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Psilopatis I, Theocharis S, Beckmann MW. The role of peroxisome proliferator-activated receptors in endometriosis. Front Med (Lausanne) 2024; 11:1329406. [PMID: 38690174 PMCID: PMC11058831 DOI: 10.3389/fmed.2024.1329406] [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: 10/28/2023] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
Endometriosis constitutes the most common cause of chronic pelvic pain in female patients and is associated with infertility. Although there is no known cause for the disease, it is a heritable condition that is determined by numerous genetic, epigenetic, and environmental aspects. Peroxisome proliferator-activated receptors (PPARs) represent nuclear receptor proteins that control gene expression. By using the MEDLINE and LIVIVO databases we conducted a literature review in order to look into the role of PPARs in the endometriosis pathophysiology and succeeded in revealing 36 pertinent publications between 2001 and 2022. In regards to PPAR expression in endometriosis, PPARγ seems to represent the most studied PPAR isoform in endometriosis and to influence various pathways involved in the disease onset and progression. It's interesting to note that diverse treatment agents targeting the PPAR system have been identified as innovative, effective therapeutic alternatives in the context of endometriosis treatment. In conclusion, PPARs appear to contribute an important role in both endometriosis pathophysiology and therapy.
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Affiliation(s)
- Iason Psilopatis
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
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Liang Y, Mei L, Ning Q, Zhang J, Fei J, Dong J. A Case of Rectal Endometriosis Misdiagnosed as Rectal Malignancy on Three Colonoscopies and Biopsies Sharing a Combined Literature Review. Int J Womens Health 2024; 16:163-174. [PMID: 38292299 PMCID: PMC10826710 DOI: 10.2147/ijwh.s445280] [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: 11/04/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024] Open
Abstract
Background Endometriosis involves the intestine, and its clinical manifestations are nonspecific and lack of etiological manifestations. The diagnosis is difficult, which often leads to misdiagnosis. We report a case of endometriosis which was misdiagnosed as intestinal malignant tumor after colonoscopy and three biopsies. Case Presentation We reported a 42-year-old woman who went to see a doctor because of anal distension. She was examined by three gastrointestinal endoscopists at different levels in different hospitals and underwent biopsy at the same time. Combined with clinical manifestations, imaging examination, endoscopic examination and pathological examination, she was misdiagnosed as intestinal malignant tumor, and partial intestinal resection was performed according to the surgical principle of malignant tumor. Conclusion Although there are advanced gastrointestinal endoscopy and imaging techniques, intestinal endometriosis is still easy to be misdiagnosed. As our case report shows, after three colonoscopy and biopsy, it is still misdiagnosed as intestinal malignant tumor. Further research is needed to improve the ability of preoperative diagnosis, which deserves the attention of gastroenterologists and obstetricians and gynecologists.
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Affiliation(s)
- Yufei Liang
- Department of Gynaecology and Obstetrics, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Lina Mei
- Department of Digestive, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Qipeng Ning
- Department of Digestive, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Jiao Zhang
- Department of Digestive, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Jingying Fei
- Department of Ultrasound, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Jie Dong
- Department of Gynaecology and Obstetrics, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
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Psilopatis I, Vrettou K, Fleckenstein FN, Theocharis S. The Impact of Histone Modifications in Endometriosis Highlights New Therapeutic Opportunities. Cells 2023; 12:cells12091227. [PMID: 37174627 PMCID: PMC10177435 DOI: 10.3390/cells12091227] [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: 04/07/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Endometriosis is a chronic disorder of the female reproductive system which afflicts a great number of women worldwide. Histone deacetylases (HDACs) prevent the relaxation of chromatin, thereby positively or negatively modulating gene transcription. The current review aims at studying the impact of histone modifications and their therapeutic targeting in endometriosis. In order to identify relevant studies, a literature review was conducted using the MEDLINE and LIVIVO databases. The current manuscript represents the most comprehensive, up-to-date review of the literature focusing on the particular role of HDACs and their inhibitors in the context of endometriosis. HDAC1, HDAC2, HDAC3, Sirtuin 1, and Sirtuin 3, are the five most studied HDAC enzymes which seem to, at least partly, influence the pathophysiology of endometriosis. Both well-established and novel HDACIs could possibly represent modern, efficacious anti-endometriotic drug agents. Altogether, histone modifications and their therapeutic targeting have been proven to have a strong impact on endometriosis.
