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Long-Term Survival Outcomes of Early-Stage Grade 1 and 2 Endometrioid Type Endometrial Cancer Patients
(Selçuk Üniversitesi, 2023 Nisan) Avcı, Fazıl; Eren, Önder; Bilgi, Ahmet; Başaran, Hamit; Çelik, Murat; Çağlayan, Melek; Çelik, Çetin
Aim: Early-stage endometrioid-type endometrial cancer (EC) has a favorable prognosis. The recurrence is still the biggest issue. There are differences in the literature in terms of treatment modalities in the early-stage. The aim of the study is to retrospectively investigate the long-term survival outcomes of early-stage grade 1 and 2 endometrioid-type endometrial cancer patients. Methods: Out of 327 cases, 294 cases in stage 1 and 33 cases in stage 2 were evaluated. Age, stage, tumor size, histologic grade, degree of myometrial invasion, presence of lymphovascular invasion (LVSI), peritoneal cytology positive, presence of recurrence, overall survival (OS), and disease-free survival (DFS) between two groups were evaluated statistically. Results: The mean age of 327 patients was 64.0±10.0 years. Out of 327, 65.7% were ?60 years, and 90% were stage 1, 74.6% were grade 1, 1.8% had positive peritoneal cytology, 8.3% had LVSI and 86% had ?50% myometrial invasion. Recurrence was detected in 6.4% of patients. 40.7% of patients received adjuvant radiotherapy. Only the adjuvant radiotherapy found a significant association between two groups. Only presence of recurrence in terms of OS and DFS durations was a significant parameter in the regression analysis. Conclusion: Development of recurrence in the early-stage endometrioid-type EC is the main prognostic predictor for survival. The early diagnosis and treatment of recurrence have a positive impact on the prognosis.
Epitelover Kanserleri ve Benign Adneksiyal Kitlelerde Human Epididymis Protein 4 İle Hesaplanan Malignite Risk İndeksi
(Selçuk Üniversitesi, 2019 Eylül) Akar, Serra; Çiçek, M. Nedim; Topcuoğlu, Canan
Amaç: Over kanseri kadınlarda kanser türleri arasında 7. sırada yer almaktadır ancak jinekolojik kanserler arasında en yüksek mortaliteye sahiptir. Adneksiyel kitlelerde malignite ayrımı için yüksek sensitivite ve spesifisitesi olan testlerin kullanılması yalancı pozitif sonuçlara bağlı morbiditeyi arttırmadanEpitelyalOver Kanserlerinin(EOK)’lerinin erken tanısına yardımcı olmaktadır. Bu çalışmanın amacı CA 125 yerine HE4 ile hesaplanan RMI’inin malignite ayrımındaki öngörü değerini CA 125 ile hesaplanan RMI ile kıyaslamaktı. Gereç ve Yöntem: Şubat 2015 ve Ekim 2015 arasında adneksiyel kitle öntanısı ile ameliyat olan 78 hasta prospektif olan bu çalışmaya dahil edildi.Preoperatif olarak CA 125 ve HE4 ile ayrı RMI hesaplandı. Ameliyat sonrasında Epitelyal over karsinomları ve benign kist tanısı alan hastalar arasında HE4 ve CA 125 ile ayrı hesaplanan RMI’lerinin malignite ayrımındaki etkinlikleri kıyaslandı. Bulgular: Benign kist ile EOK tanıları alan hastalar arasında serum HE4 seviyelerinde anlamlı fark saptanmadı (p=0.24). RMI-CA125’in hem de RMI-HE4’ün over kanserini öngörmede anlamlı tanısal karar verdirici özelliklerinin olduğu ve RMI-CA125’in karar verdirici özelliğinin RMI-HE4’ten daha yüksek olduğu görüldü. Sonuç: RMI’inin spesifitesi ve HE4’ün önceki çalışmalarda bildirilen yüksek öngörü değerleri nedeniyle RMI’in HE4 ile hesaplanmasının CA 125 ile hesaplanan RMI’ine üstünlük sağlayacağı düşünülmüştür. Ancak HE4 ile ilgili yapılan çalışmaların çoğunluğunun aksine, çalışmamızda HE4 değerlerinin malign ve benign kitlelerde anlamlı şekilde değiştiğini saptayamadık. RMI-HE4’ün Epitelyal over karsinomundaki artışının ultrasonografi skoru ile menopoz durumuna bağlı olduğu görüldü. Toplam hasta sayısının kısıtlı olması ve özellikle over kanseri histolojik alt sınıflarını temsil eden vaka sayılarının kısıtlı olması nedeniyle çalışmanın daha geniş nüfusta ve daha yüksek alt sınıf sayılarıyla beraber yapılması daha aydınlatıcı olabilir.
