Prevalence and determinants of long‑acting reversible contraception initiation among teenage mothers in a tertiary hospital / Philippine Journal of Obstetrics and Gynecology

Background@#According to the WHO, about 16 million girls at the age of 15–19 years give birth each year. In the Philippines, 600 live births a day are registered under teenage mothers. At Mariano Marcos Memorial Hospital and Medical Center, 12% of all obstetric admissions yearly are teenagers. The American College of Obstetricians and Gynecologists recommends long‑acting reversible contraception (LARCs), in the form of intrauterine device and progestin subdermal implant as pregnancy prevention options for young mothers. The objective of the study was to identify the prevalence and determinants of long‑acting reversible contraception (LARC) initiation among teenage mothers in Mariano Marcos Memorial Hospital and Medical Center.@*Methodology@#Prospective observational study: A self‑administered questionnaire was given to the respondents wherein they ranked determinants involved in their selection of a contraceptive method on a scale of 1–4 (1 being the most important, and 4, the least important.@*Results@#A total of 162 teenage mothers participated in the study. Majority of the respondents were 17–18 years old, enrolled up to high school, single, unemployed, and primiparas. Eighty‑seven percentage of all teenage mothers admitted at Mariano Marcos Memorial Hospital and Medical Center from December 2020 to December 2021 used long‑active reversible contraception. Ranked from most (1) to least (4) important, the respondents considered: (1) Effectivity, (2) Long duration, (3) Family influence, and (4) Peer influence as their determinants for initiating LARC method. The high effectiveness and long duration of LARC were the primary reasons for initiation, while the least factors they considered were that of peer and family influence.

Outcomes of frozen-thawed embryo transfer cycles of progestin-primed ovarian stimulation protocol compared with other three ovulation hyperstimulation protocols / 解剖学报

Objective To analyze the clinical outcomes of progestin primed ovarian stimulation (PPOS) compared with the other three different controlled ovarian hyperstimulation (COH) protocols in fresh embryo transfer (ET) and frozen-thawed embryo transfer (FET) cycles. Methods A total of 430 oocyte pick-up cycles and 272 FET cycles were retrospectively analyzed. Number of oocytes retrieved, laboratory indexes and pregnancy outcome of FET were compared. Results The mean oocytes retrieved (11.1±7.3), fertilization rate (85.6%), cleavage rate (95.1%) and excellent embryo rate (20.2%) as well as transplantable embryo rate (4. 5 ±3.1) of the PPOS group did not show significant differences compared with the other 3 subgroups (all P<0.05) in fresh cycle. As for pregnancy outcomes in FET cycles, no statistically significant differences were observed among the four groups in embryo implantation rate (26.2%), clinical pregnancy rate (63.0%) and abortion rate (11.8%) (all P<0.05). However, embryo implantation rate, clinical pregnancy rate was higher in PPOS group compared with the other groups. Conclusion Compared with the other three ovulation stimulation programme, PPOS might be used as a new alternative for controlled ovulation stimulation protocols.

Endometrial hyperplasia treatment with the levonorgestrel-impregnated intrauterine system or oral progestogens / Шинэ санаа Шинэ нээлт

Background@#To investigate relapse rates after the successful treatment of patients with non-atypical endometrial hyperplasia (EH) either a levonorgestrel impregnated intrauterine system (LNG-IUS; MIRENA®) or two regimens of oral dydrogesterone (DGS) after primary histological response. Currently, the incidence of EH is indistinctly reported to be around 200,000 new EH cases per year in Western countries.@*Methods@#Patients were at their choice assigned to one of the following three treatment arms: LNG-IUS; 10 mg of oral DGS administered for 10 days per cycle for 6 months; or 10 mg of oral DGS administered daily for 6 months. The women were followed for 6 months after ending therapy. [Figure2] Women aged 25-55 years with low or medium risk endometrial hyperplasia met the inclusion criteria, and 35 completed the therapy. @*Results@#Histological relapse was observed in 55/ (41%) women who had an initial complete treatment response. The relapse rates were similar in the three therapy groups (P = 0.66). In our study involved 25-55 (mean 42.2±1.61) aged 35 women. Among them had reproductive aged 31.43% (n= 11) premenopausal women 42.86 % (n= 15) postmenopausal women 25.71% (n= 9). Their mean body mass index had 28.8±1.15 kg/m², and normal weight 34.29% (n=12), overweight 34.29% (n=12), obese 17.14% (n=6), extremely obese 14.29 % (n=5). [Figure3] Types of obesity had normal 37.14% (n=13), android 25.71% (n=9), gynecoid 37.14% (n=13). Mean parity had 1.8±0.19 to nulliparous 14.29% (n=5), primiparous 60% (n=21), multiparous 25.71% (n=9). Smoke 17.14% (n=6). Non combined disease had 65.7% (n=23), diabetes mellitus 17.14% (n=6), PCOS 14.29% (n=5), cardiovascular disease had 2.86% (n=1). [Table1] Mean endometrial thickness of TVUS had ( 16.0±0.91mm). Smoke (p=0.0391), types of obesity (p=0.0436) and myoma of the uterus (p=0.0187) seen affected the endometrial thickness. LNG-IUD group had after treatment’s menstrual period 11.11% heavy 80ml (n=1), 88.89% light 5ml (n=8). DGS (5-25 day) group had after treatment’s menstrual period 9.09% heavy =80ml (n=1), 90.91% light5ml (n=10), DGS (16-25 day) group after treatment menstrual period 40% heavy 80ml (n=6), 46.67% normal 5-80ml (n=7), 13.33% light 5ml (n=2) байв. Therefore between the three treatment groups had no differences. But treatment’s before and after result had statistics probability differences (P= 0.4064). [Figure4] @*Conclusions@#Finally, given the long natural history of menorrhagia, study outcomes need to be assessed over a period that is longer than 2 years. In conclusion, our study showed that both the LNG-IUD, oral progestin treatment reduced the adverse effect of menorrhagia on women’s lives over the course of two years. LNG-IUD was the more effective first choice, as assessed impact of bleeding on the women’s quality of life.

