Semen Quality, Hormonal Levels, and Androgen Receptor Gene Polymorphisms in a Population of Young Male Volunteers from Two Different Regions of Poland.

BACKGROUND: The population of healthy Polish men has not been frequently and systematically investigated for fertility status. The aim of this study was to assess the quality of semen in a randomly recruited population of young males. The most important task was to find a relationship between semen parameters, sex hormones, and AR gene polymorphism. MATERIAL AND METHODS: Semen and blood samples from young men from the Poznan (n=113) and Lublin regions (n=89) were collected for semen analysis, assessment of hormonal concentrations, and calculation of the CAG and GGN repeats of the AR gene. RESULTS: Statistical comparisons of the hormones and circulating proteins and the seminological parameters revealed significant differences between the regional groups of males studied. Among the correlations found, we emphasize the positive relationship between inhibin B levels and both the number of spermatozoa per ml (R=0.37; p=0.0001) and the total sperm concentration (R=0.40; p=0.00003). Positive correlations between IGF1 and sperm morphology was also found (R=0.40; p=0.000004). The mean number of CAG repeats in our tested groups was 21.93±2.79, in a range from 16 to 31. The mean number of GGN repeats was 23.2±1.66 and ranged from 16 to 29. Numerous significant correlations were found between CAG or GGN repeats and blood hormones or circulating proteins and semen parameters; however, Spearman's rank correlations revealed rather weak coefficients. CONCLUSIONS: This report attempted to determine the quality of semen samples and sex hormones in a population of Polish young men. The results were found to be similar to data obtained in Scandinavia. The calculated means and range of CAG or GGN repeats of the AR gene in Polish males were similar to West European epidemiological data.

Expression of genes coding for proangiogenic factors and their receptors in human placenta complicated by preeclampsia and intrauterine growth restriction.

The aim of the study was to investigate the expression of genes coding for vascular endothelial growth factor (VEGF) and placenta growth factor (PlGF) as well as their receptors, fms-like tyrosine kinase receptor 1 (VEGFR-1/Flt-1) and VEGF receptor 2 (VEGFR-2/KDR) in the placentae of patients with pregnancies complicated by preeclampsia (PE) and intrauterine growth restriction (IUGR). Tissue samples were collected from placentae of women with PE (n=31) and IUGR syndrome (n=25) as well as of healthy control women (n=31). Total RNA was extracted and purified, mRNA reversely transcribed, and amplified using real-time PCR. Expression of the examined genes was normalized to ß-actin. Higher levels of PlGF (p<0.001) and Flt-1 (p<0.05) transcription were found in PE placentae compared to normal ones. A positive correlation between PlGF and Flt-1 expression was revealed in the PE patients. In conclusion, the presented data indicate the upregulation of both PlGF and Flt-1 in placentae of women with PE, which could be induced by a pathological process possibly due to endothelial dysfunction.

[Level of satisfaction in patients giving birth in Poland/Rzeszów and in the Federal Republic of Germany/Gross-Gerau]. / Satysfakcja z opieki okoloporodowej pacjentek rodzacych w Polsce/Rzeszow i w Republice Federalnej Niemiec/Gross-Gerau.

