The impact of polycystic ovary syndrome on the health-related quality of life: A systematic review and meta-analysis تأثیر سندروم تخمدان پلی کیستیک بر کیفیت زندگی مرتبط با سلامت: مرور نظام مند و متاآنالیز 2 1 مقدمه: سندروم تخمدان پلیکیستیک (PCOS) باعث کاهش قابل توجه کیفیت زندگی مرتبط با سلامت میگردد. اگرچه، میزان تأثیر در هر حیطه در میان جوامع مختلف متغیر بوده و تاکنون این موضوع که کدام حیطه از ابعاد اختصاصی کیفیت زندگی مرتبط با سلامت بیشتر تحت تأثیر قرار میگیرد، نامشخص است. هدف: هدف پژوهش حاضر، بررسی نظاممند تأثیر PCOS روی حیطههای کیفیت زندگی اختصاصی مرتبط با سلامت میباشد. مواد و روشها: جستجوی متون با استفاده از موتورهای جستجوگر پایگاههای اطلاعاتی (PubMed, PsychInfo, Cinahl, Central, Scopus) شش مقاله مرتبط را یافت نمود. دو داور، با استفاده از ابزارهای نظاممند این مقالات را ارزیابی نمودند. نمرات هر حیطه از پرسشنامه کیفیت زندگی مرتبط با PCOS (PCOSQ) و نسخه اصلاح شده آن (MPCOSQ) شامل 1140 زن مبتلا به PCOS وارد متاآنالیز گردید. نتایج: میانگین ترکیبی بعد روان (04/5-77/0 CI 95%؛ 40/4)، نازایی (45/4-81/3 CI 95%؛ 13/4) و وزن (42/5-33/2 CI 95%؛ 88/3) نسبت به میانگین ترکیبی حیطه قاعدگی (04/4-63/3 CI 95%؛ 84/3) و هیرسوتیسم (35/4-26/3 CI 95%؛ 81/3) بالاتر بود. نتیجهگیری: متاآنالیز حاضر نشان داد که مهمترین حیطههای مؤثر بر کیفیت زندگی اختصاصی بیماران مبتلا به PCOS شامل هیرسوتیسم و قاعدگی میباشند. بر اساس این یافتهها، آگاهی رسانی ارائهدهندگان خدمات بهداشتی به این موضوع و انجام مراقبتهای متناسب توصیه میگردد. 2 Background: Polycystic ovary syndrome (PCOS) has been shown to cause a reduction in health-related quality of life (HRQOL). However, the relative degree of impairment in each domain differed among samples, and it was not clear which aspect of disease-specific HRQOL (modified polycystic ovary syndrome health-related quality of life questionnaire) was most negatively affected. Objective: To systematically review the effects of PCOS on specific domains of HRQOL. Materials and Methods: Literature search using search engine of database (PubMed, PsychInfo, CINAHL, CENTRAL, and Scopus) between 1998 to December 2013 yields 6 relevant publications. Pairs of raters used structural tools to analyze these articles, through critical appraisal and data extraction. The scores of each domain of polycystic ovarian syndrome questionnaire (PCOSQ) or modified version (MPCOSQ) of 1140 women with PCOS were used in meta-analysis. Results: The combine mean of emotional (4.40; 95% CI 3.77-5.04), infertility (4.13; 95% CI 3.81-4.45) and weight (3.88; 95% CI 2.33-5.42) dimensions were better, but menstruation (3.84; 95% CI 3.63-4.04) and hirsutism (3.81; 95% CI 3.26-4.35) domains were lower than the mean score of PCOSQ/MPCOSQ in related dimension. Conclusion: The meta-analysis showed that the most affected domains in specific HRQOL were hirsutism and menstruation. Based on these findings, we recommend healthcare providers to be made aware that HRQOL impairment of PCOS is mainly caused by their hirsutism and menstruation, which requires appropriate management. 61 70 2017/10/1 1396/7/9 2017/11/6 1396/8/15 فاطمه بازرگانی پور Fatemeh Bazarganipour Hormozgan Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandarabbas, Iran ایران سید عبدالوهاب تقوی Seyed Abdolvahab Taghavi Hormozgan Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandarabbas, Iran ایران علی منتظری Ali Montazeri Mental Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran ایران فضل الله احمدی Fazlollah Ahmadi Department of Nursing, Tarbiat Modares University, Tehran, Iran ایران رضا چمن Reza Chaman Department of Social Medicine, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran ایران احمد خسروی Ahmad Khosravi Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran ایران khosravi2000us@yahoo.com Polycystic ovary syndrome Review Meta-analysis Quality of life. مرور نظام مند متا آنالیز سندروم تخمدان پلی کیسیتک کیفیت زندگی مرتبط با سلامت World Health Organization.Preventing chronic diseases: a vital investment. 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Influence of ω-3 fatty acid eicosapentaenoic acid on IGF-1 and COX-2 gene expression in granulosa cells of PCOS women اثر اسید چرب امگا-3 ایکوزاپنتاانوییک اسید بر بیان ژن های IGF-1 و COX-2 در سلول های گرانولوزای انسانی 2 1 مقدمه: در حال حاضر، اسید چرب امگا-3 ایکوزاپنتاانوئیک اسید (EPA) به عنوان مکمل بهبود دهنده ناباروری به ویژه در افراد مبتلا به سندرم تخمدان پلیکیستیک (PCOS) کاربرد بالینی دارد. هدف: این مطالعه به منظور بررسی اثر EPA بر بیان ژنهای فاکتور رشد شبه انسولین 1 (IGF-1) و سیکلواکسیژناز 2 (COX-2) در کشت سلولهای گرانولوزای بدست آمده از بیماران تحت IVF و همچنین مقایسه با همین اثر در سلولهای گرانولوزای بیماران مبتلا به PCOS طراحی شده است. مواد و روشها: در این مطالعه تجربی، سلولهای گرانولوزای انسانی از زنان نرمال و مبتلا به PCOS طی درمان IVF جداسازی شد. سلولهای بدست آمده کشت داده شدند و پس از انکوباسیون با غلظتهای مختلف EPA، از نظر میزان بیان IGF-1 و COX-2 با روش Real-time PCR بررسی شدند. نتایج: در مقایسه با کنترل، همه غلظتهای EPA باعث افزایش بیان mRNA ژن IGF-1 شدند. غلظتهای بالای EPA در حضور FSH نوترکیب (rFSH) اثر افزایشی بر IGF-1 و اثر کاهشی بر COX-2 داشتند (01/0=p). این اثرها در سلولهای گرانولوزای بدست آمده از بیماران مبتلا به PCOS بیشتر بود. نتیجهگیری: اثر EPA بر بیان ژنهای IGF-1 و COX-2 در سلولهای گرانولوزا در جهت مخالف یکدیگر بود و این اثر در وضعیت PCOS شاخصتر بود. این یافتهها بیانگر مکانیسمهای مولکولی ممکن برای تأثیر مثبت اسیدهای چرب امگا-3 بر باروری زنان به ویژه در بیماران مبتلا به PCOS میباشد. 2 Background: The omega-3 (ω-3) fatty acid eicosapentaenoic acid (EPA) is currently used in the clinic as a nutritional supplement to improve infertility, particularly in women with polycystic ovarian syndrome (PCOS). Objective: The present study was designed to investigate the effect of EPA on insulin-like growth factor 1 (IGF-1) and cyclooxygenase 2 (COX-2) gene expression in primary cultured granulosa cells from patients undergoing in vitro fertilization (IVF), and also to compare this effect with those in granulosa cells of PCOS patients. Materials and Methods: In this experimental study, human granulosa cells were isolated from follicular fluid of normal and PCOS women undergoing IVF by hyaluronidase digestions, followed by Percoll gradient centrifugation. Cells were cultured in vitro, exposed to a range of concentrations of the EPA (25-100 μM) for 24 hr, and investigated with respect to COX-2 and IGF-1 gene expression by real time-PCR. Results: In both groups, all doses of the EPA significantly induced IGF-1 mRNAgene expression compared to the untreated control. High doses of EPA in thepresence of recombinant (r) FSH produced a stimulatory effect on IGF-1 and asuppressive effect (p=0.01) on the COX-2 gene expression, which were morepronounced in granulosa cells from PCOS patients. Conclusion: EPA affect diversely the gene expression of IGF-1 and COX-2 in granulosa cells, which were more pronounced in PCOS compared to control. These findings represent the possible underlying molecular mechanisms for the positive impact of the ω-3 fatty acids on reproduction, especially in patients with PCOS. 71 78 2017/10/12017/10/1 1396/7/9 2017/11/62017/11/6 1396/8/15 وحیده شهنازی Vahideh Shahnazi Women’s Reproductive Health Research Center, Al-zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran ایران مینا زارع Mina Zaree Department of Biochemistry and Clinical Laboratories, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran ایران محمد نوری Mohammad Nouri Women’s Reproductive Health Research Center, Al-zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran ایران مهزاد مهرزاد صدقیانی Mahzad Mehrzad-Sadaghiani Women’s Reproductive Health Research Center, Al-zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran ایران شبنم فایضی Shabnam Fayezi Students Research Committee, Infertility and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran ایران darabim@tbzmed.ac.ir مریم دارابی Maryam Darabi Drug Applied Research Center of Tabriz University of Medical Sciences, Tabriz, Iran ایران سجاد خانی Sajjad Khani Research Center for Pharmaceutical Nanotechnology, Tabriz University of Medical Sciences, Tabriz, Iran ایران مسعود دارابی Masoud Darabi Women’s Reproductive Health Research Center, Al-zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran ایران darabim@tbzmed.ac.ir Eicosapentaenoic acid Insulin-like growth factor 1 Cyclooxygenase 2 Granulosa cells Polycystic ovary syndrome. ایکوزاپنتاانوئیک اسید فاکتور رشد شبه انسولین 1 سیکلواکسیژناز 2 سلول های گرانولوزا سندرم تخمدان پلی کیستیک Kaur S, Archer KJ, Devi MG, Kriplani A, Strauss JF, Singh R. 