Single­incision mesh vs sacrospinous ligament fixation in posthysterectomy women at a three-year follow-up: a randomized trial.

OBJECTIVES: The primary clinical objective was to prospectively compare the effectiveness of the "single­incisionMESH" technique versus sacrospinous ligament fixation (ACSSF) in correcting the defect of pelvic organ prolapse(POP) in the anterior and apical compartments, Their effectiveness was assessed at a 1-year/3-year follow-up (FU). METHODS: In the period of 2013-2015, we have randomized 146 women into two groups, namely 73 into ACSSF group and 73 into MESH groupRESULTS: At 1-year/3-year FU, we achieved an effectiveness of 92 %/87 % in the point Ba (≤‒1 cm) in the MESH group (48/52; 40/46) vs 70 %/66 % in the ACSSF group (35/50; 30/45); (p = 0.005/p = 0.021). At 1-year/3-year FU, in the area of point C (≤‒1 cm), we achieved a 94 %/91 % effectiveness in the MESH group (49/52; 42/46) vs 90 %/80 % in the ACSSF group (45/50; 36/45); (p = 0.005/p = 0.192). In the MESH group, we observed a more frequent occurrence of "de novo" SUI (11 % vs 6 %) and a defect in the unoperated (posterior) compartment (18 % vs 8 %); the difference was not statistically significant. CONCLUSION: Our study showed that the vaginal synthetic mesh repair of POP did not improve women's outcomes in terms of effectiveness or adverse effects, while the patient satisfaction is the same as compared to that with sacrospinous ligament fixation at a 3­year FU. In gynecology, there are situations in which the comparison replaces the scientific solution (Tab. 5, Fig. 2, Ref. 50). Text in PDF www.elis.sk Keywords: sacrospinous ligament fixation, quality of life index, synthetic mesh, randomized trial, prolapse.

Possibilities of objectivization of pelvic floor muscle exercises in patients with urine leakage after delivery.

BACKGROUND: Examination of pelvic floor muscle function is very important before starting exercises in patients with urine leakage and other pelvic floor dysfunctions. Perineometer and palpation examination is currently being used. A new trend in physiotherapy is the ultrasound examination of pelvic floor muscles. The examination can be performed by abdominal approach or perineal approach. We evaluate 2D and 3/4D images of pelvic floor muscles. METHODS: The International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF). OAB-q - overactive bladder questionnaire - short form. The Urinary Incontinence Quality of Life scale (I-QoL) - self-assessment scale for assessing the quality of life of patients with urinary incontinence. Adjusted Oxford scale to assess pelvic floor muscle strength. PERFECT scheme by Laycock and Jerwood. Pelvic floor examination by perineometer (Peritron-Ontario, L4V, Canada). Pelvic floor examination by 2D and 3/4D ultrasound examination (Volunson-i BT 11 Console, VCI volume contrast imaging software, (GE Healthcare Austria GmbH & Co OG, Zipf, Austria, RAB4-8-RS 3D/4D 4-8 MHz probe). High intensity exercise of pelvic floor muscles with stabilization elements. CONCLUSION: The effect of pelvic floor muscle training was objectively proved by the above mentioned objectivization methods with subjective improvement of quality of life. There was also a significant effect of education in USG exercise.

Selected physicochemical properties of amniotic fluid according to week of pregnancy.

BACKGROUND: A hundred years ago, scientists believed that amniotic fluid is a yellowish hypotonic mixture of foetal urine and maternal transudate with peculiar odour. Current knowledge shows that it represents a dynamic, complex mixture of inorganic and organic compounds. OBJECTIVES: Despite modern technological procedures, information is still lacking about the composition and properties of amniotic fluid. We focused on dynamics of selected physical and chemical properties of the amniotic fluid with the increasing gestational week. METHODS: The physicochemical characteristics of 89 amniotic fluid samples were determined according to the week of pregnancy. The determination of pH, specific gravity, glucose and nitrites was performed immediately, at room temperature. RESULTS: Our results show a significant negative correlation between week of pregnancy and semi-quantitative determined parameters of specific gravity (p < 0.001), pH (p < 0.01) and glucose (p < 0.001) values. Within the whole group of samples (n = 89), 29 % (n = 26) were nitrites positive (N+) and 71 % (n = 63) nitrites negative (N-). CONCLUSION: In this study were determined basic parameters of amniotic fluid, which could be related to a wide range of pathological states (Tab. 2, Fig. 1, Ref. 27).

Analysis of transcriptional activities of angiogenic biomarkers during intrauterine complications leading to preterm birth.

