Impact of the mandatory age-based single-embryo transfer legislation in Turkey on outcome of in vitro fertilization: a multicentre study.

This study in Turkey evaluated the impact of age-based mandatory single-embryo transfer (SET) legislation with the subsequent increase in frozen-thawed embryo transfer (FT-EU) on pregnancy outcome of in vitro fertilization (IVF) patients. SET, FT-FT and double-embryo transfer were used in 5632 patients after legislation, while traditional IVF and FT-FT approach was used in 6029 patients before legislation. The cumulative pregnancy rate after legislation was slightly lower (38.2%) than before legislation (42.0%) but not significantly so. The single pregnancy rate for SET and traditional IVF were similar between the 2 groups (37.8% versus 28.7%), while multiple pregnancy rates were significantly higher before than after legislation (13.7% versus 0.3%). For FT-ET, the number of cycles was significantly higher after legislation (862 versus 616). SET yielded similar results to traditional IVF. In order to reduce multiple pregnancies without significantly decreasing pregnancy rates, SET might be a successful strategy.

Impact of the mandatory age-based single-embryo transfer legislation in Turkey on outcome of in vitro fertilization:a multicentre study

This study in Turkey evaluated the impact of age-based mandatory single-embryo transfer [SET] legislation with the subsequent increase in frozen-thawed embryo transfer [FT-ET] on pregnancy outcome of in vitrofertilization [IVF] patients. SET, FT-ET and double-embryo transfer were used in 5632 patients after legislation, while traditional IVF and FT-ET approach was used in 6029 patients before legislation. The cumulative pregnancy rate after legislation was slightly lower [38.2%] than before legislation [42.0%] but not significantly so. The single pregnancy rate for SET and traditional IVF were similar between the 2 groups [37.8% versus 28.7%], while multiple pregnancy rates were significantly higher before than after legislation [13.7% versus 0.3%]. For FT-ET, the number of cycles was significantly higher after legislation [862 versus 616]. SET yielded similar results to traditional IVF. In order to reduce multiple pregnancies without significantly decreasing pregnancy rates, SET might be a successful strategy

Does maternal knowledge impact blood phenylalanine concentration in Turkish children with phenylketonuria?

The aim of this study was to compare the level of maternal knowledge and the blood phenylalanine (Phe) control in phenylketonuria (PKU; OMIM 261600). The study was conducted on 144 children (81 boys, 63 girls) with PKU, aged between 1 and 15 years, at Hacettepe University Ihsan Dogramaci Children's Hospital, Metabolism and Nutrition Unit. All subjects were treated with a low-Phe diet using a Phe-exchange system. A 20-question multiple-choice questionnaire was applied to the mothers to determine their knowledge about PKU and its dietary treatment. Questions in the test consisted of the knowledge about the disease (6 questions), general dietary knowledge (14 questions) and knowledge about specific exchange within the dietary questions (6 questions). The median blood Phe concentration for the previous 3-year period was used as an indicator of metabolic control. Eighty-seven children had a median blood Phe concentration above the MRC Working Party Guidelines. There was a negative correlation between maternal knowledge about exchange and median blood Phe concentration in the child (p<0.05). Maternal knowledge about a standard 15 mg Phe exchange system is correlated with dietary compliance as measured by blood Phe concentrations in our subjects. We would like to implement an easier method of measuring Phe exchanges to improve dietary knowledge in the mothers.

Percutaneous dilatational tracheostomy.

BACKGROUND: The aim of this study was to investigate the rate, timing, the incidence of complications of percutaneous dilatational tracheostomy (PDT) and its effects by on nosocomial pneumonia. METHODS: The study is a retrospective analysis of 104 patients (56 males, 48 females) > or = 18 years (54 +/- 19) who had undergone a PDT for respiratory failure during the five years 1998-2003. RESULTS: Among 238 patients requiring mechanical ventilation > or = 48 hours, 104 (43.7%) required PDT. PDT was performed after 4.3 +/- 2.3 days of ventilation and the disconnection from mechanical ventilation was 13.6 +/- 8.5 days. Lower airway tract infection was detected in 88 patients: 55 patients (62.5%) before PDT and in 33 patients (37.5%) after PDT. The nosocomial pneumonia was observed after 5.9 +/- 1.67 days of ventilation. CONCLUSIONS: Our results suggest that PDT was performed relatively early, with an acceptable complication rate and that our post-PDT nosocomial pneumonia incidence is low.

Effects of sevoflurane and desflurane on cytokine response during tympanoplasty surgery.

