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Ochoa Bernal MA, Fazleabas AT. The Known, the Unknown and the Future of the Pathophysiology of Endometriosis. Int J Mol Sci 2024; 25:5815. [PMID: 38892003 PMCID: PMC11172035 DOI: 10.3390/ijms25115815] [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: 04/02/2024] [Revised: 05/14/2024] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
Endometriosis is one of the most common causes of chronic pelvic pain and infertility, affecting 10% of women of reproductive age. A delay of up to 9 years is estimated between the onset of symptoms and the diagnosis of endometriosis. Endometriosis is currently defined as the presence of endometrial epithelial and stromal cells at ectopic sites; however, advances in research on endometriosis have some authors believing that endometriosis should be re-defined as "a fibrotic condition in which endometrial stroma and epithelium can be identified". There are several theories on the etiology of the disease, but the origin of endometriosis remains unclear. This review addresses the role of microRNAs (miRNAs), which are naturally occurring post-transcriptional regulatory molecules, in endometriotic lesion development, the inflammatory environment within the peritoneal cavity, including the role that cytokines play during the development of the disease, and how animal models have helped in our understanding of the pathology of this enigmatic disease.
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Affiliation(s)
- Maria Ariadna Ochoa Bernal
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, Grand Rapids, MI 49503, USA;
- Department of Animal Science, Michigan State University, East Lansing, MI 48824, USA
| | - Asgerally T. Fazleabas
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, Grand Rapids, MI 49503, USA;
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2
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Tourny C, Zouita A, El Kababi S, Feuillet L, Saeidi A, Laher I, Weiss K, Knechtle B, Zouhal H. Endometriosis and physical activity: A narrative review. Int J Gynaecol Obstet 2023; 163:747-756. [PMID: 37345574 DOI: 10.1002/ijgo.14898] [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: 03/11/2023] [Revised: 05/05/2023] [Accepted: 05/16/2023] [Indexed: 06/23/2023]
Abstract
Endometriosis is a painful gynecological disorder that affects many women. Constant treatments and contraception changes affect women looking for solutions to treat and limit the problems caused by endometriosis. The current narrative review discusses the effects of physical activity on the management, pain, and quality of life in patients with endometriosis. Findings suggest that body awareness practices such as Hatha yoga, the Jacobson method, and progressive muscle relaxation reduce pain and stress and improve the quality of life associated with endometriosis. It also highlights the current knowledge gap on available evidence and future research. Moreover, care must be taken when considering patients' physical abilities and goals and avoiding intense physical activities. The forms of endometriosis and its symptoms vary from one woman to another, so it is important to perform studies with various nonmedicinal or surgical techniques. It is important to continue randomized controlled trials to obtain more data on the benefits of physical activity in women with endometriosis and also to identify what types of activities could be beneficial to combat pain symptoms and improve the daily lives of women with endometriosis.
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Affiliation(s)
- Claire Tourny
- Univ Rouen Normandie, CETAPS - UR 3832, Mont Saint Aignan, France
| | - Amira Zouita
- Higher Institute of Sport and Physical Education of Ksar-Said, Research Unit "Sports Performance, Health & Society" (UR17JS01), University of Manouba, Manouba, Tunisia
| | - Samira El Kababi
- High Institute of Nursing Professions and Health Techniques, Casablanca, Morocco
| | - Léa Feuillet
- Univ Rouen Normandie, CETAPS - UR 3832, Mont Saint Aignan, France
| | - Ayoub Saeidi
- Department of Physical Education and Sport Sciences, Faculty of Humanities and Social Sciences, University of Kurdistan, Sanandaj, Kurdistan, Iran
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Katja Weiss
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
- Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
| | - Hassane Zouhal
- Univ Rennes, M2S (Laboratoire Mouvement, Sport, Santé), Rennes, France
- Institut International des Sciences du Sport (2I2S), Irodouer, France
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3
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Gynaecological pathologies leading to emergency department admissions: A cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2023; 282:38-42. [PMID: 36630817 DOI: 10.1016/j.ejogrb.2023.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/03/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Knowing the population's needs in order to plan measures to reduce emergency department (ED) use is fundamental. The objective of this study was to describe gynaecological ED visits and associated findings in women of reproductive age. METHODS This study was a retrospective anonymized chart review analysis of visits to the ED for gynaecological disturbances at the University Hospital of Modena. All consecutive women of reproductive age were included. Women aged <18 years and postmenopausal women were excluded from this study. RESULTS In total, 461 records were analysed. The median age was 41 (interquartile range 34-46) years. The most common symptom was dysmenorrhoea (42.7 %), followed by heavy menstrual bleeding (33.2 %). The most common gynaecological findings in the ED were adenomyosis (86.1 %), endometriosis (37.1 %) and leiomyomas (13.7 %). Adenomyosis was the most common finding, regardless of age. Endometriosis was more prevalent in women aged <41 years (43.8 % vs 31.2 %; p < 0.05). Meanwhile, adenomyosis and leiomyomas were more prevalent in women aged ≥41 years (81.11 % vs 90.57 % and 7.37 % vs 19.26 %, respectively; p < 0.05). Moreover, potentially life-threatening findings had low prevalence [i.e. haemorrhagic ovarian cyst (0.2 %), tubo-ovarian abscess (0.2 %) and pelvic inflammatory disease (0.4 %)]. CONCLUSION In the study setting, chronic pathologies such as adenomyosis, endometriosis and leiomyomas significantly impacted use of the ED. Adenomyosis was the most common pathology, regardless of age. Adenomyosis and leiomyomas were more prevalent in women aged ≥41 years, and endometriosis was more prevalent in women aged <41 years.
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Rodent Animal Models of Endometriosis-Associated Pain: Unmet Needs and Resources Available for Improving Translational Research in Endometriosis. Int J Mol Sci 2023; 24:ijms24032422. [PMID: 36768741 PMCID: PMC9917069 DOI: 10.3390/ijms24032422] [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: 12/12/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
Chronic pain induced by endometriosis is a maladaptive pain experienced by half of women with this disease. The lack of pharmacological treatments suitable for the long-term relief of endometriosis-associated pain, without an impact on fertility, remains an urgent unmet need. Progress has been slowed by the absence of a reproducible rodent endometriosis model that fully replicates human physiopathological characteristics, including pain symptoms. Although pain assessment in rodents is a complicated task requiring qualified researchers, the choice of the behavioral test is no less important, since selecting inappropriate tests can cause erroneous data. Pain is usually measured with reflex tests in which hypersensitivity is evaluated by applying a noxious stimulus, yet this ignores the associated emotional component that could be evaluated via non-reflex tests. We conducted a systematic review of endometriosis models used in rodents and the number of them that studied pain. The type of behavioral test used was also analyzed and classified according to reflex and non-reflex tests. Finally, we determined the most used reflex tests for the study of endometriosis-induced pain and the main non-reflex behavioral tests utilized in visceral pain that can be extrapolated to the study of endometriosis and complement traditional reflex tests.
