Environmental tobacco smoke and stress as risk factors for miscarriage and preterm births

Back ground

Exposure of pregnant women to environmental tobacco smoke has been shown to be associated with low birth weight. Many studies have suggested that stress have a role in the etiology of preterm birth.

Aims

This study carried out from June 2008 to March 2009 to find the relation between environmental tobacco smoke, stress and miscarriage and preterm births.

Methods

A total of 33 subjects consisted of multiparous pregnant women that were in their early third trimester were chosen for this investigation. Subjects were divided into test group women with adverse pregnancy outcome, control group women with successful pregnancy. Four ml of unstimulated whole saliva were collected. The concentrations of cotinine and cortisol were evaluated using commercially available ELISA kit.

Results

Pregnancies in which the average standardized cortisol during history of previous miscarriage(s) which occurred within 6th–27th week or/and history of preterm labor which occurred within 28th–36th weeks of gestation, demonstrated higher cortisol level (1.0201?±?0.1855?ng/ml) compared to control group 0.9757?±?0.2860?ng/ml (P?=?0.323); statistical analysis showed no significant differences. Women of control group were more likely to be environmental tobacco smoke exposed (1.2714?±?1.7639?ng/ml) than women with miscarriage and preterm births (0.9889?±?0.5498?ng/ml).

Conclusion

The results from this primarily study demonstrated no association between cotinine, cortisol, miscarriage and preterm births.     

Pain levels associated with renal colic and primary dysmenorrhea: a prospective controlled study with objective and subjective outcomes

Objectives

To evaluate the degree of pain associated with renal colic and primary dysmenorrhea using objective and subjective measurements.

Methods

In total, 60 subjects participated in this study. There were 20 subjects in the renal colic group (average age 24.45?±?2.35?years), 20 subjects in the primary dysmenorrhea group (average age 23.75?±?1.86?years), and 20 subjects in the control group (average age 24.20?±?2.57?years). The serum chromogranin A (CgA) values were determined by an enzyme-linked immunosorbent assay and the mean pain score was assessed by means of a Visual Analog Scale (VAS) for each individual.

Results

The serum CgA level was 19.83?±?19.61?ng/ml for the renal colic group, 13.45?±?8.52?ng/ml for the primary dysmenorrhea group and 12.45?±?7.76?ng/ml for the control group. The mean VAS score for pain was 7.95?±?1.54 for the renal colic group and 7.05?±?1.50 for the primary dysmenorrhea group.

Conclusions

Primary dysmenorrheic pain is as intense as renal colic pain. Emergency room physicians should display the same degree of care and attention for the treatment of patients with primary dysmenorrhea as they do for patients with renal colic, and rapidly initiate an effective treatment for these patients.     

La consultation préconceptionnelle : pourquoi des adhésions diverses malgré un concept excellent ?

Introduction

Preconceptional clinics and the associated activities seem to be largely accepted but their promotion seems to vary from one country to another. To what extent is this a subjective impression or an objective reality, and which would be the rationale leading to a certain degree of caution in this field?

Material and methods

Three approaches were taken: 1. a ??PubMed?? search; 2. a review of a sample of national recommendations, their presentation and their contents; 3. a research of the first 30 sites listed by Google in Belgium using the keyword ??preconception??.

Results

1. Among the 226 identified publications, only 32% dealt with preconception care, and only 16% presented research/evaluation data. The remainder of the publications related to physiology. 2. The contents of the recommendations were relatively similar; the main difference was the volume of the documents. 3. Less than half of the websites (14/30) were developed by ??medical?? organizations. The others were run by business firms.

Discussion

Several elements can explain the differences between countries. These include all of the following: poor levels of evidence of effectiveness for some components; mix of validated and non validated recommendations; benefits mainly to the educated middle class; predominance of the Western cultural model and finally the appropriateness of limiting healthy lifestyle recommendations to families intending to have a child.

Conclusion

The variations in enthusiasm for the concept of the preconception care may well reflect societal variations, explaining the differences between countries. To what point preconceptional care outside specific medical conditions is, or is not, a priority for public health action warrants further analysis, based on more evidence.     

The effects of different concentrations of sodium selenite on the in vitro maturation of preantral follicles in serum-free and serum supplemented media

Purpose

This study was to investigate the effect of sodium selenite (SS) on in vitro maturation of mouse preantral follicles.

