Athanasios Chasiotis, Antonios Makrygiannakis, Sophia Kalantaridou, Nikolaos Vrachnis

Abstract

The aim of this systematic review is the collection and presentation of all scientific data to date, regarding the effectiveness of the intrauterine injury in cases of repeated failed attempts of conception, through in vitro fertilization. A systematic review of studies evaluating the association between intrauterine injury and increased fertility in women with recurrent failed IVF attempts was performed, in the databases Medline, PubMed, Embase, Google Scholar and Cochrane Central Registry, with regard to information about the fertility potential of these women. The data of the studies analyzed in the present study, indicate that there is a significant correlation between endometrial injury and increased fertility in women with repeated failed IVF attempts. Hysteroscopy with endometrial tissue damage, or the use of a suction pipette catheter during the menstrual cycle that precedes the ovarian stimulation for a subsequent IVF / ICSI, can highly improve the implantation and clinical pregnancy rates in women with failed IVF attempts. The application of local endometrial injury at the cycle preceding the ovarian stimulation for IVF/ICSI, especially during the luteal phase, seems to enhance the endometrial receptivity to the implanted fetus. The endometrial injury may induce changes in the endometrium that are thought to be able to improve the outcomes of the assisted reproduction efforts. Future RCTs are required in order to establish the integration of this therapeutic approach in ART protocols.

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Ermioni Tsarna, Ioanna Mavrommati, Grigorios Bogdanis, Olga Triantafillidou, George Paltoglou, Panagiotis Christopoulos

Abstract

Introduction: Physical activity and exercise during pregnancy is regarded safe and beneficial in absence of pregnancy complications. The aim of this cross-sectional study is to describe physical activity of pregnant women in Greece and explore if it changes during pregnancy compared to the period before pregnancy.

Material and Methods: The study was conducted in a private maternity hospital. Women were asked to fill in an adapted questionnaire based on Pregnant Physical Activity Questionnaire; birth outcomes and anthropometric measurements of the neonate were collected by the research midwife.

Results: In our study population of 193 pregnant women, approximately half reported no or minimal physical activity during pregnancy and were less active than current guidelines’ recommendations. Gynaecologist’s opinion regarding exercise during pregnancy was conceived as positive only by a minority of women. Overall, women were less active during pregnancy than before, although they spent more time slowly walking for fun or exercise. Lastly, significant decrease was observed in all occupational activities involving slow or quick walking and lifting weights.

Conclusions: These results indicate that systematic counselling of pregnant women regarding physical activity and exercise during pregnancy will be needed to achieve optimal physical activity levels for the majority of women in Greece.

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Sofia Dionysopoulou, Evangelia Charmandari, Alexandra Bargiota, Nikolaos F Vlahos, George Mastorakos and Georgios Valsamakis

Abstract
Obesity is often associated with cognitive and mood disorders. Recent evidence suggests that obesity may cause hypothalamic inflammation. Our aim was to investigate the hypothesis that there is a causal link between obesity-induced hypothalamic inflammation and cognitive and mood disorders. Inflammation may influence hypothalamic inter-connections with regions important for cognition and mood, while it may cause dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis and influence monoaminergic systems. Exercise, healthy diet, and glucagon-like peptide receptor agonists, which can reduce hypothalamic inflammation in obese models, could improve the deleterious effects on cognition and mood.

Keywords: diet; obesity; hypothalamic inflammation; cognitive disorders; mood disorders; depression; dementia

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Konstantinos Sfakianoudis, Anna Rapani, Sokratis Grigoriadis, Dimitra Retsina, Evangelos Maziotis, Petroula Tsioulou, Polina Giannelou, Konstantinos Pantos, Michael Koutsilieris, Nikolaos Vlahos, George Mastorakos, and Mara Simopoulou

Abstract
Ovarian insufficiency is described as a multifaceted issue typically encountered in the field of assisted reproduction. The three main identified diagnoses of ovarian insufficiency include premature ovarian failure (POF), poor ovarian response (POR), and advanced maternal age (AMA). Patient heterogeneity in the era of individualized medicine drives research forward leading to the emergence of novel approaches. This plethora of innovative treatments in the service of adequately managing ovarian insufficiency is called to undertake the challenge of addressing infertile patients exploring their reproductive options. This review provides an all-inclusive presentation and critical analysis on novel treatments that have not achieved routine clinical practice status yet, but have recently emerged as promising. In light of the lack of randomized controlled trials conveying safety and efficiency, clinicians are left puzzled in addressing the “how” and “for whom” these approaches may be beneficial. From ovarian injection employing platelet-rich plasma (PRP) or stem cells to artificial gametes and ovaries, ovarian transplantation, and mitochondrial replacement therapy, this descriptive review provides insight toward assisting the practitioner in decision making regarding these cutting-edge treatments. Biological mechanisms, invasiveness levels, efficiency, as well as possible complications, the current status along with bioethical concerns are discussed in the context of identifying future optimal treatment.