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Effect of prostaglandin on luteinizing hormone-stimulated proliferation of theca externa cells from chicken prehierarchical follicles. Prostaglandins Other Lipid Mediat 2010; 92: 77-84.##Lee CH, Lee, SD, Ou HC, Lai SC, Cheng YJ. Eicosapentaenoic Acid Protects against Palmitic Acid-Induced Endothelial Dysfunction via Activation of the AMPK/eNOS Pathway. Int J Mol Sci 2014; 15: 10334-10349.##Glister C, Hatzirodos N, Hummitzsch K, Knight PG, Rodgers RJ. The global effect of follicle-stimulating hormone and tumour necrosis factor α on gene expression in cultured bovine ovarian granulosa cells. BMC Genom 2014; 15: 72-75.##Coffler MS, Patel K, Dahan MH, Malcom PJ, Kawashima T, Deutsch R, et al. Evidence for abnormal granulosa cell responsiveness to follicle-stimulating hormone in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2003; 88: 1742-1777.##Yang M, Du J, Lu D, Ren C, Shen H, Qiao J, et al. 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Premature progesterone rise at human chorionic gonadotropin triggering day has no correlation with intracytoplasmic sperm injection outcome افزایش پروژسترون پیش از موعد (PPR) در روز تزریق HCG با نتایج تزریق داخل سیتوپلاسمی اسپرم (ICSI) ارتباطی ندارد 2 1 مقدمه: پیش از ساخت آنالوگهای GnRh لوتیینیزاسیون پیش از موعد در سیکلهای IVF به طور شایعی رخ میداد. سطح بالای پروژسترون که به صورت ناخواسته طی برخی از سیکلهای IVF رخ میدهد با اثرات جانبی روی نتایج بارداری همراه است که احتمال داده میشود ناشی از افزایش نامناسب سطح LH باشد. هدف: هدف از انجام مطالعه ارزیابی سطح پروژسترون در روز تزریق HCG در پروتکل آگونیست و آنتاگونیست GnRh و ارتباط آن با نرخ بارداری بالینی و سقط بود. مواد و روشها: 107 خانم که تحت تزریق داخل سیتوپلاسمی اسپرم (ICSI) قرار گرفته بودند و 46 نفر از آنها در پروتکل آنتاگونیست طولانی و 61 نفر از آنها در پروتکل آنتاگونیست قرار داشتند وارد مطالعه شدند، نمونه خون از این افراد برای اندازه گیری سطح پروژسترون در روز تزریق HCG گرفته شد. نرخ بارداری بالینی و سقط به عنوان نتایج اصلی و نرخ بارداری بیوشیمیایی و نرخ لانه گزینی به عنوان نتایج ثانویه در نظر گرفته شدند. نتایج: شیوع افزایش پیش از موعد پروژسترون (ng/ml 2/1≤p) در کلیه بیماران 1/13% (14 از 107) بود و در گروه پروتکل آنتاگونیست طولانی به میزان 2/15% (7 از 46) و در گروه پروتکل آنتاگونیست به میزان 5/11% (7از 61) بود. افزایش پیش از موعد پروژسترون ارتباط معنی داری با نرخ بارداری بالینی در کلیه بیماران (174/0=p) و در گروه پروتکل آنتاگونیست طولانی (545/0=p) و در گروه پروتکل آنتاگونیست (129/0=p) نداشت. همچنین افزایش پیش از موعد پروژسترون ارتباط معنی داری با نرخ سقط در کلیه بیماران تحت مطالعه نداشت. نتیجهگیری: افزایش پیش از موعد پروژسترون در زمان تزریق HCG منجر به کاهش نرخ بارداری و نرخ لانهگزینی و افزایش نرخ سقط نمیشود. 2 Background: Premature luteinization during in vitro fertilization was commonly happened before the introduction of GnRh analogues. High level of unwanted progesterone is associated with adverse pregnancy outcome and is thought to be induced by inappropriate LH elevation. Objective: To evaluate the progesterone level on the day of Human Chorionic Gonadotropin (HCG) triggering in GnRh agonist and antagonist protocols, and its correlation with clinical pregnancy rate and miscarriage rate. Materials and Methods: One hundred and seven women underwent intracytoplasmic sperm injection with long agonist protocol (n=46) or antagonist protocol (n=61). Blood sample was obtained from each patient for progesterone level measurement in HCG administration day, then patients were divided into two groups according to their serum progesterone levels on the HCG triggering day: progesterone level <1.2 ng/ml, and progesterone level ≥1.2 ng/ml. Clinical pregnancy and miscarriage rates were evaluated as main outcomes and biochemical pregnancy rate and implantation rate were considered as secondary outcomes. Results: The increased prevalence rate of premature progesterone (progesterone level ≥1.2 ng/ml) in total patients was 13.1% (14/107) and in long agonist protocol group and antagonist protocol group was 15.2% (7/46) and 11.5% (7/61) respectively. Premature progesterone rise had no significant correlation with clinical pregnancy rate in total patients (p=0.174), agonist protocol (p=0.545), and antagonist protocol (p=0.129). Also premature progesterone rise had no significant association with miscarriage rate in total patients (p=0.077), agonist protocol group (p=0.383) and antagonist protocol group (p=0.087). Conclusion: A significant rise in progesterone levels at the time of HCG triggering doesn’t lead to decrease in pregnancy rate and implantation rate and increase in miscarriage rate. 79 84 2017/10/12017/10/12017/10/1 1396/7/9 2017/11/62017/11/62017/11/6 1396/8/15 نسرین سحرخیز Nasrin Saharkhiz Infertility and Reproductive Health Research Center (IRHRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran ایران ساغر صالحپور Saghar Salehpour Infertility and Reproductive Health Research Center (IRHRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran ایران mahboobetavasoli@yahoo.com محبوبه توسلی Mahboobeh Tavasoli Infertility and Reproductive Health Research Center (IRHRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran ایران علی عقیقی Ali Aghighi Baqiyatallah University of Medical Sciences, Tehran, Iran ایران Progesterone rise HCG triggering GnRh agonist GnRh antagonist Intracytoplasmic sperm injection. سطح پروژسترون تزریق HCG پروتکل آگونیست طولانی پروتکل آنتاگونیست تزریق داخل سیتوپلاسمی اسپرم. Huang R, Fang C, Xu S, Yi Y, Liang X. Premature progesterone rise negatively correlated with live birth rate in IVF cycles with GnRH agonist: an analysis of 2,566 cycles. Fertil Steril 2012; 98: 664-670.##Hamori M, Stuckensen JA, Rumpf D, Kniewald T, Kniewald A, Kurz CS. Premature luteinization of follicles during ovarian stimulation for in-vitro fertilization. Hum Reprod 1987; 2: 639-643.##Lindheim SR, Cohen MA, Chang PL, Sauer MV. Serum progesterone before and after human chorionic gonadotropin injection depends on the estradiol response to ovarian hyperstimulation during in vitro fertilization-embryo transfer cycles. J Assist Reprod Genet 1999; 16: 242-246.##Ochsenkuhn R, Arzberger A, von Schonfeldt V, Gallwas J, Rogenhofer N, Crispin A, et al. Subtle progesterone rise on the day of human chorionic gonadotropin administration is associated with lower live birth rates in women undergoing assisted reproductive technology: a retrospective study with 2,555 fresh embryo transfers. Fertil Steril 2012; 98: 347-354.