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Cano-Herrera G, Salmun Nehmad S, Ruiz de Chávez Gascón J, Méndez Vionet A, van Tienhoven XA, Osorio Martínez MF, Muleiro Alvarez M, Vasco Rivero MX, López Torres MF, Barroso Valverde MJ, Noemi Torres I, Cruz Olascoaga A, Bautista Gonzalez MF, Sarkis Nehme JA, Vélez Rodríguez I, Murguiondo Pérez R, Salazar FE, Sierra Bronzon AG, Rivera Rosas EG, Carbajal Ocampo D, Cabrera Carranco R. Endometriosis: A Comprehensive Analysis of the Pathophysiology, Treatment, and Nutritional Aspects, and Its Repercussions on the Quality of Life of Patients. Biomedicines 2024; 12:1476. [PMID: 39062050 PMCID: PMC11274817 DOI: 10.3390/biomedicines12071476] [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: 03/29/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Endometriosis is a chronic proinflammatory pathology characterized by the growth of tissue similar to the endometrium outside the uterus, affecting approximately 5 to 15% of women worldwide. Suffering from endometriosis entails a complex pathophysiological process, significantly impacting the quality of life and reproductive function of affected women; therefore, it must be addressed in a personalized and comprehensive manner, as its management requires a multidisciplinary approach. This article aims to conduct a comprehensive literature review of endometriosis, not only as a pathophysiological condition but also as a significant factor impacting the social, nutritional, and mental well-being of those who experience it. Emphasis is placed on the importance of understanding and assessing the impact of the pathology to provide a better and more comprehensive approach, integrating various alternatives and strategic treatments for the factors involved in its development. The aim is to provide a complete overview of endometriosis, from its pathophysiology to its impact on the quality of life of patients, as well as a review of current treatment options, both pharmacological and alternative, in order to broaden the perspective on the pathology to improve the care of patients with this disease.
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Affiliation(s)
- Gabriela Cano-Herrera
- Escuela de Ciencias de la Salud, Universidad Anáhuac Puebla, 72810 San Andrés Cholula, Mexico;
| | - Sylvia Salmun Nehmad
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | - Jimena Ruiz de Chávez Gascón
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | - Amairani Méndez Vionet
- Facultad de Ciencias de la Salud, Universidad Panamericana, 03920 Ciudad de México, Mexico
| | - Ximena A. van Tienhoven
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | - María Fernanda Osorio Martínez
- División de Ciencias Biológicas y de la Salud, Unidad Xochimilco, Universidad Autónoma Metropolitana, 04960 Ciudad de México, Mexico
| | - Mauricio Muleiro Alvarez
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Mariana Ximena Vasco Rivero
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | - María Fernanda López Torres
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | - María Jimena Barroso Valverde
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | - Isabel Noemi Torres
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | - Alexa Cruz Olascoaga
- División de Ciencias Biológicas y de la Salud, Unidad Xochimilco, Universidad Autónoma Metropolitana, 04960 Ciudad de México, Mexico
| | - Maria Fernanda Bautista Gonzalez
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | - José Antonio Sarkis Nehme
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | | | - Renata Murguiondo Pérez
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | - Felipe Esparza Salazar
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Ana Gabriela Sierra Bronzon
- Departamento de Cirugía Ginecológica de Mínima Invasión, Instituto Pélvico Neurovascular, 76807 San Juan del Río, Mexico
| | - Eder Gabriel Rivera Rosas
- Departamento en Cirugía Pélvica, Doyenne High Quality and Multidisciplinary Treatment Center for Endometriosis, 06700 Ciudad de México, Mexico
| | - Dante Carbajal Ocampo
- Departamento en Cirugía Pélvica, Doyenne High Quality and Multidisciplinary Treatment Center for Endometriosis, 06700 Ciudad de México, Mexico
| | - Ramiro Cabrera Carranco
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
- Departamento en Cirugía Pélvica, Doyenne High Quality and Multidisciplinary Treatment Center for Endometriosis, 06700 Ciudad de México, Mexico
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Harrah PC, Deering AJ, Chung MT, Hughes K, Hosein RC. Endometriosis in Patients Undergoing Plastic Surgical Procedures: A Case Report and Review of the Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5904. [PMID: 38911574 PMCID: PMC11191020 DOI: 10.1097/gox.0000000000005904] [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: 12/01/2023] [Accepted: 05/01/2024] [Indexed: 06/25/2024]
Abstract
Background Endometriosis is a common gynecological disorder described as the presence of functional endometrial tissue outside the uterus, which can also be found in extrapelvic locations. Although patients seeking treatment for endometriosis usually present to gynecologists, there are rare cases of endometriosis encountered by plastic surgeons in routine practice, either incidentally or as a concomitant finding. Methods We present a rare case of a 36-year-old woman with symptoms of panniculitis desiring panniculectomy. During surgery, an abdominal mass was excised and confirmed by pathological analysis to be endometriosis. A comprehensive literature review was conducted using the PubMed search engine of the National Institutes of Health to identify cases of endometriosis in plastic surgery. Following screening of the results, 14 articles were included in this analysis that fit the criteria of our search. Results Of the 14 articles reviewed, cutaneous endometriosis was the most common subtype found in plastic surgery. None of the studies described findings of endometriosis in routine panniculectomies. Several identified endometriosis discovered during cosmetic abdominoplasties. Conclusions Endometriosis encountered in plastic surgery is a rare but clinically important occurrence, with the cutaneous subtype representing the majority of cases. Endometriosis should always be on the differential diagnosis when an abdominal mass is found in a patient with a history of abdominal surgery. Abdominal masses found during routine aesthetic or reconstructive surgery should be submitted for tissue analysis to guide possible secondary treatments.
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Affiliation(s)
- Payden C. Harrah
- From the Division of Plastic and Reconstructive Surgery, Long School of Medicine, University of Texas Medical Center San Antonio, San Antonio, Tex
| | - Augustine J. Deering
- From the Division of Plastic and Reconstructive Surgery, Long School of Medicine, University of Texas Medical Center San Antonio, San Antonio, Tex
| | - Michael T. Chung
- From the Division of Plastic and Reconstructive Surgery, Long School of Medicine, University of Texas Medical Center San Antonio, San Antonio, Tex
| | - Kenneth Hughes
- Department of Pathology, Long School of Medicine, University of Texas Medical Center San Antonio, San Antonio, Tex
| | - Rayaad C. Hosein
- From the Division of Plastic and Reconstructive Surgery, Long School of Medicine, University of Texas Medical Center San Antonio, San Antonio, Tex
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de Oliveira GC, Cintra MTR, Lima MFP, Gomes MKO, de Marqui ABT. Genetic variants in miR-146a and miR-196a2 in endometriosis: a Brazilian study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231382. [PMID: 38775532 PMCID: PMC11101185 DOI: 10.1590/1806-9282.20231382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE The aim of this study was to determine the allelic and genotypic frequencies of the polymorphisms, rs2910164 miR-146a and rs11614913 miR-196a2, by investigating their association with endometriosis. METHODS This is a case-control study performed with approximately 120 women. The polymorphisms were determined by real-time polymerase chain reaction. For the statistical analysis, the chi-square and logistic regression tests were used. RESULTS There were no significant differences in the genotype and allele frequencies of rs2910164 and rs11614913 between cases and controls. The frequencies in both polymorphisms are in accordance with Hardy-Weinberg equilibrium regarding miR-146a (patients: χ2=1.64, p=0.20; controls: χ2=0.25, p=0.62) and miR-196a2 (patients: χ2=0.58, p=0.44; controls: χ2=2.78, p=0.10). No relationship was observed between rs2910164 and rs11614913 and endometriosis in the inheritance models analyzed. CONCLUSION In this study, our results show that the studied polymorphisms are not implicated in the development of endometriosis.
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Affiliation(s)
| | | | - Marco Fábio Prata Lima
- Universidade Federal do Triângulo Mineiro, Institute of Health Sciences – Uberaba (MG), Brazil
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Vanhie A, Caron E, Vermeersch E, O D, Tomassetti C, Meuleman C, Mestdagh P, D’Hooghe TM. Circulating microRNAs as Non-Invasive Biomarkers in Endometriosis Diagnosis-A Systematic Review. Biomedicines 2024; 12:888. [PMID: 38672242 PMCID: PMC11048084 DOI: 10.3390/biomedicines12040888] [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: 09/01/2023] [Revised: 12/18/2023] [Accepted: 01/25/2024] [Indexed: 04/28/2024] Open
Abstract
The aim of this systematic review is to assess the power of circulating miRNAs as biomarkers as a diagnostic tool in endometriosis. In endometriosis-suspected women with uncertain imaging, the only way to confirm or exclude endometriosis with certainty is currently laparoscopy. This creates a need for non-invasive diagnostics. We searched the literature through the PubMed database using the Mesh terms 'endometriosis' and 'miRNAs'. Some, but limited, overlap was found between the 32 articles included, with a total of 20 miRNAs reported as dysregulated in endometriosis in two or more studies. MiR-17-5p was reported as dysregulated in six studies, followed by miR-451a and let-7b-5p in four studies and miR-20a-5p, miR-143-3p, miR-199a-5p and miR-3613-5p in three studies. Furthermore, a possible impact of the menstrual phase on miRNA expression was noted in five studies, while no influence of hormonal intake was observed in any included study. The modest reproducibility between studies may be attributable to biological variability as well as to the lack of universal protocols, resulting in pre- and analytical variability. Despite the identification of several suitable candidate biomarkers among the miRNAs, the need for high-quality studies with larger and well-defined population cohorts and the use of standardized protocols lingers.
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Affiliation(s)
- Arne Vanhie
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Ellen Caron
- Department of Obstetrics and Gynecology, University Hospital Leuven, 3000 Leuven, Belgium
| | - Eveline Vermeersch
- Department of Obstetrics and Gynecology, University Hospital Leuven, 3000 Leuven, Belgium
| | - Dorien O
- Department of Obstetrics and Gynecology, University Hospital Leuven, 3000 Leuven, Belgium
| | - Carla Tomassetti
- Department of Obstetrics and Gynecology, University Hospital Leuven, 3000 Leuven, Belgium
| | - Christel Meuleman
- Department of Obstetrics and Gynecology, University Hospital Leuven, 3000 Leuven, Belgium
| | - Pieter Mestdagh
- UGent, Center for Medical Genetics, Thent University, 9000 Ghent, Belgium
- UGent, Cancer Research Institute Ghen, Ghent University, 9000 Ghent, Belgium
| | - Thomas M. D’Hooghe
- Department of Obstetrics and Gynecology, University Hospital Leuven, 3000 Leuven, Belgium
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Koutalia N, Gkrozou F, Vatopoulou A, Lentzaris D, Skentou C, Paschopoulos M. Role of Molecular Biomarkers in Endometriosis-Related Infertility: A Narrative Review of the Literature. Cureus 2024; 16:e59288. [PMID: 38813329 PMCID: PMC11135608 DOI: 10.7759/cureus.59288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
Endometriosis is a chronic benign inflammatory disease that affects women of reproductive age. The clinical presentations of endometriosis include dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. There is a well-established association between endometriosis and infertility. Therefore, there is a need for an early diagnosis of endometriosis-related infertility. In this study, we aim to identify the role of biomarkers as predictive factors of the presence of the disease and its severity and their correlation with the pregnancy outcome. We performed an electronic database search of all published studies in PubMed and EMBASE from January 2018 to May 2023. Numerous innovative biomarkers identified in cases of endometriosis and infertility have been studied over the past years, including micro-RNAs, BCL6 endometrial expression, cytotoxic T-lymphocyte antigen 4, human leukocyte antigen G, programmed cell death protein 1, programmed cell death ligand 1 immune checkpoint molecules, plasma fibronectin-fibrin complexes, homeobox A10 gene, systemic inflammatory response markers, uterine natural killer cells, and the eutopic endometrium proteome. Considerable research has been done to identify diagnostic biomarkers for the early detection and prevention of endometriosis-associated infertility. However, none of these biomarkers displayed enough diagnostic accuracy to be used in daily clinical practice. Future research is valuable to establish them as reliable diagnostic tools.
