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Background Varicocele occurs as a result of dilatation of the pampiniform plexus in the spermatic veins. In this study, our primary aim was to evaluate the effect of Transversalis Fascia Plane Block (TFPB) on pain scores in the postoperative period in patients undergoing varicocelectomy surgery, and our secondary aim was to evaluate the effect of TFPB on analgesic consumption. Methods The study was initiated following local ethics committee approval, and sixty ASA I-II patients > 18y scheduled to undergo varicocelectomy and who consented to participation were enrolled. Before the procedure, the patients were randomly assigned two groups: Transversalis Fascia Plan block group (Group TFPB) or surgical incision site infiltration group (Group I).All surgeries were carried out under general anesthesia, and microsurgery using the subinguinal approach. After surgical suturing, TFPB and local infiltration blocks were applied prior to termination of anesthesia.For each block, 20 mL of 0.25% bupivacaine was utilized. Patients' demographic information, passive and active VAS ratings after surgery, usage of non steroidal anti-inflammatory medications and rescue analgesia, and the requirement for rescue analgesia, were recorded. Results A total of 60 patients were included in the study. In terms of demographic data, there was no difference between the groups. At all hours, there was a statistically significant decrease in favor of Group TFPB in terms of active and passive VAS scores (p p p Conclusion This study has shown that TFPB can provide a more effective analgesia when compared to surgical site infiltration.

The October 30, 2020 Earthquake caused unexpectedly significant damage in İzmir considering its distance to the city. This paper evaluates the recorded ground motions, summarizes the performance of structures affected from the earthquake with emphasis on the reasons of damage. A detailed damage assessment was carried out by the Earthquake Engineering Research Center of Middle East Technical University to compile data on the damage of RC and masonry buildings. It was observed that majority of the damage was concentrated in the Bayraklı district due to its peculiar soil properties where many 7-10 story mid-rise RC buildings suffered heavy damage and collapse. The level of amplified ground motions combined with deficiencies of apparently non-code compliant buildings exacerbated the damage. The main reasons of damage were mainly attributed to the presence of soft stories, lack of proper detailing, poor construction quality, presence of heavy overhangs, and hence significant lack of code-compliance in essence. The influence of infill walls on seismic performance of deficient and inadequate buildings was clearly seen in this earthquake. This paper also discusses seismic code requirements in effect and their influence on the observed building performance. The recorded ground motions were compared with the code spectra to evaluate the performance of the buildings. The code response spectra were found to be well above the recorded ground motion spectra at the sites where significant damage was observed.

This paper presents forced and ambient vibration tests on a six-storey precast concrete frame building, a structural system that has not often been the focus of such tests in spite of its widespread use. Precast buildings come with semi-rigid connections so their idealisation requires good knowledge of the construction practice for those connections and their details. Structural system dynamic properties are identified for the first three translational modes along each axis of the building and for the first three torsional modes. The study shows that the three-dimensional finite-element structural model for the building is capable of replicating the measured in situ dynamic properties. In the small displacement elastic range, the finite-element modelling of precast concrete frame systems is not very different from their cast-in-place counterparts but an extrapolation to the large displacement range requires empirical confirmation.

Study Objective To evaluate whether the presence of an ultrasonographic visible isthmocele has an impact on the chance of pregnancy in women undergoing embryo transfer. Design Age-matched retrospective study. Setting Private-assisted reproductive center. Patients The study included a total of 150 patients with a history of cesarean delivery with 75 isthmocele cases and 75 controls. All patients underwent embryo transfer from January 2017 through June 2018. The diagnosis of isthmocele was based on transvaginal ultrasound assessment. Isthmocele was defined as an anechoic indentation on the previous cesarean scar at the midsagittal plane, with a depth of >1 mm. Interventions Embryo transfer. Measurements and Main Results The groups were similar in patient and treatment characteristics. The live birth rate was 44% in the isthmocele group and 46.7% in the control group (odds ratio [OR] 0.89; 95% confidence interval [CI], 0.47–1.71; p = .743). The clinical pregnancy rates were 49.3% and 50.7%, respectively (OR, 0.94; 95% CI, 0.50–1.79; p = .870). The miscarriage rate was greater in the isthmocele group (8%) than in the control group (4%); however, it did not reach statistical significance (OR, 2.09; 95% CI, 0.50–8.67; p = .302). The multiple pregnancy rate was similar between the groups (8% vs 5.3%, respectively; OR, 1.54; 95% CI, 0.41–5.70; p = .513). The groups were also similar in ectopic pregnancy rates (p = .560). These outcomes remained similar when adjusted for potential confounders on the regression analysis. Conclusion Isthmocele does not seem to have a significant impact on the chance of pregnancy in assisted reproductive treatment settings. However, the embryo transfer procedure may be more difficult in the presence of an isthmocele.

Escherichia coli is the leading etiological agent of community-acquired urinary tract infection (UTI). Fluoroquinolones have long been the choice of empirical treatment for UTIs. Plasmid-mediated fluoroquinolone-resistance (PMFR) is important not only for conferring resistance to fluoroquinolones but also because of the presence of PMFR genes on plasmids carrying genes encoding resistance to other antimicrobials. In this study, we aimed at investigating the frequency of PMFR genes in fluoroquinolone-resistant and/or expanded spectrum beta-lactamase (ESBL)-producing E. coli strains isolated from pediatric and adult patients diagnosed with UTI. E. coli strains isolated from urine cultures of 141 adult and 117 pediatric outpatients were evaluated. Antimicrobial susceptibilities were interpreted according to the EUCAST criteria. The presence of PMFR genes (qnrA, qnrB, qnrC, qnrS, qepA, aac(6')-Ib, and aac(6')-Ib-cr) was investigated by multiplex PCR analysis. One hundred-three (73.05%) adult and 92 (78.63%) pediatric isolates were fluoroquinolone resistant and/or ESBL producers. One third (92/258) of all isolates carried at least one PMFR gene, the most prevalent one being qnrS (67.4%). None of the isolates carried qnrC and qepA genes. PMFR determinants were found to be widespread among adult and pediatric isolates. Rational antimicrobial use is crucial for prevention of resistance in both adult and pediatric populations.

