Comparison of metformin, myoinositol and metformin-myoinositol combined treatments for polycystic ovary syndrome.

Objective: The objective of this study was to assess the effectiveness of myoinositol (4 g myoinositol + 400 mcg folic acid/day) compared with metformin (average 1700 mg/day), as well as the combined efficacy of both treatments in managing insulin-resistant polycystic ovary syndrome (PCOS) among women. Materials and Methods: We retrospectively analyzed the records of 68 reproductive-age PCOS patients with insulin resistance over a 3-month period. Oral glucose tolerance tests (OGTT) (75 gr) were conducted to measure glucose levels at 0 and 120 min. Moreover, changes in prolactin, thyroid stimulating hormone, high-density lipoprotein, low-density lipoprotein, triglyceride levels, total cholesterol, follicle-stimulating hormone, luteinizing hormone, total testosterone, free testosterone, and dehydroepiandrosterone sulfate (DHEA-S) levels were evaluated pre- and post-treatment over a 3-month period. Results: Statistically significant improvements were observed in menstrual regularity, body mass index (BMI), modified Ferriman Gallwey scores, OGTT glucose levels at 0 and 120 min, total testosterone, free testosterone, and DHEA-S levels across all groups (p<0.005). Conclusion: No significant variances were observed in terms of BMI, modified Ferriman Gallwey scores, or androgen levels across the three treatment cohorts. The combination of myoinositol and metformin did not confer additional benefits compared with either treatment alone.

Barbed versus conventional suture in laparoscopic myomectomy: A randomized controlled study.

Objective: To compare the surgical and clinical results of traditional absorbable polyglactin 910 and barbed sutures in laparoscopic myomectomy. Materials and Methods: This single-center randomized study included 75 women who underwent laparoscopic myomectomy. The uterine wall defects were closed with a continuous conventional absorbable polyglactin 910 suture (Vicryl; Ethicon, Somerville, NJ, USA) in 41 women and with a unidirectional barbed suture (V-Loc 180; Covidien, Mansfield, MA, USA) in 34 women. Results: The time required to suture the uterine wall defect was lower in the V-Loc group than in the Vicryl group (p=0.007). However, no significant difference was observed in the operative time between the two study groups. The intraoperative blood loss and need for postoperative blood transfusion were significantly lower in the barbed group than in the Vicryl group (p=0.018 and p=0.048, respectively). Conclusion: In laparoscopic myomectomy cases, the unidirectional barbed suture is more effective than the conventional absorbable suture. Barbed sutures facilitate the suturing process and reduce the time required to suture the uterine wall defect, blood loss, and the need for postoperative blood transfusion.

McCall culdoplasty vs. vaginally assisted laparoscopic sacrocolpopexy in the treatment of advanced uterine prolapse: A randomized controlled study.

OBJECTIVE: The primary aim of this study was to compare the anatomic outcomes of vaginally assisted laparoscopic sacrocolpopexy (VALS) with those of McCall culdoplasty (McCC) in patients undergoing concurrent vaginal hysterectomy. MATERIALS AND METHODS: This randomized controlled study presents the outcomes of 68 patients who underwent hysterectomy and vaginal suspension for apical prolapse ≥ Stage III according to the Pelvic Organ Prolapse Quantification (POP-Q) system between October 2017 and December 2020. Among these patients, 33 underwent VALS and 35 underwent McCC. Clinical features, surgical data, concomitant surgical procedures, postoperative complications, and recurrence rates were assessed. Before and after one year of surgery, the short form of the Pelvic Floor Impact Questionnaire and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire were used to evaluate subjective symptoms. Patient Global Impression of Improvement Questionnaire was used to assess patient satisfaction. RESULTS: The mean follow-up durations were 25.5 ± 7.63 months and 25.6 ± 5.96 months in the VALS and McCC groups, respectively. Prolapse recurrence occurred in 3 (9.1%) women in the VALS group versus 12 (34.3%) women in the McCC group (p = 0.031). CONCLUSION: The McCC operation was associated with a shorter operation time, whereas the VALS operation had a significantly higher objective success rate. Based on this study, it may be concluded that McCC is not an effective procedure for advanced uterine prolapse.

Investigation of a novel ring-cusp magnetically confined plasma bridge neutralizer.

