Serum neprilysin levels are elevated in preeclampsia

ObjectiveTo evaluate the possible associations between serum Neprilysin (NEP) levels and preeclampsia and mild and severe preeclampsia subgroups.Materials and methodsFifty-five consecutive women with mild preeclampsia and fifty-five consecutive women with severe preeclampsia were compared with 110 approximately gestational age-matched (±1 week) women with an uncomplicated pregnancy.ResultsMean serum NEP was significantly higher in women with preeclampsia compared to that of the gestational age-matched-controls (231.62 ± 65.30 pg/mL vs. 187.75 ± 84.38 pg/mL, p < 0.001). Mean serum NEP was significantly higher in the mild preeclampsia group compared to its gestational age-matched control group (228.84 ± 67.26 pg/mL vs. 186.14 ± 85.09 pg/mL, p = 0.008); and in the severe preeclampsia group compared to its gestational age-matched control group (234.45 ± 63.85 pg/mL vs. 189.29 ± 84.59 pg/mL, p = 0.004). Serum NEP was positively correlated with systolic and diastolic blood pressure, BUN, uric acid, and creatinine.ConclusionMean serum NEP was significantly higher in women with preeclampsia than women with an uncomplicated pregnancy. Further studies are needed to elucidate the possible therapeutic role of NEP inhibitors to treat preeclampsia.     

Thiol/disulfide homeostasis in pregnant women with obstructive sleep apnea syndrome

Background: Repetitive episodes of hypoxia and reoxygenation during sleep in patients with obstructive sleep apnea syndrome (OSAS) resemble an ischemia-reperfusion injury. We aimed to test the hypothesis that oxidative stress occurs in pregnant women with OSAS. We also aimed to compare thiol/disulfide homeostasis with ischemia-modified albumin (IMA) and total antioxidant capacity (TAC) as markers of ischemia-reperfusion injury in pregnant women with and without OSAS and healthy control.

Methods: This study included 29 pregnant women with OSAS, 30 women without OSAS in the third trimester applying for periodic examinations, and 30 healthy women. Serum IMA and TAC (using the ferric reducing power of plasma method) were measured. Serum thiol/disulfide homeostasis was determined by a novel automated method.

Results: The mean age of the pregnant women with OSAS was 31.0?±?4.7 years with a mean gestational age of 36.5?±?3.0 weeks. The mean age of pregnant women without OSAS was 29.8?±?4.9 years with a mean gestational age of 36.9?±?2.7 weeks. The mean age of the nonpregnant control group was 29.7?±?6.4 years. Both native thiol (291?±?29?μmol/L versus 314?±?30?μmol/L; p?=?.018) and total thiol (325?±?32 versus 350?±?32, p?=?.025) levels were lower in pregnant women with OSAS compared to pregnant women without OSAS, respectively (p?Conclusions: This is the first study demonstrating the thiol/disulfide homeostasis in pregnant women with OSAS. Native thiol and total thiol levels were lower in pregnant women with OSAS compared to those without OSAS. However, dynamic thiol/disulfide homeostasis parameters cannot provide valuable information to discriminate OSAS in pregnant women.     

Abnormal uterine artery remodelling in the stroke prone spontaneously hypertensive rat

IntroductionThe stroke prone spontaneously hypertensive rat (SHRSP) is an established model of human cardiovascular risk. We sought to characterise the uteroplacental vascular response to pregnancy in this model and determine whether this is affected by the pre-existing maternal hypertension.MethodsDoppler ultrasound and myography were utilised to assess uterine artery functional and structural changes pre-pregnancy and at gestational day 18 in SHRSP (untreated and nifedipine treated) and in the normotensive Wistar-Kyoto (WKY) rat. Maternal adaptations to pregnancy were also assessed along with histology and expression of genes involved in oxidative stress in the placenta.ResultsSHRSP uterine arteries had a pulsatile blood flow and were significantly smaller (70906 ± 3903 μm² vs. 95656 ± 8524 μm² cross-sectional area; p < 0.01), had a significant increase in contractile response (57.3 ± 10.5 kPa vs 27.7 ± 1.9 kPa; p < 0.01) and exhibited impaired endothelium-dependent vasorelaxation (58.0 ± 5.9% vs 13.9 ± 4.6%; p < 0.01) compared to WKY. Despite significant blood pressure lowering, nifedipine did not improve uterine artery remodelling, function or blood flow in SHRSP. Maternal plasma sFLT-1/PlGF ratio (5.3 ± 0.3 vs 4.6 ± 0.1; p < 0.01) and the urinary albumin/creatinine ratio (1.9 ± 0.2 vs 0.6 ± 0.1; p < 0.01) was increased in SHRSP vs WKY. The SHRSP placenta had a significant reduction in glycogen cell content and an increase in Hif1α, Sod1 and Vegf.DiscussionWe conclude that the SHRSP exhibits a number of promising characteristics as a model of spontaneous deficient uteroplacental remodelling that adversely affect pregnancy outcome, independent of pre-existing hypertension.     