AIM OF THE STUDY: The main purpose of the study was to examine opinions on perinatal care expressed by women hospitalized after childbirth in Poland and Germany Different socio-demographic variables were also analyzed in order to evaluate the quality of perinatal care in two different countries. MATERIALS AND METHODS: The study group comprised of postpartum patients from two facilities: the Clinical Ward of Gynecology and Obstetrics of Frideric Chopin Province Specialist Hospital in Rzeszów, Poland, and the Obstetrics-Gynecology Hospital in Gross-Gerau, Germany The group of randomly selected women, who were initially invited to participate in the study included 259 Polish and 230 German females. In order to measure the level of satisfaction with perinatal care, the authors used "The Newcastle Satisfaction with Nursing Scale" (originally constructed at the Center for Health Services Research, "University of Newcastle upon Tyne, UK, and adopted in Poland by Poznan University of Medical Sciences) and their own questionnaire. Finally 200 patients, one hundred from Poland and one hundred from Germany were enclosed. Statistical analysis was performed using the Statistics 8.0 software and a p valued below 0.05 was regarded significant. RESULTS: Generally perinatal care was assessed as being satisfactory by both Polish (91%) and German (97%) respondents. The study population varied in terms of age, education, place of residence or marital status. Only one socio-demographic variable (education) had a significant impact on the perception of the obtained perinatal care. However a limited number of patients (25% in Poland and 47% in Germany) participated in the prental and parenting classes. CONCLUSIONS: 1. Perinatal care was positively assessed by Polish and German patients of both hospitals. 2. The greatest importance in selecting the location for childbirth was attributed by both Polish and German subjects to such factors as: opinion of their friends, highly qualified personnel, modern medical equipment and instruments on premises. Additionally Polish respondents found it important that the doctor who had provided care for a given woman during pregnancy was employed at that particular hospital. In turn, German respondents also paid particular attention to the distance between their place of residence and hospital. 3. All study participants, regardless of their nationality admitted that the hospitals offered to their close relatives the possibility to visit and accompany the patients during childbirth.

Valproic acid transfer across human placental cotyledon during dual perfusion in vitro.

Valproic acid (VPA ) is a well-known antiepileptic drug with a significant teratogenic effect when administered during pregnancy. To investigate the transplacental transport of VPA, we used an in vitro experiment of dual perfusion of a human placental cotyledon. Eighteen normal placentas at term were investigated; ten were treated with a therapeutic dose of VPA (initial level at maternal circulation 75 microgram/ml), while the remaining eight were supplied with toxic VPA doses (initial level at maternal circulation 225 microgram/ml). VPA concentrations in fetal compartment were lower than those in the maternal compartment at all timepoints with both doses applied. The maternal and foetal VPA concentrations were stable at 60 min and 120 min for the therapeutic dose of VPA (transfer percentages from the maternal to the fetal circulation were 22.7 +- 9.1 percent and 22.7 +- 7.1 percent, respectively). Interestingly, a significant decrease of VPA level in the maternal perfusate was observed after 120 min due to the slightly higher transfer of the drug to the foetal compartment. In conclusion, our data confirmed an easy and rapid transfer of VPA accross the placental barrier. Since the incidence of congenital malformations in infants correlates positively with VPA concentrations in maternal serum, monitoring of VPA should be mandatory due to possible harmful effects on the foetus.

[Maternal serum concentration of angiogenic factors: PIGF, VEGF and VEGFR-1 and placental volume in pregnancies complicated by intrauterine growth restriction]. / Ocena lozyskowych czynników angiogennych (PIGF, VEGF, VEGF R1) oraz objetosci lozyska w ciazach powiklanych opóznieniem wzrastania wewnatrzmacicznego plodu (IUGR).

INTRODUCTION: Pathomechanism of intrauterine growth restriction is a complex issue, involving many different factors, and is still undergoing an investigation. Improper placental angiogenesis, resulting in placental pathology, is considered to be one of the most important causes of IUGR. Placental vascular growth factors--placental growth factor (PIGF), vascular endothelial growth factor (VEGF) and its receptor (VEGFR-1), are involved in the mechanism of placental vascular development and maternal endothelial function during the pregnancy. AIM: The aim of our study was to evaluate the maternal serum concentration of vascular growth factors (PIGF, VEGF) and their receptor (VEGFR-1), as well as the placental volume in pregnancies complicated by IUGR, and to compare the results with healthy control groups. MATERIAL AND METHODS: 20 patients with intrauterine growth restriction and 18 healthy pregnant women were recruited. Their blood serum samples were assayed for the placental growth factor (PIGF), vascular endothelial growth factor (VEGF) and their receptor (VEGFR-1). These placental factors were measured with the ELISA- method (R@D Systems Kits. In all cases the placental volume was assessed with an ultrasound (Voluson V730 GE) with VOCAL (Virtual Organ Komputer-aided AnaLysis). RESULTS: Our investigation revealed significantly lower maternal serum concentrations of PIGF in pregnancies with IUGR, comparing to the controls in the third trimester. In most cases, VEGF concentrations were undetectable in the maternal serum both, in the second as well as in the third trimester. In the 2nd trimester VEGFR-1 concentrations were statistically higher in the investigated group. In the 3rd trimester the concentrations of VEGFR-1 were higher in the investigated group, but the difference has not achieved the level of statistical importance. The mean placental volume was lower in the investigated group but with not statistical gnificance. CONCLUSIONS: Presented and documented dependencies may indicate the involvement of angiogenic factors in a pathomechanism of intrauterine growth restriction process. It seems that the measurement of placental volume may be useful in IUGR diagnosis. However, it should be a complementary examination only, due to technical limitations.