Keywords
ovarian insufficiency, premature ovarian failure, poor ovarian response, stem cells, platelet rich plasma, mitochondria replacement therapy

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Δημοσίευση κεφαλαίου The Controversial Interplay of Gut Microbiome and Reproductive Function in Humans

Panagiotis Christopoulos, Ermioni Tsarna, and Ekaterini Domali

στο βιβλίο: Gut Microbiome-Related Diseases and Therapies, Editors: Gazouli, Maria, Theodoropoulos, George (Eds.)

σελίδες 265-297

ΟΝΟΜΑΤΕΠΩΝΥΜΟ                        Τριανταφυλλίδου Όλγα
ΟΝΟΜΑ ΠΑΤΡΟΣ                               Βιτάλι
ΟΝΟΜΑ ΜΗΤΡΟΣ                              Νίνα
ΗΜΕΡ. ΓΕΝΝΗΣΗΣ                             8-10-1978
Δ/ΝΣΗ ΚΑΤΟΙΚΙΑΣ                             Πισιδίας 11, Ν. Σμύρνη
Τ.Κ.                                                          17124
ΟΙΚΟΓΕΝΕΙΑΚΗ ΚΑΤΑΣΤΑΣΗ         Έγγαμη
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Η Δρ Κανδαράκη Άννα (PHD, MSc) είναι Κλινική Ψυχολόγος – Ψυχοθεραπεύτρια. Αριστούχος Πανεπιστημίου Paris V Rene Descartes της Σορβόννης (2010), κάτοχος Μεταπτυχιακού στην Κλινική Ψυχολογία από το ίδιο Πανεπιστήμιο (2012) και Διδακτορικού από την Ιατρική Σχολή Αθηνών με βαθμό Άριστα (2019).  Έχει εργαστεί ως Επικεφαλής Ψυχολογικού Τμήματος σε αρκετά Γενικά Νοσοκομεία, Ιδρύματα και Ψυχιατρικές Κλινικές. Ειδικεύεται στη Συστημική Υπαρξιακή Ψυχοθεραπεία και είναι Ιδιοκτήτρια & Διευθύντρια του Κέντρου Ψυχοθεραπείας Therapy Nest.

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Περισσότερες πληροφορίες στο σύνδεσμο «Προϋποθέσεις Εισαγωγής» του ιστοχώρου
και στη γραμματεία του Δ.Π.Μ.Σ. (Μαρία Ρήγα, 210-7286298, e-mail: mrriga@med.uoa.gr).

[:EL]Vasiliki M. Korvesi MD, MSc, Ioanna Chouvarda Prof, George Mastorakos Prof, Dimitrios G. Goulis Prof

Background: Despite the production of clinical practice guidelines (CPGs) in many medical areas, their use is not sufficiently adopted in clinical practice. Incorporation of CPGs in knowledge tools (KnowT) or decision support systems (DSS) for routine use can improve healthcare providers’ compliance to CPGs.
Materials and methods: Clinical practice guidelines for gestational diabetes mellitus (GDM) were searched for, collected and compared. The CPG that met prespecified criteria ([a] published by a European or American organization between 2010 and 2018, [b] being developed a systematic way and [c] having statements of “level of evidence” and “strength of recommendation”) was chosen for implementation (Endocrine Society, 2013). Its recommendations were deconstructed, re-organized and reconstructed as an algorithm (in the form of a flowchart), which was integrated into a KnowT. Content completeness and evaluation of CPG by the Guideline Implementability Appraisal tool (GLIA) were performed as well. The primary objective was the development of a clinical algorithm in the field of GDM and its integration into a KnowT. The secondary objective was to demonstrate the completeness of the CPG content and evaluate its implementability in the KnowT.
Results: Endocrine Society 2013 CPG was restructured as a flowchart, and a KnowT was constructed with the use of the “Openlabyrinth” software. The completeness of the content was confirmed, and GLIA appraisal demonstrated its implementability.
Conclusion: Endocrine Society 2013 CPG for GDM is a complete set of recommendations. Its structure makes possible the design of a clinical algorithm and its implementation into a KnowT.

