فهرست مطالب shahla chaichian

Endometriosis is one of the common gynecological problems during the reproductive years, affecting the quality of life, fertility, and sexual function of women. It is known that sexual dysfunction and quality of life are interrelated. Therefore, this study aimed to evaluate the effect of resection of endometriosis lesions via laparoscopic surgery on the improvement of sexual dysfunction in women with endometriosis.

This clinical trial was performed on 30 patients with endometriosis. The Female Sexual Function Index, Endometriosis Health Profile-30, and Visual Analog Scale were completed for the patients before laparoscopic surgery and three, six, and 12 months after surgery. The results were examined and compared before and after the intervention using the ANOVA test.

The present results showed that the mean pain score of the patients (dysmenorrhea, dyspareunia, and pelvic pain) was significant after laparoscopic surgery (P<0.005). The female sexual function improved after laparoscopic surgery compared to the preoperative phase, and changes in the domains of psychological stimulation, humidity, and sexual orgasm were significant (P<0.005). Moreover, the female quality of life scores increased in all dimensions compared to the preoperative phase, although these improvements were not statistically significant.

The present results revealed that laparoscopic surgery is an effective treatment, leading to a considerable improvement in female sexual function.

 Fast-track surgery (FTS) consists of different pathways to decrease surgical complications and improve outcomes and patient satisfaction. FTS in an elective gynecologic laparoscopic surgery has not been well assessed. No consensus guidelines have been developed for gynecologic laparoscopic surgeries. The purpose of this study is to evaluate enhanced recovery after surgery (ERAS) for total laparoscopic hysterectomy.

260 patients underwent for laparoscopic hysterectomy surgery. All patients were divided into two groups as follows: one group received traditional laparoscopic hysterectomy surgery and the intervention group was treated under ERAS protocol. ERAS protocol includes not receiving preoperative mechanical bowel preparation and laxatives as well as fasting 6 h and not drinking liquids 2h before surgery. The patients were allowed to resume the ordinary diet 6h post-operation. Ondansetron 4 mg were prescribed after surgery for nausea and vomiting, pain was controlled with non-narcotic analgesics diclofenac suppository 100 mg/q12 h and paracetamol 1000 mg/q6 h until discharge. Urinary catheter was removed whenever possible and early ambulation occurred 6h after the surgery.

 A total of 260 patients were studied. Regarding the length of hospitalization, significant differences were shown between the groups (P<0.001). Return to daily functions was occurred earlier in the fast-track surgery group than another group. Complications and VAS pain scores showed no significant differences between the groups.

Our results show that ERAS surgery has fewer side effects and better outcomes which make it more suitable for patients undergoing laparoscopic hysterectomy.

One of the challenges in gene therapy is the transfer of the gene to the target cell. MicroRNAs (miRNAs) regulate gene expression after transcription by binding directly to the messenger and play a vital role in cell behaviors and the pathogenesis of some diseases. This study was aimed at developing poly (lactic-co-glycolic acid) (PLGA)- based nanoparticles (NPs) for gene delivery to endometriotic cyst stromal cells (ECSCs).

In this experimental study, endometriosis cells were isolated from women with severe endometriosis (DIE) and digested by the enzymatic method (40 µg/ml DNAase I and 300 µg/ml collagenase type 3). PLGA-based NPs were synthesized and characterized. The size of sole PLGA NPs and PLGA/miRNA were 60 ± 4 nm and 70 ± 5.1 nm respectively. Poly lactic-co-glycolic-based NPs were used as vector carriers for miRNA 503 transfection in endometriosis cells. The cells were divided into the five groups of control and four doses (25, 50, 75, and 100 µm) of miRNA 503/PLGA at 12, 24, 48, and 72 hours. Viability and apoptosis were evaluated by the MTT assay and Annexin Kits. Data were analyzed by one-way analysis of variance.

The results show that the size of PLGA/miRNA complex with dynamic light scattering (DLS) was 70 ± 5.1 nm and zeta potential values of the PLGA/PEI/miRNA complexes were 27.9 mV. Based on the MTT assay results, the optimal dose of miRNA 503/PLGA was 75 µm, at which the viability of ECSCs was 52.6% ± 1.2 (P≤0.001), and the optimal time was 48 hours. The apoptotic rates of ECSCs treated with PLGA/miRNA503 (34.75 ± 4.9%) were significantly higher than those of ECSCs treated with PLGA alone (3.35 ± 2.58%, P≤0.01).