The plasma bridge neutralizer (PBN) based on a tungsten filament is a promising technique of a thermionic DC electron source where a hot filament is immersed in an inert gas flow and electrons are "bridged" from a small orifice to the ion beam. PBNs have been widely used in space propulsion and industrial applications due to their relatively simple structure and low power consumption. However, they have well-known disadvantages, namely, low emission current density and short lifetime. In this article, we propose a novel ring-cusp magnetically confined PBN (RCM-PBN) to address these issues. In the RCM-PBN, electrons are confined by a ring-cusp magnetic field, which improves the ionization efficiency and reduces the discharge chamber wall losses. Electrical insulation of the orifice plate from the chamber wall prevents a large number of electrons from being collected by the orifice plate, which greatly improves the extracted electron current. The effects of different operating parameters on the extracted electron current were studied through experiments. It was found that the increase in the extracted electron current with the extraction voltage was related to the anode spot formation. Analysis of the gas utilization factor and electron extraction cost shows that the optimal operating condition was obtained at an argon mass flow rate of 1.2 SCCM and a heater power of 45 W. At its optimum, a stable electron current of 1.1 A was extracted from the RCM-PBN with a gas utilization factor of 12.8 and an electron extraction cost of 143 W/A.

Risk of uterine niche following single-layer locked versus unlocked uterine closure: a randomized study.

INTRODUCTION: The primary objective of the present study is to evaluate the effect of single-layer locked versus single-layer unlocked uterine closure techniques on the development of uterine niche. The secondary objective is to evaluate the effect of the ratio of lower uterine segment (LUS) to upper uterine segment (UUS) on the development of uterine niche, which was not previously investigated in literature but which the authors consider to be a major risk factor for the development of uterine niche. METHODS: Included in this randomized study were 194 patients who were admitted to the Department of Obstetrics and Gynecology at Health Sciences University Antalya Training and Research Hospital and who underwent cesarean section (CS) due to any reason between October 2017 and May 2018. Two different techniques were used in the closure of hysterotomy: Single-layer locked continuous suturing (Group 1) and single-layer unlocked continuous suturing (Group 2). During surgery, the thicknesses of the LUS and UUS were measured using a sterile scale prior to hysterotomy closure. The patients were evaluated for the development of uterine niche at postoperative six months by transvaginal ultrasound. RESULTS: Control transvaginal ultrasound performed at six months after surgery revealed uterine niches in 58 out of 194 patients (29.29%; 34 patients in Group 1 [34.3%] and 24 patients in Group 2 [25.3%]). No significant difference was noted in terms of the development of uterine niche between the two groups (p = .167). The mean LUS and UUS in patients without uterine niche development were 6.81 ± 1.26 mm and 9.38 ± 1.26 mm, whereas the mean LUS and UUS in patients with uterine niche development were 4.24 ± 1.15 mm and 9.21 ± 2.15, respectively (p = .001 and p = .236). The mean UUS/LUS ratio is 1.4 ± 0.16 among patients without uterine niche and 2.21 ± 0.31 in patients with uterine niche (p < .001). CONCLUSIONS: The present study found no statistically significant difference in niche size between the two groups. However, the study reports that the ratio of upper to lower uterine segment that was not previously investigated in literature is a major risk factor for the development of uterine niche.

Reference ranges for flow velocities and the indices of the ductus venosus in low-risk pregnancies

Objective: Ductus venosus blood flow velocity measurements are mandatory in many clinical indications. The evaluation of the flow is performed either by comparing results with general reference tables or by qualitative assessment of the "a" flow, in regard to reversed or absent flow in the spectral waveforms. The aim was to develop normal reference ranges in low-risk pregnancies in our population. Material and Methods: Measurements of flow velocities (S, v, D, a) and indices (pulsatility index for veins, peak velocity index for veins, a/S, S/a) were performed by a single experienced specialist in 1279 singleton, uncomplicated pregnancies between 11 and 40 weeks gestation. The absolute flow velocities (S, v, D, a, VmPeak) and indices were obtained from spectral waveforms using the equipment producer's inbuilt system. The still images were stored in the picture archiving and communication system. Results: The predicted reference ranges of the ductus venosus blood flow velocities according to the gestational age are shown in tables and graphics. Predicted reference curves based on the 5th and 95th percentiles according to gestational week were plotted and are given in tables and figures. Conclusion: Normal reference ranges for absolute flow velocities and indices were calculated from a population of uncomplicated pregnancies attending a tertiary care center. The measurements were made from both the classic patterns of the waveforms and also considered variants of the spectral waveforms, which have recently been reported, for the first time in the medical literature.