[Maternal serum concentration of placental growth factor (PIGF) and endothelial growth factor (VEGF) in pregnancies complicated by preeclampsia]. / Ocena stezenia lozyskowego czynnika wzrostu (PlGF) oraz naczyniowego czynnika wzrostu (VEGF) w surowicy krwi ciezarnych z preeklampsja.

UNLABELLED: Preeclampsia is one of the most frequent and dangerous complications of a pregnancy. In preeclamptic pregnancies the spiral arteries are not modified properly. Disturbed blood flow finally leads to hypoxia which is responsible for the dysfunction of the endothelium. Endothelial growth factor (VEGF) and placental growth factor (PIGF) play an important role in the angiogenesis and thus may participate in the pathomechanism of preeclampsia. AIM: The aim of our study was to estimate VEGF and PIGF level in serum of patients with preeclampsia. MATERIALS AND METHODS: The study comprised 25 gravidas with preeclampsia and a control group of 18 healthy gravidas. In 25 preeclamptic women the angiogenic factors levels were measured in the III trimester and in 7 of them in the II trimester. In the control group these parameters were assessed in both periods. Both factors were measured by commercial available ELISA KIT. RESULTS: PIGF concentrations were significantly (p < 0.0001) lower in sera of patients with preeclampsia in the II and III trimester in comparison to the controls: 17.4 vs. 290.3 pg/ml and 99.1 vs. 347.8 pg/ml, respectively. In most cases serum VEGF levels were undetectable. CONCLUSIONS: (1) PIGF is involved in the pathomechanism of preeclampsia and its maternal serum concentration decreases significantly in the course of the disease. (2) The sensitivity of the commercially available ELISA assay is too low to assess the serum VEGF concentration in women with preeclampsia.

[Ectopic and intrauterine simultaneous pregnancies--diagnostic difficulties]. / Ciaza wewnatrzmaciczna i jajowodowa--trudnosci diagnostyczne.

There are special troubles to diagnose ectopic and intrauterine simultaneous pregnancies. The intrauterine pregnancy usually releases from coexisting ectopic pregnancy diagnosis. Diagnostic difficulties were analysed.

[The stress level and structure in parents awaiting babies from high risk pregnancies]. / Ocena nasilenia i struktury stresu u rodziców w przypadkach ciazy wysokiego ryzyka.

OBJECTIVES: The analysis of stress in patients with high risk pregnancies. DESIGN: The purpose of this research was analysis of stress level and structure in patients awaiting the baby from high risk pregnancies. MATERIALS AND METHODS: 50 married couples were recruited to the study: 14 with threatened abortion, 18 with impending preterm delivery and 18 with a chronic disease (preeclampsia or diabetes). Trauma Symptoms Inventory (J. Briere) was implemented in this research. RESULTS: Women exhibited higher levels of anxious arousal (AA). They revealed more frequently lowered mood and depression (D), as well as anger and irritability (AI). The clinical type of the threat seems to be the factor modifying the level of experienced stress. The highest level of stress occurred in those couples in which the women suffered from a chronic disease (preeclampsia, diabetes). CONCLUSIONS: Threatened pregnancy is a trigger for psychological stress in parents. Both women and men reveal increased behaviours directed to reduction of emotional tension. The level of experienced stress is most heavily affected by the type of threat. The symptoms of stress are similar in both parents in a group with a particular diagnosis.