Neoplasia Pseudopapilar sólida del Páncreas. A Propósito de un Caso / Solid Pseudopapillary Neoplasia of the Pancreas. Case Report

Introducción: La neoplasia pseudopapilarsólida del páncreas es una patología poco frecuente, que se presenta en mujeres jóvenes y es de comportamiento incierto. La prevalencia es del 1-2% y el tratamiento es quirúrgico. En el presente caso se describe a una paciente de sexo femenino de 10 años de edad que muestra esta patología y su correspondiente manejo. Caso clínico:Paciente de sexo femenino, de 10 años de edad, con antecedentes de una nefrectomía hace 6 años por hidronefrosis, refiere dolor abdominal localizado en egigastrio tipo cólico y pérdida de peso. En los estudio de imagen a nivel peritoneal se observa lesión de aspecto ocupativo de tipo sólido neoplásico con área central de probable necrosis y que desplaza en sentido posterior al páncreas así como al estómago y se asocia con adenomegalias peritoneales y retroperitoneales. Evolución:Lapaciente fue sometido a una espleno-pancreatectomía distal.El estudio anatomo-patológico concluyó en neuplasia pseudopapilar sólida del páncreas.Continúa en valoración por consulta externa. Conclusión:Neoplasia Pseudopapilar sólida del Páncreasdebe ser sospechada en pacientes con una masa sólida o quística pancreática con un estudio de imágenes compatibles. Palabras clave:Neoplasia pseudopapilar sólida del páncreas, prevalencia, inmunohistoquímica, receptores progestágenos,Informe de caso

Introduction:Solid pseudopapillary neoplasia of the pancreas is a rare pathology that occurs in young women and has an uncertain behavior. The prevalence is 1-2% and the treatment is surgical. In the present case, a 10-year-old female patient with this pathology and its corresponding management is described. Clinical case: A 10-year-old femalepatient with a history of nephrectomy 6 years ago due to hydronephrosis, complains of colicky localized abdominal pain in the egigastrium and weight loss. In peritoneal imaging studies, a neoplastic solid type occupational lesion with a central area of probable necrosis is observed, which displaces the pancreas as well as the stomach posteriorly and is associated with peritoneal and retroperitoneal adenomegaly. Evolution: The patient underwent a distal spleno-pancreatectomy. The anatomopathological studyconcluded in solid pseudopapillary neuplasia of the pancreas. He continues to be evaluated by external consultation. Conclusion: Solid Pseudopapillary Neoplasia of the Pancreas should be suspected in patients with a solid or cystic pancreatic mass with a compatible imaging study. Key words:Solid pseudopapillary neoplasm of the pancreas, prevalence, immunohistochemistry, progestin receptors, Case Report.

Hormonal Contraceptives and Breastfeeding: A Review of Literature

@#<p>The use of hormonal contraceptives in a breastfeeding patient has been questioned by breastfeeding advocates. Their fear was that hormonal contraceptives will affect the milk production of the patient. This review of literature showed that progestins do not affect breastmilk supply whether it is the progestin only pill (POP), depot medroxyprogesterone acetate, levonorgestrel-containing intrauterine system (LNG-IUS) or the etonogestrel implant (ENG). The timing of administration of the progesterone derivative contraceptive method also does not affect milk production, whether immediately postpartum (within 48 hrs after delivery) or delayed (4 - 6 weeks postpartum). With this in mind, clinicians may safely advise these to breastfeeding patients to prevent unplanned pregnancies.</p>

Discordance for hormone receptors and Her-2 expressions in primary lesion and ipsilateral axillary lymph node metastasis of breast cancer and its influence in prognosis / 吉林大学学报(医学版)