This article presents the use of the analytic signal procedure for processing the large volume of structural vibration data recorded in forced vibration tests. The analytic signal facilitates the computationally laborious task of extracting the steady-state amplitude for each response measure of interest from the recorded accelerations throughout the building at each operated frequency of the forced vibration source. The implementation of the signal processing procedure introduced here is illustrated in deriving the acceleration–frequency response curves from the forced vibration test of the first permanently instrumented building in Turkey. This reinforced concrete building, subsequently strengthened with cast-in-place reinforced concrete infill shear walls, is located in close proximity to the North Anatolian Fault. Later, system identification of the building yields the in situ structural system dynamic properties for the first translational and torsional vibration modes, which are compared with those identified from the ambient vibrations of the building recorded following its forced vibration test. The analytic signal procedure is a convenient tool for the rapid and correct derivation for mode shapes and associated frequencies and damping ratios from forced vibration testing of structural systems.

PURPOSE: To compare outcomes between daily intramuscular progesterone (IMP) and daily vaginal progesterone (VP) gel plus weekly intramuscular hydroxyprogesterone caproate (IMHPC) for luteal phase support (LPS) in single, autologous euploid frozen-thawed blastocyst transfers (FBTs) following artificial endometrial preparation (EP). METHODS: The retrospective cohort study included 767 single, autologous FBTs from 731 patients between January 2015 and March 2018. LPS was performed either with IMP (100 mg/day) or with VP gel (90 mg, twice daily) plus IMHPC (250 mg/week). Oral estrogen was prescribed in combination of both regimes. Oral estrogen was discontinued following the visualization of fetal cardiac activity on ultrasound and progesterone at 10 weeks of gestation. The primary outcome was live birth rate. The secondary outcomes included implantation, clinical pregnancy, and multiple pregnancy rates. RESULTS: Patient characteristics did not differ in LPS regimes. Of 767 FBTs, 608 had IMP (100 mg/day) for LPS and 159 had VP gel (90 mg, twice daily) plus IMHPC (250 mg/week) for LPS. The live birth rate was 51.8% and 50.3%, respectively (p = 0.737, OR 0.94, 95%CI 0.66–1.33). The implantation rate was 62.7% and 64.2%, respectively (p = 0.730, OR 1.06, 95%CI 0.74–1.53). The clinical pregnancy rates were also similar in both groups (59.5% vs. 61.6%, respectively, p = 0.631, OR 1.09, 95%CI 0.76–1.56). CONCLUSIONS: We did not observe significant differences in the rates of live birth, implantation, and clinical pregnancy between daily IMP and daily VP gel plus weekly IMHPC for LPS in single, autologous euploid FBTs after artificial EP.

Research question: Does the use of preimplantation genetic testing for aneuploidies (PGT-A) improve outcomes in couples with severe male factor infertility (SMFI)? Design: This retrospective cohort study included SMFI cases that underwent blastocyst transfer with/without PGT-A. Inclusion criteria were SMFI (azoospermia and sperm count

A radio-resistant bacterium, designated as strain WMA-LM9, was isolated from desert soil. 16S rRNA gene sequencing indicated that the bacterium belongs to genus Deinococcus with maximum similarity to Deinococcus radiopugnans. Deinococcus sp. strain WMA-LM9 was found to be resistant to a ultraviolet (UV) dose of 5 × 103 J/m2, hydrogen peroxide (50 mM) and mitomycin C (10 μg/ml). A carotenoid pigment was extracted using chloroform/methanol/acetone (7:5:3) and purified by high-performance liquid chromatography on a C18 analytical column. The compound was characterised as mono-esterified astaxanthin by 1H, 13C nuclear magnetic resonance and mass spectrometry. It was tested for antioxidant activity, total flavonoids and phenolic content, radioprotective potential in correlation to the prevention of protein oxidation and DNA strand breaks in vitro. The carotenoid pigment showed a very potent antioxidant activity and significantly stronger scavenging ability against superoxides, with an IC50 (concentration causing 50% inhibition of the desired activity) of 41.6 μg/ml. The total phenolic and flavonoid contents were 12.1 and 7.4 μg in terms of gallic acid and quercetin equivalents per milligram of dried mass, respectively. astaxanthin also showed a higher inhibitory action against oxidative damage to collagen, elastin and bovine serum albumin than did β-carotene. The carotenoid also inhibited breaks to DNA strands, as indicated by the results of the DNA damage prevention assay. We conclude that astaxanthin from Deinococcus sp. strain WMA-LM9 has protective effects against radiation-mediated cell damage, and it also protects cellular protein and DNA against oxidative stress and other anti-oxidant activities.

Can serum oestradiol concentrations on the day of progesterone initiation predict live birth rates in single, autologous vitrified-warmed blastocyst transfers following artificial endometrial preparation?This retrospective study included the first transfers of 468 patients with unexplained or tubal factor infertility who underwent freeze-all cycles using single, top-quality blastocysts after artificial endometrial preparation from January 2015 to January 2018. Patients were stratified into four groups based on serum oestradiol concentration percentiles on the day of progesterone initiation: Group 1 (25th percentile), Group 2 (25-50th percentile), Group 3 (51-75th percentile) and Group 4 (75th percentile). The primary outcome was live birth rate. The secondary outcomes were implantation, clinical pregnancy and multiple pregnancy rates. Receiver operating characteristic (ROC) curves were generated to evaluate serum oestradiol concentrations in predicting implantation, clinical pregnancy and live birth.Similar live birth rates of 51.6%, 55.1%, 54.9% and 56.4% for Groups 1, 2, 3 and 4, respectively, were found. The groups also showed similar implantation and clinical pregnancy rates. ROC analysis revealed that serum oestradiol concentrations on the day of progesterone initiation were not predictive for implantation (area under the curve [AUC] 0.490, 95% CI 0.445-0.554), clinical pregnancy (AUC 0.507, 95% CI 0.453-0.561) or live birth (AUC 0.514, 95% CI 0.461-0.566).Serum oestradiol concentration monitoring just prior to progesterone administration does not appear to be predictive for live birth rates in good prognosis patients undergoing single, autologous vitrified-warmed blastocyst transfer after artificial endometrial preparation. Therefore, the current practice of monitoring serum oestradiol concentration is not supported by this study.