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Litson J, Agnes R, Ravikumar G. Histotyping and grading of endometriosis and its association with clinico-pathological parameters. J OBSTET GYNAECOL 2022; 42:3628-3636. [PMID: 36409219 DOI: 10.1080/01443615.2022.2146997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Current clinical staging/grading schemes of endometriosis show poor correlation with clinical symptoms and histopathological confirmation is only in half of the clinically suspected endometriosis. In this study, done over an 8-year period, several histological features were analysed including an attempt to grade the severity of endometriosis histologically based on the number of foci per low power field. The components in each focus, the phasing of the glands and stroma, the type of glands (endometrial type or undifferentiated type), and stromal features were all analysed. This study attempts to histologically grade endometriosis while relating it to the clinical manifestations and anatomical location. Eighty cases of endometriosis were included. Most common clinical presentation was cyclical pain (n = 62) and the most common anatomical location was adnexa (n = 50). Histologically, severe endometriosis (>3 foci) was seen in 37 cases. The components were mixed in 68 cases. Well-differentiated glandular pattern was typical (n = 54), while 6 cases had undifferentiated. Proliferative phase was seen in 38 cases. Fibrosis and inflammation were present in 29 and 42 cases, respectively. Significant vascular proliferation and plasma cell infiltrate was noted (n = 35). The severe grade was significantly associated with fibrosis (p = 0.03) and inflammation (p = 0.014). Endometriotic foci, unlike eutopic endometrium, shows significant plasma cell infiltrate and vascular proliferation.IMPACT STATEMENTWhat is already known on this subject? Endometriosis, a chronic inflammatory condition in reproductive age group women. The currently used clinical staging and grading systems show poor correlation with patient symptoms and treatment outcomes. Endometriosis with classical histopathological features pose no diagnostic difficulty, however, there is poor concordance with histopathology. Atypical endometriosis is proposed as potential precursor for endometriosis related neoplasms, however, it remains as a controversial entity.What do the results of this study add? The study identifies the uncommon histological patterns which may be encountered in biopsy samples from clinically identified endometriotic lesions. The recognition of these patterns will reduce clinico-pathological discrepancies. In keeping with the other grading systems, attempts at histological grading did not show any correlation with location or patient symptoms. Atypical features were seen only in two cases and was likely to be reactive in nature.What are the implications of these findings for clinical practice and/or further research? Undifferentiated glandular pattern is often a under-recognized histological pattern. Histological grading of severity was a novel attempt to correlate with clinical parameters. Significant plasma cell infiltrate and vascular proliferation in endometriotic foci, underscores the quest for novel therapeutic targets. This study suggests that the use of non-invasive diagnostic methods like fibroscan/inflammatory markers to clinically identify severe disease should be investigated further.
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Affiliation(s)
- Jyothika Litson
- Department of Pathology, St. John’s Medical College, Bengaluru, India
| | - Rini Agnes
- Department of Pathology, St. John’s Medical College, Bengaluru, India
| | - Gayatri Ravikumar
- Department of Pathology, St. John’s Medical College, Bengaluru, India
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Manti F, Battaglia C, Bruno I, Ammendola M, Navarra G, Currò G, Laganà D. The Role of Magnetic Resonance Imaging in the Planning of Surgical Treatment of Deep Pelvic Endometriosis. Front Surg 2022; 9:944399. [PMID: 35836610 PMCID: PMC9273906 DOI: 10.3389/fsurg.2022.944399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background To prospectively evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) for the planning of surgical treatment of deep pelvic endometriosis. Materials and Methods From January 2020 to December 2021, we evaluated 72 patients with symptoms characteristic of endometriosis to plan appropriate surgical treatment. Sensitivity (Se), specificity (Sp), positive and negative predictive values (VPP/VPN), and the accuracy of MRI for the detection of deep pelvic endometriosis were calculated. Results Seventy-two patients (mean age, 35.5 years; range, 20–46 years) suspected of having pelvic endometriosis were recruited. Pelvic endometriosis was confirmed at pathologic examination in 56 (77.7%) of 72 patients. A total of 22 (39.3%) of 56 patients were subjected to video laparoscopy (VLS), and 16 (72.2%) of 22 were treated by surgery. Se, Sp, VPP, and VPN in intestinal endometriosis diagnosis were, respectively, 100%, 93.3%, 100%, and 87.5%, and diagnostic accuracy was 95.4%. MRI Se in ureteral endometriosis diagnosis was 50%, Sp 100%, VPP 100%, VPN 78%, and diagnostic accuracy 82%. MRI Se in endometrioma diagnosis was 92.3%, Sp 100%, VPP 100%, VPN 90%, and diagnostic accuracy 95.4%. MRI Se in rectum-vaginal septum (SRV) endometriosis diagnosis was 80%, Sp 100%, VPP 100% VPN 85.7%, and diagnostic accuracy 91%. The MRI Se in the diagnosis of endometriosis involving ULS was 100%, Sp 92.8%, VPP 89%, VPN 100%, and diagnostic accuracy 95.4%. Complete concordance results in a 100% accuracy for all calculated values in diagnosing bladder endometriosis localizations. Conclusion MR imaging demonstrates high accuracy in detecting deep pelvic endometriosis in specific locations. It allows the localization of deep pelvic lesions with highly fibrotic components that are hardly recognizable with other imaging methods and not visible with VLS.
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Affiliation(s)
- Francesco Manti
- Radiology Unit, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Catanzaro, Italy
| | - Caterina Battaglia
- Radiology Unit, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Catanzaro, Italy
| | - Iennarella Bruno
- Radiology Unit, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Catanzaro, Italy
| | - Michele Ammendola
- Science of Health Department, Digestive Surgery Unit, University “Magna Graecia” Medical School, Catanzaro, Italy
- Correspondence: Michele Ammendola
| | - Giuseppe Navarra
- Department of Human Pathology of Adult and Evolutive Age, Surgical Oncology Division, “G. Martino” Hospital, University of Messina, Messina, Italy
| | - Giuseppe Currò
- Science of Health Department, General Surgery Unit, University “Magna Graecia” Medical School, Catanzaro, Italy
| | - Domenico Laganà
- Radiology Unit, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Catanzaro, Italy
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Till SR, Nakamura R, Schrepf A, As-Sanie S. Approach to Diagnosis and Management of Chronic Pelvic Pain in Women. Obstet Gynecol Clin North Am 2022; 49:219-239. [DOI: 10.1016/j.ogc.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Schwartz NRM, Afeiche MC, Terry KL, Farland LV, Chavarro JE, Missmer SA, Harris HR. Glycemic Index, Glycemic Load, Fiber, and Gluten Intake and Risk of Laparoscopically Confirmed Endometriosis in Premenopausal Women. J Nutr 2022; 152:2088-2096. [PMID: 35554558 PMCID: PMC9445851 DOI: 10.1093/jn/nxac107] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/31/2022] [Accepted: 05/09/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The etiology of endometriosis is not well understood. Limited evidence suggests that dietary factors influence risk, but prospective data related to carbohydrate, fiber, and gluten consumption are scarce. Despite this, recommendations concerning fiber, gluten intake, and endometriosis are pervasive in the lay literature. OBJECTIVES We aimed to investigate the associations of carbohydrate quality [glycemic index (GI) and glycemic load (GL)], fiber intake (total, legume, vegetable, cruciferous vegetable, fruit, cereal), and gluten intake with incident laparoscopically confirmed endometriosis. METHODS This was a prospective cohort study using data collected from 81,961 premenopausal women in the Nurses' Health Study II (mean age = 36 y in 1991). Diet was assessed with a validated FFQ every 4 y. Cox proportional hazards models were used to calculate rate ratios (RRs) and 95% CIs. RESULTS A total of 3810 incident cases of laparoscopically confirmed endometriosis were reported over 24 y of follow-up. Women in the highest quintile of GI had 12% (95% CI: 1.01, 1.23; Ptrend = 0.03) higher risk of endometriosis diagnosis than those in the lowest quintile. Total vegetable and cruciferous vegetable fiber intakes were also associated with higher risk (highest compared with lowest quintile RR: 1.13; 95% CI: 1.02, 1.24; Ptrend = 0.004 and RR: 1.17; 95% CI: 1.06, 1.29; Ptrend = 0.02, respectively). Higher intake of fruit fiber was associated with lower risk of endometriosis but the association was not significant after adjusting for the Alternative Healthy Eating Index. Gluten intake was also associated with lower risk (highest compared with lowest quintile RR: 0.91; 95% CI: 0.80, 1.02; Ptrend = 0.01), but these results were not consistent in direction nor statistical significance across sensitivity analyses. No association was observed for GL or total, legume, or cereal fiber intake. CONCLUSIONS Our findings suggest that carbohydrate quality and specific types of fiber-total vegetable and cruciferous vegetable fiber-are associated with endometriosis diagnosis in premenopausal women. These results also indicate it is unlikely that gluten intake is a strong factor in the etiology or symptomatology of endometriosis.