Objective: To investigate the discordance for estrogen receptor (E R), progestin receptor (PR) and human epidermal growth factor receptor 2 (Her-2) expressions in the primary lesion of breast cancer and ipsilateral axillary lymph node metastases, and to discuss the effect of discordance on the prognosis of patients. Methods: The climical materials and pathological samples of 120 cases of breast cancer patients with ipsilateral axillary lymph node metastasis were collected. The expressions of ER, PR, Her-2 and Ki-67 in the primary lesion and axillary lymph node metastasis of the breast cancer patients were detected by immunohistochemistry. Paired Chi-square test was used to analyze the differences in the receptor expressions between the primary lesion and the axillary lymph node metastasis. Chi-square test was used to evaluate the correlations between the Ki-67 expression and the receptor expressions and the correlations between the clinical characteristics of breast cancer and the expression differences in ER, PR and Her-2. Spearman correlation analysis was used to analyze the correlations between the clinical stages of breast cancer and the expression differences of ER, PR and Her-2. Survival analysis was conducted by Kaplan-Meier method. Results: There were some differences in the expression of levels of ER, PR and Her-2 between the primary lesion and the ipsilateral lymph node metastasis, but there was no statistically significant differences (P> 0. 05). The clinical stages of breast cancer were related to the expression differences of ER and PR (P < 0 . 05). The Ki-67 expression was significantly associated with the expressions of ER and PR in primary lesion of breast cancer patients (P < 0 . 05). There were a statistically significant differences in the overall survival (OS) and disease-free survival (DFS) between concordant and discordant cases for ER status in the primary lesion and the corresponding lymph node metastasis (P < 0 . 05). The OS and DFS were significantly lower in the discordant cases for ER status. The OS and DFS of the patients with ER-positive in the primary lesion and ER-positive in the lymph node metastasis were higher than those of the patients with ER positive in the primary lesion and ER negative in the lympy node metastasis (+ /+ vs. +/ -) (P

Six months response rate of combined oral medroxyprogesterone/levonorgestrel-intrauterine system for early-stage endometrial cancer in young women: a Korean Gynecologic-Oncology Group Study / 부인종양

OBJECTIVE: To evaluate the efficacy of combined oral medroxyprogesterone acetate (MPA)/levonorgestrel-intrauterine system (LNG-IUS) treatment and to compare the diagnostic accuracy of endometrial aspiration biopsy with dilatation & curettage (D&C) in young women with early-stage endometrial cancer (EC) who wished to preserve their fertility. METHODS: A prospective phase II multicenter study was conducted from January 2012 to January 2017. Patients with grade 1 endometrioid adenocarcinoma confined to the endometrium were treated with combined oral MPA (500 mg/day)/LNG-IUS. At 3 and 6 months of treatment, the histologic change of the endometrial tissue was assessed. The regression rate at 6 months treatment and the consistency of the histologic results between the aspiration biopsy and the D&C were evaluated. RESULTS: Forty-four patients were enrolled. Nine voluntarily withdrew and 35 patients completed the protocol treatment. The complete regression (CR) rate at 6 months was 37.1% (13/35). Partial response was shown in 25.7% of cases (9/35). There were no cases of progressive disease and no treatment-related complications. A comparison of the pathologic results from aspiration biopsy and D&C was carried out for 33 cases. Fifteen cases were diagnosed as “EC” by D&C. Among these, only 8 were diagnosed with EC from aspiration biopsy, yielding a diagnostic concordance of 53.3% (ĸ=0.55). CONCLUSION: Combined oral MPA/LNG-IUS treatment for EC showed 37.1% of CR rate at 6 months. Considering the short treatment periods, CR rate may be much higher if the treatment continued to 9 or 12 months. So, this treatment is still a viable treatment option for young women of early-stage EC. Endometrial aspiration biopsy with the LNG-IUS in place is less accurate than D&C for follow-up evaluation of patients undergoing this treatment. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01594879

Effect of Progestin-primed Ovarian Stimulation Protocol on Outcomes of Aged Infertile Women Who Failed to Get Pregnant in the First IVF/ICSI Cycle: A Self-controlled Study / 华中科技大学学报（医学）（英德文版）