On line link[:en]Vasiliki M. Korvesi MD, MSc, Ioanna Chouvarda Prof, George Mastorakos Prof, Dimitrios G. Goulis Prof

Background: Despite the production of clinical practice guidelines (CPGs) in many medical areas, their use is not sufficiently adopted in clinical practice. Incorporation of CPGs in knowledge tools (KnowT) or decision support systems (DSS) for routine use can improve healthcare providers’ compliance to CPGs.
Materials and methods: Clinical practice guidelines for gestational diabetes mellitus (GDM) were searched for, collected and compared. The CPG that met prespecified criteria ([a] published by a European or American organization between 2010 and 2018, [b] being developed a systematic way and [c] having statements of “level of evidence” and “strength of recommendation”) was chosen for implementation (Endocrine Society, 2013). Its recommendations were deconstructed, re-organized and reconstructed as an algorithm (in the form of a flowchart), which was integrated into a KnowT. Content completeness and evaluation of CPG by the Guideline Implementability Appraisal tool (GLIA) were performed as well. The primary objective was the development of a clinical algorithm in the field of GDM and its integration into a KnowT. The secondary objective was to demonstrate the completeness of the CPG content and evaluate its implementability in the KnowT.
Results: Endocrine Society 2013 CPG was restructured as a flowchart, and a KnowT was constructed with the use of the “Openlabyrinth” software. The completeness of the content was confirmed, and GLIA appraisal demonstrated its implementability.
Conclusion: Endocrine Society 2013 CPG for GDM is a complete set of recommendations. Its structure makes possible the design of a clinical algorithm and its implementation into a KnowT.[:]

[:EL]

Nikitas S Skarakis, George Mastorakos, Neoklis Georgopoulos & Dimitrios G Goulis

* Poster Presentation in 7th ESE Young Endocrinologists and Scientists (EYES) Meeting

Background and aim: Low energy availability (LEA) may lead to menstrual disorders and low bone mineral density, predisposing to the female athlete triad (FAT) syndrome. The primary aim of this review was to systematically investigate the impact of sports on the energy status of professional female athletes compared to sedentary, recreationally active controls, with regard to their menstrual status and bone mineral density (BMD). A secondary aim was the estimation of the combined prevalence of the components of FAT in athletes as compared with non-athletes.
Materials and methods: A systematic review was conducted from 2007 to February 2018. Inclusion and exclusion criteria of studies were established in advance of the literature search, according to the clinical inquiry and the study design.
Results: Four studies were included in this systematic review. The FAT syndrome was more prevalent in professional athletes compared with non-athletes. The same results occurred for both LEA and menstrual disorders. However, BMD and Z-scores showed high heterogeneity among the studies.
Conclusions: Both professional athletes and sedentary women are prone to LEA and subsequent menstrual disorders and low BMD or osteoporosis. Future studies are needed to examine the energy availability in elite female athletes, as well as in non-athletes.[:en]

Nikitas S Skarakis, George Mastorakos, Neoklis Georgopoulos & Dimitrios G Goulis

* Poster Presentation in 7th ESE Young Endocrinologists and Scientists (EYES) Meeting

Background and aim: Low energy availability (LEA) may lead to menstrual disorders and low bone mineral density, predisposing to the female athlete triad (FAT) syndrome. The primary aim of this review was to systematically investigate the impact of sports on the energy status of professional female athletes compared to sedentary, recreationally active controls, with regard to their menstrual status and bone mineral density (BMD). A secondary aim was the estimation of the combined prevalence of the components of FAT in athletes as compared with non-athletes.
Materials and methods: A systematic review was conducted from 2007 to February 2018. Inclusion and exclusion criteria of studies were established in advance of the literature search, according to the clinical inquiry and the study design.
Results: Four studies were included in this systematic review. The FAT syndrome was more prevalent in professional athletes compared with non-athletes. The same results occurred for both LEA and menstrual disorders. However, BMD and Z-scores showed high heterogeneity among the studies.
Conclusions: Both professional athletes and sedentary women are prone to LEA and subsequent menstrual disorders and low BMD or osteoporosis. Future studies are needed to examine the energy availability in elite female athletes, as well as in non-athletes.[:]