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Affiliation(s)
- Iason Psilopatis
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Bld 10, Goudi, 11527 Athens, Greece
| | - Kleio Vrettou
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Bld 10, Goudi, 11527 Athens, Greece
| | - Florian Nima Fleckenstein
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, 10117 Berlin, Germany
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Bld 10, Goudi, 11527 Athens, Greece
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Plasma and Peritoneal Fluid Fibronectin and Collagen IV Levels as Potential Biomarkers of Endometriosis. Int J Mol Sci 2022; 23:ijms232415669. [PMID: 36555313 PMCID: PMC9778765 DOI: 10.3390/ijms232415669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Laparoscopy as a diagnostic tool for patients with suspected endometriosis is associated with several potentially life-threatening complications. Therefore, it is imperative to identify reliable, non-invasive biomarkers of the disease. The aim of this study was to analyse the concentrations of fibronectin and type IV collagen in peritoneal fluid and plasma to assess their role as potential biomarkers in the diagnosis of endometriosis. Fibronectin and collagen IV protein levels were assessed by surface plasmon resonance imaging (SPRi) biosensors with the usage of monoclonal antibodies. All patients enrolled in the study were referred for laparoscopy for the diagnosis of infertility or chronic pelvic pain (n = 84). The study group included patients with endometriosis confirmed during surgery (n = 49). The concentration of fibronectin in the plasma (329.3 ± 98.5 mg/L) and peritoneal fluid (26.8 ± 11.1 μg/L) in women with endometriosis was significantly higher than in the control group (251.2 ± 84.0 mg/L, 7.0 ± 5.9 μg/L). Fibronectin levels were independent of endometriosis stage (p = 0.874, p = 0.469). No significant differences were observed in collagen IV levels (p = 0.385, p = 0.465). The presence of elevated levels of fibronectin may indicate abnormalities in cell-ECM signalling during the course of endometriosis, and may be a potential biomarker for early detection.
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Ghasemi F, Alemzadeh E, Allahqoli L, Alemzadeh E, Mazidimoradi A, Salehiniya H, Alkatout I. MicroRNAs Dysregulation as Potential Biomarkers for Early Diagnosis of Endometriosis. Biomedicines 2022; 10:biomedicines10102558. [PMID: 36289820 PMCID: PMC9599310 DOI: 10.3390/biomedicines10102558] [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: 09/18/2022] [Revised: 10/08/2022] [Accepted: 10/09/2022] [Indexed: 11/16/2022] Open
Abstract
Endometriosis is a benign chronic disease in women that is characterized by the presence of active foci of the endometrium or endometrial tissue occurring outside of the uterus. The disease causes disabling symptoms such as pelvic pain and infertility, which negatively affect a patient's quality of life. In addition, endometriosis imposes an immense financial burden on the healthcare system. At present, laparoscopy is the gold standard for diagnosing the disease because other non-invasive diagnostic tests have less accuracy. In addition, other diagnostic tests have low accuracy. Therefore, there is an urgent need for the development of a highly sensitive, more specific, and non-invasive test for the early diagnosis of endometriosis. Numerous researchers have suggested miRNAs as potential biomarkers for endometriosis diagnosis due to their specificity and stability. However, the greatest prognostic force is the determination of several miRNAs, the expression of which varies in a given disease. Despite the identification of several miRNAs, the studies are investigatory in nature, and there is no consensus on them. In the present review, we first provide an introduction to the dysregulation of miRNAs in patients with endometriosis and the potential use of miRNAs as biomarkers in the detection of endometriosis. Then we will describe the role of the mir-200 family in endometriosis. Several studies have shown that the expression of the mir-200 family changes in endometriosis patients, suggesting that they could be used as a diagnostic biomarker and therapeutic target for endometriosis.