Repeated dose of prostaglandin E2 vaginal insert when the first dose fails.

OBJECTIVE: To compare the obstetric and neonatal outcomes of patients treated with repeated-dose prostaglandin E2 (dinoprostone) vaginal insert when the first dose fails. MATERIALS AND METHODS: This retrospective study included 1.043 pregnant women who received dinoprostone for labor induction between November 2012 and August 2015. Pregnant women were divided into two groups according to the number of dinoprostone administrations: group 1, single-dose dinoprostone (n=1.000), and group 2, repeated-dose dinoprostone (n=43). Intrapartum, postpartum, and neonatal outcomes of the pregnant women were compared. RESULTS: Vaginal delivery rate was 65% in group 1 and 30.2% in group 2 (p=0.001). The need for the neonatal intensive care unit was found in 44 pregnant women (4.4%) in group 1 and 6 pregnant women (13.6%) in group 2 (p=0.006). CONCLUSION: When obstetric and neonatal data were evaluated in our study, we observed that dinoprostone administration was associated with increased cesarean rates and adverse neonatal outcomes with repeated-dose dinoprostone when the first dose failed.

Comparison of the effects of bilateral and unilateral laparoscopic ovarian drilling on pregnancy rates in infertile patients with polycystic ovary syndrome.

AIM: This study aims to investigate the effects of unilateral and bilateral laparoscopic ovarian drilling (LOD) on pregnancy rates in patients with clomiphene citrate (CC) resistant infertile polycystic ovary syndrome. METHODS: This prospective cohort study included 75 patients who were admitted to the Department of Obstetrics and Gynecology of the Antalya Training and Research Hospital between July 2016 and December 2017 and underwent LOD operation. Among these patients, 37 underwent unilateral laparoscopic ovarian drilling (ULOD) and 38 underwent bilateral laparoscopic ovarian drilling (BLOD). The drilling procedure was carried out using the following equation: Number of punctures (np) = 60 J/cm3 /30 watt × 4 s by selecting the larger ovary in the patients who underwent ULOD and by taking the ovarian volume of each ovary in the BLOD group. RESULTS: During the 1-year follow-up, 20 of the ULOD patients (54.1%) and 13 of the BLOD patients (34.2%) were observed to be pregnant. Although a higher number of pregnancies were obtained in the ULOD group, no statistically significant difference was found between the two groups (P = 0.083). The pregnancies occurred more in the first 6 months during the postoperative follow-ups of the patients. A total of 14 (70%) of the 20 pregnancies in the ULOD group and 9 (69.2%) of the 13 pregnancies in the BLOD group occurred in the first 6 months. CONCLUSION: ULOD with respect to a larger ovarian volume should be preferred to BLOD for CC-resistant PCOS patients because of the high pregnancy rates and fewer potential side effects.

Noninvasive determination of the fetal cardiac interatrial pressure gradients by Doppler ultrasonography: preliminary results.

OBJECTIVE: In 2000, Johnson et al. measured the atrial pressures puncturing the atria invasively in 19 fetuses that will be terminated. In this study, it is aimed to define the fetal cardiac interatrial pressure gradient noninvasively. The pressure gradients were calculated using the ductus venosus (DV) and pulmonary vein (PV) blood flow velocities and Bernoulli equation for flowing fluids. METHODS: "S," "a," and the time-averaged maximum velocities in both veins of 246 fetuses were used in the simplified Bernoulli equation; Δp=4 (VDV2-VPV2). Additionally, the umbilical vein maximum velocity is measured in order to calculate ducto-umbilical pressure gradient. RESULTS: The average interatrial pressure gradient was biggest in the ventricular systole and the least gradient was in the atrial systole of a cardiac cycle. The pressure gradient changes throughout the second and the third trimester have four periods with two increases and two decreases. CONCLUSIONS: The interatrial and ducto-umbilical pressure gradients can be measured noninvasively in order to follow the hemodynamic of the fetal circulatory system.

Spontaneous unilateral quadruplet tubal ectopic pregnancy.