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Affiliation(s)
- Nikoleta Koutalia
- Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, GRC
| | - Fani Gkrozou
- Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, GRC
| | | | | | - Chara Skentou
- Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, GRC
| | - Minas Paschopoulos
- Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, GRC
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Wang T, Ji M, Sun J. Identification and validation of an endoplasmic-reticulum-stress-related gene signature as an effective diagnostic marker of endometriosis. PeerJ 2024; 12:e17070. [PMID: 38549776 PMCID: PMC10977089 DOI: 10.7717/peerj.17070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/18/2024] [Indexed: 04/02/2024] Open
Abstract
Background Endometriosis is one of the most common benign gynecological diseases and is characterized by chronic pain and infertility. Endoplasmic reticulum (ER) stress is a cellular adaptive response that plays a pivotal role in many cellular processes, including malignant transformation. However, whether ER stress is involved in endometriosis remains largely unknown. Here, we aimed to explore the potential role of ER stress in endometriosis, as well as its diagnostic value. Methods We retrieved data from the Gene Expression Omnibus (GEO) database. Data from the GSE7305 and GSE23339 datasets were integrated into a merged dataset as the training cohort. Differentially expressed ER stress-related genes (DEG-ERs) were identified by integrating ER stress-related gene profiles downloaded from the GeneCards database with differentially expressed genes (DEGs) in the training cohort. Next, an ER stress-related gene signature was identified using LASSO regression analysis. The receiver operating characteristic curve was used to evaluate the discriminatory ability of the constructed model, which was further validated in the GSE51981 and GSE105764 datasets. Online databases were used to explore the possible regulatory mechanisms of the genes in the signature. Meanwhile, the CIBERSORT algorithm and Pearson correlation test were applied to analyze the association between the gene signature and immune infiltration. Finally, expression levels of the signature genes were further detected in clinical specimens using qRT-PCR and validated in the Turku endometriosis database. Results In total, 48 DEG-ERs were identified in the training cohort. Based on LASSO regression analysis, an eight-gene-based ER stress-related gene signature was constructed. This signature exhibited excellent diagnostic value in predicting endometriosis. Further analysis indicated that this signature was associated with a compromised ER stress state. In total, 12 miRNAs and 23 lncRNAs were identified that potentially regulate the expression of ESR1, PTGIS, HMOX1, and RSAD2. In addition, the ER stress-related gene signature indicated an immunosuppressive state in endometriosis. Finally, all eight genes showed consistent expression trends in both clinical samples and the Turku database compared with the training dataset. Conclusions Our work not only provides new insights into the impact of ER stress in endometriosis but also provides a novel biomarker with high clinical value.
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Affiliation(s)
- Tao Wang
- Department of Gynecology, Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji Medical University, Shanghai, Pudong New Area, China
| | - Mei Ji
- Department of Gynecology, Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji Medical University, Shanghai, Pudong New Area, China
| | - Jing Sun
- Department of Gynecology, Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji Medical University, Shanghai, Pudong New Area, China
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Ni C, Li D. Ferroptosis and oxidative stress in endometriosis: A systematic review of the literature. Medicine (Baltimore) 2024; 103:e37421. [PMID: 38489713 PMCID: PMC10939684 DOI: 10.1097/md.0000000000037421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/19/2023] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Endometriosis (EMT) a common gynecological condition in women, an inflammatory disease characterized by the presence of endometrial tissue on organs and tissues in the pelvis, and is mainly associated with chronic pelvic pain and infertility. As the etiology has not been fully elucidated, current treatment is limited to surgery, hormones and painkillers, with more side effects and difficulty in achieving long-term relief. Oxidative stress manifests itself as an overproduction of reactive oxygen species, which has an integral impact in the pathology of female reproductive disorders. In this review, we evaluate the mechanisms of iron overload-induced oxidative stress and ferroptosis in EMT and their pathophysiological implications. METHODS Because the etiology has not been fully elucidated, current treatments are limited to surgery, hormones, and painkillers, which have many side effects and are difficult to achieve long-term relief. RESULTS We interpreted that antioxidants as well as ferroptosis inducers show promising results in the treatment of EMT, but their application in this population needs to be further investigated. CONCLUSION In combination with the interpretation of previous studies, it was shown that iron overload is present in the peritoneal fluid, endometriotic lesions, peritoneum and macrophages in the abdominal cavity. However, the programmed cellular ferroptosis associated with iron overload is resisted by endometriotic foci, which is critical to the pathophysiology of EMT with local iron overload and inflammation.
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Affiliation(s)
- Chenghong Ni
- Department of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Dingheng Li
- Department of Obstetrics and Gynecology, Hangzhou Women’s Hospital, Hangzhou, Zhejiang Province, China
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Hearn JH, Bryson K, Barsauskaite L, Bullo S. A COM-B and Theoretical Domains Framework Mapping of the Barriers and Facilitators to Effective Communication and Help-Seeking Among People With, or Seeking a Diagnosis Of, Endometriosis. JOURNAL OF HEALTH COMMUNICATION 2024; 29:174-186. [PMID: 38262475 DOI: 10.1080/10810730.2023.2299003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Endometriosis is a chronic condition in which tissue resembling the endometrium grows outside the womb, causing severe chronic pain. People with endometriosis report difficulty in help-seeking and communicating with healthcare professionals, contributing to diagnosis delays and ineffective management. The present study aimed to identify barriers and facilitators to effective communication using the Theoretical Domains Framework (TDF) and COM-B model to inform behavior change intervention development. This study was a qualitative semi-structured interview and open-ended survey design. Thematic Analysis was utilized to identify barriers and facilitators to effective communication which were mapped to the TDF and COM-B model. Four women aged 25 to 44 with a formal diagnosis of endometriosis participated in interviews. Thirty-three participants, aged 20-48 years, participated in the online survey, 21 of whom had a diagnosis of endometriosis (12 were currently seeking diagnosis). Five COM-B domains were identified: reflective motivation, social and physical opportunity, physical and psychological capability. Ten TDF domains were reflected in concerns surrounding dismissal, disempowerment, social norms, beliefs about consequences, cognitive resources, reinforcement, and environmental context and resources, among others. This is the first study to identify barriers and facilitators of effective communication and help-seeking in light of established behavioral change theory and frameworks for comprehensive intervention design. This provides a comprehensive explanation of challenges in help-seeking for endometriosis and represents the first step in the development of complex interventions to improve help-seeking and communication for people with endometriosis. Interventions targeting salient barriers will have greater potential to change behavior and improve outcomes.
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Affiliation(s)
| | - Katie Bryson
- Brooks Building, Manchester Metropolitan University, Manchester, UK
| | | | - Stella Bullo
- School of Arts, Humanities & Social Sciences, Plymouth Marjon University, Plymouth, UK
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da Silva MCM, Ferreira LPDS, Della Giustina A. It is time to change the definition: Endometriosis is no longer a pelvic disease. Clinics (Sao Paulo) 2024; 79:100326. [PMID: 38325019 PMCID: PMC10862498 DOI: 10.1016/j.clinsp.2024.100326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/15/2023] [Accepted: 01/07/2024] [Indexed: 02/09/2024] Open
Affiliation(s)
| | - Luiz Philipe de Souza Ferreira
- Department of Morphology and Genetics, Structural and Functional Biology Graduate Program, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Amanda Della Giustina
- Sprott Centre for Stem Cell Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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Talebloo N, Bernal MAO, Kenyon E, Mallett CL, Mondal SK, Fazleabas A, Moore A. Imaging of Endometriotic Lesions Using cRGD-MN Probe in a Mouse Model of Endometriosis. NANOMATERIALS (BASEL, SWITZERLAND) 2024; 14:319. [PMID: 38334590 PMCID: PMC10856945 DOI: 10.3390/nano14030319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
Approximately 10% of women suffer from endometriosis during their reproductive years. This disease is a chronic debilitating condition whose etiology for lesion implantation and survival heavily relies on adhesion and angiogenic factors. Currently, there are no clinically approved agents for its detection. In this study, we evaluated cRGD-peptide-conjugated nanoparticles (RGD-Cy5.5-MN) to detect lesions using magnetic resonance imaging (MRI) in a mouse model of endometriosis. We utilized a luciferase-expressing murine suture model of endometriosis. Imaging was performed before and after 24 h following the intravenous injection of RGD-Cy5.5-MN or control nanoparticles (Cy5.5-MN). Next, we performed biodistribution of RGD-Cy5.5-MN and correlative fluorescence microscopy of lesions stained for CD34. Tissue iron content was determined using inductively coupled plasma optical emission spectrometry (ICP-OES). Our results demonstrated that targeting endometriotic lesions with RGD-Cy5.5-MN resulted in a significantly higher delta T2* upon its accumulation compared to Cy5.5-MN. ICP-OES showed significantly higher iron content in the lesions of the animals in the experimental group compared to the lesions of the animals in the control group. Histology showed colocalization of Cy5.5 signal from RGD-Cy5.5-MN with CD34 in the lesions pointing to the targeted nature of the probe. This work offers initial proof-of-concept for targeting angiogenesis in endometriosis which can be useful for potential clinical diagnostic and therapeutic approaches for treating this disease.
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Affiliation(s)
- Nazanin Talebloo
- Precision Health Program, Michigan State University, 766 Service Road, East Lansing, MI 48824, USA; (N.T.); (E.K.); (S.K.M.)
- Department of Chemistry, College of Natural Sciences, Michigan State University, 578 S Shaw Lane, East Lansing, MI 48824, USA
| | - M. Ariadna Ochoa Bernal
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, 400 Monroe Avenue NW, Grand Rapids, MI 49503, USA; (M.A.O.B.); (A.F.)
- Department of Animal Science, Michigan State University, 474 S Shaw Ln #1290, East Lansing, MI 48824, USA
| | - Elizabeth Kenyon
- Precision Health Program, Michigan State University, 766 Service Road, East Lansing, MI 48824, USA; (N.T.); (E.K.); (S.K.M.)
- Department of Radiology, College of Human Medicine, Michigan State University, 766 Service Road, East Lansing, MI 48824, USA;
| | - Christiane L. Mallett
- Department of Radiology, College of Human Medicine, Michigan State University, 766 Service Road, East Lansing, MI 48824, USA;
- Institute for Quantitative Health Science and Engineering, Michigan State University, 775 Woodlot Drive, East Lansing, MI 48824, USA
| | - Sujan Kumar Mondal
- Precision Health Program, Michigan State University, 766 Service Road, East Lansing, MI 48824, USA; (N.T.); (E.K.); (S.K.M.)
- Department of Radiology, College of Human Medicine, Michigan State University, 766 Service Road, East Lansing, MI 48824, USA;
| | - Asgerally Fazleabas
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, 400 Monroe Avenue NW, Grand Rapids, MI 49503, USA; (M.A.O.B.); (A.F.)
| | - Anna Moore
- Precision Health Program, Michigan State University, 766 Service Road, East Lansing, MI 48824, USA; (N.T.); (E.K.); (S.K.M.)
- Department of Radiology, College of Human Medicine, Michigan State University, 766 Service Road, East Lansing, MI 48824, USA;
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Peven K, Wickham AP, Wilks O, Kaplan YC, Marhol A, Ahmed S, Bamford R, Cunningham AC, Prentice C, Meczner A, Fenech M, Gilbert S, Klepchukova A, Ponzo S, Zhaunova L. Assessment of a Digital Symptom Checker Tool's Accuracy in Suggesting Reproductive Health Conditions: Clinical Vignettes Study. JMIR Mhealth Uhealth 2023; 11:e46718. [PMID: 38051574 PMCID: PMC10731551 DOI: 10.2196/46718] [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: 02/23/2023] [Revised: 09/06/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Reproductive health conditions such as endometriosis, uterine fibroids, and polycystic ovary syndrome (PCOS) affect a large proportion of women and people who menstruate worldwide. Prevalence estimates for these conditions range from 5% to 40% of women of reproductive age. Long diagnostic delays, up to 12 years, are common and contribute to health complications and increased health care costs. Symptom checker apps provide users with information and tools to better understand their symptoms and thus have the potential to reduce the time to diagnosis for reproductive health conditions. OBJECTIVE This study aimed to evaluate the agreement between clinicians and 3 symptom checkers (developed by Flo Health UK Limited) in assessing symptoms of endometriosis, uterine fibroids, and PCOS using vignettes. We also aimed to present a robust example of vignette case creation, review, and classification in the context of predeployment testing and validation of digital health symptom checker tools. METHODS Independent general practitioners were recruited to create clinical case vignettes of simulated users for the purpose of testing each condition symptom checker; vignettes created for each condition contained a mixture of condition-positive and condition-negative outcomes. A second panel of general practitioners then reviewed, approved, and modified (if necessary) each vignette. A third group of general practitioners reviewed each vignette case and designated a final classification. Vignettes were then entered into the symptom checkers by a fourth, different group of general practitioners. The outcomes of each symptom checker were then compared with the final classification of each vignette to produce accuracy metrics including percent agreement, sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS A total of 24 cases were created per condition. Overall, exact matches between the vignette general practitioner classification and the symptom checker outcome were 83% (n=20) for endometriosis, 83% (n=20) for uterine fibroids, and 88% (n=21) for PCOS. For each symptom checker, sensitivity was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, and 100% for PCOS; specificity was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 75% for PCOS; positive predictive value was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, 80% for PCOS; and negative predictive value was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 100% for PCOS. CONCLUSIONS The single-condition symptom checkers have high levels of agreement with general practitioner classification for endometriosis, uterine fibroids, and PCOS. Given long delays in diagnosis for many reproductive health conditions, which lead to increased medical costs and potential health complications for individuals and health care providers, innovative health apps and symptom checkers hold the potential to improve care pathways.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Stephen Gilbert
- Else Kröner Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany
| | | | - Sonia Ponzo
- Flo Health UK Limited, London, United Kingdom
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12
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Farias JCD, Nascimento MDDSB, Leal PDC, Oliveira CMBD, Moura ECR. Impact of deep resection of endometriosis in the pelvis on urodynamic parameters. Acta Cir Bras 2023; 38:e386323. [PMID: 38055398 DOI: 10.1590/acb386323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/19/2023] [Indexed: 12/08/2023] Open
Abstract
PURPOSE To evaluate the effects of deep resection of endometriosis in the posterior pelvic region on urodynamic parameters. METHODS A prospective observational study conducted with female patients diagnosed with deep pelvic endometriosis before and after endometriosis resection surgery. Clinical history, image exams, the Female Lower Urinary Tract Symptoms questionnaire, urodynamic examination, cystometry, and voiding study were evaluated. RESULTS Patients aged 30-39 years old, operative duration of 132.5 minutes, and 2.7 days of hospital stay. Uroflowmetry and cystometry showed tendency for an increase after the surgery in the flow duration, time to maximum flow, and first voiding desire and decreased residual volume and maximum cystometric capacity. Opening, maximum urinary flow, and maximum flow pressure decreased at T1, and the closing parameters increased, although statistically non significant. The variables decreased at T1 in the urodynamic, except for detrusor overactivity. Although we observed a reasonable number of low bladder compliance and abnormal bladder sensation, the results were maintained at T1. General scores for filling and incontinence showed a significant decrease after surgery. CONCLUSIONS A significant response in the patient's perception of urinary function was demonstrated after surgery. It is observed that the surgical procedure did not affect the uroflowmetric and cystometric characteristics of the evaluated patients.
