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    Comparison of histomorphological findings of cardinal ligament in patients with and without uterine prolapse
    (2020) Peker, Nurullah; Kirici, Pinar; Kaya, Sehmus; Yildirim, Ayhan; Karacor, Talip
    Aim: This study aimed to investigate histomorphological changes in cardinal ligaments between patients with and without uterine prolapse.Material and Methods: This study included 30 patients who underwent vaginal hysterectomy for POP-Q stage 4 uterine prolapse (Group 1) and 30 patients who underwent abdominal hysterectomy for benign reasons except uterine prolapse (Group 2) at a tertiary center hospital. Demographic data, parity, uterine weight, and histomorphological findings of cardinal ligaments were compared between the two groups.Results: Age and parity were significantly higher unlike uterine weight was lower in Group 1. In histomorphological findings of cardinal ligaments, vessel wall thickness, peripheral nerve thickness and the number of cells in the connective tissue stroma counted in 1 mm2 area were statistically significantly higher in Group 1. While the presence of extravasated erythrocytes was greater in Group 1, no significant difference was found between the two groups in terms of inflammation.Conclusion: It is obvious that some histomorphological changes are formed in the cardinal ligaments of patients with uterine prolapse due to pressure on the uterus. We believe that the increase in the number of extravasated erythrocytes and the thickness of the vascular wall and peripheral nerve should be supported by further studies.
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    Effects of Different Progesterone Doses on the Concentrations of Proinflammatory and Anti-inflammatory Cytokines in Pregnant Women With Threatened Abortion
    (Springernature, 2021) Kirici, Pinar; Tanriverdi, Elif Seren
    Background and objective This study aimed to investigate how different doses of progesterone influence the concentrations of interleukin-6 (IL-6) and tumor necrotizing factor-alpha (TNF-alpha), which are proinflammatory cytokines, as well as that of IL-10, which is an anti-inflammatory cytokine, in pregnant women with threatened abortion. Materials and methods This is a prospective, single-center, randomized controlled trial conducted with 221 patients with a threatened abortion diagnosis. Group 1 consisted of IL-6, IL-10, and TNF-alpha values in pre-treatment blood samples from 221 patients diagnosed with imminent abortion. Group 2 included 81 patients who received natural oral 100 mg micronized progesterone MP twice a day for two weeks. Group 3 included 83 patients who were administered oral 200 mg of natural micronized progesterone MP twice a day for two weeks. Group 4 included 57 patients who received oral 200 mg of natural micronized progesterone MP twice a day for two weeks, and one depot progesterone was added to the treatment by administering it at a dosage of 500 mg/day intramuscularly. Results IL-6 values between groups were lower in group 4 compared to group 3 (p=0.007). When IL-10 values were compared between the groups, the IL-10 ratio was highest in group 4 and lowest in group 2 (p<0.001, p=0.003, p<0.001). When the TNF-alpha values between the groups were compared, the value in group 4 was decreased compared to groups 1 and 2 (p=0.031, p<0.001). In the logistic regression analysis, the IL-6 value above 12.01 increased the abortion imminens rate 1.01 times, and a TNF-alpha value above 11.04 increased the abortion imminens rate 1.21 times. Conclusion Progesterone used to treat imminent abortion reduces the levels of proinflammatory cytokines, such as IL-6 and TNF-alpha, while increasing those of anti-inflammatory cytokine IL-10 in proportion to the dose administered. Progesterone can prevent imminent abortion by generating an anti-inflammatory environment.
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    Evaluation of specific heavy metal levels of pregnant women complicated by neural tube defects
    (2020) Karacor, Talip; Kirici, Pinar; Nacar, Mehmet Can; Bulbul, Mehmet; Onderci, Muhittin; Peker, Nurullah
    Aim: The etiology of neural tube defect (NTD) is still not clear enough. In our study, we aimed to evaluate plasma heavy metal levels of pregnant women with NTD and to determine whether there is a relationship between heavy metal levels and NTD severity.Material and Methods: TThis study was conducted in Adıyaman University, Department of Gynaecology and Obstetrics. The study included 38 pregnant women with NTD and 42 pregnant women with healthy infants. Pregnant women who have NTD were divided into two groups as NTD Type 1 and NTD Type 2 according to the anomaly type. Levels of heavy metals such as Mercury (Hg), Cadmium (Cd), Cobalt (Co), Lead (Pb), Manganese (Mn) and Arsenic (As) were compared between groups.Results: Plasma Hg, Co, Cd and Pb levels were higher in NTD group than control group. (p values, respectively; p 0.001, p = 0.001, p 0.001, p 0.001). As and Mn levels were not statistically different between the two groups (p values; p = .519, p = .819, respectively). In the NTD group, Hg was found to be higher in NTD Type 1 than NTD Type 2 (p 0.001).Conclusion: It is obvious that some histomorphological changes are formed in the cardinal ligaments of patients with uterine prolapse due to pressure on the uterus. We believe that the increase in the number of extravasated erythrocytes and the thickness of the vascular wall and peripheral nerve should be supported by further studies.