##Edelstein MC, Seltman HJ, Cox BJ, Robinson SM, Shaw RA, Muasher SJ. Progesterone levels on the day of human chorionic gonadotropin administration in cycles with gonadotropin releasing hormone agonist suppression are not predictive of pregnancy outcome. Fertil Steril 1990; 54: 853-857.##Silverberg KM, Martin M, Olive DL, Burns WN, Schenken RS. Elevated serum progesterone levels on the day of human chorionic gonadotropin administration in in vitro fertilization cycles do not adversely affect embryo quality. Fertil Steril 1994; 61: 508-13.##Ubaldi F, Camus M, Smitz J, Bennink HC, Van Steirteghem A, Devroey P. Premature luteinization in in vitro fertilization cycles using gonadotropin releasing hormone agonist (GnRH-a) and recombinant follicle-stimulating hormone (FSH) and GnRH-a and urinary FSH. Fertil Steril 1996; 66: 275-280.##Bosch E, Valencia I, Escudero E, Crespo J, Simon C, Remohi J, et al. Premature luteinization during gonadotropin-releasing hormone antagonist cycles and its relationship with in vitro fertilization outcome. Fertil Steril 2003; 80: 1444-1449.##Lee FK, Lai TH, Lin TK, Horng SG, Chen SC. Relationship of progesterone/estradiol ratio on day of hCG administration and pregnancy outcomes in high responders undergoing in vitro fertilization. Fertil Steril 2009 Oct; 92: 1284-1289.##Kiliçdag EB, Haydardedeoglu B, Cok T, Hacivelioglu SO, Bagis T. Premature progesterone elevation impairs implantation and live birth rates in GnRH-agonist IVF/ICSI cycles. Arch Gynecol Obstet 2010; 281: 747-752.##Nayak S, Ochalski ME, Fu B, Wakim KM, Chu TJ, Dong X, et al. Progesterone level at oocyte retrieval predicts in vitro fertilization success in a short-antagonist protocol: a prospective cohort study. Fertil Steril 2014; 101; 676-682.##Doldi N, Marsiglio E, Destefani A, Gessi A, Merati G, Ferrari A. Elevated serum progesterone on the day of HCG administration in IVF is associated with a higher pregnancy rate in polycystic ovary syndrome. Hum Reprod 1999; 14: 601-605.##Legro RS, Ary BA, Paulson RJ, Stanczyk FZ, Sauer MV. Premature luteinization as detected by elevated serum progesterone is associated with a higherpregnancy rate in donor oocyte in-vitro fertilization. Hum Reprod 1993; 8: 1506-1511.##Miller KF, Behnke EJ, Arciaga RL, Goldberg JM, Chin NW, Awadalla SG. The significance of elevated progesterone at the time of administration of human chorionic gonadotropin may be related to luteal support. J Assist Reprod Genet 1996; 13: 698-701.##Lai TH, Lee FK, Lin TK, Horng SG, Chen SC, Chen YH, et al. An increased serum progesterone-to-estradiol ratio on the day of human chorionic gonadotropin administration does not have a negative impact on clinical pregnancy rate in women with normal ovarian reserve treated with a long gonadotropin releasing hormone agonist protocol. Fertil Steril 2009; 92: 508-514.##Saleh HA, Omran MS, Draz M. Does subtle progesterone rise on the day of HCG affect pregnancy rate in long agonist ICSI cycles? J Assist Reprod Genet 2009; 26: 239-242.##Venetis CA, Kolibianakis EM, Tarlatzis BC. Progesterone elevation andprobability of pregnancy after IVF: facts and fiction. Hum Reprod Update 2008; 14: 538.##Younis JS. ''Premature luteinization'' in the era of GnRH analogue protocols: time to reconsider. J Assist Reprod Genet 2011; 28: 689-692.##Elnashar AM. Progesterone rise on the day of HCG administration (premature luteinization) in IVF: an overdue update. J Assist Reprod Genet 2010; 27: 149-155.##Hofmann GE, Bentzien F, Bergh PA, Garrisi GJ, Williams MC, Guzman I, et al. Premature luteinization in controlled ovarian hyper stimulation has no adverse effect on oocyte and embryo quality. Fertil Steril 1993; 60: 675-679.##Younis JS, Simon A, Laufer N. Endometrial preparation: lessons from oocyte donation. Fertil Steril 1996; 66: 873-884.##Copperman AB, Horowitz GM, Kaplan P, Scott RT, Navot D, Hofmann GE. Relationship between circulating human chorionic gonadotropin levels and premature luteinization in cycles of controlled ovarian hyperstimulation. Fertil Steril 1995; 63: 1267-1271.##Ubaldi F, Albano C, Peukert M, Riethmuller-Winzen H, Camus M, Smitz J, et al. Subtle progesterone rise after the administration of the gonadotrophin releasing hormone antagonist cetrorelix in intracytoplasmic sperm injection cycles. Hum Reprod 1996; 11: 1405-1407.##Younis JS, Matilsky M, Radin O, Ben-Ami M. Increased progesterone/estradiol ratio in the late follicular phase could be related to low ovarian reserve in in vitro fertilization- embryo transfer cycles with a long gonadotropin releasing hormone agonist. Fertil Steril 2001; 76: 294-299.##Pangas SA, Li X, Robertson EJ, Matzuk MM. Premature luteinization and cumulus cell defects in ovarian-specific Smad4 knockout mice. Mol Endocrinol 2006; 20: 1406-1422.##Schoolcraft W, Sinton E, Schlenker T, Huynh D, Hamilton F, Meldrum DR.Lower pregnancy rate with premature luteinization during pituitary suppression with leuprolide acetate. Fertil Steril 1991; 55: 563-566.##Check JH, Lurie D, Askari HA, Hoover L, Lauer C. The range of subtle rise in serum progesterone levels following controlled ovarian hyperstimulation associated with lower in vitro fertilization pregnancy rates is determined by the source of manufacturer. Eur J Obstet Gynecol Reprod Biol 1993; 52: 205-209.##Lahoud R, Kwik M, Ryan J, Al-Jefout M, Foley J, Illingworth P. Elevated progesterone in GnRH agonist down regulated in vitro fertilization (IVFICSI) cycles reduces live birth rates but not embryo quality. Arch Gynecol Obstet 2012; 285: 535-540.##Fanchin R, Hourvitz A, Olivennes F, Taieb J, Hazout A, Frydman R. Premature progesterone elevation spares blastulation but not pregnancy rates in in vitro fertilization with co culture. Fertil Steril 1997; 68: 648-652.##Papanikolaou EG, Kolibianakis EM, Pozzobon C, Tank P, Tournaye H, Bourgain C, et al. Progesterone rise on the day of human chorionic gonadotropin administration impairs pregnancy outcome in day 3 single-embryo transfer, while has no effect on day 5 single blastocyst transfer. Fertil Steril 2009; 91: 949-952.##Fanchin R, de Ziegler D, Taieb J, Hazout A, Frydman R. Premature elevation of plasma progesterone alters pregnancy rates of in vitro fertilization and embryo transfer. Fertil Steril 1993; 59: 1090-1094.## ##

Effects of Ghrelin on germ cell apoptosis and proinflammatory cytokines production in Ischemia-reperfusion of the rat testis اثر گرلین بر تولید میانجی های التهابی و آپوپتوزیس سلول های زایا در ایسکمیا/ رپرفیوژن بیضه موش بزرگ آزمایشگاهی 2 1 مقدمه: پیچ خوردگی بیضه از مواردی است که مداخله سریع جراحی جهت خون رسانی مجدد به آن ضروری است. آسیب ناشی از عدم خونرسانی و خونرسانی مجدد به بیضهها (ایسکمیا/ رپرفیوژن) در ارتباط با تولید مواد میانجی التهابی و مرگ برنامه ریزی شده (آپوپتوزیس) سلولهای زایا در بیضهها است. هدف: در مطالعه حاضر ما تأثیر هورمون گرلین را بر میزان مواد میانجی التهابی وآپوپتوزیس سلولهای زایا در بیضهها در شرایط ایسکمیا/ رپرفیوژن مورد بررسی قرار داده ایم. مواد و روشها: 45 سر موش بزرگ صحرائی نر جهت مطالعه انتخاب و بصورت تصادفی در سه گروه هر کدام 15 سر تقسیم شدند. در حیوانات حاضر در دو گروهی که بصورت تجربی تحت شرایط ایسکمیا/ رپرفیوژن قرار میگیرند یعنی گروههای دریافت کننده گرلین و سرم فیزیولوژی، پیچ خوردگی بیضه به میزان 720 درجه در خلاف جهت حرکت عقربههای ساعت به مدت یک ساعت ایجاد و سپس با رفع پیچ خوردگی اجازه داده شد که خون رسانی به بیضهها به مدت 4 ساعت، یک روز و یا 7 روز انجام گیرد. در گروه سوم پیچ خوردگی در بیضهها ایجاد نگردیده و به عنوان کنترل