Methods

The isolated preantral follicles were cultured in TCM 199 medium supplemented with different concentrations (0, 5, 10, 15 ng/ml) of SS and 3 mg/ml bovine serum albumin (BSA) or 5% Fetal Bovine Serum (FBS). The ovulation was induced by addition of 1.5 IU/ml human chorionic gonadotropin. The size and development of follicles and oocytes were assessed by calibrated eyepiece.

Results

The survival rates of follicles in FBS supplemented groups containing 5 and 10 ng/ml SS (88.23%, 90.83%) were higher than other groups (P?P?P?Conclusion The sodium selenite and FBS improve the in vitro growth and maturation of mouse preantral follicles.     

Is there any correlation between amh and obesity in premenopausal women?

Purpose

To evaluate the correlation between the levels of anti-mullerian hormone and body mass index between obese and non-obese premenopausal women.

Methods

Serum anti-mullerian hormone levels of women younger than 45?years admitted to our reproductive endocrinology clinic for investigation of infertility were examined in this cross-sectional study. Body mass indices were lower than 30?kg/m² in 222 patients and equal to or higher than 30?kg/m² in 37 patients. Levels of antimullerian hormone were analyzed in each group. Blood samples obtained from study subjects were assayed for levels of anti-mullerian hormone, follicle-stimulating hormone, luteinizing hormone, estradiol, prolactin and thyroid stimulating hormone.

Results

There was no significant difference in terms of mean age between the two groups. There was no statistically significant difference between these two groups in terms of FSH, LH, estradiol and prolactin levels. Anti-mullerian hormone levels were 3.46?±?2.79?ng/ml and 3.79?±?2.93?ng/ml in non-obese and obese participants, respectively. No statistically significant correlation was found between Anti Müllerian Hormone (AMH) levels and BMI levels in either group (P?>?0.05).

Conclusions

Body mass index does not have an effect on serum AMH levels in women of reproductive age. Obesity has no association with levels of serum follicle stimulating hormone, luteinizing hormone, estradiol, prolactin and thyroid stimulating hormone. Obesity is unlikely to affect ovarian reserve in the premenopausal age group.     

Fundamental role of folliculo-luteal function in recurrent miscarriage

Purpose

To re-evaluate the role of folliculo-luteal function (FLF) in recurrent miscarriage (RM) on the basis of new hormonal diagnostic criteria.

Methods

A prospective, randomized, single-blinded, placebo-controlled study was carried out at 110 apparently healthy patients with three or more miscarriages not related to any presumable predisposing factors of RM were investigated. In the treatment group FLF was normalized preconceptionally. Women in the control group received placebo. FLF was regarded as physiological when the mean of three progesterone (P) values measured every second day between the 4th and 9th day after ovulation or before menstruation was 21.0?±?2.0?ng/ml.

Results

A significant difference (p?<?0.001) was found between the physiological and placebo groups in the occurrence of live births: 93 versus 56?%, pregnancy losses: 7 versus 44?%; premature delivery per births: 10 versus 57?%. Luteal mean P and estradiol values were significantly (p?<?0.001) different in cases of spontaneous abortions and premature and mature deliveries, respectively (P: 14.6?±?2.2, 20.2?±?2.7, 27.6?±?3.9?ng/ml). A strong and significant correlation (p?<?0.001) was found between luteal mean P values and the duration of pregnancy (r?=?0.85), as well as between the P means measured in the luteal phase and different parameters of the newborns: weight (r?=?0.89), weight percentile (0.86) and length (0.73). Retrospective analysis of our data suggests that a luteal P mean value of 29.3?±?2.9?ng/ml characterising patients with singular, mature, eutroph newborns seems to be the most favorable P value for successful reproduction in RM.

Conclusion

Determining the oocyte quality and placentation, FLF quantitatively determines the outcome of pregnancy: its duration and different characteristics of the newborns in RM.     

Practicability of vaginal washing fluid creatinine level in detecting premature rupture of membranes

Objective

The purpose of this study was to evaluate the reliability of vaginal washing fluid creatinine level for the diagnosis of premature rupture of membranes (PROM).

Method

A prospective diagnostic study performed in Shahid Sedoughi Hospital on 160 pregnant women (30 definite PROM, 30 no PROM and 100 suspected PROM) at 28?C40?weeks of gestation. The vagina was washed by injection with a syringe filled with 3?ml of saline solution, and the washing fluid was collected from the posterior vaginal fornix and send to laboratory. Creatinine values in vaginal washing were measured and compared.