Vaginal Versus Robotic Hysterectomy and Concomitant Pelvic Support Surgery: A Comparison of Postoperative Vaginal Length and Sexual Function

Study ObjectiveTo compare the change from pre- to postoperative total vaginal length (TVL) in women who underwent either a total vaginal hysterectomy (TVH) with uterosacral ligament suspension (USLS) or a robotic hysterectomy (RH) with colpopexy (SCP). Secondary objectives included comparing sexual function, pelvic floor function, and prolapse recurrence between routes of surgery.DesignThis was a retrospective cohort study (Canadian Task Force classification II-2).SettingThis was conducted at 1 tertiary academic medical center over a 2-year period.PatientsWomen who underwent either TVH/USLS or RH/SCP.InterventionsBaseline and postoperative POP-Q Pelvic Organ Prolapse Quantification exams were recorded as well as postoperative validated questionnaires. Twenty-nine subjects were needed in each group to detect a 1.5-cm difference in TVL.Measurements and Main ResultsThere were 38 TVH/USLS and 46 RH/SCP participants. RHs were either total (28/46 [61%]) or supracervical (18/46 [39%]). The mean postoperative follow-up was 9.5 ± 3.1 months. For the primary outcome, women in the TVH/USLS group had a decrease in TVL, whereas women in the RH/SCP group had an increase in TVL (−0.6 ± 1.0 cm vs 0.5 ± 0.8 cm, p < .001). Among sexually active women (55/84, 65.5%), there was no difference in postoperative sexual function between groups based on Pelvic Organ Prolapse/Urinary incontinence Sexual Function Questionnaire short form scores, with good sexual function in both groups (32.6 ± 6.2 TVH/USLS vs 35.1 ± 7.3 RH/SCP, p = .22). Although both groups showed good postoperative apical support, the TVH/USLS group had a slightly lower mean C point compared with the RH/SCP group (−6.8 ± 1.2 vs −7.7 ± 1.8, p = .02). Both groups showed good postoperative pelvic floor function, with no difference in mean postoperative Pelvic Organ Prolapse Distress Inventory scores (42.2 ± 45.4 vs 52.7 ± 46.6, p = .44). Recurrent prolapse (defined as any prolapse at or beyond the hymen) was not different between groups (13.2% for TVH/USLS vs 6.5% for RH/SCP, p = .46).ConclusionVaginal length decreased after vaginal hysterectomy with pelvic support surgery compared with RH with pelvic support surgery, with no differences in postoperative sexual function or pelvic floor function between groups.     

Outcomes and complications of severe acute postpartum hemorrhage treated with or without transarterial embolization in a single tertiary referral center: A 20-year experience