بکار رفتند. گرلین 15 دقیقه قبل از رفع پیچخوردگی بصورت داخل صفاقی به گروه دریافت کننده هورمون تزریق گردید. برداشت بیضهها در انتهای زمانهای مورد اشاره برای خون رسانی مجدد انجام و با روش ایمونوهیستو شیمی میزان BAX، PCNA، IL-1β ،IL-6 و TNF-α در بافت بیضه اندازه گیری شد. نتایج: نتایج نشان داد که در گروه دریافت کننده گرلین تعداد سلولهای اسپرماتوسیت دارای پروتئین آنتی BAX در روز 7 پس از رپرفیوژن بطور معنیداری در مقایسه با گروهی که گرلین دریافت نکرده و همزمان پیچ خوردگی بیضه در آنها ایجاد شده بود کمتر است. مقایسه بین این دو گروه تفاوت معنی داری از نظر ایجاد PCNA در سلولهای اسپرماتوسیت و اسپرماتوگونی در هیچ یک از روز های نمونه برداری (1 و 7) نشان نداد. تزریق گرلین بطور معنیداری میزان IL-6 و TNF-α را کاهش داده در حالیکه بر میزان IL-1β تأثیری نداشت. نتیجهگیری: میتوان نتیجه گیری کرد که گرلین دارای اثرات قابل ملاحظه ضد التهابی و ضد آپوپتوزیس در آسیب ناشی از ایسکمیا/ رپرفیوژن است. 2 Background: Testicular torsion is a medical emergency that requires surgical intervention to reperfuse the affected testis. Ischemia reperfusion injury is usually associated with proinflammatory cytokine generation and apoptosis of germ cells in the testes. Objective: In this study we investigate the effect of ghrelin on the proinflammatory cytokines levels and germ cell apoptosis in testicular ischemia reperfusion. Materials and Methods: 45 male rats were selected for the study and randomly divided into 3 groups, each containing 15 rats. Animals in the testicular torsion and ghrelin treated groups were subjected to unilateral 720 counterclockwise testicular torsion for 1 hr and then reperfusion was allowed after detorsion for 4 hr, 1 and 7 days. The ghrelin-treated group received intraperitoneal injection of ghrelin 15min before detorsion. The expression levels of bcl-2-associated X protein and proliferating cell nuclear antigen in testicular tissue in the different groups were detected by immunohistochemical assay and tissue cytokines interleukin-1β, tumor necroses factor-α and interleukin-6 were measured using enzyme-linked immunosorbent assay Results: After being treated by ghrelin, the population of immunoreactive cells against BAX in the spermatocytes on day 7 after reperfusion significantly decreased when compared to tortion/ detortion-saline animals (p=0.024). In contrast, PCNA expression in the spermatocytes and spermatogonia were not significantly different between tortion/ detortion-ghrelin and tortion/ detortion-saline groups on both experimental days. Administration of ghrelin significantly attenuated the testicular tumor necroses factor-α and interleukin-6 levels compared with the untreated animals, but had no significant effect on the level of interleukin-1β. Conclusion: Ghrelin offers remarkable anti-inflammatory and anti-apoptotic effects in testicular ischemia reperfusion injury. 85 92 2017/10/12017/10/12017/10/12017/10/1 1396/7/9 2017/11/62017/11/62017/11/62017/11/6 1396/8/15 مجید طاعتی Majid Taati Department of Pathobiology, School of Veterinary Medicine, Lorestan University, Khorramabad, Iran ایران taatimajid@yahoo.com مهرنوش مقدسی Mehrnoush Moghadasi Department of Physiology, Faculty of Medicine, Lorestan University of Medical Sciences, Khoramabad, Iran ایران امید دزفولیان Omid Dezfoulian Department of Pathobiology, School of Veterinary Medicine, Lorestan University, Khorramabad, Iran ایران پیمان اسدیان Payman Asadian Department of Pathobiology, School of Veterinary Medicine, Lorestan University, Khorramabad, Iran ایران مرتضی زنده دل Morteza Zendehdel Department of Physiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran ایران Ghrelin Ischemia Reperfusion Testes Apoptosis. گرلین ایسکمی خونرسانی مجدد بیضه آپوپتوز. Lysiak JJ, Nguyen QAT, Kirby JL, Turner TT. Ischemia-Reperfusion of the Murine Testis Stimulates the Expression of Proinflammatory Cytokines and Activation of c-jun N-Terminal Kinase in a Pathway to E-Selectin Expression. Biol Reprod 2003; 69: 202-210.##Bozlu M, Coskun B, Cayan S, Acar D, Aktas S, Ulusoy E, et al. Inhibition of poly (adenosine diphosphate-ribose) polymerase decreases long-term histologic damage in testicular ischemia-reperfusion injury. Urology 2004; 63: 791-795.##Jassem W, Fuggle SV, Rela M, Koo DDH, Heaton ND. The role of mitochondria in ischemia/reperfusion injury. Transplantation 2002; 73: 493-499.##Webster KA, Discher DJ, Kaiser S, Hernandez O, Sato B, Bishopric NH. Hypoxia-activated apoptosis of cardiac myocytes requires reoxygenation or a pH shift and is independent of p53. J Clin Invest 1999; 104: 239-252.##Lysiak JJ, Nguyen QAT, Turner TT. Peptide and nonpeptide reactive oxygen scavengers provide partial rescue of the testis after torsion. J Androl 2002; 23: 400-409.##Lysiak JJ. The role of tumor necrosis factor-alpha and interleukin-1 in the mammalian testis and their involvement in testicular torsion and autoimmune orchitis. Reprod Biol Endocrin 2004; 2: 1-10.##Ranade AV, Tripathi Y, Rajalakshmi R, Vinodini NA, Soubhagya RN, Nayanatara AK, et al. Effect of vitamin E administration on histopathological changes in rat testes following torsion and detorsion. Singapore Med J 2011; 52: 742-746.##Hamed GM, Ahmed RM, Emara MM, Mahmoud MH. Effect of Erythropoietin on Experimental Unilateral Testicular Torsion Detorsion in Rat Model. Life Sci J 2011; 8: 405-412.##Korbonits M, Goldstone AP, Gueorguiev M, Grossman AB. Ghrelin: a hormone with multiple functions. Front Neuroendocrinol 2004; 25: 27-68.##Konturek PC, Brzozowski T, Walter B, Burnat G, Hess T, Hahn EG, et al. Ghrelin-induced gastroprotection against ischemia-reperfusion injury involves an activation of sensory afferent nerves and hyperemia mediated by nitric oxide. Eur J Pharmacol 2006; 536: 171-181.##Tena-Sempere M. Ghrelin: novel regulator of gonadal function. J Endocrinol Invest 2005; 28: 26-29.##Kheradmand A, Dezfoulian O, Alirezaei M, Rasoulian B. Ghrelin modulates testicular germ cells apoptosis and proliferation in adult normal rats. Biochem Biophys Res Commun 2012; 419: 299-304.##Yao YM, Bahrami S, Redl H, Fuerst S, Schlag G. IL-6 release after intestinal ischemia/reperfusion in rats is under partial control of TNF. J Surg Res 1997; 70: 21-26.##Mak TW, Yeh WC. Signaling for survival and apoptosis in the immune system. Arthitis Res 2004; 4: S243-S252.##Gorman A, McGowan AJ, Cotter TG. Role of peroxide and superoxide anion during tumor cell apoptosis. FEBS Lett 1997; 404: 27-33.##Minutoli L, Antonuccio P, Romeo C, Nicòtina PA, Bitto A, Arena S, et al. Evidence for a role of mapk3/mapk1 in the development of testicular ischemia-reperfusion injury. Biol Reprod 2005; 73: 730-736.##Turgut B, Gül FC, Dağli F, Ilhan N, Özgen M. Impact of ghrelin on vitreous cytokine levels in an experimental uveitis model. Drug Des Devel Ther 2013; 7: 19-24.##Lao KM, Lim WS, Ng DL, Tengku-Muhammad TS, Choo QC, Chew CH. Molecular Regulation of Ghrelin Expression by Pro-Inflammatory Cytokines TNF-α and IL-6 In Rat Pancreatic AR42J Cell Line. J Biol Life Sci 2013; 4: 32-40.##Dixit VD, Taub DD. Ghrelin and Immunity: A Young Player in an Old Field. Exp Gerontol 2005; 40: 900-910.##Hutson JC. Secretion of tumor necrosis factor alpha by testicular macrophages. Reprod Immunol 1993; 23: 63-72.##Lysiak JJ, Bang HJ, Nguyen QAT, Turner TT. Activation of the Nuclear Factor Kappa B Pathway Following Ischemia-Reperfusion of the Murine Testis. J Androl 2005; 26: 129-135.##Rodriguez A, Gomez-Ambrosi J, Catalan V, Rotellar F, Valenti V, Silva C, et al. The ghrelin O-acyltransferase-ghrelin system reduces TNF-α-induced apoptosis and autophagy in human visceral adipocytes. 