Unexpected content of kynurenine in mother's milk and infant formulas.

Mother's milk is widely recommended as complete food for the offspring in earliest postnatal time. However, the knowledge about detailed composition and the physiological role of bioactive components of breast milk is incomplete. Therefore, the aim of our study was to determine the content of kynurenine (KYN) in human breast milk during lactation and to explore the effects exerted by intragastric KYN administration from birth to weaning on physical and psychomotor development of adult rats. We found that KYN is consistently present in human milk and its content gradually increased from day 4 to 28 after delivery and that it is present in commercial baby formulas in amounts noticeably exceeding its physiological range. Animal studies showed that KYN supplementation resulted in a marked elevation of absorptive surface of rat intestine and in enhanced expression of both, aryl hydrocarbon receptor and G protein-coupled receptor 35 in the intestinal tissue in rats. Moreover, we discovered that KYN administration from birth to weaning resulted in neurobehavioral changes in adult rats. Therefore, we postulate that further research is required to thoroughly understand the function of KYN in early developmental stages of mammals and to ensure the safety of its presence in baby food products.

LC-QTOF/MS determination of tryptophan and kynurenine in infant formulas.

A rapid, reliable and sensitive liquid chromatography quadrupole time-of-flight mass spectrometry method for the determination of tryptophan and its metabolite kynurenine in milk formulas for neonates and infants was developed and validated. Two extraction techniques based on EMR Lipid QuEChERS and liquid-liquid extraction with diethyl ether to extract lipids and methanol to precipitate the protein were tested and compared. Four different infant formula products were randomly selected and evaluated for the effect of co-extracted matrix components on the quantitative analysis results. The influence of matrix components on analytical signals was normalized by the use of stable isotope-labeled standards and matrix-matched calibration. The developed method was found to be sensitive and effective for both analytes in all the examined infant formulas with satisfactory linearity (R2 ≥ 0.9995), recovery in the range of 75.7% ± 4.5 - 99.0% ± 1.1, and intra- and inter-day precision with the coefficient of variation below 6.3% and 17.9%, respectively. The limits of detection (LOD) and quantification (LOQ) for both compounds differed significantly between the examined formulas. The LOD and LOQ values were found to be in the range of 2.18-9.85 µg/g and 6.61-29.84 µg/g for the determination of tryptophan and in the range of 0.21-2.71 µg/g and 0.63-8.23 µg/g for the determination of kynurenine, respectively. The method was proved to be suitable for the determination of tryptophan and kynurenine in infant formulas, and it can be used to study the link between tryptophan metabolism via kynurenine pathway and metabolic disorders in infants.

Kynurenic acid as the neglected ingredient of commercial baby formulas.

The global increase in resorting to artificial nutritional formulas replacing breastfeeding has been identified among the complex causes of the obesity epidemic in infants and children. One of the factors recently recognized to influence metabolism and weight gain is kynurenic acid (KYNA), an agonist of G protein-coupled receptor (GPR35). Therefore the aim of the study was to determine the concentration of KYNA in artificial nutritional formulas in comparison with its level in human breast milk and to evaluate developmental changes in rats exposed to KYNA enriched diet during the time of breastfeeding. KYNA levels were measured in milk samples from 25 heathy breast-feeding women during the first six months after labor and were compared with 21 time-adjusted nutritional formulas. Animal experiments were performed on male Wistar rats. KYNA was administered in drinking water. The content of KYNA in human milk increases more than 13 times during the time of breastfeeding while its level is significantly lower in artificial formulas. KYNA was detected in breast milk of rats and it was found that the supplementation of rat maternal diet with KYNA in drinking water results in its increase in maternal milk. By means of the immunoblotting technique, GPR35 was evidenced in the mucosa of the jejunum of 1-day-old rats and distinct morphological changes in the jejunum of 21-day-old rats fed by mothers exposed to water supplemented with KYNA were found. A significant reduction of body weight gain of rats postnatally exposed to KYNA supplementation without changes in total body surface and bone mineral density was observed. The rat offspring fed with breast milk with artificially enhanced KYNA content demonstrated a lower mass gain during the first 21 days of life, which indicates that KYNA may act as an anti-obesogen. Further studies are, therefore, warranted to investigate the mechanisms regulating KYNA secretion via breast milk, as well as the influence of breast milk KYNA on mass gain. In the context of lifelong obesity observed worldwide in children fed artificially, our results imply that insufficient amount of KYNA in baby formulas could be considered as one of the factors associated with increased mass gain.