ObjectivePPH is usually unpredictable; and such fast, urgent and sudden massive life-threating hemorrhage. This study is to assess the efficacy of transarterial embolization (TAE) in treating severe PPH in a single institution over a period of 20 years.Materials and methodsFrom January 2000 to October 2019, all women with acute PPH more than 1500 cc and/or DIC were enrolled in this retrospective study. These women were divided into two groups according to whether they have received TAE as the second-line treatment. Group 1 (n = 27) included women without receiving TAE from January 1, 2000 to October 31, 2009, and group 2 (n = 30) included those who receiving TAE from November 1, 2009 to October 31, 2019.ResultsThe overall success rate of TAE in control the PPH and preserved the uterus is 80%. The hemoglobin 12 h after PPH in group 2 is significantly lower than in group 1 (7.64 ± 1.6 vs. 8.58 ± 1.9, respectively. P = 0.05). Total unit of packed red blood cell (pRBC) transfusion is significantly higher in the group 2 than group 1 (9.8 ± 5.7 vs. 6.8 ± 3.9; p = 0.03). The rate of hysterectomy is significantly higher in group 1 than group 2 (46.7 vs. 20%; p < 0.001).ConclusionIn conclusion, TAE is safe and effective in control bleeding in PPH with a high success rate to preserve uterus and prevent DIC. TAE should be routinely used as a secondary line of treatment during PPH in all hospitals.     

Investigation of serum thiol/disulphide homeostasis in patients with abortus imminens

Aim: The aim of our study is to compare serum thiol/disulphide homeostasis of women diagnosed with abortus imminens (AI) and healthy pregnant women, and to determine whether it has a role in the pathogenesis of the disease or not.

Materials and methods: A total of 100 pregnant women were included in the study. The study group consisted of 50 patients with AI whereas 50 healthy pregnant women were chosen as the control group. All of the patients in the two groups were matched for age, gestational age, and body mass index. Thiol/disulphide levels were analyzed with a newly developed automated spectrophotometric method.

Results: We found significantly reduced levels of native thiol (SH) (370.2?±?35.2?μmol/l versus 397.6?±?29.3?μmol/l) and total thiol (406?±?37.1?μmol/l versus 434.5?±?29.9?μmol/l), in the sera of the study group compared to the control group (p?p: .612). Similarly, no significant differences were observed between the two groups in terms of SS/SH, SS/total thiol and SH/total thiol ratios (all p?>?.05).

Conclusions: We found a decrease in thiol levels which have antioxidant properties in patients with AI. Decreased antioxidant level in the body is thought to play a role in the etiology of AI. In this regard, further studies are needed to elucidate the potential role of dynamic thiol/disulphide homeostasis in the pathogenesis of AI.     

Is conventional cardiac examination adequate for obese pregnant women? A prospective case–control study

ObjectiveObesity in pregnancy shows short- and long-term adverse effects for both mother and baby. We aimed to investigate the effects of obesity on cardiac functions in the third trimester of pregnancy.Materials and methods: A prospective case–control study where the pregnant women at the third trimester of pregnancy were divided into two groups: obese (BMI≥30) and the controls (BMI<30). All participants underwent conventional 2D and speckle-tracking echocardiography, while structural and functional cardiac parameters were measured. The unpaired t-test or the Mann-Whitney-U test were used to compare values between the two groups. p ≤ 0.05 was outlined to be statistically significant.ResultsForty-one obese pregnant women and 41 healthy and normal-weight pregnant controls were recruited. The mean BMI was 24.6 ± 2.4 kg/m² in the controls and 38.5 ± 5.4 kg/m² in the obese group. SV was significantly higher in obese patients (p = 0.02). SVI was markedly lower in the obese group (p < 0.01). CO and Cardiac Index were significantly higher in obese patients compared to the controls (p < 0.01). TVRI was significantly higher in the obese group than the controls. EF was similar between the two groups (p = 0.33). LVM and LVMI were significantly higher in obese patients than the controls (p = 0.024 and p = 0.01). Diastolic dysfunction was present in 3 (7.3%) controls; 21 (51.2%) of the obese women demonstrated diastolic dysfunction, and it was significantly higher than the controls (p < 0.01). LV-GLS and LV-GCS were substantially lower in the obese group (p < 0.01). RV-FAC and RV-GS were markedly lower in the obese group (p < 0.01). TAPSE was similar in obese and control groups (p = 00.17).ConclusionObesity in pregnancy is associated with increased subclinical systolic and diastolic dysfunction, which cannot be detected by standard 2D methods.     

An alternative method for measuring oxidative stress in intrahepatic cholestasis of pregnancy: thiol/disulphide homeostasis

Purpose: The aim of our study was to evaluate the oxidative stress (OS) in pregnant women with intrahepatic cholestasis of pregnancy (ICP) by evaluating thiol/disulphide homeostasis using an alternative technique.