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Affiliation(s)
- Fahimeh Ghasemi
- Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran
- Department of Biotechnology, Faculty of Medicine, Birjand University of Medical Sciences, Birjand 9717853577, Iran
| | - Effat Alemzadeh
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran
| | - Leila Allahqoli
- Midwifery Department, Ministry of Health and Medical Education, Tehran 1467664961, Iran
| | - Esmat Alemzadeh
- Department of Biotechnology, Faculty of Medicine, Birjand University of Medical Sciences, Birjand 9717853577, Iran
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran
| | - Afrooz Mazidimoradi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz 7134814336, Iran
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran
| | - Ibrahim Alkatout
- Kiel School of Gynaecological Endoscopy, Campus Kiel, University Hospitals Schleswig-Holstein, Ar-nold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany
- Correspondence:
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AN ULTRASOUND-BASED PREDICTION MODEL TO PREDICT URETEROLYSIS AT LAPAROSCOPIC ENDOMETRIOSIS SURGERY. J Minim Invasive Gynecol 2022; 29:1170-1177. [PMID: 35817365 DOI: 10.1016/j.jmig.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/01/2022] [Accepted: 07/02/2022] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVES To develop a model, including clinical features and ultrasound findings, to predict the need for ureterolysis (i.e. dissection of the ureter) during laparoscopy for endometriosis. DESIGN A retrospective observational study of patients who had transvaginal ultrasound (TVS) according to the International Deep Endometriosis Analysis (IDEA) consensus and subsequent laparoscopy +/- excision of endometriosis between January 2017 and February 2021 was conducted. SETTING Sydney Medical School Nepean, University of Sydney, Nepean Hospital and Blue Mountains Hospital, New South Wales, Australia INTERVENTION: The demographic, clinical, TVS and intra-operative data were extracted through electronic clinical records. MEASUREMENTS Multi-categorical decision-tree and baseline models were built to choose the variables most correlated to the outcome under study. Receiver operating characteristic (ROC) analysis was performed on the binary classification. Based on our results, we selected the variables performing with significant statistical differences (p-value < .05). MAIN RESULTS During the study period, 177 consecutive patients were recruited and divided into two subgroups, ureterolysis (51.4%) and and non-ureterolysis (48.6%). Ureterolysis was noted in 87.5% of patients in which the left ovary was immobile (p-value< .001), and in 82.5% in which the right ovary was fixed (p-value<.001). For patients with right uterosacral ligament (USL) deep endometriosis (DE), ureterolysis was performed on 96.2% (p-value< .001), and 64.6% (p-value= .043) for left USL DE. Among patients with bowel DE, the proportion of patients undergoing ureterolysis was 95.5% (p-value < .001). The prognostic variables utilized in the final model to predict ureterolysis included dyschezia, absence of ovarian mobility, presence of right or left USL DE and presence of bowel DE on TVS. According to the developed model, the baseline risk for performing ureterolysis is 20% in our sample. The overall model performance demonstrated an area under the ROC curve 0.82. CONCLUSION Our study demonstrates that it is possible to predict the need for ureterolysis with clinical and sonographic data. Furthermore, patients presenting with the combination of the variables of our model (dyschezia, ovarian immobility, USL and bowel DE lesions) have a high risk of ureterolysis. On the other hand, patients without these features have a low risk (approximately 20%) of needing ureterolysis.
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Antibody Arrays Identified Cycle-Dependent Plasma Biomarker Candidates of Peritoneal Endometriosis. J Pers Med 2022; 12:jpm12060852. [PMID: 35743637 PMCID: PMC9225192 DOI: 10.3390/jpm12060852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/18/2022] [Accepted: 05/21/2022] [Indexed: 02/04/2023] Open
Abstract
Endometriosis is an estrogen-dependent inflammatory disease affecting women in their reproductive age. Due to non-specific symptoms, women with endometriosis are often misdiagnosed or are accurately diagnosed only after several years. Diagnosis of peritoneal endometriosis is especially challenging and relies only on laparoscopic surgery. To date, different molecules have been proposed as potential non-invasive biomarkers of endometriosis; however, none have been confirmed as clinically useful. Therefore, this study aimed to discover novel plasma biomarker candidates for peritoneal endometriosis using an antibody array platform. This study included patients with endometriosis-like symptoms characterized by the absence (controls) or presence of peritoneal endometriosis (cases) after laparoscopic surgery and histological evaluation. Patients were further divided into secretory and proliferative groups, according to the phase of their menstrual cycle. Their plasma samples were collected and analyzed on an antibody array platform targeting more than 1350 proteins with over 1820 antibodies. In the proliferative group, the analysis revealed three differential proteins between cases and controls: ITB3, ITA2B2, and ACVL-1. In the secretory group, none of the examined proteins reached the log-fold change (logFC) and significance thresholds simultaneously. The potential of the identified differential proteins as plasma biomarker candidates for peritoneal endometriosis should be evaluated on a larger cohort, and their role in endometriosis should be investigated in further studies.
