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Laganà AS, Etrusco A, Haydamous J, Semaan S, Agrifoglio V, Chiantera V, Vitagliano A, Riemma G, D'Amato A, Montagna E. Efficacy of letrozole for the treatment of tubal ectopic pregnancy: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2024; 299:322-328. [PMID: 38968783 DOI: 10.1016/j.ejogrb.2024.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/25/2024] [Accepted: 06/30/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Tubal ectopic pregnancy (EP) is a life-threatening condition, especially if undiagnosed or misdiagnosed, tipically in low income countries and/or where women have limited access to health care. The current management protocol of tubal EP consists of either surgical management, or medical management with methotrexate. Recent studies, while few, have suggested that letrozole, an aromatase inhibitor, may play a role in the medical treatment of tubal EP. OBJECTIVES To evaluate the effectiveness of letrozole alone in the medical treatment of tubal EP. SEARCH STRATEGY Electronic databases were searched until 31 December 2023. SELECTION CRITERIA Retrospective or prospective studies reporting the treatment of tubal EP with letrozole alone were considered eligible for inclusion. DATA COLLECTION AND ANALYSIS Pooled results were expressed as OR with 95 %CI. Heterogeneity was assessed using Higgins I2. Subgroup analysis was performed to compare outcomes according to time after intervention. Subgroup differences were checked through χ2 test. RESULTS A total of 152 patients were included. Seventy-nine patients (51.97 %) were treated with letrozole, 39 patients (16.54 %) with methotrexate, and 34 patients (31.49 %) underwent surgical treatment. Pooled data analysis supports the consistency of the effect of letrozole in reducing β-hCG over time at a comparable rate among studies, and that treatment with letrozole is superior to surgery and has the same efficacy as methotrexate. However, all the included studies were judged at high risk of bias in terms of study design, sample representativeness, and sampling technique. Furthermore, short and long term side effects were not reported in any of the included studies. CONCLUSIONS Letrozole is a promising alternative to methotrexate and surgical therapy in the treatment of tubal EP. Although this meta-analysis suggests efficacy and low hazard of the drug and encourages its application, the data available today remain extremely sparse, which weakens any claims that can be made, and is not sufficient to assert that letrozole is safe and effective in the treatment of EPs. There is an absolute need for randomized studies with accurate patient selection, fixed doses, large sample sizes, and reporting of short- and long-term side effects to refute or confirm this assumption.
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Affiliation(s)
- Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, 90127 Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy
| | - Andrea Etrusco
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, 90127 Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy
| | - Joe Haydamous
- Department of Obstetrics Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UT Health), 77030 Houston, United States
| | - Samar Semaan
- Department of Obstetrics Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UT Health), 77030 Houston, United States
| | - Vittorio Agrifoglio
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, 90127 Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy; Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", 80131 Naples, Italy
| | - Amerigo Vitagliano
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari "Aldo Moro", Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Van-vitelli", 80138 Naples, Italy
| | - Antonio D'Amato
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari "Aldo Moro", Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Erik Montagna
- Postgraduation Program in Health Sciences, Faculdade de Medicina do ABC/Centro Universitário FMABC, 09060-870 Santo André, Brazil
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Tarafdari A, Eslami Khotbesara S, Keikha F, Parsaei M, Poorabdoli M, Chill HH, Hadizadeh A. Comparing the effectiveness of letrozole versus methotrexate for treatment of ectopic pregnancy: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2024; 299:219-224. [PMID: 38901084 DOI: 10.1016/j.ejogrb.2024.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/13/2024] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE To evaluate the efficacy of two different regimens of Letrozole, an aromatase inhibitor, in the management of ectopic pregnancy compared to methotrexate. STUDY DESIGN This randomized controlled trial was conducted on 88 women diagnosed with ectopic pregnancy with a baseline level of serum beta-human chorionic gonadotropin under 3000 mIU/mL between June 30, 2023, and December 30, 2023, at the Department of Obstetrics and Gynecology of the Vali-e-Asr Hospital affiliated with Tehran University of Medical Sciences. Participants were allocated into either methotrexate (n = 43), 5-day course Letrozole (n = 24), or 10-day course Letrozole (n = 21) treatments. The methotrexate group received a single dose of 50 mg/m2 dosage intramuscular methotrexate. The 5-day Letrozole group received a 2.5 mg Letrozole tablet three times daily for 5 days, whereas the 10-day Letrozole group received a 2.5 mg Letrozole tablet twice daily for 10 days. The primary outcome was the treatment response, defined as the achievement of a negative serum beta-human chorionic level without the need for additional methotrexate treatment or surgery. The secondary outcomes were the need for additional methotrexate dose or laparoscopic surgery intervention. The trial protocol was prospectively registered in ClinicalTrials.gov with code NCT05918718. RESULTS The treatment response rates in methotrexate, 5-day Letrozole, and 10-day Letrozole groups were 76.7 %, 75.0 %, and 90.5 %, respectively, with no significant differences between the groups (P-value = 0.358). A total of 10 (23.3 %) patients from the methotrexate group, 3 (12.5 %) from the 5-day Letrozole group, and 2 (9.5 %) from the 10-day Letrozole group required an additional methotrexate dose, with no significant differences between the groups (P-value = 0.307). Furthermore, only 3 (12.5 %) patients, all from the 5-day Letrozole group, were suspected of tubal rupture and underwent surgery (P-value = 0.016). CONCLUSION Our findings suggest Letrozole as a safe alternative to methotrexate in treating stable ectopic pregnancies, with a favorable treatment response rate. However, there is still a need for future larger studies to determine the applicability of Letrozole in the EP management. Also, the non-significant higher effectiveness of the 10-day Letrozole regimen than the 5-day Letrozole group underscores the need for future research to determine the optimal Letrozole regimen for the management of ectopic pregnancy.
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Affiliation(s)
- Azadeh Tarafdari
- Department of Obstetrics and Gynecology, Vali-e-Asr Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Eslami Khotbesara
- Department of Obstetrics and Gynecology, Vali-e-Asr Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Keikha
- Department of Obstetrics and Gynecology, Vali-e-Asr Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadamin Parsaei
- Breastfeeding Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Maternal, Fetal & Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Marzie Poorabdoli
- Department of Obstetrics and Gynecology, Vali-e-Asr Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Henry H Chill
- Female Pelvic Medicine and Reconstructive Surgery (FPMRS) Division, University of Chicago Pritzker School of Medicine, Northshore University HealthSystem, Skokie, IL, USA
| | - Alireza Hadizadeh
- Female Pelvic Medicine and Reconstructive Surgery (FPMRS) Division, University of Chicago Pritzker School of Medicine, Northshore University HealthSystem, Skokie, IL, USA
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Vannuccini S, Petraglia F, Carmona F, Calaf J, Chapron C. The modern management of uterine fibroids-related abnormal uterine bleeding. Fertil Steril 2024; 122:20-30. [PMID: 38723935 DOI: 10.1016/j.fertnstert.2024.04.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 06/21/2024]
Abstract
Uterine fibroids (UFs) are the most common female benign pelvic tumors, affecting >60% of patients aged 30-44 years. Uterine fibroids are asymptomatic in a large percentage of cases and may be identified incidentally using a transvaginal ultrasound or a magnetic resonance imaging scan. However, in approximately 30% of cases, UFs affect the quality of life and women's health, with abnormal uterine bleeding and heavy menstrual bleeding being the most common complaints, along with iron deficiency (ID) and ID anemia. Medical treatments used for UFs-related abnormal uterine bleeding include symptomatic agents, such as nonsteroidal antiinflammatory drugs and tranexamic acid, and hormonal therapies, including combined oral contraceptives, gonadotropin-releasing hormone agonists or antagonists, levonorgestrel intrauterine systems, selective progesterone receptor modulators, and aromatase inhibitors. Nevertheless, few drugs are approved specifically for UF treatment, and most of them manage the symptoms. Surgical options include fertility-sparing treatments, such as myomectomy, or nonconservative options, such as hysterectomy, especially in perimenopausal women who are not responding to any treatment. Radiologic interventions are also available: uterine artery embolization, high-intensity focused ultrasound or magnetic resonance-guided focused ultrasound, and radiofrequency ablation. Furthermore, the management of ID and ID anemia, as a consequence of acute and chronic bleeding, should be taken into account with the use of iron replacement therapy both during medical treatment and before and after a surgical procedure. In the case of symptomatic UFs, the location, size, multiple UFs, or coexistent adenomyosis should guide the choice with a shared decision-making process, considering long- and short-term treatment goals expected by the patient, including pregnancy desire or wish to preserve the uterus independently of reproductive goals.