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Cabergoline plus metformin therapy effects on menstrual irregularity and androgen system in polycystic ovary syndrome women with hyperprolactinemia بررسی تأثیر مکملی کابرگولین بر روی اختلال سیکل های قاعدگی و علائم آزمایشگاهی بیماران مبتلا به سندرم تخمدان پلی کیستیک 2 1 مقدمه: سندرم تخمدان پلیکیستیک (PCOS) یک اختلال متابولیکی شایع و یک بیماری اندوکرین ناهمگن در زنان سنین باروری بوده که مجموعه ای از علایم و اختلالات هورمونی (هایپر انسولینمی، هایپرآندروژنمی، افزایش سطح LH و هایپرپرولاکتینمی در 30% موارد) را شامل میشود. درمان PCOS با توجه به سن بروز آن که بیشتر زنان جوان در سنین باروری را درگیر کرده و نیز با توجه به عوارض مرتبط با آن مانند ناباروری از اهمیت بالایی برخوردار است. مطالعات اندکی در زمینه درمان بیماران مبتلا به PCOS با استفاده از آگونیستهای طولانی اثر رسپتور دوپامین وکاهنده ترشح پرولاکتین نظیر کابرگولین انجام شده است. در سالهای اخیر استفاده از کابرگولین در درمان PCOS به صورت چشمگیری مورد توجه قرار گرفته است. هدف: این مطالعه با هدف بررسی اثراضافه کردن کابرگولین به داروی متفورمین که درمان معمول در این بیماران میباشد به انجام رسیده است. مواد و روشها: در این مطالعه که به صورت کارآزمایی بالینی به انجام رسید، 110 بیمار مبتلا به PCOS با شرایط مورد نظر، به روش نمونهگیری آسان انتخاب شده و به دو گروه مورد و شاهد تقسیم شدند. گروه مورد تحت درمان با متفورمین gr 1 روزانه همراه با کابرگولین mg 5/0 هفتگی به مدت 4 ماه قرار گرفته و گروه کنترل نیز تحت درمان با متفورمین gr 1 روزانه به اضافه پلاسبو به صورت هفتگی قرار گرفتند. سپس اطلاعات مورد نظر همچون اطلاعات دموگرافیک و آزمایشگاهی در پرسشنامه محقق ساخته جمع آوری شد و مورد تجزیه و تحلیل آماری قرار گرفت. نتایج: مقایسه میانگین پرولاکتین قبل و بعد از مداخله در گروه مورد اختلاف معنیداری داشت ( 001/0> p). ولی در گروه شاهد میانگین پرولاکتین قبل وبعد از مداخله تغییر معناداری نداشت (08/0=p). مقایسه میانگین تغییرات DHEAS (09/0=p)، وزن ( 73/0=p) و تستوسترون (072/0=p) در دو گروه مورد مطالعه قبل و بعد از مداخله اختلاف معنیداری نشان نداد در حالی که در مورد تغییرات پرولاکتین (001/0>p) اختلاف معنیدار بود. کلیه بیماران در هر دو گروه مورد مطالعه سیکل قاعدگی نامنظم داشتند که میزان منظم شدن بعد از مداخله در دو گروه مورد 2/58 % و در گروه شاهد 4/36 % بود که با (022/0=p) تفاوت معنیدار بود. نتیجهگیری: نتایج این مطالعه نشان میدهد که کابرگولین می تواند بهعنوان یک درمان مناسب برای بیماران PCOS با پرولاکتین بالا برای بهبود اختلالات قاعدگی و کاهش آندروژنهای سرم به کار گرفته شود. 2 Background: 30% of patients with polycystic ovary syndrome (PCOS) show mild, transient hyperprolactinemia. It is suggested that a reduction of the dopamine inhibitory effect might raise both prolactin and luteinizing hormone. Objective: To investigate the adjuvant cabergoline therapy effects on menstrual irregularity and androgen system in PCOS women with hyperprolactinemia. Materials and Methods: This randomized clinical trial was done on 110 polycysticovary syndrome women with increased serum prolactin concentration [1.5 fold morethan normal level (>37.5 ng/ml)]. Participants were divided into two groups: Casegroup (n=55) treated with metformin 1gr/day and cabergoline 0.5 mg/week for 4months and control group (n=55) treated with metformin 1g/day and placeboweekly. Testosterone, prolactin, and dehydroepiandrosterone sulfate level weremeasured before and four months after intervention in two groups. Also, situation ofmenstrual cycles asked and recorded before and after intervention. Results: We found decrease in the mean of dehydroepiandrosterone sulfate, weightand total testosterone level in the two groups after intervention but their changeswere not significant. Patients in case group showed a significant decrease in serumprolactin level before and after intervention (p<0.001), but no difference was foundin control group. All patients in both studied groups had irregular menstrual cycles,which regulate after intervention and the difference was significant (p=0.02). Conclusion: The results showed that cabergoline can be used as a safe administration in PCOS patients with hyperprolactinemia to improve the menstrual cycles. Considering that the administration of cabergoline plus metformin may reduce the required duration and dose of metformin, patient acceptability of this approach is higher. 93 100 2017/10/12017/10/12017/10/12017/10/12017/10/1 1396/7/9 2017/11/62017/11/62017/11/62017/11/62017/11/6 1396/8/15 اعظم قانعی Azam Ghaneei Department of Endocrinology, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ایران اکرم جوکار Akram Jowkar Department of Endocrinology, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ایران akjowkar@gmail.com محمدرضا حسنی قوام Mohammad Reza Hasani Ghavam Shahid Sadoughi University of Medical Sciences, Yazd, Iran ایران محمدابراهیم قانعی Mohammad Ebrahim Ghaneei Khatam-Ol- Anbia Clinic, Yazd, Iran ایران Polycystic ovarian syndrome Cabergoline Metformin Menstrual cycle Laboratory findings. سندرم تخمدان پلی کیستیک دوپامین آگونیست کابرگولین متفورمین سیکل قاعدگی علایم آزمایشگاهی. 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Clin Endocrinol (Oxf) 2008; 69: 634-641.##Asunción M, Calvo RM, San Millán JL, Sancho J, Avila S, Escobar-Morreale HF. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab 2000; 85: 2434-2438.##Azziz R. PCOS: a diagnostic challenge. Reprod Biomed Online 2004; 8: 644-648.##Wood JR, Dumesic DA, Abbott DH, Strauss JF. Molecular abnormalities in oocytes from women with polycystic ovary syndrome revealed by microarray analysis. J Clin Endocrinol Metab 2007; 92: 705-713.##Toulis KA, Gouli DG, Farmakiotis D, Georgopoulos NA, Katsikis I, Tarlatzis BC, et al. Adiponectin levels in women with polycystic ovary syndrome: a systematic review and a meta-analysis. Hum Reprod Update 2009; 15: 297-307.##Moran L, Teede H. Metabolic features of the reproductive phenotypes of polycystic ovary syndrome. Hum Reprod Update 2009; 15: 477-488.##Rotterdam ESHRE/ ASRM- Sponsored PCOS consensus workshop group Hum Reprod. Review Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19: 41-47.##Sengoku K, Tamate K, Takuma N, Yoshida T, Goishi K, Ishikawa M. The chromosomal normality of unfertilized oocytes from patients with polycystic ovarian syndrome. Hum Reprod 1997; 12: 474-477.##Boomsma CM, Fauser BCJM, Macklon NS. Pregnancy complications in women with olyscystic ovary syndrome. Semin Reprod Med 2008; 26: 72-84.##Duignam NM. Polycystic ovarian disease. Br J Obstet Gynaecol 1976; 83: 593.##Falaschi P, Frajese G, Rocco A, Toscano V, Sciarra F. Polycystic ovary syndrome and hyperprolactinemia. J Steroid Biochem 1977; 8: 13.##Coremblum B, Taylor PJ. The hyperprolactinemic polycystic ovary syndrome may not be an distinct entity. Fertil Steril 1982; 38: 549-552.##Işik AZ, Gülekli B, Zorlu CG, Ergin T, Gökmen O. Endocrinological and clinical analysis of hyperprolactinemic patients with and without ultrasonically diagnosed polycystic ovarian changes. Gynecol Obstet Invest 1997; 43: 183-185.##Doldi N, Papaleo E, De Santis L, Ferrari A. Hyperprolactinemia in IVF cycles: treatment vs no treatment and outcome of ovarian stimulation, oocyte retrieval and oocyte quality. Gynecol Endocrinol 2000; 14: 437-441.##Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J. Harrison's Principles of Internal Medicine. 18th Ed. USA, Elsevier; 2011.##Webster J. Dopamine agonist in hyperprolactinemia. J Reprod Med 1999; 44: 1105-1110.