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Problem The initiation of labor is accompanied by alterations in the level of maternal immune tolerance toward fetal antigens. It is a complex molecular response leading to a brief activation of the maternal immune system with an accompanying capacity to restrict this same activation. The aim of our study was to evaluate the subpopulation of regulatory T cells (Tregs) and B7-H4 macrophages in the decidua basalis during cesarean sections performed on patients in various stages of labor. Method of study The decidual tissue samples evaluated in our study were obtained from 23 pregnant women who underwent cesarean sections at term. Moreover, the patients were divided into three subgroups according to the progression of labor at the time of the cesarean. The presence of Treg cells and B7-H4 positive macrophages were analysed by fluorescence-activated cell sorter. Results The percentages of FOXP3+ cells in the subpopulation of CD25+ CD4+ T lymphocytes found in the deciduas of patients decreased with the successive stages of labor, while the percentages of B7-H4 positive cells in the macrophage subpopulation remained almost constant. Conclusion These changes in the Treg cell subpopulation in the decidua would seem to be related to a brief activation of the maternal immune system as labor begins and lack of analogical changes in the subpopulation of decidual suppressive B7-H4+ macrophages that enable the restriction of this same activation as labor progresses.

Problem Alterations in RCAS1 (a receptor-binding cancer antigen expressed on SiSo cells) expression in the placenta and decidua may be related to the regulation of the process of maternal immune tolerance against fetal antigens. Moreover, it has been demonstrated that the occurrence of the spontaneous beginning of stillbirth is related to a decrease in the placental expression of RCAS1. There are no data currently available on the immune processes in decidua during stillbirth. The aim of this study was to evaluate the RCAS1 immunoreactivity level in decidua and to identify the cytotoxic immune cells present during labor, induced after intrauterine fetal death either with a combination of oxytocin (OT) and prostaglandins or with OT alone; a further objective was to assess the potential impact of these molecular alterations on the effectiveness of stillbirth induction. Methods The immunoreactivity of RCAS1, CD3, CD56, CD69, and CD25 was assessed by immunohistochemistry in 31 decidual samples derived from patients in whom the stillbirth occurred before the onset of labor. Results The RCAS1 immunoreactivity level was higher in a statistically significant manner in decidual tissue samples derived from patients in whom OT alone proved insufficient to induce labor after the diagnosis of intrauterine fetal death but required additionally the use of prostaglandins when compared with samples from women in whom stillbirth was induced successfully with OT alone. However, we did not observe any differences either in CD56 and CD3 positive cell presence or in CD25 and CD69 antigen immunoreactivity in the respective decidua of these two groups of patients. Conclusion The level of RCAS1 in decidua seems to influence the effectiveness of stillbirth induction.

Objectives: To apply computer generated artificial neural networks (ANNs) for the development of a statistical model, helpful in better preoperative discrimination between benign and malignant adnexal tumors. Materials and methods: The retrospective study included data of 162 patients who were examined with gray scale and color Doppler sonography (B-K Medical, 2002 ADI, Denmark and Voluson 530, and 730 Kretz, Austria) because of adnexal tumors. Following variables were analyzed with the use of ANN: patient's age, menopausal status, years since menopause, tumor size and volume, presence of solid parts, papillary projections >3 mm, localization of blood vessels (central or peripheral), resistive and pulsatility indices, peak systolic velocity and color Doppler score according to Timmerman et al. (1999). The output variable was classified as either benign or malignant. The ANNs were generated with the use of a statistical package (Statistical Neural Networks, Statsoft, USA) and included linear, radial basis function and multiple layer perceptron networks. The networks were trained on randomly selected 81 cases, verified (n = 40), and tested on the remaining 41 cases. Sensitivity and specificity of generated statistical models were compared with those calculated for all individual sonographic parameters. Results: In 43 women, the cysts resolved spontaneously whereas 119 patients were subsequently operated. Removed tumors were classified histologically as either benign (n = 93) or malignant (n = 26), including four borderline; five stage I ovarian cancers. The best performance was found for the radial basis function network with six input neurons and one hidden neuron. The specificity and sensitivity at the best decision cut-off point were 96.1% (25 of 26) and 94.8% (129 of 136), respectively. These percentages were significantly better than respective prognostic values derived from independent use of each tested variable (P