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Latar belakang: Heterogenitas pasien endometriosis terkait presentasi fenotip klinisnya memerlukan standar pengambilan data. Saat ini belum ada standardisasi pengambilan data fenotip klinis pasien endometriosis di Indonesia. Translasi kuesioner klinis WERF-EPHect Clinical Questionnaire (Standard) (EPQ-S) ke dalam Bahasa Indonesia dan validasi kuesioner ini diperlukan untuk mengetahui apakah alat ini dapat digunakan di Indonesia sebagaimana telah digunakan di negara lain dan memastikan bahwa data yang dihasilkan akurat dan andal.

 

Tujuan: Untuk membuat sebuah standar pengambilan data fenotip klinis pasien endometriosis di Indonesia dan untuk mengetahui hasil terjemahan dan validitas kuesioner klinis WERF-EPHect Clinical Questionnaire (Standard) (EPQ-S) yang telah diterjemahkan ke dalam Bahasa Indonesia

 

Metode: Penelitian ini dilakukan dengan metode transkultural adaptasi. Uji validasi ini kuesioner EPHect EPQ-S dilakukan melalui proses forward-backward translation, harmonisasi oleh para expert, cognitive debriefing kepada target kuesoioner serta proofreading dan finalisasi oleh para expert. Penelitian dilakukan di RSCM selama 6 bulan yaitu Januari 2019 sampai Juli 2019.

 

Hasil: Translasi dan validasi isi kuesioner WERF-EPHect Clinical Questionnaire (Standard) Versi Indonesia memiliki 10 tahap termasuk proses persiapan, Forward Translation (translasi maju), proses rekonsiliasi, Backward Translation (translasi balik), review translasi balik, Proses Harmonisasi, proses Cognitive Debriefing, review hasil cognitive debriefing dan finalisasi, proses Proofreading dan laporan Final. Terdapat perbedaan budaya dari negara kuesioner asal termasuk obat-obatan yang tersedia di Indonesia, istilah-istilah medis yang lumrah di Negara asal namun asing di populasi Indonesia, dan penyajian suku ras yang tidak menggambarkan varian suku ras Indonesia.

 

Kesimpulan: Didapatkan kuesioner klinis WERF-EPHect Clinical Questionnaire (Standard) (EPQ-S) versi Bahasa Indonesia dengan isi sesuai kebutuhan pengguna di Indonesia dan dapat diaplikasikan di RSCM, dari 116 butir pertanyaan terdapat 21 butir pertanyaan dalam kuesioner yang harus terpimpin.

 

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Background: The heterogeneity of endometriosis patients related to the presentation of clinical phenotypes requires standard data collection. At present there is no standardization of clinical phenotype data for endometriosis patients in Indonesia. Translation of the WERF-EPHect Clinical Questionnaire (Standard) clinical questionnaire (EPQ-S) into Indonesian language and the validation of this questionnaire is needed to find out whether this tool can be used in Indonesia as it has been used in other countries and ensure that the resulting data is accurate and reliable.

 

Objective: To create a standard for taking clinical phenotype data for endometriosis patients in Indonesia and to find out the translation results and the validity of the WERF-EPHect Clinical Questionnaire (Standard) clinical questionnaire (EPQ-S) that has been translated into Indonesian and has been accurate and reliable.

 

Method: This research was conducted with the transcultural adaptation method. This validation test EPHect EPQ-S questionnaire was carried out through a process of forward-backward translation, harmonization by experts, cognitive debriefing to questionnaire targets and proofreading and finalization by experts. The study was conducted at the RSCM for 6 months, namely January 2019 to July 2019.

 

Results: Translation and validation of the contents of the Indonesian version of the WERF-EPHect Clinical Questionnaire (Standard) questionnaire have 10 stages including the preparation process, Forward Translation, forward reconciliation process, Backward Translation, back translational review, Harmonization Process, Cognitive Debriefing process, reviewing cognitive debriefing and finalization results, Proofreading process and Final report. There are cultural differences from the country of origin of the questionnaire including medicines available in Indonesia, medical terms that are common in the country of origin but unfamiliar in Indonesian population, and the presentation of racial tribes that do not describe variants of Indonesian racial tribes.

 

Conclusion: The WERF-EPHect Clinical Questionnaire (Standard) (EPQ-S) Indonesian version was obtained with contents according to the needs of users in Indonesia and can be applied at the RSCM, out of 116 questions there are 21 questions in the questionnaire that must be guided.