##Falaschi P, Rocco, A, Del Pozo E. Inhibitory effect of bromocriptine treatment on luteinizing hormone secretion in polycystic ovary syndrome. J Clin Endocrinol Metab 1986; 62: 348-351.##Prelevic GM, Wurzburger MI, Peric LJA. 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Predictive value of maternal serum β-hCG concentration in the ruptured tubal ectopic pregnancy ارزش پیشگویی غلظت β-hCG سرم مادری در پارگی حاملگی نابجا لوله ای 2 1 مقدمه: خونریزی ناشی از پارگی حاملگی لولهای علیرغم روشهای تشخیصی و درمانی پیشرفته، هنوز مهمترین علت مرگ و میر مادری مرتبط با حاملگی در سه ماهه اول بارداری است. اندازهگیری β-hCG که یک مارکر دقیق قابلیت حیات تروفوبلاستی است، به طور معمول برای تشخیص و پیگیری نتایج درمان این بیماران استفاده میشود. هدف: هدف ما از انجام این مطالعه، بررسی ارزش پیشگویی غلظت β-hCG سرم مادر برای شانس پارگی در حاملگیهای لولهای جهت شناسایی زنان در معرض خطر است. مواد و روشها: این مطالعه به صورت مقطعی- تحلیلی گذشته نگر بر روی زنان مبتلا به حاملگی لولهای درمان شده در مرکز آموزش و درمانی بیمارستان الزهرا شهر رشت، طی سالهای 1380 الی 1387 انجام شد. دادهها برای هر خانم از پرونده پزشکی جمع آوری شدند. در نهایت بیماران در دو گروه مبتلا به پارگی لولهای و بدون پارگی مقایسه شدند. آنالیز آماری به کمک SPSS ورژن 19 انجام شد. نتایج: در مجموع 247 نفر مبتلا به حاملگی لولهای وارد مطالعه شدند. 197 نفر (8/79%) حاملگی لولهای پاره نشده و 50 نفر (2/20%) پاره شده داشتند. سطح میانگین β-hCG در بیماران مبتلا به حاملگی لولهای پاره شده نسبت به پاره نشده به طور معنیداری بیشتر بود (IU/ml 67/3849±09/3063 در مقابل IU/ml 86/3429±29/1851 و 0001/0˂p). آنالیز لوجستیک نیز نشان داد که غلظت IU/ml 1750˃β-hCG ریسک فاکتور قابل توجهای برای پارگی حاملگی لولهای است (68/1-18/1:CI 95% 41/1:OR). نتیجهگیری: سطح بالای β-hCG به نظر میرسد ریسک فاکتور مهمی برای پارگی در حاملگی لولهای باشد. 2 Background: Measurement of serum β-hCG concentration commonly used to diagnose tubal ectopic pregnancy (EP) and follow up patients treated conservatively. Objective: The aim of this study was to determine the predictive value of maternal serum β-hCG concentration in ruptured tubal ectopic pregnancy to help physicians identify those women who are at greatest risk. Materials and Methods: This is a cross-sectional study conducted on all women with a diagnosis of tubal ectopic pregnancy who were treated in Alzahra Hospital, in Rasht, from March 2002 to February 2011. The data was collected for each woman from medical records and included age, parity, gravidia, gestational age, primary level of serum β-hCG, rupture status, past history of pelvic inflammation disease, EP, abortion, and intrauterine contraceptive device use. Women with tubal rupture were compared to those without rupture. Statistical analysis was conducted by SPSS 19 for Windows. Results: A total of 247 cases of tubal ectopic pregnancy were recorded during the study period. One hundred and ninety seven (79.8%) were cases with unruptured EP and 50 patients (20.2 %) were cases with ruptured EP. The mean level of β-hCG was significantly higher in patients with ruptured EP compared to patients with unruptured EP (p=0.03). Logistic regression analysis revealed that >1750 IU/ml of β-hCG levels (OR: 1.41; 95% CI: 1.18-1.68) was the significant risk factors for tubal rupture. Conclusion: Higher β-hCG levels seem to be significant risk factors for rupture of a tubal EP. 101 106 2017/10/12017/10/12017/10/12017/10/12017/10/12017/10/1 1396/7/9 2017/11/62017/11/62017/11/62017/11/62017/11/62017/11/6 1396/8/15 رویا فرجی درخانه Roya Faraji Darkhaneh Reproductive Health Research Center, Department of Obstetrics and Gynecology, Guilan University of Medical Sciences, Rasht, Iran ایران مریم اصغرنیا Maryam Asgharnia Reproductive Health Research Center, Department of Obstetrics and Gynecology, Guilan University of Medical Sciences, Rasht, Iran ایران maryamasgharnia@yahoo.com نسترن فرهمند Nastaran Farahmand Porkar Guilan University of Medical Sciences, Rasht, Iran ایران علی اکبر علی پور Ali Akbar Alipoor Guilan University of Medical Sciences, Rasht, Iran ایران Tubal ectopic pregnancy Tubal rupture Serum β-hCG concentration. حاملگی نابجا حاملگی لوله ای خطر پارگی لوله ای غلظت β-hCG سرمی. Goksedef BP, Kef S, Akca A, Bayik RN, Cetin A. Risk factors for rupture in tubal ectopic pregnancy: definition of the clinical findings. Eur J Obstet Gynecol Reprod Biol 2011; 154: 96-99.##Houry DE, Salhi BA. Acute complications of pregnancy. In: Marx JA, editor. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th Ed. Philadelphia, Pa: Mosby Elsevier; 2009.##Turgut EN, Celik E, Celik S, Arikan DC, Altuntas H, Leblebici C, et al. Could serum β-hCG levels and gestational age be the indicative factors for the prediction of the degree of trophoblastic invasion into tubal wall in unruptured ampullary pregnancies. Arch Gynecol Obstet 2013; 287: 323-328.##Murray H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ectopic pregnancy. CMAJ 2005; 173: 905-912.##Creanga AA, Shapiro-Mendoza CK, Bish CL, Zane S, Berg CJ, Callaghan WM. Trends in ectopic pregnancy mortality in the United States: 1980-2007. Obstet Gynecol 2011; 117: 837.##Natale A, Candiani M, Merlo D, Izzo S, Gruft L, Busacca M. Human chorionic gonadotropin level as a predictor of trophoblastic infiltration into the tubal wall in ectopic pregnancy: a blinded study. Fertil Steril 2003; 79: 981-986.##Borrelli PT, Butler SA, Docherty SM, Staite EM, Borrelli AL, Iles RK. Human chorionic gonadotropin isoforms in the diagnosis of ectopic pregnancy. Clin Chem 2003; 49: 2045-2049.##Cartwright J, Duncan WC, Critchley HO, Horne AW. Serum biomarkers of tubal ectopic pregnancy: current candidates and future possibilities. Reproduction 2009; 138: 9-22.##Fauconnier A, Mabrouk A, Heitz D, Ville Y. Ectopic pregnancy: interest and value of clinical examination in management policy. J Gynecol Obstet Biol Reprod 2003; 32: 18-27.##Bickell NA, Bodian C, Anderson RM, Kase N. Time and the risk of ruptured tubal pregnancy. Obstet Gynecol 2004; 104: 789-794.##SindosM, Togia A, SergentanisTN, Kabagiannis A, Malamas F, Farfaras A, et al. Ruptured ectopic pregnancy: risk factors for a life-threatening condition. Arch Gynecol Obstet 2009; 279: 621- 623.##Berlingieri P, Bogdanskiene G, Grudzinskas J. Rupture of tubal peregnancy in the Vilnius population. Eur J Obstet Gynecol Reprod Biol 2007; 131: 85-88.##Roussos D, Panidis D, Matalliotakis I, Mavromatidis G, Neonaki M, Mamopoulos M, et al. Factors that may predispose to rupture of tubale ectopic pregnancy. Eur Obstet Gynecol Repord Biol 2000; 89: 15-17.##Mol BW, Hajenius PJ, Engelsbel S, Ankum WM, Van der Veen F, Hemrika DJ, et al. Can noninvasive diagnostic tools predict tubal rupture or active bleeding in patients with tubal pregnancy? Fertil Steril 1999; 71: 167-173.##Downey LV, Zun LS. Indicators of potential for rupture for ectopics seen in the emergency department. J Emerg Trauma Shock 2011; 4: 374-377.##Skinner A, Jones P. Negative beta-hCG: positive ectopic pregnancy. N Z Med J 2003; 116: U630.##Galstyan K, Kurzel RB. Serum beta-hCG titers do not predict ruptured ectopic pregnancy. Int J Fertil Womens Med 2006; 51: 14-16.##LatchawG, Takacs P, Gaitan L, Geren S, Burzawa J. Risk factors associated with the rupture of tubal ectopic pregnancy. Gynecol Obstet Invest 2005; 60: 177-180.##Saxon D, Falcone T, Mascha EJ, Marino T, Yao M, Tulandi T. A study of ruptured tubal ectopic pregnancy. Obstet Gynecol 1997; 90: 46-49.## ##

