Protective effects of erythropoietin on ischemia/reperfusion injury of rat ovary

Objectives

To evaluate the effects of erythropoietin (EPO) as an antioxidant and tissue protective agent and study the biochemical and histopathological changes in experimental ischemia and ischemia/reperfusion (I/R) injury in rat ovaries.

Study design

36 Adult female rats were used. The experimental groups were designed as Group 1: sham operation; Group 2: bilateral ovarian ischemia; and Group 3: 3 h period of ischemia followed by 3 h reperfusion. Group 4 rats were administered a 5000 IU dose of EPO, before 0.5 h of ischemia, and then bilateral ovarian ischemia was applied. After a 3 h period of ischemia, the bilateral ovaries were removed. In Group 5, a 3 h period of bilateral ovarian ischemia was applied. 2.5 h after the induction of ischemia, the rats were administered the same dose of EPO. At the end of a 3 h period of ischemia, 3 h reperfusion was continued after the ovaries were removed. Group 6 underwent a sham operation after administration of 5000 IU/kg of EPO. After the experiments, superoxide dismutase (SOD), inducible nitric oxide synthase (iNOS), and myeloperoxidase (MPO) activity were determined, and histopathological changes were examined in all rat ovarian tissue.

Results

Ischemia and ischemia/reperfusion increased the iNOS and MPO activity while decreasing the SOD activity significantly in comparison to the sham group. The 5000 IU/kg of EPO before ischemia and I/R reversed the trend in iNOS and MPO activities. The levels of SOD were decreased by the ischemia and I/R. The administration of EPO before ischemia and I/R treatments also reversed the trend in the SOD levels. In the ischemia/reperfusion plus EPO groups, though we observed minimal vascular dilation in the ovary stroma and some degenerative cell clusters, most of cellular structures did not show any pathological changes.

Conclusions

Administration of EPO is effective in reversing tissue damage induced by ischemia and/or ischemia/reperfusion in ovaries.     

Growth hormone reduces tissue damage in rat ovaries subjected to torsion and detorsion: biochemical and histopathologic evaluation

Objective

To evaluate the effects of growth hormone (GH) as an antioxidant and tissue-protective agent and analyse the biochemical and histopathological changes in rat ovaries due to experimental ischemia and ischemia/reperfusion injury.

Study design

Forty-eight adult female rats were randomly divided into eight groups. In Group 1, a period of bilateral ovarian ischemia was applied. In Groups 2 and 3, 1 and 2 mg/kg of GH was administered, and 30 min later, bilateral ovarian ischemia was applied (after a 3-h period of ischemia, both ovaries were surgically removed). Group 4 received a 3-h period of ischemia followed by 3 h of reperfusion. Groups 5 and 6 received 1 and 2 mg/kg of GH, respectively, 2.5 h after the induction of ischemia. At the end of a 3-h period of ischemia, bilateral vascular clips were removed, and 3 h of reperfusion continued. Group 7 received a sham operation plus 2 mg/kg of GH. Group 8 received a sham operation only. After the experiments, superoxide dismutase and myeloperoxidase activity and levels of glutathione and lipid peroxidation were determined, and histopathological changes were examined in all rat ovarian tissue.

Results

Ischemia and ischemia/reperfusion decreased superoxide dismutase activity and glutathione levels in ovarian tissue, but increased lipid peroxidation levels and myeloperoxidase activity significantly in comparison to the sham group. The 1 and 2 mg/kg doses of GH before ischemia and ischemia/reperfusion decreased lipid peroxidation levels and myeloperoxidase activity in the experimental groups. The administration of GH before ischemia and ischemia/reperfusion treatments also increased superoxide dismutase and glutathione levels. The histopathological findings also suggested a protective role of GH in ischemia/reperfusion injury. That is, ovarian tissues in the ischemia groups showed histopathological changes, such as haemorrhage, cell degeneration, and necrotic and apoptotic cells, but these changes in the GH groups were lesser. Moreover, in the ischemia/reperfusion groups, acute inflammatory processes - such as neutrophil adhesion and migration, apoptotic and degenerative cells, stromal oedema and haemorrhage - were present. However, the ovarian tissues of the IR + GH (1 mg) group had minimal apoptotic cells, and the IR + GH (2 mg) group had no apoptotic cells. In addition, the general ovarian histological structures of these groups were similar to those of the healthy control group.