Uterin Serviksin Minimal Deviasyon Adenokarsinomu (Mda)
(Selçuk Üniversitesi, 2018 Mart) Gül, Ayhan; Çelik, Zeliha Esin; Çakır, Tansel; Çintesun, Ersin; Çelik, Çetin
Minimal deviasyon adenokarsinom(MDA) servikal adenokarsinomların %1-3 oranında görülen bir varyantıdır.Nadir görülmesi nedeniyle standart tanısal metot ve tedavi protokolü yoktur. Uterin servikste 10-12 cm boyutunda kitlesi olan vakamızda tanı servikal biyopsi ile konamadı.Manyetik rezonans görüntülemede (MRI) MDA tanısı düşünüldü ve operasyon sonrası tanı kondu. Postoperatif olarak adjuvant kemoradyoterapi (KRT) uygulandı ve hasta 16 aylık bir süre rekürrens olmadan izlendi.
Endometrium Kanserli Hastalarda Preoperatif Tam Kan Sayımının Prognostik Parametreler ve Sağkalımla İlişkisi
(Selçuk Üniversitesi, 2018 Mart) Çelik, Zeliha Esin; Yavaş, Güler; Yılmaz, Burcu Sanal; İlhan, Tolgay Tuyan; Yavaş, Çağdaş; Ata, Özlem; Çelik, Çetin
Amaç: Çalışmamızda endometriyum adenokarsinomu tanılı hastalarda preoperatif tam kan sayımı parametrelerinin çeşitli klinikopatolojik prognostik parametrelerle ve sağkalım ile ilişkisi olup olmadığını değerlendirmeyi amaçladık. Gereç ve Yöntem: Ocak 2011-Aralık 2014 tarihleri arasında fakültemizde opere edilen ve endometrial adenokarsinom tanısı alan 144 hasta çalışmaya dahil edilmiştir. Hemogram parametrelerinden absolü beyaz küre sayısı (BK), absolü platelet sayısı (Plt) hematokrit (Hct), hemoglobin (Hb) değerleri yanı sıra absolü nötrofil sayısının absolü lenfosit sayısına bölümü olan NLR, absolü platelet sayısının absolü lenfosit sayısına bölümü olan PLR ve absolü monosit sayısının absolü lenfosit sayısına bölümü olan MLR oranlarının; tümör çapı, tümör derecesi, FIGO evresi, serviks invazyonu, pozitif lenf nodu sayısı, lenf nodunda ekstrakapsüler yayılım, lenfovasküler invazyon (LVİ), myometrial invazyon derinliği gibi prognostik parametreler ve hastalıksız ve genel sağkalım süreleri ile olan ilişkisi istatistiksel metodlarla araştırılmıştır. Bulgular: Derece 3 tümöre sahip hastalarda BK sayısının derece 1 tümörlü hastalara göre anlamlı derecede düşük olduğu görüldü (p=0.04). LVİ olan olgularda PLR (p=0.018) ve MLR (p=0.028) LVİ olmayan hastalara göre daha düşük idi. Düşük evre olgularda (evre I-II) PLR, yüksek evreli olgulara göre (evre II-III) daha düşük tespit edildi (p=0.03). Tedavi öncesi bakılan tam kan parametreleri ile tümör çapı, serviks invazyonu, pozitif lenf nodu sayısı, lenf nodunda ekstrakapsüler yayılım, myometrial invazyon derinliği, hastalıksız sağkalım ve genel sağkalım arasında anlamlı bir ilişki saptanmadı (p>0.05). Sonuç: Endometriyum kanserinde tedavi öncesi tam kan sayımı parametrelerinin bir arada kullanılması, hastalığın prognozu ile ilgili fikir verebilir. Çalışmamızın sonuçlarının daha uzun takip süresine ve daha geniş olgu sayısına sahip çalışmalarla desteklenmesi gereklidir.
