May ratio of neutrophil to lymphocyte be useful in predicting the risk of developing preeclampsia? A pilot study

Objective: The aim of the study was to evaluate the relationship between neutrophil to lymphocyte ratio (NLR) and preeclampsia.

Methods: Demographic data and laboratory tests for NLR of 203 pregnant women (73 normotensive pregnants, 23 pregnants with mild preeclampsia and 107 pregnants with severe preeclampsia) were retrospectively analyzed. Neutrophil to lymphocyte ratios were compared between the study groups.

Results: Preeclamptic pregnant women had smaller gestation weeks, lower hemoglobin level and fetal birth weight than that of normal pregnant women. NLR in preeclamptic group was significantly higher than that of normal group (p?=?0.023) and area under ROC curve was found statistically significant (p?=?0.023). However, there was no statistically significant relationship between NLR and severity, proteinuria level, subjective symptoms and onset time of the disease.

Conclusion: The findings showed that the measurement of NLR periodically may be useful to predict high-risk pregnancies in terms of preeclampsia, but further studies are needed to determine its contribution.     

Polymerase ε (POLE) ultra-mutation in uterine tumors correlates with T lymphocyte infiltration and increased resistance to platinum-based chemotherapy in vitro

Objective

Up to 12% of all endometrial-carcinomas (EC) harbor DNA-polymerase-ε-(POLE) mutations. It is currently unknown whether the favorable prognosis of POLE-mutated EC is derived from their low metastatic capability, extraordinary number of somatic mutations thus imparting immunogenicity, or a high sensitivity to chemotherapy.

Can preoperative neutrophil:lymphocyte and platelet:lymphocyte ratios be used as predictive markers for lymph node metastasis in squamous cell carcinoma of the vulva?

Objective

To determine whether the neutrophil:lymphocyte ratio (NLR) and platelet:lymphocyte ratio (PLR) before complete surgical staging provide information on lymph node metastasis in vulvar squamous cell carcinoma (SCC).

Study design

All patients with vulvar SCC who underwent complete surgical staging at two institutions between 1 January 2005 and 31 December 2011 were identified retrospectively from patient databases. Receiver operating characteristic (ROC) curve analysis was used to evaluate cut-off, sensitivity, and specificity values for preoperative NLR and PLR to predict lymph node metastasis.

Results

Data from 64 women with adequate information were analyzed. Lymph node involvement was detected in 19 (29.7%) patients. NLR and PLR were higher in the lymph node – positive group than in the – negative group (p < 0.001). The best cut-off values for predicting lymph node metastasis were 2.81 for the NLR, with 84.5% sensitivity and 89.5% specificity, and 139.5 for the PLR, with 68.9% sensitivity and 89.5% specificity. Forty of the 64 (62.5%) patients had NLRs ≤2.81 and 24 (37.5%) had NLRs >2.81. Lymph node involvement was more common in the NLR >2.81 group [60.7% vs. 5.6%; relative risk RR = 10.9, 95% confidence interval CI = 2.7–43.4; p < 0.001]. Mean tumor sizes were 4.2 ± 2.3 cm in the NLR >2.81 group and 2.1 ± 1.2 cm in the NLR ≤2.81 group (p = 0.001). The rate of lymph node involvement was higher in the PLR >139.5 group than in the PLR ≤ 139.5 group (54.8% vs. 6.1%; RR = 9.0, 95% CI = 2.2–35.9; p < 0.001).

Conclusion

Preoperative NLR and PLR are directly associated with nodal involvement status of vulvar SCC. These markers are simple, readily obtained and calculated, and easy to integrate into the surgical work-up of patients with vulvar SCC, at no extra cost.     

Evaluation of neutrophil–lymphocyte ratio,platelet–lymphocyte ratio and red blood cell distribution width–platelet ratio as early predictor of acute pancreatitis in pregnancy

Objective: Acute pancreatitis (AP) is a state of inflammation. It has been widely known that neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and red blood cell distribution width (RDW) to platelet ratio (RPR) reflect systemic inflammation. The aim of this study is to investigate whether these inflammatory markers could be used as reliable markers in early prediction of AP in pregnancy and if there is a relationship between disease severity and these markers.

Methods: The study group consisted of 14 patients, who developed AP in ongoing pregnancy, and the control group consisted of 30 healthy pregnant women. NLR, PLR and RPR were calculated for both the groups.

Results: NLR was significantly elevated in the AP group when compared with the controls (p?=?0.00), but there was no statistically significant difference in terms of PLR and RPR (p?>?0.05). ROC curve analysis results for NLR showed that there was a significant prediction power of NLR for AP (R²?=?0.842; p?<?0.001). For NLR parameter, if cut-off value is chosen to be 4.1030, then sensitivity is 71.4% and specificity is 100.0%. There was statistically significant and positive correlation between C-reactive protein (CRP) and glucose with NLR (p?=?0.001, p?=?0.043). It was seen that Ranson was close to be significant (p?=?0.051).

Conclusion: NLR might be used as an early marker of AP and may have a role in prediction of disease severity.     

Second cycle: to hatch or not to hatch?

The objective of this study was to assess the impact of assisted hatching (AH) on pregnancy rate (PR), clinical pregnancy rate (CPR), and implantation rate (IR) after a single failed, fresh, nondonor IVF cycle. Accordingly, we report that patients with one prior implantation failure benefit from AH with improved PR, CPR, and IR in a subsequent cycle.     