The effect of autoclaved aerated concrete (AAC) infill walls on the structural system dynamics of a two-story reinforced concrete building is investigated using its finite element structural model, which is calibrated to simulate the acceleration-frequency response curves from its forced vibration test. The model incorporating the AAC infill walls by equivalent diagonal struts captures the increase in lateral stiffness of the building and the torsional motions induced due to the asymmetrically placed AAC infill walls. A higher strut width coefficient than in ASCE/SEI 41-06 is recommended to model the stiffness of the AAC infill walls in the elastic range.

The aim of this study was to investigate the relationship of cathepsin B, relaxin and anti-Mullerian hormone (AMH) in follicular fluid (FF) with pregnancy rates in infertility patients.Seventy-nine infertile couples who underwent ICSI were included in the study. The FF levels of cathepsin B, relaxin and AMH were measured using ELISA kits.The FF cathepsin B levels were statistically higher in pregnant patients compared with non-pregnant patients (0.20±0.13 versus 0.13±0.03; P0.001). There were statistically significant differences in the total number of oocytes (10.00±6.85 versus 5.96±3.94); the mean number of M2 oocytes (8.65±5.63 versus 4.58±3.36) between the pregnant and non-pregnant patients (P0.05). There were no significant correlations between pregnancy rates and relaxin and AMH (P0.05). The area under the curve of cathepsin B for prediction of pregnancy was 0.662 (p=0.024, 95% Confidence Interval 0.528-0.797).This study demonstrated that increased level of cathepsin B in FF significantly correlates with a better chance of clinical pregnancy. Further studies are needed to clarify the role of cathepsin B in the reproductive process of humans.

It has been documented that exogenously administered irisin (1010 fibronectin-type III domain-containing 5 [FNDC5]), which is a new polypeptide hormone, induces the browning of subcutaneous fat and thermogenesis. In this study, effects of physical activity and exogenous administration of irisin were investigated on parameters related with reproduction and metabolism in the high-fat diet-induced obesity model of the female C57BL/6J mice. Sixty mice were gathered at age approximately 5 to 6weeks and were divided into 3 groups. Control group remained sedentary. Irisin group remained also sedentary but intravenously received 1010 FNDC5-expressing adenovirus after 20 weeks. Exercise group performed treadmill after 6 weeks. All mice were sacrificed 22 to 23 weeks after the start of the study. There was a significantly greater Δ weight in the controls compared with the irisin and exercise groups ( P .05), whereas primary and secondary follicles per ovary were higher in the irisin and exercise groups compared with controls ( P < .05). Pharmacologic introduction of irisin may improve metabolic factors such as insulin sensitivity and obesity by promoting weight loss and consequently improving the reproductive potential.

Aim: The aim of this study is to evaluate the effects of number and size of antral follicles on ovarian reserve and subsequently in vitro fertilization (IVF) outcome. Material and Method: 44 patients treated with IVF in the Infertility Clinic of Zeynep Kamil Women’s and Children Disease Education and Research Hospital (Istanbul, Turkey) were prospectively included in this study. On the third day of menstrual bleeding, transvaginal ultrasound was performed. Antral follicle count (AFC) and antral follicle (AF) size were recorded in these patients. Group I as AF > 5mm and Group II as AF ≤ 5mm were defined. The patients underwent controlled ovarian hyperstimulation with rec-FSH following. Results: Our findings indicated that there was not a statistical difference in number of total oocytes ( 11.03± 6.59 vs. 13.71± 5.38), embryos (5.7± 4.46 vs. 7.29± 5.05) and pregnancy rates ( 76.7% vs. 71.4%) between groups according to antral follicle size (AF ≤5mm vs. AF >5 mm) . Under the area of ROC curve estimations for ovarian response revealed that antral follicle (AF) >5 mm had the largest area 0.675±0.083 (0.517-0.808). Discussion: There might be an association between AF that is larger than 5 mm in size and number of retrieved mature oocytes. Since AFC, is a routine screening test in any IVF center, we believe paying closer attention to the measurement of AFC that are larger than 5 mm in size might help clinicians to achieve more successful outcomes in terms of on embryo quality and pregnancy outcome in women undergoing an in vitro fertilization.

To investigate fetuin-A concentrations and its association with metabolic and sonographic cardiovascular markers in women with polycystic ovary syndrome (PCOS) and healthy subjects.Thirty-five women with PCOS and 37 healthy control women were matched for body mass index (BMI) and age. Serum fetuin-A concentrations, and reproductive and adrenal hormones were measured, and insulin resistance and carotid intima media thickness (CIMT) were evaluated in both groups. The correlations between cardiovascular risk factors, CIMT and fetuin-A concentrations were tested.Mean fetuin-A concentrations were significantly elevated in the PCOS group compared with control subjects (101.2 ng/ml ± 33.55 vs. 82.5 ng/ml ± 32.65, P=0.019). CIMT was also higher in women with PCOS than in control subjects (0.51 ± 0.05 mm vs. 0.44 ± 0.05 mm, P0.01). Serum lipid parameters were correlated to serum fetuin-A concentrations in the PCOS group, but no correlation was found between fetuin-A and CIMT (rPCOS=0.244, pPCOS=0.158; rcontrol=-0.002, pcontrol=0.988).In this, the first study of fetuin-A concentrations in PCOS, the results showed that fetuin-A concentrations were increased in euglycemic patients with PCOS.

To determine whether the timing of embryo transfer (day 2 or day 3) affects pregnancy outcome in IVF patients, receiving single or double embryo transfer, 380 patients were included in this retrospective study. All patients underwent GnRH antagonist protocol. When stratified by number of transferred embryos, single embryo transfer (SET) patients undergoing a day 2 embryo transfer (ET) had similar biochemical pregnancy (25% vs 20.4%; p > 0.05) and clinical pregnancy (16.6% vs 14.6%; p > 0.05) rates to SET patients that were undergoing a day 3 ET. A similar observation was again noted in double embryo transfer (DET) patients undergoing a day 2 ET, with similar biochemical pregnancy (35% vs 29.8%; p > 0.05) and clinical pregnancy (25% vs 15.5%; p > 0.05) rates to DET patients undergoing a day 3 ET. Women, despite age, number of transferred embryos and ET timing, have similar reproductive outcomes. Shortening or lengthening the duration of in vitro culture provides no obvious benefit.