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Wetzk M, Grübling N, Forberger A, Klengel J, Kuhlmann JD, Wimberger P, Goeckenjan M. Diagnostic Benefit of the Detection of Mitotic Figures in Endometriotic Lesions. Geburtshilfe Frauenheilkd 2022; 82:85-92. [PMID: 35027863 PMCID: PMC8747893 DOI: 10.1055/a-1580-0601] [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: 04/22/2021] [Accepted: 08/05/2021] [Indexed: 11/01/2022] Open
Abstract
Objectives Endometriosis is a chronic disease which is diagnosed by surgical intervention combined with a histological work-up. Current international and national recommendations do not require the histological determination of the proliferation rate. The diagnostic and clinical importance of the mitotic rate in endometriotic lesions still remains to be elucidated. Methods In this retrospective study, the mitotic rates and clinical data of 542 patients with histologically diagnosed endometriosis were analyzed. The mean patient age was 33.5 ± 8.0 (17 - 72) years, and the mean reproductive lifespan was 21.2 ± 7.8 (4 - 41) years. Patients were divided into two groups and patients' reproductive history and clinical endometriosis characteristics were compared between groups. The study group consisted of women with confirmed mitotic figures (n = 140, 25.83%) and the control group comprised women without proliferative activity according to their mitotic rates (n = 402, 74.27%). Results Women with endometriotic lesions and histologically confirmed mitotic figures were significantly more likely to have a higher endometriosis stage (p = 0.001), deep infiltrating endometriosis (p < 0.001), ovarian endometrioma (p = 0.012), and infertility (p = 0.049). A mitotic rate > 0 was seen significantly less often in cases with incidental findings of endometriosis (p = 0.031). The presence of symptoms and basic characteristics such as age, age at onset of menarche, reproductive lifespan and parity did not differ between the group with and the group without mitotic figures. Conclusion This study shows that a simple histological assessment of the mitotic rate offers additional diagnostic value for the detection of advanced stages of endometriosis. The possible role as a predictive marker for the recurrence of endometriosis or the development of endometriosis-associated cancer will require future study.
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Affiliation(s)
- Michelle Wetzk
- Department of Obstetrics and Gynecology, Technische Universität Dresden, Dresden, Germany
| | - Nannette Grübling
- Department of Obstetrics and Gynecology, Technische Universität Dresden, Dresden, Germany
| | - Almuth Forberger
- Institute for Pathology, Technische Universität Dresden, Dresden, Germany
| | - Jörg Klengel
- Department of Obstetrics and Gynecology, Technische Universität Dresden, Dresden, Germany
| | - Jan Dominik Kuhlmann
- Department of Obstetrics and Gynecology, Technische Universität Dresden, Dresden, Germany
| | - Pauline Wimberger
- Department of Obstetrics and Gynecology, Technische Universität Dresden, Dresden, Germany
| | - Maren Goeckenjan
- Department of Obstetrics and Gynecology, Technische Universität Dresden, Dresden, Germany
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Namazov A, Kathurusinghe S, Mehdi E, Merlot B, Prosszer M, Tuech JJ, Marpeau L, Horace R. Evolution of bowel complaints after laparoscopy endometriosis surgery: a 1497 women comparative study. J Minim Invasive Gynecol 2021; 29:499-506. [PMID: 34839059 DOI: 10.1016/j.jmig.2021.11.018] [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: 08/28/2021] [Revised: 11/17/2021] [Accepted: 11/20/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE To assess what degree can digestive symptoms improve after endometriosis surgery for different localisations? DESIGN A comparative retrospective study employing data prospectively recorded in The North-West Inter-Regional Female Cohort for Patients with Endometriosis (CIRENDO) from June 2009 to November 2018. SETTING Two referral centres Patients: 1,497 women undergoing surgery due to pelvic endometriosis were divided into three groups: superficial endometriosis (Group 1, n=396), deep endometriosis sparing the bowel (Group 2, n=337), and deep endometriosis involving the bowel (Group 3, n=764). INTERVENTIONS Surgery for endometriosis. MEASUREMENTS AND MAIN RESULTS Preoperative and postoperative gastrointestinal symptoms were evaluated with standardised questionnaires, including the Gastrointestinal Quality of Life Index (GIQLI) and Knowles-Eccersley-Scott-Symptom questionnaire (KESS). The degree of postoperative improvement in digestive symptoms was compared between the groups. The women in Group 3 were significantly symptomatic in terms of cycle-related gastrointestinal symptoms and scores of standardised questionnaires GIQLI, KESS. According to the 1-year postoperative evaluation, women in Group 3 experienced the most significant improvement in their gastrointestinal symptoms. CONCLUSION Women with severe bowel symptoms and deep endometriosis infiltrating the bowel should be informed about the high probability of symptom improvement after the removal of bowel nodules. Conversely, in women without deep endometriosis, postoperatively, there is less improvement in baseline digestive complaints.
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Affiliation(s)
- Ahmet Namazov
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of Negev, Beer-Sheva, Israel
| | | | - Elnur Mehdi
- Azerbaijan National Center of Oncology, Baku, Azerbaijan
| | - Benjamin Merlot
- Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux, France
| | - Maria Prosszer
- Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux, France
| | - Jean Jacques Tuech
- Department of Digestive Surgery, Rouen University Hospital, F-76000 Rouen, France
| | - Loic Marpeau
- Department of Gynecology and Obstetrics, Rouen University Hospital, F-76000 Rouen, France
| | - Roman Horace
- Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux, France; Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark.
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