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Affiliation(s)
| | | | - Kathryn L Terry
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, MA, USA,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Jorge E Chavarro
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Stacey A Missmer
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA,Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA,Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA,Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
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Gortazar De Las Casas S, Spagnolo E, Lopez A, Yebenes Gregorio L, Hernandez A, Pascual I. Laparoscopic ileocaecal resection with intracorporeal anastomosis for bowel endometriosis-a video vignette. Colorectal Dis 2022; 24:667-668. [PMID: 35038376 DOI: 10.1111/codi.16052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/11/2021] [Accepted: 01/08/2022] [Indexed: 02/08/2023]
Affiliation(s)
| | | | - Ana Lopez
- Department of Gynecology, La Paz University Hospital, Madrid, Spain
| | | | - Alicia Hernandez
- Department of Gynecology, La Paz University Hospital, Madrid, Spain
| | - Isabel Pascual
- Department of Surgery, La Paz University Hospital, Madrid, Spain
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10
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Tejada MA, Santos-Llamas AI, Escriva L, Tarin JJ, Cano A, Fernández-Ramírez MJ, Nunez-Badinez P, De Leo B, Saunders PTK, Vidal V, Barthas F, Vincent K, Sweeney PJ, Sillito RR, Armstrong JD, Nagel J, Gomez R. Identification of Altered Evoked and Non-Evoked Responses in a Heterologous Mouse Model of Endometriosis-Associated Pain. Biomedicines 2022; 10:biomedicines10020501. [PMID: 35203710 PMCID: PMC8962432 DOI: 10.3390/biomedicines10020501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/17/2022] [Indexed: 01/01/2023] Open
Abstract
The aim of this study was to develop and refine a heterologous mouse model of endometriosis-associated pain in which non-evoked responses, more relevant to the patient experience, were evaluated. Immunodeficient female mice (N = 24) were each implanted with four endometriotic human lesions (N = 12) or control tissue fat (N = 12) on the abdominal wall using tissue glue. Evoked pain responses were measured biweekly using von Frey filaments. Non-evoked responses were recorded weekly for 8 weeks using a home cage analysis (HCA). Endpoints were distance traveled, social proximity, time spent in the center vs. outer areas of the cage, drinking, and climbing. Significant differences between groups for von Frey response, climbing, and drinking were detected on days 14, 21, and 35 post implanting surgery, respectively, and sustained for the duration of the experiment. In conclusion, a heterologous mouse model of endometriosis-associated evoked a non-evoked pain was developed to improve the relevance of preclinical models to patient experience as a platform for drug testing.
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Affiliation(s)
- Miguel A. Tejada
- Research Unit on Women’s Health-INCLIVA, Institute of Health Research, 46010 Valencia, Spain; (M.A.T.); (A.I.S.-L.); (L.E.); (J.J.T.); (A.C.)
| | - Ana I. Santos-Llamas
- Research Unit on Women’s Health-INCLIVA, Institute of Health Research, 46010 Valencia, Spain; (M.A.T.); (A.I.S.-L.); (L.E.); (J.J.T.); (A.C.)
| | - Lesley Escriva
- Research Unit on Women’s Health-INCLIVA, Institute of Health Research, 46010 Valencia, Spain; (M.A.T.); (A.I.S.-L.); (L.E.); (J.J.T.); (A.C.)
| | - Juan J. Tarin
- Research Unit on Women’s Health-INCLIVA, Institute of Health Research, 46010 Valencia, Spain; (M.A.T.); (A.I.S.-L.); (L.E.); (J.J.T.); (A.C.)
- Department of Cellular Biology, Functional Biology and Physical Anthropology, University of Valencia, 46100 Burjassot, Spain
| | - Antonio Cano
- Research Unit on Women’s Health-INCLIVA, Institute of Health Research, 46010 Valencia, Spain; (M.A.T.); (A.I.S.-L.); (L.E.); (J.J.T.); (A.C.)
- Department of Pediatrics and Obstetrics and Gynecology, University of Valencia, 46010 Valencia, Spain;
| | - Maria J. Fernández-Ramírez
- Department of Pediatrics and Obstetrics and Gynecology, University of Valencia, 46010 Valencia, Spain;
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario, 46010 Valencia, Spain
| | - Paulina Nunez-Badinez
- Bayer AG. Research & Early Development, Pharmaceuticals, Reproductive Health, Müllerstr. 178, 13342 Berlin, Germany; (P.N.-B.); (B.D.L.)
| | - Bianca De Leo
- Bayer AG. Research & Early Development, Pharmaceuticals, Reproductive Health, Müllerstr. 178, 13342 Berlin, Germany; (P.N.-B.); (B.D.L.)
| | - Philippa T. K. Saunders
- Centre for Inflammation Research, Queen’s Medical Research Institute, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK;
| | - Victor Vidal
- Faculty of Science, International University of La Rioja, Avda de la paz 137, 26006 Logrono, Spain;
| | | | - Katy Vincent
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford OX1 2JD, UK;
| | - Patrick J. Sweeney
- Actual Analytics, 99 Giles Street, Edinburgh EH6 6BZ, UK; (P.J.S.); (R.R.S.); (J.D.A.)
| | - Rowland R. Sillito
- Actual Analytics, 99 Giles Street, Edinburgh EH6 6BZ, UK; (P.J.S.); (R.R.S.); (J.D.A.)
| | - James Douglas Armstrong
- Actual Analytics, 99 Giles Street, Edinburgh EH6 6BZ, UK; (P.J.S.); (R.R.S.); (J.D.A.)