Methods: A total of 57 pregnant women with ICP were compared with 50 gestational age and body mass index matched controls. A recently defined method was used for the measurement of plasma native-total thiol and disulphide levels. The independent two-sample t test, Mann–Whitney-U test, Chi-square test, binary logistic regression with backward elimination and receiver operating characteristic (ROC) curve was performed for statistical analyses.

Results: Pregnant women with ICP (n?=?57) versus controls (n?=?50) had significantly lower serum levels of native thiol (233.8?±?47.4?μmol/L vs. 308.5?±?51.7?μmol/L, p?p?p?p?p?Conclusions: To our knowledge, this is the first study in the literature exploring thiol/disulphide balance in ICP. We found that thiol/disulphide balance indicate OS in pregnant woman with ICP.     

Shoulder pain after natural orifice transluminal endoscopic surgery decreased with abdominal compression and pulmonary recruitment maneuver: A retrospective study

ObjectiveThe study aimed to assess the efficacy of abdominal compression and pulmonary recruitment maneuver (CPRM) after transvaginal natural orifice transluminal endoscopic surgery (vNOTES) to alleviate post-laparoscopic shoulder pain (PLSP).Materials and methodsIn this retrospective cross-sectional study conducted in a tertiary referral medical center, women who underwent vNOTES between January 2018 and May 2019 were classified into control group and CPRM group with CO₂ force expelled. Data on the demographic characteristics, indications for surgery, and surgical history were collected. Postoperative pain was assessed 24 and 48 h postoperatively using the visual analog scale (VAS, 0–10). Chest radiography was used to determine the residual air volume 24 h after surgery.ResultsOf 10 patients, 6 and 4 underwent vNOTES adnexal surgeries and vNOTES hysterectomy, respectively. The median volumes of residual pneumoperitoneum were 9.02 mL and 28.11 mL in the CPRM and control groups, respectively (p = 0.001). The intensity of PLSP in the CPRM and control groups were 0 ± 0 vs. 3.4 ± 3.4 and 0.4 ± 0.8 vs. 2.2 ± 2.2 24 and 48 h after surgery, respectively (p = 0.005 for 24 h and p = 0.04 for 48 h).ConclusionCPRM might facilitate decrease in residual gas volume and PLSP after vNOTES. CPRM might be considered using in vNOTES to decrease PLSP.     

Comparison of serum human Klotho levels and thiol/disulfide homeostasis in women with polycystic ovary syndrome and in healthy women

ObjectivesWomen with polycystic ovary syndrome (PCOS) have an increased cardiometabolic risk. Similarly, it was previously shown that atherosclerotic and cardiovascular risk is increased in the general population with lower serum Klotho levels. The aim of this study was to investigate the lotho and thiol/disulfide levels in women with non-obese PCOS compared to healthy controls and also to investigate the relationship of serum Klotho and thiol/disulfide homeostasis with cardiometabolic risk factors.Materials and methodsIn this prospective case control study, human serum alpha Klotho levels and thiol/disulfide homeostasis of women with PCOS aged between 19-33 were compared to their age and BMI matched non – PCOS healthy controls. In addition, the correlation of these molecules with other metabolic markers/measurements were also investigated.ResultsMetabolic parameters such as mean waist circumference, lipid accumulation product, visceral adiposity index, fasting insulin, homeostasis model assessment of insulin resistance and triglyceride values were higher in the PCOS group (p = 0.038, p = 0.008, p = 0.001, p = 0.001, p = 0.002 and p = 0.002, respectively) compared to controls. However, mean serum Klotho and native thiol levels (respectively p < 0.0001 and p = 0.038) were lower compared to controls. Correlation analysis revealed that serum Klotho levels were negatively correlated with BMI, waist circumference, disulphide/total thiol, disulphide/native thiol, HOMA-IR and LAP-index.ConclusionsFindings of decreased serum Klotho and native thiol values of the PCOS group compared to controls and the negative correlation of serum Klotho levels with metabolic markers supports the idea that decreased Klotho may be another mechanism by which cardiovascular risk is increased in women with PCOS.     

