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Jiang Y, Qin S, Wang Y, Liu Y, Liu N, Tang L, Fang J, Jia Q, Huang X. Intravoxel incoherent motion diffusion-weighted MRI for predicting the efficacy of high-intensity focused ultrasound ablation for uterine fibroids. Front Oncol 2023; 13:1178649. [PMID: 37427113 PMCID: PMC10324408 DOI: 10.3389/fonc.2023.1178649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose To evaluate the significance of magnetic resonance (MR) intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) quantitative parameters in predicting early efficacy of high-intensity focused ultrasound (HIFU) ablation of uterine fibroids before treatment. Method 64 patients with 89 uterine fibroids undergoing HIFU ablation (51 sufficient ablations and 38 insufficient ablations) were enrolled in the study and completed MR imaging and IVIM-DWI before treatment. The IVIM-DWI parameters, including D (diffusion coefficient), D* (pseudo-diffusion coefficient), f (perfusion fraction) and relative blood flow (rBF) were calculated. The logistic regression (LR) model was constructed to analyze the predictors of efficacy. The receiver operating characteristic (ROC) curve was drawn to assess the model's performance. A nomograph was constructed to visualize the model. Results The D value of the sufficient ablation group (931.0(851.5-987.4) × 10-6 mm2/s) was significantly lower than that of the insufficient ablation group (1052.7(1019.6-1158.7) × 10-6 mm2/s) (p<0.001). However, differences in D*, f, and rBF values between the groups were not significant (p>0.05). The LR model was constructed with D value, fibroid position, ventral skin distance, T2WI signal intensity, and contrast enhanced degree. The area under the ROC curve, specificity, and sensitivity of the model were 0.858 (95% confidence interval: 0.781, 0.935), 0.686, and 0.947. The nomogram and calibration curves confirmed that the model had excellent performance. Conclusion The IVIM-DWI quantitative parameters can be used to predict early effects of HIFU ablation on uterine fibroids. A high D value before treatment may indicate that the treatment will be less effective in the early stages.
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Affiliation(s)
- Yu Jiang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Shize Qin
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yanlin Wang
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Yang Liu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Nian Liu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Lingling Tang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jie Fang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Qing Jia
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiaohua Huang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Yang F, Chen Y. Urinary phytoestrogens and the risk of uterine leiomyomata in US women. BMC Womens Health 2023; 23:261. [PMID: 37179289 PMCID: PMC10182647 DOI: 10.1186/s12905-023-02381-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Uterine leiomyomata (UL) is a common gynecological disease in women. Studied on the relationship between single metabolites of urinary phytoestrogens and UL, especially for the combined effects of mixed metabolites on UL still are insufficient. METHODS In this cross-sectional study, we included 1,579 participants from the National Health and Nutrition Examination Survey. Urinary phytoestrogens were assessed by measuring urinary excretion of daidzein, genistein, equol, O-desmethylangolensin, enterodiol and enterolactone. The outcome was defined as UL. Weighted logistic regression was used to analyze the association between single metabolites of urinary phytoestrogens and UL. Notably, we adopted the weighted quantile sum (WQS) regression, Bayesian kernel machine regression (BKMR), and quantile g-computation (qgcomp) models, to investigate the combined effects of six mixed metabolites on UL. RESULTS The prevalence of UL was approximately 12.92%. After adjusting age, race/ethnicity, marital status, drinking status, body mass index, waist circumference, menopausal status, ovary removed status, use of female hormones, hormones/hormone modifiers, total energy, daidzein, genistein, O-desmethylangolensin, enterodiol, and enterolactone, the association of equol with UL was significant [Odds ratio (OR) = 1.92, 95% confidence interval (CI): 1.09-3.38]. In the WQS model, mixed metabolites of urinary phytoestrogen had a positive association with UL (OR = 1.68, 95%CI: 1.12-2.51), with the highest weighted chemical of equol. In the gpcomp model, equol had the largest positive weight, followed by genistein and enterodiol. In the BKMR model, equol and enterodiol have positive correlation on UL risk, while enterolactone has negative correlation. CONCLUSION Our results implied a positive association between the mixed metabolites of urinary phytoestrogen and UL. This study provides evidence that urinary phytoestrogen-metabolite mixture was closely related to the risk of female UL.
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Affiliation(s)
- Fang Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, No.899 Pinghai Road, Suzhou, 215006, P. R. China
| | - Youguo Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, No.899 Pinghai Road, Suzhou, 215006, P. R. China.
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Neblett MF, Stewart EA. Oral Gonadotropin-Releasing Hormone Antagonists for the Treatment of Uterine Leiomyomas. Obstet Gynecol 2023; 141:901-910. [PMID: 37103532 DOI: 10.1097/aog.0000000000005145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/27/2022] [Indexed: 04/28/2023]
Abstract
Uterine leiomyomas are common hormone-responsive neoplasms that frequently cause heavy menstrual bleeding, anemia, pelvic pressure, pain, and adverse reproductive outcomes. In this overview, the efficacy and safety of oral gonadotropin-releasing hormone (GnRH) antagonists, co-administered with menopausal replacement-level steroid hormones or used at doses to avoid complete hypothalamic suppression, are reviewed for the management of uterine leiomyomas. Oral GnRH antagonists provide rapid suppression of sex steroids and avoid the initial steroidal flare and resultant temporary worsening of symptoms typically seen with parenteral GnRH agonists. Oral GnRH antagonists are effective in reducing leiomyoma-associated heavy menstrual bleeding, with high rates of amenorrhea and improved anemia and leiomyoma-associated pain, and providing modest reduction in uterine volume when used in combination with menopausal replacement-level steroid hormones. This add-back therapy can reduce hypogonadal side effects, including hot flushes and bone mineral density loss, close to levels seen with placebo therapy. Currently, both elagolix 300 mg twice daily with once-daily estradiol (1 mg) and norethindrone (0.5 mg) and relugolix 40 mg once daily with estradiol (1 mg) and norethindrone (0.5 mg) combination therapy are approved for leiomyoma treatment by the U.S. Food and Drug Administration. Linzagolix is under investigation in the United States but approved at two does with and without steroid hormones in the European Union. The efficacy of these agents appears to be robust over a wide spectrum of clinical presentations, demonstrating that worse disease parameters at baseline do not appear to inhibit efficacy. Across clinical trials, participants largely reflected the population of individuals affected by uterine leiomyomas.
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Affiliation(s)
- Michael F Neblett
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, the Department of Physiology and Biomedical Engineering, the Division of Endocrinology, Department of Medicine, the Department of Surgery, and the Women's Health Research Center, Mayo Clinic, and Mayo Clinic Alix School of Medicine, Rochester, Minnesota
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Langton CR, Gerety M, Harmon QE, Baird DD. Keloids, hypertrophic scars, and uterine fibroid development: a prospective ultrasound study of Black and African American women. F&S SCIENCE 2023; 4:172-180. [PMID: 37028513 PMCID: PMC10200770 DOI: 10.1016/j.xfss.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE To examine the association between keloids, hypertrophic scars, and uterine fibroid incidence as well as growth. Both keloids and fibroids are fibroproliferative conditions that have been reported to be more prevalent among Blacks than Whites, and they share similar fibrotic tissue structures, including extracellular matrix composition, gene expression, and protein profiles. We hypothesized that women with a history of keloids would have greater uterine fibroid development. DESIGN A prospective community cohort study (enrollment 2010-2012) with 4 study visits over 5 years to conduct standardized ultrasounds to detect and measure fibroids ≥0.5 cm in diameter, assess the history of keloid and hypertrophic scars, and update covariates. SETTING Detroit, Michigan area. PATIENTS A total of 1,610 self-identified Black and/or African American women aged 23-35 years at enrollment without a previous clinical diagnosis of fibroids. EXPOSURE(S) Keloids (raised scars that grow beyond the margins of the original injury) and hypertrophic scars (raised scars that stay within the bounds of the original injury). Because of the difficulties in distinguishing keloids and hypertrophic scars, we separately examined the history of keloids and the history of either keloids or hypertrophic scars (any abnormal scarring) and their associations with fibroid incidence and growth. MAIN OUTCOME MEASURE(S) Fibroid incidence (new fibroid after a fibroid-free ultrasound at enrollment) was assessed using Cox proportional-hazards regression. Fibroid growth was assessed using linear mixed models. The estimates for the change in log volume per 18 months were converted to the estimated percentage difference in volume for scarring vs. no-scarring. Both incidence and growth models were adjusted for time-varying demographic, reproductive, and anthropometric factors. RESULT(S) Of the 1,230 fibroid-free participants, 199 (16%) reported ever having keloids, 578 (47%) reported keloids or hypertrophic scars, and 293 (24%) developed incident fibroids. Neither keloids (adjusted hazard ratio = 1.04; 95% confidence interval: 0.77, 1.40) nor any abnormal scarring (adjusted hazard ratio = 1.10; 95% confidence interval: 0.88, 1.38) were associated with fibroid incidence. Fibroid growth differed little by scarring status. CONCLUSION(S) Despite molecular similarities, self-reported keloid and hypertrophic scars did not show an association with fibroid development. Future research may benefit from the examination of dermatologist-confirmed keloids or hypertrophic scars; however, our data suggest little shared susceptibility for these 2 types of fibrotic conditions.
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Affiliation(s)
- Christine R Langton
- Women's Health Group, Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina.
| | - Meghan Gerety
- Department of Statistics, University of Virginia, Charlottesville, Virginia
| | - Quaker E Harmon
- Women's Health Group, Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Donna D Baird
- Women's Health Group, Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
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Rubio EM, Hilton JF, Bent S, Parvataneni R, Oberman E, Saberi NS, Varon S, Schembri M, Waetjen LE, Jacoby VL. Complementary and Alternative Medicine Use Among Women with Symptomatic Uterine Fibroids. J Womens Health (Larchmt) 2023; 32:546-552. [PMID: 37023398 DOI: 10.1089/jwh.2022.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Objective: The aim of this study is to examine complementary and alternative medicine (CAM) use among women with symptomatic uterine fibroids in the United States. Materials and Methods: In this cross-sectional analysis of baseline data from a multicenter, prospective cohort study of premenopausal women undergoing surgery for symptomatic fibroids and who enrolled in the Uterine Leiomyoma Treatment with Radiofrequency Ablation study from 2017 to 2019, we contrast women indicating use of at least one CAM modality specifically for fibroid symptoms against women using CAM for other reasons and CAM nonusers. Multivariable logistic regression models were performed to identify participant characteristics independently associated with CAM use for fibroids. Results: Among 204 women, 55% were Black/African American and the mean age was 42 (standard deviation 6.6) years. CAM use was common (67%), with 42% (95% confidence interval [CI]: 35%-49%) reporting use of CAM specifically to treat fibroid symptoms. Most commonly, CAM treatments used for fibroids were diet (62%) and herbs (52%), while CAM treatments for other reasons were exercise (80%) and massage (43%). On average, each participant who reported CAM use utilized three different types of CAM modalities. In a multivariable model, participants were more likely to use CAM for fibroids if they had pelvic pressure (odds ratio [OR] 2.50, 95% CI: 1.07-5.87, p = 0.04), a body-mass index lower than average (OR 0.76, 95% CI: 0.60-0.97, p = 0.03), and a lower health-related quality of life score (OR 0.61, 95% CI: 0.46-0.81, p = 0.001). Conclusions: In this diverse sample of women with symptomatic fibroids, CAM use was highly prevalent. Our findings highlight the need for providers to query patients about CAM use and understand the role of CAM in fibroid management. ClinicalTrials.gov Identifier: NCT02100904.