This study aimed to explore the outcomes of progestin-primed ovarian stimulation protocol (PPOS) in aged infertile women who failed to get pregnant in the first IVF/ICSI-ET cycles with GnRH-a long protocol.A self-controlled study was conducted to retrospectively investigate the clinical outcomes of 104 aged infertile patients who didn't get pregnant in the first IVF/ICSI-ET treatment by stimulating with GnRH-a long protocol (non-PPOS group),and underwent PPOS protocol (PPOS group) in the second cycle between January 2016 and December 2016 in the Center for Reproductive Medicine,Renmin Hospital of Wuhan University.The primary outcomes included clinical pregnancy rate of frozen-thawed embryos transfer (FET) in PPOS group,and good-quality embryo rate in both groups.The secondary outcomes were fertilization rate,egg utilization rate and cycle cancellation rate.The results showed that there were no significant differences in basal follicle stimulating hormone (bFSH),antral follicle count (AFC),duration and total dosage of gonadotropin (Gn),number of oocytes retrieved,intracytoplasmic sperm injection (ICSI) rate,fertilization rate,and cycle cancellation rate between the two groups (P＞0.05).However,the oocyte utilization rate and good-quality embryo rate in PPOS group were significantly higher than those in non-PPOS group (P＜0.05).By the end of April 2017,62 FET cycles were conducted in PPOS group.The clinical pregnancy rate and embryo implantation rate were 22.58％ and 12.70％,respectively.In conclusion,PPOS protocol may provide better clinical outcomes by improving the oocyte utilization rate and good-quality embryo rate for aged infertile patients who failed to get pregnant in the first IVF/ICSI-ET cycles.

Effect of Progestin-primed Ovarian Stimulation Protocol on Outcomes of Aged Infertile Women Who Failed to Get Pregnant in the First IVF/ICSI Cycle: A Self-controlled Study / 华中科技大学学报（医学）（英德文版）

This study aimed to explore the outcomes of progestin-primed ovarian stimulation protocol (PPOS) in aged infertile women who failed to get pregnant in the first IVF/ICSI-ET cycles with GnRH-a long protocol.A self-controlled study was conducted to retrospectively investigate the clinical outcomes of 104 aged infertile patients who didn't get pregnant in the first IVF/ICSI-ET treatment by stimulating with GnRH-a long protocol (non-PPOS group),and underwent PPOS protocol (PPOS group) in the second cycle between January 2016 and December 2016 in the Center for Reproductive Medicine,Renmin Hospital of Wuhan University.The primary outcomes included clinical pregnancy rate of frozen-thawed embryos transfer (FET) in PPOS group,and good-quality embryo rate in both groups.The secondary outcomes were fertilization rate,egg utilization rate and cycle cancellation rate.The results showed that there were no significant differences in basal follicle stimulating hormone (bFSH),antral follicle count (AFC),duration and total dosage of gonadotropin (Gn),number of oocytes retrieved,intracytoplasmic sperm injection (ICSI) rate,fertilization rate,and cycle cancellation rate between the two groups (P＞0.05).However,the oocyte utilization rate and good-quality embryo rate in PPOS group were significantly higher than those in non-PPOS group (P＜0.05).By the end of April 2017,62 FET cycles were conducted in PPOS group.The clinical pregnancy rate and embryo implantation rate were 22.58％ and 12.70％,respectively.In conclusion,PPOS protocol may provide better clinical outcomes by improving the oocyte utilization rate and good-quality embryo rate for aged infertile patients who failed to get pregnant in the first IVF/ICSI-ET cycles.

Electroacupuncture at intercostal nerve for mammary gland hyperplasia in rats / 中国针灸

<p><b>OBJECTIVE</b>To explore the correlation between efficacy of electroacupuncture (EA) on mammary gland hyperplasia (MGH) and the regulatory pathway of intercostal nerve.</p><p><b>METHODS</b>Fifty female SD rats were randomly divided into a blank group (group A, 12 rats), a model group (group B, 12 rats), an EA group (group C, 13 rats) and an intercostal nerve transection group (group D, 13 rats). The rats in the group B, group C and group D were prepared into MGH model; after model was successfully prepared, the 7th intercostal nerve was cut off in the group D. EA was applied at back acupoints including bilateral "Tianzong" (SI 11), "Ganshu" (BL 18) and "Shenshu" (BL 23) as well as chest acupoints including bilateral "Wuyi" (ST 15), "Hegu" (LI 4) and "Danzhong" (CV 17) in the group C and D. The two groups of acupoints were selected alternately. EA was given for 20 min, once a day; 5-day treatment was taken as one course; there was an interval of 2 days between course; totally 20 treatments were given. After treatment, the height and diameter of papilla were observed; the contents of serum estradiol (E) and progestin (P), the expression of estrogen receptor α (ERα) and progestrone receptor (PR) in mammary gland were measured.</p><p><b>RESULTS</b>(1) The height and diameter of papilla: after treatment, the height and diameter of papilla in the group C were significantly smaller than those in the group B (both<0.05); the height and diameter of left-side papilla in the group D were significantly bigger than those in the group C (both<0.05). (2) Serum Eand P: after treatment, compared with the group B, the contents of Eand E/P were reduced and the content of P was increased in the group C and group D (all<0.05). Compared with the group C, the contents of Eand E/P were increased and the content of P was reduced in the group D (all<0.05). (3) ERα and PR in mammary gland: compared with the group B, the content of ERαwas decreased and the content of PR was increased in the group C (both<0.05). Compared with the group C, the content of ERαwas increased and the content of PR was decreased in the group D ((both<0.05).</p><p><b>CONCLUSION</b>The efficacy mechanism of EA for MGH is likely to be related with the pathway of intercostal nerve; the mechanism may be acupuncture regulating the contents of serum Eand P as well as contents of ERα and PR in mammary gland.</p>

