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"Latar belakang: Vitrifikasi folikel pre-antral menjadi pilihan dalam upaya preservasi fungsi reproduksi karena dapat menurunkan risiko mikrometastasis sel kanker akibat transplantasi korteks ovarium serta tidak dipengaruhi oleh perfusi jaringan. Tujuan: Memperoleh upaya preservasi fungsi ovarium yang efektif dengan penilaian apoptosis folikel pre-antral. Tempat: Departemen Obstetri Ginekologi Fakultas Kedokteran Universitas Indonesia - RS Dr. Cipto Mangunkusumo dan RS Fatmawati Jakarta. Metode: Studi ini merupakan penelitian eksperimental untuk menilai apoptosis folikel pre-antral pasca vitrifikasi. Folikel pre-antral segar merupakan kelompok kontrol. Hasil: Korteks ovarium didapatkan dari 6 enam pasien kanker serviks dan kanker payudara berumur 30-37 tahun yang menjalani operasi ooforektomi. Tidak terdapat perbedaan morfologi folikel primordial, folikel primer dan folikel sekunder dari korteks ovarium segar dan korteks ovarium pasca vitrifikasi. Dari 6 sampel korteks ovariumSeratus enam puluh satu berhasil di-isolasi 161 folikel pre-antral berhasil di-isolasi dengan 70 % di antaranya merupakan folikel sekunder. Tidak tampak perbedaan morfologi folikel pre-antral berdasarkan kriteria membran basalis, sel granulosa, zona pelusida dan oosit. Rerata ekspresi mRNAgen FasL folikel pre-antral segar adalah 0,43 ± 0,20 dibandingkan 0,51 ± 0,20 pada folikel pre-antral pasca vitrifikasi (nilai p = 0,22). Rerata ekspresi mRNAgen kaspase-3 folikel pre-antral segar adalah 0,56 ± 0,49 dibandingkan 0,27 ± 0,21 pada folikel pre-antral pasca vitrifikasi (nilai p = 0,233). Satu folikel sekunder dari korteks ovarium segar berhasil tumbuh menjadi folikel antral lanjut pada hari ke-6 kultur. Simpulan: Vitrifikasi folikel pre-antral terbukti tidak menyebabkan perubahan morfologi folikel dan peningkatan ekspresi gen mRNA FasL dan kaspase-3. Untuk membuktikan pengaruh vitrifikasi terhadap kesintasan folikel pre-antral pasca dalam kultur diperlukan penelitian lanjutan.

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Background: Pre-antral follicle vitrification should be considered as fertility preservation method because it lowers the risk of cancer micrometastasis of ovarian tissue transplantation and is not disturbed by ovarian tissue perfusion.

Objectives: To obtain the effective method of ovarian function preservation with pre-antral follicle apoptosis assessment.

Setting: Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital and Fatmawati Hospital Jakarta.

Method: This is an experimental study about apoptosis in pre-antral follicles after vitrification. Fresh pre-antral follicles served as a control group.

Results: Ovaries from six women between 30‒37 years of age who underwent oophorectomy due to cervical cancer or breast cancer were examined. There was no significant difference between primordial, primary and secondary follicles morphology from fresh and warmed-vitrified ovaries based on basal membrane, granulosa cells, zona pellucida and oocytes. From 6 six ovarian cortex, 161 pre- antral follicles were isolated and 70 % of them is secondary follicle. There was no significant difference between the morphology of isolated pre-antral follicles from fresh and warmed-vitrified ovaries. The mean FasL mRNA expression on the fresh isolated pre-antral follicles was 0.43±0.20 versus 0.51±0.20 on the warmed-vitrified group (p=0.22). The mean caspase-3 mRNA expression on the fresh isolated pre-antral follicles was 0.56±0.49 versus 0.27±0.21 on the warmed- vitrified group (=0.233). One secondary follicle grew and developed to an antral follicle within 6 days of culture.