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Affiliation(s)
- Elia Marina Rubio
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Joan F Hilton
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Stephen Bent
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Ram Parvataneni
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California, USA
- University of California Fibroid Network, USA
| | - Erica Oberman
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California, USA
- University of California Fibroid Network, USA
| | - Naghmeh Salamat Saberi
- University of California Fibroid Network, USA
- Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, California, USA
| | - Shira Varon
- University of California Fibroid Network, USA
- Department of Obstetrics and Gynecology, University of California, San Diego, San Diego, California, USA
| | - Michael Schembri
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
| | - L Elaine Waetjen
- University of California Fibroid Network, USA
- Department of Obstetrics and Gynecology, University of California, Davis, Davis, California, USA
| | - Vanessa L Jacoby
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- University of California Fibroid Network, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
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Li Y, McNally RP, Feng Y, Kim JJ, Wei JJ. Racial differences in transcriptomics and reactive oxygen species burden in myometrium and leiomyoma. Hum Reprod 2023; 38:609-620. [PMID: 36749068 PMCID: PMC10068273 DOI: 10.1093/humrep/dead020] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/12/2023] [Indexed: 02/08/2023] Open
Abstract
STUDY QUESTION Are there differences in Mediator Complex Subunit 12 mutations (MED12) mutation, transcriptomics, and protein expression in uterine myometrium and leiomyomas of Black and White women? SUMMARY ANSWER RNA sequencing, tissue microarray, and immunohistochemistry data revealed that Black and White women have significant differences in their myometrium and leiomyoma profiles. WHAT IS KNOWN ALREADY Black women develop uterine leiomyoma earlier than White women, and are more likely to be anemic, have multiple tumors, undergo hysterectomy at an earlier age, have a higher uterine weight, and report very severe pelvic pain. STUDY DESIGN, SIZE, DURATION Uterine tissues were collected from premenopausal women undergoing hysterectomy or myomectomy at Northwestern University Prentice Women's Hospital (Chicago, IL) from 2010 to 2021. Tissues were collected from a total of 309 women, including from 136 Black women, 135 White women, and 38 women from other racial groups. A total of 529 uterine leiomyomas (290 from Black women, 184 from White women, and 55 from women of other racial groups) were subjected to molecular analysis. Leiomyoma and matched myometrium from a total of 118 cases including 60 Black women and 58 White women, were used for tissue microarrays, along with 34 samples of myometrium without leiomyoma from White women. PARTICIPANTS/MATERIALS, SETTING, METHODS Tissues from the above patient cohorts were analyzed by tissue microarray, immunohistochemistry, RNA sequencing, and mutation analysis. MAIN RESULTS AND THE ROLE OF CHANCE The results indicated that leiomyoma from Black women have a higher rate of MED12 mutations (79.0%) than those from White women (68.5%) (*P ≤ 0.05). RNA-sequencing analysis in myometrium revealed differentially expressed genes (270 upregulated, 374 downregulated) dependent on race, wherein reactive oxygen species, hypoxia, and oxidative phosphorylation pathways were positively correlated with samples derived from Black patients. The levels of proteins associated with oxidative DNA damage and repair, 8-hydroxyguanosine (8-OHdG), 8-oxoguanine glycosylase (OGG1), heme oxygenase-1 (HO-1), and kelch-like ECH-associated protein 1 (KEAP1), were higher in leiomyoma and matched myometrium, particularly those from Black patients, compared to the control myometrium (with leiomyoma) (***P ≤ 0.001). LARGE SCALE DATA The datasets are available in the NCBI (The BioProject number: PRJNA859428). LIMITATIONS, REASONS FOR CAUTION Myometrium without leiomyoma derived from White patients was used as a control in the tissue microarray analysis, as myometrium without leiomyoma from Black patients was not accessible in large numbers. The RNA sequencing was performed on myometrium tissue with leiomyoma present from 10 White and 10 Black women. However, one sample from a Black woman yielded low-quality RNA-sequencing data and was excluded from further analysis. WIDER IMPLICATIONS OF THE FINDINGS Women with symptomatic leiomyomas have a considerable loss in their quality of life. This study provides information on underlying genetic and molecular defects that may be necessary for future therapeutics targeted at leiomyomas. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by grants from NCI (R01CA254367) and NICHD (P01HD057877). The authors declare no conflict of interest.
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Affiliation(s)
- Yinuo Li
- Department of Pathology, Northwestern University, Chicago, IL, USA
| | - Ross P McNally
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
| | - Yue Feng
- Department of Pathology, Northwestern University, Chicago, IL, USA
| | - J Julie Kim
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
| | - Jian-Jun Wei
- Department of Pathology, Northwestern University, Chicago, IL, USA
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
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Anchan RM, Wojdyla D, Bortoletto P, Terry K, Disler E, Milne A, Gargiulo A, Petrozza J, Brook O, Srouji S, Morton CC, Greenberg J, Wegienka G, Stewart EA, Nicholson WK, Thomas L, Venable S, Laughlin-Tommaso S, Diamond MP, Maxwell GL, Marsh EE, Myers ER, Vines AI, Wise LA, Wallace K, Jacoby VL, Spies JB. A Comparative Analysis of Health-Related Quality of Life 1 Year Following Myomectomy or Uterine Artery Embolization: Findings from the COMPARE-UF Registry. J Womens Health (Larchmt) 2023; 32:423-433. [PMID: 36637808 PMCID: PMC10079244 DOI: 10.1089/jwh.2022.0133] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective: To compare 12-month post-treatment health-related quality of life (HR-QoL) and symptom severity (SS) changes among patients with symptomatic uterine fibroids (SUF) not seeking fertility and undergo a hysterectomy, abdominal myomectomy (AM), or uterine artery embolization (UAE). Materials and Methods: The Comparing Options for Management: Patient-Centered Results for Uterine Fibroids (COMPARE-UF) Registry is a multi-institutional prospective observational cohort study of patients treated for SUF. A subset of 1465 women 31-45 years of age, who underwent either hysterectomy (n = 741), AM (n = 446), or UAE (n = 155) were included in this analysis. Demographics, fibroid history, and symptoms were obtained by baseline questionnaires and at 1 year post-treatment. Results were stratified by all treatments and propensity score weighting to adjust for differences in baseline characteristics. Results: Women undergoing UAE reported the lowest baseline HR-QoL and highest SS scores (mean = 40.6 [standard deviation (SD) = 23.8]; 62.3 [SD = 24.2]) followed by hysterectomy (44.3 [24.3]; 59.8 [SD = 24.1]). At 12 months, women who underwent a hysterectomy experienced the largest change in both HR-QoL (48.7 [26.2]) and SS (51.9 [25.6]) followed by other uterine-sparing treatments. Propensity score weighting revealed all treatments produced substantial improvement, with hysterectomy patients reporting the highest HR-QoL score (92.0 [17.8]) compared with myomectomy (86.7 [17.2]) and UAE (82.6 [21.5]) (p < 0.0001). Similarly, hysterectomy patients reported the lowest SS scores (8.2 [15.1]) compared with myomectomy (16.5 [15.1]) and UAE (19.6 [17.5]) (p < 0.0001). Conclusion: All procedures showed improvement in HR-QoL and reduction in SS score at 12 months, hysterectomy showing maximum improvement. Of importance, at 12 months, patients who underwent either a myomectomy or UAE reported comparable symptom relief and HR-QoL. Clinicaltrials.Gov Identifier: NCT02260752.
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Affiliation(s)
- Raymond M. Anchan
- Department of Obstetrics, Gynecology, and Reproductive Biology, Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Wojdyla
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Pietro Bortoletto
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Kathryn Terry
- Department of Obstetrics, Gynecology, and Reproductive Biology, Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Emily Disler
- Department of Obstetrics, Gynecology, and Reproductive Biology, Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ankrish Milne
- Department of Obstetrics, Gynecology, and Reproductive Biology, Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Antonio Gargiulo
- Department of Obstetrics, Gynecology, and Reproductive Biology, Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John Petrozza
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Olga Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Serene Srouji
- Department of Obstetrics, Gynecology, and Reproductive Biology, Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Cynthia C. Morton
- Department of Obstetrics, Gynecology, and Reproductive Biology, Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - James Greenberg
- Department of Obstetrics, Gynecology, and Reproductive Biology, Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | | | - Wanda K. Nicholson
- Department of Obstetrics and Gynecology, Center for Women's Health Research, and Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Laine Thomas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Shannon Laughlin-Tommaso
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael P. Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia, USA
| | - G. Larry Maxwell
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Erica E. Marsh
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Evan R. Myers
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Anissa I. Vines
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lauren A. Wise
- Slone Epidemiology Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kedra Wallace
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Vanessa L. Jacoby
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
| | - James B. Spies
- Department of Radiology, Georgetown University School of Medicine, Washington, District of Columbia, USA
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Aleynikova EY, Solovyeva AV. Uterine fibroids: modern methods of treatment, advantages and complications. RUDN JOURNAL OF MEDICINE 2023. [DOI: 10.22363/2313-0245-2023-27-1-57-64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
The state of the reproductive system by women with uterine fibroids is considered as a part of this literature review. The main clinical manifestations of myomatous nodes were identified by writing the review: abnormal uterine and heavy menstrual bleeding, infertility, miscarriage, chronic pelvic pain, dysfunction of adjacent organs, which are indications for surgical treatment. It is noted that approximately 30 % of women with uterine fibroids suffer from abnormal uterine bleeding, leading to anemia and reduced quality of life. Chronic pelvic pain significantly reduces the quality of life of patients, worsening their functional and mental state and disrupting sexual function. This review focuses on reproductive problems in women with leiomyoma. Taking into consideration the high prevalence of this nosology and the need to preserve the fertility of patients, the review describes modern methods of treating patients with uterine myoma, including drug therapy surgical treatment and alternative methods. Currently, in order to stop the symptoms of uterine fibroids, as well as for preoperative preparation, conservative therapy is used, which allows to reduce pain, restore hemoglobin levels, reduce intraoperative blood loss and reduce surgery time. Reproductive disorders associated with uterine fibroids, such as infertility, recurrent miscarriage, and adverse obstetric outcomes, are a significant reason to improve organ-preserving therapies or develop new ones. Although hysterectomy is a radical treatment for uterine fibroids, it is unacceptable for patients who have not realized their reproductive function. Therefore, the most justified intervention is myomectomy with various surgical approaches, and as an alternative treatment, uterine artery embolization, radiofrequency ablation or high-intensity focused ultrasound treatment of uterine fibroids. These data allow us to conclude that the high prevalence and versatility of symptoms of uterine fibroids among patients of reproductive age determine the relevance of searching for optimal methods of treatment.
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Hazimeh D, Massoud G, Parish M, Singh B, Segars J, Islam MS. Green Tea and Benign Gynecologic Disorders: A New Trick for An Old Beverage? Nutrients 2023; 15:1439. [PMID: 36986169 PMCID: PMC10054707 DOI: 10.3390/nu15061439] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Green tea is harvested from the tea plant Camellia sinensis and is one of the most widely consumed beverages worldwide. It is richer in antioxidants than other forms of tea and has a uniquely high content of polyphenolic compounds known as catechins. Epigallocatechin-3-gallate (EGCG), the major green tea catechin, has been studied for its potential therapeutic role in many disease contexts, including pathologies of the female reproductive system. As both a prooxidant and antioxidant, EGCG can modulate many cellular pathways important to disease pathogenesis and thus has clinical benefits. This review provides a synopsis of the current knowledge on the beneficial effects of green tea in benign gynecological disorders. Green tea alleviates symptom severity in uterine fibroids and improves endometriosis through anti-fibrotic, anti-angiogenic, and pro-apoptotic mechanisms. Additionally, it can reduce uterine contractility and improve the generalized hyperalgesia associated with dysmenorrhea and adenomyosis. Although its role in infertility is controversial, EGCG can be used as a symptomatic treatment for menopause, where it decreases weight gain and osteoporosis, as well as for polycystic ovary syndrome (PCOS).
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Affiliation(s)
| | | | | | | | - James Segars
- Department of Gynecology and Obstetrics, Division of Reproductive Sciences & Women’s Health Research, Johns Hopkins Medicine, Baltimore, MD 21205, USA
| | - Md Soriful Islam
- Department of Gynecology and Obstetrics, Division of Reproductive Sciences & Women’s Health Research, Johns Hopkins Medicine, Baltimore, MD 21205, USA
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Ali M, Bariani MV, Vafaei S, Omran MM, Yang Q, Madueke-Laveaux OS, Al-Hendy A. Prevention of Uterine Fibroids: molecular mechanisms and potential clinical application. JOURNAL OF ENDOMETRIOSIS AND UTERINE DISORDERS 2023; 1:100018. [PMID: 37637856 PMCID: PMC10451784 DOI: 10.1016/j.jeud.2023.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Uterine fibroids (UFs; leiomyoma) are the most common benign neoplastic threat to women worldwide, exacting an immense personal burden on female health and a monetary expense to the healthcare system estimated in the hundreds of billions of dollars every year globally. With no long-term non-invasive treatment option currently available to treat UFs, deeper insights regarding tumor etiology are the key for developing newer therapies. Accordingly, in this review, we discuss new mechanistic paradigm to explain UF tumor development through an exquisite model involving developmental reprogramming of myometrial stem cells due to early life endocrine disruptors exposure, inflammation, fibrosis, DNA damage, and eventually tissue stiffness. Further, we propose to utilize shear wave elastography as a potential screening tool for the early identification of women at risk for developing UFs who can benefit from several simple preventive strategies, including the consumption of natural compounds such as vitamin D and green tea as a safe fertility friendly non-hormonal modality to delay or even arrest or reverse UF progression.