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    Metabolic and carbohydrate characteristics of different phenotypes of polycystic ovary syndrome
    (Aves, 2016) Celik, Ebru; Turkcuoglu, Ilgin; Ata, Baris; Karaer, Abdullah; Kirici, Pinar; Eraslan, Sevil; Taskapan, Cagatay
    Objective: To compare the prevalence of various metabolic and cardiovascular risk factors and insulin resistance between polycystic ovary syndrome (PCOS) patients with or without hyperandrogenism. Material and Methods: This is a retrospective cross-sectional study involving women with PCOS as diagnosed according to the Androgen Excess (AE) Society definition (n=504) and women with normoandrogenemic PCOS (n=183). Anthropometrics, lipid profile, glucose, insulin, oral glucose tolerance test (OGTT), and reproductive hormone levels were evaluated. Results: Women with PCOS diagnosed according to the AE Society had a significantly higher prevalence of metabolic syndrome compared with the normoandrogenemic PCOS phenotype: odds ratio (OR) 2.95 [95% confidence interval (CI) 1.21-7.21]. There was no significant difference in the prevalence glucose intolerance test between the groups [OR: 2.15, 95% CI 0.71-6.56]. The prevalence of low high density lipoprotein (HDL)-cholesterol in the group under the AE-PCOS Society criteria was higher than that of the normoandrogenemic PCOS group [OR: 2.82, 95% CI 1.29-3.36]. Conclusion: The risks of metabolic syndrome and cardiovascular disease may vary among the phenotypes of PCOS based on the Rotterdam criteria. This new data may be of reference in informing women with PCOS, although further prospective studies are needed to validate this proposition.
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    NF-κB as an Inflammatory Biomarker in Thin Endometrium: Predictive Value for Live Birth in Recurrent Implantation Failure
    (Mdpi, 2025) Kali, Zercan; Karli, Pervin; Tanilir, Fatma; Kirici, Pinar; Ege, Serhat
    Background: Recurrent implantation failure (RIF) poses a major challenge in assisted reproductive technologies, with thin endometrium (<= 7 mm) being a frequently observed yet poorly understood condition. Emerging evidence implicates nuclear factor-kappa B (NF-kappa B), a key transcription factor in inflammatory signaling, in impaired endometrial receptivity. However, its clinical relevance and prognostic value for live birth outcomes still need to be fully elucidated. Objective: We aim to evaluate the expression levels of endometrial NF-kappa B in patients with RIF and thin endometrium and to determine its potential as a predictive biomarker for live birth outcomes following IVF treatment. Methods: In this prospective case-control study, 158 women were categorized into three groups: Group 1 (RIF with thin endometrium, <= 7 mm, n = 52), Group 2 (RIF with normal endometrium, >7 mm, n = 38), and fertile controls (n = 68). NF-kappa B levels were assessed using ELISA and immunohistochemical histoscore. Pregnancy outcomes were compared across groups. ROC analysis and multivariable logistic regression were performed to assess the predictive value of NF-kappa B. Results: NF-kappa B expression was significantly elevated in Group 1 compared to Group 2 and controls (p = 0.0017). ROC analysis identified a cut-off value of 7.8 ng/mg for live birth prediction (AUC = 0.72, sensitivity 74%, specificity 75%). Multivariable analysis confirmed NF-kappa B is an independent predictor of live birth (p = 0.045). Histological findings revealed increased NF-kappa B staining in luminal and glandular epithelial cells in the thin endometrium group. Conclusions: Increased endometrial NF-kappa B expression is associated with thin endometrium and reduced live birth rates in RIF patients. NF-kappa B may serve not only as a biomarker of pathological inflammation but also as a prognostic tool for treatment stratification in IVF. Based on findings in the literature, the therapeutic targeting of NF-kappa B may represent a promising strategy to improve implantation outcomes.