Conclusion: It was shown that vitrification did not affect pre-antral follicles morphology and mRNA expression of FasL and caspase-3 on isolated pre-antral follicles and ovarian cortex. Further studies are required to establish whether vitrification affect in vitro culture of pre-antral follicles"

"The conclusion briefly evaluates some of the key accomplishments of the recent historic preservation movement. It also provides a synthesis that draws on the lessons of each of the chapters, sketching out some of the hurdles that remain and are likely to occupy the agendas of preservationists in the decades ahead. The development of the historic preservation movement is, in itself, evidence of our particular American culture, as it changes. All of the evidencestrongly suggests, however, that this social campaign will continue and our legacy will extend to future generations."

"Tesis ini bertujuan untuk memperoleh upaya preservasi fungsi ovarium yang efektif dengan penilaian apoptosis sel granulosa. Vitrifikasi korteks ovarium menjadi pilihan dalam upaya mempertahankan fungsi reproduksi wanita penderita kanker karena dengan teknik ini dapat disimpan banyak folikel primordial, dilakukan kapan saja saat siklus haid tanpa penundaan terapi kanker dan dapat dilakukan untuk pasien prepubertas dan belum menikah. Penelitian vitrifikasi korteks ovarium masih terbatas pada hewan coba serta belum terdapat data yang menilai kejadian apoptosis sel granulosa pasca vitrifikasi korteks ovarium manusia yang dilihat dari ekspresi gen terkait apoptosis. Penelitian ini merupakan penelitian kuasi eksperimental yang dilaksanakan di Departemen Obstetri Ginekologi Fakultas Kedokteran Universitas Indonesia - RSUPN Dr. Cipto Mangunkusumo dan RS Fatmawati Jakarta dalam rentang waktu Maret 2012 hingga Mei 2015. Korteks ovarium didapatkan dari tiga belas pasien berusia 31-37 tahun yang menjalani ooforektomi atas indikasi ginekologis. Secara morfologi, folikel dari korteks ovarium segar tidak terdapat perbedaan dibandingkan dengan dari korteks ovarium pasca vitrifikasi. Rerata ekspresi protein Bax dari korteks ovarium segar yang dinilai dalam bentuk H-score adalah 1,66 ± 0,14 dibandingkan 1,68 ± 0,13 pada ovarium pasca vitrifikasi (p = 0,165). Sedangkan rerata ekspresi protein Bcl-2 dari korteks ovarium segar adalah 1,73 ± 0,10 dibandingkan 1,71 ± 0,10 pada ovarium pasca vitrifikasi (p = 0,068). Vitrifikasi korteks ovarium terbukti tidak menyebabkan peningkatan ekspresi gen Bax dan Bcl-2.

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The aim of this study was to obtain the effective method of ovarian function preservation with granulose cell apoptosis assessment. Ovarian tissue vitrification became a method for ovarian function preservation in women with cancer. This technique can be done anytime without delay on cancer therapy, in prepubertal and unmarried patient. It also can store many primordial follicles. Ovarian tissue vitrification study is still limited to animal test and there was no data about apoptosis assessment after ovarian vitrification in human ovary.

This is a quasi experimental study which was held in Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital and Fatmawati Hospital Jakarta from March 2012 to May 2015. Ovaries from thirteen women between 31-37 years of age who underwent oophorectomy with gynecological indication were examined.

There were no difference morphologically between follicles from fresh and warmed-vitrified ovaries. The mean protein Bax expression on the fresh ovaries which assessed in the form of H-score was 1,66 ± 0,14 compared to 1,68 ± 0,13 on the warmed-vitrified grup (p = 0,165). The mean protein Bcl-2 expression on the fresh ovaries which assessed in the form of H-score was 1,73 ± 0,10 compared to 1,71 ± 0,10 on the warmedvitrified grup (p = 0,068). As a conclusion, it was shown that vitrification did not affect Bax and Bcl-2 expression on human ovary."