Prognostic significance of solid growth in endometrioid endometrial adenocarcinoma
(SPRINGER JAPAN KK, 2020) Akar, Serra.; Çelik, Zeliha Esin.; Fındık, Sıddıka.; İlhan, Tolgay Tuyan.; Ercan, Fedi.; Çelik, Çetin.
Background Endometrioid endometrial cancer is the most common histological subtype of endometrial adenocarcinoma. In the FIGO grading scheme, both architectural and nuclear grade are taken into consideration. However, the specific impact of solid growth alone on endometrioid endometrial adenocarcinoma outcome is not well documented. We sought to assess the degree of impact of solid growth on lymphovascular space invasion (LVSI), myometrial invasion, tumor size, FIGO stage, lymph node metastasis (LNM), relapse-free survival (RFS) and disease-specific survival (DSS). Methods Paraffin blocks of 269 patients treated for endometrioid endometrial cancer were retrospectively analyzed with morphometry for solid growth percentages. Results A statistically significant cut-off value of 1% solid growth was found for predicting LNM and advanced stage (III or IV), myometrial invasion and LVSI (p < 0.001) and a cut-off value of 8% was found for predicting adverse survival outcome (p < 0.001). The mean DSS was significantly higher in patients with < 6% solid growth compared to patients with 6-50%, 51-75% and > 75% solid growth (p < 0.001). Although, the mean RFS and DSS were lowest in patients with 51-75% solid growth, this did not reach statistical significance in comparison to 6-50% and > 75% (p > 0.05). Conclusion Although > 75% solid growth was most significantly associated with many of the adverse prognostic factors, this subset did not provide prognostic superiority in predicting adverse survival when compared to subsets within 6-75% solid growth. In conclusion, although no statistically significant difference in survival was found among subdivisions of architectural grades 2 and 3, solid growth, especially >= 8%, appeared to be an independent prognostic factor for survival in patients with early-stage endometrioid endometrial cancer.
Two-stage surgery for extra pelvic intravenous leiomyomatosis: Report of a case
(TAYLOR & FRANCIS INC, 2019) Bayramoglu, Denizhan.; Orhan, Atilla.; Gul, Ayhan.; Sahin, Gozde.; Celik, Zeliha Esin.; Koplay, Mustafa.; Celik, Cetin.
Intravenous leiomyomatosis (IVL) is a variant of leiomyoma characterised by intravascular proliferation and originates from the uterine mesoderm. The main pathogenesis of IVL has not been exactly assessed, yet (Xu et al. 2013; Li et al. 2014). There are two main theories; the first one is: a tumour arises from the walls of venous structures and the second one is: a primary tumour (e.g. myoma) directly spreads into adjacent small venouses (Moniaga and Randall 2012). The early studies have reported an incidence of 0.25–0.41% of IVL in patients with uterine fibroid tumours (Ma et al. 2016; Low et al. 2017). Here, we presented a case suspected of IVL during the operation; although it was reported as uterine sarcoma and vena cava inferior thrombus on radiological imaging methods, pre-operation.
The relationship between KRAS LCS6 polymorphism and endometrium cancer
(TAYLOR & FRANCIS INC, 2019) Cintesun, Feyza Nur Incesu; Secilmis Kerimoglu, Ozlem; Cintesun, Ersin; Nergiz, Suleyman; Acar, Hasan; Çelik, Çetin
The aim of this study was to investigate the relationship between KRAS LCS6 mutation and endometrial cancer (EC). The study included 105 patients who had hysterectomy for benign reasons and 99 EC patients. The patients with Type 1 EC were classified according to histological properties, cancer stage, grade, tumour dimension, myometrial invasion (MMI), lymphovascular invasion (LVI), cytology, and number of positive lymph nodes. KRAS LCS6 mutation was examined in blood samples taken from all patients in both groups. No statistically significant difference was determined between the EC patients and the control group in demographic features. Weight and the Body Mass Index (BMI) values were higher in EC group (p < .001). While the incidence of this polymorphism is 5.8% throughout the world, the polymorphism rate was found to be 16.2% in the EC group and 12.4% in the control group, with no statistically significant difference determined (p > .05). Despite the higher rate of LCS6 polymorphism incidence in EC patients in this study conducted on a relatively large sample, there was not found to be a statistically significant difference in comparison with the control group. In addition, the presence of LCS6 polymorphism was not determined to have an effect on EC histopathological characteristics.Impact statement What is already known on this subject? Endometrial cancer (EC) is a genital system cancer which is one of the most widespread gynecological cancers seen in the USA and other developed countries, In EC, the most frequently seen gene mutations are PTEN tumour suppressor gene, KRAS, beta 1 catenin, BCL-2, CTNNB and P53 mutations. KRAS LCS6(let-7 miRNA binding region polymorphism) polymorphism has a worldwide incidence of 5.8% (Chin et al. 2008).There are studies shown that KRAS LCS6 polymorphism has an effect on developing EC (Lee et al. 2014), ovarian cancer(Ratner et al. 2010)and endometriosis in women (Grechukhina et al. 2012). What do the results of this study add? In our study, LCS6 located on KRAS 3'-UTR was found at the rate of 16.2% in Type 1 EC patients. This increase is noticeable when it is considered that the incidence of this polymorphism is 5.8% in the general population. The results of the current study supports the preliminary findings of Lee et al.