Abnormal uterine bleeding (AUB) is a substantial cause of ill health in women worldwide. In this study, our aim was to evaluate the effectiveness of endometrial ablation using a modified urologic resectoscope along with tranexamic acid in AUB. Sixty patients were enrolled in this study. All patients underwent resectoscopic surgery. Patients were randomly divided into two groups. Group 1 (n = 30) received 500 mg of tranexamic acid. Group 2 (n = 30) served as the control group and underwent surgery without the administration of tranexamic acid. Total pictorial blood loss assessment chart (PBAC) scores were significantly lower postoperatively (152.14 ± 9.65 versus 6.6 ± 0.90; P < 0.001). When stratified by the administration of tranexamic acid, the number of patients with a postoperative day 1 PBAC score ≤15 was higher in the tranexamic group (19 versus 13), whereas the number of patients with a post operative day 1 PBAC score >15 was lower in the tranexamic group (11 versus 17), but the differences were not statistically significant (P > 0.05). AUB is a complex disease that may need repeated treatments. In expert hands, the treatment rate of resectoscopic surgery seems acceptable. However, some patients may require additional interventions, like repeated surgery, hysterectomy, or a drug therapy in the long run. Introduction of tranexamic acid as a potential adjunct to rollerball endometrial ablation may present an interesting option that requires additional well-designed studies before firm conclusions can be made.

To evaluate the tear osmolarity and ocular surface changes in patients with polycystic ovary syndrome (PCOS).Forty-eight patients with recently diagnosed PCOS and thirty-three control volunteers were enrolled in this prospective, observational study. Ocular surface disease index (OSDI) score was calculated. Tear osmolarity was measured using the TearLab Osmolarity System (Tearlab, San Diego, CA, USA). All subjects also underwent the following ophthalmologic evaluation: Schirmer I test, tear-film breakup time (TBUT), ocular surface flourescein staining, and conjunctival impression cytology.Mean OSDI score was significantly higher in patients with PCOS than control subjects (P = 0.001). Tear osmolarity was similar in both groups (P = 0.404). There were no significant differences between groups in Schirmer I test results, TBUT, and ocular surface flourescein staining scores (P0.05). Compared to control group, a statistically significant squamous metaplasia was observed in temporal bulbar conjunctival impression cytology specimens in PCOS group (P = 0.032).In patients with recently diagnosed PCOS, tear volume and osmolarity are not affected but, conjunctival morphology may be affected, though on a limited scale.

The aim of the study was to evaluate the fatty acid-binding protein-4 (FABP4) and irisin concentrations in women with polycystic ovary syndrome (PCOS). Forty-nine women with PCOS, diagnosed according to Rotterdam criteria and 39 healthy women matched for body mass index (BMI) and age. Serum irisin and plasma FABP4 concentrations were measured in both groups. The association of irisin and FABP4 concentrations with metabolic parameters were also tested. Women with PCOS had significantly lower mean serum irisin concentrations than control subjects (158.5 ± 123.3 versus 222.9 ± 152.2 ng/ml, p 0.05). Concentrations of FABP4 in PCOS and control groups were not significantly different (10.5 ± 4.4 versus 10.9 ± 4.2 ng/ml, p 0.05). FABP4 concentrations were correlated with BMI, waist-hip ratio (WHR) and HOMA-IR (r = 0.57, p = 0.001; r = 0.26, p = 0.03; r = 0.26, p = 0.03, respectively). No associations between irisin and all the others parameters except serum levels of LH were found. Serum irisin concentrations of women with PCOS were lower compared to the controls. Moreover, there were no difference in plasma FABP4 concentrations between women with PCOS and controls.

Gonadotropins used in controlled ovarian stimulation have been increasing in number. Beside the recombinant preparations such as rec-FSH, rec-LH and h-hMG human-derived preparations have entered the market. We decided to compare the effects of rec-FSH and HP-hMG with GnRHa on embryo quality and pregnancy outcome in women undergoing an IVF cycle.In this study, data of 87 patients who had applied to our center from 2007 to 2008 and who had met all inclusion criteria, were analyzed. The patients underwent controlled ovarian hyperstimulation with HP-hMG, rec-FSH following down-regulation with a GnRHa in a long protocol, selected according to determined criteria and acquired embryo via IVF transfer.Of the 87 patients, 44 were stimulated with rec-FSH and 43 with HP-hMG. Distribution of infertility causes was similar between the groups. Duration of gonadotropin administration (p=0.677, Student's t-test) and the total dose of gonadotropin received (p=0.392, Student's t-test) were similar between the two groups. The fertilization rate of the rec-FSH group was significantly higher than the HP-hMG group (p=0.001, Mann-Whitney U test). No significant differences were observed between the study groups in biochemical, clinical and ongoing pregnancy parameters.The higher oocyte yield with rec-FSH does not result in higher quality embryos. LH activity in combination with FSH activity positively affected the oocyte and embryo maturation. Therefore, when we consider the clinical and ongoing pregnancy rates there is no inferiority of HP-hMG in controlled ovarian stimulation.Son dekatta ovulasyon indüksiyonu ve kontrollü over stimülasyonu için kullanılan gonadotropinler hızla çoğalmıştır. Çeşitli rekombinant preperatların yanında; rec-FSH, rec-LH, insan kaynaklı gonadotropinlerde pazara girmiştir. Bu çalışmadaki amaç; in vitro fertilizasyon protokolünde yer alan rec- FSH ve HP-hMG’nin elde edilen embriyoların kalitesi ve gebelik sonuçları üzerindeki etkilerinin karşılaştırılmasıdır.Çalışmamıza 2007–2008 tarihleri arasında Zeynep Kamil kadın ve çocuk hastalıkları eğitim ve araştırma hastanesi tüp bebek merkezine başvuran, çalışmaya dahil edilme kriterlerini sağlayan 87 hastanın verileri kullanıldı. Belirlenen kriterlere göre seçilen, ovulasyon indüksiyonu için rec-FSH ve/veya HP-hMG kullanarak uzun protokol agonist tedavi protokolleri uygulanmış; IVF yöntemi ile ovum fertilizasyonu sağlanmış ve elde edilen embriyolarla transfer yapılmıştır.Olgular rec-FSH (n=44) ve HP-hMG (n=43) olmak üzere iki grup altında incelenmiştir. İnfertilite nedenlerin dağılımı her iki grup arasında benzer olarak bulunmuştur. Gruplara göre olgulara uygulanan total gonadotropin dozları (p=0.677, Student t-test) ve süresi (p=0.392, Student t-test) arasında istatistiksel olarak anlamlı bir farklılık bulunmamaktadır. Rec-FSH grubundaki olguların fertilizasyon sayıları, HP-hMG grubundaki olguların fertilizasyon sayılarından istatistiksel olarak ileri düzeyde anlamlı fazladır (p0.01). rec-FSH ve HP-hMG gruplarında kimyasal gebelik, klinik ve devam eden gebelik görülme oranları arasında istatistiksel olarak anlamlı bir farklılık bulunmamaktadır.rec-FSH grubunda yüksek oosit sayısı olmasına rağmen yüksek kalitede embriyo sayısı elde edilmemiştir. FSH aktivitesi ile birlikte LH aktivitesi oosit ve embriyo gelişimini pozitif yönde etkilemiştir. Bu sebepten dolayı klinik ve devam eden gebelik oranları incelendiğinde, HP-hMG grubunda herhangi bir düşüş rastlanılmamıştır.