Comparison of the influence of three fibroid treatment options: supracervical hysterectomy, ulipristal acetate and uterine artery embolization on ovarian reserve - an observational study.

BACKGROUND: To assess and compare the influence of three fibroid treatment options: supracervical hysterectomy, ulipristal acetate and uterine artery embolization on ovarian reserve. METHODS: Prospective, observational, open-label study performed at the 3rd Chair and Department of Gynecology of the Medical University of Lublin, Poland. Premenopausal Caucasian women with symptomatic uterine fibroids were recruited into 3 groupspatients qualified for supracervical hysterectomies; patients qualified for preoperative ulipristal acetate (UPA) treatment scheduled for supracervical hysterectomies or myomectomies; patients qualified for uterine artery embolization (UAE). The following markers of ovarian reserve were investigated: antral follicle count (AFC), anti-Mullerian hormone (AMH), inhibin B (INHB), follicle stimulating hormone (FSH) and estradiol (E2). These markers were assessed before and 3 months after supracervical hysterectomies, before and 3 months after UAEs, and before and after 3 months of UPA treatment, before the scheduled surgeries. Baseline characteristics (age, parity, dominant fibroid volume, hemoglobin level, BMI, as well as AFC, AMH, INHB, FSH and E2) were compared between the study groups by Kruskall-Wallis ANOVA. Pre- and post-interventional values of AFC, AMH, INHB, FSH and E2 in the studied groups were compared with the Wilcoxon matched pairs test. RESULTS: Twenty-six, 27 and 30 patients were included in the final analysis in the supracervical hysterectomy, UPA and UAE groups, respectively. Three months after supracervical hysterectomy INHB and E2 significantly decreased, while AFC, AMH and FSH remained unchanged. After 3 months of UPA treatment the values of all the assessed markers of ovarian reserve were not significantly different in comparison to baseline. Conversely, three months after UAE the values of AFC, AMH, INHB, and E2 were significantly decreased, while FSH was significantly increased. CONCLUSIONS: Of the compared fibroid treatment methods UAE seems to have the greatest impact on ovarian function and should not be offered to patients concerned about their ovarian function. Supracervical hysterectomy did not affect the most accurate markers of ovarian reserve, and therefore appears to be safe in terms of ovarian function. UPA did not change any of the studied markers of ovarian reserve and seems a reasonable option when ovarian function is concerned.

Extensive postpartum urinary retention successfully treated with clean intermittent catheterization.

We present a case of extensive urine retention after vaginal delivery. Postpartum urinary retention occurs in 0.7 to 0.9% of vaginal deliveries. In the literature, mediolateral episiotomy, epidural analgesia, perineal lacerations, macrosomic birth and prolonged 2nd stage of labor are suggested as risk factors for postpartum urine retention.

Selected vitamins and quality of life in menopausal women.

The article presents the results of the latest studies on the correlation between the levels of selected vitamins, their bio-availability and their influence on bodily tissues and the quality of life in menopausal women. It also discusses the correlations between vitamin concentrations and the incidence of diseases characteristic of the transitional period, which affects the quality of life.

Secondary dysmenorrhea due to a rudimentary, non-communicating functional uterine horn.

Unicornuate uterus with a rudimentary horn is a rare congenital Müllerian anomaly, which may lead to many obstetrical and gynaecological complications. This pathology occurs in approximately 1/100 000 women. A rudimentary horn forms due to insufficient development of the Müllerian duct. The diagnosis of this anomaly is usually delayed, as it remains asymptomatic until adolescence and its main symptom is dysmenorrhea.