CPITN changes during pregnancy and maternal demographic factors ‘impact on periodontal health تغییرات CPITN در طی حاملگی و تأثیر شاخصه های دموگرافیک مادر بر سلامت لثه ای 2 1 مقدمه: تا بحال بحثهایی پیرامون ارتباط تغییرات هورمونی و ویژگیهای فردی- اجتماعی مادران با سلامت پریودنتال آنها در دوره بارداری انجام شده است. هدف: با توجه به کمبود اطلاعات در مورد وضعیت پریودنتال زنان باردار در یزد، این مطالعه با هدف بررسی تغییرات شاخص نیاز به درمان پریودنتال (CPITN) طی بارداری و ارزیابی ارتباط احتمالی میان این شاخص و ویژگیهای دموگرافیک مادران انجام شد. مواد و روشها: این مطالعه یک مطالعه توصیفی طولی است. نمونهها شامل 115 زن باردار مراجعهکننده به مراکز درمانی یزد بودند. جمع آوری اطلاعات مادران با کمک پرسشامهای سه قسمتی شامل رضایتنامه، دادههای دموگرافیک و CPITN ثبت شده، انجام شد. معاینات با استفاده از نور یونیت دندانپزشکی، آینه مسطح و پروب مدرج WHO صورت گرفت. نتایج: در ابتدای مطالعه، 61% سکستانتهای بررسی شده وضعیت لثهای سالم داشتند 9/25% دارای کد 1 و 4% دارای کد 2 بودند. کد 3 و 4 در هیچ سکستانتی دیده نشد. میان مقادیر CPITN کمتر و تحصیلات بالاتر، اشتغال به کار و دفعات بیشتر مسواک زدن مادران ارتباط معناداری وجود داشت اما میان این شاخص با سن مادر و تعداد حاملگیها ارتباطی دیده نشد. ارتباط میان CPITN و افزایش سن جنینی نیز معنادار بود. نتیجهگیری: احتمالا میان بالا رفتن ماه بارداری و افزایش نیاز به درمانهای پریودنتال ارتباطی وجود دارد. بالا رفتن این شاخص طی بارداری نشان دهنده اهمیت مراقبتهای پریودنتال در این دوران است. 2 Background: There have been speculations about the effects of hormonal changes and socio-demographic factors on periodontal health during pregnancy. Objective: According to the lack of sufficient epidemiologic information about the periodontal status of pregnant women in Yazd, this study was accomplished to determine the changes of Community Periodontal Index for Treatment Needs (CPITN) during pregnancy and evaluating the possible relationship between this index and demographic characteristics of the mothers. Materials and Methods: This was a longitudinal descriptive study. The samplesincluded 115 pregnant women who were referred to health centers of Yazd, Iran.The mothers’ data were obtained from a questionnaire consisted of 3 parts: consentpaper, demographic data and CPITN records. Examination was performed withdental unit light, flat dental mirror and WHO’s scaled probe. Results: In the beginning of the study, 60.1% of checked sextants had healthy gingival status. 25.9% had code1 and 14% had code 2. Code 3 and 4 were not seen in any sextants. There was a significant relationship between lower CPITN and higher maternal education, occupation and more frequencies of tooth-brushing but there was not a relationship between CPITN and mother’s age and number of pregnancies. CPITN had a significant relationship with increasing of the gestational age. Conclusion: There might be a relationship between increasing the month of pregnancy and more periodontal treatment needs. CPITN Increasing during pregnancy shows the importance of periodontal cares during this period. 107 112 2017/10/12017/10/12017/10/12017/10/12017/10/12017/10/12017/10/1 1396/7/9 2017/11/62017/11/62017/11/62017/11/62017/11/62017/11/62017/11/6 1396/8/15 فهیمه رشیدی میبدی Fahimeh Rashidi Maybodi Department of Periodontology, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ایران احمد حائریان اردکانی Ahmad Haerian-Ardakani Department of Periodontology, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ایران ahmad.haerian@gmail.com فرزانه وزیری Farzaneh Vaziri Department of Periodontology, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ایران آرزو خبازیان Arezoo Khabbazian Department of Periodontology, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran ایران سالم محمدی اصل Salem Mohammadi-Asl Dr. Mohammadi-Asl Clinic, Soosangerd, Iran ایران CPITN Pregnancy Periodontal status Demographic. CPITN بارداری وضعیت پریودنتال دموگرافیک Newman MG, Takei HH, Carranza FA, Klokkevold PR. Carranza's clinical periodontology 10th Ed. Philadelphia, WB Saunders; 2006.##Güncü GN, Tözüm TF, Cağlayan F. Effects of endogenous sex hormones on the periodontium-review ofliterature. Aust Dent J 2005; 50: 138-145.##Rose LF, Mealey BL, Genco R. Periodontics, medicine, surgery and implant. St. Louis Missouri, Mosby; 2004.##Haerian-Ardakani A, Eslami Z, Rashidi-Meibodi F, Haerian A, Dallalnejad P. Relationship between maternal periodontal disease and low birth weight babies. Iran J Reprod Med 2013; 11: 625-630.##Khader Y, Al-shishani L, Obeidat B, Khassawneh M, Burgan S, Amarin ZO, et al. Maternal periodontal status and preterm low birth weight delivery: a case-control study. Arch Gynecol Obstet 2009; 279: 165-169.##Mokeem SA, Molla GN, AL-Jewair TS. The prevalence and relationship between periodontal disease and preterm low birth weight infants at King Khalid University Hospital in Riyadh, Saudi Arabia. J Contemp Dent Pract 2004; 5: 40-56.##Toygar HU, Seydaoglu G, Kurklu S, Guzeldemir E, Arpak N. periodontal health and adverse pregnancy outcome in 3576 Turkish women. J Periodontol 2007; 78: 2081-2094.##Shirinzad M, Tiznobaik A, Ranjbari A, Abdolsamadi HR. The Study of Mothers'Periodontal Status and newborn's low birth weight. J Hamadan Univ Med Sci 2006; 41: 57-61.##Wandera M, Engebretsen IM, Okullo I, Tumwine JK, Astrøm AN. Socio-demographic factors related to periodontal status and tooth loss of pregnant women in Mbale district, Uganda. BMC Oral Health 2009; 9: 18.##Golpasand Hagh L, Zakavi F, Taymuri H. Evaluation of Community Periodontal Index of Treatment Needs in Pregnant and Non Pregnant Women. Sci Med J 2011; 10: 309-316.##Yalcin F, Eskinazi E, Soydinc M, Basegmez C, Issever H, Isik G, et al. The effect of sociocultural status on periodontal conditions in pregnancy. J Periodontol 2002; 73: 178-182.##Tezel A. periodontal condition of pregnant women assessed by CPITN and the role of nurses according to the needs of treatment. Health Med 2011; 1: 1951-1955.##Pak Nejad M, Ghavam M, Khoshbar M. [The prevalence of CPITN in pregnant and feeding women in Ilam city]. J Islamic Dental Assoc 2002; 41: 82-95. (In Persian)##Baghaei F. Evaluation of Knowledge and practice of pregnant woman about periodontal health and oral and dental hygiene in pregnancy in Yazd in 2010. [Dissertation]. School of dentistry, Shahid Sadoughi Medical University; 2010.##Hossaini A. Evaluation of Knowledge, attitude and practice of pregnant woman about their oral health and hygiene in Yazd in 1997. [Dissertation]. School of dentistry, Shahid Sadoughi Medical University; 1997.##Karunachandra NN, Perera IR, Fernando G. Oral health status during pregnancy: rural-urban comparisons of oral disease burden among antenatal women in Sri Lanka. Rural Remote Health 2012; 12: 1902.##Safavi SD, Gholak Kheibari P. Evaluation of CPI index of pregnant women referring to Taleghani and 29 Bahman hospitals, Tabriz, 2001. J Dent Sch 2003; 21: 536-543. (In Persian)##Nouri M, Valaie N, Sadeghi SF, Bidarmanesh A. An epidemiological assessment on periodontal status of pregnant women (Tehran-Ghaemshahr) 1997. J Dent Sch 1999; 4: 374-380. (In Persian)##Vogt M, Sallum AW, Cecatti JG, Morais SS. Factors associated with the prevalence of periodontal disease in low-risk pregnant women. Reprod Health 2012; 9: 3.##Torabi M, Najafi GhA, Mskani AR. Evaluation of CPITN index in pregnant women Kerman 2001-2002. J Dent Sch 2006; 24: 33-39. (In Persian)## ##