Reconstruction of the large defects that develop after pelvic exenteration with local flaps may result in higher morbidity because of poor perineal wound healing after pelvic radiation. A well vascularised reconstructive flap originating from distant non-irradiated areas is needed. We report two cases of pelvic exenteration and rectus abdominis myocutaneous flap procedure in patients with recurrent vulvar malignancies that had undergone external beam pelvic radiation and subsequently developed pelvic fibrosis, necrosis and fistulas. Both flaps were totally viable postoperatively; the abdominal wound healed without any complication, no perineal wound complications developed with a follow-up of nine months. In conclusions, rectus abdominis myocutaneous flap reconstruction seems to be an ideal option for the large defects resulting from exenteration operations in patients with previous perineal radiation.

Introduction: To evaluate the need for a prognostic classification system for obstetric fistula (OF) with the data obtained by a voluntarily action for OF repair in a regional hospital and Niger Africa. Material and methods: Obstetric fistula (OF) characteristics of 51 women with vesicovaginal fistula in a fistula campaign in Maradi Regional Hospital Niger were evaluated. Initial basic gynecological examination methylene blue (MBT) test and direct cystoscopy were used to describe the characteristics of the lesions. Demographic and clinical data were compared with the existing literature. Results: In 31 (60 %) cases were the sizes of the fistula greater than 4 cm. The urethra was circumferentially lost in 8 (15.7%) women. In 18 (35.3%) women the trigone was involved. Extensive fibrosis was present in 10 (19.6%) patients. Only in 11 (21.6%) patients without any obliterating scarring neither the trigone nor urethra were damaged. Five (9.8%) patients had severe infection. Five (9.8%) had multiple lesions. Thirty-four (66.6%) had a history of at least one previous attempt for fistula repair. A significant proportion of women were divorced or abandoned from their husband and socially isolated. Conclusions: A simple reproducible and universally accepted scientific classification or staging system for OF dealing with outcomes rather than anatomic landmarks should replace the present proposed classification systems for prognostic and ethical purposes.

Seismic fragilities are essential to earthquake loss estimation and performance-based earthquake engineering in regions of high seismicity. Construction practices for frames in regions of moderate seismicity are quite different, and such frames have received less attention in the literature. Fragilities for performance levels identified in recent seismic regulations are developed herein for reinforced concrete frames designed for gravity load in low-seismic regions using probabilistic non-linear finite element analysis. An examination of the contribution of uncertainties in material and structural parameters reveals that structural damping, concrete strength, and cracking strain in beam–column joints have the greatest impact on the fragilities of such frames. However, fragilities that incorporate these sources of uncertainty are only slightly different from those based solely on the uncertainty in seismic demand from earthquake ground motion, suggesting that fragilities that are developed under the assumption that all structural parameters are deterministic and equal to their median (or mean) values are sufficient for purposes of earthquake damage and loss estimation in regions of moderate seismicity. Confidence bounds on the fragilities are also presented as a measure of their accuracy for risk-informed decision-making, for prioritizing risk mitigation efforts in regions of low-to-moderate seismicity.

The infrequent nature of earthquakes in the Central and Eastern United States (CEUS), and the fact that none with intensity comparable to the New Madrid sequence of 1811-12 has occurred in the past century, have caused the earthquake hazard in the CEUS to be neglected until quite recently. The performance of reinforced concrete (RC) frames in the CEUS may be deficient if they are subjected to earthquakes that are believed to be plausible in the New Madrid Seismic Zone (NMSZ). This study presents a set of probability-based tools for seismic vulnerability and risk assessment of such gravity load designed (GLD) RC frames, and uses these tools to evaluate the seismic vulnerability of RC frames that are representative of the building inventory in Memphis, Tenn.—the largest population center close to the NMSZ. This evaluation indicates that traditional GLD RC frames have a substantial probability of suffering life-threatening damage or collapse in the event that they are subjected to earthquake demands stipulat...

Uncertainty in response of buildings and other civil infrastructure to earthquake ground motion is due to the inherent randomness in the ground motion itself—peak intensity, time-varying amplitude and strong-motion duration, and frequency content—and local design and construction practices. In the recently completed SAC project and ongoing research in the Pacific Earthquake Engineering Research (PEER) Center, the focus is on performance of buildings designed for regions of high seismicity. In contrast, current research in the Mid-America Earthquake (MAE) Center is examining the potential impact of earthquakes on building construction in regions of low-to-moderate seismicity in the Central and Eastern United States (CEUS) where design and construction practices seldom have made provision for earthquake resistance. This paper assesses the seismic fragilities of several typical low-to-mid-rise steel and reinforced concrete buildings representative of design and construction practices in the CEUS. A comparison of these fragilities with those incorporated in HAZUS carries implications for damage and loss estimation in this region. Copyright © 2007 John Wiley & Sons, Ltd.