Conclusions

The administration of GH is protective against ischemia and/or ischemia/reperfusion-induced ovarian damage. This protective effect can be attributed to the antioxidant properties of GH.     

Serum ischemia-modified albumin as a novel marker of ovarian torsion: An experimental study

Objective

To evaluate the effect of ovarian torsion on serum levels of ischemia-modified albumin (IMA) in an experimental model.

Study design

Sixteen female adult Sprague–Dawley rats were involved in the study. Rats were allocated randomly to group I or group II on the day of the experiment. Group I (eight rats) comprised the control (sham operated) group. In group II (eight rats), a torsion model was created by using atraumatic vascular clips just above and below the right ovary. At the end of a 3-h period of ischemia, the ovaries were removed. Blood was sampled before and after operation to assess serum IMA levels. Serum IMA levels (absorbance units) and histopathologic damage scores were evaluated.

Results

Initial serum IMA levels were similar in both groups. After the operation, significant elevation was observed in group II in contrast to group I (0.191 ± 0.034 and 0.277 ± 0.089 ABSU, p = 0.05). Histologic specimens of the ovaries in group II had higher scores of follicular cell degeneration, vascular congestion, hemorrhage and inflammatory cell infiltration than those in group I (p < 0.001).

Conclusions

The elevated serum IMA levels observed in the ovarian torsion model seem to have a potential role as a serum marker in the early diagnosis of ovarian torsion.     

Protective effect of infliximab on ischemia/reperfusion injury in a rat ovary model: biochemical and histopathologic evaluation

Objective

The aim of this study was to investigate the effect of infliximab on experimentally induced ovarian ischemia/reperfusion injury (IRi).

Study design

A total of 42 female rats were equally divided into 6 experimental groups; group 1: sham operation, group 2: 3-h ischemia, group 3 and 4: 3-h ischemia, 3-h reperfusion, group 5 and 6: 3-h ischemia, 24 h reperfusion. In group 4 and group 6, 30 min before reperfusion, infliximab was administered intraperitoneally at a dose of 5 mg/kg. Bilateral ovaries were removed for histopathologic and biochemical analysis. Serum MDA (sMDA), tissue MDA (tMDA), serum NO (sNO), tissue NO (tNO) and serum catalase concentrations were analyzed. Tissue damage of ovarian tissue was scored by histological examination.

Results

The infliximab administration significantly lowered the sNO, tNO and sMDA concentrations in group 4 compared to group 3 (p = 0.041, p = 0.025 and p = 0.035, respectively). sNO, tNO and sMDA concentrations were also lower in group 6 when compared to group 5, but this differences were not significant (p > 0.05). On the other hand, tMDA concentrations were lower in infliximab-applied groups when compared to ischemia/reperfusion groups (group 3 vs. 4 and 5 vs. 6) (p = 0.045 and p = 0.048, respectively). Moreover, histopathologic tissue damage scores in infliximab administration groups were significantly lower than in ischemia/reperfusion groups (p < 0.001).

Conclusion

Infliximab attenuates I/R-induced ovarian tissue injury in rats subjected to ischemia/reperfusion.     

Protective effects of dexmedetomidine in pneumoperitoneum-related ischaemia–reperfusion injury in rat ovarian tissue

Objectives

To determine the effects of dexmedetomidine on pneuomoperitoneum-related ischaemia–reperfusion (I/R) injury in rat ovarian tissue.

Study design

Animals were randomized into three groups: Group S (n = 8), no pneumoperitoneum; Group C (n = 8), pneumoperitoneum; and Group D (n = 8), 100 μg intraperitoneal dexmedetomidine 30 min before pneumoperitoneum. Ovarian tissue was collected from all rats 30 min after desufflation, and fresh frozen for histological and biochemical evaluation.