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Affiliation(s)
- Silvia Vannuccini
- Division of Obstetrics and Gynecology, Department of Experimental, Clinical, and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy.
| | - Felice Petraglia
- Division of Obstetrics and Gynecology, Department of Experimental, Clinical, and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Francisco Carmona
- Department of Obstetrics and Gynecology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Joaquim Calaf
- Hospital Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Charles Chapron
- Département de Gynécologie, Obstétrique et Médecine de la Reproduction, Faculté de Santé, Faculté de Médicine Paris Centre, Centre Hospitalier Universitaire (CHU), Université Paris-Cité, Paris, France
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Capezzuoli T, Aslan B, Vannuccini S, Orlandi G, La Torre F, Sorbi F, Fambrini M, Petraglia F. Recurrence of Uterine Fibroids After Conservative Surgery or Radiological Procedures: a Narrative Review. Reprod Sci 2024; 31:1171-1178. [PMID: 38110820 DOI: 10.1007/s43032-023-01418-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/29/2023] [Indexed: 12/20/2023]
Abstract
The present narrative review aims to discuss the available data on the incidence and the risk factors of uterine fibroids (UFs) recurrence after different types of conservative surgical or radiologic procedures in women wishing to preserve their uterus. UFs are the most common benign tumors in women all over the world. Clinical presentation, including abnormal uterine bleeding (AUB), pelvic pain, bulky symptoms, and infertility affect patients' quality of life, and a large variety of conservative treatments are available especially for those with desire of pregnancy. Fertility sparing surgery, by either laparoscopy, hysteroscopy or laparotomy, or radiological interventions (uterine artery embolization, high-intensity focused ultrasound or magnetic resonance-guided focused ultrasound), are the most common therapeutic approaches. However, the genetic or acquired predisposition to UFs remain despite the treatments, and the recurrences are frequently described in a large percentage of patients. The most relevant risk factors for recurrence of UFs are young age at the first surgery, incomplete fibroid resection, the presence of multiple lesions, an enlarged uterus, and the coexistence with other pelvic diseases. The discussion on the possible medical strategy to reduce the recurrence is an open field of clinical investigation, in particular by using hormonal drugs.
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Affiliation(s)
- Tommaso Capezzuoli
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Batuhan Aslan
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Silvia Vannuccini
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Gretha Orlandi
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Francesco La Torre
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Flavia Sorbi
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Massimiliano Fambrini
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy.
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Wynn AB, Shultz RL, Dayton EF, Farmer K. Prolapse of a Large Degenerating Uterine Leiomyoma: A Case Report. Cureus 2024; 16:e60622. [PMID: 38894786 PMCID: PMC11182761 DOI: 10.7759/cureus.60622] [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: 03/27/2024] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
Uterine leiomyomas (ULs) are common benign tumors seen in a large percent of women that can be classified based on their location within the uterus. They can cause a number of pelvic complications and can be managed medically, but more often surgically. Uterine pyomyomas often occur postpartum, possibly from infarction, and can lead to degeneration and sepsis. Our patient presents with a two-month development of a potential pyomyoma, found initially on computed tomography (CT). Office exam reveals a protruding mass from the cervical os, and removal was attempted but ultimately postponed for general anesthesia exam due to pain. The leiomyoma was removed and shown to be necrosing. Pyomyomas are often insidious and can often mimic other concerning pathologies. Modern imaging can show lesions within the pelvis but struggle to determine between fluid collection and possible infarcted masses. The importance of quality care measures in cases like this deserve to be emphasized to prevent serious complications.
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Affiliation(s)
- Austin B Wynn
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Rachel L Shultz
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Emily F Dayton
- Department of Obstetrics and Gynecology, Florida State University College of Medicine, Tallahassee, USA
| | - Kenneth Farmer
- Department of Obstetrics and Gynecology, Southeast Health Medical Center, Dothan, USA
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Inácio Â, Aguiar L, Rodrigues B, Pires P, Ferreira J, Bilhim T, Pisco J, Bicho M, Clara Bicho M. Leiomyoma and the importance of genetic variation on genes related to the vasculature system - CβS, MTHFR, NOS3, CYBA, and ACE1. Eur J Obstet Gynecol Reprod Biol 2024; 294:65-70. [PMID: 38218160 DOI: 10.1016/j.ejogrb.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/29/2023] [Accepted: 01/07/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE The link between the systemic vasculature system and tumor biology is here investigated by studying the contribution of CβS (844ins68), MTHFR (677C > T), NOS3 (4a/4b), CYBA (C242T), and ACE1 (I/D) genes to leiomyoma onset, uterus and leiomyoma volumes. METHODS DNA samples from 130 women with leiomyomas and 527 from healthy women were genotyped by PCR or PCR-RFLP. Qui-square (χ2) or Fisher's exact test were used to test associations. All the mentioned tests were performed in IBM® SPSS® Statistics Version 28. Statistical significance was defined as a p-value < 0.05. RESULTS Results revealed that CβS (in the codominant and allelic models, p = 0.044 and, p = 0.015, OR = 1.791 [1.114-2.879], respectively), MTHFR (in the codominant, allelic and dominant models, p = 0.009, p = 0.002, OR = 0.585 [0.416-0.824] and p = 0.003, OR = 0.527 [0.346-0.802], respectively) and ACE1 (dominant model, p = 0.045, OR = 0.639 [0.411-0.992]) genes are associated with leiomyoma onset. NOS3 4a4a genotype is associated with a lower uterus volume (p = 0.004). This study also uncovers intriguing epistatic interactions among some genes that further accentuate their roles in disease modulation. Indeed, the epistatic interactions between the CC genotype (MTHFR) and (+/+) (CβS; p = 0.003), 4b4b (NOS3; p = 0.006, OR = 2.050 [1.223-3.439]) or DD (ACE1; p < 0.001, OR = 2.362 [1.438-3.880]) were shown to be associated with the disease, while 4a presence (NOS3) in epistasis with I presence (ACE1), increased the effect protection having just the I allele presence (p = 0.029, OR = 0.446 [0.214-0.930]). CONCLUSIONS We conclude that variation in genes related to the systemic vascular system can play a role in the onset and development of leiomyoma.
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Affiliation(s)
- Ângela Inácio
- Instituto de Investigação Científica Bento da Rocha Cabral, Calçada Bento Rocha Cabral, 14, 1257-047 Lisboa, Portugal; Laboratório de Genética, Faculdade de Medicina da Universidade de Lisboa, Avenida Egas Moniz, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal; Instituto de Saúde Ambiental, Laboratório Associado TERRA, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.