Cell death increased with increasing the concentration of miRNA; thus, it can be suggested as a treatment for endometriosis.

Endometriosis is a common devastating gynecological disease with severe complications. Researches on noninvasive diagnostic tests with acceptable accuracy are still ongoing. The purpose of the present study was to evaluate the diagnostic value of serum Galectin-9 (Gal-9) level in comparison with laparoscopic results in endometriosis patients.

Sixty-one patients, referred to Booali, Rasool-e-Akram, and Pars Hospitals affiliated to Islamic Azad University of Medical Sciences, were recruited. Patients laparoscopically diagnosed with endometriosis were assigned to the case (n=32) and who diagnosed with other diseases were assigned to the control group (n=29). In general, 56 patients (30 in case and 26 in control group) completed the study. The serum level of Galectin-9 was measured using ELISA method before laparoscopy and was compared between the groups. Next, categorical variables were compared using Chi square and quantitative variables using independent samples ttest or Mann-Whitney U test. The Gal-9 cut-off was calculated using the Youden’s index and ROC curve; then, sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio of Gal-9 were reported. The p<0.05 were considered statistically significant.

Mean serum level of Galectin-9 was 669.3±416.50 pg/ml in the case group and 265.42±492.30 pg/ml in the control group (p=0.001). Considering a cut-off value of 138 pg/ml, Galectin-9 had a sensitivity of 100% and specificity of 88.46% for diagnosis of endometriosis (p<0.001).

Galectin-9 measurement is helpful in diagnosis of endometriosis. Future studies are recommended for investigating the generalizability of these results.

Endometriosis is one of the most common gynecological disorders, which causes pain and reduces fertility. An accurate diagnostic technique would be helpful in the management of these patients preoperatively. The objective of this study was to do a comparative evaluation of uterosacral involvement in deep infiltrative endometriosis by transvaginal sonography (TVS) and laparoscopic biopsy.

TVS and laparoscopy were done in all patients suspected to have endometriosis. TVS examination was carried out to identify endometriotic lesions, and in suspicious laparoscopic views, biopsy was done and laparoscopic findings were confirmed by pathologic report. Then, TVS and pathological findings in laparoscopy were compared and data analyzed by SPSS Version 23.

In our study on 80 patients, the mean age was 34.47 ± 5.94 (mean ± SD) years. Comparison of ultrasound with laparoscopic examinations showed that ultrasound as the gold standard method, has sensitivity, specificity, and positive and negative predictive values of 93%, 65%, and 87%, and 78.9%, respectively, while in the diagnosis of increased uterosacral ligament thickness showed 82%, 100%, and 100% and 6.66%, respectively. While in the diagnosis of nodules in the uterosacral ligament, 100% for all four parameters in the diagnosis of endometrioma in the ovaries, and 71%, 96.4%, and 97.3% and 64.2%, respectively, in the diagnosis of rectal, bladder, and ureteral involvement.

TVS can be used in the diagnosis of endometriosis by examining the increase in the thickness of the uterosacral ligament and the presence of hypoechoic nodules in it; also, this method demonstrates acceptable sensitivity and specificity in ovarian endometrioma.

The first case of inguinal endometriosis was described by Cullen. Endometriosis in the round ligament could be in the pelvic or inguinal area and is a rare disease occurring in 0.6% of women. Women with inguinal endometriosis have a painful inguinal mass during menstrual cycles and they mostly have a history of surgery. The right side is more commonly involved in inguinal endometriosis than the left side (90-94%). A history of gynecologic or abdominal surgery is common in women with inguinal endometriosis.

In our case, a 39-yr-old virgin woman presented with localized pain in the right inguinal that had been present for 4 yr. She did not have any history of previous surgery, and abdominal ultrasonography showed a hypoechoic mass with minimal vascularity. Inguinal endometriosis was correctly diagnosed by two expert radiologists preoperatively, and she underwent laparoscopic surgery.

Considering inguinal endometriosis in the differential diagnosis of women with inguinal masses is important, even if there is no history of gynecologic or abdominal surgery.