Therapeautic Mechanism of Electroacupuncture with Unblocking and Regulating Needling Therapy for Liver-stagnation Mammary Gland Hyperplasia Rats and Its Relationship with Vagus Nerve Regulation / 广州中医药大学学报

Objective To explore the actions of vagus nerve in electroacupuncture (EA) with unblocking and regulating needling therapy for the treatment of mammary gland hyperplasia(MGH)with liver stagnation type, and to provide experimental evidences for clinical usage of EA with unblocking and regulating needling therapy. Methods Sixty healthy SD rats were randomly divided into 5 groups,namely blank control group,model control group,EA group,EA with disconnection of vagus nerve group,and sham-operation EA group,12 rats in each group. Except for the blank control group, the rats in the remaining groups were modeled. After successful establishment of the model of mammary gland hyperplasia (MGH) with liver stagnation type, the rats in EA group with disconnection of vagus nerve were given disconnection of unilateral vagotomy operation, the rats in sham-operation EA group were given sham operation, and EA group had no treatment, and then all of the 3 treatment groups were given EA with unblocking and regulating needling therapy. At the end of the experiment, the diameter and height of rat nipple were measured,the serum contents of estradiol (E2)and progestin (P)in the rats were detected by enzyme-linked immunoassay(ELISA),and the contents of anti-estrogen receptor alpha (ERα)and anti-progesterone receptor(PR)in the rat breast tissue were detected by immunofluorescence double staining and Western blotting method. Results (1)EA treatment can obviously improve the diameter and height of MGH rat nipple, but the therapeutic effect of EA group with disconnection of vagus nerve was not obvious. (2)Compared with the model control group,the levels of serum E2 and mammary ERαwere markedly reduced(P<0.01),and serum P level and mammary PR content were obviously increased in EA group and sham-operation EA group (P < 0.01). However,the above indexes had no obvious changes in EA group with disconnection of vagus nerve (P>0.05). Conclusion The therapeutic mechanism of EA with unblocking and regulating needling therapy for liver-stagnation MGH may be closely related with the regulation of vagus nerve.

Clinical effect of single use or combination of dydrogesterone and progestin in treatment of threatened abortion caused by uteal phase defect / 药物评价研究

Objective To explore the clinical effect of single use or combination of dydrogesterone and progestin in treatment of threatened abortion caused by uteal phase defect.Methods Totally 186 patients with threatened abortion caused by uteal phase defect accepted in The First Affiliated Hospital of Henan from April 2015 to April 2016 were selected and randomly divided into groups A,B,and C with 62 cases in each group.Patients in group A were given dydrogesterone,those in group B were given progestin,and those in group C were given dydrogesterone combined with progestin.Then the clinical effect,expression of hormones,treatment outcome,and adverse reaction were observed and compared.Results The total effective rates of groups A and B were 72.58％ and 66.13％,respectively,which were obviously lower than 90.32％ of group C with statistically significance (P ＜0.05).The expression levels of P,E2,and hCG of three groups after treatment were higher than those before,those in group C were the highest among them (P ＜ 0.05).The successful treatment rates of groups A,B,and C were 83.87％,82.26％,and 95.16％,respectively,which had no great difference.Conclusion Combination use of dydrogesterone and progestin has better effective rate in treatment of threatened abortion caused by uteal phase defect compared to single use of these two drugs,which has good safety and worth of clinical application.

Prognosis after fertility-sparing management with oralprogestin for women with complex endometrial hyperplasia and endometrial cancer / 基础医学与临床

Objective To investigate the oncologic and reproductive outcomes after progestin treatment of complex endometrial hyperplasia(CEH) and grade 1 endometrial carcinoma(EC).Methods In a retrospective study, data were obtained for patients with CEH or grade 1 EC at presumed stage IA(without myometrial invasion) who wished to preserve fertility and were treated at the Peking Union Medical College Hospital, China, between January 1, 2000 and December 31, 2011.Patients had received oral medroxyprogesterone acetate(250-500 mg/d) or megestrol acetate(160-480 mg/d) for at least 6 months.Results Among 55 included patients, median age was 32 years(range 21-41 years).41(75%) achieved complete response after a median period of 6(3-24) months.Complete response was less frequent among obese than nonobese patients(4/12 [33%] vs 37/43 [86%];P=0.001).Disease recurrence was recorded in 10(24%) patients with complete response;the 5-year recurrence-freesurvival rate was 71%.Among the 33 patients who retained a desire to conceive, 17(52%) became pregnant.Conclusions Fertility-sparing management with oral progestin is effective and safe.Obesity is associated with a lower probability of long-term success.