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Affiliation(s)
- Mohamed Ali
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Maria Victoria Bariani
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
| | - Somayeh Vafaei
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
| | - Mervat M. Omran
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
- Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Qiwei Yang
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
| | - Obianuju Sandra Madueke-Laveaux
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
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Katon JG, Plowden TC, Marsh EE. Racial disparities in uterine fibroids and endometriosis: a systematic review and application of social, structural, and political context. Fertil Steril 2023; 119:355-363. [PMID: 36682686 PMCID: PMC9992263 DOI: 10.1016/j.fertnstert.2023.01.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
IMPORTANCE Uterine fibroids and endometriosis are 2 of the leading causes of morbidity among reproductive-aged women. There are significant racial disparities in disease prevalence, incidence, age of onset, and treatment profile in fibroids. The data on endometriosis are less clear. OBJECTIVE To conduct a systematic review of racial disparities in prevalence of uterine fibroids and endometriosis in the United States and summarize the literature on these 2 highly prevalent benign gynecologic conditions using a framework that explicitly incorporates and acknowledges the social, structural, and political contexts as a root cause of racial disparities between Black and White women. EVIDENCE REVIEW A systematic review regarding racial disparities in prevalence of fibroids and endometriosis was conducted separately. Two separate searches were conducted in PubMed to identify relevant original research manuscripts and prior systematic reviews regarding racial disparities in uterine fibroids and endometriosis using standardized search terms. In addition, we conducted a structured literature search to provide social, structural, and political context of the disparities. FINDINGS A systematic review of the literature indicated that the prevalence of uterine fibroids was consistently higher in Black than in White women with the magnitude of the difference varying depending on population and case definition. Prevalence of endometriosis varied considerably depending on the base population and case definition, but was the same or lower among Black vs. White women. As a result of the social, structural, and political context in the United States, Black women disproportionately experience a range of exposures across the life course that may contribute to their increased uterine fibroid incidence, prevalence, and severity of uterine fibroids. However, data suggest no racial difference in the incidence of endometriosis. Nevertheless, Black women with fibroids or endometriosis experience worse clinical and surgical outcomes than their White counterparts. CONCLUSION AND RELEVANCE Racial disparities in uterine fibroids and endometriosis can be linked with differential exposures to suspected etiologic agents, lack of adequate access to health care, including highly skilled gynecologic surgeons, and bias and discrimination within the health care system. Eliminating these racial disparities will require solutions that address root causes of health disparities through policy, education and programs to ensure that all patients receive culturally- and structurally-competent care.
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Affiliation(s)
- Jodie G Katon
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Torie C Plowden
- Division of Reproductive Endocrinology and Infertility, Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Erica E Marsh
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan.
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Hutton D, Mustafa A, Patil S, Rathod S, Shrikhande G, Advincula A, Drummond J, Gregersen P, Hall J, Metz C, Milspaw A, Orbuch IK, Stahl P, Stein A, Shrikhande A. The burden of Chronic Pelvic Pain (CPP): Costs and quality of life of women and men with CPP treated in outpatient referral centers. PLoS One 2023; 18:e0269828. [PMID: 36757947 PMCID: PMC9910684 DOI: 10.1371/journal.pone.0269828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/27/2022] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Chronic Pelvic Pain (CPP) is a complex, multifaceted condition that affects both women and men. There is limited literature on the cost utilization the healthcare system and CPP patients incur. The purpose of this analysis is to characterize the overall healthcare utilization, cost burden, and quality-of-life restrictions experienced by CPP patients using data from an outpatient pelvic rehabilitation practice. METHODS Healthcare utilization data was gathered by systematically reviewing and analyzing data from new patient visit progress notes stored in the clinic's electronic health records (EHR). We obtained in-network costs by using the FAIR Health Consumer online database. Overall costs were then calculated as the utilization times the per-unit costs from the FAIR database. Additionally, data on patients' visual analogue scale (VAS), absenteeism, presenteeism emergency room visits, usage of common pain medications, use of diagnostics, and participation in common treatment modalities was gathered. RESULTS Data from 607 patients was used. The overall cost burden per patient for all surgeries combined was $15,750 for in-network services. The cost burden for diagnostics was $5,264.22 and treatments was $8,937 per patient for in-network treatments. CONCLUSION Chronic Pelvic Pain was found to have a large cost burden of $29,951 for in-network services which includes treatments, diagnostics, and surgeries. This analysis sets the stage for future investigations involving data on costs of medications that patients have tried prior to presenting to us and costs associated with work hours lost.
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Affiliation(s)
- David Hutton
- Department of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Aida Mustafa
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, Florida, United States of America
- The Feinstein Institute for Medical Research, Manhasset, New York, United States of America
| | - Soha Patil
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, Florida, United States of America
- The Feinstein Institute for Medical Research, Manhasset, New York, United States of America
| | - Saira Rathod
- Department of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Gautam Shrikhande
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, Florida, United States of America
- The Feinstein Institute for Medical Research, Manhasset, New York, United States of America
| | - Arnold Advincula
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, United States of America
| | - Jessica Drummond
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, Florida, United States of America
- The Feinstein Institute for Medical Research, Manhasset, New York, United States of America
| | - Peter Gregersen
- The Feinstein Institute for Medical Research, Manhasset, New York, United States of America
| | - Jason Hall
- Boston University Medical Center, Boston, Massachusetts, United States of America
- Dempsey Center for Digestive Disorders, Boston, Massachusetts, United States of America
| | - Christine Metz
- The Feinstein Institute for Medical Research, Manhasset, New York, United States of America
| | - Alexandra Milspaw
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, Florida, United States of America
- The Feinstein Institute for Medical Research, Manhasset, New York, United States of America
| | - Iris Kerin Orbuch
- Advanced Gynecologic Laparoscopy Center, Los Angeles, California, United States of America
| | - Peter Stahl
- Department of Urology, Columbia University, New York, New York, United States of America
| | - Amy Stein
- Beyond Basics Physical Therapy, New York, New York, United States of America
| | - Allyson Shrikhande
- Department of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, Florida, United States of America
- * E-mail:
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Tanaka LF, Schoffer O, König J, Weyer-Elberich V, Blettner M, Klug SJ. Changes in the probability of hysterectomy in the city of Mainz and Mainz-Bingen region, Germany. BMC Public Health 2023; 23:84. [PMID: 36631748 PMCID: PMC9832650 DOI: 10.1186/s12889-022-14916-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND To assess the hysterectomy probability by calendar period and age, the overall and the age-specific prevalence of hysterectomy in women aged 30-65 years. METHODS Baseline data (2005-2007) from the population-based MARZY study conducted in Mainz and Mainz-Bingen, Germany, were analysed. 6429 women aged 30-65 years were asked whether they had undergone a hysterectomy and the date and indication of the procedure. We calculated the 5-year age-specific prevalence of hysterectomy and estimated the probability of undergoing a hysterectomy combining two approaches: 1) Kaplan-Meier and 2) Inverse probability weighting (IPW). We assessed potential changes over calendar periods by simulating survival curves, having hysterectomy as the event, employing a Cox proportional hazard model. RESULTS Data on hysterectomy were available for 4719 women. Of these, 961 (20.4%) had undergone a hysterectomy between 1960 and 2006. The hysterectomy prevalence was highest among the 60-64 year-olds (40.7%). The IPW-corrected probability of having a hysterectomy up to the age of 65 years was 36.4%. The age-specific probability of hysterectomy increased from 0.1% (20-24 years), peaking at 45-49 years (7.8%) and declining thereafter to less than 5% among women aged 50 and older. Over time, women were hysterectomised at an increasingly older age. Most hysterectomies (86.7%) were done due to benign disease. CONCLUSIONS A shift to older age at hysterectomy with an advancing calendar period likely reflects changes in clinical practice in Germany. TRIAL REGISTRATION Landesärztekammer Rheinland-Pfalz: 837.438.03 (4100).
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Affiliation(s)
- Luana F. Tanaka
- grid.6936.a0000000123222966Chair of Epidemiology, TUM Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany ,grid.5252.00000 0004 1936 973XCenter for International Health, Ludwig Maximilian University of Munich (LMU), Munich, Germany
| | - Olaf Schoffer
- grid.6936.a0000000123222966Chair of Epidemiology, TUM Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany ,grid.4488.00000 0001 2111 7257Center of Evidence-Based Health Care, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jochem König
- grid.5802.f0000 0001 1941 7111Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Veronika Weyer-Elberich
- grid.5949.10000 0001 2172 9288Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Maria Blettner
- grid.5802.f0000 0001 1941 7111Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Stefanie J. Klug
- grid.6936.a0000000123222966Chair of Epidemiology, TUM Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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Sefah N, Ndebele S, Prince L, Korasare E, Agbleke M, Nkansah A, Thompson H, Al-Hendy A, Agbleke AA. Uterine fibroids - Causes, impact, treatment, and lens to the African perspective. Front Pharmacol 2023; 13:1045783. [PMID: 36703761 PMCID: PMC9871264 DOI: 10.3389/fphar.2022.1045783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023] Open
Abstract
Leiomyomas, or uterine fibroids as they are commonly known, are mostly seen in women of reproductive age. However, they can go undetected in most women, and approximately 25% of women show clinical symptoms. Although fibroids are a global burden impacting 80% of premenopausal women, they are more prevalent among Black women than among women of other races. Based on clinical diagnosis, the estimated cumulative incidence of fibroids in women ≤50 years old is significantly higher for black (>80%) versus white women (∼70%). The cause of leiomyomas is not clearly known, but studies have shown evidence of factors that drive the development or exacerbation of the disease. Evidence has linked risk factors such as lifestyle, age, environment, family history of uterine fibroids, and vitamin D deficiencies to an increased risk of uterine fibroids, which impact women of African descent at higher rates. Treatments may be invasive, such as hysterectomy and myomectomy, or non-invasive, such as hormonal or non-hormonal therapies. These treatments are costly and tend to burden women who have the disease. Sub-Saharan Africa is known to have the largest population of black women, yet the majority of uterine fibroid studies do not include populations from the continent. Furthermore, the prevalence of the disease on the continent is not well determined. To effectively treat the disease, its drivers need to be understood, especially with regard to racial preferences. This paper aims to review the existing literature and build a case for conducting future research on African women.
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Cai L, Li J, Long R, Liao Z, Gong J, Zheng B, Zhang H. An autophagy-related diagnostic biomarker for uterine fibroids: FOS. Front Med (Lausanne) 2023; 10:1153537. [PMID: 37138755 PMCID: PMC10150886 DOI: 10.3389/fmed.2023.1153537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
Uterine fibroids (UFs) are the most common benign gynecologic tumors in reproductive-aged women. The typical diagnostic strategies of UFs are transvaginal ultrasonography and pathological feature, while molecular biomarkers are considered conventional options in the assessment of the origin and development of UFs in recent years. Here, we extracted the differential expression genes (DEGs) and differential DNA methylation genes (DMGs) of UFs from the Gene Expression Omnibus (GEO) database, GSE64763, GSE120854, GSE45188, and GSE45187. 167 DEGs with aberrant DNA methylation were identified, and further Gene Ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) were performed by the relevant R package. We next discerned 2 hub genes (FOS, and TNFSF10) with autophagy involvement by overlapping 167 DEGs and 232 autophagic regulators from Human Autophagy Database. FOS was identified as the most crucial gene through the Protein-Protein Interactions (PPI) network with the correlation of the immune scores. Moreover, the down-regulated expression of FOS in UFs tissue at both mRNA and protein levels was validated by RT-qPCR and immunohistochemistry respectively. The area under the ROC curve (AUC) of FOS was 0.856, with a sensitivity of 86.2% and a specificity of 73.9%. Overall, we explored the possible biomarker of UFs undergoing DNA-methylated autophagy and provided clinicians with a comprehensive assessment of UFs.
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Affiliation(s)
- Lei Cai
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Li
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Long
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiqi Liao
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Juejun Gong
- Department of Oncology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bowen Zheng
- Medical Record Department, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Hanwang Zhang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Hanwang Zhang,
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Edzie EKM, Dzefi-Tettey K, Brakohiapa EK, Abdulai AB, Kekessie KK, Aidoo E, Amoah S, Boadi E, Kpobi JM, Quarshie F, Edzie RA, Kusodzi H, Asemah AR. Assessment of the Clinical Presentations and Ultrasonographic Features of Uterine Fibroids in Adult Africans: A Retrospective Study. Oman Med J 2023; 38:e459. [PMID: 36908828 PMCID: PMC9996686 DOI: 10.5001/omj.2023.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/17/2022] [Indexed: 11/03/2022] Open
Abstract
Objectives We sought to determine the clinical presentations and ultrasonographic features of uterine fibroids in adult Ghanaians. Methods Between 1 January 2018 and 31 December 2021, 4279 ultrasound-confirmed cases of uterine fibroids were retrieved. The data obtained, which included age, clinical presentations, and sonographic features were analyzed. A chi-squared test was done to assess for possible associations between the clinical indications, age distribution, and ultrasonographic features of uterine fibroids. Results The mean age of the patients diagnosed with uterine fibroids was 37.1±11.5 years (range = 16-69 years). Routine checkup (n = 1310, 28.1%), menorrhagia (n = 1104, 23.7%), and lower abdominal mass (n = 801, 17.2%) were the leading clinical indications. Dysmenorrhea, amenorrhea, menorrhagia, and routine checkup were significantly noted in the younger patients (p ≤ 0.001). The majority of the fibroid nodules had smooth regular outline (n = 4125, 96.4%) and were mostly heterogeneous (n = 3282, 76.7%). The echo pattern of the nodules was predominantly hypoechoic (n = 3358, 51.1%) followed by hyperechoic nodules (n = 2554, 38.9%). Degenerative changes accounted for less than one-third of the total fibroid nodules, with the least recorded degenerative change being nodules with cystic areas (n = 55, 5.4%) and the most observed degenerative feature being nodules with rim of calcification and areas of calcified degeneration (n = 965, 94.6%). Almost all the sonographic features were significantly seen in the 30-44 years age category. Conclusions Sonographically, uterine fibroids were mostly hypoechoic heterogeneous nodules with a smooth regular outline with a predominant occurrence within women in the fourth to fifth decade of life.