 

Keywords: Translation, Validation, WERF-EPHect Clinical Questionnaire (Standard), Clinical Phenotype, Endometriosis, Indonesia

 

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"Latar belakang: Karsinoma ovarium adalah salah satu keganasan paling mematikan di bidang ginekologik. Penyebab keganasan belum diketahui pasti dan umumnya tidak memiliki gejala klinik yang jelas. Karsinoma ovarium tipe I khususnya karsinoma endometrioid dan karsinoma sel jernih diketahui dapat berasal dari endometriosis. Karsinoma yang berasal dari endometriosis dikenal sebagai endometriosis-associated ovarian carcinoma (EAOC). Pengembangan model hewan coba karsinoma ovarium yang berhubungan dengan endometriosis diperlukan untuk penelitian dasar dan uji klinik menggantikan jaringan manusia. Pada penelitian ini dikembangkan model hewan coba karsinoma ovarium dengan teknik autoimplantasi dan induksi DMBA. Bahan dan cara kerja: Penelitian ini mengunakan blok parafin dari tikusyang sebelumnya telah mendapatkan operasiplasebo (SHAM), autoimplantasi endometrium, kombinasi autoimplantasi endometrium dan induksi DMBAyangdikorbankan pada minggu ke-5,10, dan 20. Dilakukan penilaian histopatologik dan pulasan imunohistokimia ARID1A dengan penilaian persentase positivitas pada 200 sel. Hasil: Penelitian ini menghasilkan lesi endometriosis atipik sebanyak 1 (20%) dan karsinoma sel jernih sebanyak 1 (20%)pada implantasi dan induksi DMBA 10 minggu dan karsinoma endometrioidsebanyak 100% pada kelompok induksi DMBA. Pulasan ARID1A tidak menunjukkan perbedaan bermakna (p=0,313) pada seluruh kelompok perlakuan.

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Background: Ovarian carcinoma is one of the most deadly malignancies in the gynecologic field. The cause of malignancy is not known for sure and generally do not have clear clinical symptoms. Type I ovarian carcinoma especially endometrioid carcinoma and clear cell carcinoma is known to originate from endometriosis. Carcinoma originating from endometriosis is known as endometriosis-associated ovarian carcinoma (EAOC). The development of experimental animal models of ovarian carcinoma associated with endometriosis is needed for basic research and clinical trials replace human tissue. In this study an experimental model of ovarian carcinoma was developed with autoimplantation and DMBA induction techniques.

Materials and methods: This study used paraffin blocks from mice that had previously received placebo surgery (SHAM), endometrial autoimplantation, combination of endometrial autoimplantation and DMBA induction and were sacrificed at 5,10 and 20 weeks. Assessment of ARID1A expression by assessing the percentage of positivity in 200 cells.

Results: This study resulted in 1 (20%) atypical endometriosis lesions and 1 (20%) clear cell carcinoma in 10 weeks DMBA implantation and 100% endometrioid carcinoma in the DMBA induction group. ARID1A ekspression did not show a significant difference (p = 0.313) in all treatment groups."

"Pendahuluan: Endometriosis merupakan suatu kelainan jinak ginekologi yang dapat mengalami transformasi menjadi kanker. Stres oksidatif diduga berperan dalam perkembangan penyakit endometriosis. Gen supresor tumor ARID1A banyak ditemukan termutasi dan inaktif pada kanker ovarium yang berhubungan dengan endometriosis. Tujuan penelitian adalah untuk menganalisis peran stres oksidatif terhadap ekspresi gen supresor tumor ARID1A dalam transformasi endometriosis menjadi ganas. Metoda: Penelitian dimulai dengan 10 sampel jaringan kanker ovarium, 10 sampel endometriosis dan3 jaringan endometrium eutopik sebagai kontrol yang diisolasi mRNA dan proteinnya. Analisis ekspresi gen ARID1A pada tingkat mRNA dilakukan dengan pemeriksaan RT-qPCR dan pada tingkat protein dengan ELISA. Pada sel endometriosis dan kanker ovarium dilakukan analisis stres oksidatif dengan pemeriksaan aktivitas antioksidan MnSOD dan pemeriksaan kadar MDA sebagai salah bukti kerusakan salah satu komponen sel. Setelah itu dilakukan uji eksperimental pada kultur sel endometriosis dan endometrium eutopik sebagai kontrol. Kedua sel kultur diinduksi dengan H2O2 konsentrasi 0 nM, 100 nM, dan 1000 nM. Analisis dilakukan terhadap ketahanan hidup sel, kadar ROS dan ekspresi gen ARID1A pada tingkat mRNA dan protein. Hasil: Efek induksi H2O2 dalam menekan ekspresi gen ARID1A sel endometriosis dan sel endometrium eutopik pada tingkat mRNA dan protein, bermakna, meskipun pada kanker ovarium tidak bermakna pada penelitian ini. Kesimpulan: Stres oksidatif berperan dalam menekan ekspresi gen supresor tumor ARID1A ditingkat mRNA dan protein pada endometriosis.

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Introduction: Endometriosis as a gynecologic benign lesion, can transform itself into cancer. Oxidative stress is considered as an important factor in endometriosis development. Studies found that ARID1A as tumor suppressor gene, was frequently mutated and inactivated in endometriosis associated ovarian cancer. The aim of the study is to analyze the role of oxidative stress on ARID1A expresion in endometriosis malignant transformation.