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Affiliation(s)
| | | | - Plínio da Cunha Leal
- Universidade Federal do Maranhão - Postgraduate Program in Adult Health - São Luís (MA) - Brazil
| | | | - Ed Carlos Rey Moura
- Universidade Federal do Maranhão - Postgraduate Program in Adult Health - São Luís (MA) - Brazil
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Wang TM, Lee YL, Chung CH, Sun CA, Kang CY, Wu GJ, Chien WC. Association Between Endometriosis and Mental Disorders Including Psychiatric Disorders, Suicide, and All-Cause Mortality -A Nationwide Population-Based Cohort Study in Taiwan. Int J Womens Health 2023; 15:1865-1882. [PMID: 38046265 PMCID: PMC10693200 DOI: 10.2147/ijwh.s430252] [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: 07/12/2023] [Accepted: 11/08/2023] [Indexed: 12/05/2023] Open
Abstract
Objective A multitude of previous studies has substantiated that endometriosis correlated highly with psychiatric health. This study aims to investigate the association between endometriosis and psychiatric health. Methods Utilizing the National Health Insurance Research Database of Taiwan, 100,770 enrolled participants, including 20,154 patients with endometriosis and 80,616 in the control group (1:4), matched for age, and index date from Taiwan's Longitudinal Health Insurance Database between January 1, 2000, and December 31, 2015. The Cox proportional regression model was used to compare the risk of mental disorders during the 16 years of follow-up after adjusting for confounding factors. Results Of the study patients, 4083 (20.26%) developed mental disorders; 9225 of the 80,616 controls (11.44%) developed mental disorders. The Cox regression demonstrated that, after adjusting for age, monthly income, urbanization level, etc., people with endometriosis are more likely to suffer from mental disorders compared to those without endometriosis (hazard ratio [HR]=2.131; 95% confidence interval [CI]= 1.531-2.788; p<0.001). The result illustrated that women over 40 years old had a more significant risk. Conclusion Compared to people without endometriosis, this study provides evidence that patients with endometriosis are at a 2.131-fold higher risk of developing mental disorders, especially in elder women. Regular psychiatric follow-up might be needed for those patients.
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Affiliation(s)
- Tsan-Min Wang
- Department of Medical Research, Tri-Service General Hospital, Taipei, 11490, Taiwan
| | - Yi-Liang Lee
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Department of Obstetrics and Gynecology, Kang Ning Hospital, Taipei, Taiwan, Republic of China
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei, 11490, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, 11490, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China
| | - Chieh-Yi Kang
- Department of Obstetrics & Gynecology, Chi Mei Medical Center Gynecologic Oncologist Division, Tainan City, Taiwan, Republic of China
| | - Gwo-Jang Wu
- Department of Medical Research, Tri-Service General Hospital, Taipei, 11490, Taiwan
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, 11490, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei, 11490, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, 11490, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, 11490,Taiwan
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14
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Kılıçkıran H, Halilzade İ, Halilzade Mİ, Topçuoğlu C, Çınar M. Role of cystatin C levels as an inflammatory marker in predicting endometriosis. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230613. [PMID: 38055453 DOI: 10.1590/1806-9282.20230613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/26/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Endometriosis is a common chronic inflammatory disease associated with infertility and pelvic pain. Diagnosis is based on the appearance of endometriotic lesions at the time of surgery. Our study aimed to determine whether cystatin C can be used as a predictor of endometriosis and to investigate its potential role in doing so. METHODS The study included 45 patients with endometriosis between the ages of 18 and 40 years whose pathology results were compatible with endometriosis and were operated on, and a control group of 45 healthy women. These two groups were compared in terms of serum cystatin C levels, demographic-clinical characteristics, operation results, and other laboratory values. RESULTS The cystatin C and hs-CRP levels of the endometriosis patients were found to be significantly higher than the control subjects (p<0.005). Whether the endometriosis disease could be detected for serum cystatin C levels was determined by the receiver operating characteristic analysis and the most appropriate positive cutoff value for cystatin C was found to be 5.14 ng/mL (86.7% sensitivity and 77.8% specificity). In the linear regression analysis, it was observed that the probability of endometriosis increased 2.5 times when cystatin C levels increased above the threshold value of 5.14 ng/mL (OR: 2.5; 95%CI 2.24-2.76). CONCLUSION Our study shows that the serum cystatin C levels can be used as a guide for diagnosis in patients with advanced endometriosis. However, more research is needed to prove its reliability and accuracy in order to put it into practice.
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Affiliation(s)
- Harun Kılıçkıran
- University of Health Sciences, Ankara City Hospital, Department of Obstetrics and Gynecology - Ankara, Turkey
| | - İnci Halilzade
- University of Health Sciences, Ankara City Hospital, Department of Obstetrics and Gynecology - Ankara, Turkey
| | - Mohammad İbrahim Halilzade
- University of Health Sciences, Ankara City Hospital, Department of Obstetrics and Gynecology - Ankara, Turkey
| | - Canan Topçuoğlu
- University of Health Sciences, Ankara City Hospital, Department of Biochemistry - Ankara, Turkey
| | - Mehmet Çınar
- University of Health Sciences, Ankara City Hospital, Department of Obstetrics and Gynecology - Ankara, Turkey
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15
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Volpini C, Bloise N, Dominoni M, Barra F, Vellone VG, Minzioni P, Gardella B, Ferrero S, Visai L. The nano-revolution in the diagnosis and treatment of endometriosis. NANOSCALE 2023; 15:17313-17325. [PMID: 37874212 DOI: 10.1039/d3nr03527a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Endometriosis is a painful gynecological disease with a high prevalence, affecting millions of women worldwide. Innovative, non-invasive treatments, and new patient follow-up strategies are needed to deal with the harmful social and economic effects. In this scenario, considering the recent, very promising results already reported in the literature, a commitment to new research in the field of nanomedicine is urgently needed. Study findings clearly show the potential of this approach in both the diagnostic and therapeutic phases of endometriosis. Here, we offer a brief review of the recent exciting and effective applications of nanomedicine in both the diagnosis and therapy of endometriosis. Special emphasis will be placed on the emerging theranostic application of nanoproducts, and the combination of phototherapy and nanotechnology as new therapeutic modalities for endometriosis. The review will also provide interested readers with a guide to the selection process and parameters to consider when designing research into this type of approach.
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Affiliation(s)
- Cristina Volpini
- Molecular Medicine Department (DMM), Centre for Health Technologies (CHT), UdR INSTM, University of Pavia, Pavia, Italy.
- Medicina Clinica-Specialistica, UOR5 Laboratorio di Nanotecnologie, ICS Maugeri, IRCCS, Pavia, Italy
- Interuniversity Center for the promotion of the 3Rs principles in teaching and research (Centro 3R), University of Pavia Unit, Italy
| | - Nora Bloise
- Molecular Medicine Department (DMM), Centre for Health Technologies (CHT), UdR INSTM, University of Pavia, Pavia, Italy.
- Medicina Clinica-Specialistica, UOR5 Laboratorio di Nanotecnologie, ICS Maugeri, IRCCS, Pavia, Italy
- Interuniversity Center for the promotion of the 3Rs principles in teaching and research (Centro 3R), University of Pavia Unit, Italy
| | - Mattia Dominoni
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Valerio Gaetano Vellone
- Anatomia Patologica Universitaria, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Università di Genova, Italy
| | - Paolo Minzioni
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy
| | - Barbara Gardella
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
- DINOGMI, University of Genova, Italy
| | - Livia Visai
- Molecular Medicine Department (DMM), Centre for Health Technologies (CHT), UdR INSTM, University of Pavia, Pavia, Italy.
- Medicina Clinica-Specialistica, UOR5 Laboratorio di Nanotecnologie, ICS Maugeri, IRCCS, Pavia, Italy
- Interuniversity Center for the promotion of the 3Rs principles in teaching and research (Centro 3R), University of Pavia Unit, Italy
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Pan HY, Wan J. Serum HSF1 is upregulated in endometriosis patients and serves as a potential diagnostic biomarker. Kaohsiung J Med Sci 2023; 39:1045-1051. [PMID: 37409787 DOI: 10.1002/kjm2.12723] [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: 02/24/2023] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 07/07/2023] Open
Abstract
Endometriosis (EMS) is a prevalent gynecological condition lacking reliable diagnostic biomarkers. This prospective study aimed to analyze the potential of serum heat shock transcription factor 1 (HSF1) as a diagnostic marker for EMS. Clinical features of 92 EMS patients and 52 controls were recorded, revealing significant differences in dysmenorrhea, dyspareunia, pelvic pain, nulliparity, and CA125 levels. Serum HSF1 was upregulated in EMS patients, with higher levels in American Society for Reproductive Medicine (ASRM) III/IV than ASRM I/II. Receiver operating characteristic curve analysis demonstrated good diagnostic function for serum HSF1 (AUC: 0.857, sensitivity: 91.30%, specificity: 63.46%). Serum HSF1, dysmenorrhea, dyspareunia, and nulliparity were independent risk factors for EMS, while dysmenorrhea and serum HSF1 were independent risk factors for EMS severity. Additionally, the GSE25628 dataset was downloaded from the GEO database for differential analysis of gene expression. The HSF1 downstream target genes PTGES3, HSP90AA1, and HSPB1 showed significant differential expression in EMS, suggesting their involvement in the regulatory mechanism of HSF1 in EMS.
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Affiliation(s)
- Hui-Ying Pan
- Department of Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Jing Wan
- Department of Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
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Talebloo N, Bernal MAO, Kenyon E, Mallett CL, Fazleabas A, Moore A. Detection of Endometriosis Lesions Using Gd-Based Collagen I Targeting Probe in Murine Models of Endometriosis. Mol Imaging Biol 2023; 25:833-843. [PMID: 37418136 PMCID: PMC10598151 DOI: 10.1007/s11307-023-01833-6] [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: 02/27/2023] [Revised: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Endometriosis is a chronic condition characterized by high fibrotic content and affecting about 10% of women during their reproductive years. Yet, no clinically approved agents are available for non-invasive endometriosis detection. The purpose of this study was to investigate the utility of a gadolinium-based collagen type I targeting probe (EP-3533) to non-invasively detect endometriotic lesions using magnetic resonance imaging (MRI). Previously, this probe has been used for detection and staging of fibrotic lesions in the liver, lung, heart, and cancer. In this study we evaluate the potential of EP-3533 for detecting endometriosis in two murine models and compare it with a non-binding isomer (EP-3612). PROCEDURES For imaging, we utilized two GFP-expressing murine models of endometriosis (suture model and injection model) injected intravenously with EP3533 or EP-33612. Mice were imaged before and after bolus injection of the probes. The dynamic signal enhancement of MR T1 FLASH images was analyzed, normalized, and quantified, and the relative location of lesions was validated through ex vivo fluorescence imaging. Subsequently, the harvested lesions were stained for collagen, and their gadolinium content was quantified by inductively coupled plasma optical emission spectrometry (ICP-OES). RESULTS We showed that EP-3533 probe increased the signal intensity in T1-weighted images of endometriotic lesions in both models of endometriosis. Such enhancement was not detected in the muscles of the same groups or in endometriotic lesions of mice injected with EP-3612 probe. Consequentially, control tissues had significantly lower gadolinium content, compared to the lesions in experimental groups. Probe accumulation was similar in endometriotic lesions of either model. CONCLUSIONS This study provides evidence for feasibility of targeting collagen type I in the endometriotic lesions using EP3533 probe. Our future work includes investigation of the utility of this probe for therapeutic delivery in endometriosis to inhibit signaling pathways that cause the disease.