A successful pregnancy during the treatment of cervical sarcoma botryoides and advantage of fertility sparing management: A case report یک حاملگی موفق در ضمن درمان سارکوم بوتریوئید سرویکس و مدیریت سقط باروری: یک گزارش مورد 2 1 مقدمه: سارکوم بوتریوئید سرویکس یک نوع بسیار نادر رامبومیوسارکوم (RMS) دستگاه تناسلی زنانه میباشد. این سارکوم معمولا درد دهه اول با دوم زندگی تشخیص داده میشود و با پولیپ سرویکس و یا ندرتا تدوههای نفوذکننده خود را نشان میدهد. در این گزارش مورد هدف ما گزارش یک بیمار 21 ساله با حاملگی اول و RMS امبریونال (سارکوم بوتریوئید) سرویکس و همچنین شرح انواع درمان دریافت شده در مطالعه منابع و برجسته نمودن مزایای مدیریت سقط باروری در این بیماران میباشد. مورد: یک زن 21 ساله با حاملگی اول از یک توده بیرون آمده از اینتراوتوس شکایت کرد که به شکل یک پولیپ سرویکس شبیه انگور cm 8×7 در آزمایش اسپکولوم مشاهده شد. آزمایش هیستوپاتولوژیک بیوپسی تهیه شده به همراه رنگ آمیزی ایمنوهیستوشیمیایی با دسیمن، میوژنین، S100، ویمنتین و میوگلوبین انجام شد. کولونوسکوپی، بیوپسی دوم و ترموگرافی پوزیترون emission جهت پیگیری استفاده شد. آزمایش هیستوپاتولوژیک نشان دهنده RMS امبریونال سرویکس بود. بیمار سه سیکل شیمی درمانی مرکب از دوکسوروبیسین و اینوسفامید دریافت کرد. او با جراحی موافقت نکرد زیرا که یک حاملگی برنامه ریزی نشده را در ماه بعد از شیمی درمانی داشت. او دیگر برای کنترل مراجعه نکرد. بعد از یک حاملگی بدون عوارض و یک زایمان موفق او در ماه ششک بعد از زایمان مراجعه کرد. بررسی کولوسکوپیک نشاندهنده یک ناحیه موضعی پولیپوئید بود که آزمایش هیستوپاتولوژی بیوپسی نشاندهنده عود بود هرچند که توموگرافی پوزیترون emission غیراختصاصی بود. بنابراین درمان تکمیلی برنامه ریزی شد و conization و لنفاونوکتومی لگنی انجام شد. هیستوپاتولوژی نشاندهنده عدم وجود تومور در مواد conization و عدم درگیری لنف نودهای لگنی بود. نتیجهگیری: مدیریت سقط باروری شامل شیمی درمانی ترکیبی دوکسوروبیسین و اینفوسفامید میتواند درمان انتخابی باشد. حاملگی و زایمان موفق در حین درمان امکانپذیر است. کولوسکوپی جهت تشخیص زودرس عود رحم میباشد. 2 Background: Sarcoma botryoides of cervix is a rare variant of rhabdomyosarcomas (RMS) of female genital tract. It is usually diagnosed in first or second decade of life. In this case report, we aimed to present a 21 year-old nulligravid patient who was diagnosed with embryonal RMS of the cervix, to discuss the treatment options that have been stated in the literature, and to highlight the advantage of fertility sparing management in these young patients. Case: We report a 21-year-old nulligravid woman complaining about a mass protruding from introitus, which was represented with a 8×7 cm “grape-like” cervical polyp on speculum examination. The histopathologic examination of the biopsy taken was combined with immunohistochemical staining with desmin, myogenin, S100, vimentin, and myoglobin. Colposcopy, second biopsy, and positron emission tomography were used during the follow-up. The histopathologic examination revealed embryonal RMS of cervix. She received three cycles of combination chemotherapy, doxorubicin and ifosfamide. She refused to have a surgery because of an unplanned, desired pregnancy at two months after the chemotherapy. She was lost during the follow-up. After having an uneventful pregnancy and a successful delivery, she reapplied at postpartum 6th month. Colposcopic evaluation revealed a local polypoid area, the histopathologic examination of biopsy suggested recurrence even though positron emission tomography scans were unremarkable. Therefore complementary treatment was planned as conization and pelvic lymphadenectomy. The histopathology revealed no residual tumor on the conization material and no involvement of pelvic lymph nodes. Conclusion: Fertility sparing management, including doxorubicin and ifosfamid combination in chemotherapy step, can be management option. Pregnancy and successful delivery is possible during the treatment. Colposcopy has importance for early detection of recurrences 113 116 2017/10/12017/10/12017/10/12017/10/12017/10/12017/10/12017/10/12017/10/1 1396/7/9 2017/11/62017/11/62017/11/62017/11/62017/11/62017/11/62017/11/62017/11/6 1396/8/15 Selçuk Ayas Selçuk Ayas Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children Diseases Research and Training Hospital, Turkey Lutfiye Uygur Lutfiye Uygur Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children Diseases Research and Training Hospital, Turkey lutfiyeuygur@gmail.com Evrim Bostanci Evrim Bostanci Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children Diseases Research and Training Hospital, Turkey Ayşe Gürbüz Ayşe Gürbüz Department of Gynecology, Kadıköy Florence Nightingale Hospital, Turkey Rhabdomyosarcoma Embryonal Cervix Pregnancy Fertility sparing. رابدومیوسارکوم امبریونال سرویکس بارداری باروری ناخواسته. Young JL, Miller RW. Incidence of malignant tumors in U. S. children. 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Embryonal rhabdomyosarcoma of the uterine cervix: a report of 14 cases and a discussion of its unusual clinicopathological associations. Mod Pathol 2012, 25: 602-614.##Herrera JM, Krebs A, Harris P, Barriga F. Childhood tumors. Surg Clin North Am 2000; 80: 747-760.##Rutledge F, Sullivan MP. Sarcoma botryoides. Ann N Y Acad Sci 1967, 142:694-708.##Daya DA, Scully RE. Sarcoma botryoides of the uterine cervix in young women: a clinicopathological study of 13 cases. Gynecol Oncol 1988; 29: 290-304.##Crist W, Gehan EA, Ragab AH, Dickman PS, Donaldson SS, Fryer C, et al. The third intergroup rhabdomyosarcoma study. J Clin Oncol 1995; 13: 610-630.##Zeisler H, Mayerhofer K, Joura EA, Bancher-Todesca D, Kainz C, Breitenecker G, et al. Embryonal rhabdomyosarcoma of the uterine cervix: case report and review of the literature. Gynecol Oncol 1998; 69: 78-83.##Gordon AN, Montag TW. Sarcoma botryoides of the cervix: excision followed by adjuvant chemotherapy for preservation of reproductive function. Gynecol Oncol 1990; 36: 119-124.##Lin J, Lam SK, Cheung TH. Sarcoma botryoides of the cervix treated with limited surgery and chemotherapy to preserve fertility. Gynecol Oncol 1995; 58:270-273.##Marana HR, Andrade JM, Llorach-Velludo MA, Marana RR, Cunha SP, Tone AG, et al. Sarcoma botryoides of the female genital tract: long-term results of conservative treatment followed by pregnancy. A case report. Eur J Gynaecol Oncol 1999; 20: 122-123.##Porzio G, Toro G, Paris I, Ricevuto E, Ficorella C, Marchetti P. Cervical sarcoma botryoides treated with conservative surgery and adjuvant chemotherapy: a case report. Eur J Gynaecol Oncol 2000; 21: 499-500.##Behtash N, Mousavi A, Tehranian A, Khanafshar N, Hanjani P. Embryonal rhabdomyosarcoma of the uterine cervix: case report and review of the literature. Gynecol Oncol 2003; 91: 452-455.##Bernal KL, Fahmy L, Remmenga S, Bridge J, Baker J. Embryonal rhabdomyosarcoma (sarcoma botryoides) of the cervix presenting as a cervical polyp treated with fertility-sparing surgery and adjuvant chemotherapy. Gynecol Oncol 2004; 95: 243-246.##Zanetta G, Rota SM, Lissoni A, Chiari S, Bratina G, Mangioni C. Conservative treatment followed by chemotherapy with doxorubicin and ifosfamide for cervical sarcoma botryoides in young females. Br J Cancer 1999; 80: 403-406.##Perrone T, Carson LF, Dehner LP. Rhabdomyosarcoma with heterologous cartilage of the uterine cervix: a clinicopathologic and immunohistochemical study of an aggressive neoplasm in a young female. Med Pediatr Oncol 1990; 18: 72-76.##Vlahos NP, Matthews R, Veridiano NP: Cervical sarcoma botryoides: A case report. J Reprod Med 1999; 44: 306-308.##Arndt CA, Donaldson SS, Anderson JR, Andrassy RJ, Laurie F, Link MP, et al. What constitutes optimal therapy for patients with rhabdomyosarcoma of the female genital tract? Cancer 2001; 91: 2454-2468.##https://doi.org/10.1002/1097-0142(20010615)91:12<2454::AID-CNCR1281>3.0.CO;2-C## ##