Methods: This study started with ten samples of ovarian cancer, ten samples of endometriosis, and 3 samples of eutopic endometrioid tissues as control. They were analyzed for the expression of ARID1A by RT-qPCR and ELISA, then analyzed for the activity of MnSOD as antioxidant enzyme and level of malondialdehyde as one of the oxidative stress damage effect evidence on cell's components. The second part of the study was experimental study on cultured eutopic endometrial and endometriosis cells. They were induced by H2O2 of 0, 100, and 1000 nM concentration. Analysis of the expression of ARID1A by RTqPCR and ELISA, and the DCFH-DA for the level of Reactive oxygen species were done.

Result: The impact of the H2O2 induction in repressing ARID1A gene expression on the endometriosis as well on the eutopic endometrium cells are significant, but not on the ovarian cancer in this study.

Conclusion: Oxidative stress has a role in repressing the expression of ARID1A gene at the mRNA and protein levels on the endometriosis."

"Tujuan: Menilai keberadaan reseptor PPARγ serta membandingkan tampilan reseptor PPARγ pada endometrium eutopik dan ektopik pada penderita endometriosis Metode: Penelitian ini merupakan penelitian potong lintang (cross sectional). Sepuluh subjek penderita endometriosis yang menjalani laparoskopi atau laparotomi, yang masuk dalam kriteria penerimaan (consecutive sampling) diambil dua percontoh, yakni endometrium eutopik dan endometrium ektopik yang berasal dari dinding kista endometriosis saat dilakukan pembedahan kemudian dilihat tampilan reseptor PPARγ dengan two-step RT-qPCR. Tampilan masing-masing percontoh diuji statistik dengan uji tes-t berpasangan dan tes korelasi Pearson. Hasil: Didapatkan tampilan reseptor PPARγ pada endometrium eutopik dan endometrium ektopik penderita endometriosis dengan metode RT-qPCR. Tampilan resptor PPARγ endometrium eutopik dan ektopik didapatkan secara statistik tidak berbeda bermakna (1.16 lipatan relatif vs 1.25 lipatan relatif; p=0.26). Pada uji korelasi Pesrson didapatkakan korelasi positif lemah antara tampilan PPARγ endometrium eutopik dan ektopik (r=0.16). Kesimpulan: Tampilan reseptor PPARγ pada endometrium eutopik dan ektopik penderita endometriosis didapatkan dengan metode two-step RT-qPCR. Dengan semikuantifikasi tampilan reseptor PPARγ tidak didapatkan perbedaan antara tampilan reseptor PPARγ pada endometrium eutopik dan ektopik pada penderita endometriosis. Terdapat korelasi positif lemah antara tampilan reseptor PPARγ pada endometrium eutopik dan ektopik pada penderita endometriosis.

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Objective: To evaluate the expression of the PPARγ receptor and to compare its expression in the eutopic and ectopic endometrium in women with endometriosis Method: This is a cross sectional study. Ten female subjects with endometriosis that underwent laparoscopy or laparotomy that fulfilled the inclusion criteria were recruited by consecutive sampling. Two samples were taken, eutopic endometrium and ectopic endometrium from endometriosis cyst wall during surgery of each subject, PPARγ expression was examined by two-step RT-qPCR. Each sample was statistically examined using the paired t-test and Pearson’s corelation test.

Result: PPARγ was found to be expressed in the eutopic and ectopic endometrium of women with endometriosis using the RT-qPCR method. The expression of PPARγ was not statistically different in eutopic and ectopic endometrium (1.16 relative fold vs 1.25 relative fold:p=0.26). By Pearson’s corelation there was a weak positive corelation between PPARγ expression of the eutopic and ectopic endometrium (r=0.16).

Conclusion: PPARγ was detected by two-step RT-qPCR in eutopic and ectopic endometrium of women with endometriosis. Semiquantification of PPARγ expression showed that there was no significant difference betweenits expression in the eutopic and ectopic endometrium of women with endometriosis. There was a weak postive corelation of PPARγ expression between the eutopic and ectopic endometrium of women with endometriosis."