Synchronization of estrus in paca (Cuniculus paca L. ): possible impacts on reproductive and productive parameters / Sincronização do estro em pacas (Cuniculus paca L. ): possíveis impactos sobre parâmetros reprodutivos e produtivos

Estrus synchronization is a reproductive biotechnology used to improve artificial insemination or pairing through the manipulation of the estrous cycle at a desirable time. Employing this technique in captive pacas (Cuniculus paca L.) is important because it creates expectation of meeting the demand for paca meat and, consequently, reduces poaching. Thus, this research aims to verify the effect of a progestogen implant associated with two doses of eCG on the synchronization and induction of fertile estrus. Twenty-seven adult pacas were used, 18 non-pregnant females and nine males, divided into three groups. G1 and G2 females groups (treatments) received 1.5 mg Norgestomet and were injected intramuscularly, seven days later, with 0.13 mg of prostaglandin. After 24 hours the implants were removed and the animals immediately received 25 IU and 50 IU of ECG intramuscularly, respectively. The mating of the three groups took place on the same days. G3 females' group (control) showed estrus on different days after D0. Females under treatment displayed estrus only after removing the implant (D8). G1, G2, and G3 pregnancy rates were 100%, 66%, and 50%, respectively. Regarding births per parturition, 100% of G1 and G3 produced one offspring, while 50% of G2 produced two. Progestogen in the form of subcutaneous implants was effective in mimicking the luteal phase of the estrous cycle. After removal, implants favored the occurrence of a fertile estrus. As a conclusion, further studies must be conducted in order to establish in-depth possible association between 50 IU of eCG, and the occurrence of twin pregnancies.(AU)

A sincronização é uma biotécnica reprodutiva que melhora a porcentagem de cobertura por meio da manipulação do ciclo estral. Empregar esta biotécnica em pacas de cativeiro (Cuniculus paca L.) é importante, pois cria-se a expectativa de que a demanda pela carne seja atendida e a caça ilegal diminua. O objetivo da pesquisa foi verificar o efeito de implantes de progestágenos associados a duas doses de gonadotrofina coriônica equina (eCG) na sincronização e indução de cios férteis de pacas. Foram utilizadas 18 fêmeas não prenhas e nove machos, divididos em três grupos. Fêmeas do G1 e G2 receberam implantes com 1,5mg de Norgestomet e, sete dias depois, 0,13mg de prostaglandina via intramuscular (IM). No dia 8 (D8), foram retirados os implantes e G1 e G2 receberam 25 UI e 50 UI de eCG, IM, respectivamente; G3 foi o controle. O pareamento nos três grupos aconteceu nos mesmos dias. As fêmeas do G3 apresentaram cio alguns dias após o dia zero (D0). Fêmeas que receberam tratamento apresentaram cio só após a retirada do implante no dia 8 (D8). As taxas de prenhez de G1, G2 e G3 atingiram 100%, 66% e 50%, respectivamente. Em relação a filhotes por parto, 100% do G1 e G3 produziram uma cria, enquanto 50% do G2 produziram duas crias. O progestágeno do implante foi eficaz em mimetizar a fase lútea do ciclo estral. Após a remoção, o tratamento hormonal favoreceu a ocorrência de cio fértil. Outros estudos devem ser realizados a fim de estabelecer uma possível associação entre 50 UI de eCG e a ocorrência de gestações gemelares.(AU)

A perspective on current research investigating the effects of hormonal contraceptives on determinants of female athlete performance

Abstract Hormonal contraceptives are used by approximately half of female athletes and may affect athletic performance as a result of their action on the endogenous hormonal milieu. In athletes, hormonal contraceptive use appears to have little effect on body composition, however further studies are needed assessing progestin-only contraceptives as they may have a negative effect in the general population. The type of progestin contained within the contraceptive may influence the anabolic response of muscle to loading although this relationship is complex as it may be due to either direct or indirect effects of exogenous hormones on protein synthesis and satellite cell proliferation. The altered hormonal milieu in hormonal contraceptive users has predominately been shown to have no effect on muscle strength and whilst maximal oxygen uptake is sometimes reduced, this does not translate into measures of performance. The majority of previous research has used cross-sectional designs and/or grouped together different types and brands of hormonal contraceptives and little research has been conducted on progestin-only contraceptives in athletes. Future research should use prospective, randomised-controlled designs to assess the effects of all types of hormonal contraceptives on athletic performance in females.(AU)