Result

The mean vaginal fluid creatinine levels in definite PROM group, suspected PROM and no PROM were 0.40?±?0.20, 0.16?±?0.04 and 0.08?±?0.01?mg/dl, respectively, where the difference was statistically significant (P?=?0.001). The sensitivity, specificity, positive and negative predictivity values and accuracy were 98.7, 100, 100, 98.8 and 87.1%, respectively, in detecting PROM by evaluation of vaginal fluid creatinine concentration with cut-off value of 0.14?mg/dl.

Conclusion

This study showed that creatinine determination in vaginal washing fluid is a useful marker for PROM diagnosis. It is a reliable, simple, cheap and rapid test.     

The value of urocortin and Ca-125 in the diagnosis of endometrioma

Purposes

In this study, we sought to establish the value of a new molecule, urocortin (Ucn), in the diagnosis of endometrioma and compare with Ca-125 to identify superiority of urocortin.

Methods

Of the patients operated on at our hospital with the initial diagnosis of adnexal mass, 88 patients whose pathology results were endometrioma and benign ovarian cyst were included in the study. As a result of the pathological examination, the patients were assessed in two groups. Group 1 consisted of 42 cases of endometrioma and Group 2 included 46 cases of benign ovarian cyst (control group). The serum Ucn and CA 125 levels of patients were measured from the blood samples drawn prior to the operation.

Results

While the serum Ucn level was 4.8?±?1.00?ng/ml in the endometrioma group, it was 4.5?±?1.03?ng/ml in the control group (P?=?0.21). The difference was statistically not meaningful. On the other hand, mean serum Ca-125 level was 43.8?U/l (11.7?C251) in the endometrioma group, it was 16.5?U/l (4.3?C121.1) in the control group. The difference was statistically meaningful (P?=?0.001). When the cut-off point for Serum Ca-125 level was taken as 21.38, sensitivity and specificity levels were found to be 88.1 and 63%. When the cut-off point for Ucn was taken as 4.16, sensitivity was 76.2%, and specificity 45.7%.

Conclusion

Ucn was not found to be efficient in distinguishing endometrioma from other benign ovarian cysts or to be superior to CA125 in the diagnosis of endometrioma.     

Analysis about the influence on the fetus infected with parvovirus B19 using amniotic erythropoietin and troponin-T

Objective

We tried to identify the influence on the fetus infected with parvovirus B19 (PB19) and retrospectively analyze the severity of fetal infection.

Methods

Twenty pregnant women who developed maternal PB19 infection were included in this study. A total of 20 amniotic fluid samples were collected for measurement of PB19-DNA, erythropoietin (Epo) and troponin-T (TnT).

Results

Of the 5 fetuses with hydrops, 2 were rescued by fetal therapy. Significant differences between groups were found for Epo and TnT: Epo 107.1 ± 45.3 mU/ml and TnT 0.040 ± 0.028 ng/ml (mean ± standard deviation) for the symptomatic fetus group; and Epo 18.9 ± 13.7 mU/ml and TnT 0.008 ± 0.014 ng/ml for the asymptomatic fetus group (p = 0.043 for both variables). Setting Epo ≥50 mU/ml as the predictor of disease onset resulted in an Odds ratio of 56.0, with a 95 % confidence interval of 7.68–1,108.76.

Conclusion

The study has determined an amniotic Epo level of ≥50 mU/ml as a factor of the influence on the fetus infected with PB19. The measurement of amniotic Epo level combined with amniotic TnT level is effective for determining the severity of fetal hypoxia.     

Sister Mary Joseph’s nodule associated with rare endometrial squamous cell carcinoma

Background

Umbilical metastasis (Sister Mary Joseph??s nodule) is a rare physical sign seen only in 1?C3?% of patients with an intra-abdominal and/or pelvic malignancy. Here, we present a case of Sister Mary Joseph??s (SMJN) nodule originating from a primary squamous cell carcinoma of the endometrium, a rare histological subtype.

Case history

SMJN was detected in a 30-year-old woman after a preoperative CT scan for a suspected umbilical hernia. Subsequent laparotomy and histopathological examination confirmed endometrial squamous cell carcinoma metastasizing to the umbilical region.

Conclusion

The SMJN may be the first presenting sign of an intra-abdominal and/or pelvic malignancy and may co-exist with an umbilical hernia. Therefore, malignancy should be considered one of the differentials of an umbilical mass.     

Serum Fetuin-A levels in women with polycystic ovary syndrome

Purpose

The liver-derived Fetuin-A (α2-Heremans Schmid glycoprotein) is a circulating glycoprotein that may be related to insulin resistance and polycystic ovary syndrome (PCOS). We aimed to investigate the Fetuin-A levels in patients with PCOS.