"ABSTRAK Latar belakang: Endometriosis merupakan kelainan ginekologik yang palingsering ditemukan. Seperti halnya endometrium di uterus juga dapat terjadiberbagai perubahan pada epitel yang melapisi kista endometriosis di ovarium,antara lain metaplasia, hiperplasia, atipia bahkan perubahan ke arah keganasan.Saat ini banyak penelitian yang menghubungkan antara endometriosis dan kankerovarium terutama jenis clear cell dan dikenal dengan istilah endometriosisassociatedovarian carcinoma (EAOC) dan dilaporkan adanya mutasi yangmenginaktifkan gen supresor tumor (ARID1A), sehingga protein BAF250a tidakdiekpresikan pada Clear cell carcinoma (CCC) ovarii.Bahan dan cara: Dilakukan pulasan imunohistokimia ARID1A pada sampel 20kasus endometriosis non atipik, 20 kasus atipik dan 20 kasus CCC ovarii tahun2012 hingga Maret 2015. Dari kelompok kasus CCC didapatkan 9 kasus EAOC.Selanjutnya dilihat adakah perbedaan persentase ekspresi ARID1A padaendometriosis non atipik, atipik, CCC ovarii serta endometriosis disertai CCC(EAOC).Hasil: Pada kelompok kasus endometriosis non atipik, atipik dan CCC adaperbedaan bermakna persentase ekspresi ARID1A (uji Kruskal-Wallis p=0,0035).Selanjutnya dilakukan analisis Post Hoc uji Mann-Whitney dan didapatkanperbedaan bermakna persentase ekspresi ARID1A antara endometriosis non atipikdan atipik dengan CCC ovarii (p=0,001 dan p=0,0015). Pada kelompok kasusendometriosis non atipik, atipik dan endometriosis pada EAOC, didapatkan adaperbedaan bermakna persentase ekspresi ARID1A (Uji Kruskal-Walis p=0,011).Selanjutnya dilakukan analisis Post Hoc uji Mann-Whitney dan ada perbedaanbermakna persentase ekspresi ARID1A antara endometriosis non atipik dan atipikdengan EAOC (p=0,005 dan p=0,008). Kesimpulan: Ekspresi ARID1A pada endometriosis non atipik dan atipik lebihtinggi bermakna dibanding CCC ovarii dan EAOC. Sehingga ekspresi ARID1Akemungkinan dapat digunakan sebagai petanda adanya transformasi ganas padaendometriosis.ABSTRACT Background: Endometriosis is one of the most common gynecologicalabnormalities found. Endometriosis cyst in the ovary also exhibited changes inepithelial cyst just like endometrium in the uterus. Changes in the epithelial cellsalso include metaplasia, hyperplasia, atyphia even changes toward malignancharacteristics. Nowadays, there are some research that linked endometriosis andclear cell ovarian cancer which is known with endometriosis-associated ovariancarcinoma (EAOC) it is reported that there?s a mutation that activated tumorsuppressor gene (ARID1A), so protein BAF250a is not expressed in Clear CellCarcinoma (CCC) in the ovarium.Materials and Methods: Immunohistochemistry staining of ARID1A were donein 20 samples of non-atypical endometriosis, 20 samples of atypicalendometriosis, 20 samples of CCC in the ovarium from the year 2012 until march2015. From the group that experienced CCC we get 9 cases of EAOC. After that,we see if there?s any difference in the percentage of ARID1A expression in nonatypicalendometrosis, atypical endometriosis, CCC in the ovarium andendometriosis with CCC( EAOC).Results: In non-atypical endometriosis, atypical and CCC cases groups there aresignificant differences on the percentage of ARID1A expression (Kruskal-Walistest p=0,0035). Post Hoc analysis were done using Mann-Whitney test and thereare significant differences on ARID1A expression between non-atypical andatypical endometriosis with CCC (p=0,001 and p=0,0015). In non-atypicalendometriosis, atypical and EAOC groups there are significant differences on thepercentage of ARID1A expression (Kruskal-Walis test p=0,011). Post Hocanalysis were done using Mann-Whitney test and there are significant differenceson ARID1A expression between non-atypical and atypical endometriosis withEAOC (p=0,005 and p=0,008).Conclusion: Expression of ARID1A in non atypical and atypical endometriosisare significantly higher compared to ovarian CCC and EAOC. So, we can say thatARID1A may be used as a marker for malignancy transformation inendometriosis.;Background: Endometriosis is one of the most common gynecologicalabnormalities found. Endometriosis cyst in the ovary also exhibited changes inepithelial cyst just like endometrium in the uterus. Changes in the epithelial cellsalso include metaplasia, hyperplasia, atyphia even changes toward malignancharacteristics. Nowadays, there are some research that linked endometriosis andclear cell ovarian cancer which is known with endometriosis-associated ovariancarcinoma (EAOC) it is reported that there?s a mutation that activated tumorsuppressor gene (ARID1A), so protein BAF250a is not expressed in Clear CellCarcinoma (CCC) in the ovarium.Materials and Methods: Immunohistochemistry staining of ARID1A were donein 20 samples of non-atypical endometriosis, 20 samples of atypicalendometriosis, 20 samples of CCC in the ovarium from the year 2012 until march2015. From the group that experienced CCC we get 9 cases of EAOC. After that,we see if there?s any difference in the percentage of ARID1A expression in nonatypicalendometrosis, atypical endometriosis, CCC in the ovarium andendometriosis with CCC( EAOC).Results: In non-atypical endometriosis, atypical and CCC cases groups there aresignificant differences on the percentage of ARID1A expression (Kruskal-Walistest p=0,0035). Post Hoc analysis were done using Mann-Whitney test and thereare significant differences on ARID1A expression between non-atypical andatypical endometriosis with CCC (p=0,001 and p=0,0015). In non-atypicalendometriosis, atypical and EAOC groups there are significant differences on thepercentage of ARID1A expression (Kruskal-Walis test p=0,011). Post Hocanalysis were done using Mann-Whitney test and there are significant differenceson ARID1A expression between non-atypical and atypical endometriosis withEAOC (p=0,005 and p=0,008).Conclusion: Expression of ARID1A in non atypical and atypical endometriosisare significantly higher compared to ovarian CCC and EAOC. So, we can say thatARID1A may be used as a marker for malignancy transformation inendometriosis.;Background: Endometriosis is one of the most common gynecologicalabnormalities found. Endometriosis cyst in the ovary also exhibited changes inepithelial cyst just like endometrium in the uterus. Changes in the epithelial cellsalso include metaplasia, hyperplasia, atyphia even changes toward malignancharacteristics. Nowadays, there are some research that linked endometriosis andclear cell ovarian cancer which is known with endometriosis-associated ovariancarcinoma (EAOC) it is reported that there?s a mutation that activated tumorsuppressor gene (ARID1A), so protein BAF250a is not expressed in Clear CellCarcinoma (CCC) in the ovarium.Materials and Methods: Immunohistochemistry staining of ARID1A were donein 20 samples of non-atypical endometriosis, 20 samples of atypicalendometriosis, 20 samples of CCC in the ovarium from the year 2012 until march2015. From the group that experienced CCC we get 9 cases of EAOC. After that,we see if there?s any difference in the percentage of ARID1A expression in nonatypicalendometrosis, atypical endometriosis, CCC in the ovarium andendometriosis with CCC( EAOC).Results: In non-atypical endometriosis, atypical and CCC cases groups there aresignificant differences on the percentage of ARID1A expression (Kruskal-Walistest p=0,0035). Post Hoc analysis were done using Mann-Whitney test and thereare significant differences on ARID1A expression between non-atypical andatypical endometriosis with CCC (p=0,001 and p=0,0015). In non-atypicalendometriosis, atypical and EAOC groups there are significant differences on thepercentage of ARID1A expression (Kruskal-Walis test p=0,011). Post Hocanalysis were done using Mann-Whitney test and there are significant differenceson ARID1A expression between non-atypical and atypical endometriosis withEAOC (p=0,005 and p=0,008).Conclusion: Expression of ARID1A in non atypical and atypical endometriosisare significantly higher compared to ovarian CCC and EAOC. So, we can say thatARID1A may be used as a marker for malignancy transformation inendometriosis.;Background: Endometriosis is one of the most common gynecologicalabnormalities found. Endometriosis cyst in the ovary also exhibited changes inepithelial cyst just like endometrium in the uterus. Changes in the epithelial cellsalso include metaplasia, hyperplasia, atyphia even changes toward malignancharacteristics. Nowadays, there are some research that linked endometriosis andclear cell ovarian cancer which is known with endometriosis-associated ovariancarcinoma (EAOC) it is reported that there?s a mutation that activated tumorsuppressor gene (ARID1A), so protein BAF250a is not expressed in Clear CellCarcinoma (CCC) in the ovarium.Materials and Methods: Immunohistochemistry staining of ARID1A were donein 20 samples of non-atypical endometriosis, 20 samples of atypicalendometriosis, 20 samples of CCC in the ovarium from the year 2012 until march2015. From the group that experienced CCC we get 9 cases of EAOC. After that,we see if there?s any difference in the percentage of ARID1A expression in nonatypicalendometrosis, atypical endometriosis, CCC in the ovarium andendometriosis with CCC( EAOC).Results: In non-atypical endometriosis, atypical and CCC cases groups there aresignificant differences on the percentage of ARID1A expression (Kruskal-Walistest p=0,0035). Post Hoc analysis were done using Mann-Whitney test and thereare significant differences on ARID1A expression between non-atypical andatypical endometriosis with CCC (p=0,001 and p=0,0015). In non-atypicalendometriosis, atypical and EAOC groups there are significant differences on thepercentage of ARID1A expression (Kruskal-Walis test p=0,011). Post Hocanalysis were done using Mann-Whitney test and there are significant differenceson ARID1A expression between non-atypical and atypical endometriosis withEAOC (p=0,005 and p=0,008).Conclusion: Expression of ARID1A in non atypical and atypical endometriosisare significantly higher compared to ovarian CCC and EAOC. So, we can say thatARID1A may be used as a marker for malignancy transformation inendometriosis."