Subclinical inflammation markers in hyperemesis gravidarum and ketonuria: A case control study
(WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2019) Çintesun, Ersin; Akar, Serra; Gül, Ayhan; Çintesun, Feyza Nur İncesu; Şahin, Gözde; Ezveci, Huriye; Akyürek, Fikret; Çelik, Çetin
INTRODUCTION: Subclinical inflammation markers play a significant role in hyperemesis gravidarum (HEG). Simple hematological markers such as mean platelet volume (MPV), platelet distribution width (PDW), neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), plateletcrit (PCT), and platelet-to-lymphocyte ratio (PLR) have been shown to reflect inflammatory burden and disease activity in several disorders. Ketonuria is a parameter used in the diagnosis of severe HEG, but its correlation with disease severity remains controversial. The relationship of subclinical inflammation markers with degree of ketonuria has not been examined previously. In this study, we aimed to determine the diagnostic value of these subclinical inflammation markers and the relationship between these markers and grade of ketonuria in patients with HEG. MATERIALS AND METHODS: A total of 94 pregnant women with a diagnosis of HEG and 100 gestational age-matched healthy pregnant women were enrolled in this retrospective study. MPV, PDW, NLR, PLR, PCT, and ketonuria were calculated and analyzed from complete blood cell counts and total urine analyses. RESULTS: Lymphocyte count was significantly higher in the control group (P< 0,001): NLR and PLR values were significantly higher in the HEG group (P< 0,001). Among inflammation markers, RDW increased significantly (P = 0,008) with an increase in ketonuria in patients with HEG. A statistically significant correlation was found between white blood cell (WBC) and NLR, PLR, PCT. A moderate uphill relationship was observed between NLR and WBC and a weak uphill linear relationship was observed between WBC and PLR and between WBC and PCT CONCLUSIONS: PLR and NLR can be considered effective markers to aid in the diagnosis of HEG. No marker was found to correlate with ketonuria grade except RDW, although the relationship of the severity of ketonuria with severity of disease is controversial. RDW increases as the degree of ketonuria increases.
Serum and cord blood-methylated arginine levels in gestational diabetic subjects
(WALTER DE GRUYTER GMBH, 2019) Yıldırımkaya, Metin; Abuşoğlu, Sedat; Yılmaz, Setenay Arzu; Saraçlıgil, Beyza; Hataysal, Esra Paydaş; Ecer, Büşra; Ünlü, Ali
Objectives: Micro- and macrovascular endothelial deterioration has been mentioned in diabetic pregnants with critical clinical outcome for the fetus. Our aim was to measure serum and cord blood concentrations of methylated arginines in patients with gestational diabetes and find a relationship with endothelial dysfunction. Materials and methods: Methylated arginines were detected with high performance liquid chromatography mass spectrometry via electrospray ionization positive technique with a chromatographic C18 column. Results: Although gestational diabetes mellitus (GDM) groups' asymmetric dimethylarginine (ADMA) levels were higher compared to control group, this difference was not significant. Control cord blood ADMA and N-monomethy-larginine levels were significantly higher than insulin-regulated GDM cord blood ADMA and N-monomethylarginine levels (p = 0.001; p= 0.003, respectively). Diet-regulated GDM group's cord blood N-monomethylarginine was significantly higher than insulin-regulated GDM group's cord blood N-monomethylarginine (p= 0.045). A negative correlation was found between cord blood symmetric dimethylarginine and oral glucose tolerance testing Oh glucose values (r = -0.453, p = 0.002). Conclusions: According to this study's results, methylated arginine levels may not be associated with endothelial deterioration in GDM otherwise with preeclampsia risk.
