[Internal standardization of sperm morphology evaluated according to strict morphological criteria]. / Próba standaryzacji badan morfologicznych plemników w oparciu o material wlasny pracowni seminologicznej.

OBJECTIVE: To evaluate sperm morphology and find cut-off values for local andrology lab based on morphological strict criteria. To compare the results to WHO guidelines. MATERIAL AND METHODS: Strict morphological criteria were applied to 300 sperm smears stained according to the Papanicolaou method. Specific sperm defects were described in details. The results were analyzed statistically. RESULTS: The normal sperm morphology was found in 18.54% of cases, which is less than the cut-off value suggested in the WHO guidelines. The lab cut-off value aimed by the 25th percentile was 8%. CONCLUSION: Sperm morphology requires broader multi-center standardization to enable compatible exchange of morphological data and find predictive factors of sperm fertilizing potential.

[The analysis of the sperm parameters in view of its concentration and motility in relation to men's age and occupation]. / Analiza parametrów nasienia ze szczególnym uwzglednieniem koncentracji i ruchliwosci w stosunku do wieku i niektórych zawodów.

OBJECTIVE: To evaluate chosen sperm parameters (concentration and progressive motility) in relation to men's age and occupation. MATERIAL AND METHODS: Retrospective study of laboratory records containing semen analysis results (n = 473, 1995-1997) of patients attending local andrology lab. Linear regression analyses was applied to co-related the age of the patients with the sperm concentration and progressive motility. Mean sperm counts and percentage of motile spermatozoa were compared in the general population vs. car drivers and soldiers. RESULTS: Sperm characteristics were not associated with the age of men. No differences between the general population, drivers and soldiers were found. The values of the mean sperm counts and percentage of motilile spermatozoa were higher than the cut-off values of the WHO. CONCLUSION: The data show no evidence of deterioration in sperm quality in relation to the age and occupation of patients.

[The role of steroid therapy in treatment of bronchial asthma in children]. / Miejsce steroidoterapii w leczeniu astmy oskrzelowej u dzieci.

Bronchial asthma is a chronic inflammatory disease of respiratory system. Antiinflammatory therapy, especially inhaled steroid is a basic form of pharmacotherapy. Inhaled steroids are used in chronic mild, medium and severe bronchial asthma. Dose of drugs depends on severity of the illness.