Methods

A total of 88 women were included in the study. We measured the Fetuin-A levels in 44 women with PCOS and compared with 44 healthy women.

Results

The mean age in control group was 28.61?±?5.0 (18–38) and 25.5?±?4.1 (17–36) in PCOS group. While there was statistically significant difference in terms of age and testosterone levels, there was no difference in terms of smoking status and BMI between the groups. Accordingly, women with PCOS were older than controls [28.61?±?5.0 (18–38) and 25.5?±?4.1 (17–36), respectively, p?=?0.002]. The mean Fetuin-A level of PCOS group was 255.4?±?37.2 (203.1–388.9) ng/mL and the mean Fetuin-A level of control group was 253.0?±?43.2 (179.9–355.4) ng/mL. There was no difference between the groups with regard to Fetuin-A, before and after adjustment for age (p values 0.780 and 0.835, respectively).

Conclusions

Serum Fetuin-A levels of women with PCOS did not change in comparison with the healthy controls.     

BiClamp? forceps was significantly superior to conventional suture ligation in radical abdominal hysterectomy: a retrospective cohort study in 391 cases

Objective

To evaluate the efficacy and security of ERBE BiClamp^? forceps in radical abdominal hysterectomy for managing those cervical cancers, extending to other gynecologic cancers such as endometrial cancer and ovarian cancer as well.

Methods

A retrospective cohort study was made in 391 cases from 450 FIGO IA2-IIB cervical cancers between November 2005 and September 2010. After baseline character analysis, the conventional group (n?=?195) was compared with the BiClamp group (n?=?196) on the basis of surgical outcome and complications. Data analysis was based on intention to treat with statistics software SPSS17.0.

Results

Comparison between conventional suture ligation and BiClamp^? forceps is as follows: the operation time was 247.7?±?47.7?min for the conventional suture ligation versus 224.1?±?36.2?min (P?? forceps, estimated blood loss was 769.2?±?310.4?ml versus 534.8?±?232.5?ml (P?P?P?P?=?0.085), postoperative blood transfusion rate was 17.0 versus 15.6% (P?=?0.818), closed suction drainage was 268.8?±?162.0?ml versus 208.3?±?141.7?ml (P?P?P?=?0.027).

Conclusion

With obvious decrease of operation time, blood loss, postoperative complications, hospital stay and particularly, intra-operative blood transfusion rate, BiClamp^? forceps has been proved more efficient and controllable in radical abdominal hysterectomies of cervical cancers than conventional suture ligations, extending to endometrial cancers and ovarian cancers, hence deserves to be popularized.     

Efficacy of low-dose hCG in late follicular phase in controlled ovarian stimulation using GnRH agonist protocol

Objective

Safe, simple and cost-effective protocol is an important goal in ART cycles. The aim of this prospective study was whether administration of low-dose hCG in late follicular phase can be used clinically to replace gonadotropin administration in GnRH long protocol.

Materials and methods

122 patients who were candidates for ART enrolled the study and randomly divided into two groups. The control group (n?=?62) received standard long protocol and gonadotropin administration continued until the day of hCG injection (10,000?IU) for final follicular maturation. The study group (n?=?60) received GnRH long protocol and when at least ??6 follicles with mean diameter ??12?mm were observed in both ovaries, hMG was displaced by 200?IU per day of hCG until final follicular maturation.

Results

There were no significant differences in age, basal FSH, infertility duration and infertility etiology between two groups. There were no statistically significant differences between two groups regarding chemical pregnancy, clinical pregnancy, ongoing pregnancy, and abortion per cycle (50, 40, 40, and 20?% in study group vs. 45.2, 35.5, 35.5, and 21.4?% in control group, respectively). Mean dose of used gonadotropins was significantly higher in control group than that in the study group (2,524?±?893?IU in control group and 1,439?±?433?IU in study group) (p?=?0.000).

Conclusion

According to our data, we recommend the use of low-dose hCG in GnRH long protocol because of lower doses of used gonadotropins.     

IVF/ICSI outcomes of the OCP plus GnRH agonist protocol versus the OCP plus GnRH antagonist fixed protocol in women with PCOS: a randomized trial

Objective

To compare the IVF/ICSI outcomes of the long GnRH agonist and the fixed GnRH antagonist protocol in women with PCOS.

Design

Randomized controlled trial.

Setting

Baskent University Department of Obstetrics and Gynecology.

Patients

Three hundred women with PCOS.