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Affiliation(s)
- Nazanin Talebloo
- Precision Health Program, Michigan State University, 766 Service Road, East Lansing, MI, 48824, USA
- Department of Chemistry, College of Natural Sciences, Michigan State University, 578 S Shaw Lane, East Lansing, MI, 48824, USA
| | - Maria Ariadna Ochoa Bernal
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, 400 Monroe Avenue NW, Grand Rapids, MI, 49503, USA
- Department of Animal Science, Michigan State University, 474 S Shaw Ln, East Lansing, MI, 48824, USA
| | - Elizabeth Kenyon
- Precision Health Program, Michigan State University, 766 Service Road, East Lansing, MI, 48824, USA
- Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI, 48824, USA
| | - Christiane L Mallett
- Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI, 48824, USA
- Institute for Quantitative Health Science and Engineering, Michigan State University, 775 Woodlot Drive, East Lansing, MI, 48824, USA
| | - Asgerally Fazleabas
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, 400 Monroe Avenue NW, Grand Rapids, MI, 49503, USA
| | - Anna Moore
- Precision Health Program, Michigan State University, 766 Service Road, East Lansing, MI, 48824, USA.
- Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI, 48824, USA.
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Deng T, Lin Y, Chen L, Jiang JY. Comparison of Dydrogesterone and GnRH-a Effects After Laparoscopic Surgery in Patients with Stage III and IV Endometriosis. Int J Gen Med 2023; 16:4357-4364. [PMID: 37786803 PMCID: PMC10541528 DOI: 10.2147/ijgm.s429953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
Objective To compare the spontaneous pregnancy rates between dydrogesterone and Gonadotropin-releasing hormone agonist (GnRH-a) treatments in patients with endometriosis stage III and IV after laparoscopy. Methods The clinical data of patients with endometriosis stage III and IV administered laparoscopic surgery in our hospital from January 2018 to March 2020 were retrospectively analyzed. Totally 151 cases were divided into two groups according to postoperative medication, including the study (70 cases) and control (81 cases) groups treated with dydrogesterone and GnRH-a, respectively. The spontaneous pregnancy and subsequent pregnancy outcomes were assessed within 12 months. Results Totally 49 patients had spontaneous pregnancy. Among them, there were 31 cases in the dydrogesterone group (spontaneous pregnancy rate of 44.3%, 31/70), including 25 live birth cases (35.7%, 25/70), 4 miscarriage cases, and 2 ectopic pregnancy cases. The time to conception was 1-10 months (median value of 5 months). Totally 18 cases in the GnRH-a group had spontaneous pregnancy (22.2%, 18/81), including 16 live birth cases (19.8%, 16/81). 81) and 2 miscarriage cases; the time to conception was 3-11 months (median value of 6 months). There were significant differences in spontaneous pregnancy rate and cumulative spontaneous pregnancy rate between the two groups (P = 0.005 and 0.003, respectively). Conclusion Dydrogesterone after laparoscopic surgery in patients with endometriosis stage III and IV improved the natural pregnancy rate.
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Affiliation(s)
- Ting Deng
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, People’s Republic of China
| | - Yin Lin
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, People’s Republic of China
| | - Li Chen
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, People’s Republic of China
| | - Jun-Ying Jiang
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, People’s Republic of China
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Pant A, Moar K, K Arora T, Maurya PK. Biomarkers of endometriosis. Clin Chim Acta 2023; 549:117563. [PMID: 37739024 DOI: 10.1016/j.cca.2023.117563] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023]
Abstract
Endometriosis is one of the most severe female reproductive disorders, affecting 6-10% of women between 18 and 35. It is a gynaecological condition where endometrial tissue develops and settles outside the uterus. The aetiology of endometriosis is primarily influenced by genetic, epigenetic, and non-genetic variables, making it highly challenging to create a therapeutic therapy explicitly targeting the ectopic tissue. The delay in the treatment is due to the limitations in the diagnostic approaches, which are restricted to invasive techniques such as laparoscopy or laparotomy. This accords to 70% of the women being diagnosed at later stages. By understanding the subject, several treatment medications have been produced to lessen the disease's symptoms. Nevertheless, endometriosis cannot be permanently cured. A viable or persuasive standard screening test for endometriosis must be utilized in a clinical context. A helpful assessment method for the early identification of endometriosis could be biomarkers. A major research priority is the identification of a biomarker that is sensitive and specific enough for detecting endometriosis. The present article has reviewed studies published on the expression of biomarkers of endometriosis. It outlines various biomarkers from different sample types, such as serum/plasma and urine, in addition to tissue. This would provide a non-invasive approach to diagnosing the disease at the initial stages without any harmful repercussions. Future high-throughput advances in science and technology are anticipated to result in the creation of a potent remedy for endometriosis. To achieve successful outcomes, it is necessary to research the discussed biomarkers that demonstrate substantial results extensively.
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Affiliation(s)
- Anuja Pant
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India
| | - Kareena Moar
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India
| | - Taruna K Arora
- Reproductive Biology and Maternal Child Health Division, Indian Council of Medical Research, New Delhi 110029, India
| | - Pawan Kumar Maurya
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India.
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Li Y, He Y, Cheng W, Zhou Z, Ni Z, Yu C. Double-edged roles of ferroptosis in endometriosis and endometriosis-related infertility. Cell Death Discov 2023; 9:306. [PMID: 37607902 PMCID: PMC10444804 DOI: 10.1038/s41420-023-01606-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 08/24/2023] Open
Abstract
Endometriosis is strongly associated with infertility. Several mechanisms have been reported in an attempt to elucidate the pathophysiological effects that lead to reduced fertility in women with endometriosis. However, the mechanisms by which endometriosis affects fertility have not been fully elucidated. Ferroptosis is a novel form of nonapoptotic cell death that is characterized by iron-dependent lipid peroxidation membrane damage. In past reports, elevated iron levels in ectopic lesions, peritoneal fluid and follicular fluid have been reported in patients with endometriosis. The high-iron environment is closely associated with ferroptosis, which appears to exhibit a double-edged effect on endometriosis. Ferroptosis can cause damage to ovarian granulosa cells, oocytes, and embryos, leading to endometriosis-related infertility. This article summarizes the main pathways and regulatory mechanisms of ferroptosis and explores the possible mechanisms of the formation of an iron-overloaded environment in endometriotic ectopic lesions, peritoneal fluid and follicular fluid. Finally, we reviewed recent studies on the main and potential mechanisms of ferroptosis in endometriosis and endometriosis-related infertility.
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Affiliation(s)
- Yangshuo Li
- Department of Gynecology of Traditional Chinese Medicine, the First Affiliated Hospital of Naval Medical University, 200433, Shanghai, China
| | - Yalun He
- Department of Gynecology of Traditional Chinese Medicine, the First Affiliated Hospital of Naval Medical University, 200433, Shanghai, China
| | - Wen Cheng
- Department of Gynecology of Traditional Chinese Medicine, the First Affiliated Hospital of Naval Medical University, 200433, Shanghai, China
| | - Zhihao Zhou
- Department of Gynecology of Traditional Chinese Medicine, the First Affiliated Hospital of Naval Medical University, 200433, Shanghai, China
| | - Zhexin Ni
- Department of Gynecology of Traditional Chinese Medicine, the First Affiliated Hospital of Naval Medical University, 200433, Shanghai, China.
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, 100850, Beijing, China.
| | - Chaoqin Yu
- Department of Gynecology of Traditional Chinese Medicine, the First Affiliated Hospital of Naval Medical University, 200433, Shanghai, China.
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Lv SJ, Sun JN, Gan L, Sun J. Identification of molecular subtypes and immune infiltration in endometriosis: a novel bioinformatics analysis and In vitro validation. Front Immunol 2023; 14:1130738. [PMID: 37662927 PMCID: PMC10471803 DOI: 10.3389/fimmu.2023.1130738] [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: 12/30/2022] [Accepted: 07/27/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Endometriosis is a worldwide gynacological diseases, affecting in 6-10% of women of reproductive age. The aim of this study was to investigate the gene network and potential signatures of immune infiltration in endometriosis. Methods The expression profiles of GSE51981, GSE6364, and GSE7305 were obtained from the Gene Expression Omnibus (GEO) database. Core modules and central genes related to immune characteristics were identified using a weighted gene coexpression network analysis. Bioinformatics analysis was performed to identify central genes in immune infiltration. Protein-protein interaction (PPI) network was used to identify the hub genes. We then constructed subtypes of endometriosis samples and calculated their correlation with hub genes. qRTPCR and Western blotting were used to verify our findings. Results We identified 10 candidate hub genes (GZMB, PRF1, KIR2DL1, KIR2DL3, KIR3DL1, KIR2DL4, FGB, IGFBP1, RBP4, and PROK1) that were significantly correlated with immune infiltration. Our study established a detailed immune network and systematically elucidated the molecular mechanism underlying endometriosis from the aspect of immune infiltration. Discussion Our study provides comprehensive insights into the immunology involved in endometriosis and might contribute to the development of immunotherapy for endometriosis. Furthermore, our study sheds light on the underlying molecular mechanism of endometriosis and might help improve the diagnosis and treatment of this condition.
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Affiliation(s)
- Si-ji Lv
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jia-ni Sun
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Gan
- Department of Gynaecology and Obstetrics, Ningbo First Hospital, Ningbo, Zhejiang, China
| | - Jing Sun
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
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22
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Kovács Z, Reidy F, Glover L, McAuliffe FM, Stockmann H, Kilbane MT, Twomey PJ, Peters M, Saare M, Rudd PM, Utt M, Wingfield M, Salumets A, Saldova R. N-glycans from serum IgG and total serum glycoproteins specific for endometriosis. Sci Rep 2023; 13:10480. [PMID: 37380737 DOI: 10.1038/s41598-023-37421-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 06/21/2023] [Indexed: 06/30/2023] Open
Abstract
Endometriosis is a chronic inflammatory gynaecological disease characterized by the growth of endometrial tissue outside the uterine cavity. There are currently no definitive non-invasive diagnostic tools. Glycosylation is the most common posttranslational modification of proteins and altered glycosylation has been found in many diseases, including chronic inflammatory conditions and cancer. Sialylation and galactosylation on serum IgG have previously been found to be altered in endometriosis and serum sialylation changed after Zoladex (Goserelin Acetate) therapy. Using IgG and whole serum glycoproteins, we investigated N-glycosylation in two clinical cohorts of women with and without endometriosis. PNGase F-digested serum samples were fluorescently labelled and N-glycans were profiled by ultra-performance liquid chromatography. Clinical data was collected to link glycomic findings with metabolic and hormonal profiles. Total serum glycoprotein and IgG glycosylation differed in patients with endometriosis compared to control cases. The most significantly altered was glycan peak 3 from IgG, containing bisected biantennary glycans, which was decreased in the endometriosis cohorts (p = 0.0000005-0.018). In conclusion, this is the first pilot study to identify changes in N-glycans from whole serum glycoproteins associated with endometriosis. A larger validation study is now warranted and such studies should include the follow-up of surgically and pharmacologically treated patients.
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Affiliation(s)
- Zsuzsanna Kovács
- NIBRT GlycoScience Group, National Institute for Bioprocessing Research and Training, Belfield, Blackrock, Dublin, A94 X099, Co. Dublin, Ireland
| | - Fiona Reidy
- Merrion Fertility Clinic and National Maternity Hospital, Dublin, Ireland
| | - Louise Glover
- Merrion Fertility Clinic and National Maternity Hospital, Dublin, Ireland
- Obstetrics and Gynaecology, UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Fionnuala M McAuliffe
- Obstetrics and Gynaecology, UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Henning Stockmann
- NIBRT GlycoScience Group, National Institute for Bioprocessing Research and Training, Belfield, Blackrock, Dublin, A94 X099, Co. Dublin, Ireland
| | - Mark T Kilbane
- Department of Clinical Chemistry, St. Vincent's University Hospital, Dublin, Ireland
| | - Patrick J Twomey
- Department of Clinical Chemistry, St. Vincent's University Hospital, Dublin, Ireland
- UCD School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Maire Peters
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Competence Centre On Health Technologies, Tartu, Estonia
| | - Merli Saare
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Competence Centre On Health Technologies, Tartu, Estonia
| | - Pauline M Rudd
- NIBRT GlycoScience Group, National Institute for Bioprocessing Research and Training, Belfield, Blackrock, Dublin, A94 X099, Co. Dublin, Ireland
| | - Meeme Utt
- Department of Immunology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Mary Wingfield
- Merrion Fertility Clinic and National Maternity Hospital, Dublin, Ireland
- Obstetrics and Gynaecology, UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Andres Salumets
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Competence Centre On Health Technologies, Tartu, Estonia
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Radka Saldova
- NIBRT GlycoScience Group, National Institute for Bioprocessing Research and Training, Belfield, Blackrock, Dublin, A94 X099, Co. Dublin, Ireland.
- College of Health and Agricultural Science (CHAS), UCD School of Medicine, University College Dublin (UCD), Dublin, D07 A8NN, Ireland.