Nicotinamide N-Methyltransferase expression in high-grade serous carcinoma and its association with survival
(SPRINGER INDIA, 2019) Akar, Serra.; Harmankaya, İsmail.; Uğraş, Serdar.; Çelik, Çetin.
Introduction Ovarian cancer is the most lethal gynecological malignancy. Mechanisms involved in the progression of primary high-grade serous carcinoma (HGSC) into metastatic carcinoma are not understood. Nicotinamide N-methyltransferase (NNMT) is overexpressed in cancer, and its overexpression leads to epigenetic changes through hypomethylation of histones. It plays a role in epithelial-mesenchymal transition and sustenance of cancer stem cells. NNMT expression in primary and metastases of ovarian carcinoma and its relationship with survival have not been studied before. Materials and Methods We compared the expression of NNMT between primary and matched synchronous metastatic carcinoma of patients, diagnosed with HGSC. Benign ovarian and omental tissues were used as controls. The relationships between NNMT expression and relapse-free and disease-specific survival were analyzed. Results NNMT expression in metastases was significantly higher than matched primary carcinoma. NNMT was overexpressed in the stroma of primary and metastatic tumors. Increased NNMT expression was associated with decreased relapse-free and disease-specific survival. Conclusion This study detected a higher expression of NNMT in metastases of HGSC compared to matched primary and associated increased metastatic NNMT expression with decreased survival. Upregulation of NNMT in tumor stroma suggests it plays a role in desmoplasia. Targeting of NNMT and desmoplasia may play a critical role in the treatment of HGSC.
Nicotinamide N-Methyltransferase expression in cervical adenocarcinoma and its clinical significance
(SPRINGER INDIA, 2019) Akar, Serra.; Harmankaya, İsmail.; Uğraş, Serdar.; Çintesun, Ersin.; Çelik, Çetin.
IntroductionNicotinamide N-methyltransferase (NNMT) is a metabolic enzyme increasingly implicated in tumor progression and resistance to treatment. It is overexpressed in human cancers including glioblastoma, gastric, pancreatic, lung and colorectal cancers. The role of NNMT in cervical adenocarcinoma has not been studied thus far. We aimed to evaluate expression of NNMT in cervical adenocarcinoma and investigate its prognostic significance.MethodsNNMT expression was assayed in 18 cases of cervical adenocarcinoma and 19 cases of benign cervical tissue. NNMT immunoreactivity was scored by multiplying staining intensity with percentage of immunoreactive cells.ResultsThe expression of NNMT was significantly higher in cervical adenocarcinoma than in benign tissue (p=0.024). NNMT expression was significantly higher in patients with locally advanced than early cervical cancer (p=0.031). NNMT expression was higher in patients with tumor size greater than 4cm and in those with poorly differentiated tumors compared to patients with tumors of 4cm or less and well-moderate differentiation, respectively (p=0.044, p=0.014).ConclusionAlthough on a preliminary level, this is the first study to detect an overexpression of NNMT in cervical adenocarcinoma and an increased expression associated with advanced stage, increased tumor size and poor differentiation. NNMT has been shown to carry prognostic and therapeutic importance in a variety of cancers, and it can be a potential treatment target in cervical adenocarcinomas.
Is the low AMH level associated with the risk of cardiovascular disease in obese pregnants?