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Affiliation(s)
- Emmanuel Kobina Mesi Edzie
- Department of Medical Imaging, University of Cape Coast, Cape Coast, Ghana.,Department of Radiology, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | | | | | | | - Kafui Kossi Kekessie
- Department of Medical Imaging, University of Health and Allied Sciences, Ho, Ghana
| | - Eric Aidoo
- Department of Anatomy and Cell Biology, University of Cape Coast, Cape Coast, Ghana
| | - Stephen Amoah
- Department of Anatomy and Cell Biology, University of Cape Coast, Cape Coast, Ghana
| | - Evans Boadi
- Department of Radiology, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | | | - Frank Quarshie
- Department of Mathematical Sciences, African Institute for Mathematical Sciences, Accra, Ghana
| | - Richard Ato Edzie
- Department of Medical Imaging, University of Cape Coast, Cape Coast, Ghana
| | - Henry Kusodzi
- Department of Medical Imaging, University of Cape Coast, Cape Coast, Ghana
| | - Abdul Raman Asemah
- Department of Medical Imaging, University of Cape Coast, Cape Coast, Ghana
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Edzie EKM, Dzefi-Tettey K, Brakohiapa EK, Quarshie F, Ken-Amoah S, Cudjoe O, Boadi E, Kpobi JM, Edzie RA, Kusodzi H, Dziwornu P, Asemah AR. Age of first diagnosis and incidence rate of uterine fibroids in Ghana. A retrospective cohort study. PLoS One 2023; 18:e0283201. [PMID: 36928541 PMCID: PMC10019645 DOI: 10.1371/journal.pone.0283201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Uterine fibroids are benign tumors that grow in or on the uterus of women. Globally, they occur in more than 80% of women of African ancestry and 70% in white women. Uterine fibroid requires much attention because of its high incidence rate among women of all races and ages. This study sought to document the age of first diagnosis and incidence rates of uterine fibroids in our urban setting. METHODS This study reviewed and analyzed the ages and year of diagnosis of all 2,469 patients with the first diagnosis of uterine fibroids from 1st January 2018 to 31st December 2021 in South-Central Ghana. The obtained data were analyzed using GNU PSPP, Python on Jupyter Notebook and Libre Office Calc with statistical significance level set at p≤0.05. RESULTS The overall average age was 36.29±8.08 years, with age range 17-61 years and the age groups with the highest frequencies were 35-39 years (n = 642, 26.00%), 30-34 years (n = 563, 22.80%) and 40-44 years (n = 381, 15.43%). The mean ages of the patients in 2018, 2019, 2020 and 2021 were 36.70±8.00 years (95%CI = 35.97-37.43), 37.07±7.66 years (95%CI = 36.45-37.70), 35.92±7.87 years (95%CI = 35.30-36.53) and 35.78±8.54 years (95%CI = 35.19-36.38) respectively. The incidence rate (per 100,000) of uterine fibroids in 2018, 2019, 2020 and 2021 were 66.77 (95% CI = 60.63-72.90), 81.86 (95%CI = 75.19-88.58), 85.60 (95%CI = 78.85-92.35) and 92.40 (95%CI = 85.88-98.92) respectively, with 35-39 age group recording the highest in all years. CONCLUSION The incidence rate of uterine fibroids increased as the years progressed and it is mostly high in 35-39 years age category, with a decreasing annual mean age trend indicative of early diagnosis.
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Affiliation(s)
- Emmanuel Kobina Mesi Edzie
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
- * E-mail:
| | | | | | - Frank Quarshie
- African Institute for Mathematical Sciences (AIMS), Summerhill Estates, East Legon Hills, Santoe, Accra, Ghana
| | - Sebastian Ken-Amoah
- Department of Obstetrics and Gynecology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Obed Cudjoe
- Department of Microbiology and Immunology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Evans Boadi
- Department of Radiology, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | | | - Richard Ato Edzie
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Henry Kusodzi
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Prosper Dziwornu
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Abdul Raman Asemah
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
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Uterine fibroid and its association with metabolic syndrome in women of reproductive age (literature review). ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.5-1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Uterine fibroid is one of the most common gynecological diseases in women of reproductive age and many aspects of this disease remain the subject of investigation. In particular, the role of the metabolic syndrome is of interest as a potential predictor of uterine fibroid or a comorbid condition that has pathogenetic significance. The aim of this literature review is to systematize current data on the prevalence and associations of the metabolic syndrome and uterine fibroid in women of reproductive age. Literature search was carried out using the scientific literature databases eLIBRARY, PubMed, NCBI, CyberLeninka, and the official IDF website for the period from 2010 to 2022. In PubMed search, we used the following terms: uterine fibroid, metabolic syndrome, uterine fibroid and metabolic syndrome, uterine myoma and metabolic syndrome, uterine myoma and metabolic disorders, uterine myoma and MetS. A total of 439 sources were analized, 32 sources met the search criteria. Results. An analysis of the largest epidemiological studies conducted in recent years, both in non-selective populations and in hospital samples, demonstrates a significant prevalence of both uterine fibroid and metabolic syndrome among women. The results presented in the publications which were included in the review indicate that there is a relationship between the presence of uterine fibroid and the manifestations of the metabolic syndrome. Conclusions. Uterine fibroid and metabolic syndrome are mutually aggravating conditions. Women with uterine fibroid have a worse risk profile for cardiovascular disease, and the presence of metabolic syndrome increases the risk of uterine fibroid. One of the ways to reduce the risk of occurrence and growth of uterine fibroid is the timely correction of the metabolic syndrome and its components. On the other hand, the presence of uterine fibroid should be considered as a basis for active detection of metabolic disorders and cardiovascular risks.
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Uterine Fibroids, Perceived Stress, and Menstrual Distress: a Key Role of Heavy Menstrual Bleeding. Reprod Sci 2022; 30:1608-1615. [PMID: 36471219 PMCID: PMC10160184 DOI: 10.1007/s43032-022-01126-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/05/2022] [Indexed: 12/12/2022]
Abstract
Abstract
Uterine fibroids (UFs) are the most common benign tumors in women of reproductive age, frequently associated with pain symptoms and heavy menstrual bleeding (HMB), leading to impaired quality of life. Thus, the aim of the study was to evaluate the global perception of stress and the menstrual distress in patients with UFs. A cross-sectional observational study was conducted on a group (n = 69) of fertile age women with UFs compared to age-matched controls, by administering two questionnaires: the perceived stress scale (PSS) and the Menstrual Distress Questionnaire (MEDI-Q). The PSS, MEDI-Q Total Score and 3 subscales—menstrual symptoms (MS), menstrual symptoms distress (MSD), and menstrual specificity index (MESI)—were evaluated. Patients with UFs showed higher PSS than controls (18.5 ± 5.0 vs. 13.8 ± 5.0, p < 0.001) and PSS values were very high in those with HMB, severe dysmenorrhea, and impaired social and working life. Patients with UFs also showed significantly higher score for MEDI-Q Total Score (16.51 ± 12.99 vs. 10.86 ± 12.36) (p < 0.01) as well as for the subscales MSD (2.54 ± 1.07 vs. 1.57 ± 0.98) (p < 0.001) and MESI (0.76 ± 0.30 vs 0.60 ± 0.39) (p < 0.05). The menstrual distress was associated to being uncomfortable about uterine bleeding; in fact, MEDI-Q Total Score was significantly higher in women with HMB compared to those with moderate/normal bleeding. UF characteristics (number, type, and size) did not correlate with perceived stress or menstrual distress. In conclusion, women with UFs have significantly higher levels of perceived stress and menstrual distress than controls and HMB plays a major role in determining such conditions.
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Bellala P, Valakkada J, Ayyappan A, Kumar S. Evidences in Uterine Artery Embolization: A Radiologist's Primer. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2022. [DOI: 10.1055/s-0042-1758050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractUterine artery embolization is an established minimally invasive therapy for symptomatic fibroids. It has also been used for other diseases of the uterus, including adenomyosis, uterine arteriovenous malformation, ectopic pregnancy, abnormal invasive placenta, and postpartum hemorrhage. In this review, we provide an updated and comprehensive review of uterine artery embolization based on the evidence published. We review the indications, the role of MRI, technical aspects, and complications of the procedure. The issues with a future pregnancy, risk of infertility, and fetal radiation are discussed as well.
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Affiliation(s)
- Pavankumar Bellala
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jineesh Valakkada
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Anoop Ayyappan
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Santhosh Kumar
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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Xu W, Chen W, Chen J, Hu L, Su X, Nie Y, Shi Q. Adaptability and clinical applicability of UFS-QoL in Chinese women with uterine fibroid. BMC Womens Health 2022; 22:372. [PMID: 36088381 PMCID: PMC9463796 DOI: 10.1186/s12905-022-01963-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objective
To demonstrate the applicability and adaptability of uterine fibroid symptoms and quality of life (UFS-QoL) in assessing the efficacy of treatment in Chinese populations.
Methods
This is a secondary analysis of a prospective cohort study involving 20 Chinese hospitals and 2,411 Chinese women with fibroids. Patients completed UFS-QoL and short form-36 (SF-36) at pre-surgery, 6-month and 12-month post-treatments. Internal consistency of the quality of life assessed by the UFS-QoL questionnaire using Cronbach’s α coefficient (α). Principal axis factor analysis with orthogonal rotation was established to investigate relationships between items and subscales. Concurrent validity refers to the Spearman's correlation estimate of the correlation between UFS-QoL and SF-36. Using effect size and standardized response mean, the ability to detect change was evaluated by comparing pre- and post-6-month and post-12-month treatment scores.
Results
Exploratory factor analysis yielded six subscales (concern, activities, energy/mood, control, self-consciousness, and sexual function) with eigenvalues > 1 in UFS-QoL. A 63.61% total variance was explained by the test items. Ceiling effects of self-consciousness and sexual functioning subscales from UFS-QoL were > 15%. UFS-QoL showed a positive and moderate correlation with SF-36 to establish good concurrent validity. And showed good consistency reliability (Cronbach α > 0.7 in all subscales), ability to detect change after treatment. This excluded self-consciousness (α = 0.56), which demonstrated the lowest effect size (0.38) and standardized response means (0.38) 6- and 12-months post-treatment.
Conclusions
Symptom severity, activity, and mood subscales of the Chinese UFS-QoL were valid and reliable. However, the self-consciousness domain needs further investigation on cultural adaptation, such as cognitive debriefing for how Chinese interpret these questions.
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Sparić R, Andjić M, Babović I, Nejković L, Mitrović M, Štulić J, Pupovac M, Tinelli A. Molecular Insights in Uterine Leiomyosarcoma: A Systematic Review. Int J Mol Sci 2022; 23:ijms23179728. [PMID: 36077127 PMCID: PMC9456512 DOI: 10.3390/ijms23179728] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 11/28/2022] Open
Abstract
Uterine fibroids (UFs) are the most common benign tumors of female genital diseases, unlike uterine leiomyosarcoma (LMS), a rare and aggressive uterine cancer. This narrative review aims to discuss the biology and diagnosis of LMS and, at the same time, their differential diagnosis, in order to distinguish the biological and molecular origins. The authors performed a Medline and PubMed search for the years 1990–2022 using a combination of keywords on the topics to highlight the many genes and proteins involved in the pathogenesis of LMS. The mutation of these genes, in addition to the altered expression and functions of their enzymes, are potentially biomarkers of uterine LMS. Thus, the use of this molecular and protein information could favor differential diagnosis and personalized therapy based on the molecular characteristics of LMS tissue, leading to timely diagnoses and potential better outcomes for patients.
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Affiliation(s)
- Radmila Sparić
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Koste Todorovića 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Mladen Andjić
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Koste Todorovića 26, 11000 Belgrade, Serbia
- Correspondence: (M.A.); (A.T.)
| | - Ivana Babović
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Koste Todorovića 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Lazar Nejković
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic of Gynecology and Obstetrics Narodni Front, 11000 Belgrade, Serbia
| | - Milena Mitrović
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Koste Todorovića 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Štulić
- Clinic of Gynecology and Obstetrics Narodni Front, 11000 Belgrade, Serbia
| | - Miljan Pupovac
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Koste Todorovića 26, 11000 Belgrade, Serbia
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di Ricerca Clinico SALentino), “Verisdelli Ponti Hospital”, Via Giuseppina Delli Ponti, 73020 Scorrano, LE, Italy
- Correspondence: (M.A.); (A.T.)