One of the complications of cesarean section (C/S) is related to the incision site. Considering the effectiveness of platelet–rich plasma (PRP) on healing of wounds and management of scars, the present study aimed to inquire the effect of PRP on the thickness and completeness of the uterine scar.

In a randomized double-blinded, placebo-controlled clinical trial, the women who underwent C/S from November 2019 to 2020 were included and randomized into two studied groups, including the control (n = 15) and intervention (n = 15) groups. In the intervention group, PRP, extracted from patients’ blood samples, was injected to the incision site (between decidua and myometrium), while the control group did not receive this treatment. The scar thickness of C/S as the primary outcome and postpartum hemorrhage as the secondary outcome were compared between the groups. Both groups were followed for 12 weeks.

The two groups (intervention and control) were not significantly different in terms of weight, height, BMI, age, parity, gravidity, duration of surgery, and blood hemoglobin (HB) level (P > 0.05). Comparison of scar characteristics showed the creation of a niche in the PRP group, which was almost one-fourth of that of the control group; a difference that was statistically significant (P = 0.002). The thickness of adjoining myometrium was comparable between the two groups. Mean uterine niche height in the intervention group was lower than in the control group, which was statistically significant (P = 0.048). The mean of residual myometrium thickness (RMT) in the intervention and control groups were 7.62 ± 0.95 and 5.6 ± 3.5 mm, respectively, a difference that was statistically significant (P < 0.001).

Local injection of PRP is an effective and viable measure for reducing the uterine niche; therefore, it is suggested to be included in the routine wound care of CS. Future studies are needed to confirm PRP efficacy in different settings.

 To evaluate the association between menstrual cycle disorders with obesity in Iranian women.

In the present case-control study, 405 obese women of reproductive age who referred to the Obesity Clinic of Minimally Invasive Surgery Research Center, Rasoul-e-Akram Hospital, Tehran, between Jan 2013 and Oct 2015 were included as the case group and were compared with a control normal-weight group, selected from their family members (N=293). Menstrual cycle characteristics were documented in a researcher-designed checklist. For the statistical analysis, we used SPSS version 19 and Stata version 5.0.

In the case group, 47 women (11.6%) had irregular menstrual cycles, while it existed in 22 (7.5%) of the control group (P<0.001). The prevalence of different menstrual disorders was as follows: polymenorrhea 107 (26.4%) in cases and 51 (17.4%) in controls (P<0.001), oligomenorrhea 22 (5.4%) in cases and 16 (5.5%) in controls (P<0.001).

The results of the present study showed that morbid obesity increases the risk of menstrual irregularities and dysmenorrhea; therefore, it is essential to pay greater attention to this issue in morbid obese patients for proper management of this disturbing comorbidity.

Sleep, a physiological need, may be disturbed during pregnancy due to the psychological, anatomical, biochemical, hormonal, and emotional adaptations.

The present study aimed to investigate the frequency of morningness/eveningness, insomnia, and sleep disorders in pregnant mothers.

All healthy pregnant women who referred to Rasoul-Akram Hospital in 2018-2019 for prenatal care without severe medical diseases were included in the study by census method. They were asked to fill their demographics, Morningness Eveningness questionnaire (MEQ), Pittsburgh sleep quality index (PSQI), and insomnia severity index (ISI) after signing their informed consent. The data were analyzed using SPSS V.21. Women who gave birth before the third trimester were excluded from analysis.

A total of 347 women completed the study; mean age: 31.46 ± 5.36 years, mean gestational age: 24.68 ± 9.62 weeks. The mean MEQ score was 48.77 ± 5.15; 8.1% were moderate evening type, 85.3% intermediate, and 2.6% moderate morning type. Mean ISI score was 16.92 ± 5.51; 91.9% had insomnia; 31.1% reported (rather or very) poor sleep quality. The frequency of insomnia (based on ISI scores) and sleep disorders (based on PSQI dimensions) were neither different among the three trimesters of pregnancy, nor between complicated and uncomplicated pregnancies (P > 0.05). The MEQ score (P = 0.008, OR = 4.275) was positively, and the academic degree was negatively (P = 0.005, OR = 0.202) associated with sleep disorder.

The majority of pregnant mothers reported insomnia, and about one-third reported poor sleep quality, indicating the necessity of paying greater attention to the sleep disorders of pregnant women from the early trimester to prevent further complications.