| | - Laura Aguiar
- Instituto de Investigação Científica Bento da Rocha Cabral, Calçada Bento Rocha Cabral, 14, 1257-047 Lisboa, Portugal; Laboratório de Genética, Faculdade de Medicina da Universidade de Lisboa, Avenida Egas Moniz, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal; Instituto de Saúde Ambiental, Laboratório Associado TERRA, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Beatriz Rodrigues
- Instituto de Investigação Científica Bento da Rocha Cabral, Calçada Bento Rocha Cabral, 14, 1257-047 Lisboa, Portugal; Laboratório de Genética, Faculdade de Medicina da Universidade de Lisboa, Avenida Egas Moniz, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Patrícia Pires
- Instituto de Investigação Científica Bento da Rocha Cabral, Calçada Bento Rocha Cabral, 14, 1257-047 Lisboa, Portugal; Laboratório de Genética, Faculdade de Medicina da Universidade de Lisboa, Avenida Egas Moniz, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Joana Ferreira
- Instituto de Investigação Científica Bento da Rocha Cabral, Calçada Bento Rocha Cabral, 14, 1257-047 Lisboa, Portugal; Laboratório de Genética, Faculdade de Medicina da Universidade de Lisboa, Avenida Egas Moniz, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal; Instituto de Saúde Ambiental, Laboratório Associado TERRA, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Tiago Bilhim
- Serviço de Radiologia de Intervenção do Hospital Saint Louis, R. Luz Soriano 182, 1200-249 Lisboa, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - João Pisco
- Serviço de Radiologia de Intervenção do Hospital Saint Louis, R. Luz Soriano 182, 1200-249 Lisboa, Portugal
| | - Manuel Bicho
- Instituto de Investigação Científica Bento da Rocha Cabral, Calçada Bento Rocha Cabral, 14, 1257-047 Lisboa, Portugal; Laboratório de Genética, Faculdade de Medicina da Universidade de Lisboa, Avenida Egas Moniz, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal; Instituto de Saúde Ambiental, Laboratório Associado TERRA, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Maria Clara Bicho
- Instituto de Saúde Ambiental, Laboratório Associado TERRA, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal; Instituto de Medicina Preventiva e Saúde Publica, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
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Ma Y, Li L, Yu L, He W, Yi L, Tang Y, Li J, Zhong Z, Wang M, Huang S, Xiong Y, Xiao P, Huang Y. Optimization of Diagnosis-Related Groups for 14,246 Patients with Uterine Leiomyoma in a Single Center in Western China Using a Machine Learning Model. Risk Manag Healthc Policy 2024; 17:473-485. [PMID: 38444948 PMCID: PMC10913598 DOI: 10.2147/rmhp.s442502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024] Open
Abstract
Background Uterine leiomyoma (UL) is one of the most common benign tumors in women, and its incidence is gradually increasing in China. The clinical complications of UL have a negative impact on women's health, and the cost of treatment poses a significant burden on patients. Diagnosis-related groups (DRG) are internationally recognized as advanced healthcare payment management methods that can effectively reduce costs. However, there are variations in the design and grouping rules of DRG policies across different regions. Therefore, this study aims to analyze the factors influencing the hospitalization costs of patients with UL and optimize the design of DRG grouping schemes to provide insights for the development of localized DRG grouping policies. Methods The Mann-Whitney U-test or the Kruskal-Wallis H-test was employed for univariate analysis, and multiple stepwise linear regression analysis was utilized to identify the primary influencing factors of hospitalization costs for UL. Case combination classification was conducted using the exhaustive chi-square automatic interactive detection (E-CHAID) algorithm within a decision tree framework. Results Age, occupation, number of hospitalizations, type of medical insurance, Transfer to other departments, length of stay (LOS), type of UL, admission condition, comorbidities and complications, type of primary procedure, other types of surgical procedures, and discharge method had a significant impact on hospitalization costs (P<0.05). Among them, the type of primary procedure, other types of surgical procedures, and LOS were the main factors influencing hospitalization costs. By incorporating the type of primary procedure, other types of surgical procedures, and LOS into the decision tree model, patients were divided into 11 DRG combinations. Conclusion Hospitalization costs for UL are mainly related to the type of primary procedure, other types of surgical procedures, and LOS. The DRG case combinations of UL based on E-CHAID algorithm are scientific and reasonable.
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Affiliation(s)
- Yuan Ma
- Department of Medical Record Management, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, People’s Republic of China
| | - Li Li
- Department of Medical Record Management, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Li Yu
- Department of Medical Record Management, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Wei He
- Department of Medical Record Management, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Ling Yi
- Department of Medical Record Management, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yuxin Tang
- Department of Medical Record Management, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jijie Li
- Department of Medical Record Management, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Zhigang Zhong
- Department of Prevention, Office of Cancer Prevention and Treatment, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Cancer Hospital Affiliate to University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
| | - Meixian Wang
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Shiyao Huang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, People’s Republic of China
| | - Yiquan Xiong
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, People’s Republic of China
| | - Pei Xiao
- Medical Insurance Office, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yuxiang Huang
- Department of Medical Record Management, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Vafaei S, Ciebiera M, Omran MM, Ghasroldasht MM, Yang Q, Leake T, Wolfe R, Ali M, Al-Hendy A. Evidence-Based Approach for Secondary Prevention of Uterine Fibroids (The ESCAPE Approach). Int J Mol Sci 2023; 24:15972. [PMID: 37958957 PMCID: PMC10648339 DOI: 10.3390/ijms242115972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Uterine fibroids (UFs) are common tumors in women of reproductive age. It is imperative to comprehend UFs' associated risk factors to facilitate early detection and prevention. Simple relying on surgical/pharmacological treatment of advanced disease is not only highly expensive, but it also deprives patients of good quality of life (QOL). Unfortunately, even if the disease is discovered early, no medical intervention is traditionally initiated until the disease burden becomes high, and only then is surgical intervention performed. Furthermore, after myomectomy, the recurrence rate of UFs is extremely high with the need for additional surgeries and other interventions. This confused approach is invasive and extremely costly with an overall negative impact on women's health. Secondary prevention is the management of early disease to slow down its progression or even halt it completely. The current approach of watchful observation for early disease is considered a major missed opportunity in the literature. The aim of this article is to present an approach named the ESCAPE (Evidence-Based Approach for Secondary Prevention) of UF management. It comprises simple, inexpensive, and safe steps that can arrest the development of UFs, promote overall reproductive health, decrease the number of unnecessary surgeries, and save billions of health care systems' dollars worldwide.
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Affiliation(s)
- Somayeh Vafaei
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (S.V.); (M.M.O.); (M.M.G.); (Q.Y.)
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, 00-189 Warsaw, Poland;
- Warsaw Institute of Women’s Health, 00-189 Warsaw, Poland
- Development and Research Center of Non-Invasive Therapies, Pro-Familia Hospital, 35-302 Rzeszow, Poland
| | - Mervat M. Omran
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (S.V.); (M.M.O.); (M.M.G.); (Q.Y.)
| | - Mohammad Mousaei Ghasroldasht
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (S.V.); (M.M.O.); (M.M.G.); (Q.Y.)
| | - Qiwei Yang
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (S.V.); (M.M.O.); (M.M.G.); (Q.Y.)
| | - Tanya Leake
- The White Dress Project, Atlanta, GA 30309, USA; (T.L.); (R.W.)
| | - Rochelle Wolfe
- The White Dress Project, Atlanta, GA 30309, USA; (T.L.); (R.W.)
| | - Mohamed Ali
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (S.V.); (M.M.O.); (M.M.G.); (Q.Y.)
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (S.V.); (M.M.O.); (M.M.G.); (Q.Y.)
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Huerga López C, Gutiérrez Alagüero A, Cristóbal García I. Management of uterine fibroids: Approach to medical treatment. Med Clin (Barc) 2023; 161 Suppl 1:S15-S21. [PMID: 37923509 DOI: 10.1016/j.medcli.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 06/03/2023] [Accepted: 06/27/2023] [Indexed: 11/07/2023]
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10
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Obrzut B, Kijowska M, Obrzut M, Mrozek A, Darmochwał-Kolarz D. Contained Power Morcellation in Laparoscopic Uterine Myoma Surgeries: A Brief Review. Healthcare (Basel) 2023; 11:2481. [PMID: 37761678 PMCID: PMC10531049 DOI: 10.3390/healthcare11182481] [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: 08/13/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Uterine fibromas are the most common benign uterine tumors. Although the majority of leiomyomas remain asymptomatic, they can cause serious clinical problems, including abnormal uterine bleeding, pelvic pain, and infertility, which require effective gynecological intervention. Depending on the symptoms as well as patients' preferences, various treatment options are available, such as medical therapy, non-invasive procedures, and surgical methods. Regardless of the extent of the surgery, the preferred option is the laparoscopic approach. To reduce the risk of spreading occult malignancy and myometrial cells associated with fragmentation of the specimen before its removal from the peritoneal cavity, special systems for laparoscopic contained morcellation have been developed. The aim of this review is to present the state-of-the-art contained morcellation. Different types of available retrieval bags are demonstrated. The advantages and difficulties associated with contained morcellation are described. The impact of retrieval bag usage on the course of surgery, as well as the effects of the learning curve, are discussed. The role of contained morcellation in the overall strategy to optimize patient safety is highlighted.