BACKGROUND: This study was devised to compare the effects of sevoflurane and desflurane anaesthesia on the cytokine response. METHODS: Sixty ASA I-II patients, scheduled for tympanoplasty, were randomly allocated to be anaesthetized with either sevoflurane or desflurane at maintenance inspiratory concentrations of 1-1.5 MAC of either agent. Blood samples were taken for plasma tumour necrosis factor alpha (TNFalpha), interleukin 1beta and interleukin-6 assay before induction of anaesthesia, before surgery, and at the end of surgery. Alveolar cells were obtained after induction of anaesthesia and at the end of surgery. RESULTS: Plasma TNFalpha was greater with desflurane than sevoflurane both before surgery (45.1 +/- 3.5 pg ml(-1) for desflurane vs. 23.2 +/- 2.5 pg ml(-1) for sevoflurane, P < 0.01) and (62.0 +/- 5.3 pg ml(-1) vs. 35.5 +/- 4.6 pg ml(-1), P < 0.001). Interleukin 1beta was similarly greater with desflurane than sevoflurane before (39.3 +/- 4.0 pg ml(-1) vs. 17.4 +/- 3.0 pg ml(-1); P < 0.01) and after surgery (46.0 +/- 3.4 pg ml(-1) vs. 23.3 +/- 3.2 pg ml(-1), P < 0.001). There were similar results for interleukin 6 before (42.3 +/- 3.5 pg mls(-1). 29.0 +/- 2.6 pg ml(-1), P < 0.001) and after surgery (86.0 +/- 4.5 pg ml(-1) vs. 45.9 +/- 6.3 pg ml(-1), P < 0.001). Alveolar cell TNFalpha concentrations after surgery were also greater with desflurane than sevoflurane (96.3 +/- 12.4 pg ml(-1) vs. 64.8 +/- 10.1 pg ml(-1), P < 0.001), as were interleukin 1beta (75.4 +/- 6.2 pg ml(-1) vs. 32.0 +/- 8.3 pg ml(-1), P < 0.001) and interleukin 6 concentrations (540.1 +/- 65.3 pg ml(-1) vs. 363.6 +/- 29.2 pg ml(-1), P < 0.001). CONCLUSION: Desflurane appears to cause a greater systemic and intrapulmonary pro-inflammatory response than sevoflurane during anaesthesia for ear surgery.

Correlation of plasma and tissue oxidative stresses in intra-abdominal sepsis.

BACKGROUND: The aim of this study was to investigate the correlation between plasma and tissue oxidative stress and the antioxidative response, by measuring malon dialdehyde (MDA) and glutathione (GSH) in late sepsis induced by cecal ligation and perforation. MATERIALS AND METHODS: A prospective, randomized, controlled experimental study in rats was done. Forty rats, weighing 200-250 g, were randomly divided into two groups (n = 20). In group 1, laparotomy was performed under aseptic conditions, and the cecum ligated and perforated. The abdomen was closed. In group 2, sham control, there was only laparotomy. Twenty-four hours later, blood samples were taken by cardiac puncture for plasma MDA and GSH, followed by harvesting of samples from lung, liver, kidney, and heart in both groups. RESULTS: In the liver, lung, plasma, heart, and kidney, MDA concentrations were increased in the sepsis group after 24 h (P < 0.001 for all organ samples). In the same organs, GSH concentrations were decreased by sepsis (P < 0.001 for all organ samples). In both groups, plasma MDA was positively correlated to MDA in heart (r = 0.82, P < 0.001), liver (r = 0.76, P < 0.001), lung (r = 0.78, P < 0.001), and kidney (r = 0.73, P < 0.001). Similarly, plasma GSH was positively correlated to GSH in liver (r = 0.93, P < 0.001), heart (r = 0.86, P < 0.001), lung (r = 0.91, P < 0.001), and kidney (r = 0.79, P < 0.001). CONCLUSIONS: Plasma MDA and GSH were positively correlated with tissue MDA and GSH in intra-abdominal sepsis in a rat model.

The effects of sevoflurane and desflurane on lipid peroxidation during laparoscopic cholecystectomy.