To evaluate the maternal and fetal outcomes of COVID-19 up to three months after the delivery in pregnant women. This case series study was conducted on all pregnant women with COVID-19 hospitalized in Hazrat -E- Rasoul Akram Hospital, Tehran, Iran from March 8, 2020 to December 28, 2020. Data were included maternal age and gestational age (GA) which presenting signs and symptoms were collected at hospital admission. To confirm COVID-19 diagnosis, high-resolution computed tomography (HRCT) or reverse transcription-polymerase chain reaction (RT-PCR) tests were conducted. Both the mothers and the newborns were followed up to three months after delivery. Fourteen pregnant women with the median age of 31.5 were enrolled. HRCT was done in twelve mothers (85.7%), and eleven mothers (78.6%) were evaluated via RT-PCR; four of them (36.36%) were positive. Two mothers (14.28%) were admitted to ICU. The cesarean section (C/S) was done following fetal distress in only three mothers due to their concerns of vertical transmission. Two mothers were admitted to the intensive care unit (ICU), and one of them died of pneumomediastinum. Fortunately, no neonatal death was reported three months after the delivery. COVID-19 affects mothers more in the last trimester of the pregnancy. Although no fetal death was reported in the recent study, physicians should closely monitor pregnant women to reduce the adverse event.

Coronavirus disease 2019 (COVID–19), reported pandemic in March 2020, is the current health problem with no definite prevention or treatment. As a newly emerging disease, new cases are reported each day to add to the physician’s knowledge about the best clinical approach. One of the controversies in this regard is the gold standard diagnostic method. Evidence suggests that polymerase chain reaction (RT–PCR) for Coronavirus nucleic acid has a low sensitivity and computed tomography (CT) has been suggested for more accurate diagnosis. Yet, CT has the disadvantage of radiation and is not safe in all patients. Here, we present a case series of 23 patients who underwent both RT–PCR and CT and report the outcome.

The newly emerging COVID-19 has caused severe anxiety around the world and it is infecting more people each day since there is no preventive measure or definite therapy for the diseases. The present study aimed to evaluate its effect on anxiety and stress of pregnant mothers during perinatal care.

Three–hundred pregnant mothers without COVID–19 infection who were referred to the hospitals affiliated to Iran University of Medical Sciences for delivery during April 2020, based on negative clinical symptoms and the results of polymerase chain reaction (rt-PCR) for COVID–19, were recruited by census method and asked to complete the Persian version of the perceived stress scale (PSS); participants views about their anxiety level and the role of COVID–19 as the source of their stress and worries were recorded. Women who refused to continue the study were excluded. The frequency of variables and mean scores were calculated using SPSS v. 21.

Mean age of mothers was 30.20±16.19 years; 31.3% were primigravida and mean gestational age was 38.00±4.14 weeks. Moreover, 16.3% asked for earlier pregnancy termination and 39% requested Cesarean section (C/S). Assessing the mothers’ anxiety revealed a high/very high level of anxiety in 51.3%. The majority felt worried and frustrated because of COVID–19 (86.4%). Social media had a great impact on the level of stress among these mothers (60.3%).

COVID-19 pandemic is an important source for the increased anxiety and stress among healthy pregnant mothers.

Regarding the increasing prevalence of polycystic ovarian syndrome (PCOS) in young women and the side effects of existing medication regimens, this study was performed with aim to evaluate the antioxidants and clinical effects of oral Curcumin Nanomicell capsule with the approach to improve the women's quality of life.

This cross-sectional interventional open label study was performed on 20 patients with PCOS in Tehran from April 2018 to September 2019. The subjects received 50 mg Nanomicell capsule for 90 days every other day. Quantitative indexes of oxidative stress (serum level of Malondialdehyde, Superoxide dismutase, and Catalase) were analyzed at baseline and after the end of intervention; the patients' quality of life was evaluated as monthly. Data were analyzed by SPSS software (version 24) and paired t-test and U Mann-Whitney test. P<0.05 was considered statistically significant.

Continuous 3-month oral intake of Curcumin Nanomicell reduced the menstrual pain scores (p=0.003), anxiety and depression levels (p=0.007) and hirsutism (p<0.0001), but no significant relationship was observed between the use of 80 mg Curcumin Nanomicell as monthly and every other day and reduced serum level of oxidative stress factors and other factors related to the patients' quality of life (p>0.05).