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Orellana M, Riggan KA, DSouza K, Stewart EA, Venable S, Balls-Berry JE, Allyse MA. Perceptions of Ethnoracial Factors in the Management and Treatment of Uterine Fibroids. J Racial Ethn Health Disparities 2022; 9:1184-1191. [PMID: 34013445 PMCID: PMC10695323 DOI: 10.1007/s40615-021-01059-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Uterine fibroids are non-cancerous neoplasms of the uterus. Women of color, including non-Hispanic Black/African American women and Hispanic/Latinas, have a higher uterine fibroid prevalence, incidence, and disease burden compared to non-Hispanic White women. Therefore, understanding ethnoracial factors in the diagnosis and treatment of uterine fibroids in women of color is critical. This study provides insight on the ethnoracial factors and cultural barriers experienced by women of color in the management and treatment of uterine fibroids. METHODS Women were recruited via The Fibroid Foundation, a nonprofit that provides uterine fibroid support and education. Women who were interested completed an online screening survey. Eligible participants were interviewed via phone. Transcribed audio recordings were qualitatively analyzed using the principles of grounded theory. RESULTS Forty-seven women of reproductive age who were diagnosed with uterine fibroids and received U.S.-based care participated in a semi-structured interview exploring experiences with uterine fibroid diagnosis and management. Twenty-eight women self-identified as Black, Latina, or other ethnicity. Women of color reported fibroid symptoms that significantly disrupted their work and home life. Women of color also reported perceptions that their race/ethnicity impacted their uterine fibroid treatment, including negative interpersonal provider-patient interactions. These perceptions engendered feelings of skepticism towards the medical system based on historical injustices and/or their own negative experiences and led some to go without longitudinal care. CONCLUSION Cultural and familial factors have significant impact on uterine fibroid diagnosis and management. Greater attention to culturally sensitive care and potential bias reduction in the treatment of uterine fibroids should be a priority.
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Affiliation(s)
- Minerva Orellana
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Karen DSouza
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA
| | - Elizabeth A Stewart
- Division of Reproductive Endocrinology, Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
| | | | - Joyce E Balls-Berry
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA.
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA.
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Yang Q, Ciebiera M, Bariani MV, Ali M, Elkafas H, Boyer TG, Al-Hendy A. Comprehensive Review of Uterine Fibroids: Developmental Origin, Pathogenesis, and Treatment. Endocr Rev 2022; 43:678-719. [PMID: 34741454 PMCID: PMC9277653 DOI: 10.1210/endrev/bnab039] [Citation(s) in RCA: 102] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Indexed: 11/24/2022]
Abstract
Uterine fibroids are benign monoclonal neoplasms of the myometrium, representing the most common tumors in women worldwide. To date, no long-term or noninvasive treatment option exists for hormone-dependent uterine fibroids, due to the limited knowledge about the molecular mechanisms underlying the initiation and development of uterine fibroids. This paper comprehensively summarizes the recent research advances on uterine fibroids, focusing on risk factors, development origin, pathogenetic mechanisms, and treatment options. Additionally, we describe the current treatment interventions for uterine fibroids. Finally, future perspectives on uterine fibroids studies are summarized. Deeper mechanistic insights into tumor etiology and the complexity of uterine fibroids can contribute to the progress of newer targeted therapies.
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Affiliation(s)
- Qiwei Yang
- Qiwei Yang, Ph.D. Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, M167, Billings, Chicago, IL 60637, USA.
| | - Michal Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, ul. Cegłowska 80, 01-809, Warsaw, Poland
| | | | - Mohamed Ali
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo 11566, Egypt
| | - Hoda Elkafas
- Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Pharmacology and Toxicology, Egyptian Drug Authority, formerly National Organization for Drug Control and Research, Cairo 35521, Egypt
| | - Thomas G Boyer
- Department of Molecular Medicine, Institute of Biotechnology, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229-3900, USA
| | - Ayman Al-Hendy
- Correspondence: Ayman Al-Hendy, MD, Ph.D. Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, N112, Peck Pavilion, Chicago, IL 60637. USA.
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Racial disparities in access to reproductive health and fertility care in the United States. Curr Opin Obstet Gynecol 2022; 34:138-146. [PMID: 35645012 DOI: 10.1097/gco.0000000000000780] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To examine the status of racial and ethnic inequalities in fertility care in the United States (U.S.) at inception of 2022. This review highlights addressable underpinnings for the prevalent differentials in access to and utilization of infertility treatments and underscores gaps in preventive care as key contributors to racial and ethnic disparities in risk burden for subfertility and infertility. RECENT FINDINGS Significant gaps in access to and utilization of fertility care are consistently reported among racial and ethnic minorities, particularly Black and Hispanic women. Access to and utilization of contraceptives, human papilloma virus vaccination rates, preexposure prophylaxis use, and differentials in treatment of common gynecologic disorders are relevant to the prevalent racial and ethnic disparities in reproductive health. The spectrum of differential in reproductive wellness and the magnitude of reproductive health burden afflicting racial minorities in the U.S. raise concerns regarding systemic and structural racism as plausible contributors to the prevalent state of affairs. SUMMARY Despite efforts to reform unequal reproductive health practices and policies, racial and ethnic disparities in fertility care are pervasive and persistent. In addition to measures aimed at reducing barriers to care, societal efforts must prioritize health disparity research to systematically examine underpinnings, and addressing structural racism and interpersonal biases, to correct the prevalent racial inequities and mitigate disparities.
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Mao X, Peng X, Pan Q, Zhao X, Yu Z, Xu D. Uterine Fibroid Patients Reveal Alterations in the Gut Microbiome. Front Cell Infect Microbiol 2022; 12:863594. [PMID: 35646718 PMCID: PMC9131877 DOI: 10.3389/fcimb.2022.863594] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/29/2022] [Indexed: 12/12/2022] Open
Abstract
The gut microbiota is associated with reproductive disorders in multiple ways. This research investigated possible differences in gut microbiome compositions between patients with uterine fibroids (UFs) and healthy control subjects in order to further provide new insight into its etiology. Stool samples were collected from 85 participants, including 42 UF patients (case group) and 43 control subjects (control group). The gut microbiota was examined with 16S rRNA quantitative arrays and bioinformatics analysis. The α-diversity in patients with UFs was significantly lower than that of healthy controls and negatively correlated with the number of tumorigeneses. The microbial composition of the UF patients deviated from the cluster of healthy controls. Stool samples from patients with UFs exhibited significant alterations in terms of multiple bacterial phyla, such as Firmicutes, Proteobacteria, Actinobacteria, and Verrucomicrobia. In differential abundance analysis, some bacteria species were shown to be downregulated (e.g., Bifidobacteria scardovii, Ligilactobacillus saerimneri, and Lactococcus raffinolactis) and upregulated (e.g., Pseudomonas stutzeri and Prevotella amnii). Furthermore, the microbial interactions and networks in UFs exhibited lower connectivity and complexity as well as higher clustering property compared to the controls. Taken together, it is possible that gut microbiota dysbiosis has the potential as a risk factor. This study found that UFs are associated with alterations of the gut microbiome diversity and community network connectivity. It provides a new direction to further explore the host–gut microbiota interplay and to develop management and prevention in UF pathogenesis.
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Affiliation(s)
- Xuetao Mao
- Department of Gynecology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xuan Peng
- Department of Microbiology, School of Basic Medical Science, Central South University, Changsha, China
| | - Qiong Pan
- Department of Gynecology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xingping Zhao
- Department of Gynecology, The Third Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Zheng Yu, ; Dabao Xu, ; Xingping Zhao,
| | - Zheng Yu
- Department of Microbiology, School of Basic Medical Science, Central South University, Changsha, China
- *Correspondence: Zheng Yu, ; Dabao Xu, ; Xingping Zhao,
| | - Dabao Xu
- Department of Gynecology, The Third Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Zheng Yu, ; Dabao Xu, ; Xingping Zhao,
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Zheng L, Liu D, Hu C. Effects of total laparoscopic hysterectomy on the clinical outcomes of patients with uterine fibroids. Am J Transl Res 2022; 14:2402-2409. [PMID: 35559408 PMCID: PMC9091122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/14/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To clarify the effects of total laparoscopic hysterectomy (TLH) on sex hormone levels, quality of life (QOL) and complications such as lower-extremity deep vein thrombosis (DVT) in patients with uterine fibroids (UFs). METHODS In this retrospective study, 136 patients with UFs treated in Hainan General Hospital from March 2018 to December 2020 were collected as research participants, of which 65 patients received total abdominal hysterectomy (TAH) were included in the control group and 71 patients who received TLH were assigned to the research group. The two groups were compared regarding the following items: response rate, surgical indexes, rehabilitation indicators, changes in sex hormone levels and QOL, and the occurrence of lower-extremity DVT. RESULTS The research group showed a significantly higher response rate, and better indicators of surgical treatment and rehabilitation than the control group (P<0.05). The sex hormones in the research group were more stable than that in the control group. The QOL was also significantly better and the incidence of total complications was statistically lower in the research group compared with the control group (both P<0.05). CONCLUSIONS TLH is a feasible and safe alternative than traditional TAH for UFs, as it can effectively improve patients' sex hormone levels and QOL, and reduce the incidence of complications, which is worthy of clinical promotion.
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Affiliation(s)
- Lang Zheng
- Department of Gynecology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University)Haikou 571003, Hainan Province, China
| | - Dan Liu
- Department of Hematology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University)Haikou 571003, Hainan Province, China
| | - Chunyan Hu
- Department of Gynecology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University)Haikou 571003, Hainan Province, China
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Midlife Urinary Phthalate Metabolite Concentrations and Prior Uterine Fibroid Diagnosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052741. [PMID: 35270433 PMCID: PMC8910544 DOI: 10.3390/ijerph19052741] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022]
Abstract
Fibroid etiology is poorly understood but is likely hormonally mediated. Therefore, we evaluated associations between midlife phthalates (hormone-altering chemicals) and prior fibroid diagnosis, and considered differences by weight gain status. Women (ages: 45−54; n = 754) self-reported past fibroid diagnosis. We pooled 1−4 urines collected after fibroid diagnosis over the consecutive weeks to analyze nine phthalate metabolites and calculate relevant molar sums (e.g., di(2-ethylhexyl) phthalate, ΣDEHP; anti-androgenic phthalates, ΣAA; all metabolites, ΣPhthalates). Using Poisson regression, we evaluated associations between phthalate biomarkers and the risk of having fibroid diagnosis. We explored if associations differed by weight gain from age 18 to 45−54 or in women diagnosed with fibroids within 5 years of phthalate assessment. Our major finding was that women had a 13% (RR: 1.13; 95%CI: 1.02, 1.26) and 16% (RR: 1.16; 95% CI: 1.03, 1.31) greater risk of prior fibroid diagnosis for each two-fold increase in ΣDEHP or ΣAA, respectively. These associations were strongest in women who became overweight/obese from age 18 to 45−54 and in those diagnosed <5 years before phthalate assessment. Based on these results, prospective studies should corroborate our findings related to associations between phthalates and fibroids, and may consider evaluating the role that weight gain may play in these associations.
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Mlodawska OW, Saini P, Parker JB, Wei JJ, Bulun SE, Simon MA, Chakravarti D. Epigenomic and enhancer dysregulation in uterine leiomyomas. Hum Reprod Update 2022; 28:518-547. [PMID: 35199155 PMCID: PMC9247409 DOI: 10.1093/humupd/dmac008] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/16/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Uterine leiomyomas, also known as uterine fibroids or myomas, are the most common benign gynecological tumors and are found in women of reproductive and postmenopausal age. There is an exceptionally high prevalence of this tumor in women by the age of 50 years. Black women are particularly affected, with an increased incidence, earlier age of onset, larger and faster growing fibroids and greater severity of symptoms as compared to White women. Although advances in identifying genetic and environmental factors to delineate these fibroids have already been made, only recently has the role of epigenomics in the pathogenesis of this disease been considered. OBJECTIVE AND RATIONALE Over recent years, studies have identified multiple epigenomic aberrations that may contribute to leiomyoma development and growth. This review will focus on the most recent discoveries in three categories of epigenomic changes found in uterine fibroids, namely aberrant DNA methylation, histone tail modifications and histone variant exchange, and their translation into altered target gene architecture and transcriptional outcome. The findings demonstrating how the altered 3D shape of the enhancer can regulate gene expression from millions of base pairs away will be discussed. Additionally, translational implications of these discoveries and potential roadblocks in leiomyoma treatment will be addressed. SEARCH METHODS A comprehensive PubMed search was performed to identify published articles containing keywords relevant to the focus of the review, such as: uterine leiomyoma, uterine fibroids, epigenetic alterations, epigenomics, stem cells, chromatin modifications, extracellular matrix [ECM] organization, DNA methylation, enhancer, histone post-translational modifications and dysregulated gene expression. Articles until September 2021 were explored and evaluated to identify relevant updates in the field. Most of the articles focused on in the discussion were published between 2015 and 2021, although some key discoveries made before 2015 were included for background information and foundational purposes. We apologize to the authors whose work was not included because of space restrictions or inadvertent omission. OUTCOMES Chemical alterations to the DNA structure and of nucleosomal histones, without changing the underlying DNA sequence, have now been implicated in the phenotypic manifestation of uterine leiomyomas. Genome-wide DNA methylation analysis has revealed subsets of either suppressed or overexpressed genes accompanied by aberrant promoter methylation. Furthermore, differential promoter access resulting from altered 3D chromatin structure and histone modifications plays a role in regulating transcription of key genes thought to be involved in leiomyoma etiology. The dysregulated genes function in tumor suppression, apoptosis, angiogenesis, ECM formation, a variety of cancer-related signaling pathways and stem cell differentiation. Aberrant DNA methylation or histone modification is also observed in altering enhancer architecture, which leads to changes in enhancer-promoter contact strength, producing novel explanations for the overexpression of high mobility group AT-hook 2 and gene dysregulation found in mediator complex subunit 12 mutant fibroids. While many molecular mechanisms and epigenomic features have been investigated, the basis for the racial disparity observed among those in the Black population remains unclear. WIDER IMPLICATIONS A comprehensive understanding of the exact pathogenesis of uterine leiomyoma is lacking and requires attention as it can provide clues for prevention and viable non-surgical treatment. These findings will widen our knowledge of the role epigenomics plays in the mechanisms related to uterine leiomyoma development and highlight novel approaches for the prevention and identification of epigenome targets for long-term non-invasive treatment options of this significantly common disease.