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    Noninvasive assessment of classic and high PPROM using cervicovaginal podocalyxin and nephrin: Findings from a prospective observational study
    (Lippincott Williams & Wilkins, 2025) Kali, Zercan; Karli, Pervin; Karabulut, Umran; Cagiran, Fatma Tanilir; Kirici, Pinar; Ege, Serhat
    This study assesses the diagnostic and prognostic value of cervicovaginal amniotic fluid (CVAF) podocalyxin (PDX) and nephrin levels in pregnancies with classic and high preterm premature rupture of membranes (PPROM), focusing on neonatal outcomes. This prospective study included 144 singleton pregnancies between 22 and 34 weeks, classified as classic PPROM (n = 74), high PPROM (n = 32), and controls (n = 38). CVAF and serum samples were analyzed using enzyme-linked immunosorbent assay to quantify PDX and nephrin levels. Receiver operating characteristic curves evaluated diagnostic performance. Logistic regression identified predictors of respiratory distress syndrome and bronchopulmonary dysplasia. CVAF PDX and nephrin levels were significantly higher in the classic PPROM group (35.05 +/- 5.55 and 12.88 +/- 3.85 ng/mL, respectively) compared to high PPROM and control groups. Receiver operating characteristic analysis demonstrated excellent diagnostic performance for distinguishing classic PPROM, with area under the curve values of 0.92 (95% confidence interval [CI]: 0.88-0.96) for PDX and 0.93 (95% CI: 0.89-0.97) for nephrin. In multivariable logistic regression, elevated PDX was independently associated with bronchopulmonary dysplasia (odds ratio = 1.32, 95% CI: 1.10-1.59), while elevated nephrin predicted respiratory distress syndrome (odds ratio = 1.18, 95% CI: 1.02-1.36). These findings support their utility as noninvasive biomarkers for both diagnosis and risk stratification in PPROM. CVAF PDX and nephrin demonstrated significant diagnostic and prognostic value in differentiating PPROM subtypes and may be useful for neonatal risk stratification. These findings suggest that CVAF PDX and nephrin levels may serve as noninvasive tools for early identification of high-risk PPROM cases, potentially guiding timely intervention and targeted neonatal care.
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    PTX3 as a key modulator of functional ovarian response in PCOS: evaluation alongside TSG-6 and ITI
    (Bmc, 2025) Kali, Zercan; Karabulut, Umran; Memur, Tuba; Cagiran, Fatma Tanilir; Mavral, Nihal; Kirici, Pinar
    ObjectiveTo investigate the relationship between follicular fluid pentraxin 3 (PTX-3) levels and ovarian response, embryo quality, and insulin resistance (IR) in patients with polycystic ovary syndrome (PCOS) undergoing IVF/ICSI.MethodsA total of 130 women were enrolled and categorized into three groups: lean PCOS (n = 43), overweight PCOS (n = 42), and unexplained infertility (UEI, n = 45). Patients with endocrine disorders, chronic inflammatory diseases, or recent hormonal therapy (within 3 months) were excluded. Follicular fluid (FF) and serum PTX-3 levels were measured using ELISA. Subgroup analyses were performed according to BMI and HOMA-IR status. Correlations between FF PTX-3 and clinical, hormonal, and embryological parameters were assessed. ROC curve analysis and multivariate linear regression were used to evaluate the diagnostic and predictive value of FF biomarkers for follicular output rate (FORT).ResultsFF PTX-3 levels were significantly higher in both lean (23.31 +/- 1.33 ng/mL) and overweight PCOS patients (12.54 +/- 1.05 ng/mL) compared to UEI controls (7.01 +/- 0.54 ng/mL; p = 0.029). Notably, PTX-3 remained elevated in lean PCOS despite a lower BMI, supporting its role in intrinsic ovarian inflammation. FF PTX-3 showed significant positive correlations with total testosterone (r = 0.580), AFC (r = 0.598), and oocyte count (r = 0.532), but was inversely associated with high-quality embryo number (r = - 0.482), 2PN count (r = - 0.312), and FORT (r = - 0.418). ROC analysis demonstrated moderate diagnostic performance of PTX-3 for predicting suboptimal FORT (AUC = 0.77; cut-off: 20.4 ng/mL). In multivariate analysis, FF PTX-3 (beta = - 0.65, p = 0.001), TSG-6 (beta = - 0.42), and ITI (beta = - 0.37) were independent negative predictors of FORT, while AFC was positively associated.ConclusionElevated follicular PTX-3 levels are linked to hyperandrogenism and ovarian reserve in PCOS, but may impair embryo quality and functional follicular response. PTX-3 may serve as a potential biomarker of ovarian inflammation and compromised oocyte competence, independent of BMI or systemic insulin resistance.