Hysteroscopic myomectomy.

A new International Federation of Gynecology and Obstetrics classification for myomas was recently described. Type 0, 1 and 2 are the submucosal fibroids. Submucous myomas represent one of the main indications for operative hysteroscopy. Hysteroscopic resection of submucous fibroids should be a simple, well-tolerated procedure and ideally finished in a single surgical step. Hysteroscopic myomectomy is an effective procedure. Fertility outcome and menorrhagia are improved by this procedure. However, for menorrhagia, a recurrence can occur mainly during the first year following the surgery. For bleeding outcome, a success rate from 70 to 99% has been reported by different studies. The success rate seems to decline as the follow- up period increases. For fertility outcome, submucosal fibroids have negative impact on pregnancy rates. The size of the fibroids plays a crucial role in completing the hysteroscopic myomectomy in a single step. A diameter greater than 3 cm in type 2 myomas results in a higher risk of a multiple procedure.

Ulipristal acetate as a treatment option for uterine fibroids.

Uterine fibroids are the most common benign uterine tumours. Clinical symptoms include abnormal bleeding, pelvic pressure, pelvic pain, infertility and obstetric complications. Approximately one third of women with fibroids will require treatment. The management also depends on the number, size, and location of the fibroids. There are surgical and non-surgical treatment options. The choice of therapy depends on different factors, such as the severity of symptoms, tumour characteristics, age, and wish to preserve the uterus and fertility. There is growing evidence of the main role of progesterone pathways in the pathophysiology of uterine fibroids due to the use of selective progesterone receptor modulators such as ulipristal acetate. The efficacy of long-term intermittent use of UPA was recently demonstrated by randomised controlled studies. There is great demand for alternatives to surgical intervention, especially in women seeking to preserve their fertility. One of these alternatives is ulipristal acetate, which is proven to treat fibroid symptoms effectively.

Infertility in the light of new scientific reports - focus on male factor.

Epidemiological data indicate that infertility is a problem of global proportions, affecting one- fifth of couples trying to conceive worldwide (60-80 mln). According to the trends observed, the problem is predicted to increase by another two million cases annually. In Poland, infertility-related issues are found in about 19% of couples, including 4% with infertility and 15% with limited fertility. Inability to conceive occurs equally in men and women (50%), irrespective of the direct cause. Although it is generally thought that reproductive issues concern women, infertility affects men and women equally. This study is an attempted to systematize knowledge about the role of the male factor in infertility, particularly current knowledge concerning the environmental factors of infertility. For this purpose, the Medline and CINAHL databases and the Cochrane Library was searched for articles published in English during the last 10 years, using the following keywords: infertility, male factor, semen examination and environmental factor of infertility.

The influence of uterine artery embolisation on ovarian reserve, fertility, and pregnancy outcomes - a review of literature.

Uterine fibroids are considered to be the most frequent female benign tumours. Fibroids affect mainly women of reproductive age. The most frequently reported signs and symptoms of fibroids include disturbances of the menstrual cycle such as heavy bleeding and painful menstruation, pelvic masses associated with pelvic pain, urinary problems or constipation, as well as infertility and recurrent pregnancy loss. The mainstay of fibroid treatment is still surgery. However, many patients seek alternative treatment options for fibroids, to preserve their uterus and fertility. One of the most important alternative treatment options for fibroids is uterine artery embolisation (UAE). However, there are some concerns that UAE may negatively influence ovarian function and even result in premature menopause. Moreover, the use of UAE in patients with future reproductive plans is still controversial, due to the possible pregnancy complications. The purpose of this review is to summarise the current knowledge regarding the possible influence of UAE on fertility, pregnancy outcome, and ovarian reserve.

Pelvic organ prolapse in women: how is it diagnosed and treated currently?