Resumo Os métodos contraceptivos hormonais são usados por aproximadamente metade das atletas do sexo feminino e podem afetar o desempenho atlético como resultado de sua ação hormonal sistêmica. Nas atletas, o uso de anticoncepcionais parece ter pouco efeito sobre a composição corporal, porém novos estudos são necessários para avaliar os efeitos dos contraceptivos derivados apenas de progestina, pois podem ter um efeito negativo na população em geral. O tipo de progestina contido dentro do contraceptivo pode influenciar a resposta anabólica do músculo, embora esta relação seja complexa em virtude dos efeitos diretos ou indiretos de hormônios exógenos na síntese da proteína e na proliferação das células satélites. A resposta sistêmica hormonal alterada em usuárias de contraceptivos parece não influenciar a força muscular e, embora o consumo máximo de oxigênio às vezes seja reduzida, isso não afeta as medidas de desempenho. A maioria das pesquisas utilizou desenhos transversais e/ou agrupou diferentes tipos e marcas de anticoncepcionais hormonais e poucos estudos têm sido realizada sobre anticoncepcionais com progestina em atletas. Futuros estudos devem usar desenhos experimentais prospectivos, randomizados e controlados para avaliar os efeitos de todos os tipos de contraceptivos hormonais no desempenho atlético em mulheres.(AU)

Tromboembolismo e contracepção hormonal: evidências que orientam o aconselhamento / Thromboembolism and hormonal contraception: scientific evidence that can guide counseling

A evolução da contracepção hormonal permitiu à mulher apoderar-se do controle sobre sua fertilidade e beneficiar-se de efeitos que, além de extrapolarem a contracepção, são igualmente desejados. No entanto, dentre os eventos adversos, a ocorrência de tromboembolismo em usuárias de contracepção hormonal segue sendo uma preocupação em contínua avaliação. Nesse sentido, é necessário estabelecer o real papel dos diferentes contraceptivos hormonais (CH) como fator de risco para trombose. Com esse propósito, essa revisão examina as evidências científicas anteriormente publicadas nas bases de dados Medline, Pubmed e Cochrane, utilizando-se os descritores contraceptivos hormonais e tromboembolismo venoso. Após adequação aos critérios de seleção, foram utilizadas onze revisões sistemáticas ou metanálises publicadas entre 1998 e 2014, que incluíram 145 estudos publicados entre 1982 e 2013. As evidências apontam para maior segurança nas formulações com progestogênio isolado e contraceptivos com etinilestradiol em doses iguais ou menores que 35 mcg associado a progestogênios de 1ª geração ou levonorgestrel. Mais estudos são necessários para determinar o risco de tromboembolismo com as formulações combinadas de estradiol associado ao dienogeste e norgestimato, bem como examinar o impacto das vias transdérmica e oral nas formulações comercializadas no Brasil. Assim, não se recomenda privar mulheres de baixo risco para acidentes tromboembólicos dos benefícios da contracepção hormonal. O aconselhamento deve ponderar o risco de tromboembolismo preexistente, o risco de gravidez não planejada e suas complicações biopsicossociais e a composição do CH.(AU)

The evolution of hormonal contraception has enabled women to take control of their fertility and to benefit from effects that go beyond contraception. However, among the adverse effects, the occurrence of thromboembolism in users of hormonal contraception is a concern that has been evaluated, making it necessary to determine the actual role of different hormonal contraceptives (HC) as a risk factor for thrombosis. With that purpose, it was conducted a review of the scientific evidence published in Medline, Pubmed and Cochrane database using the following keywords: hormonal contraceptives and venous thromboembolism. The current review analysed eleven systematic reviews or meta-analyzes published between 1998 and 2014, bringing together 145 studies published between 1982 and 2013. The evidences point to increased security with formulations with isolated progestins and contraceptives with ethynilestradiol in doses equal to or less than 35 mcg associated with a first generation progestin or levonorgestrel. Additional studies are necessary to determine the risk of thromboembolism of estradiol combined formulations associated with dienogeste and norgestimate, as well as transdermal and oral formulations marketed in Brazil. Thus, it is inappropiate to deprive women at low risk for thromboembolic events from the benefits of hormonal contraception. Counseling should consider the risk of pre-existing thromboembolism, the risk of unplanned pregnancy with its biopsychosocial complications and particular HC composition.(AU)

Effects of Aqueous Stem Bark Extract of Anogeissus leiocarpus on the Serum Levels of Progestin and Estradiol and the Estrous Cycle of Wistar Rat.