Tunnel form buildings, owing to their higher construction speed and quality, lower cost, and superior earthquake resistance over that of conventional reinforced concrete buildings, have been widely used for mass housing, urban renewal, and post-earthquake reconstruction projects all over the world as well as in Turkey. However, there have been few dynamic tests performed on existing buildings with this structural system. This study investigates the dynamic structural properties of a typical nine-story reinforced concrete flat plate-wall building by forced vibration testing and develops its three-dimensional (3-D) linear elastic finite element structural model. The finite element model that uses the modulus of elasticity for concrete in ACI 318 predicts the natural vibration periods well. Mode shapes are also in good agreement with the test results. Door and window openings in the shear walls, and the basement with peripheral wall emerge as modeling considerations that have the most significant impact on structural system dynamic properties.

Objective: Laparoscopic surgery is the principal minimally invasive technique that is used for the treatment of gynecologic pathologies. The single-incision laparoscopic surgery (SILS) is another innovation in minimally invasive medicine. The cost of the procedure correlates with the fundamental materials used to access the abdominal cavity and utilize trocars. Material and Methods: We applied the single-incision tubal ligation procedure to three patients. A 15-20-mm vertical incision was made in the umbilicus. Two trocars were inserted through the same incision at different fascial regions after insufflation of the abdomen. A 5-mm bipolar cautery was introduced through the accessory trocar, and the mid-portion of the tubes was coagulated and cut bilaterally. Results: The postoperative periods of the three patients were uneventful. All patients were discharged on the day of surgery. No major or minor complications occurred. Conclusion: The cost for the abdominal access will drop about 82%. When we consider the low pricing for the tubal ligation procedure, the single-incision technique will be more applicable by this method. Moreover, patients will have the advantages of single-incision laparoscopic surgery with low cost. (J Turk Ger Gynecol Assoc 2015; 16: 30-1)

Aim: We aimed to investigate possibility of different ovarian volume threshold and to study diagnostic thresholds for polycystic ovary in Turkish women, since the literature on this subject is very limited. Material and Method: Clinical study carried out Namik Kemal University School of Medicine, Tekirdag, Turkey.This case-control study included 132 patients with polycystic ovary syndrome (PCOS), diagnosed according to Rotterdam criteria and 75 controls. Comparison of ovarian volumes between PCOS patients and control group. Results: We found a mean ovarian volume of 9.44 ± 4.3 cm3 in PCOS cases and 7.63 ± 3.66 cm3 in control cases. The area under curve (AUC) for mean ovarian volume (MOV) was 0.633. The analysis showed that setting the threshold of MOV at 8.2 cm3 offered the best compromise between specificity (61.3%) and sensitivity (53.8%). Discussion: Optimum threshold of ovarian volume to distinguish the PCOS from normal women and the mean ovarian volume in Turkish PCOS patients remain beneath the criteria by Rotterdam.

Sex cord-stromal tumors account for 5% of ovarian tumors and 2% of malignant ovarian tumors. Steroid cell tumors (SCT), not otherwise specified (NOS), are rare sex cord-stromal tumors of the ovary and account for less than 0.1% of all ovarian tumors. We report a rare case of a post-menopausal woman presented with hirsutism, virilism and with findings of hyperestrogenism.Sex-cord hücreli tümörler, tüm over tümörlerinin %5 ‘ini, malign over tümörlerinin %2’sini oluşturmaktadır. Steroid hücreli tümörler nadir sex kord –stromal tümörler olup, tüm over tümörlerinin %0.1’ini oluşturmaktadır. Biz hirsutizm, virilizasyon ve hiperöströjenizm bulguları mevcut postmenapozal bir bayan olgusunu sunmak istedik.

This study investigated the effects of changes in weather conditions (monthly average temperature, monthly minimum temperature, monthly average humidity) on rotavirus and adenovirus gastroenteritis frequency and whether there was a seasonal correlation.Between 2006 and 2012, 4702 fecal samples were taken from patients ≤ 5 years of age with acute gastroenteritis; these samples were analyzed in terms of rotavirus group A and adenovirus serotype 40-41 antigens using time-series and negative binomial regression analysis.Rotavirus antigens were found in 797 samples (17.0%), adenovirus antigens in 113 samples (2.4%), and rotavirus and adenovirus antigens together in 16 samples (0.3%). There was a seasonal change in rotavirus gastroenteritis (P0.001), and a 1°C decrease in average temperature increased the ratio of rotavirus cases in those with diarrhea by 0.523%. In addition, compared with data from other years, the number of patients was lower in the first month of 2008 and in the second month of 2012, when the temperature was below -20°C (monthly minimum temperature). There was no statistically significant relationship between adenovirus infection and change in weather conditions.Various factors such as change in weather conditions, as well as the population's sensitivity and associated changes in activity, play a role in the spread of rotavirus infection.

Objective To investigate the effect of bladder distention before outpatient hysteroscopy (OH). Study design Initially, 120 eligible patients were approached, and a total of 102 patients were recruited into the randomised controlled trial. OH was completed successfully in 97 patients. Pain scoring (visual analogue scale) and the ease of cervical entry (Likert scale) were the primary outcome measures. The secondary outcome measures in this study were the duration of the procedure and patient acceptability (Likert scale). Result(s) Bladder distention before OH was related to easier cervical entry, a shorter procedural time and low pain scoring in patients who underwent the procedure with a full bladder. Conclusion(s) Bladder distention before OH significantly improved the pain score of patients and increases the feasibility of the hysteroscopy procedure.