Interventions

IVF/ICSI following the long GnRH agonist down-regulation or the fixed GnRH antagonist protocols.

Main outcome measures

Ongoing pregnancy rates.

Results

Ongoing pregnancy rates were 36.4?% in the OCP?+?GnRH agonist group and 35.9?% in the OCP?+?GnRH antagonist group (p?>?0.05). Progesterone levels on the day of hCG (0.76?±?0.71 vs. 0.58?±?0.50), endometrial thickness on the day of hCG (11.57?±?2.50 vs. 10.50?±?2.01), total gonadotropin used (1388.71?±?482.39 vs. 1253.25?±?415.81), and duration of COH (9.07?±?1.96 vs. 8.39?±?1.75) were significantly lower in the OCP?+?GnRH antagonist group.

Conclusion

The OCP?+?long GnRH agonist and the OCP?+?fixed GnRH antagonist protocols yield similar ongoing pregnancy rates in women with PCOS. Although this study consisting three hundred patients, seems to be large enough in a single center, we were not able to reach to the actual size of power analysis which was approximately 3,000.     

Adiponectin, leptin and lipid profiles evaluation in oral contraceptive pill consumers

Background

The aim of this study was to evaluate serum lipid profiles, leptin and adiponectin levels in women with a normal menstrual cycle receiving low-dose (LD) combined oral contraceptive pill (COC) (levonorgestrel 0.15?mg, ethinyl-estradiol 0.03?mg).

Study design

Serum adiponectin and leptin concentrations were measured by enzyme-linked immunosorbent assay (ELISA), and spectrophotometric assay was used for serum lipid and lipoprotein profiles assay in 50 healthy women with normal menstrual cycles who served as the control group and 50 women taking COCs. Unpaired t test and Chi-square test were used for comparison of variables between oral contraceptive users and non-oral contraceptive users.

Results

Serum adiponectin and leptin levels were changed in COC consumers. The data obtained for adiponectin in COC consumers (6.6?±?4.06?μg/ml) were significantly lower (?27.4%, P?=?0.004) than control group (9.1?±?5.09?μg/ml). The difference between the serum leptin concentration of the control group (11.5?±?6.9?ng/ml) and women receiving COCs (14.1?±?6.7?ng/ml) was not significant (+18.4%, P?=?0.083). There was nonsignificant difference between HDL levels of subjects taking COC (44.02?±?10.7?mg/dl) and control group (49.4?±?14.3?mg/dl). The LDL levels of COC consumer (131.40?±?66.40?mg/dl) was significantly higher (P?=?0.002) than controls (102.30?±?44.0?mg/dl). The serum cholesterol concentration of women receiving COC (193.2?±?70.4?mg/dl) was significantly higher (P?=?0.05) than controls (172.8?±?49.6?mg/dl). The age of COC consumption and the duration of intake of COCs beyond 36?months had no significant effect on the adiponectin and leptin concentrations.

Conclusion

LD COC uptake results in a significant decrease in serum adiponectin concentration, nonsignificant increase in leptin levels and a more atherogenic lipid profile by significantly increasing LDL and nonsignificantly decreasing HDL concentrations. These findings suggested that COC may reduce or stimulate the adiponectin and leptin concentrations, respectively. This might be due to an effect of these pills on adipocyte maturation via inhibition or stimulation of the synthesis of new adiponectin and leptin molecules or may be a result of the increased frequency of a particular allele of the adiponectin and leptin. It is suggested that these alterations in adiponectin and leptin concentrations and lipid profiles may be related to their probable effects in response to various pathological and physiological properties of COC or its metabolites. It seems that probably free radicals produced during metabolism of COCs change the amounts of adipokines and atherogenic lipids.     

Emergency cervical cerclage after miscarriage of the first fetus in dichorionic twin pregnancies: obstetric and neonatal outcomes of delayed delivery interval

Purpose

To study the effectiveness of emergency cervical cerclage in order to delay the delivery interval after miscarriage of the first fetus in dichorionic twin pregnancies.

Methods

Dichorionic twin pregnancies after miscarriage of the first fetus (<24?weeks) were exclusively included in the present analysis. Prolongation of delivery interval was managed with additional emergency cervical cerclage in the already initiated tocolytic therapy. Obstetric outcomes (cervical dilatation, gestational age at delivery of the first twin, interval between miscarriage and delivery of the second fetus) and neonatal outcomes [neonatal birth weight, Apgar score in the first and fifth minute, admission to Neonatal Intensive Care Unit (NICU)] of the second twin were analyzed.