Ectopic pregnancy (EP) is defined as the implantation of the fertilized ovum outside the uterine cavity. Importantly, the implantation site is tubal in 95% of the cases. Multiple EPs are extremely rare. We present a case of a 25-year-old patient, gravida 2 para 1, with amenorrhea accompanied by the complaints of vaginal bleeding and abdominal pain. She was admitted to the emergency department. Trans-vaginal ultrasound revealed a left ovarian anechoic cyst of 30 mm and four embryos in the right tube with positive cardiac activities. An emergency laparotomy found the rupture of tubal pregnancy on the right side, which ultimately led to hemo-peritoneum. Therefore, we performed right salpingectomy. This is the first well-documented case of a patient with spontaneous unilateral quadruplet tubal EP.

Quantitative measurements of celeration times and indexes in the ductus venosus spectral Doppler waveforms in normal fetuses.

Background Ductus venosus spectral waveform has two peaks and two nadirs: S, v, D and a velocities, which are obtained after to some extent of accelerations or decelerations throughout a cardiac cycle. It is aimed to define the actual celeration times and indexes and their relationships with the fetal heart rate (FHR). Methods The acceleration times and indexes were measured in 357 patients between 11 and 40 weeks of pregnancies with low risk. Results The FHR has a gradual increasing negative correlation from time for S to time for a with each of the cardiac times of phases according to the statistical analysis (correlations were minus 190, 269, 407 and 541 for S, v, D and a phase times, respectively). The acceleration aS and the deceleration Da have positive correlations with the FHR; however, the deceleration Sv and the acceleration vD do not correlate with the FHR. Conclusion The deceleration Da time and index are the main components for determining the FHR in fetuses. Therefore, the atrial contraction is the strongest component for determining the FHR in fetuses.

Normal variants of ductus venosus spectral Doppler flow patterns in normal pregnancies.

Objectives: Ductus venosus (DV) Doppler examinations in pregnancy have a widespread use for several important indications and play a crucial role in order to determine the fetal well-being. DV is usually visualized by the color Doppler mapping. We observed the instantaneous spectral flow type changes in pulsed Doppler examinations in spite of performing with the correct technique published by several authors. The variability of the pattern makes the sonographer/physician to be unsure for the correct placements of the sample gate despite fulfilling the all the criteria required for the vessel sampling. It is aimed in the study to define variations of the normal DV spectral flow types in the duration of the pulsed Doppler examinations instead of in a single cardiac cycle in normal pregnancies.Methods: This prospective study was conducted between January 2016 and February 2017. Wide-band Doppler technique was used for color mapping of the DV. Normal spectral Doppler waveforms in pregnancies are classified as types. When DV spectral flow pattern was not in the standard type, the spectral flow patterns were obtained from not only the umbilical artery and/or middle cerebral artery. Maximum and minimum blood flow velocities in the umbilical vein are measured. All Doppler examinations are performed by a single experienced specialist (CG), who had been certificated for DV flow and Doppler examinations by the Fetal Medicine Foundation.Results: A total of seven types of flow patterns were recorded during the study period and DV flow patterns were divided into two main categories as classic flow pattern and the other patterns. The classic pattern was observed in 160 (99.4%) cases in the first trimester, 495 (94.1%) cases in the second trimester and 206 (60.8%) cases in the third trimester.Conclusions: We think that the fetal circulation is complicated more than estimated. There might be some endocrine agents released in the instantaneous physiologic reactions and changing the venous return abruptly or due to decreasing of the cardiac output directed to the placenta after 34 weeks influence the volume of the circulating blood in the fetus and so thereby the flow velocities instantaneously. The spectral waveform recognition approach is not reliable to identify if the DV spectral Doppler pattern is not the classic (standard) type and the DV should be visualized by wide-band color Doppler techniques particularly in the third trimester for the pulsed Doppler examinations. Studies are needed to evaluate the normal spectral variants of the flows correlated with the physiological compensatory mechanisms.

Comparison of the efficacy and safety of two advanced vessel sealing technologies in total laparoscopic hysterectomy.