The aim of the paper was to summarize the current opinions about the management of pelvic organ prolapse in women. Food and Drug Administration safety announcements from 2008 and 2011 triggered the discussion about the methods of treatment of pelvic organ prolapse and the used materials and a partial return to the methods which had been totally criticized before the implementation of meshes. The decrease in mesh usage is also observed. The studies did not demonstrate the prevalence of any particular surgical procedure. The amount of studies concerning the evaluation and the treatment of pelvic organ prolapse ensures that the quality of care provided to women with urogynecological problems is continuously increasing.

Elastography in predicting preterm delivery in asymptomatic, low-risk women: a prospective observational study.

BACKGROUND: Despite the efforts to decrease the rate of preterm birth, preterm delivery is still the main cause of neonatal morbidity and mortality. Identifying patients threatened with preterm delivery remains one of the main obstetric challenges. The aim of this study was to estimate the potential value of elastographic evaluation of internal cervical os stiffness at 18-22 weeks of pregnancy in low risk, asymptomatic women in the prediction of spontaneous preterm delivery. METHODS: This prospective observational study included 333 low-risk, asymptomatic women presenting for the routine second trimester ultrasound scan according to the Polish Gynecological Society recommendation between 18-22 weeks of pregnancy. Ultrasound examinations of the cervix were performed transvaginally. The following data were recorded: elastographic color assessment of the internal os and ultrasound cervical length at 18-22 and 30 weeks of pregnancy; maternal age; obstetrical history; presence of cervical funneling at 30 weeks of pregnancy; gestational age at birth. Elastographic assessment of the internal os was performed using a color map: red (soft), yellow (medium soft), blue (medium hard) and purple (hard). If two colors were visible in the region of the internal os, the softer option was noted. Statistical analysis was performed using Statistica software (version 10, Statsoft Poland) using the following tests: chi square test to compare frequency of preterm deliveries in various categories of internal os assessment and Spearman correlation test to determine the correlation between elastographic assessment and cervical shortening. To determine the cut off category of internal os elastography assessment in selecting high preterm delivery risk patients we have calculated the sensivity, specifity, negative predictive value and positive predictive value. RESULTS: The number of preterm deliveries (<37 weeks of pregnancy) was significantly higher in the red and yellow groups, than in the blue and purple groups. The sensivity, specifity, NPV and PPV for both red and yellow internal os assessment in predicting preterm delivery were 85.7%, 97.6%, 98.3% and 81.1% respectively. CONCLUSIONS: Elastographic assessment of the internal cervical os at 18-22 weeks of pregnancy may identify patients with high risk of preterm delivery in low-risk, asymptomatic women.

Usefulness of three dimensional transvaginal ultrasonography and hysterosalpingography in diagnosing uterine anomalies.

INTRODUCTION: Uterine anomalies may lead to infertility recurrent miscarriage, preterm labour intrauterine growth restriction and post-partum haemorrhage. Infertility and recurrent miscarriage are relatively common problems in the female population. Diagnostic algorithms in such cases include the evaluation of uterine anatomy Magnetic resonance imaging (MRI) is the most accurate technique for visualizing the female genitourinary tract anatomy but as it is expensive and not readily available, it is not useful in everyday practice. Hysterosalpingography (HSG) is a frequently performed procedure that plays an important role in evaluating the uterus and fallopian tubes. The most typical indication for HSG is infertility and recurrent miscarriage, which are common problems in the female population. However this procedure is invasive, exposes the patient to ionizing radiation, carries a risk of complications and does not show the external contour of the uterus, which is essential for differentiating uterine anomalies. Three dimensional transvaginal ultrasound (3D TV USG) is a noninvasive and quick, imaging method that may be used in diagnosing uterine anomalies. This method allows evaluate the external contours of the uterus, making it comparable to MRI. OBJECTIVE AND METHODS: In this study we discuss the advantages and disadvantages of HSG and 3D TV USG in diagnosing uterine anomalies. Additionally we present the results of HSG and 3D TV USG of 155 patients referred to our Department because of infertility and/or suspected uterine anomalies. RESULTS: After performing HSG, in the studied group 118 patients were diagnosed with a normal uterus, 4 with unicornuate (including 1 patient with an unicornuate uterus, with rudimentary horn), and 6 with didelphys uterus. In 22 cases, due to the lack of evaluation of external contour of the uterus, we could not differentiate arcuate, septate and bicornuate uterus. After performing 3D TV USG we confirmed the HSG diagnosis and precise differentiated 22 disputable cases. 8 with arcuate, 11 with septate (2 complete and 9 partial) and 3 with complete bicornuate uterus. In 5 patients, severe pain and lack of cooperation during HSG made the acquisition of diagnostic X-ray images impossible. In these cases 3D TV USG allowed the anatomic assessment of the uterus, a normal uterus was found in all of them. All uterine anomalies were then confirmed by hysteroscopy and/or laparoscopy CONCLUSIONS: Basing on a review of the literature and our results, we conclude that HSG is not the optimal method for diagnosing uterine anomalies, while 3D TV USG can accurately show the uterus anomalies and may become an alternative method to MRI.