Background: The effect of aqueous stem bark extract of Anogeissus leiocarpus (AEAL) on the reproductive cycle of adult female Wistar rat and the serum levels of ovarian hormones (estradiol and progestin) was studied. Methods: Twenty-four (24) adult female Wistar rats were used. Rats were divided into groups (I - IV; n=6). Group I was control and received distilled water; groups II, III and IV received AEAL (200mg/kg, 400mg/kg, and 600mg/kg, oral, respectively) for the period of six (6) weeks. The estrous cycle changes were determined by daily observation of vaginal smear, while serum levels of estradiol and progestin was compared after the extract administration-using enzyme linked immunosorbent assay kits. Results: Result showed significant (p< 0.05) increase in the levels of serum progesterone and estradiol in groups II and III treatment; 19% higher when compared to the control. Treatment with AEAL at doses 200mg/kg and 400mg/kg prolonged di-estrus and estrus phases of the rats’ estrous cycle. The increase in the duration of the two phases (diestrus and estrus) was dose dependent, significant (p<0.05) when compared to the control. Conclusion: AEAL has effect on the reproductive cycle and serum levels of ovarian hormones of Wistar rats, hence of potential use in fertility related studies.

Effects of Tiaojing Zhuyun Capsules on the Number of Blastocyst Implantation Sites,Estrogen/Progesto-gen and Their Receptors in Mice with Implantation Dysfunction / 中国药房

OBJECTIVE:To study the effects of Tiaojing zhuyun capsules on the number of blastocyst implantation,estrogen, progestogen and their receptors(ER,PR)in mice with implantation dysfunction. METHODS:48 pregnant mice were randomly di-vided into normal control group (normal saline),pathological model group (normal saline) and Tiaojing zhuyun capsules group (24 g/kg),with 16 mice in each group. They were given relevant medicine intragastrically,once a day,for consecutive 3 d. On the 4th day,those mice were given mifepristone 0.1 ml subcutaneously to induce implantation dysfunction model except for normal control group. On the 5th day,the mice were sacrificed. The number of blastocyst implantation sites was observed. The serum lev-els of estradiol (E2) and progesterone (P) were determined by radioimmunoassay,and the expression of ER and PR protein were determined by immunohistochemistry. RESULTS:On the 5th day of pregnancy,the number of embryo implantation sites,serum levels of E2 and P and the protein expression of ER and PR in pathological model group were significantly lower than in normal con-trol group(P<0.05);the number of embryo implantation sites,levels of E2 and P,the protein expression of ER and PR in Tiao-jing zhuyun capsules group were significantly higher than in pathological model group (P<0.05). CONCLUSIONS:Tiaojing zhuyun capsules can effectively improve the serum levels of E2 and P,the protein expression of ER and PR,and increase the num-ber of blastocyst implantation sites in mice.

What is the influence of hormone therapy on homocysteine and crp levels in postmenopausal women?

OBJECTIVE: To evaluate the influence of estrogen therapy and estrogen-progestin therapy on homocysteine and C-reactive protein levels in postmenopausal women. METHODS: In total, 99 postmenopausal women were included in this double-blind, randomized clinical trial and divided into three groups: Group A used estrogen therapy alone (2.0 mg of 17β-estradiol), Group B received estrogen-progestin therapy (2.0 mg of 17 β-estradiol +1.0 mg of norethisterone acetate) and Group C received a placebo (control). The length of treatment was six months. Serum measurements of homocysteine and C-reactive protein were carried out prior to the onset of treatment and following six months of therapy. RESULTS: After six months of treatment, there was a 20.7% reduction in homocysteine levels and a 100.5% increase in C-reactive protein levels in the group of women who used estrogen therapy. With respect to the estrogen-progestin group, there was a 12.2% decrease in homocysteine levels and a 93.5% increase in C-reactive protein levels. CONCLUSION: Our data suggested that hormone therapy (unopposed estrogen or estrogen associated with progestin) may have a positive influence on decreasing cardiovascular risk due to a significant reduction in homocysteine levels. .

Determination of Eight Steroid Hormones in Butter Samples by Liquid Chromatography-Tandem Mass Spectrometry / 分析化学

A method was developed for the determination of eight steroid hormones ( estrone, α/β-estradiol, estriol, testosterone, epitestosterone, progesterone and testosterone propionate ) in butter samples by gel permeation chromatography ( GPC) purification-followed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The samples were first extracted by ethylacetate/cyclohexane (1:1, V/V) and the extract was later degreased by GPC column. Then, the GPC concentrate was separated using a C18 column ( 100 mm í2. 0 mm i. d. , 3. 0 μm) with gradient elution of acetonitrile/water. Finally, the steroid hormone components were qualitatively and quantitatively determined by mass spectrometer with electrospray ionization in multi reaction monitoring mode. Using matrix matched external standard method, good linearity in response could be obtained in the concentration range of 1 . 0-20 . 0 μg/kg with correlation co-efficiency larger than 0 . 999 . The detection limits of the method were 0. 04-0. 30 μg/kg and the quantification limit was 1. 0 μg/kg. At the spike levels of 1. 0, 2. 0 and 4. 0μg/kg, the recoveries of hormones were within the range of 64. 1%-110%, and the relative standard deviation ( RSD) was less than 11%. The results show that the method is accurate and reliable, and meets the requirements for determination of 8 steroid hormones in butter samples.