Curcumin Nanomicell improved some clinical signs of PCOs but antioxidant effect was not observed according to the serum biomarkers. However this pilot study on a small sample size opened up a new insight for future therapy of PCOs patients, further research in larger groups in longer time periods seems necessary.

 Fertility-sparing strategies are suggested for selected patients with cervical cancer, who wish to preserve their fertility, which includes neoadjuvant chemotherapy, conization, and trachelectomy. Radical trachelectomy is suggested as a safe method with favorable outcomes. However, the controversy about the success rate, fertility rate, and risk of recurrence of radical trachelectomy questions its applicability.

 Here, we presented a 39-year-old woman with high-grade invasive cervical cancer, squamous cell carcinoma (SCC) which was successfully managed by laparoscopic lymphadenectomy and radical trachelectomy and leading to normal pregnancy in the following years.

 This case report suggests that this procedure should be considered in selected patients, especially those who wish to have a child in the future. Besides, it is recommended that obstetricians pay greater attention to post-trachelectomy pregnancies to reduce the complication rates.

 The evolution of fertility treatment methods such as laparoscopic surgery and assisted reproductive technology (ART) leads to an increased chance for conception in women with endometriosis. However, it is still not clear which treatment is more likely to result in endometriosis recurrence.

 The current study aimed at assessing the recurrence rate of endometriosis and its main determinants following fertility treatment with surgery or ART.

 The current historical cohort study was conducted on 51 consecutive women with endometriosis undergoing fertilization procedures, including laparoscopic surgery (n = 42) and ART (n = 9) in Tehran from 2006 to 2016. All patients with complete hospital records were enrolled in the study. The patients in the two groups were followed up for five years for endometriosis recurrence.

 Within the follow-up time, the rate of endometriosis recurrence in patients of the surgery and ART groups was 28.6% and 44.4%, respectively, indicating no significant difference between the groups (P = 0.436). In this regard, the 1-, 2-, and 3-year recurrence-free survival rate in the ART group was 87.5%, 50.0%, and 50.0%, and in the surgery group was 96.9%, 90.6%, and 70.5%, respectively. Using the Cox proportional hazard modeling adjusted for baseline variables, the method of fertilization (ART or surgery) could not affect the rate of long-term recurrence of endometriosis (odds ratio = 1.428, 95% confidence interval: 0.177 - 9.900, P = 0.784).

 The method of fertilization treatment-e g, surgery, and ART- may not affect the rate of endometriosis recurrence in women with subfertility caused by endometriosis.

Coronavirus disease 2019 (COVID-19), newly emerging in the world as a pandemic disease, can have rare extrapulmonary manifestations. Few studies have reported coagulation disorders, induced by coronavirus; however, hemorrhage is an extremely rare and life-threatening phenomenon in COVID-19.

Herein, we present a 31-year-old woman referring with vaginal bleeding, melena, skin ecchymosis, mucosal bleeding, melena, hematuria, and hypovolemic shock. At our center, she was diagnosed as a case of severe internal hemorrhage due to ovulation site hemorrhage and underwent emergency surgery, complicated by prolonged international normalized ratio, which could be due to the presence of COVID-19 in the patient, detected by spiral computed tomography.

This case showed the importance of examining COVID-19in any patients referring to the hospital during the pandemic as well as paying greater attention to the effect of COVID-19 on coagulation disorders in these patients.

There is a growing need for information regarding maternal and neonatal outcomes during coronavirus pandemic. In this study, a comprehensive investigation was done regarding the possibility of vertical transmission using the available data in the literature.

A systematic search was conducted using electronic databases, including PubMed, Scopus, Web of Science, Embase, and Scholar. All studies containing infected COVID-19 pregnant women who had given birth were included, and the search was done up to April 14, 2020.