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23
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Ellis K, Munro D, Wood R. Dismissal informs the priorities of endometriosis patients in New Zealand. Front Med (Lausanne) 2023; 10:1185769. [PMID: 37324132 PMCID: PMC10267318 DOI: 10.3389/fmed.2023.1185769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Endometriosis is a common condition with average delays to diagnosis in New Zealand of almost 9 years. Methods In total, 50 endometriosis patients participated in anonymous, asynchronous, online group discussions about their priorities, and their experiences with the development of symptoms, seeking a diagnosis, and receiving appropriate treatment. Results Higher subsidy of care was the top change endometriosis patients wanted, followed by more research funding. When asked to choose whether research should be focused on improving diagnosis or improving treatment methods, the results were evenly split. Within this cohort, patients highlighted that they did not know the difference between normal menstrual discomfort and pathological endometriotic pain. If, upon seeking help, medical practitioners classified their symptoms as "normal," these dismissals could instill doubt in patients, which made it more difficult for them to continue to seek a diagnosis and effective treatments. Patients who did not express dismissal had a significantly shorter delay from symptom onset to diagnosis of 4.6 ± 3.4 years vs. 9.0 ± 5.2 years. Conclusion Doubt is a frequent experience for endometriosis patients in New Zealand, which was reinforced by some medical practitioners who were dismissive of their pain and thus prolonged the patient's delay to diagnosis.
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Affiliation(s)
- Katherine Ellis
- Department of Chemical and Process Engineering, University of Canterbury, Christchurch, New Zealand
| | - Deborah Munro
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
- The Biomolecular Interaction Centre, University of Canterbury, Christchurch, New Zealand
| | - Rachael Wood
- Department of Chemical and Process Engineering, University of Canterbury, Christchurch, New Zealand
- The Biomolecular Interaction Centre, University of Canterbury, Christchurch, New Zealand
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24
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Barba M, Morciano A, Melocchi T, Cola A, Inzoli A, Passoni P, Frigerio M. Superinfection of Rectovaginal Endometriosis: Case Report and Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13091514. [PMID: 37174906 PMCID: PMC10177285 DOI: 10.3390/diagnostics13091514] [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: 03/07/2023] [Revised: 04/05/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND A peculiar complication of endometriosis is a superinfection. However, the superinfection of extra-ovarian endometriosis is anecdotal, and only a few cases have been described. We wanted to present the first cases of the superinfection of rectovaginal endometriosis and to perform a literature review of the superinfection of extra-ovarian endometriosis. METHODS We present a case of a 24-year-old woman who was referred to our Pelvic Floor Unit for rectal-perineal pain, dyspareunia, and recurrent episodes of dense purulent vaginal discharge for one year, in which the superinfection of rectovaginal endometriosis was diagnosed. Moreover, we performed a systematic search of the literature indexed on PubMed up to 31 January 2023. RESULTS Laparoscopic drainage was successful in managing this condition. In the literature, clinical presentation and instrumental and microbiological findings are very heterogeneous. However, the gold standard of management is represented by surgical or percutaneous drainage. CONCLUSIONS In the case of a pelvic abscess, the superinfection of endometriosis lesions should be suspected, and this can represent the onset symptom of endometriosis. Ultrasonography may show nodular or flat hypoechoic lesions with hyperechoic debris and peripheral positive color/power Doppler intensities. The goal of management is to drain the abscess, either percutaneously or via traditional surgery, followed by proper hormonal therapy to reduce recurrence.
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Affiliation(s)
- Marta Barba
- Department of Gynecology and Obstetrics, Pelvic Floor Center, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Andrea Morciano
- Department of Gynecology and Obstetrics, Panico Pelvic Floor Center, Pia Fondazione "Cardinale G. Panico", 73039 Tricase, Italy
| | - Tomaso Melocchi
- Department of Gynecology and Obstetrics, Pelvic Floor Center, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Alice Cola
- Department of Gynecology and Obstetrics, Pelvic Floor Center, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Alessandra Inzoli
- Department of Gynecology and Obstetrics, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Paolo Passoni
- Department of Gynecology and Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, ASST Monza, Ospedale San Gerardo, 20900 Monza, Italy
| | - Matteo Frigerio
- Department of Gynecology and Obstetrics, Pelvic Floor Center, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
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25
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Pineda Mateo M, Arnáez de la Cruz M. Manejo quirúrgico del endometrioma en pacientes con deseo genésico. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2023.100851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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26
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Brunelli AC, Brito LGO, Moro FAS, Jales RM, Yela DA, Benetti-Pinto CL. Ultrasound Elastography for the Diagnosis of Endometriosis and Adenomyosis: A Systematic Review with Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:699-709. [PMID: 36528440 DOI: 10.1016/j.ultrasmedbio.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/05/2022] [Accepted: 11/10/2022] [Indexed: 06/17/2023]
Abstract
Elastography is capable of measuring tissue mechanical properties and elasticity. It is used to help diagnose various diseases, although its use in pelvic endometriosis remains to be established. A systematic review and meta-analysis were conducted to assess transvaginal ultrasound elastography for the diagnosis of different manifestations of endometriosis and adenomyosis. PRISMA guidelines were used for a Medline, PubMed, Embase, BVS/Bireme, Scopus, Cochrane Library and Escudos database search. Studies indexed until March 2021 that evaluated elastography compared with histopathological results (gold standard), ultrasound or magnetic resonance imaging for diagnosis of pelvic endometriosis and adenomyosis were eligible. The Rayyan platform was used to select studies. Sensitivity (S), specificity (Ps), positive and negative predictive values and receiver operating characteristic curves were calculated for elastographic diagnosis of endometriosis. A meta-analysis using Review Manager 5 and Open Meta Analyst was performed. Bias risk in the studies was analyzed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. This systematic review was prospectively registered in the PROSPERO database: CRD42021244555. Among the 163 identified citations, 10 studies were eligible for review (5 for diagnosis of adenomyosis, 2 for endometrioma, 3 for deep intestinal endometriosis and rectovaginal septum [deep pelvic endometriosis], N = 744 women). In deep pelvic endometriosis, lesions diagnosed by elastography were found to correlate with histopathology results. Increased "stiffness" (elastography) was associated with a higher fibrotic component, with S = 78%-100% and Ps = 100%, according to the authors. On elastography, endometriomas were stiffer than hemorrhagic cysts (S = 82%, Ps = 79%) and malignant tumors (S = 86%, Ps = 100%). For these lesions, a meta-analysis could not be performed because the small number of studies and insufficient data. In adenomyosis, meta-analysis and receiver operating characteristic curve analysis revealed that elastography had good sensitivity and specificity. Studies indicated a low bias risk by QUADAS-2. Elastography had high sensitivity and specificity for deep pelvic endometriosis diagnosis, and its findings correlated with histopathology results. For adenomyosis, the meta-analysis confirmed the sensitivity and specificity results of the studies. Given these results, elastography may be a promising imaging test, contributing to non-invasive diagnosis of endometriosis and adenomyosis.
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Affiliation(s)
- Ana Claudia Brunelli
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Luiz Gustavo Oliveira Brito
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Flavia Assad Salum Moro
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Rodrigo Menezes Jales
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Daniela Angerame Yela
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
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Xia T, Zeng K, Peng Q, Wu X, Lei X. Clinical significance of serum Th1/Th2 cytokines in patients with endometriosis. Women Health 2023; 63:73-82. [PMID: 36581403 DOI: 10.1080/03630242.2022.2144986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Endometriosis (EMS) is a challenging gynecological disorder prevalent in reproductive-aged women, and Th1/Th2 cytokines are implicated in EMS progression. This study probed the serum levels and clinical values of Th1/Th2 cytokines in EMS patients. Firstly, the clinic characteristics of EMS and control patients were recorded. The levels of interferon (IFN)-γ, interleukin (IL)-2, IL-4, and IL-10 in the serum of EMS and control patients were identified, respectively. The correlations between Th1 and Th2 cytokines and the diagnostic values of these cytokines in EMS were analyzed. We observed that EMS patients had obvious differences from the controls in dysmenorrhea, dyspareunia, pelvic pain, nulliparous, and CA125 levels. Serum IFN-γ and IL-2 were lower while IL-4 and IL-10 were higher in EMS patients. Serum IFN-γ, IL-4 were negatively correlated with serum IL-2, and IL-10 in EMS patients. Th1/Th2 cytokines may help the diagnosis of EMS. Serum IFN-γ and IL-2 were independent protective factors for EMS while dysmenorrhea, dyspareunia, nulliparous, and serum IL-4 and IL-10 were independent risk factors for EMS. Collectively, serum Th1/Th2 cytokine levels helped the diagnosis of EMS, with IFN-γ and IL-2 serving as independent protective factors whilst IL-4 and IL-10 serving as independent risk factors.
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Affiliation(s)
- Tingting Xia
- Department of Reproductive Medicine, Affiliated Hospital of Jinggangshan University, Ji'an City, Jiangxi, China
| | - Kefei Zeng
- Department of Obstetrics and Gynecology, Affiliated Hospital of Jinggangshan University, Ji'an City, Jiangxi, China
| | - Qingmei Peng
- Department of Reproductive Medicine, Affiliated Hospital of Jinggangshan University, Ji'an City, Jiangxi, China
| | - Xiaolan Wu
- Department of Obstetrics and Gynecology, Affiliated Hospital of Jinggangshan University, Ji'an City, Jiangxi, China
| | - Xianghua Lei
- Department of Obstetrics and Gynecology, Affiliated Hospital of Jinggangshan University, Ji'an City, Jiangxi, China
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28
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Gonadotropin-Releasing Hormone Antagonists-A New Hope in Endometriosis Treatment? J Clin Med 2023; 12:jcm12031008. [PMID: 36769656 PMCID: PMC9918258 DOI: 10.3390/jcm12031008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Endometriosis is a chronic disease, in which endometrial-like tissue is found outside the uterine cavity. Lesions are typically located in the true pelvis but can be found, in addition to extragenital endometriosis, in the respiratory system, the diaphragm, the pleura or the pericardium. As the extrauterine endometrial lesions undergo the menstrual cycle, they cause many symptoms, including pain, and besides infertility, they all mostly affect the quality of the patient's life. Pharmacological management of endometriosis significantly increases in importance either as a first-line treatment or as a complementary therapy after surgery. Yet, current research on antagonists of the gonadotropin-releasing hormone (GnRH) has revealed their potential benefits in endometriosis treatment. Their mechanism of action is to down-regulate the hypothalamic-pituitary-gonadal axis and therefore induce a hypoestrogenic state. The resulting reduction of estrogen levels prevents disease progression and diminishes the recurrence rate after surgical removal of endometriosis. The present review summarizes recent reports of the role oral GnRH antagonists have as a significant treatment option for pain reduction in endometriosis patients.
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29
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Frumkin N, Schmädecker R, Isermann R, Keckstein J, Ulrich UA. Surgical Treatment of Deep Endometriosis. Geburtshilfe Frauenheilkd 2023; 83:79-87. [PMID: 36643873 PMCID: PMC9833890 DOI: 10.1055/a-1799-2658] [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: 07/10/2022] [Accepted: 11/08/2022] [Indexed: 01/13/2023] Open
Abstract
In deep endometriosis (DE), clusters of endometrium-like cells penetrate more than 5 mm below the peritoneum: The affected organs and tissue structures can eventuate in an alteration of the anatomy with eliminated organ boundaries, which in some cases can pose a real surgical challenge, even for experienced surgeons. A comprehensive description of the different manifestations of the disease can be found in the #Enzian classification. Since the operation is usually the foundation for the successful treatment of DE, what is important are conclusive indications, appropriate preoperative preparation and, above all, appropriate experience on the part of the surgical team. This article aims to provide a review of the surgical options that are currently available.
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Affiliation(s)
- Nora Frumkin
- 303449Klinik für Gynäkologie und Geburtshilfe, Endometriosezentrum, Martin Luther Krankenhaus, Johannesstift Diakonie, Berlin, Germany
| | - Rasmus Schmädecker
- 303449Klinik für Gynäkologie und Geburtshilfe, Endometriosezentrum, Martin Luther Krankenhaus, Johannesstift Diakonie, Berlin, Germany
| | - Ricarda Isermann
- 303449Klinik für Gynäkologie und Geburtshilfe, Endometriosezentrum, Martin Luther Krankenhaus, Johannesstift Diakonie, Berlin, Germany
| | - Jörg Keckstein
- Endometriosezentrum Ordination Dres. Keckstein, Villach, Austria
| | - Uwe Andreas Ulrich
- 303449Klinik für Gynäkologie und Geburtshilfe, Endometriosezentrum, Martin Luther Krankenhaus, Johannesstift Diakonie, Berlin, Germany,Korrespondenzadresse Prof. Dr. Uwe Andreas Ulrich 303449Klinik für Gynäkologie und Geburtshilfe, Endometriosezentrum, Martin Luther
Krankenhaus, Johannesstift DiakonieCaspar-Theyß-Str. 27–3114193
BerlinGermany
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30
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Predictive value of preoperative MRI using the #ENZIAN classification score in patients with deep infiltrating endometriosis. Arch Gynecol Obstet 2023; 307:215-220. [PMID: 35239004 DOI: 10.1007/s00404-022-06451-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/10/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study is to investigate the correlation between the magnetic resonance imaging (MRI) and intraoperative findings of deep infiltrating endometriosis using the #ENZIAN score. METHODS This retrospective study included 64 patients who underwent surgery for deep infiltrating endometriosis between January 2017 and August 2020. Preoperative abdominopelvic MRI assessment was evaluated and scored using the #ENZIAN classification. Operative scores were considered the gold standard, and the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of MRI for each category were calculated. RESULTS MRI has higher sensitivity and specificity in showing the lesions of the compartments O (ovarian lesions), A (rectovaginal septum and posterior vaginal fornix), and B (uterosacral ligaments and parametrium) (100-100%, 100-100%, and 97-100%, respectively, p < 0.001) compared to the other compartments. The lowest sensitivity, specificity, accuracy, and PPV of the MRI was found in compartment P (14%, 76%, 70%, and 7%, respectively). CONCLUSION We demonstrated that the #ENZIAN classification in MRI reports has significant sensitivity and specificity in compartments A, B (uterosacral ligaments and parametrium), and O. Furthermore, the determination of peritoneal lesions via MRI is inadequate.