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Affiliation(s)
- Bogdan Obrzut
- Department of Obstetrics and Gynecology, Institute of Medical Sciences, Medical College, University of Rzeszów, Rejtana 16 C, 35-959 Rzeszow, Poland
| | - Marta Kijowska
- Department of Obstetrics and Gynecology, Provincial Clinical Hospital No. 2 Rzeszow, Lwowska 60, 35-301 Rzeszow, Poland
| | - Marzanna Obrzut
- Institute of Health Sciences, Medical College, University of Rzeszow, Warzywna 1a, 35-310 Rzeszow, Poland
| | - Adam Mrozek
- Department of Obstetrics and Gynecology, Institute of Medical Sciences, Medical College, University of Rzeszów, Rejtana 16 C, 35-959 Rzeszow, Poland
| | - Dorota Darmochwał-Kolarz
- Department of Obstetrics and Gynecology, Institute of Medical Sciences, Medical College, University of Rzeszów, Rejtana 16 C, 35-959 Rzeszow, Poland
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Ahmad A, Kumar M, Bhoi NR, Akhtar J, Khan MI, Ajmal M, Ahmad M. Diagnosis and management of uterine fibroids: current trends and future strategies. J Basic Clin Physiol Pharmacol 2023; 34:291-310. [PMID: 36989026 DOI: 10.1515/jbcpp-2022-0219] [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: 08/18/2022] [Accepted: 02/25/2023] [Indexed: 03/30/2023]
Abstract
Uterine fibroids (UFs), leiomyomas or myomas, are a type of malignancy that affects the smooth muscle of the uterus, and it is most commonly detected in women of reproductive age. Uterine fibroids are benign monoclonal growths that emerge from uterine smooth muscle cells (myometrium) as well as fibroblasts. Uterine fibroid symptoms include abnormal menstrual bleeding leading to anaemia, tiredness, chronic vaginal discharge, and pain during periods. Other symptoms include protrusion of the abdomen, pain during intercourse, dysfunctions of bladder/bowel leading to urinary incontinence/retention, pain, and constipation. It is also associated with reproductive issues like impaired fertility, conceiving complications, and adverse obstetric outcomes. It is the leading cause of gynaecological hospitalisation in the American subcontinent and a common reason for the hysterectomy. Twenty-five percent of the reproductive women experience the symptoms of uterine fibroids, and among them, around 25% require hospitalization due to the severity of the disease. The frequency of the disease remains underestimated as many women stay asymptomatic and symptoms appear gradually; therefore, the condition remains undiagnosed. The exact frequency of uterine fibroids varies depending on the diagnosis, and the population investigated; nonetheless, the incidence of uterine fibroids in reproductive women ranges from 5.4 percent to 77 percent. The uterine fibroid treatment included painkillers, supplementation with iron, vitamin D3, birth control, hormone therapy, gonadotropin-releasing hormone (GnRH) agonists, drugs modulating the estrogen receptors, and surgical removal of the fibroids. However, more research needed at the level of gene to get a keen insight and treat the disease efficiently.
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Affiliation(s)
- Azaz Ahmad
- Department of Pharmacy, Integral University, Lucknow, India
- Department of Reproductive Medicine, Indira IVF Hospital Pvt Ltd, Udaipur, India
| | - Manoj Kumar
- Centre for Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Nihar Ranjan Bhoi
- Department of Reproductive Medicine, Indira IVF Hospital Pvt Ltd, Udaipur, India
| | - Juber Akhtar
- Department of Pharmacy, Integral University, Lucknow, India
| | | | - Mohd Ajmal
- Department of Pharmacy, Integral University, Lucknow, India
| | - Mohammad Ahmad
- Department of Pharmacy, Integral University, Lucknow, India
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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] [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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Affiliation(s)
| | | | | | | | | | | | | | - Ayman Al-Hendy
- University of Chicago, Chicago, United States,*Correspondence: Ayman Al-Hendy, ; Andrews Akwasi Agbleke,
| | - Andrews Akwasi Agbleke
- Sena Institute of Technology, Penyi, Ghana,*Correspondence: Ayman Al-Hendy, ; Andrews Akwasi Agbleke,
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Efficacy and Safety of Oral GnRh Antagonists in Patients With Uterine Fibroids: A Systematic Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:1279-1288. [PMID: 36368594 DOI: 10.1016/j.jogc.2022.10.012] [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: 06/01/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This review aimed to assess the efficacy and safety of GnRH antagonists in patients with symptomatic uterine fibroids. DATA SOURCES A literature search was performed on PubMed, Web of Science, Embase, Cochrane, and ClinicalTrials.gov using the MeSH and Emtree terms "leiomyoma" and "gonadotropin-releasing hormone." STUDY SELECTION All clinical trials that provided efficacy and safety data in clinical terms (i.e., reduction in menstrual bleeding and discomfort, changes in the size of leiomyoma and uterine volume, etc.) were included. We excluded all preclinical studies, case reports, meta-analyses, review articles, and clinical studies irrelevant to the study question. DATA EXTRACTION AND SYNTHESIS Two authors extracted data from 9 clinical studies. The extracted data included the study's characteristics, participants' baseline characteristics, treatment drugs, efficacy measures, and toxicity. CONCLUSION Among oral GnRH antagonists, relugolix, elagolix, and linzagolix were safe in patients with uterine fibroids. These drugs, alone and in combination with E2/NETA (estradiol/norethindrone acetate), showed significantly better efficacy than placebo in improving bleeding, discomfort, uterine/leiomyoma sizes, and quality of life in premenopausal patients with symptomatic uterine fibroids. However, more randomized, double-blind, multicentre clinical trials are needed to confirm these results and to see long-term benefits.
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Alabiad MA, Said WMM, Gad AH, Sharaf ElDin MTA, Khairy DA, Gobran MA, Shalaby AM, Samy W, Abdelsameea AA, Heraiz AI. Evaluation of Different Doses of the Aromatase Inhibitor Letrozole for the Treatment of Ectopic Pregnancy and Its Effect on Villous Trophoblastic Tissue. Reprod Sci 2022; 29:2983-2994. [PMID: 35701686 PMCID: PMC9537218 DOI: 10.1007/s43032-022-00993-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 05/29/2022] [Indexed: 11/26/2022]
Abstract
Letrozole, an aromatase inhibitor, has recently been introduced as a favorable medical treatment for ectopic pregnancy. We aimed at evaluating the effects of different doses of letrozole for termination of ectopic pregnancy and study their effects on villous trophoblastic tissue. Sixty patients with undisturbed ectopic pregnancy were classified into three equal groups. Group I: the control group that contained women who underwent laparoscopic salpingectomy, Group II: patients who received letrozole (5 mg day−1) for 10 days, and Group III: patients who received letrozole (10 mg day−1) for 10 days. Subsequently, the β-hCG levels were determined on the first day and after 11 days of treatment. Group IV consisted of patients of GII and GIII; their β-hCG did not drop below 100 mIU/ml within 11 days, and underwent salpingectomy. Placental tissues from patients undergoing salpingectomy either from the control group or GIV were processed for the evaluation of estrogen (ER) and progesterone (PR) receptors, vascular endothelial growth factor (VEGF), and cleaved caspase 3 (CC-3) expression. Cases exposed to high dose letrozole 10 mg day−1 resulted in a higher ectopic pregnancy resolution rate of 85% (17/20), while the resolution rate of the low dose letrozole-treated group (5 mg day−1) was 65% (13/20), and also showed a significant reduction in β-hCG levels on the 11th day, 25.63 ± 4.29 compared to the low dose letrozole group 37.91 ± 7.18 (P < 0.001), Meanwhile, the letrozole-treated group GIV showed markedly reduced expression of ER, PR, and VEGF and a significant increase in the apoptotic index cleaved caspase-3 compared to the control group (P < 0.001). The utilization of letrozole at a dose of 10 mg day−1 for medical treatment of ectopic pregnancy results in a high-successful rate without any severe side effects. Letrozole depriving the placenta of estrogen that had vascular supporting signals resulted in destroying the vascular network with marked apoptosis.
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Affiliation(s)
- Mohamed Ali Alabiad
- Department of Pathology, Faculty of Medicine, Zagazig University, Zagazig, 44519 Egypt
| | - Warda M. M. Said
- Department of Pathology, Faculty of Medicine, Benghazi University, Benghazi, Libya
| | - Abdalla Hassan Gad
- Department of Gynecology and Obstetrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Dina Ahmed Khairy
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mai Ahmed Gobran
- Department of Pathology, Faculty of Medicine, Zagazig University, Zagazig, 44519 Egypt
| | - Amany Mohamed Shalaby
- Department of Histology and Cell Biology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Walaa Samy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Ahmed Ismail Heraiz
- Department of Gynecology and Obstetrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Ali M, A R S, Al Hendy A. Elagolix in the treatment of heavy menstrual bleeding associated with uterine fibroids in premenopausal women. Expert Rev Clin Pharmacol 2021; 14:427-437. [PMID: 33682578 DOI: 10.1080/17512433.2021.1900726] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Uterine fibroids (UFs) are the most common benign tumor arising from myometrium of reproductive age women, with significant financial burden estimated in hundreds of billions of dollars. Unfortunately, there are limitations in available long-term treatment options. Thus, there is a large unmet need in the UF space for noninvasive therapeutics. AREAS COVERED Authors reviewed the literature available for elagolix; an orally bioavailable, second-generation, non-peptide gonadotropin-releasing hormone (GnRH) antagonist recently approved by the US 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 utility of new-generation oral GnRH-antagonists, such as elagolix, relugolix and linzagolix, is offering a new potential opportunity for the future therapy of UFs: elagolix has been the most studied drug of this class for treating benign gynecological diseases, including endometriosis and UFs, for which it has been US FDA-approved in 2018 and 2020, respectively.