OBJECTIVE: Pre-eclampsia, growth retardation and preterm delivery are the most common reasons leading to increased maternal and perinatal mortality. The increased expression of hypoxia induced factors, such as HIF-1, triggers the overexpression of anti-angiogenic genes. The aim of this study was to determine the transcriptional activity of individual pro- and anti-angiogenic markers (VEGF, HIF-1, sEng, Flt-1, PlGF-1) in maternal blood samples from patients with spontaneous preterm labor, preterm labor in combination with pre-eclampsia and fetal growth restriction in comparison with physiologically terminated pregnancies. PATIENTS AND METHODS: The transcriptional activity of specific genes was detected from the blood of patients using the chromatin immunoprecipitation capture method coupled with quantitative real-time PCR. RESULTS: The maximum differences in mRNA levels of PlGF-1 and VEGF-A were detected in two groups: the group of normal-term birth with complications and the group of preterm labor with complications (both significantly lower than the control, p < 0.001). In contrast, a marked increase of mRNA levels was found in the same groups of patients for the HIF-1, endoglin and Flt-1 genes (p < 0.001). CONCLUSIONS: According to our results, we can conclude that increased oxidative stress, increasing the expression levels of anti-angiogenic genes and reduction of the transcriptional activity of pro-angiogenic genes can provide additional information during diagnostics of pathological complications of labor.

[The impact of exogenous luteinizing hormone on IVF/ICSI cycles parameters]. / Vplyv exogénneho luteinizacného hormónu na parametre IVF/ICSI cyklov.

OBJECTIVE: To evaluate the effect of exogenous luteinizing hormone on IVF/ICSI success. DESIGN: Retrospective clinical study. SETTING: 2nd Department of Gynaecology and Obstetrics, Medical Faculty and L. Pasteur University Hospital Kosice, Slovak Republic. METHODS: Individual parameters and clinical pregnancy rate of 232 IVF/ICSI cycles were compared in dependence on stimulation protocol (pure rFSH vs. rFSH and 75 IU rLH from S7). RESULTS: There was no statistically significant difference in IVF/ICSI success between individual groups and subgroups, but we demonstrated the increase in clinical pregnancy rate per ET in agonist cycles group with exogenous LH activity totally above 11% (27.6% vs. 38.6%), in patients under 35 years above 12% (30.4% vs. 42.6%) and in patients over 35 years above 14% (16.7% vs. 30.8%). In antagonist cycles group there was demonstrated the increase in clinical pregnancy rate only in women over 35 years - above 14% (13.3% vs. 30.8%). CONCLUSIONS: Despite of negative statistical analyses, from the clinical point of view we can strongly recommend the LH addition during COH, especially in agonist cycles and in older women.

[Risk of the prolapse "de novo" in primary unaffected compartment by using the syntethic mesh in the surgery treatment of the pelvic organe prolapse]. / Riziko vzniku prolapsu "de novo" v primárne nepostihnutom kompartmente pri pouzití syntetického implantátu v rámci operacnej liecby prolapsu panvových orgánov.

OBJECTIVE: The aim of this retrospective trial was to evaluate the risk of the prolapse "de novo" in primary unaffected compartment by using the syntethic mesh. DESIGN: Rerospective multicentric trial. SETTING: 2nd department of Gynaecology and Obstetrics, Medical Faculty of Safarik's University and L. Pasteur Hospital, Kosice and Gynaecology department, Gynpor, s.r.o., Sliac, Slovakia. POPULATION AND METHODS: One hundred and eleven women with stage > or = 2 prolapse according to the Pelvic Organe Prolapse - Quantification (POP-Q) system was enrolled into the study. In group MESH A (anterior compartment) was 86 (17x Prolift Anterior; 69x Prolift Anterior like MESH and group MESH P (posterior compartment) was 25 (9x Prolift Posterior; 16x Prolift posterior like MESH) of enrolled women. The primary outcome was the risk of POP > or = 2 "de novo" prolapse in primary unaffected compartment at 12 months follow-up. The second was the efficacy of the treatment by using synhetic mesh. Third was: Did uterus sparing operation increase the risk of reccurance of the prolapse. Complications was also reported. RESULTS: For subject attendigs the 12-month follow-up, the risk of "de novo" prolapse in MESH A group was 20.9% (17/86) compared with only 16% (4/25) in the MESH P group and was not significantly different (p<0.13). The efficacy was 91.6% in the MESH A group and 84% in the MESH P group and was not significantly different. Uterus sparing operation did not increase the risk the prolapse,,de novo" in primary unaffected compartment. Vaginal mesh exposure occured in 14.4%. CONCLUSION: Vaginal repair by using MESH is effective in the treatment of the pelvic organe prolapse, but is posible to provoke the development of prolapse in primary unaffected compartment.