"Membandingkan dan menentukan rerata kadar AMH serum pada wanita infertil dengan tanpa endometriosis serta mengetahui rerata kadar AMH serum pada masing-masing derajat endometriosis. Metode: Penelitian ini merupakan penelitian potong lintang (cross sectional). Enam puluh delapan subjek yang menjalani laparoskopi, yang masuk dalam kriteria penerimaan dibagi menjadi dua kelompok sama besar, yakni kelompok endometriosis dan tanpa endometriosis secara konsekutif (consecutive sampling). Masing-masing subjek diambil percontoh dari darah sebelum dilakukan laparoskopi kemudian diukur kadar AMH serum. Rerata masing-masing kelompok diuji statistik dengan uji Mann-Whitney. Hasil: Rerata kadar AMH serum pada kelompok endometriosis lebih rendah dibandingkan dengan tanpa endometriosis dan secara statistik berbeda bermakna (2,30+1,8 ng/ml vs 3,75+2,13 ng/ml; p=0,005). Dengan uji Kruskal-Wallis, didapatkan perbedaan bermakna secara statistik pada subjek kelompok endometriosis berdasarkan derajat endometriosis (p=0,005). Bila dilakukan pengelompokkan kelompok endometriosis minimal-ringan dan kelompok endometriosis sedang-berat dibandingkan dengan kelompok tanpa endometriosis, maka hasilnya menunjukkan tidak adanya hubungan yang bermakna antara kadar AMH serum pada kelompok endometriosis minimal-ringan dengan kelompok tanpa endometriosis (p=0,34), sedangkan pada kelompok endometriosis sedang-berat dengan kelompok tanpa endometriosis terdapat hubungan yang bermakna (p<0,005).