Overall, 21 articles were reviewed, and clinical characteristics of 90 pregnant patients and 92 neonates born to mothers infected with COVID-19 were reviewed. The most common symptoms included fever, cough, and dyspnea. The main laboratory findings included leukocytosis, lymphopenia, thrombocytopenia, and elevated C-reactive protein. The most commonly reported complications were preterm labor and fetal distress. Three mothers were admitted to ICU and required mechanical ventilation; among them, one died, and one was on extracorporeal membrane oxygenation. Overall, 86 neonates were tested for the possibility of vertical transmission and 82 cases were negative in RT-PCR, while 4 were positive. Out of 92 neonates, one died, and one was born dead. Nineteen patients reported having no symptoms, while breathing problems and pneumonia were reported as the most common neonatal complications.

There were no differences in the clinical characteristics of pregnant women and non-pregnant COVID-19 patients. COVID-19 infection has caused higher incidence of fetal distress and premature labor in pregnant women. Although the possibility of vertical transmission in infected pregnant women is rare, four neonates’ test results for COVID-19 infection were positive in this review.

The aim of this study was to compare noninvasive prenatal testing (NIPT) of cell‐free DNA in maternal blood and amniocentesis in the diagnosis of aneuploidy. This study was designed to evaluate sensitivity, specificity, accuracy, positive predictive value and negative predictive value of NIPT for detection of aneuploidies compared gold standard test of amniocentesis.
This cross sectional study performed on Iranian pregnant women (GA≥12 weeks) and candidate for NIPT, referred to the Nilou laboratory in Tehran and 16 provinces of Iran between Aug 2016 and Aug 2018. Analysis study was performed by SPSS version 21.
11960 pregnant women which candidate for NIPT enrolled in this study and 139 persons detected as high risk for NIPT.  The mean (±standard deviation) age of participants was 33.7 ± 6.4 years and 34.4 ± 5.2 years for amniocentesis and NIPT groups, respectively. Specificity of NIPT in the diagnosis of trisomies of T21, T18 and T13 was 99.94%, 99.95% and 99.97% respectively. Failure rate was calculated as 0.27.
Non-invasive prenatal testing has very high sensitivity and specificity for aneuploidies but should not be used as a final diagnosis test.

The high risk of recurrence of ovarian endometrioma after laparoscopy is a major challenge.

In this study, we measured recurrence of endometriosis six months after laparoscopic surgery and evaluated its risk factors in these patients.

In this cross-sectional study, patients with endometrioma (based on the pathologic report) who underwent laparoscopic cystectomy in Rasool-Akram Hospital, Tehran, from April 2015 to August 2016, were evaluated by ultrasonography six months after the surgery. Endometriosis surgery was done by a team of expert surgeons. The demographic information of patients, number, size, and location of cysts, disease stage, and medical treatment taken after the surgery were recorded in the study checklist. The pre-operative endometriosis-related symptoms, including pelvic pain, dysmenorrhea, dyspareunia, dyschezia, and dysuria were recorded by visual analogue scale and compared with related symptoms six months after the surgery.

Seventy-nine patients completed the study with the mean age of 31.38 ± 5.98 years. The mean cysts’ size was 69.2 ± 2.76 mm: 44.3% had multiple cysts and 39.2% bilateral endometrioma. In 53.1% deep infiltrative endometriosis (DIE) was recorded. After six months, 13.9% had a recurrence with the mean size of 37.2 ± 13.3 mm. There was a statistically significant correlation between recurrence and a previous surgery (P = 0.001) and infertility (P = 0.02). All endometriosis-related symptoms significantly decreased six months after the surgery.

The recurrence rate, compared to the previous report, indicated that patients with a previous surgery and infertility should be closely monitored for the risk of recurrence. Possibly, damages in the previous surgery and cellular and molecular abnormalities that encountered more deeply in endometriosis-associated infertility predispose the patients to more recurrence rate, which can be further investigated.

The aim of this study was to investigate the attitudes of the students of Medical Sciences and Technical Sciences Universities toward HIV/AIDS. This cross-sectional study was performed on 950 first-year Medical Sciences students and first-year Technical Sciences students between May 2017 and June 2018 in Tehran, Iran. The students were selected using the census-sampling method to fill out the International AIDS Questionnaire-Persian version (IAQ-P). SPSS version 21 was used to analyze data by the chi-square test and nonparametric tests. There was a significant difference in the mean score of AIDS attitude between the two groups (P < 0.001). Confounding factors including age, gender, and marital status had a significant effect on students’ AIDS attitude between the different groups using regression models (P < 0.001). There is an increasing trend in sexual activity among students and young people while it is not true about its attitude and awareness. Therefore, we need to improve attitude toward AIDS in developing countries.