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Affiliation(s)
- Mohamed Ali
- Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Sara A R
- Al-Galaa Military Hospital, Cairo, Egypt, Drug Research Center (DRC), Cairo, Egypt
| | - Ayman Al Hendy
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
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Shon J, Zou P, Tran D, Seo SK, Lu Y. Clinical Pharmacology at the Intersection of Women's Health and Regulation: Drug Development Considerations for Uterine Fibroids. J Clin Pharmacol 2020; 60 Suppl 2:S39-S48. [PMID: 33274511 DOI: 10.1002/jcph.1736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/03/2020] [Accepted: 08/12/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Jihong Shon
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Peng Zou
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Doanh Tran
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Shirley K Seo
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Yanhui Lu
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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Uterine leiomyomas: correlation between histologic composition and stiffness via magnetic resonance elastography - a Pilot Study. Ginekol Pol 2020; 91:373-378. [PMID: 32542642 DOI: 10.5603/gp.a2020.0067] [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: 11/27/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To evaluate magnetic resonance elastography as a tool for characterizing uterine leimyomas. MATERIAL AND METHODS At total of 12 women with symptomatic leiomyomas diagnosed in physical and ultrasound examinations were enrolled in this pilot study. Before surgery, all patients underwent magnetic resonance elastography of the uterus using a 1.5 T MR whole-body scanner (Optima, GE Healthcare, Milwaukee, WI, USA). Surgical specimens were forwarded for histological examination. The findings were allocated into 3 categories depending on the percentage content of connective tissue: below 15%, from 15 to 30% and more than 30%. The median stiffness of leiomyomas for each of the group was calculated. The U-Mann Whitney test was used for statistical analysis. RESULTS The stiffness of the leiomyomas ranged between 3.7-6.9 kPa (median value 4.9 kPa). The concentration of extracellular components in the leiomyomas did not exceed 40%. An increasing trend of the stiffness with the growing percentage of extracellular component was observed. Stiffness of the leiomyomas obtained by MRE varies depending on microscopic composition. CONCLUSIONS The value of stiffness shows a trend of increasing with the percentage of extracellular component of the leiomyoma. Further studies are required to assess the usefulness of MRE in diagnostics of uterine leiomyomas.
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Del Bello B, Marcolongo P, Ciarmela P, Sorbi F, Petraglia F, Luisi S, Maellaro E. Autophagy up-regulation by ulipristal acetate as a novel target mechanism in the treatment of uterine leiomyoma: an in vitro study. Fertil Steril 2020; 112:1150-1159. [PMID: 31843092 DOI: 10.1016/j.fertnstert.2019.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/25/2019] [Accepted: 08/06/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To assess the effect of ulipristal acetate (UPA) on the autophagic process of uterine leiomyoma cells. DESIGN In vitro study in primary cultures of leiomyoma and myometrial cells isolated from biopsy specimen, and gene expression evaluation in biopsy material. SETTING Cellular pathology laboratory. PATIENT(S) Premenopausal women (without hormonal treatment) undergoing myomectomy or hysterectomy for symptomatic leiomyomas. INTERVENTION(S) Surgical specimens collected from uterine leiomyomas and matched normal myometria. MAIN OUTCOME MEASURE(S) After treatment of myometrial and leiomyoma cells with UPA, autophagy was evaluated by Western blot analysis of the typical biochemical markers, LC3-II, LC3-II:LC3-I ratio, and p62/SQSTM1. The expression level of Atg7 and Atg4D proteins was also assessed by Western blot. RESULT(S) The increase of LC3-II protein, LC3-II:LC3-I ratio, and p62/SQSTM1 protein indicates that UPA treatment up-regulates the autophagic response in leiomyoma cells, whereas these markers were almost unchanged in myometrial cells. Consistently, an increased level of Atg7 and Atg4D proteins was observed only in UPA-treated leiomyoma cells. The autophagic machinery is put into motion selectively in these cells, despite that the basal messenger RNA levels of LC3, SQSTM1, and ATG7 in leiomyoma biopsy specimen were not significantly different from those found in normal myometrial biopsy material. CONCLUSION(S) In vitro UPA treatment stimulates the autophagic response selectively in leiomyoma cells, which adds a novel indication for the clinical use of this selective P receptor (PR) modulator. Autophagy up-regulation may potentially contribute to the leiomyoma shrinkage occurring in UPA-treated patients and warrants further study.
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Affiliation(s)
- Barbara Del Bello
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Paola Marcolongo
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Pasquapina Ciarmela
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Flavia Sorbi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy; Unit Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - Felice Petraglia
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy; Unit Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - Stefano Luisi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy; Unit Obstetrics and Gynecology, University Hospital, Siena, Italy
| | - Emilia Maellaro
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
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Greco S, Islam MS, Zannotti A, Delli Carpini G, Giannubilo SR, Ciavattini A, Petraglia F, Ciarmela P. Quercetin and indole-3-carbinol inhibit extracellular matrix expression in human primary uterine leiomyoma cells. Reprod Biomed Online 2020; 40:593-602. [PMID: 32276890 DOI: 10.1016/j.rbmo.2020.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/19/2019] [Accepted: 01/10/2020] [Indexed: 01/03/2023]
Abstract
RESEARCH QUESTION What is the effect of quercetin and indole-3-carbinol (I3C) on extracellular matrix expression, cell migration and proliferation in human myometrial and uterine leiomyoma cells. DESIGN Myometrial and leiomyoma cells were treated with quercetin or I3C at different concentrations (10 µg/ml; 50 µg/ml; 100 µg/ml; and 250 µg/ml) for 48 h to measure mRNA and protein expressions of extracellular matrix (collagen 1A1, fibronectin and versican), as well as cell migration and the proliferation rate. RESULTS Quercetin decreased mRNA levels of collagen 1A1 in myometrial (P < 0.0001) and leiomyoma cells (P < 0.0001). Quercetin reduced mRNA and protein levels of fibronectin in myometrial cells (P < 0.05) and fibronectin protein in leiomyoma cells (P < 0.05). I3C reduced collagen 1A1 mRNA levels in myometrial (P < 0.05) and leiomyoma cells at higher dose (P < 0.05). The protein levels of fibronectin were also reduced in both myometrial and leiomyoma cells with highest dose of I3C (P < 0.05), although mRNA levels were not affected in leiomyoma cells. Neither quercetin nor I3C treatment altered versican mRNA levels in both cell types. A significant reduction of the migration of both myometrial and leiomyoma cells in response to quercetin was observed (P < 0.05) and I3C (P < 0.05 for myometrial and P < 0.01 for leiomyoma cells) treatment. Both quercetin and I3C significantly reduced myometrial cell proliferation (P < 0.05). CONCLUSIONS The in-vitro anti-fibrotic, anti-migratory and anti-proliferative effects of quercetin and I3C form the scientific basis for developing new therapeutic, preventive agents, or both, for uterine leiomyomas.
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Affiliation(s)
- Stefania Greco
- Department of Experimental and Clinical Medicine, Faculty of Medicine, Università Politecnica delle Marche, 60020 via Tronto 10/a Ancona, Italy
| | - Md Soriful Islam
- Department of Experimental and Clinical Medicine, Faculty of Medicine, Università Politecnica delle Marche, 60020 via Tronto 10/a Ancona, Italy
| | - Alessandro Zannotti
- Department of Experimental and Clinical Medicine, Faculty of Medicine, Università Politecnica delle Marche, 60020 via Tronto 10/a Ancona, Italy; Department of Medical Biotechnology and Department of Molecular and Developmental, Medicine, Obstetrics, and Gynaecology, Università Politecnica delle Marche, Ancona 60020, Italy
| | - Giovanni Delli Carpini
- Department of Medical Biotechnology and Department of Molecular and Developmental, Medicine, Obstetrics, and Gynaecology, Università Politecnica delle Marche, Ancona 60020, Italy
| | - Stefano Raffaele Giannubilo
- Department of Medical Biotechnology and Department of Molecular and Developmental, Medicine, Obstetrics, and Gynaecology, Università Politecnica delle Marche, Ancona 60020, Italy
| | - Andrea Ciavattini
- Department of Medical Biotechnology and Department of Molecular and Developmental, Medicine, Obstetrics, and Gynaecology, Università Politecnica delle Marche, Ancona 60020, Italy
| | - Felice Petraglia
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Obstetrics and Gynaecology, University of Florence, Italy
| | - Pasquapina Ciarmela
- Department of Experimental and Clinical Medicine, Faculty of Medicine, Università Politecnica delle Marche, 60020 via Tronto 10/a Ancona, Italy.