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To compare and to determine the differences in levels of serum AMH in infertile women with and without endometriosis, and also to determine the mean levels of serum AMH in every grade of endometriosis.

Methods: This study is a cross-sectional study. Sixty-eight subjects who have undergone laparoscopy fulfilled the inclusion criteria are included and divided into two groups, i.e groups of endometriosis and without endometriosis consecutively (consecutive sampling). Blood samples are taken from each subject before laparoscopy which is then measured the levels of serum AMH. The mean levels of each group are tested with an Mann-Whitney test.

Results: The mean levels of serum AMH were lower in the endometriosis group than that group without endometriosis and it was statistically significance ( 2,30+1,8 ng/ml vs 3,75+2,13 ng/ml; p=0,005). With Kruskal-Wallis test, it was found that there was statistically significant difference among endometriosis group based on grading. There was no different at the mean levels of serum AMH between the minimal-mild endometriosis group and without endometriosis group (p=0,34), but the mean levels of serum AMH was lower in the moderate-severe endometriosis compare to the group without endometriosis and it was statistically significance (p<0,005).

Conclusions: The mean levels of serum AMH in infertile women with endometriosis were lower than that group without endometriosis and were statistically significantly different. There was no different between the mean levels of serum AMH in minimal-mild endometriosis group and that group without endometriosis, while in moderate-severe endometriosis group, it was lower than without endometriosis and it was statistically significance."

"Latar Belakang: Salah satu hipotesis yang menjelaskan hubungan endometriosis dengan infertilitas adalah endometriosis diyakini menyebabkan gangguan fisiologi ovarium, salah satunya dengan mempengaruhi folikulogenesis yang menyebabkan penurunan kualitas oosit. Oosit memainkan peran penting dalam mengatur dan mendukung pertumbuhan folikel, melalui produksi faktor pertumbuhan oosit. Beberapa faktor pertumbuhan telah diidentifikasi pada oosit manusia, termasuk growth differentiation factor-9 GDF-9 . Namun, sampai saat ini penelitian mengenai ekspresi GDF-9 pada sel granulosa pada wanita infertil dengan endometriosis masih belum banyak dilakukan. Tujuan: Untuk mengetahui ekspresi mRNA GDF-9 pada sel granulosa pasien endometriosis yang menjalani FIV dan untuk mencari adanya korelasi antara ekspresi GDF-9 dengan kualitas oosit. Metode: Penelitian potong lintang ini dilakukan di Klinik IVF Yasmin RSCM dan Klinik Sander B di Jakarta pada bulan Juli 2014 - Juli 2017. Sebanyak 50 sampel terdiri atas 25 wanita dengan endometriosis dan 25 kontrol. Sampel sel granulosa dikumpulkan pada saat petik oosit. Ekspresi mRNA GDF-9 dinilai menggunakan real time PCR. Hasil: Terdapat penurunan jumlah ambilan oosit, jumlah oosit matur dan skor morfologi oosit pada kelompok pasien dengan endometriosis dan bermakna secara statistik. Ekspresi GDF-9 secara kuantitatif lebih rendah pada kelompok endometriosis dibandingkan dengan kontrol 5.05 0.00002 ndash; 3523 ng/ l vs 81.93 1,47 ndash; 32450 ng/ l; p=0,01 . Pada penelitian ini tidak didapatkan korelasi antara ekspresi GDF-9 dan kualitas oosit dari skor morfologi oosit dan laju fertilisasi. Kesimpulan: Ekspresi GDF9 lebih rendah pada kelompok endometriosis dibandingkan kelompok kontrol. Namun, kami tidak menemukan korelasi antara ekspresi GDF-9 dengan kualitas oosit. Dibutuhkan studi dengan besar sampel yang lebih besar untuk mengkonfirmasi apakah perubahan ekspresi GDF-9 memiliki korelasi dengan kualitas oosit serta untuk membuktikan apakah GDF-9 dapat digunakan sebagai penanda molekuler baru untuk memprediksi kompetensi perkembangan oosit.