Vesicouterine fistula (VUF) is a rare type of genitourinary fistula. Lower-segment cesarean section is the leading cause of VUF. Patients mostly present with the classical triad of menouria, amenorrhea, and urinary incontinence, with the history of a previous cesarean section. Conservative management with catheterization and open, laparoscopic, and robotic surgeries are the prescribed treatment options. We present the case of a 35-year-old woman who presented with cyclical menouria and urinary incontinence. After diagnosis of VUF by cystoscopy, the laparoscopic approach was chosen. During the procedure, we used anterior abdominal wall peritoneum and adjacent adipose tissue interposition for the first time, instead of omental interposition, because of the unavailability of omentum. The postoperative period was uneventful, and the procedure was successful. In conclusion, the laparoscopic approach is feasible and the anterior abdominal wall peritoneal flap can be used instead of omentum for tissue interposition when the omentum is not available.

Background and Objectives: The aim of this study was to compare the in vitro fertilization (IVF) outcomes of long gonadotropin-releasing hormone agonist (GnRH-a) and GnRH-antagonist (GnRH-ant) protocols in endometriosis patients who have undergone laparoscopic endometrioma resection surgery. To our knowledge, there is no study in the current literature that compares the effectiveness of long GnRH-a and GnRH-ant protocols in management of IVF cycles in endometriosis patients who underwent laparoscopic endometrioma resection surgery. Methods: Eighty-six patients with stage III to IV endometriosis who had undergone laparoscopic resection surgery for endometrioma were divided into 2 groups: those who had ovarian stimulation with a long GnRH-a protocol (n = 44), and those who had ovarian stimulation with a GnRHant protocol (n = 42). Results: The number of follicles on human chorionic gonadotropin injection day, duration of hyperstimulation, number of retrieved metaphase II oocytes, and total number of grade 1 embryos were statically significantly higher in the long GnRH-a protocol. There were no significant differences in positive beta-human chorionic gonadotropin pregnancy rates (25% vs 21.4%; P = .269) and ongoing pregnancy rates per patient (20.5% vs 19.1%; P = .302) between the 2 protocols. Conclusions: Long GnRH-a and GnRH-ant protocols both present similar IVF outcomes in patients with endometriosis who have undergone laparoscopic endometrioma resection surgery. A long GnRH-a protocol may lead to a higher number of embryos that can be cryopreserved, providing the possibility of additional embryo transfers without having to go through the process of ovarian stimulation again. Scientific Research Projects Coordination Unit of Istanbul UniversityIstanbul University [33502] An earlier version of this research was presented at the 29th Annual Meeting of the European Society of Human Reproduction and Embryology in London, 2013. This was made possible by funding from the Scientific Research Projects Coordination Unit of Istanbul University (#33502).

The primary aim of this study is to evaluate the effects of previous abdominal surgery on the feasibility of performing and the safety of total laparoscopic hysterectomy (TLH).In this retrospective study, we analysed 62 laparoscopic hysterectomies which were performed at our institute between February 2011 and January 2013. We chose to perform laparoscopic surgery for all patients, including those who had previously undergone abdominal surgery. The patients were classified into two groups: Group 1 included patients with a history of abdominal surgery (n=24) and Group 2 included patients without a history of abdominal surgery (n=38).THE OPERATING PERIOD WAS COMPARED IN BOTH GROUPS: 184.43±51.0 min. for Group 1 and 195.41±64.1 min. for Group 2 (p=0.471). Postoperative hospital stay and blood loss was also compared. There was just 1 conversion from TLH to a laparotomy in both groups. None of the patients in Group 1 needed a blood transfusion, whereas 1 in Group 2 did.We found that operation time, postoperative hospital stay, blood loss, rate of operative complications or conversion rate to open surgery between patients with and without a history of abdominal surgery were comparable. Therefore, it appears that a history of abdominal surgery does not adversely affect the safety of TLH.Bu çalışmanın öncelikli amacı, daha önce geçirilmiş abdominal cerrahinin, total laparoskopik histerektomi (TLH) yapılabilirliği ve güvenliği üzerine etkisini değerlendirmektir.Bu retrospektif çalışmada, Şubat 2011 ve Ocak 2013 tarihleri arasında kurumumuzda gerçekleştirilen 62 TLH operas-yonun kayıtları incelendi. Laparoskopik cerrahiyi, geçirilmiş abdominal cerrahisi olsa da tüm hastalarda düşündük. Hastalar iki gruba ayrıldı. Grup 1 geçirilmiş abdominal cerrrahisi olanları, Grup 2 geçirilmiş abdominal cerrahisi olmayanları içerdi.Operasyon süresi her iki grupta da karşılaştırılabilirdi (184.43±51.0 dk. Grup1 ve 195.41±64.1 dk. Grup 2; p=0.471). İki grup arasında intraoperatif komplikasyon açısından anlamlı fark bulunmadı. Operasyon sonrası hastanede kalış süresi ve kan kaybı da karşılaştırılabilirdi. Her iki grupta da sadece 1 vakada laparotomiye geçiş yapıldı. Grup 1’de hiçbir hastada kan transfüzyonu ihtiyacı olmazken, Grup 2’de 1 hastada oldu.Çalışmamızda cerrahi geçirmiş ve geçirmemiş olan grup arasında, operasyon süresi, postoperatif kalış süresi, kan kaybı, operatif komplikasyon oranı veya açık cerrahiye geçiş oranı karşılaştırabilir bulundu. Sonuç olarak, abdominal cerrahi hikayesinin olması TLH nin güvenliğini olumsuz etkilememektedir.