Results

Body weight was similar in all three groups (202.62 ± 28.86, 211.00 ± 14.45 and 212.87 ± 15.71 g in Groups S, D and C, respectively). The mean malondialdehyde level was higher in Group C than the other groups (p < 0.03). When the histological samples of ovarian tissue were compared, vascular congestion, haemorrhage, follicular cell degeneration and infiltrative cell infiltration scores were higher in Group C compared with the other groups (p < 0.05). Significantly lower scores for the histological parameters were found in Group D compared with Group C (p < 0.05). Similar scores for follicular cell degeneration and inflammatory cell infiltration were found in Group D and Group S (p > 0.05). Although vascular congestion and haemorrhage scores were significantly lower compared with Group C, higher scores were found for Group D compared with Group S (p < 0.05).

Conclusion

Pneumoperitoneum caused oxidative injury in rat ovarian tissue. Dexmedetomidine reduced oxidative stress and histological injury related to I/R.     

Morphologic,endocrinologic and natural pregnancy assessment of allogeneic ovarian orthotopic transplantation without a vascular pedicle in rabbits

Objective

The objective was to assess the natural pregnancy of rabbits subjected to bilateral oophorectomy and orthotopic allogeneic intact and sliced ovarian transplantation without a vascular pedicle, and to determine the morphofunctional aspects of the transplanted ovaries.

Study design

Thirty-two female rabbits were studied. The ovaries were removed and orthotopically transplanted without vascular anastomoses between the two breeds of rabbits. In Group 1 (n = 8), only laparotomy and laparorrhaphy were performed, in Group 2A (n = 8) intact ovaries were transplanted on both sides, in Group 2B (n = 8) both ovaries were sliced and orthotopically transplanted, and in Group 2C (n = 8) an intact ovary was transplanted on one side and a sliced ovary on the other side. Three months later, the animals were paired with males for copulation. Estradiol, progesterone, follicle-stimulating hormone, and luteinizing hormone levels were assessed. A histologic study was carried out and the numbers of pregnancies and litters were also determined.

Results

Pregnancies occurred in seven rabbits in Group 1, 37.5% of rabbits in Group 2A, 50% in Group 2B, and 62.5% in Group 2C. Hormone levels and histology confirmed the vitality and function of all ovaries.

Conclusions

Intact or sliced orthotopic allogeneic ovarian transplantation without a vascular pedicle is viable in rabbits, and preserves their hormonal and fertile functions.     

Aliskiren – a promising strategy for ovarian ischemia/reperfusion injury protection in rats via RAAS

The aim of this study was to evaluate the effects of aliskiren, direct renin inhibitor, as an antioxidant and tissue protective agent and evaluate the molecular, biochemical, and histopathological changes in experimental?ischemia?and?ischemia/reperfusion injury in rat ovaries. Forty-eight female rats were randomly divided into eight groups: in Group 1, only sham operation was performed. Group 2 received 100?mg/kg aliskiren and sham operated. In Group 3, 3?h-period of bilateral ovarian?ischemia?was applied. Group 4 received a 3-h period of?ischemia?followed by 3?h of reperfusion. Groups 5 and 6 received 50 and 100?mg/kg, respectively, of aliskiren and bilateral ovarian?ischemia?was applied (after a 3-h period of ischemia, both ovaries were surgically removed). To Groups 7 and 8, 50 and 100?mg/kg of aliskiren were administered, respectively, and the induction of?ischemia was performed. At the end of a 3-h period of?ischemia, bilateral vascular clips were removed, and 3?h of reperfusion continued. After the experiments, IL-1β, IL-6, TNF-α, and iNOS mRNA expressions and SOD, GSH, MDA, renin, and angiotensin-II levels were determined and histopathological changes were examined in rat ovaries. Aliskiren treatment normalized excessive changes in cytokine and oxidative stress markers in both ischemia and ischemia/reperfusion injury. Histopathologically, treatment with aliskiren ameliorated the development of?ischemia?and/or ischemia/reperfusion tissue injury. This study concluded that aliskiren treatment is effective in reversing ischemia and/or ischemia/reperfusion induced ovary damage via the improvement of oxidative stress, reduction of inflammation, and suppression of the renin-angiotensin aldosterone system.     