- School of Informatics, University of Edinburgh, 10 Crichton Street, Edinburgh EH8 9AB, UK
| | - Jens Nagel
- Bayer AG. Research & Early Development, Pharmaceuticals, Exploratory Pathobiology, Aprather Weg 18a, 42096 Wuppertal, Germany;
| | - Raúl Gomez
- Research Unit on Women’s Health-INCLIVA, Institute of Health Research, 46010 Valencia, Spain; (M.A.T.); (A.I.S.-L.); (L.E.); (J.J.T.); (A.C.)
- Department of Pathology, University of Valencia, 46010 Valencia, Spain
- Correspondence:
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Burden of Endometriosis: Infertility, Comorbidities, and Healthcare Resource Utilization. J Clin Med 2022; 11:jcm11041133. [PMID: 35207404 PMCID: PMC8880408 DOI: 10.3390/jcm11041133] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/16/2022] [Indexed: 12/11/2022] Open
Abstract
The goal of our study was to evaluate the burden of endometriosis in the community by comparing healthcare resource utilization, total direct medical costs, infertility, and comorbidity rates of women with and without a diagnosis of endometriosis. A retrospective case–control study was performed using the databases of a 2.1 million-member nationwide healthcare plan. The study population included women aged 15–55 years enrolled in the healthcare plan. Women with a diagnosis (ICD-9) of endometriosis were compared to controls without diagnosed endometriosis. Women were individually matched (1:4) on age and residence area. Patient characteristics were described, including infertility, comorbidities, and annual healthcare resource utilization. Total direct medical costs were analyzed in a generalized linear model adjusting for age. Women with endometriosis (n = 6146, mean age ± SD: 40.4 ± 8.0 y) were significantly more likely than controls (n = 24,572) to have a lower BMI and a higher socioeconomic status. After adjusting for BMI and socioeconomic status, endometriosis was significantly associated with infertility (OR = 3.3; 95% CI 3.1–3.5), chronic comorbidities, higher utilization of healthcare services (hospitalization: OR = 2.3; 95% CI 2.1–2.5), pain medications, and antidepressants. Women aged 15–19 y with endometriosis had substantially higher utilization of primary care visits (57.7% vs. 14.4%) and oral contraceptive use (76.9% vs. 9.6%). Direct medical costs associated with endometriosis were higher than those for controls (OR = 1.75; 95% CI 1.69–1.85). Endometriosis is associated with a high burden of comorbidities, increased healthcare resource utilization, and excess costs, particularly for younger patients whose healthcare needs may differ widely from the older population.
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Krzeczowski RM, Jackson TN, Kabbani W, Grossman Verner HM, Sladek P. Splenic Cysts and the Case of Mistaken Identity. Cureus 2022; 14:e22012. [PMID: 35340504 PMCID: PMC8913435 DOI: 10.7759/cureus.22012] [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] [Accepted: 02/08/2022] [Indexed: 11/15/2022] Open
Abstract
Endometriosis is a well-described pathology, with anatomic location of endometrial cell implantation extending both intraperitoneal and rarely extraperitoneal. Interestingly, previous reports indicated that the spleen enjoys immunity to endometriosis. Here, we present a patient with unremitting abdominal pain who, upon further workup, revealed multicystic disease of the spleen. The patient underwent an open splenectomy with pathology revealing intraparenchymal endometriosis likely due to seeding from traumatic splenorrhaphy. Two-week follow-up demonstrated resolution of symptoms and a well-healing incision with no postoperative complications.
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Metformin as a Potential Treatment Option for Endometriosis. Cancers (Basel) 2022; 14:cancers14030577. [PMID: 35158846 PMCID: PMC8833654 DOI: 10.3390/cancers14030577] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/07/2022] [Accepted: 01/21/2022] [Indexed: 02/07/2023] Open
Abstract
Endometriosis is a common disease in women of reproductive age, and its pathogenesis seems to be largely affected by hormone imbalance, inflammation, oxidative stress, and autophagy dysregulation. These pathophysiological disturbances interact with one another through mechanisms that are still awaiting elucidation. The aim of this article is to present current knowledge regarding the possibilities of using metformin in the pharmacological treatment of endometriosis. Metformin is an insulin sensitizer widely used for the treatment of type 2 diabetes mellitus. The pleiotropic effects of metformin are mainly exerted through the activation of AMP-activated protein kinase, which is the key cellular energy homeostasis regulator that inhibits mTOR, a major autophagy suppressor. Metformin regresses endometriotic implants by increasing the activity of superoxide dismutase. It is also an inhibitor of metalloproteinase-2, decreasing the levels of the vascular endothelial growth factor and matrix metalloproteinase-9 in animal studies. In endometriosis, metformin might modify the stroma-epithelium communication via Wnt2/β-catenin. With its unique therapeutic mechanisms and no serious side effects, metformin seems to be a helpful anti-inflammatory and anti-proliferative agent in the treatment of endometriosis. It could be a missing link for the successful treatment of this chronic disease.
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Stochino-Loi E, Major AL, Gillon TER, Ayoubi JM, Feki A, Bouquet de Joliniere J. Metformin, the Rise of a New Medical Therapy for Endometriosis? A Systematic Review of the Literature. Front Med (Lausanne) 2021; 8:581311. [PMID: 34046415 PMCID: PMC8144644 DOI: 10.3389/fmed.2021.581311] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
Medical treatments for endometriosis aim to control pain symptoms and stop progression of endometriotic lesions. However, their adverse effects and their contraceptive effect in women who desire pregnancy, limit their long terms use. Although there is only one study investigating the effects of metformin on women with endometriosis, metformin seems to have a unique therapeutic potential. It may be a helpful anti-inflammatory and antiproliferative agent in the treatment of endometriosis. As such metformin may be more beneficial thanks to the lack of serious side effects.