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Schuttringer E, Beleche T. The impact of recent power morcellator risk information on inpatient surgery and patient outcomes. J Comp Eff Res 2019; 9:53-65. [PMID: 31840551 DOI: 10.2217/cer-2019-0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We examine the impact of the new risk information about a surgical device on surgery and patient outcomes for hysterectomy in the inpatient setting. Methods: We utilize a difference-in-differences approach to assess the impact of new risk information on patient outcomes in the inpatient setting between 2009 and 2014. The inpatient data come from a nationally representative sample of hospitalizations in the USA. We use the likelihood of laparoscopic surgery, measures of resource use and surgical complications as outcome variables. Results: We estimate a three-percentage point decrease in the likelihood of receiving laparoscopic hysterectomy, a one-percentage point increase in the likelihood of experiencing a surgical complication and no impact on resource use, relative to pre-existing means. Conclusion: Our findings show that there was movement away from laparoscopic surgery in the months following the dissemination of new risk information. These changes had limited effect on patient outcomes.
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Affiliation(s)
- Ehren Schuttringer
- Food & Drug Administration Office of the Commissioner, 10903 New Hampshire Ave, Silver Spring, Maryland, MD 20993, USA
| | - Trinidad Beleche
- Food & Drug Administration Office of the Commissioner, 10903 New Hampshire Ave, Silver Spring, Maryland, MD 20993, USA
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Łoziński T, Filipowska J, Gurynowicz G, Zgliczyńska M, Kluz T, Jędra R, Skowyra A, Ciebiera M. The effect of high-intensity focused ultrasound guided by magnetic resonance therapy on obstetrical outcomes in patients with uterine fibroids – experiences from the main Polish center and a review of current data. Int J Hyperthermia 2019; 36:582-590. [DOI: 10.1080/02656736.2019.1616117] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Tomasz Łoziński
- Department of Obstetrics and Gynecology, Pro-Familia Hospital, Rzeszów, Poland
| | - Justyna Filipowska
- Department of Obstetrics and Gynecology, Pro-Familia Hospital, Rzeszów, Poland
- Faculty of Medicine, Institute of Nursing and Health Sciences, University of Rzeszów, Rzeszów, Poland
| | - Grzegorz Gurynowicz
- Division of Perinatology and Women’s Diseases, Poznań University of Medical Sciences, Poznań, Poland
| | - Magdalena Zgliczyńska
- Students’ Scientific Association at the First Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Kluz
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Rzeszów, Poland
| | - Robert Jędra
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Warsaw, Poland
| | - Artur Skowyra
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Warsaw, Poland
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Warsaw, Poland
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Peng J, Zhang M, Yu P, Wang N. Can single disease payment system based on clinical pathway reduce hospitalization costs in rural area? A case study of uterine leiomyoma in Anhui, China. BMC Health Serv Res 2018; 18:990. [PMID: 30572899 PMCID: PMC6302448 DOI: 10.1186/s12913-018-3807-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/11/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Single disease payment program based on clinical pathway (CP-based SDP) plays an increasingly important role in reducing health expenditure in china and there is a clear need to explore the scheme from different perspectives. This study aimed at evaluating the effect of the scheme in rural county public hospitals within Anhui, a typical province of China,using uterine leiomyoma as an example. METHODS The study data were extracted from the data platform of the New Rural Cooperative Medical Office of Anhui Province using stratified-random sampling. Means, constituent ratios and coefficients of variations were calculated and/or compared between control versus experiment groups and between different years. RESULTS The total hospitalization expenditure (per-time) dropped from 919.08 ± 274.92 USD to 834.91 ± 225.29 USD and length of hospital stay reduced from 9.96 ± 2.39 days to 8.83 ± 1.95 days(P < 0.01), after CP-based SDP had implemented. The yearly total hospitalization expenditure manifested an atypical U-shaped trend. Medicine expense, nursing expense, assay cost and treatment cost reduced; while the fee of operation and examination increased (P < 0.05). The expense constituent ratios of medicine, assay and treatment decreased with the medicine expense dropped the most (by 4.4%). The expense constituent ratios of materials, ward, operation, examination and anesthetic increased,with the examination fee elevated the most (by 3.9%).The coefficient of variation(CVs) of treatment cost declined the most (- 0.360); while the CV of materials expense increased the most (0.186). CONCLUSION There existed huge discrepancies in inpatient care for uterine leiomyoma patients. Implementation of CP-based SDP can help not only in controlling hospitalization costs of uterine leiomyoma in county-level hospitals but also in standardizing the diagnosis and treatment procedures.
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Affiliation(s)
- Jing Peng
- Management School of Hefei University of Technology, Hefei, 230000 Anhui China
- School of Health Service Management, Anhui Medical University, Hefei, 230000 Anhui China
| | - Mengran Zhang
- School of Health Service Management, Anhui Medical University, Hefei, 230000 Anhui China
| | - Pingfeng Yu
- School of Health Service Management, Anhui Medical University, Hefei, 230000 Anhui China
| | - Nan Wang
- School of Health Service Management, Anhui Medical University, Hefei, 230000 Anhui China
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Shin SJ, Kim J, Lee S, Baek J, Lee JE, Cho C, Ha E. Ulipristal acetate induces cell cycle delay and remodeling of extracellular matrix. Int J Mol Med 2018; 42:1857-1864. [PMID: 30015921 PMCID: PMC6108884 DOI: 10.3892/ijmm.2018.3779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 07/05/2018] [Indexed: 11/06/2022] Open
Abstract
Uterine leiomyoma is a benign tumor that grows within the muscle tissue of the uterus. Ulipristal acetate (UPA) is a pre-operative drug used to reduce the size of leiomyoma. The aim of the present study was to examine the in vitro mechanistic details of action of UPA on uterine leiomyomas. Primary cultures of leiomyoma cells were isolated from patient myomectomy specimens and incubated in the presence or absence of UPA at various concentrations. The proliferation, cell viability and doubling time properties of the treated cells were analyzed. In addition, the mRNA and protein expression levels of p21, p27, cyclin E, cyclin-dependent kinase 2 (CDK2), matrix metalloproteinase (MMP)-2 and MMP-9 were examined, as well as the structure of F-actin in the primary-cultured leiomyoma cells. The results demonstrated that UPA exerted inhibitory effects on proliferation of primary-cultured leiomyoma cells. Expression of p21 and p27 was upregulated, while cyclin E and CDK2 were downregulated in UPA-treated primary-cultured leiomyoma cells. An increased expression of MMP-2 was observed in primary-cultured leiomyoma cells and a leiomyoma tissue sample of a patient with previous history of UPA treatment. Furthermore, a pronounced formation of F-actin stress fibers was observed in leiomyoma cells of the UPA-treated patient. These data suggest that UPA treatment attenuated the proliferation of uterine fibroid cells via upregulation of p21 and p27, resulting in cell cycle delay. The findings in the current study also suggest that UPA may cause extracellular matrix constriction, leading to the shrinkage in size of the leiomyoma possibly via stimulation of MMP-2 expression and induction of actin stress fibers.