The effect of edaravone on ischemia-reperfusion injury in rat ovary

Objective

The aim of this study was to investigate the effect of edaravone on experimentally induced ovarian torsion/detorsion ischemia/reperfusion (I/R) injury.

Study design

: Forty-six female adult Wistar-Albino rats were utilized to create five groups: In group 1, only 5 mg/kg edaravone was given and ovary torsion was not performed. In group 2, torsion was not performed and no drug was given. In group 3, vehicle was given and torsion/detorsion was performed. In group 4, 1 mg/kg edaravone was given and torsion/detorsion was performed. In group 5, edaravone; 5 mg/kg drug was administered and torsion/detorsion was performed. Right ovarian torsion was simulated for a 3-h period of ischemia and a 1-h reperfusion period. Right ovaries were then surgically extirpated in all groups. In ovarian tissue samples malondialdehyde (MDA) levels and activity of superoxide dismutase were studied. Microscopic ovarian tissue damage was scored by histologic and electron microscopic findings.

Results

The MDA level in the group 5 was significantly lower than group 3 (p < 0.001). Superoxide dismutase activity in the group 5 was significantly higher than group 3 (p < 0.001). Histopathological ovarian tissue damage in the group 5 were significantly lower than group 3 (p < 0.001).

Conclusion

These results indicate that edaravone could be an effective agent in the short-term treatment and prevention of ovarian ischemia and reperfusion damage.     

Trichloroacetic acid for the treatment of dysfunctional uterine bleeding: a pilot prospective clinical trial

Objective

The aim of the trial was to assess the safety and efficacy of tricholoroacetic acid for the treatment of dysfunctional uterine bleeding using topical versus intrauterine instillation.

Study design

In a pilot prospective randomized clinical trial, seventy women were randomly allocated to one of two groups. In Group I, the patients were subjected to intrauterine instillation of 95% tricholoroacetic acid. Group II underwent dilatation and curettage before topical application of 95% tricholoroacetic acid.

Results

The groups were similar regarding baseline clinical characteristics. There was a satisfactory clinical reduction of menstrual flow (amenorrhea, hypomenorrhea and eumenorrhea) at a rate of 97.1% (Group I) and 85.7% (Group II) at 6 months. A significant increase was observed in the mean haemoglobin value at 3 and 6 months in both treatment groups (P < 0.05).Group I showed a significant increase in haemoglobin level compared to Group II (P < 0.05) and a significant reduction of the endometrial thickness compared to Group II (2.21 ± 0.41 versus 3.03 ± 3.37).

Conclusion

Trichloroacetic acid use for treating dysfunctional uterine bleeding seems to be efficient and safe, especially in women who do not require conception. Trichloroacetic acid intrauterine instillation is associated with longer duration of reduced menstrual bleeding than topical application.     

Effect of ovarian stimulation with human menopausal gonadotropin and recombinant follicle stimulating hormone on the expression of integrins alpha(3), beta(1) in the rat endometrium during the implantation period

Objective

To investigate the effect of exogenous ovarian stimulation with human menopausal gonadotropin (hMG) and recombinant follicle stimulating hormone (rFSH) on the expression of integrins alpha(3), beta(1) in the rat endometrium during implantation.

Study design

Following three successive normal estrous cycles the animals were divided into five groups: Group I (n = 10, control group) received no medication; Group II (n = 10) received 10 units of hMG; Group III (n = 10) received 20 units of hMG; Group IV (n = 10) received 10 units of rFSH; Group V (n = 10) received 20 units of rFSH at midday of middiestrous. The rats were then mated with fertile males. The animals were sacrificed on the day of implantation. The uterine horns were placed in fixative and paraffin blocks of the tissue were cut in 5 μm sections. The tissues were stained with primary antibodies; monoclonal anti-integrin alpha(3) and monoclonal anti-integrin beta(1) using immunohistochemical methods. The staining intensities of alpha(3) and beta(1) integrins were calculated separately for epithelium and stroma in each group.