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Background: One of the hypothesis that explains the association between endometriosis and infertility is that endometriosis is believed to cause ovarian physiology disturbances, one of them by affecting folliculogenesis that cause decreased oocyte quality. The oocyte plays an important role in regulating and promoting follicle growth, by the production of oocyte growth factors. Several growth factors have been identified in human oocytes, including growth differentiation factor-9 GDF-9. However the studies on GDF-9 expression in granulosa cells of infertile women with endometriosis are sparse.

Objective: To investigate the expression of GDF-9 mRNA in granulosa cells of endometriosis patients undergoing IVF and to find the correlation between GDF-9 expression and oocyte quality.

Method: This cross sectional study was done at Yasmin IVF Clinic and dr. Sander B Clinic Jakarta in July 2014 - July 2017. A total fifty samples of 25 womens with endometriosis and 25 controls were included. We collect the granulosa cells sample at the time of oocyte retrieval. GDF-9 mRNA expression were investigated by Real-Time PCR.

Result: The number of oocytes retrieved, mature oocytes and the oocyte morphology score were lower in the group of patients with endometriosis and this was statistically significant. GDF-9 mRNA expression levels was quantitatively lower in endometriosis groups compared to control 5.05 0.00002 ndash; 3523 ng/ l vs 81.93 1,47 ndash; 32450 ng/ l; p=0,01. However, we did not find any correlation between GDF-9 expression levels and oocyte quality from oocyte morphology score and fertilization rate.

Conclusion: GDF9 mRNA level was lower in endometriosis group compared to control group. However, we did not find correlation between individual GDF-9 level and oocyte quality. Large-sample studies were needed to confirm whether the expression of GDF-9 had a correlation with oocyte quality as well as to prove whether GDF-9 could be used as a new molecular marker to predict the oocyte developmental competence."

"Pengantar: Endometriosis merupakan salah satu penyebab infertilitas dan menjadi indikasi fertilisasi in vitro (FIV). Laju apoptosis dan stress oksidatif yang tinggi pada pasien endometriosis diyakini menimbulkan efek negatif terhadap peluang keberhasilan FIV. Namun, pengaruh endometriosis terhadap keberhasilan FIV menunjukkan bukti yang inkonsisten dan belum banyak studi yang menilai langsung efek endometriosis terhadap kualitas oosit sebagai parameter keberhasilan FIV.Tujuan: Untuk menilai laju apoptosis pada sel granulosa pasien endometriosis dibanding pasien non-endometriosis melalui rasio ekspresi mRNA BAX/BCL-2 dan menilai korelasinya dengan kualitas oosit yang didapatkan saat petik ovum.Hasil: Sampel didapatkan dari 15 subjek dengan endometriosis dan 15 subjek kontrol. Dosis rekombinan FSH total yang diterima pada kelompok endometriosis untuk stimulasi ovarium lebih tinggi dibandingkan kelompok kontrol (p=0.005). Terdapat perbedaan bermakna kadar ekspresi BAX (p=0.029) dan BCL-2 (p<0.001) pada kedua kelompok, tetapi perbedaan rasio keduanya tidak signifikan (p=0.787). Korelasi antara rasio BAX/BCL-2 dengan parameter kualitas oosit tidak menunjukkan hubungan bermakna di kedua kelompok.Kesimpulan: Tidak terdapat perbedaan signifikan pada rasio kadar BAX/BCL-2 di kedua kelompok dan tidak ditemukan hubungan bermakna antara rasio tersebut dengan kualitas oosit. 

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Introduction: Endometriosis is one of common conditions causing infertility and an indication to undergo in vitro fertilization (IVF). High apoptosis rate and oxidative stress in patient with endometriosis is believed to cause negative effect on IVF success rate. However, there has been conflicting results on endometriosis effect to IVF success and there have been limited studies that directly assess endometriosis and its effect on oocyte quality.

Aim: To assess apoptosis rate on granulosa cells in patients with endometriosis compared to non-endometriosis patients through mRNA BAX/BCL-2 ratio and how it correlates with oocyte quality collected during ovum pick up.

Results: Samples were collected from 15 subjects with endometriosis and 15 control subjects. Total dose of recombinant FSH received by endometriosis group is significantly higher compared to control (p=0.005). There is difference in BAX level (p=0.029) and BCL-2 level (p<0.001) in both groups. However, the ratio does not differ significantly (p=0.787). No significant correlation is found in BAX/BCL-2 ratio and any of the oocyte quality parameters.

Conclusion: We found no significant difference in BAX/BCL-2 ratio between endometriosis and control group as well as significant correlation between the ratio and oocyte quality."