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31
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Quesada J, Härmä K, Reid S, Rao T, Lo G, Yang N, Karia S, Lee E, Borok N. Endometriosis: A multimodal imaging review. Eur J Radiol 2023; 158:110610. [PMID: 36502625 DOI: 10.1016/j.ejrad.2022.110610] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/07/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
Endometriosis is a chronic inflammatory disorder characterized endometrial-like tissue present outside of the uterus, affecting approximately 10% of reproductive age women. It is associated with abdomino-pelvic pain, infertility and other non - gynecologic symptoms, making it a challenging diagnosis. Several guidelines have been developed by different international societies to diagnose and classify endometriosis, yet areas of controversy and uncertainty remains. Transvaginal ultrasound (TV-US) is the first-line imaging modality used to identify endometriosis due to its accessibility and cost-efficacy. Enhanced sonographic techniques are emerging as a dedicated technique to evaluate deep infiltrating endometriosis (DIE), depending on the expertise of the sonographer as well as the location of the lesions. MRI is an ideal complementary modality to ultrasonography for pre-operative planning as it allows for a larger field-of-view when required and it has high levels of reproducibility and tolerability. Typically, endometriotic lesions appear hypoechoic on ultrasonography. On MRI, classical features include DIE T2 hypointensity, endometrioma T2 hypointensity and T1 hyperintensity, while superficial peritoneal endometriosis (SPE) is described as a small focus of T1 hyperintensity. Imaging has become a critical tool in the diagnosis, surveillance and surgical planning of endometriosis. This literature review is based mostly on studies from the last two decades and aims to provide a detailed overview of the imaging features of endometriosis as well as the advances and usefulness of different imaging modalities for this condition.
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Affiliation(s)
- Juan Quesada
- Department of Obstetrics & Gynecology, Campbelltown Hospital (South-Western Sydney Local Health District), Terry Rd, Campbelltown, NSW 2560, Australia.
| | - Kirsi Härmä
- Department of Diagnostic, Interventional and Pediatric Radiology - University Hospital of Bern, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Shannon Reid
- Western Sydney University, Faculty of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia; Sonacare Women's Health and Ultrasound, Harrington, NSW 2567, Australia
| | - Tanushree Rao
- Department of Obstetrics & Gynecology at Liverpool Hospital, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Glen Lo
- Department of Radiology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; The Western Ultrasound for Women, 1/160a Cambridge St, West Leederville, Perth, WA 6007, Australia.
| | - Natalie Yang
- Department of Radiology, The Austin Hospital, 145 Studley Rd, Heidelberg, Victoria 3084, Australia.
| | - Sonal Karia
- Department of Obstetrics & Gynecology, Campbelltown Hospital (South-Western Sydney Local Health District), Terry Rd, Campbelltown, NSW 2560, Australia.
| | - Emmeline Lee
- Department of Radiology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; The Western Ultrasound for Women, 1/160a Cambridge St, West Leederville, Perth, WA 6007, Australia
| | - Nira Borok
- Department of Radiology, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW 1871, Australia.
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Expert opinion on the use of transvaginal sonography for presurgical staging and classification of endometriosis. Arch Gynecol Obstet 2023; 307:5-19. [PMID: 36367580 PMCID: PMC9837004 DOI: 10.1007/s00404-022-06766-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022]
Abstract
Gynecological ultrasonography plays a central role in the management of endometriosis. The rapid technical development as well as the currently increasing evidence for non-invasive diagnostic methods require an updated compilation of recommendations for the use of ultrasound in the management of endometriosis. The present work aims to highlight the accuracy of sonography for diagnosing and classifying endometriosis and will formulate the present list of key messages and recommendations. This paper aims to demonstrate the accuracy of TVS in the diagnosis and classification of endometriosis and to discuss the clinical applications and consequences of TVS findings for indication, surgical planning and assessment of associated risk factors. (1) Sophisticated ultrasound is the primary imaging modality recommended for suspected endometriosis. The examination procedure should be performed according to the IDEA Consensus. (2) Surgical intervention to confirm the diagnosis alone is not recommended. A preoperative imaging procedure with TVS and/or MRI is strongly recommended. (3) Ultrasound examination does not allow the definitive exclusion of endometriosis. (4) The examination is primarily transvaginal and should always be combined with a speculum and a bimanual examination. (5) Additional transabdominal ultrasonography may enhance the accuracy of the examination in case of extra pelvic disease, extensive findings or limited transvaginal access. (6) Sonographic assessment of both kidneys is mandatory when deep endometriosis (DE) and endometrioma are suspected. (7) Endometriomas are well defined by sonographic criteria. When evaluating the ovaries, the use of IOTA criteria is recommended. (8) The description of sonographic findings of deep endometriosis should be systematically recorded and performed using IDEA terminology. (9) Adenomyosis uteri has sonographically well-defined criteria (MUSA) that allow for detection with high sensitivity and specificity. MRI is not superior to differentiated skilled ultrasonography. (10) Classification of the extent of findings should be done according to the #Enzian classification. The current data situation proves the best possible prediction of the intraoperative situs of endometriosis (exclusive peritoneum) for the non-invasive application of the #Enzian classification. (11) Transvaginal sonographic examination by an experienced examiner is not inferior to MRI diagnostics regarding sensitivity and specificity in the prediction of the extent of deep endometriosis. (12) The major advantage of non-invasive imaging and classification of endometriosis is the differentiated planning or possible avoidance of surgical interventions. The recommendations represent the opinion of experts in the field of non-invasive and invasive diagnostics as well as therapy of endometriosis. They were developed with the participation of the following national and international societies: DEGUM, ÖGUM, SGUM, SEF, AGEM/DGGG, and EEL.
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Uzuner C, Mak J, El-Assaad F, Condous G. The bidirectional relationship between endometriosis and microbiome. Front Endocrinol (Lausanne) 2023; 14:1110824. [PMID: 36960395 PMCID: PMC10028178 DOI: 10.3389/fendo.2023.1110824] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/21/2023] [Indexed: 03/09/2023] Open
Abstract
Endometriosis has been described by many different theories of pathogenesis over the years. It is now also appreciated to be a state of chronic inflammation, and the role of immune dysfunction in its development has been proven. There is increasing evidence to support the role of the microbiome in the formation and progression of endometriosis via inflammatory pathways. The dysbiosis seen in endometriosis is thought to be both causative and a consequence of the pathogenesis. Gut, peritoneal fluid and female reproductive tract microbiota has been studied to understand if there are any microbiome signatures specific to endometriosis. New research on how to manipulate the microbiome for better detection and treatment of endometriosis is emerging.
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Affiliation(s)
- Cansu Uzuner
- Endometriosis Ultrasound and Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Sydney, NSW, Australia
- *Correspondence: Cansu Uzuner,
| | - Jason Mak
- Endometriosis Ultrasound and Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Sydney, NSW, Australia
| | - Fatima El-Assaad
- University of New South Wales Microbiome Research Centre, St. George and Sutherland Clinical Campuses, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - George Condous
- Endometriosis Ultrasound and Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Sydney, NSW, Australia
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Sun J, Gan L, Sun J. Identification and Validation of Three m6A Regulators: FTO, HNRNPC, and HNRNPA2B1 as Potential Biomarkers for Endometriosis. Genes (Basel) 2022; 14:genes14010086. [PMID: 36672827 PMCID: PMC9858668 DOI: 10.3390/genes14010086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/09/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND N6-methyladenosine is involved in numerous biological processes. However, the significance of m6A regulators in endometriosis is still unclear. METHODS We extracted three significant m6A regulators between non-endometriosis and endometriosis patients from GSE6364 and then we used the random forest model to obtain significant m6A regulators. In addition, we used the nomogram model to evaluate the prevalence of endometriosis. The predictive ability of the candidate genes was evaluated through the receiver operating characteristic curves, while the expression of candidate biomarkers was validated via Western blotting. Additionally, according to candidate genes, we identified m6A subtypes based on which functional enrichment analysis and immune infiltration were performed. RESULTS Three significant m6A regulators (fat mass and obesity-associated protein, heterogeneous nuclear ribonucleoprotein A2/B1, and heterogeneous nuclear ribonucleoprotein C) were discovered. We identified three m6A subtypes, including clusterA, clusterB, and clusterC. ClusterB was demonstrated to be correlated with significantly overexpressed VEGF and notably downregulated ESR1 and PGR, which are convincing biomarkers of endometriosis. Furthermore, we discovered that patients in clusterB were associated with high levels of neutrophil infiltration, a reduced Treg/Th17 ratio, and overexpressed pyroptosis-related genes, which also indicated that clusterB was highly linked to endometriosis. CONCLUSION In conclusion, m6A regulators are of great significance for the occurrence and process of endometriosis. The findings of our study provide novel insights into the underlying molecular mechanism of endometriosis. The novel investigation of m6A patterns and their correlation with immunity may also help to guide the clinical diagnosis, provide prognostic significance, and develop immunotherapy strategies for endometriosis patients.
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Affiliation(s)
- Jiani Sun
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Lei Gan
- Department of Gynaecology and Obstetrics, Ningbo First Hospital, Ningbo 315010, China
| | - Jing Sun
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai 200092, China
- Correspondence:
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Abril-Coello R, Correyero-León M, Ceballos-Laita L, Jiménez-Barrio S. Benefits of physical therapy in improving quality of life and pain associated with endometriosis: A systematic review and meta-analysis. Int J Gynaecol Obstet 2022. [PMID: 36571475 DOI: 10.1002/ijgo.14645] [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: 05/31/2022] [Revised: 11/17/2022] [Accepted: 12/17/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess whether non-pharmacologic conservative therapeutic interventions are beneficial in improving pain intensity and quality of life in women with endometriosis compared with placebo. METHODS A systematic review with meta-analysis was designed. A literature search was performed in the following databases: PubMed, PEDro, Embase, CINAHL, Isi Web of Science, Enfispo, and Cochrane. Randomized controlled trials included women with endometriosis treated with conservative treatment versus placebo. The quality of the studies was assessed using the PEDro scale, and the risk of bias of the individual studies was assessed using the Cochrane Risk of Bias tool. For the overall quality of the studies, the GRADE guidelines were used. RESULTS Meta-analysis included six studies. Significant results were obtained for pain intensity (standardized mean difference [SMD] -0.89; 95% confidence interval [CI] -1.21 to -0.57; I2 69%) and concerning quality of life, significant results were only obtained for the sub-variable physical function (SMD -1.49; 95% CI -2.88 to -0.10; I2 95%). No statistically significant differences were found for the rest of the variables analyzed. CONCLUSION Non-pharmacologic conservative therapies are a therapeutic option for women with endometriosis for improving pain intensity and physical function.