Results

Staining intensities of alpha(3) and beta(1) integrins in both the epithelium and the stroma were significantly lower in the treatment groups than the control group (p < 0.05).

Conclusion

Ovarian stimulation by low and high doses of HMG and rFSH may have an effect on endometrial receptivity, possibly via a decrease in expression of integrins in the endometrium during the implantation period.     

Reproductive performance after conservative surgical treatment of postpartum hemorrhage

Objective

To evaluate the impact of bilateral internal iliac artery ligation (BIL), bilateral uterine artery ligation (BUAL), step-wise uterine devascularization (SWUD), and B-Lynch on infertility, ovarian reserve, and pregnancy outcome.

Methods

The study included 168 infertile or pregnant patients—recruited at outpatient clinics in Egypt—who had previously undergone uterine-sparing surgery (BIL [group I], n = 59; SWUD [group II], n = 65); BUAL [group III], n = 2; and B-Lynch [group IV], n = 42). One-way analysis of variance was used to compare the prevalence of infertility, the status of ovarian reserve, and the prevalence and type of relevant maternal and/or fetal obstetric complications between the groups.

Results

Groups II and IV had the highest prevalences of infertility. The ovarian reserve was significantly lower in group II. Unexplained infertility was the predominant cause of infertility in group I, anovulation and premature ovarian failure in group II, and endometriosis and intrauterine adhesions in group IV. The frequency of obstetric complications, particularly placenta previa and preterm labor, was high in group IV.

Conclusion

Of the 4 procedures, BIL had the least deleterious effect on reproductive performance; SWUD increased the risk of premature ovarian failure, and B-Lynch increased the risks of endometriosis, intrauterine adhesions, placenta previa, and preterm labor.     

Effects of melatonin on ovarian follicles

Objective

To evaluate the histomorphometry and expression of Ki-67 and c-kit in ovarian follicles of pinealectomized or melatonin-treated pinealectomized rats.

Study design

Forty adult rats were randomly divided into four groups of 10 animals: Group I – control; Group II – sham-pinealectomized; Group III – pinealectomized (Px), and Group IV – Px treated with melatonin (10 μg/night, per animal). After two months’ treatment, on the night of proestrous, the animals were placed in metabolic cages for night urine collection and subsequent measurement of 6-sulfatoxymelatonin (6-SMT). The rats were anesthetized, blood samples were taken for estrogen and progesterone determinations, and they were then euthanized. The ovaries were dissected out for further histological and immunohistochemical analyses. Data were first submitted to analysis of variance (ANOVA) complemented with the Tukey–Kramer test for multiple comparisons (P < 0.05).

Results

The urinary levels of 6-SMT and serum progesterone were lower in the Px group (GIII). Exogenous melatonin treatment restored both blood melatonin and 6-SMT urinary levels. The histomorphometric data in Group III revealed a significant increase of degenerating antral and non-antral follicles with regard to the other groups. In addition no corpora lutea were observed in this group. No significant differences were noticed regarding the number of corpora lutea among the other groups (I, II and IV), but the number of cells and the thickness of the theca interna of Px animals (Group III) were higher than in the other groups. Conversely, the density of progesterone receptors (fmol/g) in the ovaries of Group III was significantly lower than in the other groups.

Conclusion

Our data indicate that melatonin exerts a role on the maintenance of a proper follicular function, and is thus important for ovulation and progesterone production.     

FTY720 and cyclosporin protect ovarian tissue grafted into rabbits

Objective

To determine whether FTY720 combined with CsA has immunomodulatory effects on human ovarian tissue transplanted to the back muscle of rabbits for an 8-week period.