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Affiliation(s)
- So-Jin Shin
- Department of Gynecology and Obstetrics and Institute for Cancer Research, School of Medicine, Keimyung University, Daegu, North Gyeongsang 42403, Republic of Korea
| | - Jinyoung Kim
- Department of Internal Medicine, School of Medicine, Keimyung University, Daegu, North Gyeongsang 42403, Republic of Korea
| | - Seungmee Lee
- Department of Gynecology and Obstetrics and Institute for Cancer Research, School of Medicine, Keimyung University, Daegu, North Gyeongsang 42403, Republic of Korea
| | - Jongwoo Baek
- Department of Obstetrics and Gynecology, Gumi CHA Hospital, CHA University, Gumi, North Gyeongsang 39295, Republic of Korea
| | - Jin Eui Lee
- Department of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Chiheum Cho
- Department of Gynecology and Obstetrics and Institute for Cancer Research, School of Medicine, Keimyung University, Daegu, North Gyeongsang 42403, Republic of Korea
| | - Eunyoung Ha
- Department of Biochemistry, School of Medicine, Keimyung University, Daegu, North Gyeongsang 42403, Republic of Korea
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Ciebiera M, Włodarczyk M, Ciebiera M, Zaręba K, Łukaszuk K, Jakiel G. Vitamin D and Uterine Fibroids-Review of the Literature and Novel Concepts. Int J Mol Sci 2018; 19:E2051. [PMID: 30011902 PMCID: PMC6073230 DOI: 10.3390/ijms19072051] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/06/2018] [Accepted: 07/12/2018] [Indexed: 02/08/2023] Open
Abstract
This article provides a detailed review of current knowledge on the role of vitamin D and its receptor in the biology and management of uterine fibroids (UFs). Authors present ideas for future steps in this area. A literature search was conducted in PubMed using the following key words: "uterine fibroid" and "vitamin D". The results of the available studies, published in English from January 2002 up to April 2018, have been discussed. Vitamin D is a group of steroid compounds with a powerful impact on many parts of the human body. This vitamin is believed to regulate cell proliferation and differentiation, inhibit angiogenesis, and stimulate apoptosis. Nowadays, hypovitaminosis D is believed to be a major risk factor in the development of UFs. In many studies vitamin D appears to be a powerful factor against UFs, resulting in inhibition of tumor cell division and a significant reduction in its size, however, the exact role of this compound and its receptor in the pathophysiology of UFs is not fully understood. According to available studies, vitamin D and its analogs seem to be promising, effective, and low-cost compounds in the management of UFs and their clinical symptoms, and the anti-tumor activities of vitamin D play an important role in UF biology. The synergy between vitamin D and selected anti-UF drugs is a very interesting issue which requires further research. Further studies about the biological effect of vitamin D on UF biology are essential. Vitamin D preparations (alone or as a co-drugs) could become new tools in the fight with UFs, with the additional beneficial pleiotropic effect.
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Affiliation(s)
- Michał Ciebiera
- Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
| | - Marta Włodarczyk
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy with Division of Laboratory Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland.
- Center for Preclinical Research, Medical University of Warsaw, 02-097 Warsaw, Poland.
| | - Magdalena Ciebiera
- Students' Scientific Association at the Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015 Warsaw, Poland.
| | - Kornelia Zaręba
- Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
| | - Krzysztof Łukaszuk
- Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdansk, 80-210 Gdansk, Poland.
- INVICTA Fertility and Reproductive Center, 80-172 Gdansk, Poland.
| | - Grzegorz Jakiel
- Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
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Alternatives to excisional therapy: a clinical review of our current options to conservatively manage symptomatic leiomyomas. Curr Opin Obstet Gynecol 2018; 30:279-286. [PMID: 29975307 DOI: 10.1097/gco.0000000000000470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article provides a clinical review of the alternatives to traditional excisional surgical therapies for uterine leiomyomas, such as myomectomy or hysterectomy. RECENT FINDINGS In this review, currently available hormonal medications will be briefly discussed. Then, nonhormonal medical therapy will be addressed with respect to mechanism of action, safety, and efficacy. Finally, the risk-benefit profile of nonexcisional procedures for management of leiomyomas will be addressed. SUMMARY This provides an update on the information available for more conservative options for symptomatic leiomyoma management.
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26
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Emrahi L, Behroozi J, Shahbazi S. Expression study of CYP19A1 gene in a cohort of Iranian leiomyoma patients. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2018. [DOI: 10.1016/j.ejmhg.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Islam MS, Ciavattini A, Petraglia F, Castellucci M, Ciarmela P. Extracellular matrix in uterine leiomyoma pathogenesis: a potential target for future therapeutics. Hum Reprod Update 2018; 24:59-85. [PMID: 29186429 DOI: 10.1093/humupd/dmx032] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/17/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Uterine leiomyoma (also known as fibroid or myoma) is the most common benign tumor of the uterus found in women of reproductive age. It is not usually fatal but can produce serious clinical symptoms, including excessive uterine bleeding, pelvic pain or pressure, infertility and pregnancy complications. Due to lack of effective medical treatments surgery has been a definitive choice for the management of this tumor. OBJECTIVE AND RATIONALE Extracellular matrix (ECM) accumulation and remodeling are thought to be crucial for fibrotic diseases such as uterine leiomyoma. Indeed, ECM plays important role in forming the bulk structure of leiomyoma, and the ECM-rich rigid structure within these tumors is thought to be a cause of abnormal bleeding and pelvic pain. Therefore, a better understanding of ECM accumulation and remodeling is critical for developing new therapeutics for uterine leiomyoma. SEARCH METHODS PubMed and Google Scholar were searched for all original and review articles/book chapters related to ECM and medical treatments of uterine leiomyoma published in English until May 2017. OUTCOMES This review discusses the involvement of ECM in leiomyoma pathogenesis as well as current and future medical treatments that target ECM directly or indirectly. Uterine leiomyoma is characterized by elevated levels of collagens, fibronectin, laminins and proteoglycans. They can induce the mechanotransduction process, such as activation of the integrin-Rho/p38 MAPK/ERK pathway, resulting in cellular responses that are involved in pathogenesis and altered bidirectional signaling between leiomyoma cells and the ECM. ECM accumulation is affected by growth factors (TGF-β, activin-A and PDGF), cytokines (TNF-α), steroid hormones (estrogen and progesterone) and microRNAs (miR-29 family, miR-200c and miR-93/106b). Among these, TGF-βs (1 and 3) and activin-A have been suggested as key players in the accumulation of excessive ECM (fibrosis) in leiomyoma. The presence of elevated levels of ECM and myofibroblasts in leiomyoma supports the fibrotic character of these tumors. Interestingly, ECM may serve as a reservoir of profibrotic growth factors and enhance their activity by increasing their stability and extending their duration of signaling. At present, several classes of compounds, including gonadotropin-releasing hormone (GnRH) agonist (leuprolide acetate), GnRH antagonist (cetrorelix acetate), selective progesterone receptor modulators (ulipristate acetate and asoprisnil), antiprogestin (mifepristone) and natural compounds like vitamin D and resveratrol have been studied as medical treatments that target ECM in uterine leiomyoma. WIDER IMPLICATIONS Although several types of drugs (mostly antiproliferative agents) are available for leiomyoma treatment, none of them were introduced specifically as antifibrotic agents. In light of its critical role in the process of fibrosis in leiomyoma, we propose that ECM should be considered as a crucial target for future therapeutics. Thus, the introduction of drugs that are specifically antifibrotic could be a good solution to control abnormal leiomyoma growth and associated clinical symptoms. The antifibrotic compounds can be introduced based on their ability to regulate ECM components and their receptors, as well as growth factors, cytokines, steroid hormones and their corresponding receptors and intracellular signaling pathways, as well as microRNAs, involved in ECM production in leiomyoma.
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Affiliation(s)
- Md Soriful Islam
- Department of Experimental and Clinical Medicine, Faculty of Medicine, Università Politecnica delle Marche, via Tronto 10/a, Ancona 60020, Italy.,Biotechnology and Microbiology Laboratory, Department of Botany, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Andrea Ciavattini
- Department of Clinical Science, Università Politecnica delle Marche, Ancona, Italy
| | - Felice Petraglia
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', Obstetrics and Gynecology, University of Florence, Italy
| | - Mario Castellucci
- Department of Experimental and Clinical Medicine, Faculty of Medicine, Università Politecnica delle Marche, via Tronto 10/a, Ancona 60020, Italy
| | - Pasquapina Ciarmela
- Department of Experimental and Clinical Medicine, Faculty of Medicine, Università Politecnica delle Marche, via Tronto 10/a, Ancona 60020, Italy.,Department of Information Engineering, Università Politecnica delle Marche, Ancona 60131, Italy
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Wen KC, Sung PL, Chou YT, Pan CM, Wang PH, Lee OKS, Wu CW. The role of EpCAM in tumor progression and the clinical prognosis of endometrial carcinoma. Gynecol Oncol 2018; 148:383-392. [DOI: 10.1016/j.ygyno.2017.11.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/15/2017] [Accepted: 11/24/2017] [Indexed: 02/07/2023]
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Ali M, Chaudhry ZT, Al-Hendy A. Successes and failures of uterine leiomyoma drug discovery. Expert Opin Drug Discov 2017; 13:169-177. [PMID: 29254389 DOI: 10.1080/17460441.2018.1417381] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION To-date, the only cure for symptomatic uterine fibroids (UFs) is surgical intervention. However, surgery may eliminate the hope of future pregnancies; moreover, the intrinsic risks of surgery make it a less favorable to women with UFs. Because of this, conservative medical therapies have become an attractive and prior option for those women. Leuprolide acetate (LA), a gonadotropin-releasing hormone (GnRH) agonist, is the only pharmacological agent currently approved for the short-term and pre-operative management of symptomatic UFs in the USA. Areas covered: This systematic review covers the successes and failures of prominent drugs that have been researched for UFs in the past and agents that have shown promise in recent clinical trials. The most recent clinical trials and advances in drug therapy are presented in a comprehensive overview outlining the direction UF drug discovery is heading. Expert opinion: Experts in the field are already on the forefront leading the responsibility to uncover potential drugs as long term fertility friendly viable options for non-invasive treatment/prevention of UFs. Indeed, a shift in the UF management is expected in the future.