Diagnosing Small for Gestational Age during second trimester routine screening: Early sonographic clues

ObjectiveSmall for gestational age (SGA) is generally defined as birth weight being at or below the 10th percentile. Children with SGA have a higher risk for complications. There is a need for early predictors, as the accurate diagnosis rate is only 50%. In the current study, we aimed to evaluate diagnostic performance of ultrasound (US)/color Doppler ultrasound (CDUS) parameters (umbilical vein-UV, right portal vein-RPV diameter/flow rate, and portal sinus-PS diameter) examined at 20–22 gestational week as SGA diagnostic factors.Materials and methods93 pregnant included (32 SGA, 61 controls). All the US examinations were performed between 20 and 22 weeks of gestation. UV, RPV, and PS measurements were performed by using the same image acquired for abdominal circumference measurement. A fetus with as estimated fetal weight (EFW) below the 10th percentile was diagnosed as SGA and SGA at birth was defined as having a birth weight under the 10th percentile.ResultsPregnant women in the SGA group were significantly older (30 ± 4.8 vs. 26.6 ± 5.4 years, p < 0.01). Median UV diameter was significantly lower in SGA group (2.20 vs. 2.40 mm, p = 0.001). Median RPV diameter was significantly lower in SGA group (2 vs. 2.10 mm, p = 0.018). Median PS diameter was significantly lower in SGA group (2 vs. 20.10 mm, p = 0.008).ConclusionUV, RPV, and PS diameters can be earlier predictors for SGA diagnosis. Routinely evaluation of these parameters during second trimester screening can increase SGA diagnosis rates and serve for early diagnose.     

Effects of low back massage on perceived birth pain and satisfaction

AimThe aim of the study was to evaluate the effect of low back massage on perceived birth pain and delivery.MethodThis study was designed as a study-control experimental type. The study sample consisted of 62 pregnant women (massage group = 31, control group = 31).Massage was applied to the study group in three phases during intrapartum period. The massages were done at the end of latent, active and transition phases (at cervical dilatation 3–4 cm, 5–7 cm, 8–10 cm) correspondingly. The VAS scores were evaluated three times during all phases.ResultsThe first mean VAS score was 5.2 ± 0.9 and 7.3 ± 1.3 for massage and control groups, respectively. Second VAS score was found as 6.6 ± 1.6 in massage group and 8.8 ± 1.0 in control group. The third VAS score was significantly higher in the control group than massage group during third evaluation (9.2 ± 2.4 vs 6.7 ± 2.7) (p < 0.05). The mean duration of second stage was 24.6 ± 12.7 min in massage group and 31.7 ± 20.9 min in control group (p > 0.05). The mean scores of satisfaction about delivery were found as 8.8 ± 0.7 in massage group and 6.9 ± 0.8 in control group (p < 0.05).ConclusionIt was determined in the study that lower back massage has a significant impact on reducing labor pain and increasing the satisfaction with birth. Health professionals, who work in the delivery unit, can use massage intervention for decreasing pain, shortening delivery time and increasing satisfaction with birth experience.     

Reproductive Outcomes and Overall Prognosis of Women with Asherman's Syndrome Undergoing IVF

Study ObjectiveTo evaluate the impact of Asherman syndrome (AS) following hysteroscopic adhesiolysis on reproductive outcomes and the time to achieve pregnancy in women with infertility undergoing in vitro fertilization (IVF) treatment.DesignCase-control study.SettingTertiary university-affiliated medical center.PatientsFifty-one infertile women who were treated for AS and underwent IVF (study group) matched for age and etiology of infertility with non-AS controls at a 1:1 ratio.InterventionsMedical records search, chart review, and phone survey were used to assess reproductive outcomes.Measurements and Main ResultsA multivariate logistic regression analyses was used to assess live birth, accounting for patient age at stimulation cycle start, parity, number of embryos transferred, and endometrial thickness. A survival analysis was performed to assess the times that had lapsed from interventions to conception.The study group of 51 women included 38 (74.5%) with moderate to severe disease. The mean number of embryo transfers per woman was similar for the study and control groups (4.9 ± 4.6 vs 6.22 ± 4.3, respectively, p = .78). The controls had a significantly higher mean endometrial thickness before embryo transfer (8.7 ± 1.8 mm vs 6.95 ± 1.7 mm, p = .001). The overall time to achieve live birth was significantly longer in women with AS (p = .022). In a logistic regression analysis, the presence of moderate to severe AS was shown to be an independent factor for achieving a live birth (adjusted odds ratio 0.174, 95% confidence interval [CI], 0.032–0.955, p = .004). Women with AS who had live births had a significantly thicker mean endometrial thickness (8.2 ± 1.4 mm vs 6.9 ± 1.2, p = .001).ConclusionModerate and severe AS has a detrimental effect on reproductive performance in infertile women. Endometrial thickness is an important predictor for live births among women with AS who undergo IVF.     