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Affiliation(s)
- Rebeca Abril-Coello
- Department of Surgery, Opthalmology, Otorhinolaryngology, and Physiotherapy, Facult of Health Sciences, University of Valladolid, Soria, Spain
| | - Marta Correyero-León
- Department of Surgery, Opthalmology, Otorhinolaryngology, and Physiotherapy, Facult of Health Sciences, University of Valladolid, Soria, Spain
| | - Luis Ceballos-Laita
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology, Otorhinolaryngology, and Physiotherapy, Faculty of Health Sciences, University of Valladolid, Soria, Spain
| | - Sandra Jiménez-Barrio
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology, Otorhinolaryngology, and Physiotherapy, Faculty of Health Sciences, University of Valladolid, Soria, Spain
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Wu S, Wang X, Liu H, Zheng W. Efficacy of cognitive behavioral therapy after the surgical treatment of women with endometriosis: A preliminary case-control study. Medicine (Baltimore) 2022; 101:e32433. [PMID: 36595829 PMCID: PMC9794269 DOI: 10.1097/md.0000000000032433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Regardless of unique status or symptoms, any woman with endometriosis is at risk of developing mental health issues such as anxiety and depression. Cognitive behavioral therapy (CBT) is an effective psychological treatment for depression, anxiety, and stress. The objectives of the study were to see whether usual care combined with CBT improves depression, anxiety, and stress in patients after surgery for endometriosis as compared to usual care alone. METHODS Patients aged 18 to 50 years old with endometriosis who were scheduled for surgery were received usual care (Chinese martial arts) with CBT (1 pre-surgery and 6 post-surgery CBT sessions; Case or Intervention group, n = 48) or usual care only (Control group, n = 48). The demographic characteristics questionnaire was given to all individuals. Depression, anxiety, and stress were evaluated at baseline (within 24 hours after admission to the hospital) and postintervention (immediately before discharged) in both groups using the Chinese short version of Depression Anxiety and Stress scale (DASS-21). RESULTS At postintervention DASS-21 scores for depression, anxiety, and stress of the case group and the control group were decreased as compared to baseline (P < .0001 for all). At postintervention DASS-21 score for anxiety of the case group was decreased compared to the control group (P = .0091). Usual care plus CBT significantly increased the number of females with no symptoms of depression as compared to baseline at postintervention(s) (P = .0356). At postintervention(s), there was no female with extremely severe depression in both groups. Usual care plus CBT significantly decreased the number of females with symptoms of extremely severe anxiety as compared to baseline at postintervention(s) (P = .035). Unlike the control group, in the case group, there were no females with extremely severe stress at postintervention. CONCLUSIONS females with endometriosis who had surgery reported high levels of depression, anxiety, and stress at the time of hospital admission. Patients with endometriosis can benefit from CBT.
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Affiliation(s)
- Shanshan Wu
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xia Wang
- Cancer department of traditional Chinese medicine, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu Sichuan, China
| | - Heng Liu
- Department of Obstetrics and Gynecology, the General Hospital of Western Theater Command PLA, Chengdu, Sichuan, China
| | - Wei Zheng
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- *Correspondence: Wei Zheng, Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, No. 20, Section 3, Renmin South Road, Chengdu, Sichuan 610041, ChinaKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China (e-mail: )
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Mitchell JB, Chetty S, Kathrada F. Progestins in the symptomatic management of endometriosis: a meta-analysis on their effectiveness and safety. BMC Womens Health 2022; 22:526. [PMID: 36528558 PMCID: PMC10127994 DOI: 10.1186/s12905-022-02122-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Endometriosis is a complex chronic disease that affects approximately 10% of women of reproductive age worldwide and commonly presents with pelvic pain and infertility. METHOD & OUTCOME MEASURES A systematic review of the literature was carried out using the databases Pubmed, Scopus, Cochrane and ClinicalTrials.gov in women with a confirmed laparoscopic diagnosis of endometriosis receiving progestins to determine a reduction in pain symptoms and the occurrence of adverse effects. RESULTS Eighteen studies were included in the meta-analysis. Progestins improved painful symptoms compared to placebo (SMD = -0.61, 95% CI (-0.77, -0.45), P < 0.00001) with no comparable differences between the type of progestin. After median study durations of 6-12 months, the median discontinuation rate due to adverse effects was 0.3% (range: 0 - 37.1%) with mild adverse effects reported. CONCLUSION The meta-analysis revealed that pain improvement significantly increased with the use of progestins with low adverse effects. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021285026.
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Affiliation(s)
- Jon-Benay Mitchell
- Division of Pharmacology, Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarentha Chetty
- Division of Pharmacology, Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Fatima Kathrada
- Division of Clinical Pharmacy, Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Egashira EM, Trovó-Marqui AB, Tanaka SCSV, Cintra MTR. Investigation of biomarkers in Endometriosis-associated infertility: Systematic Review. AN ACAD BRAS CIENC 2022; 94:e20211572. [PMID: 36477241 DOI: 10.1590/0001-3765202220211572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/01/2022] [Indexed: 11/30/2022] Open
Abstract
The relationship between endometriosis and infertility is still unknown, but it is possible that genetic polymorphisms influence these two variables. This study aims to identify, in the literature, which polymorphisms are related to infertility in women with endometriosis. A search was performed in databases using the descriptors: polymorphisms genetics and infertility and endometriosis. 386 articles were identified, and after applying the inclusion and exclusion criteria, 33 case-control studies were included. Genes and their respective polymorphisms, which exhibited statistically significant values, were classified into three categories: related to metabolic/cellular processes, steroidogenesis and sex hormone receptors, inflammation and immune response. In summary, the results of these studies suggest that the polymorphisms rs882605 of MUC4 gene, rs16826658 of WNT4 gene, rs10953316 of MUC17 gene, rs10928050 of KAZN gene, rs1799889 of PAI-1 gene, (TA)n repeats of ESR1 gene, (CA)n repeats of ESR2 gene, rs605059 of HSD17B1 gene, rs743572 of CYP17A1 gene, insLQ of LHR gene, p.Ile49Ser of AMH gene, rs12700667 of NPVF/NFE2L3 gene, G1502A of LHβ gene, G + 1730A of ERβ gene, rs7528684 of FCRL3 gene, rs3761549 of FOXP3 gene and rs28362491 of NFKβ1 gene are implicated in the etiology of infertility in women with endometriosis.
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Affiliation(s)
- Erika M Egashira
- Programa de Pós-Graduação em Ciência e Tecnologia de Materiais, Universidade Federal do Triângulo Mineiro/UFTM, Rua Vigário Carlos, 100, Nossa Senhora da Abadia, 38025-350 Uberaba, MG, Brazil
| | - Alessandra B Trovó-Marqui
- Universidade Federal do Triângulo Mineiro/UFTM, Departamento de Patologia, Genética e Evolução, Campus I, Praça Manoel Terra, 330, Nossa Senhora da Abadia, 38025-015 Uberaba, MG, Brazil
| | - Sarah C S V Tanaka
- Programa de Pós-Graduação em Medicina Tropical e Infectologia, Universidade Federal do Triângulo Mineiro, Av. Getúlio Guaritá, s/n, Abadia, 38025-180 Uberaba, MG, Brazil
| | - Mariangela T R Cintra
- Universidade Federal do Triângulo Mineiro/UFTM, Departamento de Ciências Biológicas, Av. Randolfo Borges Júnior, 1400, Univerdecidade, 38064-200 Uberaba, MG, Brazil
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Volker C, Mills J. Endometriosis and body image: Comparing people with and without endometriosis and exploring the relationship with pelvic pain. Body Image 2022; 43:518-522. [PMID: 36375365 DOI: 10.1016/j.bodyim.2022.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/24/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022]
Abstract
Qualitative studies have shown that people with endometriosis report feeling discontent with their bodies relating to the visual and functional effects of the disease. However, few studies exist which compare people with endometriosis to those without, leaving it largely unknown as to whether this discontentment differs from that regularly experienced by women. The current study therefore aimed to 1) quantitatively assess body image, namely appearance satisfaction and functionality appreciation, in people with and without endometriosis, and 2) explore the relationship between endometriosis-related pelvic pain and body image. Australians aged 18 and over were recruited for two groups: those with endometriosis (n = 312, 99 % female, Mage = 30.78, SDage = 7.40) and a control group without suspected or diagnosed endometriosis (n = 74, 100 % female, Mage = 32.38, SDage = 8.84). Participants completed an online survey consisting of measures of appearance satisfaction, functionality appreciation, and pelvic-pain impact. The endometriosis group demonstrated significantly poorer body image when compared to the control group, and endometriosis-related pelvic pain was shown to negatively correlate with body image. These findings demonstrate the likely negative effects endometriosis and pelvic pain have on body image and provide much needed insight to help develop interventions tailored to endometriosis.
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Hu Y, Ren Q, Sun H, Wei Y. The abnormal increase in the resistance index of the uterine artery in women with endometriosis after cervical pushing. Asian J Surg 2022; 45:2799-2800. [PMID: 35753911 DOI: 10.1016/j.asjsur.2022.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/08/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Yijia Hu
- Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Qiongzhen Ren
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Hong Sun
- Department of Chinese Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
| | - Ying Wei
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
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Squatrito M, Blacher S, Henry L, Labied S, Noel A, Nisolle M, Munaut C. Comparison of Morphological and Digital-Assisted Analysis for BCL6 Endometrial Expression in Women with Endometriosis. J Clin Med 2022; 11:6164. [PMID: 36294483 PMCID: PMC9604760 DOI: 10.3390/jcm11206164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2024] Open
Abstract
BCL6 (B-cell lymphoma 6) is a proto-oncogene and transcriptional repressor initially described as being involved in B-cell lymphoma. Recently, this factor has been identified as a promising tissue biomarker which could be used to diagnose women affected by endometriosis. Previous studies used HSCORE for BCL6 staining quantification in the endometrium. However, this semi-quantitative technique of analysis has some limitations, including a lack of objectivity, robustness, and reproducibility that may lead to intra- and inter-observer variability. Our main goal was to develop an original computer-assisted method to quantify BCL6 staining from whole-slide images reliably. In order to test the efficiency of our new digital method of quantification, we compared endometrial BCL6 expression between fertile and infertile women without or with different stages of endometriosis by using the widely used HSCORE analysis and our new automatic digital image analysis. We find a higher expression of BCL6 in the endometrium of infertile women with endometriosis and women with stage IV endometriosis. Furthermore, we demonstrate a significant correlation between the two types of independent measurements, indicating the robustness of results and also the reliability of our computer-assisted method for BCL6 quantification. In conclusion, our work, by using this original computer-assisted method, enables BCL6 quantification more objectively, reliably, robustly, and promptly compared to HSCORE analysis.
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Affiliation(s)
- Marlyne Squatrito
- Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, 4000 Liège, Belgium
| | - Silvia Blacher
- Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, 4000 Liège, Belgium
| | - Laurie Henry
- Obstetrics and Gynecology Department, University of Liege, 4000 Liège, Belgium
| | - Soraya Labied
- Obstetrics and Gynecology Department, University of Liege, 4000 Liège, Belgium
| | - Agnès Noel
- Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, 4000 Liège, Belgium
| | - Michelle Nisolle
- Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, 4000 Liège, Belgium
- Obstetrics and Gynecology Department, University of Liege, 4000 Liège, Belgium
| | - Carine Munaut
- Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, 4000 Liège, Belgium
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Chauhan S, More A, Chauhan V, Kathane A. Endometriosis: A Review of Clinical Diagnosis, Treatment, and Pathogenesis. Cureus 2022; 14:e28864. [PMID: 36225394 PMCID: PMC9537113 DOI: 10.7759/cureus.28864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/06/2022] [Indexed: 12/13/2022] Open
Abstract
Endometriosis is a condition that affects women of reproductive age, and it is distinguished by the development of endometrial-like tissue outside the uterine cavity. It is frequently accompanied by persistent pelvic discomfort and infertility. This investigation looks into recent findings on clinical manifestation to help doctors and improve women's health. PubMed and Google Scholar were used to review on clinical diagnosis of endometriosis. The search strategy contained the terms “endometriosis” and “clinical diagnosis.” All research articles published between 1960 and 2021 were included in the search. The findings were then categorized to summarize the evidence. There was a total of 29 instances of endometriosis discovered. The patients' ages varied from 20 to 45 years old, with a median of 28.8 years and a mean of 29.4±7.7 years. Dysmenorrhea is a common disorder among adolescent girls experiencing various physical and emotional symptoms which have a detrimental influence on their quality of life. In this study, scar endometriosis was shown to be the more common variety of endometriosis, with 50% of cases predominantly developing at the lower segment cesarean section (LSCS) scar site. As a result, women with endometriosis are more likely to have miscarriages, and the quality of their embryos declines as a result.
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Senocak GNC, Yapca OE, Yılmaz EPT, Ozturk N, Ozdes S, Kumtepe Y. May endocan be a new biomarker in the diagnosis of endometriosis? J Gynecol Obstet Hum Reprod 2022; 51:102423. [DOI: 10.1016/j.jogoh.2022.102423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/27/2022] [Accepted: 06/08/2022] [Indexed: 10/18/2022]
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Ellis K, Munro D, Wood R. The experiences of endometriosis patients with diagnosis and treatment in New Zealand. Front Glob Womens Health 2022; 3:991045. [PMID: 36118149 PMCID: PMC9471549 DOI: 10.3389/fgwh.2022.991045] [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: 07/11/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Endometriosis is a chronically painful, invasive, inflammatory disease, with limited treatment options and long delays to diagnosis, which impacts 10% of females in New Zealand. Introduction As part of a larger group discussion study, this paper covers three themes associated with endometriosis patient experiences: intensity of pain, diagnostic tool shortcomings and perspectives of treatment options. Materials and methods The goal of this research was the inclusion of patient voices to guide research priorities. In early 2022, 50 New Zealand endometriosis patients participated in anonymous, asynchronous, text-based group discussions on the VisionsLive platform. The patients ranged in age from 18-48. The patients answered 50 questions, 23 text-based and 27 quantitative, and then took part in online group discussions. Results and discussion The average age of symptom onset was 15.3 years, while the average delay from symptom onset to a working or surgically confirmed diagnosis was 7.91 years. The top five reported symptoms within the cohort were pain-based, and the participants discussed the many impacts of this pain on their work and education. The four main diagnostic tools employed on this cohort were abdominal ultrasound (72%), transvaginal ultrasound (68%), laparoscopy (82%) and sharing their symptom history with a medical practitioner (88%). The most common emotions patients experienced following receiving a diagnosis of endometriosis were relief (86%), feeling overwhelmed (54%), and anger (32%). The main treatments offered to this cohort were pain relief (96%), laparoscopic surgery (84%) and the combined oral contraceptive pill (80%). Of these three treatments, only laparoscopic surgery was viewed positively by the majority of users, with 67% considering laparoscopy an effective treatment, compared to 46% of users for pain relief, and 25% of users for the combined oral contraceptive pill. Conclusions Gathering the voice of patients revealed that long delays to diagnosis and dismissal by medical practitioners frequently manifests as a reaction of relief by patients once diagnosed. Results also showed treatment options such as pain relief and hormonal medications were often considered ineffective, but were routinely offered as the first, or only, options for patients. It is therefore important that both quicker routes to diagnosis and more effective treatment options be developed.