AIM: Adequately powered, randomized controlled studies evaluating efficacy and safety of advanced bipolar energy devices in gynecologic laparoscopic surgery are very few. We aimed to compare the two most commonly used devices in total laparoscopic hysterectomy. METHODS: This randomized controlled trial was carried out in the department of obstetrics and gynecology in an education and research hospital. One hundred thirty-two women who underwent total laparoscopic hysterectomy for benign indications were included. Women with age younger than 18 years, suspected malignancy, stage 3-4 endometriosis and cervical/intraligamentary leiomyoma were excluded. Patients were randomized preoperatively to LigaSure or Articulating Enseal. One experienced surgeon performed all operations. RESULTS: LigaSure was used in 67 patients and Enseal was used in 65 patients. Primary outcomes of the study were operative time (time from start of sealing and transection of the round ligament until completion of colpotomy) and total operative time (time from skin incision to skin closure). Secondary outcomes were intraoperative blood loss (blood lost during operative time period) and perioperative complications. Operative time was significantly shorter in LigaSure group (P = 0.001). Total operative time, intraoperative blood loss and perioperative complications were similar. When two groups were further classified according to uterine weight taking 300 g as cut-off value, operative time was significantly shorter in LigaSure group in both subgroups (P = 0.003 and P = 0.007). CONCLUSION: LigaSure use in total laparoscopic hysterectomy shortens operative time when compared with Enseal; without an apparent increase in intraoperative blood loss and perioperative complications. On the other side, total operative time remains unaffected.

The types of connections between the portal sinus and main portal vein in foetuses / Tipos de conexiones entre el seno portal y la vena porta principal en fetos

In the prenatal period, the three types of connections between the portal sinus and main portal vein have been published in the literature: T, X and H-shaped. The T type is the most frequent in the literature, and the aim of our study is to define the percentage of the connection types during the prenatal period in our population. In this prospective study, 237 women between 20 and 38 weeks of pregnancy without a foetal anomaly or pregnancy-related complications were included, and the precordial veins of the foetuses were examined using a wide-band color Doppler technique. The types of connections were determined by two specialists according to the shape of the colour coded vessels in Doppler examinations. The criteria of Czubalski & Aleksandrowicz (2000) were used. All of the connection types in patients were confirmed using video clips and were stored in the picture archiving and communication system. In 237 patients, the types of connection were determined by the first specialist as 189 foetuses (79.7 %) with the X-shaped or side-to-side connection, 16 foetuses (6.8 %) with the T-shaped or end-to-side type and 32 foetuses (13.5 %) with the H-shaped or parallel-coursed vessels connected with a short segment. The most common types of connections between the portal sinus and main portal vein in foetuses are X shaped or side-to-side, which is contrary to previous studies.

En el período prenatal, se han publicado en la literatura los tres tipos de conexiones entre el seno portal y la vena porta principal: en forma de T, X y H. El tipo T es el más frecuente, y el objetivo de nuestro estudio fue definir el porcentaje de tipos de conexión durante el período prenatal en nuestra población. En este estudio prospectivo, se incluyeron 237 mujeres entre 20 y 38 semanas de embarazo, sin anomalías fetales o complicaciones relacionadas con el embarazo, y se examinaron las venas precordiales de los fetos utilizando una técnica Doppler de banda ancha. Los tipos de conexiones fueron determinados por dos especialistas según la forma de los vasos codificados por color en los exámenes Doppler. Se utilizaron los criterios del estudio de Czubalski & Aleksandrowicz. Todos los tipos de conexión en los pacientes se confirmaron mediante videoclips y se almacenaron en el sistema de comunicación y en archivo de imágenes. En 237 pacientes, el primer especialista determinó en 189 fetos (79,7 %) la conexión en forma de X o de lado a lado; en 16 fetos (6,8 %) la forma de T o Tipo de extremo a lado; y en 32 fetos (13,5 %) los vasos en forma de H o paralelos, conectados con un segmento corto. Los tipos más comunes de conexiones entre el seno portal y la vena porta principal en los fetos son en forma de X o de lado a lado, lo que es contrario a estudios anteriores.

The role of anti-Mullerian hormone in predicting the response to clomiphene citrate in unexplained infertility.