(TAYLOR & FRANCIS INC, 2019) Guler, Basak; Özler, Sibel; Kadioglu, Nezaket; Ozkan, Eda; Gungoren, Merve Sibel; Celen, Sevki
Our aim was to investigate whether Antimullerian Hormone (AMH), complete blood count (CBC), Homeostasis model assessment (HOMA-IR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and weight gain have any diagnostic value for the prediction of cardiovascular disease (CVD) in obese and non-obese pregnant patients. A prospective, case-control study was carried out, including 187 patients (93 obese, and 94 non-obese). CVD risk for each patient was evaluated according to the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA). A multivariate logistic regression model was used to identify the independent risk factors of CVD in obese and non-obese patients. The obese patients had significantly lower levels of AMH when compared to the non-obese ones (p = .002). Insulin, HOMA-IR, HbA1c, and SBP were significantly higher in obese patients than non-obese ones (p < .001, p < .001 and p = .001, respectively). Age, SBP, and decreased AMH levels had significantly associated with risk factors of CVD in the obese group (p = .001, p = .002, and p = .049, respectively). Our study suggests that decreased AMH levels, increased age, and SBP are associated with CVD in obese patients. AMH may be used to evaluate CVD risk in advanced aged, obese patients.IMPACT STATEMENT What is already known on this subject? Obesity is one of the most common medical complications of pregnancy. Obesity increases maternal complications such as preeclampsia, caesarean rate, cardiovascular disease, obesity, and diabetes after pregnancy; and neonatal complications including macrosomia, hypoglycaemia, hyperbilirubinemia, delivery trauma, shoulder dystocia, and adult-onset obesity, and diabetes. Obese patients have lower serum AMH levels. What the results of this study add? A significant relationship between AMH levels and CVD risk in obese pregnant women was observed.
Increased levels of serum IL-33 is associated with adverse maternal outcomes in placenta previa accreta
(TAYLOR & FRANCIS LTD, 2019) Ozler, Sibel; Oztas, Efser; Guler, Basak Gumus; Caglar, Ali Turhan
Purpose: IL-33 is associated with invasion, proliferation, and metastasis of various cancers. The trophoblastic cells of placenta previa accreta (PPA) invade into the myometrium in a similar way to the invasion of cancers. We studied the role of IL-33 in PPA and also aimed to investigate its relation with adverse maternal outcome in this placental disorder. Methods: A total of 87 pregnant patients were enrolled in this prospective case-control study [27 with PPA, 30 with placenta previa totalis (PPT; nonadherent placenta previa), and 30 controls]. IL-33 and IL-6 levels were studied in maternal serum at late preterm gestation weeks. Multiple logistic regression analyses analyzed the risk factors which are associated with PPA and adverse maternal outcomes. Adjusted odds ratios and 95% confidence intervals were also calculated. Enzyme-linked immunosorbent assay (ELISA) method was used to determine maternal serum IL-33 and IL-6 levels. Results: Serum IL-33 levels were significantly higher in PPA patients when compared with both nonadherent PPT and the control groups (p = .011, p = .010). Serum IL-6 and neutrophil/lymphocyte ratio levels were significantly higher than the control group's (p = .045, p = .028). IL-33 levels and history of previous cesarean section were found to be significantly associated with PPA (OR: 1.039, 95% CI: 1.004-1.075; p = .030 and OR: 0.067, 95% CI: 0.014-0.309, p = .001, respectively). Serum IL-33 levels were positively correlated with previous cesarean section history in PPA. Increased maternal serum IL-33 levels were found to be independently associated with a cesarean hysterectomy and massive transfusion in PPA patients (OR: 1.098, 95% CI: 0.998-1.207; p = .049 and OR: 1.162 95% CI: 1.010-1.337; p = .036). Conclusion: Increased levels of maternal serum IL-33 and history of previous cesarean section were found to be significantly associated with PPA, and also increased maternal serum IL-33 levels were related to cesarean hysterectomy and massive blood transfusion in PPA. We suggest that IL-33 may have a role in abnormal placental invasion.
In vitro vasoactive effects of dexmedetomidine on isolated human umbilical arteries
(COMENIUS UNIV, 2019) Arun, O.; Taylan, S. B.; Duman, I; Oc, B.; Yilmaz, S. A.; Tekin, A.; Celik, C.; Bariskaner H.; Celik J. B.