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Affiliation(s)
- Emanuela Stochino-Loi
- Department of Obstetrics and Gynecology, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Attila L Major
- Department of Obstetrics and Gynecology, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland.,Femina Gynecology Center, Geneva, Switzerland
| | - Tessa E R Gillon
- Department of Obstetrics and Gynecology, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Jean-Marc Ayoubi
- Department of Obstetrics and Gynecology, Foch Hospital, University of West Paris, Suresnes, France
| | - Anis Feki
- Department of Obstetrics and Gynecology, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Jean Bouquet de Joliniere
- Department of Obstetrics and Gynecology, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
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Abdalla-Ribeiro H, Maekawa MM, Lima RF, de Nicola ALA, Rodrigues FCM, Ribeiro PA. Intestinal endometriotic nodules with a length greater than 2.25 cm and affecting more than 27% of the circumference are more likely to undergo segmental resection, rather than linear nodulectomy. PLoS One 2021; 16:e0247654. [PMID: 33857130 PMCID: PMC8049285 DOI: 10.1371/journal.pone.0247654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/10/2021] [Indexed: 11/18/2022] Open
Abstract
Study objective To analyze the efficacy of intestinal ultrasonography with bowel preparation (TVUSBP) for endometriosis mapping in evaluating intestinal endometriosis to choose the surgical technique (segmental resection or linear nodulectomy) for treatment. Design Cross-sectional observational study. Setting University Hospital—Center for Advanced Endoscopic Gynecologic Surgery from April 2010 to November 2014. Patient(s) One hundred and eleven women with clinically suspected endometriosis and intestinal endometriotic nodule or intestinal adherence in TVUSBP for endometriosis mapping. Intervention(s) All patients with suspected endometriosis underwent TVUSBP for endometriosis mapping prior to videolaparoscopy for complete excision of endometriosis foci, including intestinal foci, using the linear nodulectomy or segmental resection techniques, depending on the characteristics of the intestinal lesion with confirmation of endometriosis on anatomopathological examination. Measurements and main results Preoperative ultrasonographic assessment of the length of the intestinal nodule, circumference of the intestinal loop affected by the endometriotic lesion, distance from the anal verge and intestinal wall layers infiltrated by endometriosis, as well as other endometriosis sites. Of the 111 patients who participated in the study, 63 (56.7%) presented intestinal endometriotic nodules in ultrasonography, performed by a single examiner (A.L.A.N.), and underwent intestinal surgical treatment of deep endometriosis—linear nodulectomy or segmental resection. The analysis of the receiver operating characteristic (ROC) curve showed that a longitudinal length of the intestinal nodule of 2.25 cm and a loop circumference of 27% are cutoff points separating linear nodulectomy from segmental resection techniques for excising intestinal endometriosis. The information obtained by TVUSBP helps the surgeon and patient, in the preoperative period, to select the surgical technique to be performed for resection of intestinal endometriosis and plan the surgical procedure while taking into account postoperative morbidity.
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Affiliation(s)
- Helizabet Abdalla-Ribeiro
- Department of Obstetrics and Gynecology of Santa Casa de de Misericórdia São Paulo, Sector of Gynecological Endoscopy and Endometriosis at Santa Casa de São Paulo, São Paulo, São Paulo, Brazil
- School of Medical Science of Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil
| | - Marina Miyuki Maekawa
- Department of Obstetrics and Gynecology of Santa Casa de de Misericórdia São Paulo, Sector of Gynecological Endoscopy and Endometriosis at Santa Casa de São Paulo, São Paulo, São Paulo, Brazil
- * E-mail:
| | - Raquel Ferreira Lima
- Department of Obstetrics and Gynecology of Santa Casa de de Misericórdia São Paulo, Sector of Gynecological Endoscopy and Endometriosis at Santa Casa de São Paulo, São Paulo, São Paulo, Brazil
| | - Ana Luisa Alencar de Nicola
- Department of Obstetrics and Gynecology of Santa Casa de de Misericórdia São Paulo, Sector of Gynecological Endoscopy and Endometriosis at Santa Casa de São Paulo, São Paulo, São Paulo, Brazil
| | - Francisco Cesar Martins Rodrigues
- Department of Obstetrics and Gynecology of Santa Casa de de Misericórdia São Paulo, Sector of Gynecological Endoscopy and Endometriosis at Santa Casa de São Paulo, São Paulo, São Paulo, Brazil
| | - Paulo Ayroza Ribeiro
- Department of Obstetrics and Gynecology of Santa Casa de de Misericórdia São Paulo, Sector of Gynecological Endoscopy and Endometriosis at Santa Casa de São Paulo, São Paulo, São Paulo, Brazil
- School of Medical Science of Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil
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Application of robotic single-site surgery with optional additional port for endometriosis: a single institution's experience. J Robot Surg 2021; 16:127-135. [PMID: 33651315 DOI: 10.1007/s11701-021-01217-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
To evaluate the safety and feasibility of treating stage I-IV endometriosis patients with robotic single-site surgery (RSSS). A retrospective chart review was conducted on 334 patients with endometriosis treated by a single surgeon at a university hospital from January 2015 to November 2019. Surgeries were performed in a single institution between 2015 and 2019. All patients presented with pelvic pain and underwent surgical resection of the lesion. American Society of Reproductive Medicine (ASRM) standards were used to classify endometriosis. The primary goal of this study is to investigate the feasibility and safety of RSSS for surgical resection of stage I-IV endometriosis patients. We will compare patient characteristics and surgical parameters, such as blood loss, operating time, and postoperative complications, across different endometriosis stages to evaluate the effectiveness of this novel technique. RSSS was used for all cases, with no conversions to laparotomy or traditional laparoscopy. One to two additional ports were placed in 41 patients with deeply infiltrating endometriosis (DIE) involving the colorectal and urinary tract and/or extensive pelvic adhesions. Across patient groups, there were no significant differences in age, BMI, fertility history, abdominal surgery history, and hysterectomy ratio (P > 0.05). The median operation time was 140.25 min (range: 85.50-260.00 min, P < 0.05) and median blood loss was 31.25 mL (range: 15-100 mL, P < 0.05). Histopathology supported the diagnosis in 259/334 patients. The undiagnosed patients were associated with lower ASRM scores. For 83.3% of patients (295/334), the length of hospital stay was < 24 h. The postoperative complication rate was 6.0% (20/334), although only two cases were severe. Our results indicate that RSSS is an alternative, safe, and acceptable platform for the surgical treatment of all stages of endometriosis.
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Mikhaleva LM, Solomatina AA, Milovanov AP, Beeraka NM, Khovanskaya TN, Chabieva LB, Mikhalev SA, Gracheva NA, Chigray LV, Beylerli O, Patsap OI, Aliev G. Histomorphological and Functional Features of the Eutopic Endometrium in Patients with Ovarian Endometriosis After Surgery-a Clinical Study. Reprod Sci 2021; 28:2350-2358. [PMID: 33650096 DOI: 10.1007/s43032-021-00508-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/21/2021] [Indexed: 12/15/2022]
Abstract
Endometriosis causes infertility and the alterations in endometrial receptivity. Pinopodia in eutopic endometrial epithelium may have significant implications in the endometriosis-associated infertility. The aim of this study is to ascertain whether the surgical interventions to remove endometrioid ovarian cysts (EOCs) can improve endometrial receptivity. The study included 172 patients of reproductive age with EOC, who underwent laparoscopic cystectomy. Aspiration endometrial biopsy was performed at 6 and 12 months after the surgery during the proliferation and secretion phases. Histopathology analysis included H&E staining and IHC. Morphometric studies were performed on endometrial biopsies collected during the proliferation phase of 28 patients, and the secretion phase of 12 patients. The expression of IHC markers for estrogen receptors (ER) and progesterone receptors (PR) and the percentage of cells containing pinopodia were determined. A significant increase in the ER and PR expression was observed in the epithelium during the "middle stage, proliferation phase" and in the stroma and glands during "middle stage, secretion phase". A delay in endometrial secretory transformation and statistically significant decrease in the number of pinopodia was observed on the apical surface of the cells. These structural and functional alterations were observed both at 6 and 12 months after cystectomy. The endometriosis-associated infertility after surgical intervention of EOC could be due to the extensive expression of ER and PR during the proliferation and secretion phases, as well as the delayed secretory transformation and impaired formation of pinopodia in the eutopic endometrium in the patients at 6 and 12 months after surgery.