OBJECTIVE: To determine the role of anti-Mullerian hormone (AMH) levels in predicting the response to clomiphene citrate (CC) therapy for ovulation induction in women with unexplained infertility. MATERIALS AND METHODS: For this retrospective study, fifty consecutive patients who responded to CC were taken as Group 1, while fifty consecutive patients who failed to show adequate ovulatory response with CC were taken as Group 2. We compared the AMH levels of the two groups and receiver operating characteristic (ROC) curve was used to determine the threshold for AMH in predicting the ovulatory response to CC therapy. RESULTS: Mean age, body mass index, luteinizing hormone, prolactin, and thyroid-stimulating hormone values were similar in the two groups. AMH and antral follicle count (AFC) values were higher in Group 1 than in Group 2 (p = 0.001 and p = 0.001, respectively). There was a statistically significant negative correlation between FSH and AFC (r = -0.339, p = 0.001), while AFC and AMH displayed a statistically significant positive correlation (r = 0.713 and p = 0.001). AMH values and AFC were found to be predictors of the adequate ovulatory response to CC. The area under the ROC curve was 0.86 vs 0.80, respectively. At an AFC cutoff value of 14, the sensitivity and specificity for prediction of ovulation were 68% and 80%, respectively. CONCLUSION: The AMH and AFC cut-off values for the prediction of positive ovarian response to CC in patients with unexplained infertility were 2.78 ng/mL and 14, respectively. If further prospective and randomized studies confirm our results, these thresholds may be useful to predict successful ovulation induction and reduce the unresponsive cycles.

Note: Precision balance for sub-miliNewton resolution direct thrust measurement.

We attempted to test the suitability of a commercial precision balance as a simple alternative sub-miliNewton resolution continuous thrust stand on a vertically oriented 300 W-class Hall thruster. The measured thrust data were in the range of 1-10 mN with a maximum error of 0.1 mN. The performance of the precision balance was compared to the performance of a hanging pendulum thrust stand. The measured thrust from the precision balance falls within the standard error of the hanging pendulum indicating good quantitative agreement.

Is pregnancy associated plasma protein-A (PAPP-A) a marker for adverse perinatal outcomes in preterm isolated oligohydramnios cases?

OBJECTIVE: Isolated oligohydramnios is defined as an amniotic fluid index below five centimeter with no other coexisting condition. There are still controversies about the management and pregnancy outcomes. A marker predicting these is crucial. Low pregnancy associated plasma protein-A levels were reported to be related with adverse pregnancy outcomes. We aimed to determine the role of first trimester pregnancy associated plasma protein-A for poor outcomes in preterm isolated oligohydramnios cases. MATERIAL AND METHODS: Fifty-one patients with singleton pregnancies diagnosed as isolated oligohydramnios at 28/0-36/6 weeks of gestation and 110 gestational age matched healthy controls between January and December 2015 were included. Maternal age, gestational age at delivery, mode of delivery, indication for cesarean section, Apgar scores at first and fifth minutes, birth weight, neonatal intensive care unit admission and mortality were recorded. Pregnancy associated plasma protein-A levels were compared between groups and its role in adverse perinatal outcomes was evaluated. RESULTS: Pregnancy associated plasma protein-A levels and pregnancy outcomes were similar in two groups (p > 0.050) except birth weight, gestational age at delivery and presence of fetal distress. Pregnancy associated plasma protein-A levels did not differ in terms of delivery mode, presence of fetal distress, first and fifth minutes Apgar scores and neonatal intensive care unit admission (p = 0.323,0.650,0.990,0.112,0.853). Also, it was not determined as a risk factor for cesarean section, presence of fetal distress, low Apgar scores and neonatal intensive care unit admission. CONCLUSION: Pregnancy associated plasma protein-A, a well-known prognostic factor for some of high risk pregnancy conditions, may not be used as a marker in preterm isolated oligohydramnios cases.

Body iodine status in women with postmenopausal osteoporosis.