[Effect of anti-epileptic drugs on human placenta and the fetus]. / Wplyw leków przeciwpadaczkowych na lozysko i plód.

The pregnancy in women with epilepsy is associated with an increased risk of complications and especially with an increased incidence of congenital malformations in offspring. Currently, anti-epileptic drugs (AEDs) are concerned to be a major etiologic factor of abnormal fetal development. The most of AEDs may cross the placenta and reach pharmacologically concentrations in the fetus. Although the pathomechanism of teratogenicity of AEDs is complex and not well understood, a AEDs--dependent folate deficiency is thought as crucial. The reasons may also theoretically include a primary effect of AEDs on placental function and morphology. In the own study on perfused human placental cotyledon, only toxic concentrations of valproic acid caused morphological changes in placental tissue, including microvascular degeneration of cytoplasm, atrophy of syncytiotrophoblast, colliquative necrosis of some mesenchymal cells. The toxic but not therapeutic dose of valproic acid influenced also hormonal function of placenta by lowering of chorionic gonadotrophin concentration in perfusate. Although a knowledge about an influence of AEDs on the placenta and fetus is not complete, the use of these drugs during pregnancy may be more safe. If a dosage of AEDs in pregnant women with epilepsy is reduced to a reasonable minimum and the monotherapy is preferred, the risk of congenital malformations in their offspring can be minimized.

Forceps delivery after two previous Caesarean sections.

Caesarean section is one of the most frequently performed surgical procedures in current obstetric practice. There are several reasons for this upward tendency, including well developed hemotherapy, anesthesia, antibiotic treatment and skilled doctors. Despite such risks as uterine rupture, necessity of blood transfusion or the possibility of the necessity of ending the delivery by means of surgery, it is possible, in justified cases, to attempt spontaneous labor. A decision jointly made by the patient and her doctor, based on careful consideration of benefits and risks, as well as positive attitude on the woman's part may lead to positive outcome of labor. Taking the above factors into account we have decided to present a study of a difficult, operational labor after two Caesarean sections.

[Immunotherapy as an effective treatment of recurrent spontaneous abortion--own experience]. / Immunoterapia poronien nawykowych--doswiadczenia wlasne.

OBJECTIVES: Recent data emphasize relationship between antiphospholipid antibodies (APA) and increased natural killer cell activity in women with recurrent spontaneous abortion (RSA). Therefore, it has been proposed that final common mechanism involved in the pathogenesis of RSA is associated with auto- and alloimmunity. DESIGN: The aim of this study was to present our data concerning diagnosis and treatment of women with RSA. MATERIALS AND METHODS: Sixty nonpregnant women with the history of RSA were studied, among them 41 were screened at the beginning of their next pregnancy. We investigated the existence of inherited (deficiencies of protein C, protein S, antithrombin III, a resistance to the activated protein C-including Leiden V mutation) or acquired thrombophilia (APA-anticardiolipin antibodies, antiphosphatidylserine antibodies, lupus anticoagulant). Natural killer cell activity was measured using flow cytometry. In addition, the following lymphocytes surface antigens: CD3, CD4, CD8, CD16, CD56 were studied using flow cytometry. We also studied the existence of autoimmunity: antinuclear antibodies (ANA), antithyroid antibodies (ATA). According to presence of auto- or alloimmunity, we introduce immunotherapy: intravenous immunoglobulin, alloimmunization, heparin/aspirin, aspirin alone, steroids or combine therapy. RESULTS: We determined the existence of thrombophilia in 17 women, ANA in 5 women, ATA in 5 women, increased number of NK cells in 16 women and increased NK cell activity in 14 women. Forty-one women were pregnant and followed up during pregnancy, among them 33/41 delivered normal healthy baby, 7/41 experienced the next abortion and 1/41 had ectopic pregnancy. Therefore, overall success of immunotherapy was 80.5%. CONCLUSIONS: Immunotherapy seems to be effective treatment for women with the history of RSA and combined immune abnormalities. Regulation of immune system activity may underlie possible effect of such therapy.