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Affiliation(s)
- Katherine Ellis
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Deborah Munro
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
- The Biomolecular Interaction Centre, University of Canterbury, Christchurch, New Zealand
| | - Rachael Wood
- The Biomolecular Interaction Centre, University of Canterbury, Christchurch, New Zealand
- Department of Chemical and Process Engineering, University of Canterbury, Christchurch, New Zealand
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Mohamed A, Salah M, Tahoun M, Hawner M, Abdelsamie AS, Frotscher M. Dual Targeting of Steroid Sulfatase and 17β-Hydroxysteroid Dehydrogenase Type 1 by a Novel Drug-Prodrug Approach: A Potential Therapeutic Option for the Treatment of Endometriosis. J Med Chem 2022; 65:11726-11744. [PMID: 35993890 DOI: 10.1021/acs.jmedchem.2c00589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A novel approach for the dual inhibition of steroid sulfatase (STS) and 17β-hydroxysteroid dehydrogenase type 1(17β HSD1) by a single drug was explored, starting from in-house 17β HSD1 inhibitors via masking their phenolic OH group with a sulfamate ester. The sulfamates were intentionally designed as drugs for the inhibition of STS and, at the same time, prodrugs for 17β-HSD1 inhibition ("drug-prodrug approach"). The most promising sulfamates 13, 16, 18-20, 22-24, 36, and 37 showed nanomolar IC50 values for STS inhibition in a cellular assay and their corresponding phenols displayed potent 17β-HSD1 inhibition in cell-free and cellular assays, high selectivity over 17β-HSD2, reasonable metabolic stability, and low estrogen receptor α affinity. A close relationship was found between the liberation of the phenolic compound by sulfamate hydrolysis and 17β-HSD1 inactivation. These results showed that the envisaged drug-prodrug concept was successfully implemented. The novel compounds constitute a promising class of therapeutics for the treatment of endometriosis and other estrogen-dependent diseases.
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Affiliation(s)
- Abdelrahman Mohamed
- Department of Pharmacy, Pharmaceutical and Medicinal Chemistry, Saarland University, Campus C23, Saarbrücken D-66123, Germany.,Pharmaceutical Organic Chemistry Department, Assiut University, Assiut 71526, Egypt
| | - Mohamed Salah
- Department of Pharmacy, Pharmaceutical and Medicinal Chemistry, Saarland University, Campus C23, Saarbrücken D-66123, Germany.,Department of Pharmaceutical Chemistry, Faculty of Pharmacy, October University for Modern Sciences and Arts, Cairo 12451, Egypt
| | - Mariam Tahoun
- Department of Pharmacy, Pharmaceutical and Medicinal Chemistry, Saarland University, Campus C23, Saarbrücken D-66123, Germany
| | - Manuel Hawner
- Department of Pharmacy, Pharmaceutical and Medicinal Chemistry, Saarland University, Campus C23, Saarbrücken D-66123, Germany
| | - Ahmed S Abdelsamie
- Department of Chemistry of Natural and Microbial Products, Institute of Pharmaceutical and Drug Industries Research, National Research Centre, El-Buhouth St., Dokki, P.O. Box 12622 Cairo 12451, Egypt.,Department of Drug Design and Optimization, Helmholtz Institute for Pharmaceutical Research Saarland (HIPS) - Helmholtz Centre for Infection Research (HZI), Campus Building E81, Saarbrücken 66123, Germany
| | - Martin Frotscher
- Department of Pharmacy, Pharmaceutical and Medicinal Chemistry, Saarland University, Campus C23, Saarbrücken D-66123, Germany
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Blass I, Sahar T, Shraibman A, Ofer D, Rappoport N, Linial M. Revisiting the Risk Factors for Endometriosis: A Machine Learning Approach. J Pers Med 2022; 12:jpm12071114. [PMID: 35887611 PMCID: PMC9317820 DOI: 10.3390/jpm12071114] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/16/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022] Open
Abstract
Endometriosis is a condition characterized by implants of endometrial tissues into extrauterine sites, mostly within the pelvic peritoneum. The prevalence of endometriosis is under-diagnosed and is estimated to account for 5-10% of all women of reproductive age. The goal of this study was to develop a model for endometriosis based on the UK-biobank (UKB) and re-assess the contribution of known risk factors to endometriosis. We partitioned the data into those diagnosed with endometriosis (5924; ICD-10: N80) and a control group (142,723). We included over 1000 variables from the UKB covering personal information about female health, lifestyle, self-reported data, genetic variants, and medical history prior to endometriosis diagnosis. We applied machine learning algorithms to train an endometriosis prediction model. The optimal prediction was achieved with the gradient boosting algorithms of CatBoost for the data-combined model with an area under the ROC curve (ROC-AUC) of 0.81. The same results were obtained for women from a mixed ethnicity population of the UKB (7112; ICD-10: N80). We discovered that, prior to being diagnosed with endometriosis, affected women had significantly more ICD-10 diagnoses than the average unaffected woman. We used SHAP, an explainable AI tool, to estimate the marginal impact of a feature, given all other features. The informative features ranked by SHAP values included irritable bowel syndrome (IBS) and the length of the menstrual cycle. We conclude that the rich population-based retrospective data from the UKB are valuable for developing unified machine learning endometriosis models despite the limitations of missing data, noisy medical input, and participant age. The informative features of the model may improve clinical utility for endometriosis diagnosis.
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Affiliation(s)
- Ido Blass
- The Rachel and Selim Benin School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem 91904, Israel;
| | - Tali Sahar
- Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, QC H3G 1A4, Canada;
| | - Adi Shraibman
- Department of Computer Science, The Academic College of Tel Aviv-Yaffo, Tel Aviv 69978, Israel;
| | - Dan Ofer
- Department of Software and Information Systems Engineering, Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Be’er Sheva 84105, Israel;
| | - Nadav Rappoport
- Department of Biological Chemistry, Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem 91904, Israel;
| | - Michal Linial
- Department of Software and Information Systems Engineering, Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Be’er Sheva 84105, Israel;
- Correspondence: ; Tel.: +972-54-8820035
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Chen H, Wang G, Wang X, Gao Y, Liang J, Wang J. Diagnostic value of susceptibility-weighted imaging for endometrioma: preliminary results from a retrospective analysis. Acta Radiol 2022; 63:976-981. [PMID: 34098746 DOI: 10.1177/02841851211022495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Endometrioma is a common manifestation of endometriosis that can be difficult to diagnose with conventional magnetic resonance imaging (MRI). Susceptibility-weighted imaging (SWI) may be more sensitive than conventional MRI in the detection of chronic, local hemorrhagic disease. PURPOSE To investigate whether signal voids in SWI sequences could be used in the preoperative diagnosis of endometrioma. MATERIAL AND METHODS This retrospective study included consecutive female patients with clinically suspected endometrioma. All patients underwent pelvic 3-T MRI (T1- and T2-weighted) and SWI within two weeks before laparoscopy. Two experienced radiologists blinded to the histopathologic/clinical diagnoses interpreted the images together, and any disagreements were resolved by consensus. RESULTS The final analysis included 73 patients: 46 patients (mean age=37 years; age range=22-68 years) with 85 endometrioma lesions and 27 patients (mean age=34 years; age range=15-68 years) with 34 non-endometrioid cystic lesions (18 hemorrhagic corpus luteal cysts, three simple cysts, three mucinous cystadenomas, two mature teratomas, and one endometrioid cyst with corpus luteum rupture/hemorrhage). The presenting symptoms for patients with endometrioma were chronic pelvic pain (44.6%), dysmenorrhea (31.9%), infertility (12.8%), dyspareunia (6.4%), and menstrual irregularity (4.3%). MRI identified all 119 lesions observed laparoscopically. SWI visualized punctate or curvilinear signal voids along the cyst wall or within the lesion in 67 of 85 endometriomas (78.8%) and only 3 of 31 non-endometrioid cysts (8.8%). CONCLUSION The use of SWI to look for signal voids in the cyst wall or within the lesion could facilitate the preoperative diagnosis of endometrioma.
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Affiliation(s)
- Hong Chen
- Department of Medical Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Guoliang Wang
- Department of Radiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Xuexue Wang
- Department of Medical Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yan Gao
- Department of Radiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Junhua Liang
- Department of Gynecology and Obstetrics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Jinhong Wang
- Department of Medical Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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Endometriosis: A Disease with Few Direct Treatment Options. Molecules 2022; 27:molecules27134034. [PMID: 35807280 PMCID: PMC9268675 DOI: 10.3390/molecules27134034] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 12/07/2022] Open
Abstract
Endometriosis is a gynecological condition characterized by the growth of endometrium-like tissues inside and outside the pelvic cavity. The evolution of the disease can lead to infertility in addition to high treatment costs. Currently, available medications are only effective in treating endometriosis-related pain; however, it is not a targeted treatment. The objective of this work is to review the characteristics of the disease, the diagnostic means and treatments available, as well as to discuss new therapeutic options.
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The analysis of the prevalence of extragenital pathology in infertile women with external genital endometriosis. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. External genital endometriosis (EGE) is often the cause of infertility, while coagulation of its foci leads to the restoration of fertility. Often, non-invasivepreoperative diagnosis of EGE is difficult. Today, the issue of laparoscopy in infertility and whether there is a need for additional indications for its implementation remains controversial. Identification of the relationship between certain extragenital diseases with EGE is promising in terms of both understanding the pathogenesis of EGE and predicting its development.The aim. Identification of the relationship of extragenital diseases with the presence of EGE in infertile women of reproductive age.Materials and methods. In preparation for assisted reproductive technology programs at the Vitromed Clinic, 1 132 women of reproductive age were examined from 2019 to 2021. Collection and processing of clinical and anamnestic data were carried out. The diagnosis of EGE was verified by laparoscopy with histological examination. The results were analyzed using exact test and binary logistic regression to build a model of the relationship between EGE and somatic pathology.Results. EGE was detected in 222 patients. A number of somatic diseases were found that are most common in EGE: bowel diseases; minor cardiac maldevelopments; chronic anemia; pathology of the pancreas; chronic tonsillitis; allergy. A logistic regression model was constructed to predict the presence of EGE in patients with the indicated somatic pathology with a sensitivity of 81.53 % and a specificity of 97.25 %.Conclusion. Identification of comorbid extragenital diseases associated with EGE in women with infertility can serve as a basis for expanding the scope of therapeutic and diagnostic measures, in particular for laparoscopy.
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Ellis K, Munro D, Clarke J. Endometriosis Is Undervalued: A Call to Action. Front Glob Womens Health 2022; 3:902371. [PMID: 35620300 PMCID: PMC9127440 DOI: 10.3389/fgwh.2022.902371] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/19/2022] [Indexed: 01/19/2023] Open
Abstract
Endometriosis is an inflammatory chronic pain condition caused by uterine tissue growing outside of the uterus that afflicts at least 11% of women (and people assigned female at birth) worldwide. This condition results in a substantial burden to these women, and society at large. Although endometriosis was first identified over 160 years ago, substantial knowledge gaps remain, including confirmation of the disease's etiology. Research funding for endometriosis is limited, with funding from bodies like the National Institutes of Health (NIH) constituting only 0.038% of the 2022 health budget—for a condition that affects 6.5 million women in the US alone and over 190 million worldwide. A major issue is that diagnosis of endometriosis is frequently delayed because surgery is required to histologically confirm the diagnosis. This delay increases symptom intensity, the risk of central and peripheral sensitization and the costs of the disease for the patient and their nation. Current conservative treatments of presumed endometriosis are pain management and birth control. Both of these methods are flawed and can be entirely ineffective for the reduction of patient suffering or improving ability to work, and neither addresses the severe infertility issues or higher risk of certain cancers. Endometriosis research deserves the funding and attention that befits a disease with its substantial prevalence, effects, and economic costs. This funding could improve patient outcomes by introducing less invasive and more timely methods for diagnosis and treatment, including options such as novel biomarkers, nanomedicine, and microbiome alterations.
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Affiliation(s)
- Katherine Ellis
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Deborah Munro
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
- *Correspondence: Deborah Munro
| | - Jennifer Clarke
- Faculty of Health, University of Canterbury, Christchurch, New Zealand
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