The significance of clinical symptoms of subchorionic hematomas, “bleeding first”, to stratify the high-risk subgroup of very early preterm delivery

ObjectiveTo investigate the factors that stratify high-risk cases among subchorionic hematomas (SCHs) patients with persistent vaginal bleeding in early pregnancy.Materials and methodsA total of 56 patients who required hospitalization for SCH with vaginal bleeding in early pregnancy were classified into two groups: 1) no hematoma by ultrasonography when vaginal bleeding occurred, and then hematoma was observed by ultrasonography “bleeding to hematoma (BH group, n = 15)” and 2) no vaginal bleeding when hematoma was observed by routine ultrasonography, and then vaginal bleeding occurred later “hematoma to bleeding (HB group, n = 41)”. Retrospective cohort study was performed and maternal and neonatal outcomes were evaluated.ResultsThe duration of SCHs and/or vaginal bleeding was significantly longer in the BH group than in the HB group (mean: 60.8 days [BH group] vs. 33.3 days [HB group], p = 0.015). BH group patients delivered earlier than HB group patients significantly (mean: 27.3 weeks [BH group] vs. 35.6 weeks [HB group], p = 0.0028). The frequency of chronic abruption and oligohydramnios sequence (CAOS) was significantly higher in the BH group than in the HB group (3/15; 20.0% [BH group] vs. 0/41; 0.0% [HB group], p = 0.016). The frequency of sever fetal distress (Apgar score <4 points) was significantly higher in the BH group than in the HB group (4/15; 26.7% [BH group] vs. 0/41; 0.0% [HB group], p = 0.0037). The levels of factor XIII were relatively lower in the BH group than in the HB group (mean: 54.8% (n = 4) [BH group] vs. 76.1% (n = 7) [HB group], p = 0.077).ConclusionThe order of the symptoms, bleeding first, is an important feature that reflects the subsequent prolonged duration of SCHs/vaginal bleeding, resulting in very early preterm delivery. Continuous hemorrhage consumes coagulation factor XIII, which further worsen the hemostasis.     

Comparisons on the intraoperative desaturation and postoperative outcomes in non-intubated video-assisted thoracic surgery with supraglottic airway devices or high-flow nasal oxygen: A retrospective study

BackgroundFew studies have compared intraoperative oxygenation and perioperative outcomes between non-intubated video-assisted thoracic surgery (NIVATS) with supraglottic airway devices (SADs) and NIVATS with high flow nasal oxygenation (HFNO). The aim of this retrospective study was to compare the intraoperative desaturation rate and postoperative outcomes between NIVATS with SADs and NIVATS with HFNO.MethodsData regarding NIVATS performed for lung cancer from January 2020 to December 2021 were collected. Intraoperative anesthetic results, post-anesthetic adverse effects, and surgical outcomes for patients who received SAD or HFNO were analyzed using propensity score-matched and unmatched analysis.ResultsIn total, 199 patients with i-gel™ and 95 patients with HFNO were included. Significantly more female patients (91.6 vs. 82.4%, p = 0.0378) and fewer wedge resections (78.9 vs. 85.4%, p = 0.0258) were observed in the HFNO group. Among 250 patients who underwent NIVATS wedge resections under total intravenous anesthesia, those who received HFNO had a significantly higher desaturation event rate (19.8% vs. 7.9% in i-gel™ group; p = 0.0063), lower nadir SPO₂ (94.0% vs. 96.1% in i-gel™ group; p = 0.0012), and longer hospitalization (4.0 ± 0.8 vs. 3.6 ± 0.6 in i-gel™ group; p < 0.0001). However, propensity score matching analysis revealed no significant between-group difference in the desaturation rate. A log-rank test revealed that smoking (p = 0.0005) and HFNO (p = 0.0074) were associated with intraoperative desaturation.ConclusionThe rate of SAD use in NIVATS was twice the rate of HFNO use, especially for wedge resections. There is uncertain airway patency and limited flow through HFNO during one-lung ventilation, whereas SADs like i-gel™ presented a significantly less intraoperative desaturation rate over time and similar postoperative outcomes.     