[Urinary N-acetyl-beta-D-glucosaminidase (NAG) excretion in women with pregnancy complicated with hypertension]. / Aktywnosc N-acetylo-beta-D-glukozaminidazy (NAG) w moczu u kobiet w ciazy powiklanej nadcisnieniem tetniczym.

OBJECTIVES: Hypertensive disorders in pregnancy are one of the major mortality risk factors for mother and fetus. Although pathomechanisms of hypertension are extreme complex, the involvement of kidneys usually occurs. N-acetyl-beta-D-glucosaminidase (NAG) is a lysosomal enzyme which is located in renal tubular cells. Therefore an elevation of urinary NAG activity serves as a marker of tubular cell damage. AIM: Evaluation of renal tubular damage in pregnant women with different types of hypertension by determination of urinary NAG activity. MATERIAL AND METHODS: The study comprised 84 pregnant women in third trimester, divided according to type of hypertension into 3 subgroups: pregnancy induced hypertension (n = 58), preeclampsia (n = 13) and chronic hypertension (n = 13). The control group comprised 36 healthy pregnant women. Urinary NAG activity was measured in the second morning urine samples by colorimetric method and the results were expressed as NAG/creatinine ratios (NAG/Cr). RESULTS: The highest NAG/Cr ratios were found in women with preeclampsia (median-1.520 U/mmol) and in women with pregnancy induced hypertension (median-0.874 U/mmol) and both results differed significantly from those in controls (median-0.782 U/mmol). There was slight positive correlation between NAG/Cr ratios and systolic blood pressure (r = 0.225, p < 0.05). CONCLUSIONS: Hypertension in pregnancy may lead to renal tubular damage, however clinical significance of this phenomenon requires further studies.

[Influence of valproic acid (depakine I.V.) on human placenta metabolism--experimental model]. / Wplyw kwasu walproinowego (Depakine I.V.) na metabolizm lozyska ludzkiego w modelu doswiadczalnym.

OBJECTIVES: The pregnancy in women with epilepsy is associated with an increased incidence of congenital malformations in offspring. Currently, anti-epileptic drugs (AEDs) are concerned to be a major etiologic factor of abnormal fetal development but the pathomechanism of teratogenicity of AEDs is complex and not well understood. The purpose of this study was to evaluate an influence of one of the AED-valproic acid (VPA) on placental metabolism (glucose consumption and lactate production). MATERIAL AND METHODS: Term human placental cotyledons were perfused in vitro using a recycling perfusion of maternal and fetal circulations. A total 18 placentas were perfused either with 75 micrograms/ml of VPA (therapeutic dose) or with 225 micrograms/ml of VPA (toxic dose). Eight placentas were perfused with a medium without VPA and served as controls. During 2.5 h of experiment, both maternal and fetal glucose consumption and lactate production were measured every 30 minutes. RESULTS: The introduction of different concentrations of VPA into the perfusion system did not effect placental glucose consumption and lactate production rates in both maternal and fetal compartments. CONCLUSIONS: The teratogenic effect of valproic acid is not associated with metabolic disturbances of glucose or lactate in the placental tissue.

[Long-term tocolysis--sense and nonsense in current practice]. / Dlugotrwala tokoliza--sens i bezsens wspólczesnych praktyk.