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Affiliation(s)
- Liudmila M Mikhaleva
- Research Institute of Human Morphology, 3, Tsyurupy Street, Moscow, 117418, Russia.
- Department of Public Health, City Clinical Hospital, No-31, Moscow, Russia.
| | - Antonina A Solomatina
- Department of Obstetrics and Gynecology, Russian National Research Medical University Named After N.I. Pirogov, Moscow, Russia
| | - Andrey P Milovanov
- Research Institute of Human Morphology, 3, Tsyurupy Street, Moscow, 117418, Russia
| | - Narasimha M Beeraka
- Department of Biochemistry, Center of Excellence in Molecular Biology and Regenerative Medicine (CEMR), JSS Academy of Higher Education & Research (JSS AHER), Mysore, India
| | | | - Leyla B Chabieva
- Department of Public Health, City Clinical Hospital, No-31, Moscow, Russia
- Department of Obstetrics and Gynecology, Russian National Research Medical University Named After N.I. Pirogov, Moscow, Russia
| | | | - Natalya A Gracheva
- Department of Public Health, City Clinical Hospital, No-31, Moscow, Russia
| | - Lyudmila V Chigray
- Department of Public Health, City Clinical Hospital, No-31, Moscow, Russia
| | - Ozal Beylerli
- Bashkir State Medical University, Ufa, Republic of Bashkortostan, 450008, Russia
| | - Olga I Patsap
- Department of Pathology, Federal Center of Brain Research and Neurotechnologies of the Federal Medical Biological Agency, 1-10, Ostrovityanova Street, Moscow, 117997, Russia
| | - Gjumrakch Aliev
- Research Institute of Human Morphology, 3, Tsyurupy Street, Moscow, 117418, Russia
- GALLY International Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX, 78229, USA
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Kar A, Bano S, Pradhan D, Behera P, Mishra A, Kar T. Diagnosis of endometriosis by detection of nerve fibers using protein gene product 9.5 immunohistochemistry. JOURNAL OF CURRENT RESEARCH IN SCIENTIFIC MEDICINE 2021. [DOI: 10.4103/jcrsm.jcrsm_25_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Nodler JL, Harris HR, Chavarro JE, Frazier AL, Missmer SA. Dairy consumption during adolescence and endometriosis risk. Am J Obstet Gynecol 2020; 222:257.e1-257.e16. [PMID: 31526789 DOI: 10.1016/j.ajog.2019.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/09/2019] [Accepted: 09/09/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Modifiable risk factors such as diet may be important in both the etiology and progression of endometriosis as well as the prevalence of pain symptoms and infertility associated with this condition. In adults, higher intake of dairy has been associated with a lower risk of endometriosis diagnosis. There is currently no literature on whether dairy intake during adolescence, a potentially critical window of exposure, influences endometriosis risk. OBJECTIVE The objectige of the study was to evaluate the association between consumption of dairy foods in adolescence and the risk of laparoscopically confirmed endometriosis. STUDY DESIGN This was a prospective cohort study, the Nurses' Health Study II, which has prospectively collected data since 1989. In 1998, when participants were aged 34-51 years, they completed a 124 item food frequency questionnaire about their high school diet. Cases were defined as those who self-reported laparoscopically confirmed endometriosis. Cox proportional hazard models were used to calculate hazard ratios and 95% confidence intervals for the association between dairy foods and laparoscopically confirmed endometriosis. RESULTS Among women who completed the questionnaire about their high school diet in 1998, 581 cases of laparoscopically confirmed endometriosis were diagnosed among 32,868 premenopausal women from 1998 to 2013. Women who consumed more than 4 servings per day of dairy foods during adolescence had a 32% lower risk of laparoscopically confirmed endometriosis during adulthood (95% confidence interval, 0.47-0.96; Ptrend = .04) compared with women consuming 1 or fewer servings per day. The association was similar for low-fat and high-fat dairy foods. Yogurt and ice cream consumption, specifically, were associated with a lower risk of endometriosis. Those who consumed 2 or more servings of yogurt per week as an adolescent had a 29% lower risk of endometriosis diagnosis (95% confidence interval, 0.52-0.97; Ptrend = .02) compared with those consuming less than 1 serving per week. In addition, women who consumed 1 or more servings per day of ice cream per day during adolescence had a 38% lower risk of endometriosis diagnosis (95% confidence interval, 0.40-0.94; Ptrend = .20) compared with those consuming less than 1 serving per week. CONCLUSION Our findings suggest that dairy consumption, specifically yogurt and ice cream intake, in adolescence may reduce the risk of subsequent endometriosis diagnosis. Future studies in adolescent populations are needed to confirm these results.
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Affiliation(s)
- James L Nodler
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Houston IVF, Houston, TX
| | - Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA.
| | - Jorge E Chavarro
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| | - A Lindsay Frazier
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Dana-Farber Children's Cancer Care, Boston, MA
| | - Stacey A Missmer
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA; Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI
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Karslıoglu T, Karasu AFG, Yildiz P. The Effects of Micronized Progesterone and Cabergoline On a Rat Autotransplantation Endometriosis Model: A Placebo Controlled Randomized Trial. J INVEST SURG 2020; 34:897-901. [PMID: 31906754 DOI: 10.1080/08941939.2019.1705442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIM The etiology of endometriosis is complex and various theories have been postulated. Endometriosis pathogenesis involves genetic susceptibility, immunologic alterations and inflammatory prerequisite pathways. In this pilot experimental animal study we wanted to investigate the effects of cabergoline and micronized progesterone on a rat endometriosis model. MATERIAL AND METHODS All rats were provided and housed in the animal laboratory of the Experimental Research Center of Bezmialem Vakif University. This was a placebo controlled randomized trial. The endometriosis model consisted of autotransplantation of endometrial tissue on 21 adult Sprague-Dawley rats. Endometriosis formation by second-look laparotomy was confirmed 8 weeks later. After measuring the endometriosis implant area the rats were randomized into three intervention groups: cabergoline treatment group, micronized progesterone treatment group and the control group. Four weeks after treatment, a third laparotomy was performed to remeasure implant volumes. Endometriotic implants were obtained for histopathological and immunohistochemical analysis. RESULTS After 4 weeks of treatment endometriosis implant sizes diminished in all groups. There was no statistically significant difference regarding implant size volume before and after treatment among the groups. The peritoneal histopathology and immunohistochemistry showed no difference with regards to IL-6 and TNF-α staining among groups. CONCLUSION We conclude that oral treatment of cabergoline and micronized progesterone for 4 weeks was not statistically effective in endometriotic implant regression. However, we believe further studies are warranted. Treatment for longer durations or via different routes may be investigated in further studies. When ethically applicable other mammals may be considered such as baboons.