"ABSTRAKLatar belakang. Potensi terjadinya kekambuhan paska pengobatan endometriosisdengan terapi hormonal dan pembedahan konservatif masih terjadi sekitar 11-32dalam waktu 1-5 tahun. Salah satu faktor pemicunya adalah proses inflamasi kronikyang merangsang peningkatan sitokin proinflamasi dalam rongga peritoneum, sehinggaperlu pengembangan terapi baru. Heptil galat dan oktil galat merupakan senyawaturunan asam galat yang berpotensi menekan proliferasi beberapa jenis sel kanker.Penelitian kami sebelumnya membuktikan oktil galat dapat menekan ekspresi mRNANFkB yang merupakan faktor transkripsi aktivasi jalur proinflamasi, serta dapatmenekan proliferasi sel endometriosis in vitro. Saat ini kami ingin menganalisisaktivitas heptil galat dan oktil galat terhadap protein target NFkB melalui teknik insilicodocking dan efeknya terhadap regulasi sitokin proinflamasi IL-1, COX-2, TGF-1 dan IL-10 pada kultur primer sel endometriosis.Metode. In silico docking heptil galat dan oktil galat terhadap protein target NFkBmelalui teknik bioinformatika. Sel endometriosis dari jaringan primer pasien diisolasisecara enzimatis dan dikultur, kemudian diberi perlakuan heptil dan oktil galat dengan 2macam dosis (51,2 μg/mL dan 102,4 μg/mL) selama 48 jam, dilanjutkan induksi LPS 10ng/mL selama 24 jam. Kelompok kontrol positif hanya diinduksi LPS tanpa perlakuan,dan kontrol negatif tanpa perlakuan dan LPS. Regulasi inflamasi dinilai dari tingkatkadar sitokin IL-1, COX-2, TGF-1 dan IL-10 dengan teknik ELISA.Hasil. Analisis in-silico docking protein NFkB menunjukan nilai ikatan energi oktilgalat lebih tinggi (-7,98 kkal/mol) dibandingkan heptil galat (-7,68 kkal/mol) dan asamgalat (-7,66 kkal/mol). Terjadi penurunan kadar sitokin COX-2 secara signifikan(p<0,03) pada kelompok perlakuan dibandingkan dengan kontrol positif, begitu jugadengan sitokin IL-1 dan IL-10 cenderung menurun (p>0,05). Sedangkan kadar sitokinTGF-1 mengalami kenaikan pada kelompok perlakuan dibandingkan kontrol positifmeskipun kurang bermakna secara statistik (p>0,05).Kesimpulan. Melalui jalur NF-kB sebagai regulator inflamasi, baik oktil galat danheptil galat terbukti dapat menekan produksi sitokin proinflamasi COX2 dan IL-1serta meningkatkan sitokin TGF-1 dan menurunkan sitokin IL-10 sehingga berpotensisebagai bahan terapi tambahan pada endometriosis.

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ABSTRACTBackground: The potential for relapse post endometriosis treatment with hormonaltherapy and conservative surgery still occurs around 11-32 within 1-5 years. One ofthe trigger factors is a chronic inflammatory process that stimulates an increaseproinflammatory cytokines in the peritoneal cavity, so needed the development of newtherapies. Heptyl galate and octyl galate are gallic acid derivatives which have thepotential to suppress the proliferation of several types cancer cells. Our previousresearch proved that octyl galate can suppress the expression of NFkB mRNA which isa proinflammatory activation transcription factor, and can suppress endometriosis cellproliferation in vitro. We currently want to analyze the activity of heptyl galates andoctyl galates against the NFκB target protein through in-silico docking techniques andtheir effects on the regulation of proinflammatory cytokines IL-1, COX-2, TGF-1 andIL-10 in primary cultures of endometriosis cells.Method: In silico docking heptyl and octyl galates against the NFkB target proteinsthrough bioinformatics techniques. Endometriosis cells from primary tissue wereenzymatically isolated and cultured, then given heptyl and octyl gallate treatment with 2doses (51.2 μg/mL and 102,4 μg/mL) for 48 hours, continued induction of 10 ng / mLLPS for 24 hours. The positive control group only induced LPS without treatment, andnegative treatment without treatment and LPS. Inflammatory regulation was assessedfrom levels of cytokines IL-1, COX-2, TGF-1 dan IL-10 with ELISA techniques.Results: In-silico docking analysis of the NFkB gene showed higher energy bondingvalues in octyl galate (-7,98 kcal / mol) than heptyl galate (-7,68 kcal / mol) and gallicacid (-7,66 kcal / mol). Significantly decreased levels of COX-2 cytokine (p <0,03) inthe treatment group compared with positive controls, so also the cytokines of IL-1 andIL-10 tended to decrease (p> 0,05). Whereas the levels of cytokine TGF-1 experiencedan increase in the treatment group compared to the positive control although it was lessstatistically significant (p> 0,05).Conclusion: Through the NFkB pathway as an inflammatory regulator, both octylgalates and heptyl galates have been shown to suppress the production ofproinflammatory cytokines COX2 and IL-1, as well as increase TGF-1 cytokines andreduce IL-10 cytokines so that they have the potential to be additional therapeuticagents in endometriosis."