Minimally invasive adenomyomectomy via a laparoscopic-assisted approach compared to a laparoscopic or laparotomic approach

ObjectiveThe present study assessed the safety and benefits of laparoscopic-assisted adenomyomectomy compared to laparoscopic or laparotomic adenomyomectomy.Materials and methodsThis study was a retrospective comparative study. A total of 277 patients underwent adenomyomectomy between January 2016 and January 2019 at the Department of Obstetrics and Gynaecology, Ulsan University Hospital, including 25 with laparoscopic-assisted adenomyomectomy, 82 with laparoscopic adenomyomectomy, and 170 with laparotomic adenomyomectomy. Laparoscopic-assisted adenomyomectomy consisted of a laparoscopic uterine artery procedure to reduce blood loss and a minimal incisional for laparotomic adenomyomectomy. An additional laparoscopic surgery was performed for possible pelvic pathology.ResultsData on patient demographics, surgical indications, operative times, estimated blood loss (EBL), short-term complications, and postoperative hospital stays were compared. The laparoscopic-assisted surgery (LAS) and laparotomic groups were comparable in average EBL (208.0 ± 128.8 vs. 193.6 ± 193.0 ml, p = 0.11), weight of removed mass (85.5 ± 71.7 vs. 108.2 ± 91.9 g, p = 0.39), and postoperative hospital days (HDs) (4.5 ± 1.0 vs. 4.7 ± 0.8 days, p = 0.27). These values were lower in the laparoscopic group (EBL 119.5 ± 79.6 ml, mass weight 39.3 ± 25.9 g, HD 3.6 ± 0.8 days). Additional procedures, including myomectomy and combined severe endometriosis surgery, were more frequently performed in the LAS group than the laparotomic group. The mean operating time was longer in the LAS group (179.8 ± 36.6 min) than the other groups (laparoscopy 99.9 ± 40.6 min, p < 0.00; laparotomy 133.0 ± 41.1 min, p < 0.00). The three groups did not differ significantly in transfusion rates, hemoglobin changes, or perioperative complications. However, febrile morbidity was lower in the laparoscopic group than the LAS and laparotomic groups.ConclusionLAS adenomyomectomy allows for maximal debulking of adenomyosis via extracorporeal and intracorporeal procedures while retaining the advantages of the laparoscopic approach. Additional pelvic surgery for benign uterine and adnexal pathology may easily be performed with this approach.     

The association of dynamic thiol-disulfide homeostasis and inflammatory markers in patients with polycystic ovary syndrome

ObjectivePolycystic ovary syndrome (PCOS) is a common hormonal disorder among women of reproductive age characterized by irregular menstruation and hirsutism and is associated with an increased risk for cardiovascular diseases. Increased inflammatory response and oxidative stress may also present in these patients. In this study, we aimed to compare the neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), and dynamic thiol-disulphide homeostasis (dTDH) between the patients with PCOS and healthy individuals and to investigate the correlation between these parameters and cardiovascular risk factors in patients with PCOS.Materials and methodsA total of 60 participants were included in this study. The patient group consisted of 36 patients who were diagnosed with PCOS and the control group consisted of 24 healthy individuals without PCOS. Complete blood count and hormonal tests were performed using blood samples. The NLR, MPV, and dTDH were compared between the patient and control groups.ResultsThere was no statistically significant difference in the native thiol, total thiol, disulphide levels and disulfide/native, disulfide/total and native/total thiol ratios between the patient and control groups (p = 0.494, p = 0.446, p = 0.338, p = 0.717, p = 0.723, and p = 0.717, respectively). In addition, there was no statistically significant difference in NLR and MPV between the groups (p = 0.531 and p = 0.196).ConclusionOur study results showed no significant difference in the NLR, MPV, dTDH levels, and inflammatory biomarkers including leukocyte count between the PCOS patients and healthy controls. Based on these findings, we conclude that the diagnosis of PCOS alone in overweight patients has no considerable effect on these biomarkers.     