In vitro antiproliferative and antiangiogenic effects of Flavin7.

Flavin7 (F7) is a nutritional supplement often taken by cancer patients in Central Europe during chemo- and radiation therapy. In this study, investigation of the antiproliferative and antiangiogenic activities of this supplement were performed. Flavin7 showed antiproliferative activity in Jurkat as well as in HeLa cells. It significantly reduced the growth of both cancer cell lines at the doses of 200 microg/ml to 20 microg/ml (p<0.001 and p<0.01, respectively). In F7-treated Jurkat cells we found a significant increase in the fraction of cells with sub-G(0)/G(1) DNA content, which is considered to be a marker of apoptotic cell death. Apoptosis was also confirmed by annexin V staining and DNA fragmentation. Furthermore, F7 at the doses of 100 microg/ml to 4 microg/ml inhibited endothelial cell migration and capillary tube formation what indicates its potential antiangiogenic properties. Flavin7 also inhibited the activity of matrix metalloproteinases (MMPs), preferentially MMP-9, at the doses of 100 microg/ml to 4 microg/ml. Our data suggest that F7 possesses marked antiproliferative and antiangiogenic properties in vitro. Further research is needed to elucidate also its in vivo activities.

[Prediction of intrauterine growth retardation using the integrated test markers]. / Predikcia intrauterinnej rastovej retardácie plodu pomocou markerov integrovaného testu.

OBJECTIVE: Author's objective was to ascertain the option for prediction of intrauterine growth retardation using the integrated test markers on the population of pregnant women in Kosice city. DESIGN: Retrospective, longitudinal, multicenter study. SETTING: 2nd Department of Obstetrics and Gynecology University of P. J. Safárik, Kosice, Slovak Republic. METHODS: The study group comprised 578 pregnant patients of 2nd Department of Obstetrics and Gynecology, in the period from 01.11.2001 until 31.01.2005 for integrated test consisting of (examination of the gestation age using CRL, concentration of PAPP-A, NT, AFP, uE3, hCG). Information on birth weight, gender, gestation age at the time of delivery, occurrence of preeclampsia and other pregnancy complications were found in 578 patients retrospectivelly. We have designed two outcome criteria: 1. intrauterine growth retardation <5th fetal weight percentile - IUGR 5 - and intrauterine growth retardation <10th percentile - IUGR 10. In order to make use of the summary information provided by the markers, we have used the method of logistic regression to identify statistically significant predictors of individual binary outcomes (IUGR 5 and IUGR 10). First we developed an equation based on all available predictors. Statistically insignificant predictors were gradually eliminated from the model (Stepwise regression) until the final model remained, for which a ROC curve was developed and values of sensitivity, specificity, positive and negative predictive values at 5% FP (false positivity) were calculated. RESULTS: The final model of IUGR 5, containing only statistically significant markers of integrated test achieved - at 5% FP level and 95% specificity level - a 34.8% sensitivity, 24.1% positive and 97.0% negative predictive value - in prediction of birth weight under 5th percentile with respect to gestation age and gender. The final model of IUGR 10, containing only statistically significant markers achieved - at 5% FP level and 95% specificity level - a 36.4% sensitivity, 32.1% positive and 95.8% negative predictive value - in prediction of birth weight under 10th percentile with respect to gestation age and gender. CONCLUSION: Our results, as well as the results of other studies, lead to the conclusion, that in spite of the multitude of biochemical markers and various options for their combination with ultrasound markers, so far it has been impossible to find a combination which would meet the following criteria: 1. high sensitivity and specificity at low false positive values and high positive and negative predictive value, 2. application as a screening method for prediction of intrauterine growth retardation and preeclampsia in unselected population of pregnant women.

[Prediction of preeclampsia using the integrated test markers]. / Predikcia preeklampsie pomocou markerov integrovaného testu.