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Affiliation(s)
- Mohamed Ali
- a Department of Obstetrics and Gynecology , Medical College of Georgia, Augusta University , Augusta , GA , USA.,b Clinical Pharmacy Department, Faculty of Pharmacy , Ain Shams University , Cairo , Egypt
| | - Zunir Tayyeb Chaudhry
- c Department of Clinical sciences , St. James School of Medicine , St. Vincent , Caribbean
| | - Ayman Al-Hendy
- a Department of Obstetrics and Gynecology , Medical College of Georgia, Augusta University , Augusta , GA , USA
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Ciebiera M, Łukaszuk K, Męczekalski B, Ciebiera M, Wojtyła C, Słabuszewska-Jóźwiak A, Jakiel G. Alternative Oral Agents in Prophylaxis and Therapy of Uterine Fibroids-An Up-to-Date Review. Int J Mol Sci 2017; 18:ijms18122586. [PMID: 29194370 PMCID: PMC5751189 DOI: 10.3390/ijms18122586] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 01/18/2023] Open
Abstract
Uterine fibroids (UFs) are the most common tumors of the female genital tract. The effect of UFs on the quality of life and the overall cost of treatment are significant issues worldwide. Tumor size and location are the two specific factors which influence the occurrence of symptoms, the need for, and method of, treatment (some tumors require surgery while some can be treated with selected drugs). Primary prevention and treatment of early UF disease are worthy goals that might have a great impact on health care systems. Several treatments and prophylactic methods can be used in this endeavor. This publication presents current data about lesser-known substances which may have a beneficial effect on the treatment or prophylaxis of UFs and can be administered orally, serving as an alternative to (or complement of) surgery or selective progesterone receptor modulators (SPRMs). Early prevention and treatment of UFs in women from high-risk groups should be our priority. Innovative forms of UF management are under intensive investigation and may be promising options in the near future. Many of them evaluated vitamin D, paricalcitol, epigallocatechin gallate (EGCG), elagolix, aromatase inhibitors (AIs), and cabergoline and deemed them to be safe and effective. The next step in such projects should be properly constructed randomized control trials (RCTs), carried out by successive phases.
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Affiliation(s)
- Michał Ciebiera
- Department of Obstetrics and Gynecology, The Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
| | - Krzysztof Łukaszuk
- Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdansk, 80-210 Gdansk, Poland.
- INVICTA Fertility and Reproductive Center, 80-172 Gdansk, Poland.
| | - Błażej Męczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-513 Poznan, Poland.
| | - Magdalena Ciebiera
- Students' Scientific Association at the I Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015 Warsaw, Poland.
| | - Cezary Wojtyła
- Department of Obstetrics and Gynecology, The Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
| | - Aneta Słabuszewska-Jóźwiak
- Department of Obstetrics and Gynecology, The Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
| | - Grzegorz Jakiel
- Department of Obstetrics and Gynecology, The Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
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Non-surgical Management of Myomas. J Minim Invasive Gynecol 2017; 25:229-236. [PMID: 28821471 DOI: 10.1016/j.jmig.2017.08.642] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 12/24/2022]
Abstract
Uterine myomas are a common condition and the leading cause of hysterectomy. Clinically, myomas can be challenging because they range from asymptomatic to causing severe, debilitating symptoms and occur in many women before childbearing is complete. Thus, women often seek uterine-conserving and nonsurgical management of their myomas. In this review the available uterine-conserving treatment options from medical management through minimally invasive procedures are discussed. To the extent of research available, the sustainability of symptom improvement and the effects on future fertility are reviewed. Future research may lead to therapies that reduce the risks of major surgery, decrease side effects, and offer primary or secondary prevention options.
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Arian SE, Munoz JL, Kim S, Falcone T. Robot-assisted laparoscopic myomectomy: current status. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:7-18. [PMID: 30697559 PMCID: PMC6193424 DOI: 10.2147/rsrr.s102743] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Robotic-assisted surgery has seen a rapid development and integration in the field of gynecology. Since the approval of the use of robot for gynecological surgery and considering its several advantages over conventional laparoscopy, it has been widely incorporated especially in the field of reproductive surgery. Uterine fibroids are the most common benign tumors of the female reproductive tract. Many reproductive-aged women with this condition demand uterine-sparing surgery to preserve their fertility. Myomectomy, the surgical excision of uterine fibroids, remains the only surgical management option for fibroids that entails preservation of fertility. In this review, we focus on the role of robotic-assisted laparoscopic myomectomy and its current status, in comparison with other alternative approaches for myomectomy, including open, hysteroscopic, and traditional laparoscopic techniques. Several different surgical techniques have been demonstrated for robotic myomectomy. This review endeavors to share and describe our surgical experience of using the standard laparoscopic equipment for robotic-assisted myomectomy, together with the da Vinci Robot system. For the ideal surgical candidate, robotic-assisted myomectomy is a safe minimally invasive surgical procedure that can be offered as an alternative to open surgery. The advantages of using the robot system compared to open myomectomy include a shorter length of hospital stay, less postoperative pain and analgesic use, faster return to normal activities, more rapid return of the bowel function, and enhanced cosmetic results due to smaller skin incision sizes. Some of the disadvantages of this technique include high costs of the robotic surgical system and equipment, the steep learning curve of this novel system, and prolonged operative and anesthesia times. Robotic technology is a novel and innovative minimally invasive approach with demonstrated feasibility in gynecological and reproductive surgery. This technology is expected to take the lead in gynecological surgery in the upcoming decade.
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Affiliation(s)
- Sara E Arian
- Department of Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA,
| | - Jessian L Munoz
- Department of Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA,
| | - Suejin Kim
- Department of Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA,
| | - Tommaso Falcone
- Department of Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA,
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Abnormal Uterine Bleeding in Women with Infertility. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0188-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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35
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Current and Future Medical Treatment of Adenomyosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2016. [DOI: 10.5301/je.5000261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Adenomyosis is a benign gynecological disorder associated with abnormal uterine bleeding, dysmenorrhea, dyspareunia and infertility, requiring a life-long management plan through medical or surgical treatment. The choice depends on woman's age, reproductive status and clinical symptoms. However, until now no drug labelled for adenomyosis is available; thus, the present review will focus on medical treatments currently used for adenomyosis and those in development. Adenomyosis may be considered a sex steroid hormone-related disorder associated with an intense inflammatory process. The use of gonadotropin-releasing hormone agonists (GnRH-a) for treating adenomyosis is described blocking the hypothalamic-pituitary-gonadal axis; however, it has long been associated with frequent and intolerable hypoestrogenic side effects. An antiproliferative effect of progestins suggests their use for treating adenomyosis, reducing bleeding and pain. Continuous oral norethisterone acetate or medroxyprogesterone acetate may help to inducing regression of adenomyosis, relief pain and reduce bleeding. The use of vaginal danazol has therapeutic effect on adenomyosis combining progestogenic and anti-inflammatory activity. The intrauterine device releasing levonorgestrel (Lng-IUD) is widely assessed in menorrhagia, and has been shown to be extremely effective in resolving pain and bleeding symptoms associated with adenomyosis. Recent data show a therapeutic effect of dienogest on adenomyosis symptoms. New drugs are under development for the treatment of adenomyosis, such as aromatase inhibitors (AIs) and selective estrogen receptor modulators (SERMs), that produce a hypoestrogenic environment reducing pain, but are correlated with some adverse effects and a recurrence of symptoms after discontinuation of treatment. Selective progesterone receptor modulators (SPRMs) may reduce adenomyosis-associated pelvic pain, by inhibiting endometrial proliferation and suppressing adenomyotic lesion growth, as shown in animal models; however, the long-term effect with SPRMs needs further determination.
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