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Affiliation(s)
| | | | - J Brandon Parker
- Division of Reproductive Science in Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Jian-Jun Wei
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA
| | - Serdar E Bulun
- Division of Reproductive Science in Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Debabrata Chakravarti
- Correspondence address. Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, 303 E Superior Street, Lurie 4-119, Chicago, IL 60611, USA. E-mail:
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A Call-to-Action for Clinicians to Implement Evidence-Based Best Practices When Caring for Women with Uterine Fibroids. Reprod Sci 2022; 29:1188-1196. [PMID: 35178678 PMCID: PMC8853611 DOI: 10.1007/s43032-022-00877-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/06/2022] [Indexed: 11/12/2022]
Abstract
Uterine fibroids are common benign tumors that occur in up to 80% of women. Approximately half of the women affected experience considerable physical, psychological, and economic burdens and impact on quality of life due to symptoms such as heavy menstrual bleeding, pelvic pain, and infertility. Several medical and surgical options are available to treat uterine fibroids; however, healthcare providers may benefit from practical guidance in the development of individualized treatment plans based on a personalized approach. Medical treatments and minimally invasive procedures are generally preferred by most patients before considering more invasive, higher risk surgical interventions. In general, patient-centered, uterine-preserving procedures may be prioritized based on the patient’s goals and the clinical scenario. Occasionally, hysterectomy may be the preferred treatment option for some patients who require definitive treatment. This call-to-action highlights recent challenges to patient care, including radical shifts in physician–patient interactions due to the COVID-19 pandemic and recent changes to evidence-based, clinically approved therapies. This report also reviews contemporary recommendations for women’s health providers in the diagnosis and medical and surgical management of uterine fibroids. This call-to-action aims to empower healthcare providers to optimize the quality of care for women with uterine fibroids utilizing the best available evidence and best practices.
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81
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Systematic review of oral pharmacotherapeutic options for the management of uterine fibroids. J Am Pharm Assoc (2003) 2022; 62:674-682.e5. [DOI: 10.1016/j.japh.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/24/2022]
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Muhammad J, Yusof Y, Ahmad I, Norhayati MN. Elagolix treatment in women with heavy menstrual bleeding associated with uterine fibroid: a systematic review and meta-analysis. BMC Womens Health 2022; 22:14. [PMID: 35033041 PMCID: PMC8761302 DOI: 10.1186/s12905-022-01596-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 12/29/2021] [Indexed: 02/05/2023] Open
Abstract
Background Elagolix is effective and safe for treating menorrhagia in women with uterine fibroid. However, it is reported to be associated with hypoestrogenism that can be alleviated by adding estradiol/norethindrone acetate. This systematic review and meta-analysis aimed to determine the effectiveness of elagolix treatment in women with heavy menstrual bleeding associated with uterine fibroid by comparing: elagolix versus placebo and elagolix versus estradiol/norethindrone acetate. Methodology The Cochrane Central Register of Controlled Trials (CENTRAL 2021, Issue 3 of 12), MEDLINE databases (1980 to December week 1, 2020), and trial registries for relevant randomized clinical trials were used. All randomized clinical trials were reviewed and evaluated. Random effects models were used to estimate the dichotomous outcomes and mean differences with 95% confidence intervals. Data for risk of bias, heterogeneity, sensitivity, reporting bias and quality of evidence were assessed. Results Four randomized controlled trials with 1949 premenopausal women from 323 locations were included. Elagolix improved menstrual blood loss of less than 80 ml (RR 4.81, 95% CI 2.45 to 9.45; four trials, 869 participants; moderate quality evidence) or more than 50% reduction from baseline (RR 4.87, 95% CI 2.55 to 9.31; four trials, 869 participants; moderate quality evidence) compared to placebo. There was no difference in menstrual blood loss of less than 80 ml (RR 1.08, 95% CI 1.00 to 1.16; five trials, 1365 participants; moderate quality evidence) or more than 50% reduction from baseline between the elagolix (RR 1.08, 95% CI 1.01 to 1.15; five trials, 1365 participants; high quality evidence) and elagolix with estradiol/norethindrone acetate. In both comparisons, elagolix has reduced the mean percentage change in uterine and fibroid volume, improved symptoms, and health-related quality of life. More patients had hot flush, and bone mineral density loss in the elagolix treatment compared to both placebo and elagolix with estradiol/norethindrone acetate. Conclusions Elagolix appeared to be effective in reducing heavy menstrual bleeding caused by uterine fibroid and combination with estradiol/norethindrone acetate was able to alleviate the hypoestrogenism side effects in premenopausal women. Review registration PROSPERO CDR 42021233898. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01596-2.
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Affiliation(s)
- Juliawati Muhammad
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
| | - Yusnita Yusof
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Imran Ahmad
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Mohd Noor Norhayati
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
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83
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Single Evaluation of Use of a Mixed Reality Headset for Intra-Procedural Image-Guidance during a Mock Laparoscopic Myomectomy on an Ex-Vivo Fibroid Model. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Uterine fibroids represent the highest prevalence of benign tumors in women, with reports ranging from 4.5% to 68.6%, with a significant bias towards African American women. For uterine fibroids, a significant decision is determining whether fibroids can be successfully removed using minimally invasive (MI) techniques or their removal requires open surgery. Currently, the standard-of-care for intra-procedural visualization for myomectomies is ultrasound, which has low image quality and requires a specially trained assistant. Currently, the state-of-the-art is to obtain a pre-procedural MRI scan of the patient, which can be used for diagnosis and pre-procedural planning. Although proven incredibly useful pre-procedurally, MRI scans are not often used intra-procedurally due to the inconvenient visualization as 2D slices, which are seen on 2D monitors that do not intuitively convey the depth or orientation of the fibroids, as needed to effectively perform myomectomies. To address this limitation, herein, we present the use of a mixed reality headset (i.e., Microsoft HoloLens 2), as a tool for intra-procedural image-guidance during a mock myomectomy of an ex vivo animal uterus. In this work, we created a patient-specific holographic rendering by performing image segmentation of an MRI scan of a custom-made uterine fibroid animal model. A physician qualitatively assessed the usefulness of the renderings for fibroid localization, as compared to the same visualization on a 2D monitor. In conclusion, the use of mixed reality as an intra-procedural image guidance tool for myomectomies was perceived as a better visualization technique that could lead to improvements in MI approaches and make them accessible to patients from lower socioeconomic populations.
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84
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Yu S, Bhagavath B, Shobeiri SA, Eisenstein D, Levy B. Clinical and Patient Reported Outcomes Pre- and Post-Surgical Treatment of Symptomatic Uterine Leiomyomas: A 12-Month Follow-Up Review of TRUST, a Surgical Randomized Clinical Trial Comparing Laparoscopic Radiofrequency Ablation (LAP-RFA) and Myomectomy. J Minim Invasive Gynecol 2022; 29:726-737. [DOI: 10.1016/j.jmig.2022.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 11/16/2022]
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85
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Maghraby N, El Noweihi AM, El-Melegy NT, Mostafa NAM, Abbas AM, El-Deek HEM, Radwan E. Increased Expression of Fibroblast Activation Protein is Associated with Autophagy Dysregulation and Oxidative Stress in Obese Women with Uterine Fibroids. Reprod Sci 2021; 29:448-459. [PMID: 34845667 DOI: 10.1007/s43032-021-00810-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022]
Abstract
Uterine fibroids (UF) represent an immense health burden throughout the world. Obesity is considered one of the risk factors for UF development; however, the underlying mechanisms remain largely unexplored. We investigated the effect of obesity on fibroblast activation and its association with inflammation, autophagy dysfunction, and oxidative stress in UF patients. Thirty-five pre-menopausal UF patients were included in this study and classified into non-obese group (BM1 ≤ 30 kg/m2, n = 15) and obese group (BMI > 30 kg/m2, n = 20). Tissue samples were collected from fibroids and adjacent normal myometrium. Our results showed increased expression of fibroblast activation protein (FAP) together with markers of autophagy, inflammation, and oxidative stress in UF patients, which were all more markedly upregulated in obese compared to non-obese patients. In addition, BMI was significantly positive correlated with FAP and autophagy markers. In conclusion, the results of the present study suggest that obesity-associated autophagy dysregulation together with increased FAP expression may increase the risk of UFs in obese women.
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Affiliation(s)
- Nashwa Maghraby
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Amira M El Noweihi
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Nagla T El-Melegy
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Nashwa A M Mostafa
- Department of Histology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed M Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Heba E M El-Deek
- Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Eman Radwan
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt. .,Department of Biochemistry, Sphinx University, New Assiut City, Assiut 10, Egypt.
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86
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What We Know about the Long-Term Risks of Hysterectomy for Benign Indication-A Systematic Review. J Clin Med 2021; 10:jcm10225335. [PMID: 34830617 PMCID: PMC8622061 DOI: 10.3390/jcm10225335] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/02/2021] [Accepted: 11/06/2021] [Indexed: 12/29/2022] Open
Abstract
Hysterectomy is the most common treatment option in women with uterine fibroids, providing definitive relief from the associated burdensome symptoms. As with all surgical interventions, hysterectomy is associated with risk of complications, short-term morbidities, and mortality, all of which have been described previously. However, information on the potential long-term risks of hysterectomy is only recently becoming available. A systematic literature review was performed to identify studies published between 2005 and December 2020 evaluating the long-term impact of hysterectomy on patient outcomes. A total of 29 relevant studies were identified. A review of the articles showed that hysterectomy may increase the risk of cardiovascular events, certain cancers, the need for further surgery, early ovarian failure and menopause, depression, and other outcomes. It is important to acknowledge that the available studies examine possible associations and hypotheses rather than causality, and there is a need to establish higher quality studies to truly evaluate the long-term consequences of hysterectomy. However, it is of value to consider these findings when discussing the benefits and risks of all treatment options with patients with uterine fibroids to allow for preference-based choices to be made in a shared decision-making process. This is key to ensuring that patients receive the treatment that best meets their individual needs.
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87
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Riggan KA, Stewart EA, Balls-Berry JE, Venable S, Allyse MA. Patient Recommendations for Shared Decision-Making in Uterine Fibroid Treatment Decisions. J Patient Exp 2021; 8:23743735211049655. [PMID: 34692992 PMCID: PMC8532210 DOI: 10.1177/23743735211049655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Uterine fibroids are noncancerous tumors associated with significant morbidity among symptomatic patients. While medical and surgical treatments have expanded, hysterectomy remains common. We interviewed women diagnosed with uterine fibroids (n = 47) to explore their experiences and recommendations for shared decision-making. A majority were non-Hispanic Black, highly educated (51.1%), and had graduate degrees (40.4%). Participants with both positive and negative provider experiences expressed a desire for a more proactive therapeutic approach, including a presentation by their provider of the spectrum of medical and surgical treatment options, and greater provider recognition of the impact of symptoms on quality of life. Women advocated for expanded shared decision-making that acknowledged their contribution to their own treatment plan and felt early screening and improved patient/provider education of uterine fibroid symptoms would facilitate greater congruence between treatment approaches and patient goals. Perceptions of insufficient input into their treatment plans frequently served as a barrier to care-seeking and treatment acceptance among women with uterine fibroid symptoms. Improved discussion of treatment options in the context of the unique symptom burden and values of the patient may facilitate greater provider trust and acceptance of uterine fibroid treatment.
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Affiliation(s)
- Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth A Stewart
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA.,Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Joyce E Balls-Berry
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Department of Health Science Research, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | | | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA.,Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA.,Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, USA
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88
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Ali M, Raslan M, Ciebiera M, Zaręba K, Al-Hendy A. Current approaches to overcome the side effects of GnRH analogs in the treatment of patients with uterine fibroids. Expert Opin Drug Saf 2021; 21:477-486. [PMID: 34612122 DOI: 10.1080/14740338.2022.1989409] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Uterine fibroids (UFs) are the most prevalent benign neoplastic threat originating from myometria of reproductive age women, with a profound financial load valued in hundreds of billions of dollars. Unfortunately, there is no curative treatment so far except surgery and available pharmacological treatments are restricted for short-term treatment options. Thus, there is a large unmet need in the UF space for noninvasive therapeutics.Areas covered: The authors reviewed the literature available for the utility of gonadotropin-releasing hormone (GnRH) analogs in women with UFs. We also focused on clinical studies exploring the therapeutic benefits of novel oral non-peptide GnRH antagonists that were recently approved by the U.S. Food and Drug Administration (FDA) in combination with estradiol/norethindrone acetate for the management of heavy menstrual bleeding associated with UFs in premenopausal women.Expert opinion: The results regarding the efficacy of new-generation oral GnRH-antagonists, such as elagolix, relugolix and linzagolix, are promising and offer potential prospect for the future therapy of UFs. However, these antagonists must be combined with hormonal add-back therapy to minimize the resultant hypoestrogenic side effects such as bone loss.