OBJECTIVE: We aimed to investigate the vasoactive effects of dexmedetomidine on isolated human umbilical arteries and possible mechanisms involved. METHODS: Human umbilical artery strips were suspended in Krebs-Henseleit solution and dose-response curves were obtained for cumulative dexmedetomidine before and after incubation with different agents; propranolol, atropine, yohimbine, prazosin, indomethacin, verapamil. Effects of calcium on cumulative dexmedetomidine-induced contractions were also studied. RESULTS: Cumulative dexmedetomidine resulted in dose dependent contraction responses. Incubation with propranolol (Emax: 93.3 +/- 3.26 %), atropine (Emax: 92.0 +/- 6.54 %), or indomethacin (Emax: 94.25 +/- 2.62 %), did not attenuate dexmedetomidine-elicited contractions (p > 0.05). There were significant decreases in the contraction responses of cumulative dexmedetomidine with yohimbine (Emax: 12.1 +/- 11.9 %), prazosin (Emax: 28.8 +/- 4.6 %) and verapamil (Emax: 11.2 +/- 13.6 %) (p < 0.05). In Ca+2 free medium contraction responses to cumulative dexmedetomidine was insignificant (Emax: 5.20 +/- 3.42 %). Addition of cumulative calcium to the Ca+2 free medium resulted in concentration dependent increase in contractions (Emax: 64.83 +/- 37.7 %) (p < 0.05). CONCLUSION: Dexmedetomidine induces vasoconstriction in endothelial-free umbilical arteries via both, alpha(1)- and alpha(2)-adrenergic receptors and also extracellular Ca+2 concentrations play a major role. beta-adrenergic receptors, muscarinic cholinergic receptors, and inhibition of cyclooxygenase enzyme are not involved in this vasoconstriction (Fig. 3, Ref. 36). Text in PDF www.elis.sk.
Dynamic thiol/disulfide homeostasis in predicting adverse neonatal outcomes in fetal growth restriction
(TAYLOR & FRANCIS INC, 2019) Ozler, Sibel.; Oztas, Efser.; Guler, Basak Gumus.; Erel, Ozcan.; Caglar, Ali Turhan.; Ergin, Merve.; Danisman, Nuri.
Aim: The main aim of this study was to investigate thiol/disulfide homeostasis associated with fetal growth restriction (FGR) and to evaluate whether alterations are predictive for adverse neonatal outcomes. Methods: 273 pregnant women (77 with FGR and 196 with normal fetal growth) were enrolled in this prospective case-control study. Results: Native thiol and total thiol were decreased in FGR compared to the control group (p < .001; p < .001). Decreased levels of maternal serum native and total thiol were significantly associated with adverse neonatal outcomes in FGR (OR: 0.983, 95% CI 0.976-0.991, p < .001; OR: 0.983, 95% CI 0.976-0.991, p < .001). Decreased maternal serum total thiol levels were the only significantly associated risk factor with adverse neonatal outcomes in FGR (OR: 0.981, 95% CI 0.963-1.000, p = .046). Conclusion: The decrease in the antioxidants of thiol/disulfide mechanism may be related to the development of both FGR and adverse neonatal outcome in FGR.
Benign metastasising leiomyoma with lymph node metastases in a patient with endometrial cancer after caesarean section
(TAYLOR & FRANCIS INC, 2019) Akar, Serra.; Ugras, Serdar.; Sahin, Gozde.; Demir, Fatih.; Celik, Cetin.
[Abstract not Available]
Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: Results of aggregate and individual patient data meta-analyses
(LIPPINCOTT WILLIAMS & WILKINS, 2019) Ovadia, Caroline; Seed, Paul T.; Sklavounos, Alexandros; Geenes, Victoria; Di Illio, Chiara; Chambers, Jenny; Kohari, Katherine; Bacq, Yannick; Bozkurt, Nuray; Brun-Furrer, Romana; Bull, Laura; Estiú, Maria C.; Grymowicz, Monika; Günaydın, Berrin; Hague, William M.; Haslinger, Christian; Hu, Yayi; Kawakita, Tetsuya; Kebapcılar, Ayşe Gül; Kebapcılar, Levent; Kondrackienė, Jūratė; Koster, Maria P. H.; Kowalska-Kańka, Aneta; Kupčinskas, Limas; Lee, Richard H.; Locatelli, Anna; Macias, Rocio I. R.; Marschall, Hanns-Ulrich; Oudijk, Martijn A.; Raz, Yael; Rimon, Eli; Shan, Dan; Tribe, Rachel; Tripodi, Valeria; Abide, Çiğdem Yayla; Yenidede, İlter; Thornton, Jim G.; Chappell, Lucy C.; Williamson, Catherine; Shao, Yong
Intrahepatic cholestasis of pregnancy (ICP) affects less than 0.1% to 0.2% of pregnant women. It is diagnosed in women with gestational pruritus and increased serum bile acids and can be complicated by preterm labor, fetal asphyxia, meconium-stained amniotic fluid, and stillbirth.