Preterm delivery is still a major medical and social problem in perinatology. Despite many efforts the appliance of efficient prevention methods is still not possible. The treatment and inhibition of uterine contractions is widely used in clinical practice. The use of tocolytic agents in arresting premature labor is justified by gaining time which is necessary for applying antibiotics and steroids. Short-term tocolysis, ordinarily used between 22 and 34 weeks gestation, prolongs pregnancy and usually delays the delivery by about 48 hours. There are two prevailing options to follow successful inhibition of preterm contractions. The first one recommends intravenous treatment in cases with recurrent premature contractions, the other recommends long-term tocolysis even in cases with no any threatening symptoms. In such cases many obstetricians apply oral beta-Adrenergic agonists, although most of literature data and clinical practice do not confirm good results in preventing premature labor long-term tocolytic therapy does not improve fetal condition and does not prolong the pregnancy. It is also not meaningless that during this therapy maternal adverse effects may occur. Taking the above into consideration long-term tocolysis cannot be recommended as the routine treating procedure.

[Evaluation of risk factors for neonatal infection in preterm infants--own experience]. / Wybrane czynniki sprzyjajace wystapieniu zakazenia u przedwczesnie urodzonych noworodków. Badania wlasne.

Preterm birth is one of the major problems in perinatology today. It is associated with increased risk of neonatal infection and related neonatal mortality. In this study we evaluated some perinatal risk factors for neonatal injection. We found an association of neonatal infection with low gestational age, low birth weight, low Apgar score, intraamniotic injection, maternal leukocytosis, prolonged ruptured membranes and antenatal use of steroids and tocolysis. We conclude, that appropriate diagnosis, treatment and prophylaxis of intrauterine infections may reduce the incidence of infections among preterm babies.

[Identification of encoding and regulatory sequences of RAR-alpha receptor in intraepithelial neoplasia and in invasive cervical carcinomas associated with HPV types 16 and 18]. / Identyfikacja sekwencji kodujacej i regulatorowej receptora RAR-alpha w sródnablonkowej neoplazji oraz w rakach inwazyjnych szyjki macicy skojarzonych z infekcja HPV typami 16 i 18.

The purpose of the study was the analysis of regulatory (region 5 gen) and encoding sequences of RAR-alpha receptor in cervical dysplasia and invasive cancer associated with HPV infection. A PCR method with the use of specific primers was applied to amplify and detect DNA sequence of various HPV types. A PCR-SSCP method was used to analyse the sequence of RAR--a receptor. The study revealed changes in structure of regulatory and encoding sequences of the investigated RAR receptor. Utmost changes were found in DNA isolated from tissues with diagnosis of adenocarcinoma colli uteri.

[Influence of labetalol on the resistance of human fetoplacental vessels in perfusion in vitro]. / Wplyw labetalolu na opór naczyn plodowych lozyska ludzkiego wywolany doswiadczalnie w perfuzji in vitro.

OBJECTIVES: The main unfavourable effects observed in gestosis include: increased vascular peripheral resistance and increased blood pressure with a defective uteroplacental flow. The above mentioned changes may result from disorders in prostacyclin PGI2/thromboxane A2 balance. DESIGN: The aim of the studies presented was to compare the effects of, labetalol on the fetal vascular resistance induced by U 46,619--stable analogue of thromboxane A2 an experimental bilateral perfusion of the human placental lobule. MATERIALS AND METHODS: The researchers used the experimental model described by Schneider. 12 perfusions of the human placental lobules were performed. The control and labetalol groups consisted in 6 placental lobule perfusions lasting 120 min each. Having obtained constant increase in perfusion pressure from the 60th min of the experiment, labetalol was administered along with thromboxane A2 analogue into the fetal circulation. The perfusion pressure was steadily recorded on the kymograph tape. RESULTS: The stable increase of perfusion pressure was observed from the 60th minute with the average of 185% of the initial pressure. This value represented the reference standard in the second stage of the studies in which the effects of labetalol on the experimentally increased perfusion pressure was evaluated. CONCLUSIONS: Labetalol did not significantly affect the hemodynamics of fetoplacental vessels.