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Affiliation(s)
- Mohamed Ali
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | | | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Cegłowska, Warsaw, Poland
| | - Kornelia Zaręba
- First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Żelazna, Warsaw, Poland
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
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89
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Wang A, Wang S, Owens CD, Vora JB, Diamond MP. Health Care Costs and Treatment Patterns Associated with Uterine Fibroids and Heavy Menstrual Bleeding: A Claims Analysis. J Womens Health (Larchmt) 2021; 31:856-863. [PMID: 34591695 PMCID: PMC9245789 DOI: 10.1089/jwh.2020.8983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Heavy menstrual bleeding (HMB) is one of the most common distressing complications of uterine fibroids (UF); however, data on the health care costs for treatments in women experiencing HMB associated with UF are lacking. The objective of this study was to compare the direct costs and treatments patterns for women diagnosed with UF+HMB, UF only, and HMB only in the United States. Materials and Methods: The study design was retrospective matched cohort study using claims data. Women, aged 18–51 years, comprising four cohorts (HMB only, UF only, UF+HMB, and controls) were identified in the IBM MarketScan® Commercial Claims and Encounters Database (October 1, 2007‒September 30, 2018) and matched by demographics and Charlson Comorbidity Index score. Baseline characteristics and treatments during the 12 months post-diagnosis were summarized descriptively. Costs (2018 U.S. dollars) during the post-diagnosis year were compared using analysis of variance. Results: Before matching, women with UF+HMB represented 54% of UF cases. Following diagnosis, 32% in the matched UF+HMB cohort had no treatment, 49% underwent surgeries/procedures with (12%) or without (37%) medications, and 18% received medications only. The mean all-cause total costs for UF+HMB ($16,762) exceeded that for UF only by 24% ($13,506) and HMB only by 50% ($11,135), and almost tripled the mean cost for the control cohort ($6,691) (all, p < 0.001). The mean diagnosis-related costs were significantly higher for UF+HMB ($8,741) than for UF only ($4,550) and HMB only ($3,081) (all, p < 0.0001). Surgery/procedure costs comprised 80% of diagnosis-related medical costs for UF+HMB. Conclusions: UF with HMB were associated with significant economic burden, driven primarily by surgical/procedural costs and treatment patterns.
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Affiliation(s)
- Alice Wang
- AbbVie, Inc., North Chicago, Illinois, USA
| | | | | | | | - Michael P Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia, USA
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90
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Lee SR, Kim JH, Lee YJ, Lee SW, Park JY, Suh DS, Kim DY, Kim SH, Kim YM, Kim YT. Single-Incision versus Multiport Robotic Myomectomy: A Propensity Score Matched Analysis of Surgical Outcomes and Surgical Tips. J Clin Med 2021; 10:jcm10173957. [PMID: 34501409 PMCID: PMC8432212 DOI: 10.3390/jcm10173957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/21/2021] [Accepted: 08/29/2021] [Indexed: 02/07/2023] Open
Abstract
We aimed to compare the perioperative outcomes of single-incision robotic myomectomy (SIRM) and multiport robotic myomectomy (MPRM) and provide surgical tips. We retrospectively analyzed the medical records of 462 patients with symptomatic leiomyoma who underwent MPRM or SIRM between March 2019 and April 2021. Demographic characteristics and surgical outcomes, including the total operative time (OT), estimated blood loss (EBL), and surgical complication rate, were compared between the two groups. Patients in the SIRM group had lower a body mass index and rate of previous pelvic surgery and were younger than those in the MPRM group. The myoma type was not different between groups; however, the MPRM group had larger, and more myomas than the SIRM group. After propensity score matching, these variables were not significantly different between the groups. The total OT, EBL, difference in hemoglobin levels, transfusion rate, and postoperative fever were not different between the groups. No postoperative complications occurred in the SIRM group. In the MPRM group, one patient needed conversion to laparotomy, and two patients had postoperative complications (umbilical incisional hernia and acute kidney injury). In conclusion, both MPRM and SIRM are feasible and effective surgical options for symptomatic myomas with cosmetic benefits and minimal risk of laparotomy conversion.
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Affiliation(s)
- Sa-Ra Lee
- Department of Obstetrics and Gynecology, Seoul Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.-W.L.); (J.-Y.P.); (D.-S.S.); (D.-Y.K.); (S.-H.K.); (Y.-M.K.); (Y.-T.K.)
- Correspondence: ; Tel.: +82-2-3010-3648; Fax: +82-2-3010-3630
| | - Ju-Hee Kim
- Department of Obstetrics and Gynecology, Seoul Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.-W.L.); (J.-Y.P.); (D.-S.S.); (D.-Y.K.); (S.-H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Young-Jae Lee
- Department of Obstetrics and Gynecology, Gangneung Asan Hospital, University of Ulsan College of Medicine, 38, Bangdonggil, Sacheon-myeon, Gangneung-si 25440, Gangwon-do, Korea;
| | - Shin-Wha Lee
- Department of Obstetrics and Gynecology, Seoul Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.-W.L.); (J.-Y.P.); (D.-S.S.); (D.-Y.K.); (S.-H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Jeong-Yeol Park
- Department of Obstetrics and Gynecology, Seoul Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.-W.L.); (J.-Y.P.); (D.-S.S.); (D.-Y.K.); (S.-H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Dae-Shik Suh
- Department of Obstetrics and Gynecology, Seoul Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.-W.L.); (J.-Y.P.); (D.-S.S.); (D.-Y.K.); (S.-H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Dae-Yeon Kim
- Department of Obstetrics and Gynecology, Seoul Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.-W.L.); (J.-Y.P.); (D.-S.S.); (D.-Y.K.); (S.-H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Sung-Hoon Kim
- Department of Obstetrics and Gynecology, Seoul Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.-W.L.); (J.-Y.P.); (D.-S.S.); (D.-Y.K.); (S.-H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Yong-Man Kim
- Department of Obstetrics and Gynecology, Seoul Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.-W.L.); (J.-Y.P.); (D.-S.S.); (D.-Y.K.); (S.-H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Young-Tak Kim
- Department of Obstetrics and Gynecology, Seoul Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.-W.L.); (J.-Y.P.); (D.-S.S.); (D.-Y.K.); (S.-H.K.); (Y.-M.K.); (Y.-T.K.)
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91
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Aninye IO, Laitner MH. Uterine Fibroids: Assessing Unmet Needs from Bench to Bedside. J Womens Health (Larchmt) 2021; 30:1060-1067. [PMID: 34410867 PMCID: PMC8432600 DOI: 10.1089/jwh.2021.0280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Uterine fibroids (leiomyomas) are noncancerous growths that can have deleterious effects on the health and quality of life for millions of women. Attempts to better understand the factors that influence prevalence and disparities associated with fibroids have been made; however, significant knowledge gaps continue to persist, which hinder care for individuals living with fibroids. The Society for Women's Health Research convened an interdisciplinary Uterine Fibroids Working Group to review the current state of knowledge about uterine fibroids and recommend areas in which to prioritize efforts to address research gaps and improve diagnosis, treatment, and access to care for patients with this chronic disease. Throughout a 2-day roundtable meeting, participants discussed updates on key literature, research, clinical practice, and public health data on uterine fibroids. Overarching themes and recommendations were identified and determined by consensus agreement of the participants at the conclusion of the meeting. Systematic studies of the etiology and pathology of uterine fibroids are needed to address important knowledge gaps and unmet clinical needs regarding the multifaceted management of fibroids and their effects on overall health and quality of life. The Working Group recommends addressing key deficits within the spheres of research, clinical care, and federal policy. Immediate needs include increasing research investment, improving fibroid assessment using pelvic imaging, implementing longitudinal study designs, addressing factors that contribute to disease disparities (especially among women of color), developing fertility-friendly treatment options, expanding awareness and education beyond gynecologic specialists, and advancing personalized patient care through shared decision-making approaches.
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Affiliation(s)
- Irene O Aninye
- Society for Women's Health Research, Washington, District of Columbia, USA
| | - Melissa H Laitner
- Society for Women's Health Research, Washington, District of Columbia, USA
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92
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Wesselink AK, Rosenberg L, Wise LA, Jerrett M, Coogan PF. A prospective cohort study of ambient air pollution exposure and risk of uterine leiomyomata. Hum Reprod 2021; 36:2321-2330. [PMID: 33984861 DOI: 10.1093/humrep/deab095] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/02/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION To what extent are ambient concentrations of particulate matter <2.5 microns (PM2.5), nitrogen dioxide (NO2) and ozone (O3) associated with risk of self-reported physician-diagnosed uterine leiomyomata (UL)? SUMMARY ANSWER In this large prospective cohort study of Black women, ambient concentrations of O3, but not PM2.5 or NO2, were associated with increased risk of UL. WHAT IS KNOWN ALREADY UL are benign tumors of the myometrium that are the leading cause of gynecologic inpatient care among reproductive-aged women. Black women are clinically diagnosed at two to three times the rate of white women and tend to exhibit earlier onset and more severe disease. Two epidemiologic studies have found positive associations between air pollution exposure and UL risk, but neither included large numbers of Black women. STUDY DESIGN, SIZE, DURATION We conducted a prospective cohort study of 21 998 premenopausal Black women residing in 56 US metropolitan areas from 1997 to 2011. PARTICIPANTS/MATERIAL, SETTING, METHODS Women reported incident UL diagnosis and method of confirmation (i.e. ultrasound, surgery) on biennial follow-up questionnaires. We modeled annual residential concentrations of PM2.5, NO2 and O3 throughout the study period. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for a one-interquartile range (IQR) increase in air pollutant concentrations, adjusting for confounders and co-pollutants. MAIN RESULTS AND THE ROLE OF CHANCE During 196 685 person-years of follow-up, 6238 participants (28.4%) reported physician-diagnosed UL confirmed by ultrasound or surgery. Although concentrations of PM2.5 and NO2 were not appreciably associated with UL (HRs for a one-IQR increase: 1.01 (95% CI: 0.93, 1.10) and 1.05 (95% CI: 0.95, 1.16), respectively), O3 concentrations were associated with increased UL risk (HR for a one-IQR increase: 1.19, 95% CI: 1.07, 1.32). The association was stronger among women age <35 years (HR: 1.26, 95% CI: 0.98, 1.62) and parous women (HR: 1.28, 95% CI: 1.11, 1.48). LIMITATIONS, REASONS FOR CAUTION Our measurement of air pollution is subject to misclassification, as monitoring data are not equally spatially distributed and we did not account for time-activity patterns. Our outcome measure was based on self-report of a physician diagnosis, likely resulting in under-ascertainment of UL. Although we controlled for several individual- and neighborhood-level confounding variables, residual confounding remains a possibility. WIDER IMPLICATIONS OF THE FINDINGS Inequitable burden of air pollution exposure has important implications for racial health disparities, and may be related to disparities in UL. Our results emphasize the need for additional research focused on environmental causes of UL. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the National Cancer Institute (U01-CAA164974) and the National Institute of Environmental Health Sciences (R01-ES019573). L.A.W. is a fibroid consultant for AbbVie, Inc. and accepts in-kind donations from Swiss Precision Diagnostics, Sandstone Diagnostics, FertilityFriend.com and Kindara.com for primary data collection in Pregnancy Study Online (PRESTO). M.J. declares consultancy fees from the Health Effects Institute (as a member of the review committee). The remaining authors declare they have no actual or potential competing financial interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lynn Rosenberg
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Slone Epidemiology Center, Boston University, Boston, MA, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Michael Jerrett
- Department of Environmental Health Sciences, University of California, Los Angeles, CA, USA
| | - Patricia F Coogan
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Slone Epidemiology Center, Boston University, Boston, MA, USA
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93
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High-Intensity Focused Ultrasound: A Review of Mechanisms and Clinical Applications. Ann Biomed Eng 2021; 49:1975-1991. [PMID: 34374945 DOI: 10.1007/s10439-021-02833-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/08/2021] [Indexed: 01/20/2023]
Abstract
High Intensity Focused Ultrasound (HIFU) is an emerging and increasingly useful modality in the treatment of cancer and other diseases. Although traditional use of ultrasound at lower frequencies has primarily been for diagnostic imaging purposes, the development of HIFU has allowed this particular modality to expand into therapeutic use. This non-invasive and acoustic method involves the use of a piezoelectric transducer to deliver high-energy pulses in a spatially coordinated manner, while minimizing damage to tissue outside the target area. This review describes the history of the development of diagnostic and therapeutic ultrasound and explores the biomedical applications utilizing HIFU technology including thermally ablative treatment, therapeutic delivery mechanisms, and neuromodulatory phenomena. The application of HIFU across various tumor types in multiple organ systems is explored in depth, with particular attention to successful models of HIFU in the treatment of various medical conditions. Basic mechanisms, preclinical models, previous clinical use, and ongoing clinical trials are comparatively discussed. Recent advances in HIFU across multiple medical fields reveal the growing importance of this biomedical technology for the care of patients and for the development of possible pathways for the future use of HIFU as a commonplace treatment modality.