The effect of ulipristal acetate treatment on symptomatic uterine fibroids within 12-months follow-up.

AIM OF THE STUDY: The purpose of the study was to monitor the effect of ulipristal acetate treatment on symptomatic uterine fibroids within 12-months follow-up. MATERIAL AND METHODS: Fifty six patients with symptomatic uterine fibroids qualified for surgical treatment were included in the prospective observational study. All patients received preoperative oral UPA treatment for 3 months (1 × 5 mg). Patients that refused surgical treatment after UPA therapy were followed-up for the next 9 months. The volume of the intramural fibroid was estimated by TV-US using and integrated VOCAL 3D imaging program at baseline, after 3 months of UPA treatment and further at 3-months intervals. RESULTS: Before UPA mean dominant fibroid volume was estimated to be 216.0 cm(3) (38.4-768.2 cm(3)) and decreased to 117.6 cm(3) (12.6-668.0 cm(3)) after 3 months of UPA therapy. Mean percentage volume reduction was 45.6%. Mean hemoglobin level increased from an initial 10.1 g/dL (6.8-12.9 g/dL) to 12.6 g/dL (10.1-14.8) after 3 months of UPA therapy. At 12 months after initiating UPA treatment mean dominant fibroid volume decreased by 43.9%. In one third of followed-up patients the effect of 3 month UPA therapy persisted for the next 9 months. CONCLUSIONS: Three month UPA therapy decreases fibroid volume and improves hemoglobin level before planned surgical treatment. In one third of followed-up patients the effect of 3 month UPA therapy persisted for the next 9 months.

Predicting the results of uterine artery embolization: correlation between initial intramural fibroid volume and percentage volume decrease.

INTRODUCTION AND OBJECTIVE: Uterine artery embolization (UAE) is a minimally invasive treatment option for symptomatic fibroids. Long-term follow-up studies have shown that at five-year follow-up after UAE, up to 30% of patients required a hysterectomy. Therefore, it seems of utmost importance to identify patients, who are unlikely to benefit from UAE. It has been postulated that the percentage volume reduction of fibroids may predict long-term UAE outcome. The results of available studies are equivocal, therefore it seemed of interest to investigate the correlation between the preinterventional intramural fibroid volume and imaging outcome of UAE in premenopausal patients. MATERIAL AND METHODS: Uterine artery embolization was performed in 65 premenopausal patients with symptomatic, intramural fibroids. Dominant fibroid volume was assessed using an integrated VOCAL (Virtual Organ Computer-aided AnaLysis) imaging program at baseline and 3 months after UAE. The percentage reduction of fibroid volume was calculated. The association between preinterventional fibroid volumes and percentage volume reductions was determined with the Spearman rank correlation test. RESULTS: Before UAE, the median dominant fibroid volume was 101 cm(3) (range 23.6-610). At three-month follow-up the median dominant leiomyoma volume decreased to 50.4 cm(3) (range 6.9-193.9). Median percentage reduction of fibroid volume three months after UAE was calculated at 50.1% (range 2.7-93.5). The Spearman correlation test between the preinterventional dominant fibroid volume and percentage volume reduction showed a statistically significant, positive correlation (R = 0.33; p = 0.006). CONCLUSIONS: The percentage volume reduction of intramural leiomyomas after UAE seems to be more pronounced in the case of larger tumors.