OBJECTIVE: Postmenopausal osteoporosis is a frequent cause of morbidity and can negatively impact life expectancy; iodine is an essential element for bone mineralization, and iodine deficiency is frequently observed. The aim of the present study was to understand the connection between postmenopausal osteoporosis and the level of iodine in the body. METHODS: A total of 132 participants were divided into three groups: group 1 consisted of healthy postmenopausal women (n = 34), group 2 comprised osteopenic women (n = 38), and group 3 included women with postmenopausal osteoporosis (n = 60). The three groups were compared according to demographic, clinical, and laboratory findings. RESULTS: The urinary iodine levels were recorded as 216.1 ±â€Š125.2 in the control group, 154.6 ±â€Š76.6 in the osteopenic group, and 137.5 ±â€Š64.9 in the postmenopausal osteoporosis group (P < 0.001). These differences were maintained after adjustment for body mass index (P < 0.001). The urinary iodine level accurately correlated with the total T-score for the lumbar spine (r = 0.236, P = 0.008). Multiple regression analysis showed that corrected for body mass index, alkaline phosphatase isoenzyme, and urinary deoxypyridinoline, the urinary iodine level was significantly associated with total T-score (beta coefficient = 0.270, P = 0.006). CONCLUSIONS: The urinary iodine level was significantly lower in women with postmenopausal osteoporosis, and iodine replacement may be important in preventing osteoporosis in areas where iodine deficiency is endemic.

Do We Need Mechanical Bowel Preparation before Benign Gynecologic Laparoscopic Surgeries A Randomized, Single-Blind, Controlled Trial.

AIMS: The primary objective of this study was to compare the effect of mechanical bowel preparation (MBP) with oral sodium phosphate (NaP) solution vs. MBP with NaP enema vs. fasting only with respect to intraoperative visualization of the surgical field, ease of bowel handling, and overall ease of surgery in patients undergoing benign gynecologic laparoscopic procedures. METHODS: The patients were randomized into one of 3 groups: oral NaP, NaP enema, or fasting only. The primary surgeon and assistant(s) remained blinded to the randomization assignments. Intraoperative visualization of the surgical field, ease of bowel handling, and overall ease of surgery were assessed using a surgeon questionnaire based on Visual Analog Scales. RESULTS: We enrolled 293 women, of whom 278 were randomized to receive oral NaP solution (n = 96), undergo NaP enema (n = 92), or perform fasting only (n = 90). No significant differences were found between the 3 groups. CONCLUSIONS: No differences were observed among patients who underwent MBP with oral NaP or NaP enema and those without MBP, with respect to intraoperative visualization of the surgical field, ease of bowel handling, and overall ease of surgery. No benefit of MBP was found when removing large uteri or when operating on patients with a high body mass index.

Maternal serum glycodelin levels in preeclampsia and its relationship with the severity of the disease.

PURPOSE: Preeclampsia, in which insufficient trophoblastic invasion is thought to be one of the underlying mechanisms, is a common pregnancy disorder. Glycodelin is a regulator of immunosuppression, fertilization, implantation, and placentation. Because of its inhibitory effects on trophoblastic activity, trophoblast invasion is disturbed when its levels alter. We aimed to analyze serum glycodelin levels in preeclampsia and evaluate whether it correlates with the severity of disease. METHODS: This is a prospective case-control study conducted in a research and training hospital between March and September 2016. In this study, a total of 55 preeclamptic and 65 healthy pregnants were included. Preeclamptic patients were divided into two subgroups: 25 severe and 30 mild. Maternal serum glycodelin levels were measured using enzyme-linked immunosorbent assay. RESULTS: Glycodelin levels were higher in preeclamptic group as compared with controls (71.38 ± 22.78 versus 42.32 ± 12.28 ng/ml, p < .001). Also, it was higher in severe preeclampsia than the mild group (84.19 ± 24.58 versus 60.71 ± 14.4 ng/ml, p < .001). Glycodelin was positively correlated with systolic and diastolic blood pressures (r = 0.637 and r = 0.714, respectively, p < .001), aspartate and alanine aminotransferases (r = 0.369, p = .006 and r = 0.377, p = .005) and proteinuria (r = 0.342, p = .011). Moreover, it was correlated with birth weights and gestational age at delivery (r = -0.386, p = .004 and r = -0.394, p = .003, respectively). The role of glycodelin to diagnose preeclampsia was evaluated by receiver operating curve (ROC) curve. Area under the curve for glycodelin is 0.897 with p < .001. The sensitivity of glycodelin was 83.6% and the specificity was 80% at a threshold >53.64 ng/ml. Moreover, area under the curve for glycodelin to diagnose severe preeclampsia is 0.788 with p < .001. The sensitivity of glycodelin was 59% and the specificity was 93.3% at a threshold >83.97 ng/ml. CONCLUSION: Glycodelin may be a promising marker in predicting the presence and severity of preeclampsia.