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Affiliation(s)
| | - Ayse Filiz Gokmen Karasu
- Department of Obstetrics and Gynecology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Pelin Yildiz
- Department of Pathology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
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Tsai C, Huang SH, Huang CY. Polypoid endometriosis - A rare entity of endometriosis mimicking ovarian cancer. Taiwan J Obstet Gynecol 2019; 58:328-329. [PMID: 31122518 DOI: 10.1016/j.tjog.2019.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To report a rare case of polypoid endometriosis with initial impression of ovarian cancer and review the published literature about this disease. CASE REPORT A 23-year-old female presented with sudden onset of acute lower abdominal pain. Image studies revealed an irregular shaped, heterogeneous mass at the cul-de-sac, but without ascites or enlargement of pelvic or paraaortic lymph nodes. Blood tests showed an elevated CA-125 value (1317 U/ml). Resection of the mass was performed by laparotomy and the frozen section and final pathology both revealed polypoid endometriosis. Post-operative gonadotropin-releasing hormone agonist was given for 6 months followed by oral contraceptives. She remained disease free 3 years after operation. CONCLUSION Polypoid endometriosis is an uncommon and distinctive variant of endometriosis. Gynecologists should be aware of this rare form of a commonly benign disease to avoid excessive resection in younger patients of childbearing age.
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Affiliation(s)
- Cleo Tsai
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
| | - Shih-Hung Huang
- Department of Pathology, Cathay General Hospital, Taipei, Taiwan.
| | - Chia-Yen Huang
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, Hsinchuang, New Taipei City, Taiwan; Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
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Abstract
Endometriosis is a common and challenging condition of reproductive-aged women that carries a high individual and societal cost. The many molecular dissimilarities between endometriosis lesions and eutopic endometrium create difficulties in the development of new drug therapies and treatments. Surgery remains the gold standard for definitive diagnosis, but it must be weighed against the risks of surgical morbidity and potential decreases in ovarian reserve, especially in the case of endometriomas. Safe and effective surgical techniques are discussed within this article for various presentations of endometriosis. Medical therapy is suppressive rather than curative, and regimens that are long-term and affordable with minimal side effects are recommended. Recurrences are common and often rapid when medical therapy is discontinued. Endometriosis in the setting of infertility is reviewed and appropriate management is discussed, including when and whether surgery is warranted in this at-risk population. In patients with chronic pain, central sensitization and myofascial pain are integral components of a multidisciplinary approach. Endometriosis is associated with an increased risk of epithelial ovarian cancer; however, the risk is low and currently no preventive screening is recommended. Hormone therapy for symptomatic women with postsurgical menopause should not be delayed as a result of concerns for malignancy or recurrence of endometriosis.
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Soliman AM, Surrey ES, Bonafede M, Nelson JK, Vora JB, Agarwal SK. Health Care Utilization and Costs Associated with Endometriosis Among Women with Medicaid Insurance. J Manag Care Spec Pharm 2019; 25:566-572. [PMID: 31039061 PMCID: PMC10397603 DOI: 10.18553/jmcp.2019.25.5.566] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Endometriosis is a painful chronic inflammatory disease caused by endometrial tissue implanting and growing outside the uterus, resulting in pelvic pain symptoms and subfertility. Treatment imposes a substantial economic burden on the patient and health care system. OBJECTIVE To evaluate direct health care utilization and costs among women newly diagnosed with endometriosis compared with age-matched controls in a U.S. Medicaid population. METHODS This retrospective cohort study used deidentified health care claims from the 2007-2015 MarketScan Multi-State Medicaid Database. Women (aged 18-49 years) newly diagnosed with endometriosis (ICD-9-CM 617.xx) during January 2008 through September 2014 were identified (date of first diagnosis = index date). Age-matched women without endometriosis (controls) were selected from the database and assigned index dates matching the distribution for endometriosis patients. Direct health care resource utilization (HCRU) and costs (medical and pharmacy) over the 12-month post-index period (2015 U.S. dollars) were computed by service category (hospitalization, emergency room visits, outpatient services, and prescriptions) and compared between study cohorts using the chi-square test for proportions and t-test for continuous variables. RESULTS The final sample included 15,615 endometriosis patients and 86,829 matched controls. HCRU during the 12-month post-index follow-up period was significantly higher for endometriosis cases compared with controls in all measured categories. Hospital admissions occurred among 33.1% of cases and 7.2% of controls, and 65.8% of endometriosis patients were admitted for endometriosis-related surgery. Emergency room visits occurred in 71.5% of cases, and 42.2% of controls. Mean (SD) office visits were 10.4 (8.5) for endometriosis patients and 5.1 (6.9) for controls. Endometriosis patients had significantly more prescription claims than controls, 45.9 (42.0) versus 25.1 (39.1). Mean total direct health care costs were $13,670 ($29,843) for cases versus $5,779 ($23,614) for controls. All differences between cases and controls were significant at P < 0.001. CONCLUSIONS Health care costs and resource utilization in all measured categories were higher among endometriosis cases than controls. The economic burden of endometriosis among patients with Medicaid insurance is substantial, underscoring the unmet medical need for earlier diagnosis and cost-effective treatments. DISCLOSURES This study was funded by AbbVie and conducted by Truven Health Analytics, an IBM Company. AbbVie participated in developing the study design, data analysis and interpretation, manuscript writing and revisions, and approval for publication. Soliman and Vora are employees of AbbVie and may own AbbVie stock/stock options. Surrey has served in a consulting role on research to AbbVie and is on the speaker bureau for Ferring Laboratories. Bonafede and Nelson are employees of Truven Health Analytics, an IBM Company, which received compensation from AbbVie for the overall conduct of the study and preparation of the manuscript. Agarwal has served in a consulting role on research to AbbVie. Preliminary results of this study were previously presented in a podium session at the 2017 American Society for Reproductive Medicine Scientific Congress and Expo; October 28-November 1, 2017; San Antonio, TX.
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Affiliation(s)
| | - Eric S. Surrey
- Colorado Center for Reproductive Medicine, Lone Tree, Colorado
| | - Machaon Bonafede
- Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
| | - James K. Nelson
- Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
| | | | - Sanjay K. Agarwal
- Center for Endometriosis Research and Treatment, University of California, San Diego
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Luo S, Zhang C, Huang JP, Huang GH, He J. Ultrasound-guided high-intensity focused ultrasound treatment for abdominal wall endometriosis: a retrospective study. BJOG 2019; 124 Suppl 3:59-63. [PMID: 28856852 DOI: 10.1111/1471-0528.14741] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for treating abdominal wall endometrioses (AWE). DESIGN A retrospective study. SETTING Department of Obstetrics and Gynaecology in China. POPULATION Patients with abdominal wall endometriosis. METHODS From August 2010 to April 2014, 32 patients with AWE were treated with USgHIFU in our hospital. USgHIFU treatment was performed with the Model JC-200 High Intensity Focused Ultrasound Tumor Therapeutic System. The symptom relief and the adverse effects were evaluated after USgHIFU ablation. MAIN OUTCOME MEASURES USgHIFU as a new treatment option for patients with AWE. RESULTS Contrast-enhanced ultrasound showed that all lesions were successfully ablated with USgHIFU. The follow-up results showed that the average volume of AWE lesions at 6 months after USgHIFU was significantly smaller than that before treatment (2.80 ± 0.12 versus 1.33 ± 0.31 cm3 ). The pain scores at 6 months after treatment were significantly lower than those before treatment (6.80 ± 2.64 versus 1.80 ± 0.3). The non-perfused volume (indicative of successful ablation) was measured in all patients immediately after treatment, ranging from 0.9 to 2.1 cm3 (median: 1.6 cm3 ), and the fractional ablation ranged from 87% to 100% (median: 94%). Local oedema was observed in these patients, lasting for 1-3 days only. No severe complications occurred during the follow-up period. CONCLUSIONS Based on our study, USgHIFU ablation is a safe and effective method for treating AWE. TWEETABLE ABSTRACT As a non-invasive treatment technique, HIFU could be used to treat abdominal wall endometriosis.