BACKGROUND AND OBJECTIVE: To compare the effects of sevoflurane and desflurane anaesthesia on lipid peroxidation. METHODS: We studied 40 healthy patients undergoing elective laparoscopic cholecystectomy. Patients were randomly allocated to be anaesthetized either with sevoflurane (n = 20) or desflurane (n = 20). Anaesthesia was maintained with inspiratory concentrations of sevoflurane 1-1.5 MAC (n = 20) or desflurane (n = 20). Samples were taken for plasma malondialdehyde and superoxide dismutase assays before induction of anaesthesia, before skin incision and at the end of surgery. Alveolar cell samples were obtained from the lungs using the technique of protective blind bronchoalveolar lavage, after induction of anaesthesia and at the end of surgery for malondialdehyde and superoxide dismutase concentrations. RESULTS: Plasma malondialdehyde increased more after the administration of desflurane than after sevoflurane: after induction 5.9 +/- 0.6 nmol mL(-1) for desflurane vs. 3.8 +/- 0.5 nmol L(-1) for sevoflurane (P < 0.001); at the end of the surgery: 6.7 +/- 0.4 nmol mL(-1) for desflurane vs. 4.2 +/- 0.3 nmol mL(-1) for sevoflurane (P < 0.001). There was a small but significant increase in plasma superoxide dismutase concentration after desflurane--from 24.2 +/- 1.2 to 24.9 +/- 0.9 U mL(-1) after induction and 25 +/- 1 U mL(-1) at the end of the surgery (P < 0.01)--but no increase with sevoflurane. Malondialdehyde concentrations increased significantly in the cells obtained by protective blind bronchoalveolar lavage at the end of surgery in the desflurane group (from 0.3 +/- 0.1 to 1.7 +/- 0.2 nmol mL(-1) (P < 0.001)), but not in the sevoflurane group. There were no significant differences between the two anaesthetics in the amounts of superoxide dismutase in the samples obtained by protective blind bronchoalveolar lavage. CONCLUSIONS: Desflurane may cause more systemic and regional lipid peroxidation than sevoflurane during laparoscopic cholecystectomy in healthy human beings.

Soy protein diet significantly improves endothelial function and lipid parameters.

BACKGROUND: Replacement of animal protein with soy protein in the diet is associated with decreased cholesterol levels. However, the effects of soy protein diet on endothelial function are not well known. HYPOTHESIS: The aim of the study was to investigate the effects of soy protein diet on plasma lipids and endothelial function parameters assessed by two different methods. METHODS: Twenty hypercholesterolemic, nonsmoker male patients (age 50.1+/-11.8 years), with a normal body mass index, were included. After calculating their daily requirements, a diet with 25-30% of energy from fats. 10-12% from proteins, and the rest from carbohydrates was instituted. Sixty percent of the animal source proteins of the diet were substituted by soy. The anthropometric measures, lipid parameters, and endothelial functions of the subjects were assessed at baseline and 6 weeks after soy protein diet. Flow-mediated endothelium-dependent dilatation (EDD) and plasma thrombomodulin (TM) levels were evaluated as endothelial function parameters. RESULTS: After diet, plasma total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B, and triglyceride levels decreased significantly (p <0.001, p < 0.001, p = 0.039, and p = 0.001, respectively). The mean plasma TM levels were also significantly reduced with diet (p = 0.004). Studies of the brachial artery indicated a borderline dilatation in baseline brachial artery diameter (p = 0.05), however the diameter at reactive hyperemia was significantly larger after diet (p<0.001), resulting in a significant improvement of EDD (p = 0.002). CONCLUSION: Soy protein diet significantly improves plasma lipid profile in patients with hypercholesterolemia. Furthermore, the endothelial function, as judged by two different methods (EDD and plasma TM levels), also improves with soy protein diet.

Newborn PKU screening in Turkey: at present and organization for future.

At present, pkenylketonuria screening is a national child health program in Turkey which is carried out collaboratively by the Ministry of Health and three University Children's Hospitals in Ankara, Istanbul and Izmir. Since 1986 the number of cities included in the screening program has gradually increased, now and it covers all the metropolises the country. A total of 383 babies were found with persistent hyperphenylalaninemia (1:4,172) among 1,605,582 babies screened by the Guthrie test at the Hacettepe Screening Center in Ankara. By taking into account pretreatment phenylalanine levels and phenlyalanine tolerances at five years of age, the numbers of classical and mild-moderate phenylketonuria and mild hyperphenylalaninemia cases were 216, 102 and 58, respectively. The major problems encountered in the screening program and in management of the detected cases were unsatisfactory sample collection, early discharge from maternity hospitals, difficulties in reaching some detected cases, and noncompliance with dietary therapy due to illiterate parents or to lack of social insurance. To screen and treat all newborns for phenylketonuria and to include at least hypothyroidism in the screening program, there is a need for a more disciplinary intersectoral approach than exists at present.

Micronuclei in human lymphocytes: the Co-60 gamma-ray dose-response.

Dose-response for micronuclei in cytokinesis-blocked lymphocytes after in vitro irradiation of whole blood from 3 donors with Co-60 gamma-rays in the range 0-5.0 Gy was established. The numerical relationship between radiation induced chromosomal aberrations, and micronuclei is also examined. An increased frequency of micronuclei following low doses of gamma-irradiation is reported from a study of 41 radiation workers.

In vitro dose-response curve for chromosome aberrations induced in human lymphocytes by 60Co gamma-radiation.

A dose-response curve has been obtained for the induction of chromosome aberrations in human lymphocytes from blood acutely irradiated with 60Co gamma-rays in a dose range of 0.098-4.89 Gy. This curve has been used for biological dose estimation for 21 cases of known or suspected accidental overexposure of Turkish radiation workers.