Delayed diagnosis of Herlyn-Werner-Wunderlich syndrome due to microperforation and pyocolpos in obstructed vaginal canal.

BACKGROUND: To present a rare anomaly consisting of uterus didelphys, longitudinal vaginal septum, obstructed hemivagina with pyocolpos, fistula to the open vaginal canal, and ipsilateral renal agenesis, referred as Herlyn-Werner-Wunderlich syndrome (HWWS). CASE: A 14-year-old girl with recurring purulent vaginal discharge lasting for a few months. Preoperative examination revealed one vaginal canal with one cervical opening on the right side. There was a fistula leading from the obstructed vaginal canal to the left vagina. Intravaginal ultrasound examination demonstrated a longitudinal vaginal septum and a closed pyocolpos on the right side. The longitudinal vaginal septum was excised by way of electrocauterization under direct vision. CONCLUSION: HWWS should be considered in the differential diagnosis in patients with uterus didelphys and unusual symptoms such as pyocolpos and vaginal discharge.

[Uterine artery embolization--clinical problems]. / Embolizacja tetnic macicznych--zagadnienia kliniczne.

The aim of the study was to present clinical issues concerning uterine artery embolization (UAE) in women with uterine fibromas. In order to ensure high clinical efficiency of UAE and prevent subsequent complications, it is necessary to carefully select patients eligible for the procedure. Patients with intramural fibromas, who do not plan to conceive, are the best candidates for the procedure. Fibroma necrosis, with following infection, and premature ovarian failure remain to be the most common complications after UAE. UAE may cause amenorrhea and increase FSH levels, what is typical for menopause. Thus, it may be responsible for problems with conception as well as optimal development of a pregnancy. It may also cause premature, iatrogenic menopause. This complication significantly more frequently occurs in women over the age of 45 as compared to younger patients. UAE is considered as an alternative therapeutic procedure, available to women who do not desire the surgery or wish to preserve the uterus. Patients subject to this procedure should be informed about the possible side effects.

The efficacy and safety of the tension-free vaginal tape procedure do not depend on the method of analgesia.

OBJECTIVE: The original tension-free vaginal tape (TVT) method, described by Ulmsten et al., routinely uses local anaesthesia during the procedure. Since the anaesthetic effect after local application of lidocaine hydrochloride was not always satisfactory we decided to introduce the spinal anaesthesia during this operation. The aim of the present study was to compare local and spinal anaesthesia with respect to their efficacy and safety in the TVT procedure. METHODS: 103 women, with objectively confirmed stress urinary incontinence, were randomised into the study. Sixty-seven women were anaesthetised locally and 36 patients spinally. All TVT procedures were performed as originally described. Objective assessment of the influence of anaesthesia on intra-abdominal pressure at rest and during the cough test was done using a rectal catheter and a central venous pressure manometer. The efficacy of the TVT procedure was based on a gynaecological examination with a cough test and a three-degree subjective scale: complete cure, improvement or failure. RESULTS: The success of the TVT procedure performed under local anaesthesia is comparable with that achieved under spinal analgesia (p=0.42). The number of complications that occurred in the two groups does not differ significantly (p=0.57). CONCLUSIONS: Spinal anaesthesia impairs the ability to cough effectively during the TVT procedure. However, the efficacy and safety of the operations performed under this type of anaesthesia are comparable with the efficacy and safety of operations done under local anaesthesia.