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94
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Molecular and Cellular Insights into the Development of Uterine Fibroids. Int J Mol Sci 2021; 22:ijms22168483. [PMID: 34445194 PMCID: PMC8395213 DOI: 10.3390/ijms22168483] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/12/2022] Open
Abstract
Uterine leiomyomas represent the most common benign gynecologic tumor. These hormone-dependent smooth-muscle formations occur with an estimated prevalence of ~70% among women of reproductive age and cause symptoms including pain, abnormal uterine bleeding, infertility, and recurrent abortion. Despite the prevalence and public health impact of uterine leiomyomas, available treatments remain limited. Among the potential causes of leiomyomas, early hormonal exposure during periods of development may result in developmental reprogramming via epigenetic changes that persist in adulthood, leading to disease onset or progression. Recent developments in unbiased high-throughput sequencing technology enable powerful approaches to detect driver mutations, yielding new insights into the genomic instability of leiomyomas. Current data also suggest that each leiomyoma originates from the clonal expansion of a single transformed somatic stem cell of the myometrium. In this review, we propose an integrated cellular and molecular view of the origins of leiomyomas, as well as paradigm-shifting studies that will lead to better understanding and the future development of non-surgical treatments for these highly frequent tumors.
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95
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Berman JM, Bradley L, Hawkins SM, Levy B. Uterine Fibroids in Black Women: A Race-Stratified Subgroup Analysis of Treatment Outcomes After Laparoscopic Radiofrequency Ablation. J Womens Health (Larchmt) 2021; 31:593-599. [PMID: 34287028 PMCID: PMC9063135 DOI: 10.1089/jwh.2020.9001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The disease and treatment burden of uterine fibroids (UF) in Black women is substantially greater compared with other racial groups, with higher rates of complications and poorer outcomes with both hysterectomy and myomectomy. The inequities in the access Black women have to minimally invasive routes of surgery contribute to their burden of illness. Laparoscopic radiofrequency ablation (LAP-RFA) is a minimally invasive, safe, and effective uterine-sparing treatment option. Methods: This subgroup analysis of the LAP-RFA Pivotal Trial stratified outcomes by race comparing White women (n = 28, 21%) versus Black women (n = 46, 34%). Results: At baseline, Black women had more fibroids on average (7.3 vs. 3.7; P ≤ 0.001), a greater symptom severity score (SSS) (P ≤ 0.001), and a lower health-related quality of life (HRQoL) score (P = 0.005) than White women. At 36 months post-treatment with LAP-RFA, the statistical differences that existed with baseline SSS and HRQoL score were eliminated between Black and White women. Menstrual blood loss (140.1 mL vs. 127.02 mL; P = 0.44) and mean fibroid volume reduction (47.5 cm3 vs. 36.0 cm3; P = 0.17) were similar between Black and White women at 12 months. Although not statistically significant, the intraoperative total blood loss and uterine blood loss was lower in Black women than White women, despite greater operative time (160 minutes vs. 137 minutes; P = 0.09). Conclusions: These results are promising in providing an alternative uterine-sparing option for Black women and may help to provide a minimally invasive option that can address some of the racial inequities in care for Black women with UF.
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Affiliation(s)
- Jay M Berman
- Wayne State University Medical School, Detroit, Michigan, USA
| | - Linda Bradley
- Department of OB-GYN and Reproductive Biology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Soyini M Hawkins
- Fibroid and Pelvic Wellness Center of Georgia, Peachtree Corners, Georgia, USA
| | - Barbara Levy
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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96
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Mandeville JS, Best DAJ, Waterman F. Characterizing the impact of menstrual and pelvic health disorders in a convenience sample of women in Barbados. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2021. [DOI: 10.1177/22840265211024437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To describe the impact of menstrual and pelvic health disorders on a sample of Barbadian women living with one or more disorders. Design and methods: Responses from a survey taken online by a sample of women living in Barbados (⩾18 years) were assessed. Variables collected included, age, disorder(s) diagnosed, and symptoms. The Work Productivity and Activity Impairment (WPAI) Questionnaire: Specific Health Problem, was administered to measure impact on work and other activities. T-tests, chi- square tests, odds ratios, ANOVA, and multivariate analysis were conducted to estimate the associations between patient characterization, disorder characteristics and outcomes. Results: A total of 247 unique responses were received and after data were reviewed 192 responses (77.7%) from this convenience sample were analyzed. Polycystic Ovary Syndrome was the most frequently reported diagnosis (34.7%). The most frequently reported symptom was fatigue (53%). There was an OR of 2.17 (95% CI 0.54–8.74) of missing work due to menorrhagia and 2.60 (95% CI: 1.31–5.17) of missing work if diagnosed with endometriosis. The WPAI revealed endometriosis to be the condition with the most substantial impact on work in the subgroup of persons with one diagnosis, with presenteeism of 49.2%, absenteeism of 13.3% and an impact on other activities of 56.4%. Conclusion: Pelvic and menstrual disorders have a significant impact on productivity and other activities of Barbadian women. More research is necessary to elucidate the impacts of menstrual and pelvic disorders and treatments on patient outcomes.
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Affiliation(s)
| | - Damian AJ Best
- Faculty of Medical Sciences, University of the West Indies Cave Hill Campus, Bridgetown, St. Michael, Barbados
| | - Fanta Waterman
- Serrette Brown Research and Consulting, LLC, Danbury, CT, USA
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97
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Zia G, Sebek J, Schenck J, Prakash P. Transcervical microwave ablation in type 2 uterine fibroids via a hysteroscopic approach: analysis of ablation profiles. Biomed Phys Eng Express 2021; 7. [PMID: 33975302 DOI: 10.1088/2057-1976/abffe4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/11/2021] [Indexed: 12/12/2022]
Abstract
Type 2 uterine fibroids are challenging to resect surgically as ≥ 50% volume of myoma lies within the myometrium. A hysteroscopic approach for ablating fibroids is minimally-invasive, but places a considerable burden on the operator to accurately place the ablation applicator within the target. We investigated the sensitivity of transcervical microwave ablation outcome with respect to position of the ablation applicator within 1 - 3 cm type 2 fibroids.Methods:A finite element computer model was developed to simulate 5.8 GHz microwave ablation of fibroids and validated with experiments inex vivotissue. The ablation outcome was evaluated with respect to applicator insertion angles (30°, 45°, 60°) , depth and offset from the fibroid center (±2 mm for 3 cm fibroid and ±1 mm for 1 cm fibroid) with 35 W and 15 W applied power for 3 cm and 1 cm fibroids, respectively. Power deposition was stopped when thermal dose of 40 cumulative equivalent minutes at 43 °C (CEM43) was accrued in adjacent myometrium.Results:Within the range of all evaluated insertion angles, depths and offsets, the ablation coverage was less sensitive to variation in angle as compared to depth and offset, and ranged from 34.9 - 83.6% for 3 cm fibroid in 140 - 400 s and 34.1 - 67.9% for 1 cm fibroid in 30 - 50 s of heating duration. Maximum achievable ablation coverage in both fibroid cases reach ∼ 90% if thermal dose is allowed to exceed 40 CEM43 in myometrium.Conclusion:The study demonstrates the technical feasibility of transcervical microwave ablation for fibroid treatment and the relationship between applicator position within the fibroid and fraction of fibroid that can be ablated while limiting thermal dose in adjacent myometrium.
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Affiliation(s)
- Ghina Zia
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, Kansas, United States of America
| | - Jan Sebek
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, Kansas, United States of America.,Department of Circuit Theory, Czech Technical University in Prague, Prague, Czech Republic
| | - Jessica Schenck
- Hologic, Inc., Marlborough, Massachusetts, United States of America
| | - Punit Prakash
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, Kansas, United States of America
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98
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Magnetic Resonance-Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids-Efficiency Assessment with the Use of Dynamic Contrast-Enhanced Magnetic Resonance Imaging and the Potential Role of the Administration of Uterotonic Drugs. Diagnostics (Basel) 2021; 11:diagnostics11040715. [PMID: 33923667 PMCID: PMC8072686 DOI: 10.3390/diagnostics11040715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The assessment of the usefulness of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) when qualifying patients with uterine fibroids (UFs) for magnetic resonance-guided high-intensity ultrasound (MR-HIFU). MATERIAL AND METHODS This retrospective, single center study included 283 women who underwent DCE-MRI and were treated with MR-HIFU. The patients were divided according to non-perfused volume (NPV) as well as by the type of curve for patients with a washout curve in the DCE-MRI study and patients without a washout curve. The studied women were assessed in three groups according to the type of uterotonics administered. Group A (57 patients) received one dose of misoprostol/diclofenac transvaginally and group B (71 patients) received oxytocin intravenously prior to the MR-HIFU procedure. The remaining 155 women (group C) were treated with the traditional non-drug enhanced MR-HIFU procedure. RESULTS The average NPV value was higher in no washout group, and depended on the uterotonics used. CONCLUSIONS We demonstrated a correlation between dynamic contrast enhancement curve types and the therapeutic efficacy of MR-HIFU. Our results suggest that DCE-MRI has the potential to assess treatment outcomes among patients with UFs, and patients with UFs that present with a washout curve may benefit from the use of uterotonic drugs. More studies are required to draw final conclusions.
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99
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Falahati Z, Mohseni-Dargah M, Mirfakhraie R. Emerging Roles of Long Non-coding RNAs in Uterine Leiomyoma Pathogenesis: a Review. Reprod Sci 2021; 29:1086-1101. [PMID: 33844188 DOI: 10.1007/s43032-021-00571-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/01/2021] [Indexed: 01/19/2023]
Abstract
Uterine leiomyoma (UL), as the most prevalent type of women's health disorders, is a benign tumor that originates from the smooth muscle cell layer of the uterus. A great number of associated complications are observed including infertility, miscarriage, bleeding, pain, dysmenorrhea, menorrhagia, and dyspareunia. Although the etiology of UL is largely undefined, environmental and genetic factors are witnessed to engage in the UL development. As long non-coding RNAs (lncRNAs) are involved in various types of cellular functions, in recent years, a great deal of attention has been drawn to them and their possible roles in UL pathogenesis. Moreover, they have illustrated their potential to be promising candidates for UL treatment. In this review paper, firstly, an overview of UL pathogenesis is presented. Then, the regulation of lncRNAs in UL and their possible mechanisms in cancer development are reviewed. Eventually, therapeutic approaches targeting lncRNAs in various cancers and UL are explored.
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Affiliation(s)
- Zahra Falahati
- Department of Biological Sciences, Institute for Advanced Studies in Basic Sciences (IASBS), Zanjan, Iran
| | - Masoud Mohseni-Dargah
- Department of Biochemistry, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
- School of Engineering, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Reza Mirfakhraie
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Koodakyar St., Velenjak Ave, Chamran Highway, Tehran, Iran.
- Genomic Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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100
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Osuga Y, Nakano Y, Yamauchi Y, Takanashi M. Ulipristal acetate compared with leuprorelin acetate for Japanese women with symptomatic uterine fibroids: a phase III randomized controlled trial. Fertil Steril 2021; 116:189-197. [PMID: 33715871 DOI: 10.1016/j.fertnstert.2021.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of ulipristal acetate (UPA) for uterine fibroids (UFs), a phase III study was conducted with leuprorelin (LEU) as a comparator. This is the first confirmatory trial of UPA for UFs among Asians. DESIGN Multicenter, randomized, double-blind, double-dummy, parallel-group study. SETTING Thirty-two sites in Japan. PATIENT(S) Patients were assigned to 2 arms, with 82 patients in the UPA group and 79 patients in the LEU group. INTERVENTION(S) In the UPA group, 10 mg of UPA was orally administered once a day for 12 weeks. In the LEU group, 1.88 mg or 3.75 mg of LEU was subcutaneously administered at weeks 0, 4, and 8. MAIN OUTCOME MEASURE(S) The primary endpoint was the percentage of patients with amenorrhea for 35 days. For safety evaluation, adverse events (AEs) were recorded. RESULT(S) The percentage of patients with amenorrhea for 35 days was 87.0% in the UPA group and 81.8% in the LEU group, and the efficacy of UPA for causing amenorrhea for 35 days was confirmed to be noninferior to that of LEU. AEs occurred in 78.0% of the patients in the UPA group and 88.8% of the patients in the LEU group. CONCLUSION(S) The effect of UPA on heavy menstrual bleeding was shown to be comparable with that of LEU in Japanese patients with symptomatic UFs. No notable AEs occurred because of the UPA treatment, and the incidence of AEs in the UPA group was comparable with that of AEs in the LEU group. This result demonstrates the clinical utility of UPA for Asians.
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Affiliation(s)
- Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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