Study design

We selected rabbits as recipients of ovarian xenografts with and without treatment by CsA and FTY720. Ovarian fragments from twelve patients were cut into 2 mm × 2 mm, 1–2 mm thick pieces and randomly distributed into four groups: Group 1 (FTY720 2 mg/kg/d + CsA 3 mg/kg/d), Group 2 (FTY720 1 mg/kg/d + CsA 3 mg/kg/d), Group 3 (FTY720 0.5 mg/kg/d + CsA 3 mg/kg/d) and Group 4 for control (CsA 3 mg/kg/d). FTY720 was started three days before transplantation and was given daily after transplantation. CsA was administrated post-transplantation. All the animals were killed 8 weeks post- transplantation. Levels of serum estrogen (E₂), interferon-γ (IFN-γ) and interleukin-4 (IL-4) were detected by radioimmunoassay and ELISA. Anti-CD31 and anti-Ki-67 antibodies were used to evaluate neo-vascularization in xenografts and proliferation activity of ovarian follicles. Peripheral CD4+/CD8+ T cells were analyzed by flow cytometry.

Results

Combined treatment with cyclosporin A and FTY720 improved graft survival and reduced peripheral CD4+ and CD8+ T cell counts compared to treatment with cyclosporin A alone. Neovascularization took place in the peripheral zone of the xenograft while granulosa cells, positively stained by Ki-67, were found in early-stage follicles and stromal cells in the combined treatment groups.

Conclusion

FTY720 in combination with cyclosporin A maintains human ovarian xenografts in these rabbit models.     

Protective effect of Vaccinium myrtillus on ischemia- reperfusion injury in rat ovary

Objective

It is aimed to evaluate the protective effect of bilberry on I/R injury in rat ovary.

Feasibility of laparoscopically assisted extracorporeal cystectomy via single suprapubic incision using an adjustable-view laparoscope to treat large benign ovarian cysts: comparison with conventional procedure

Objective

To demonstrate the feasibility of minimally invasive surgery using a novel optical device to treat large benign ovarian cysts and to compare the safety of the procedure with that of conventional laparoscopically assisted multiport extracorporeal cystectomy.

Study design

Twenty-one patients with large benign ovarian cysts underwent laparoscopically assisted extracorporeal ovarian cystectomy via a single suprapubic incision using a novel 10-mm rigid laparoscope with an adjustable direction of view and a multiport device, between October 2010 and July 2012. The surgical outcomes were retrospectively compared between these patients (Group A) and 32 patients who underwent the conventional 3-port laparoscopically assisted extracorporeal procedure between January 2009 and September 2010 (Group B). Data were statistically analyzed using the Mann–Whitney U-test or Fisher's exact test.

Results

None of Group A required conversion to conventional multiport laparoscopy. The total duration of surgery, elapsed time between skin incision and the start of pneumoperitoneum, and time required for intra- and extra-corporeal manipulations did not significantly differ between the groups. The time required for skin closure, however, was significantly decreased in Group A compared with Group B (13.0 ± 3.5 vs. 20.2 ± 4.8 min, P = 0.005). The volume of blood loss and postoperative blood findings were similar to those associated with the conventional procedure. Postoperative visual analog pain scales at 3 h were significantly lower in Group A than in Group B (3.7 ± 2.6 vs. 4.8 ± 2.0, P = 0.04). Postoperative complications did not arise after either procedure.

Conclusion

Laparoscopically assisted extracorporeal cystectomy via a single suprapubic incision is a feasible and safe alternative to conventional multiport cystectomy for treating large benign ovarian cysts.     

Ovarian stimulation and emergency in vitro fertilization for fertility preservation in cancer patients

Objective

To evaluate the outcome of ovarian stimulation and in vitro fertilization (IVF) in women undergoing fertility preservation prior to chemotherapy compared with healthy patients with infertility due to tubal factor.

Study design

Case control, retrospective study in an academic IVF unit. The study participants were 21 cancer patients and 1 patient with focal proliferative glomerulosclerosis, undergoing emergency IVF or intracytoplasmic sperm injection (ICSI; Group A) and 22 patients undergoing IVF for tubal factor (Group B). All patients underwent controlled ovarian stimulation, ovum pick-up, and embryo freezing or transfer. The outcome measures included: dose of gonadotropins, mean estradiol and progesterone levels, length of stimulation, number of retrieved oocytes, number of 2 pronuclei zygotes, fertilization rate, and clinical pregnancy rate. Student's t-test was used for assessment of group comparisons.