Are serum levels of ADAMTS5, TAS and TOS at 24–28 gestational weeks associated with adverse perinatal outcomes in gestational diabetic women?
(TAYLOR & FRANCIS INC, 2019) Ozler, Sibel.; Oztas, Efser.; Guler, Basak Gumus.; Erel, Ozcan.; Caglar, Ali Turhan.; Ergin, Merve.; Uygur, Dilek.
We aimed to determine the role of placental A Disintegrin and Metalloproteinase with thrombospondin motifs 5 (ADAMTS5), and maternal serum ADAMTS5, total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) levels at 24-28th gestational weeks in GDM. This study included 57 patients, who had been diagnosed as having GDM at their 24-28th gestational week, and 29 controls. The maternal blood samples were collected at the 24-28th gestational week and ADAMTS5 was studied with the enzyme-linked immunosorbent assay (ELISA) method, whereas an automated colorimetric method was used to study TAS, TOS, and OSI. The level of ADAMTS5 in maternal serum of patients with GDM were significantly lower than the controls (p = .017); whereas TOS and OSI levels were significantly higher (p = .003 and p = .008). Multivariable logistic regression analysis revealed ADAMTS5 and TOS levels were independently associated with adverse perinatal outcomes (p = .004 and p = .018). We found that serum ADAMTS5 levels decreased and TOS level increased in GDM pregnant at 24-28th gestational weeks. In addition, we found that increased levels of serum ADAMTS5 and decreased TOS levels at 24-28th weeks were associated with adverse perinatal outcomes independent of the mode of treatment in GDM.Impact statement What is already known on this subject? Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. The insulin resistance, which starts at the 24-28th gestational weeks, increases during gestation. GDM increases maternal complications like preeclampsia, cesarean rate, cardiovascular disease, obesity, and diabetes after pregnancy; and neonatal complications like macrosomia, hypoglycemia, hyperbilirubinemia, delivery trauma, shoulder dystocia, and adult-onset obesity, and diabetes. What the results of this study add? A significant relationship between ADAMTS5, TOS levels and adverse perinatal outcome. insulin resistance and was observed.
An unusual complication of LEEP cervical conisation with a retained intrauterine device (IUD): a case report
(TAYLOR & FRANCIS INC, 2019) Gul, Ayhan.; Kebapcilar, Ayse Gul.; Sahin, Gozde.; Akar, Serra.; Celik, Cetin.
[Abstract not Available]
Prognostic Significance of Tumor Grade in Early-stage Endometrioid Endometrial Cancer
(2019) Akar, Serra; Harmankaya, Ismail; Çelik, Çetin
Aim: Although tumor grade has no impact on endometrial cancer stage, it carries prognostic and therapeutic importance. Surgicalmanagement and adjuvant treatment following surgery in certain patients depends on a number of factors including tumor grade.Although grade 3 tumors are included in the high-intermediate risk group, there are data demonstrating that there is a slight differencein survival between patients with grade 1 and 2 tumors in early-stage disease. In this study, we aimed to investigate the associationof grade with clinicopathological characteristics, recurrence-free and disease-specific survival in patients treated at our clinic anddiagnosed with endometrioid endometrial cancer.Material and Methods: 279 patients with early FIGO Stage endometrioid endometrial cancer treated between 2009-2018 in aUniversity hospital were included in the study. The associations between tumor grade with stage, lymphovascular space invasion(LVSI), myometrial invasion, tumor size, and survival were analyzed.Results: LVSI, 50% myometrial invasion, advanced stage and 2 cm tumor size were significantly higher in grade 3 tumors comparedto patients with grade 1 tumors. Recurrence-free and disease-specific survival were significantly lower in patients with grade 2 and3 tumors compared to patients with grade 1 tumors. In multivariate analysis of RFS and DSS, tumor grade, LVSI and stage wereindependent prognostic factors.Conclusion: According to this study, grade 2 tumors may not differ significantly from grade 3 tumors in terms of survival. Therefore,due to the potential adverse prognosis associated with grade 2 and 3 tumors, vigilance for recurrence is warranted.

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