Results

Five cases of dichorionic twin pregnancies were included in our study. Cervical dilatation (mean?±?SD) at admission time was 3.7?±?1.4?cm. The gestational week at delivery of the first twin was 20.6?±?2.6. The median delivery interval was 72?days and the maximum 121?days. Mean gestational age at delivery of the second twin was 28.8?±?7.2?weeks and mean birth weight 1,772.5?±?742?g. The rate of live birth was 80?%, while NICU admission was demanded in 75?% of the live births. All neonates discharged from NICU remained alive after 1?month of life.

Conclusion

The present study demonstrated beneficial effect concerning obstetric and neonatal outcomes of the second twin after performing emergency cervical cerclage to postpone the delivery interval in premature dichorionic twin pregnancies.     

Vitamin D as a follicular marker of human oocyte quality and a serum marker of in vitro fertilization outcome

Purpose

This study investigated the relationship between the vitamin D [25(OH)D] level in individual follicles and oocyte developmental competence.

Methods

A prospective cohort study in a private infertility center. Infertile women (N?=?198) scheduled for intracytoplasmic sperm injection (ICSI) and a single embryo transfer (SET) provided serum samples and 322 follicular fluid (FF) specimens, each from a single follicle on the day of oocyte retrieval.

Results

FFs corresponding to successfully fertilized oocytes (following ICSI) contained significantly lower 25(OH)D level compared with those that were not fertilized (28.4 vs. 34.0 ng/ml, P?=?0.001). Top quality embryos on the third day after fertilization, when compared to other available embryos, developed from oocytes collected from follicles containing significantly lower 25(OH)D levels (24.56 vs. 29.59 ng/ml, P?=?0.007). Positive hCG, clinical pregnancy, and live birth rates were achieved from embryos derived from oocytes that grew in FF with significantly lower 25(OH)D levels than in follicles not associated with subsequent pregnancy. The concentration of 25(OH)D in FF in women with negative hCG was 32.23?±?20.21 ng/ml, positive hCG 23.62?±?6.09 ng/ml, clinical pregnancy 23.13?±?6.09 ng/ml, and live birth 23.45?±?6.11 ng/ml (P?<?0.001). Women with serum 25(OH)D?<?20 ng/ml had not only a higher fertilization rate (71 vs. 61.6%, P?=?0.026) and a higher clinical pregnancy rate (48.2 vs. 25%, P?=?0.001), but also higher miscarriage rate (14.5 vs. 3.8%, P?=?0.013) compared with those with levels ≥?20 ng/ml.

Conclusion

This study reveals that the level of 25(OH)D in FF correlates negatively with the oocytes’ ability to undergo fertilization and subsequent preimplantation embryo development. Oocytes matured in FF with low 25(OH)D concentration are more likely to produce top quality embryos and are associated with higher pregnancy and delivery rates. On the other hand, low serum vitamin D concentration is associated with higher miscarriage rates.

     

Intraabdominal adhesion formation is associated with differential mRNA expression of metabolic genes PDHb and SDHa

Purpose

Intraabdominal adhesions represent a major cause of postoperative morbidity potentially causing pain, small bowl obstruction and infertility. The process of adhesion formation might be regarded as an ischemic disease. Under hypoxic conditions, metabolic enzymes are regulated via hypoxic responsive elements by the hypoxia-inducible factor 1 (HIF-1). We therefore investigated the gene expression of HIF-1 and two pivotal metabolic genes, pyruvate-dehydrogenase?? (PDHb) and succinate-dehydrogenase-complex-subunit-A (SDHa) in a validated ischemia model of adhesion formation.

Methods

Peritoneal adhesions were created using an ischemic button model in female Wistar rats. Expression levels of HIF-1??/??, PDHb and SDHa in adhesiogenic versus native peritoneum were analyzed using quantitative PCR on the third post-operative day.

Results

Gene expression of HIF-1?? was up-regulated by 10?% (p?=?0.003), PDHb was up-regulated by 23?% (p?=?0.0004) and SDHa (p?=?0.0005) was up-regulated by 24?% in the adhesiogenic peritoneum compared to native peritoneum. The expression level of HIF-1?? was not significantly influenced by adhesion formation.

Conclusion

The increased expression level of HIF-1?? in the peritoneal tissue of ischemic buttons associated with postsurgical adhesions supports the major role for hypoxia in influencing peritoneal expression patterns of genes involved in the process of adhesion formation. As pivotal metabolic genes are upregulated, this seems to be an anabolic process associated with increased cellular metabolism.