Results

Patients in Group A (mean age 32.8 ± 5.7 years) underwent 22 emergency IVF cycles for fertility preservation prior to chemotherapy. The mean number of days until human chorionic gonadotropin administration was 10.4 ± 4.8. Eleven cycles involved normal insemination while nine involved ICSI. In one cycle three arrested immature oocytes were retrieved, and in one cycle no oocytes were retrieved. Donor sperm was used in 9 cycles. Tamoxifen was part of the treatment protocol in 6 IVF cycles of breast cancer patients. The mean age of the women in Group B was 34 ± 4.2 years. There were no significant differences in any of the main outcome measures between the two groups. Thawed embryos were transferred in four cancer patients: two patients had colon cancer, one had breast cancer and one had pseudomyxoma peritonei. Two of these four women conceived and gave birth to healthy newborns.

Conclusions

Emergency IVF is a promising approach for preserving fertility in cancer patients. Current treatment protocols offer a minimal time delay until chemotherapy is commenced, and the ovarian stimulation outcomes are comparable to those of women with tubal factor.     

The effect of erythropoietin against oxidative damage associated with reperfusion following ovarian detorsion

Objective

To determine the effect of recombinant erythropoietin on serum oxidants and the viability of ischemic ovaries after detorsion.

Study design

A non-randomized single-blind clinical trial was conducted from December 2009 to January 2011 in a University Teaching Hospital affiliated with the School of Medicine, Tabriz University of Medical Sciences. Surgery was carried out on 40 patients, aged 18–35 years, with signs and symptoms of ovarian torsion. The patients were divided into two equal groups: group 1 received recombinant erythropoietin 150 IU/kg subcutaneously during the operation and 72 h after detorsion, and group 2 received no medication. Blood samples were taken before and 72 h after detorsion to determine the plasma levels of malondialdehyde, xanthine oxidase, glutathione, superoxide dismutase, nitric oxide, and total antioxidants. In both groups, the arterial and venous blood supply of the ovary and arterial blood flow resistance were evaluated before surgery and 72 h after detorsion of the ovary. The main outcome measures were improving ovarian blood flow and reducing oxidative damage. SPSS 17.0 was used for statistical analyses.

Results

The levels of malondialdehyde, glutathione, superoxide dismutase, nitric oxide, and total antioxidants 72 h after detorsion were significantly different between the interventional and non-interventional groups (p < 0.001). There was no significant difference in the levels of xanthine oxidase (p = 0.13). The difference between groups in the blood flow of the ovary 72 h after surgery was not statistically significant (p = 0.61).

Conclusion

Recombinant erythropoietin was effective in reducing the oxidative damage of ovarian torsion.     

Serum anti-mullerian hormone levels in the main phenotypes of polycystic ovary syndrome

Objective

To characterize the difference in circulating anti-Müllerian hormone (AMH) levels between the main polycystic ovary syndrome (PCOS) phenotypic groups and evaluate the role of AMH in predicting the severity of PCOS.

Study design

Cross-sectional, retrospective study. A total of 251 women were divided into four groups based on the main features of PCOS, as follows: Group 1 (polycystic ovarian morphology [PCOM]+/oligo-anovulation [OA]+/hyperandrogenism [HA]+), Group 2 (PCOM+/OA+/HA−), Group 3 (PCOM+/OA−/HA+), and Group 4 (PCOM−/OA+/HA+). AMH and other hormone levels were measured in serum. The main outcome was serum AMH concentrations in the main phenotypes of PCOS.

Result(s)

The mean serum AMH levels were 9.50 ± 6.1 ng/mL in Group 1; 8.02 ± 6.2 ng/mL in Group 2; 6.12 ± 3.6 ng/mL in Group 3; and 3.06 ± 2.4 ng/mL in Group 4. Circulating AMH levels in Group 1 (PCOM+/OA+/HA+) were three times higher than those in Group 4 (PCOM−/OA+/HA+).