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Affiliation(s)
- S Luo
- Department of Obstetrics and Gynaecology, Suining Central Hospital, Sichuan, China
| | - C Zhang
- Department of Obstetrics and Gynaecology, Suining Central Hospital, Sichuan, China
| | - J P Huang
- Department of Obstetrics and Gynaecology, Suining Central Hospital, Sichuan, China
| | - G H Huang
- Department of Obstetrics and Gynaecology, Suining Central Hospital, Sichuan, China
| | - J He
- Department of Obstetrics and Gynaecology, Suining Central Hospital, Sichuan, China
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Grandi G, Barra F, Ferrero S, Sileo FG, Bertucci E, Napolitano A, Facchinetti F. Hormonal contraception in women with endometriosis: a systematic review. EUR J CONTRACEP REPR 2019; 24:61-70. [PMID: 30664383 DOI: 10.1080/13625187.2018.1550576] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE A systematic review was carried out of studies of women with endometriosis, to examine the evidence for efficacy of the use of hormonal contraception to improve disease-related pain and decrease postoperative risk of disease recurrence. METHODS A search of the Medline/PubMed and Embase databases was performed to identify all published English language studies on hormonal contraceptive therapies (combined hormonal contraceptives [CHCs], combined oral contraceptives [COCs], progestin-only pills [POPs] and progestin-only contraceptives [POCs]) in women with a validated endometriosis diagnosis, in comparison with placebo, comparator therapies or other hormonal therapies. Main outcome measures were endometriosis-related pain (dysmenorrhoea, pelvic pain and dyspareunia), quality of life (QoL) and postoperative rate of disease recurrence during treatment. RESULTS CHC and POC treatments were associated with clinically significant reductions in dysmenorrhoea, often accompanied by reductions in non-cyclical pelvic pain and dyspareunia and an improvement in QoL. Only two COC preparations (ethinylestradiol [EE]/norethisterone acetate [NETA] and a flexible EE/drospirenone regimen) demonstrated significantly increased efficacy compared with placebo. Only three studies found that the postoperative use of COCs (EE/NETA, EE/desogestrel and EE/gestodene) reduced the risk of disease recurrence. There was no evidence that POCs reduced the risk of disease recurrence. CONCLUSIONS CHCs and POCs are effective for the relief of endometriosis-related dysmenorrhoea, pelvic pain and dyspareunia, and improve QoL. Some COCs decreased the risk of disease recurrence after conservative surgery, but POCs did not. There is insufficient evidence, however, to reach definitive conclusions about the overall superiority of any particular hormonal contraceptive.
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Affiliation(s)
- Giovanni Grandi
- a Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico , Modena , Italy
| | - Fabio Barra
- b Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (DINOGMI) , University of Genoa, IRCCS Ospedale Policlinico San Martino , Genoa , Italy
| | - Simone Ferrero
- b Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (DINOGMI) , University of Genoa, IRCCS Ospedale Policlinico San Martino , Genoa , Italy
| | - Filomena Giulia Sileo
- a Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico , Modena , Italy
| | - Emma Bertucci
- a Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico , Modena , Italy
| | - Antonella Napolitano
- a Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico , Modena , Italy
| | - Fabio Facchinetti
- a Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico , Modena , Italy
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Yuan M, Li D, Zhang Z, Sun H, An M, Wang G. Endometriosis induces gut microbiota alterations in mice. Hum Reprod 2019; 33:607-616. [PMID: 29462324 DOI: 10.1093/humrep/dex372] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 12/05/2017] [Indexed: 02/07/2023] Open
Abstract
STUDY QUESTION What happens to the gut microbiota during development of murine endometriosis? SUMMARY ANSWER Mice with the persistence of endometrial lesions for 42 days develop a distinct composition of gut microbiota. WHAT IS KNOWN ALREADY Disorders in the immune system play fundamental roles in changing the intestinal microbiota. No study has used high-throughput DNA sequencing to show how endometriosis changes the gut microbiota, although endometriosis is accompanied by abnormal cytokine expression and immune cell dysfunction. STUDY DESIGN, SIZE, DURATION This study includes a prospective and randomized experiment on an animal endometriosis model induced via the intraperitoneal injection of endometrial tissues. PARTICIPANTS/MATERIALS, SETTING, METHODS The mice were divided into endometriosis and mock groups and were sacrificed at four different time points for model confirmation and fecal sample collection. To detect gut microbiota, 16S ribosomal-RNA gene sequencing was performed. Alpha diversity was used to analyze the complexity and species diversity of the samples through six indices. Beta diversity analysis was utilized to evaluate the differences in species complexity. Principal coordinate analysis and unweighted pair-group method with arithmetic means clustering were performed to determine the clustering features. The microbial features differentiating the fecal microbiota were characterized by linear discriminant analysis effect size method. MAIN RESULTS AND THE ROLE OF CHANCE The endometriosis and mock mice shared similar diversity and richness of gut microbiota. However, different compositions of gut microbiota were detected 42 days after the modeling. Among the discriminative concrete features, the Firmicutes/Bacteroidetes ratio was elevated in mice with endometriosis, indicating that endometriosis may induce dysbiosis. Bifidobacterium, which is known as a commonly used probiotic, was also increased in mice with endometriosis. LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION More control groups should be further studied to clarify the specificity of the dysbiosis induced by endometriosis. This study was performed only on mice. Thus, additional data acquired from patients with endometriosis are needed in future research. We only detected the changes of gut microbiota at 42 days after the modeling, while the long-term effect of endometriosis on gut microbiota remains poorly understood. Moreover, we only revealed a single effect of endometriosis on gut microbiota. WIDER IMPLICATIONS OF THE FINDINGS This study provided the first comprehensive data on the association of endometriosis and gut microbiota from high-throughput sequencing technology. The gut microbiota changed with the development of endometriosis in a murine model. The communication between the host and the gut microbiota is bidirectional, and further studies should be performed to clarify their relationship. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by Grant (81571417) from the National Science Foundation of China and Grant (2015GSF118092) from the Technology Development Plan of Shandong Province. The authors report no conflict of interest.
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Affiliation(s)
- