Kok Min Seow

Subsequent pregnancy outcome after conservative treatment of a previous cesarean scar pregnancy.

Background.  To assess pregnancy course and outcome after conservative treatment of a cesarean scar pregnancy.

Resistin mRNA levels are downregulated by estrogen in vivo and in vitro

Resistin, a hormone secreted by adipocytes, is suggested to be an important link between obesity and diabetes. The aim of this study was to evaluate the regulatory effect of estrogen on adipocyte resistin gene expression in ovariectomized (OVX) rats and in isolated rat adipocytes in vitro. Subcutaneous injection of estradiol benzoate reduced resistin mRNA levels in adipocytes isolated from the inguinal, parametrial, perirenal, retroperitoneal, or periovarian fat deposits of OVX rats, while an in vitro study showed that estradiol treatment decreased resistin mRNA levels in cultured rat periovarian fat adipocytes. Results of Western blotting analysis also showed that estrogen decreased adipose resistin contents in vivo and in vitro. These data suggest that estrogen is a pivotal negative regulator of resistin gene expression.

Laparoscopic surgery in polycystic ovary syndrome: Reproductive and metabolic effects

Polycystic ovary syndrome (PCOS) is the most common cause of chronic anovulation. Clomiphene citrate (CC) is the first-line treatment for ovulation induction for infertile women with PCOS. In CC-resistant women, a particular surgical method, laparoscopic ovarian drilling (LOD), has been proposed in recent years as an alternative treatment. LOD produces overall spontaneous ovulation and pregnancy rates of 30 to 90% and 13 to 88%, respectively, for CC-resistant PCOS women. The mechanism of LOD is still unknown. The reduction of serum androgen level is believed to be the possible mechanism of LOD to improve spontaneous ovulation and promote fertility in women with PCOS. In addition, LOD may cause a significant reduction in serum luteinizing hormone and insulin levels. However, it should be kept in mind that postoperative adhesion is the most common adverse effect of LOD, and more punctures may be responsible for premature ovarian failure.

Comparison of outcome of clomiphene citrate/human menopausal gonadotropin/cetrorelix protocol and buserelin long protocol – a randomized study

This study evaluates the efficacy of a stimulation protocol with clomiphene citrate (CC)/human menopausal gonadotropin (hMG)/cetrorelix and its effects on oocyte quality and endometrium. One hundred and twenty couples with male-factor infertility who were about to undergo their first intracytoplasmic sperm injection cycles were randomized into two groups. Sixty women were stimulated with the CC/hMG/cetrorelix protocol (cetrorelix group) and 60 received the buserelin long protocol (buserelin group). Fewer oocytes were recovered in the cetrorelix group than in the buserelin group (mean ± standard deviation (SD): 11.1 ± 4.0 vs. 17.3 ± 5.8, p < 0.001); however, the percentages of metaphase II, metaphase I and germinal vesicle oocytes were similar between the two groups. Serum estradiol level was significantly lower in the cetrorelix than in the buserelin group (mean ± SD: 2600.58 ± 1189.11 vs. 3293.46 ± 1221.49 pg/ml, p = 0.006), but the endometrial thickness was similar. The implantation rates (19.2% vs. 17.7%) and the pregnancy rates (41.7% vs. 40.0%) were similar between groups. The ampoules (mean ± SD: 18.9 ± 3.0 vs. 38.9 ± 12.2, p < 0.001) and injections (mean ± SD: 6.8 ± 1.1 vs. 15.7 ± 3.1, p < 0.001) of gonadotropin used were significantly lower in the cetrorelix group than in the buserelin group. No patients in either group developed a premature luteinizing hormone surge. The present study found no statistically significant difference between the two treatment modalities with regard to pregnancy rates.

Effects of growth factors and granulosa cell co-culture on in-vitro maturation of oocytes

The maturation medium for in-vitro oocyte maturation is usually supplemented with serum. However, supplementation with serum from pregnant women adversely affects the outcome of in-vitro maturation. The purpose of the study was to assess if growth factors or granulosa cell co-culture could overcome the adverse effects of pregnant womens serum. The basal maturation medium consisted of TCM199, 75 mIU/ml human menopausal gonadotrophin (HMG), 0.2 mmol/l pyruvate, and 10% serum. The maturation medium for control 1 contained fertile Womens serum. The maturation medium for control 2 contained pregnant Womens serum. The maturation media for the study groups consisted of medium for control 2, with the addition of EGF, IGF-I, activin, TGFbeta or granulosa cell co-culture. Immature oocytes were obtained from FVB mice, and the experiment was repeated six times. After maturation, the oocytes were fertilized and cultured to blastocysts, and the cumulus cells were analysed for apoptosis. The maturation, fertilization and blastocyst rates of the control 2 group were significantly lower than those of control 1 group (P < 0.05). Addition of EGF, IGF-1, activin, TGFbeta or granulosa cell co-culture could not improve the outcome of in-vitro maturation. Cumulus cell proliferation was inhibited by pregnant womans serum. Apoptosis of cumulus cell was not related to in-vitro oocyte maturation and subsequent embryo development.

Laminaria tent vs misoprostol for cervical priming before hysteroscopy: Randomized study.

STUDY OBJECTIVE To compare the efficacy of laminaria tents and orally administered misoprostol in priming the cervix before operative hysteroscopy. DESIGN Randomized, controlled study (Canadian Task Force classification I). SETTING Tertiary medical center. PATIENTS One hundred twenty premenopausal women who underwent operative hysteroscopy between March 2005 and January 2007. INTERVENTION The women were randomized to receive a laminaria tent or misoprostol for cervical priming. MEASUREMENTS AND MAIN RESULTS The primary outcomes were postpriming cervical width insofar as size of Hegar dilators and need for cervical dilation. The secondary outcomes were adverse effects from the priming methods. Postpriming cervical width was greater in the laminaria group but not significantly different from that in the misoprostol group. However, cervical dilation before hysteroscopy was required in more patients in the misoprostol group. Nausea, vomiting, diarrhea, and bleeding were more common in the misoprostol group, and the incidences of chills and headache were similar between the 2 groups. CONCLUSION Laminaria tents are superior to oral misoprostol insofar as less need for cervical dilation and fewer adverse effects.

Expression of visfatin mRNA in peripheral blood mononuclear cells is not correlated with visfatin mRNA in omental adipose tissue in women with polycystic ovary syndrome

BACKGROUND Visfatin, which is secreted predominantly from visceral adipose tissue, has an insulin-mimetic action and may play a role in the regulation of insulin sensitivity in humans. Peripheral blood mononuclear cells (PBMCs) from venous blood samples are the most accessible tissue for the analysis of gene expression. The aims of the study were to compare the expression of visfatin in PBMCs with that in omental adipose tissue in women with polycystic ovary syndrome (PCOS). METHODS Visfatin mRNA was measured in omental adipose tissue and PBMCs from 10 women with PCOS and 10 healthy controls, matched for BMI and age, using the real-time polymerase chain reaction (PCR). RESULTS The expression of visfatin mRNA in both omental adipose tissue and PBMCs from the women with PCOS was significantly higher (P = 0.01 and P = 0.05, respectively) than that in the controls. This finding indicated that mononuclear cells are a potential source of visfatin in women with PCOS. However, only the expression of visfatin mRNA in adipose tissue, not that in PBMCs, showed a significant positive correlation with insulin levels 2h after glucose loading (P = 0.044, r(2) = 0.45), and with homeostasis model assessment-insulin resistance (HOMA(IR); P = 0.035, r(2) = 0.47). In addition, the expression of visfatin mRNA in PBMCs did not correlate with the expression of visfatin mRNA in omental adipose tissue. CONCLUSIONS PCOS is associated with increased visfatin mRNA concentrations in PBMCs and in omental adipose tissue. However, only visfatin mRNA concentration in omental adipose tissue is closely correlated with BMI and insulin resistance.

Effectiveness of double cervical cerclage in women with at least one previous pregnancy loss in the second trimester : A randomized controlled trial

Aim:  To evaluate the effect of double cervical cerclage on the prevention of preterm delivery, and perinatal and maternal outcomes in women with previous fetal loss in the second trimester.

Outcomes and complications of laparoscopically assisted vaginal hysterectomy

Objective: To report whether operative time, intraoperative complications, and rate of conversion to laparotomy decreased after physicians had acquired an additional 4 years experience with laparoscopically assisted vaginal hysterectomy (LAVH).

P16 methylation is an early event in cervical carcinogenesis.

Background Aberrant gene promoter methylation is a critical event in tumorigenesis. The aim of this study was to explore the promoter hypermethylation of p16 and DAPK1 during the progression of cervical precancerous lesions. Methods A series of 98 cervical neoplasms (72 cervical intraepithelial neoplasia and 26 cervical carcinomas) were evaluated. The promoter methylation status of p16 and DAPK1 was assessed from cervical scrapings by methylation-specific polymerase chain reaction. Results For p16, the frequency of promoter hypermethylation showed an increasing trend from normal to dysplastic to invasive squamous cancer specimens, and this increase reached statistical significance (P < 0.0001). However, there was no significant difference in the promoter methylation state of DAPK1 with regard to the various grades of cervical lesions (P = 0.077). Specifically, methylation of p16 was a frequent event in the cervical carcinoma samples, and these figures were statistically significant compared with the normal and cervical intraepithelial neoplasia I cases (P = 0.015 and P = 0.021, respectively). Conclusions These results imply that promoter hypermethylation of p16 occurs at an early stage of cervical neoplastic progression. This early event may play an initiating role in the malignant transformation of low-grade dysplasia into high-grade dysplasia and invasive carcinoma. We suggest that aberrant promoter methylation of p16 may serve as a useful biomarker during the follow-up of low-grade dysplasia.