The incidence of placenta related disease after the hysteroscopic adhesiolysis in patients with intrauterine adhesions

ObjectiveTo analyze the correlation between placenta related disease of pregnant women with antecedent hysteroscopic adhesiolysis due to intrauterine adhesions (IUA).Materials and methodsThis is a single center, non-randomized, open-label, retrospective cohort Study. 74 patients who had adhesiolysis and hormone therapy for IUA and progressed into the third trimester were group A and 296 without IUA were group B. The main outcome measure is the incidence of placenta related disease including placenta accreta spectrum, placenta previa, placental abruption, intrauterine growth restriction (IUGR), and pregnancy-induced hypertension (PIH). The second outcome is the perinatal, and intrapartum complications.ResultsPatients in group A had a higher frequency of prior pregnancy times (2.51 ± 1.56 vs.1.84 ± 1.06, p = 0.001) and lower frequency of prior delivery times (0.20 ± 0.41 vs. 1.30 ± 0.51, p < 0.05) than group B at baseline. At delivery, there is no difference between the incidence of PIH and IUGR between two groups. However, a significantly higher frequency of placenta accreta (17.6% vs. 1.4%, OR = 15.56, 95% CI 4.91–49.34), placenta increta (5.4% vs. 0.7%, OR = 8.4, 95% CI 1.51–46.78), placenta previa (8.1% vs. 2.0%, OR = 4.265, 95%CI1.33–13.63) and postpartum hemorrhage (21.6% vs. 3.4%, OR = 7.890, 95% CI 3.41–18.26) were observed in group A than in group B.ConclusionsCompared to general population, the rates of placenta accreta, placenta increta, placenta previa, postpartum hemorrhage are higher among the IUA patients after hysteroscopic adhesiolysis, and special attention is needed at the termination of the pregnancy.     

Effects of a comprehensive physical therapy on moderate and severe obstructive sleep apnea- a preliminary randomized controlled trial

BackgroundCritically compromised by upper airway anatomical impaired properties, obstructive sleep apnea (OSA) can be categorized into different phenotypic traits, mainly including oropharyngeal muscle dysfunction. The upper airway muscle strength training was targeted on oropharyngeal muscle dysfunction by re-educating the oropharyngeal muscles to maintain the upper airway patency. OSA was characterized with multilevel collapsibility of the upper airway; however, the programs are still inconsistent and the effects are unknown. Therefore, the purpose of this study was to investigate the effects of a comprehensive physical therapy on OSA.MethodsFifteen subjects with newly diagnosed moderate or severe OSA (AHI ≥ 15) were randomized into intervention and control groups. The intervention group underwent a 12-week-intervention of hospital based physical therapy, while the control group was kept on waiting for 12 weeks. Polysomnography (PSG) data, oropharyngeal and respiratory muscle performance were measured before and after intervention.ResultsIn intervention group (n = 8), AHI was significantly improved (from 46.96 ± 19.45 to 32.78 ± 10.78 events/h, p = 0.017); in control group (n = 7), AHI was significantly increased (from 35.77 ± 17.49 to 42.96 ± 17.32 events/h, p = 0.043). While the control group remained no change between pre- and post- intervention, the intervention group demonstrated that other PSG outcomes significantly improved, including arousal index (46.04 ± 18.9 versus 32.98 ± 8.35/h), mean SpO₂ (92.88 ± 2.1 versus 94.13 ± 1.46%), and oxygen desaturation index (ODI) (31.13 ± 19.48 versus 20.57 ± 7.83/h).ConclusionThis comprehensive physical therapy can be prescribed for the significant clinical improvement on sleep apnea for the patients with moderate and severe OSA.