Prospective cohort study about the lymphocyte subpopulations’ change and impact on the pregnancy outcome in fetal growth restriction

Objective: To evaluate lymphocyte subpopulations’ change and impact on the pregnancy outcome in fetal growth restriction (FGR) through a prospective cohort study. Methods: Sixty singleton pregnancies with FGR and 20 normal pregnant women were enrolled at the third trimester of pregnancy in this study. FGR was defined according to fundal height and abdominal circumference through obstetric examination and ultrasound examination. Third trimester peripheral blood and umbilical cord blood lymphocyte subpopulations were analysed by flow cytometry. The cytotoxic activity of lymphocytes using umbilical cord blood mononuclear activated kill cells as the effector cells, K562 cells as the target cells was measured by MTT deoxidation assay. Results: There were no significant differences about the age, parity, gestational age enrolled, BMI before pregnancy between the FGR and control group. The birth weight, length and head circumference of the neonates from FGR group were less than that from normal control. The percentages of B-lymphocytes in peripheral blood at the third trimester were significantly increased in FGR group compared to that in control group (P < 0.05). In umbilical cord blood, FGR group had a higher percentage of both CD3 and CD4 lymphocyte, lower absolute cell counts and percentage of B-lymphocyte, and higher CD4/CD8 ratio than control group (P < 0.05). Most importantly, the kill cell activity of the lymphocytes in cord blood from FGR group was significantly higher than that from control group (P < 0.05). The significant positive correlations were also found that the percentage and number of B lymphocytes in umbilical cord blood with birthweight, birthlength and birth head circumference, but CD4/CD8 ratio, the kill cell activity in umbilical cord blood had negative correlations with that. The percentage of B lmyphocyte in third trimester and CD4/CD8 ratio, kill cell activity in umbilical cord blood are associated with an increased risk of prematurity and SGA birth, but contrary result was found with the percentage and number of B lmyphocyte in cord blood. Conclusions: Fetal immunological rejection could be involved in the pathogenesis of FGR. The changes of T lymphocyte subpopulations and B-cells, enhanced kill cell activity might cause FGR and preterm birth.     

Celiac disease during pregnancy: to screen or not to screen?

Permanent intolerance to gluten, known as celiac disease, affects both fertility and pregnancy outcomes when left untreated. Recent research on celiac disease and reproduction urge increased screening for celiac disease. While this may be beneficial for couples facing idiopathic infertility or those from particular risk groups, screening involves its own risks and expenses, and has not been consistently proven effective for the general population while pregnant. The present editorial discusses the potential advantages and disadvantages of screening during pregnancy and examines when screening may be helpful.     

Polycystic Ovarian Syndrome: Is It Time to Rename PCOS to HA-PODS?

The term polycystic ovarian syndrome (PCOS) came into existence 80 years ago. Pathophysiology of PCOS remains ill understood despite extensive research in this field. It is now accepted that the manifestations of PCOS are not confined to the reproductive dysfunction, and there are endocrine–metabolic implications to PCOS with several consequences to female health. PCOS is a misnomer as ovaries do not contain epithelial cysts, but they are actually antral follicles. Moreover, the name PCOS neither reflects the hyperandrogenism which is essential for diagnosis nor the metabolic derangements. While various authors have expressed the need for change of the name, a suitable new option has not yet been established. This review aims to analyse the current understanding of pathophysiology of PCOS and addresses to the controversies associated with its diagnosis and nomenclature. The name “Hyperandrogenic Persistent Ovulatory Dysfunction Syndrome or HA-PODS” is proposed here to overcome diagnostic pitfalls of previous nomenclature. This new name will help formulate appropriate treatment and promote consistency in research as well. Further categorizations of HA-PODS are also discussed in the article.     

Is letrozole superior to clomiphene for ovarian stimulation prior to intrauterine insemination?

Objective

To compare the efficacy of letrozole with clomiphene citrate for ovarian stimulation prior to intrauterine insemination.

Methods

A total of 272 patients underwent 362 cycles of stimulation prior to IUI from January 2009 to May 2011. One hundred and twenty-six patients (170 cycles) received letrozole 5 mg and 146 patients (192 cycles) received clomiphene citrate 100 mg for 5 days starting on day 3 of the cycle. Intrauterine insemination was done 36 ± 4 h after hCG injection in 99 patients (131 cycles) in the letrozole group and 115 patients (136 cycles) in the clomiphene group. The number of mature follicles and serum E2 levels was monitored on the day of hCG. Endometrial thickness was noted on the day of hCG and IUI as well. The pregnancy rate, the miscarriage rate, and other parameters were evaluated only for patients who underwent IUI.

Results

The mean number of mature follicles was significantly more in the clomiphene group (1.66 ± 1.69 vs. 1.41 ± 1.53) than in the letrozole group. No significant difference in endometrial thickness on the day of hCG administration was found; however, endometrial thickness was statistically significantly higher in the clomiphene group on the day of IUI (9.28 ± 1.43 vs. 8.77 ± 1.34). Serum E₂ levels on the day of hCG were statistically significantly higher in the clomiphene group (501.09 ± 2.45 vs. 214.79 ± 2.43 pg/ml). Pregnancy rate was 9.2 %/cycle and 12.12 %/patient in the letrozole group, and 8.1 %/cycle and 9.5 %/cycle in the clomiphene group; these differences were not statistically significant.

Conclusion

This study found no superiority of letrozole over clomiphene when used for ovarian stimulation and IUI.