What is the prevalence of abnormalities in glucose metabolism in patients with polycystic ovary syndrome (PCOS) and controls in a Turkish population?The total prevalence of glucose abnormalities in PCOS patients was 16.3% [impaired glucose tolerance (IGT) 14.3%; type 2 diabetes mellitus (T2DM) 2%] and was higher than in healthy subjects (IGT 8.5%; T2DM 0%, respectively).One of the most common markers of chronic glycemia is hemoglobin Alc (HbA1c). However, little is known about whether the use of HbA1c results in diagnosis of more cases of glucose intolerance in the PCOS population than the oral glucose tolerance test (OGTT) alone.This was a prospective study, including 252 women with PCOS and 117 control women without PCOS.The study was carried out in the gynecological outpatient department of Namik Kemal University Hospital, Turkey, between 2010 and 2012. Women with PCOS (n = 252) were diagnosed according to Rotterdam criteria. The control group included 117 women (aged 17-45 years) who were selected randomly. BMI of participants ranged between 15.6 and 47.9 kg/m(2).Patients with PCOS were comparable to controls in terms of age (24.8 versus 25.9 years, respectively) and had higher BMI (26.1 versus 24.9 kg/m(2), respectively). Of 252 patients with PCOS, 41 had glucose intolerance (IGT 14.3%; T2DM 2%) when compared with 10 of the 117 control patients (IGT 8.5%; T2DM 0%; odds ratios = 2.08; P = 0.045) during the OGTT. When an HbA1c value ≥ 5.6% was used to divide the total population, the prevalence of abnormal glucose metabolism was 7.9% in the patients with PCOS, below the value detected in the control patients (8.5%), which showed that 20 of 41 patients with abnormal glucose tolerance would not have been diagnosed, if the HbA1c alone had been used. When compared with the OGTT results, HbA1c provided 52.4% sensitivity, 74.4% specificity, 67.1% positive and 60.9% negative predictive values with a threshold value of 5.6% in abnormal glucose tolerance. The receiver operating characteristic analysis suggested a threshold value of 5.35% in HbA1c (75.6% sensitivity and 52.6% specificity) for the prediction of abnormal glucose tolerance.This study did not involve weight-matched healthy subjects, which may cause a difference in prevalence of abnormal glucose metabolism between the groups, and the results are limited to an unselected population of patients who have the full PCOS phenotype. In addition, the incidence of T2DM among the first-degree relatives and 2-h insulin levels could not be reported in full.Further investigation of the efficacy of HbA1c for the prediction of abnormal glucose tolerance should be undertaken in long-term prospective studies and in different geographic populations. At present, the only way to reliably detect abnormal glucose metabolism in Turkish women with PCOS appears to be using the OGTT.No financial support. The authors have no competing interests to declare.Not applicable.

The aim of this study was to evaluate the efficacy of vaginal misoprostol for cervical priming at doses of 200 mcg and 400 mcg, 12 to 15 hours before diagnostic office hysteroscopy (OH) without anesthesia in patients with infertility. Sixty infertile patients requiring a diagnostic office hysteroscopy for investigation of infertility were included in the study. The patients were randomly allocated into 3 vaginally administered misoprostol groups: (1) control group, (2) 200-mcg dose group, and (3) 400-mcg dose group. Misoprostol significantly facilitated the procedure of OH: cervical entry was easier; procedural time was shorter; baseline cervical width was larger; and pain scoring was lower in the misoprostol groups compared with the control group. Increasing the dose of misoprostol from 200 mcg to 400 mcg did not improve the effect on cervical dilation. Misoprostol is a promising analog to use for cervical priming before OH. Since doses of 200 mcg and 400 mcg vaginal misoprostol 12 hours before the OH both have proven to be effective regimens, 200 mcg may be preferred. However, before routine clinical usage, further research is needed through large, randomized, controlled trials powered to detect a difference in complications to determine whether misoprostol reduces complications in OH. Scientific Research Projects Coordination Unit of Istanbul UniversityIstanbul University [26324] An earlier version of this research was presented at the 42nd Annual Meeting of American Society of Reproductive Medicine in San Diego, 2012. This was made possible by funding from the Scientific Research Projects Coordination Unit of Istanbul University (grant 26324).

This study investigates copper (Cu) levels and vascular dysfunction in lean women with polycystic ovary syndrome (PCOS). 44 subjects with PCOS, diagnosed according to Rotterdam criteria, and 42 healthy subjects matched for body mass index and age. Comparison of serum Cu, homocysteine, carotid intima-media thickness (CIMT), brachial artery flow mediated dilation (FMD) was carried out between PCOS patients and the control group. Clinical study was done in Namik Kemal University School of Medicine. The CIMT and concentration of Cu in PCOS patients was significantly higher than the healthy controls. FMD levels in PCOS patients were significantly lower than those in controls. In PCOS patients, CIMT was correlated with estrogen and Cu levels. However, FMD was correlated with age and Cu levels. Among these contributing factors, Cu levels were correlated with a change in CIMT and FMD. CIMT and FMD in PCOS patients were related to Cu levels as well as several cardiovascular risk factors. Thus, increased Cu levels may be responsible for the increased risk of early vascular disease in women with PCOS.

Isotretinoin is a retinoid widely used for the treatment of severe nodulocystic acne. Although it has broad side effects, there is no well-designed study about its effects on the ovary. This study investigated possible toxic effects of isotretinoin on female gonads. A total of 30 female rats were randomly divided into three equal groups according to the dose of isotretinoin they were administered: 0 mg/kg/day (group 1), 7.5 mg/kg/day (group 2) or 15 mg/kg/day (group 3). Thirty days after the treatment, the effects of isotretinoin on the ovaries were evaluated with serum anti-Mullerian hormone (AMH) concentrations, apoptosis by TUNEL assay and immunohistochemical observations by proliferating cell nuclear antigen (PCNA). The percentage of atretic follicles was calculated for each stage of folliculogenesis. The serum AMH concentrations were found to be lower in both isotretinoin groups. The percentage of atretic follicles in both isotretinoin groups was higher than the control. The number of PCNA-positive granulosa cells was decreased in the isotretinoin groups. The number of ovarian follicles with apoptotic granulosa cells was increased in the experimental groups. These data are the first to identify that exposure of isotretinoin may be responsible for decreased ovarian reserve and toxic effects on rat ovaries.

Objective This study investigates human cartilage glycoprotein-39 (YKL-40) levels in patients with polycystic ovary syndrome (PCOS) and controls, and tests their relationship with metabolic and hormonal parameters. Design Clinical study carried out in a university hospital in Tekirdag, Turkey. Patients Eighty-five women with PCOS and normal glucose tolerance (NGT) and twenty-five women with PCOS and abnormal glucose tolerance (AGT), diagnosed according to Rotterdam criteria, and fifty-nine healthy women. Measurements YKL-40 levels, fasting hormone levels and metabolic parameters were investigated in all subjects. Results We showed increased YKL-40 levels in women with PCOS compared to controls. (152·57 ± 3·96 μg/l vs 98·16 ± 1·6 μg/l, P