OBJECTIVE: Author's objective was to ascertain the option for prediction of preeclampsia using the integrated test markers on the population of pregnant women in Kosice city. DESIGN: Retrospective, longitudinal, multicenter study. SETTING: 2nd Department of Obstetrics and Gynecology University of P. J. Safárik, Kosice, Slovak Republic. METHODS: The study group comprised 578 pregnant patients of 2nd Department of Obstetrics and Gynecology, the period from 01.11.2001 until 31.01.2005 for integrated test consisting of (CRL, NT, concentration of PAPP-A, uE3, hCG, AFP). Primary outcome was defined as incidence of preeclampsia during pregnancy. Data on incidence of preeclampsia was collected from birth journals and records in 578 patients retrospectivelly. In order to make use of the summary information provided by the markers we have used the method of logistic regression to identify statistically significant predictors of the binary outcome measure of preeclampsia. First we developed an equation based on all available predictors. Statistically insignificant predictors were gradually eliminated from the model (Stepwise regression) until the final model remained, for which a ROC curve was developed and values of sensitivity, specificity, positive and negative predictive values at 5% FP (false positivity) were calculated. RESULTS: The final model of preeclampsia, which is based only on statistically significant markers of integrated test achieved--at 5% FP and 95% specificity--36.4% sensitivity and 22.7% positive and 97,4 negative predictive value for prediction of preeclampsia in pregnant women. CONCLUSION: Our results, as well as the results of other studies, lead to the conclusion, that in spite of the multitude of biochemical markers and various options for their combination with ultrasound markers for prediction of preeclampsia, so far it has been impossible to find a combination which would meet the following criteria: (1) high sensitivity and specificity at low false positive values and high positive and negative predictive value, (2) application as a screening method for prediction of preeclampsia in unselected population of pregnant women.

Detection of virulence factors in alpha-haemolytic Escherichia coli strains isolated from various clinical materials.

In total, 201 alpha-haemolytic Escherichia coli isolates from various clinical materials (urine samples and vaginal and rectal swabs) were examined by PCR for the presence of genes for the virulence factors alpha-haemolysin (hly), cytotoxic necrotising factor type 1 (cnf1), P-fimbriae (pap), S/F1C-fimbriae (sfa/foc), aerobactin (aer) and afimbrial adhesin (afaI). Among vaginal isolates, 96% were positive for cnf1, compared with 80% of urine strains (p 0.02) and 63% of rectal strains (p 0.0001). Similarly, sfa/foc-specific DNA sequences were found in 97% of vaginal isolates compared with 75% of rectal strains (p 0.004). The afa1 and aer genes were associated more with rectal alpha-haemolytic E. coli strains than with extra-intestinal isolates. The results suggested that CNF1 and/or S/F1C-fimbriae contribute to colonisation and persistence of alpha-haemolytic E. coli strains in the vaginal environment.

[Pulsatility index and resistance index in the aortic bifurcation area of growth retarded fetuses]. / Pulzatility index a rezistencia index v oblasti bifurcatio aortae u plodov s detekovanou retardáciou rastu.

UNLABELLED: To specify diagnostic importance of fetoplacental flow parameters PI, RI during pregnancy complicated by ultrasonografically detected intrauterine growth retardation-IUGR. SETTING: Dpt. of Obstetric and Gynaecology, Safarik's University and University Hospital L. Pasteur, Kosice, Slovak Republic, Obst/Gynae Dpt., Victoria Hospital, Mahé, Seychelles Republic, Indian Ocean. SUBJECT AND METHOD: The autors measured fetal circulation on the level of descending aortal bifurcation. The results were compared in the Group-A of 112 pregnancies complicated by mild, moderate and several praeeclampsia, eclampsia with detected IUGR, and comparative Group-B of 106 pregnancies. INTERVENTION: The ACUSONIC 8, ALOKA 680 SSD using transabdominal 3.5 MHz probe with color doppler facility. The parameters were measured in weekly intervals according the clinical protocol for management of high risk pregnancies. SUBJECTS: There was opened a prospective comparative study of 112 risk pregnancies (Group-A) and a comparative Group-B of 106 pregnancies with normal growth of fetuses. Group-A was devided according classification of praeeclampsia to Subgroup-A1, mild praeeclampsia, Subgroup-A2, moderate praeeclampsia, Subgroup-A3, severe praeclampsia and Subgroup-A4, eclampsia. Parameters of vascular resistance in descending aorta were calculated from 28th week of gestation to termination of pregnancy and compared average values in corresponding stage in the Group-A and the comparative Group-B. Number of IUGR fetuses or restricted with the growth were calculated in Subgroups-A. RESULTS: Descending aorta presents significantly higher average values of PI, RI during pregnancy from 28th week of gestation in Group-A. There is no evidence of diastolic decrease after 34th week of gestation in Group-A. In Group-A 52.6% fetuses were ultrasonograficaly IUGR detected or restricted. In Subgroup-A1 of mild praeeclampsia were 20.5% of the IUGR fetuses. Subgroup-A2 of moderate praeeclampsia showed 51.3% and Subgroup-A3 severe praeeclampsia 87.8% of the IUGR fetuses of restricted. Three cases of eclampsia were restricted for growth. MAIN OUTCOME: Functional assessment of the descending aorta flow is the most reliable method for differentiation of praeclamptic and eclamptic pregnancies with suspected fetal starvation and intrauterine growth retardation.