Conclusions

The highest AMH levels were found in cases where all three main diagnostic criteria existed. AMH levels correlate best with PCOM. In addition, oligo-anovulation contributes to increased AMH levels. Hyperandrogenism criteria were found to have less influence on AMH levels. AMH levels seem to have a diagnostic role in determining the severity of PCOS.     

Comparison of serum anti-Mullerian hormone levels following hysterectomy and myomectomy for benign gynaecological conditions

Objective

To compare serum anti-Mullerian hormone (AMH) levels following hysterectomy and myomectomy.

Study design

Prospective longitudinal observational study. Serum AMH, follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels were measured pre-operatively (T1) and 2 days (T2) and 3 months (T3) following hysterectomy and myomectomy in 70 women aged 36–45 years. Hysterectomy (laparoscopy-assisted vaginal hysterectomy = 10; total abdominal hysterectomy = 25) with conservation of both ovaries for benign diseases of the uterus was performed in 35 women, and myomectomy (laparoscopy myomectomy = 15; open myomectomy = 20) was performed in another 35 women. The follow-up period was 3 months following surgery. The results were analysed using the t-test or one-way analysis of variance by repeated-measures ANOVA.

Results

Serum AMH in the hysterectomy group was 1.08 ± 0.77 ng/ml at T1, 0.78 ± 0.58 ng/ml at T2 and 0.81 ± 0.58 ng/ml at T3; the level was significantly lower at T2 and T3 compared with T1. In the myomectomy group, the corresponding values were 1.54 ± 0.95 ng/ml, 1.18 ± 0.77 ng/ml and 1.50 ± 0.58 ng/ml; serum AMH was significantly lower at T2 compared with T1, but the difference between T3 and T1 was not significant. There were no significant differences in serum FSH and LH in either group between these three time points.

Conclusion

Serum AMH was significantly lower 2 days and 3 months following hysterectomy compared with the pre-operative level. Following myomectomy, serum AMH was significantly lower than the pre-operative level 2 days following the procedure, but was similar to the pre-operative level 3 months after surgery. Therefore, hysterectomy may have a more lasting adverse effect on ovarian reserve than myomectomy. A long-term study of AMH levels is needed.     

A prospective study evaluating the clinical relevance of a chemoresponse assay for treatment of patients with persistent or recurrent ovarian cancer

Objective

Use of in vitro chemoresponse assays for informing effective treatment selection is a compelling clinical question and a topic of debate among oncologists. A prospective study was conducted evaluating the use of a chemoresponse assay in recurrent ovarian cancer patients.

Methods

Women with persistent or recurrent ovarian cancer were enrolled under an IRB-approved protocol, and fresh tissue samples were collected for chemoresponse testing. Patients were treated with one of 15 protocol-designated treatments empirically selected by the oncologist, blinded to the assay results. Each treatment was classified by the assay as: sensitive (S), intermediate (I), or resistant (R). Patients were prospectively monitored for progression-free survival (PFS) and overall survival (OS). Associations of assay response for the physician-selected treatment with PFS and OS were analyzed.

Results

A total of 262 evaluable patients were enrolled. Patients treated with an assay-sensitive regimen demonstrated significantly improved PFS and OS while there was no difference in clinical outcomes between I and R groups. Median PFS was 8.8 months for S vs. 5.9 months for I + R (hazard ratio [HR] = 0.67, p = 0.009). The association with assay response was consistent in both platinum-sensitive and platinum-resistant tumors (HR: 0.71 vs. 0.66) and was independent of other covariates in multivariate analysis (HR = 0.66, p = 0.020). A statistically significant14-month improvement in mean OS (37.5 months for S vs. 23.9 months for I + R, HR = 0.61, p = 0.010) was demonstrated.

Conclusions

This prospective study demonstrated improved PFS and OS for patients with either platinum-sensitive or platinum-resistant recurrent ovarian cancer treated with assay-sensitive agents.