Microarray technology is an accurate method for recognition of disease association gene alterations. However, there still is not an effective approach for the evaluation of gene expression in ovarian cancer. A reliable approach is described to identify genes associated with ovarian cancer. Microarray gene expression data analysis was applied to correct systematic differences through four different normalization methods; LOESS, 3D LOESS, and neural network (NN3, NN4). Then, three different clustering methods of K-means, fuzzy C-means, and hierarchical methods were examined on corrected gene expression values. The proposed approach was tested on a reliable source of genes’ information, where the entropy of genes in samples and Euclidean distance were used for gene selection. Our findings revealed that a neural-network-based normalization method could better control the effects of non-biological variations from microarray data. Moreover, the hierarchical clustering was more effective compared to other methods, and resulted in the identification of three genes, including BC029410, DUSP2, and ILDR1, as candidates for disease-association genes. According to the finding of the present study, hierarchical clustering with nonlinear-based normalization could have the ability to prioritize genes for ovarian cancer

Endometriosis is routinely treated with laparoscopy, which despite significant advantages over laparotomy cannot diminish postoperative pain. Insufficient postoperative pain control decreases patient satisfaction. This study was designed to evaluate the efficacy of intraperitoneal dexmedetomidine (DEX) combined with bupivacaine on postoperative pain in endometriosis laparoscopic surgery. Fifty-three patients with endometriosis, scheduled for laparoscopy in Rasoul-e-Akram Hospital, Tehran, from January 2016 to May 2017 who were randomly divided into three groups, including group 1 (G1, n = 21) received 50 mL intraperitoneal saline, group 2 (G2, n = 16) received 50 mL intraperitoneal instillation of bupivacaine 0.25%, and group 3 (G3, n = 16) received 50 mL bupivacaine 0.25% plus dexmedetomidine 1 µg/kg. Each patient with a history of allergy to local anesthetics or dexmedetomidine, cardiac disease, renal or hepatic failure, severe pulmonary disease; in addition, pregnant and comorbid obese patients were excluded from the study. Patients’ postoperative pain was assessed in the recovery room after 2, 6, 12, 24, and 48 hours using visual analogue scale (VAS). Total analgesic consumption was also recorded. The postoperative VAS scores were significantly lower in group 3 than other groups in the recovery room, and 2, 6, 12, 24 and 48 hours after the surgery (P < 0.001). However, there was no significant difference between 1 and 2 groups. Furthermore, total VAS in the first 24 hours in group 3 was significantly lower than the two other groups (P < 0.001). We conclude 1 μg/kg intraperitoneal DEX administration combined with bupivacaine may prolong postoperative analgesia and decrease rescue analgesia requirement compared with bupivacaine alone.

Gender identity disorder (GID) is associated with various adverse health outcomes as well as psychiatric problems. Quality of life (QOL) in patients after surgery is an important issue, as some cases report dissatisfaction and regret after surgery. The present study compared QOL in female-to-male (FTM) GID patients before and after gender reassignment surgery (GRS) in an Iranian population. In the present study, 42 natal female patients with Gender Disorder diagnosis, who were referred to the Fertility Research Center of Tehran University of Medical Sciences for GRS from December 2014 to December 2015, were prospectively recruited. The demographic characteristics, including age, body mass index (BMI), occupational and marital status, educational level, and family support were recorded. Then, participants were asked to complete the Persian version of the 36-Item Short Form Health Survey (SF-36) questionnaire under supervision of the researcher, once at baseline and once 6 months after surgery. The changes in SF-36 scores and association with the demographic variables were then evaluated using SPSS 16 at significance level of 0.05. Mean age of patients was 34.17 ± 5.58 years with a mean BMI of 43.14 ± 6.91 kg/m2 . Most were single (54.8%), had primary school education (50.5%), and acceptable family support (59.5%). Total mean score of QOL significantly improved from 26.43±6.81 to 37.52 ± 8.67 (P < 0.001), 6 months after surgery and also in all domains (P < 0.001), although the increase in emotional problem was not statistically significant (P = 0.05). In conclusion, as the results of the present study highlight, FTM GD patients have a low QOL before surgery that is significantly improved after surgery.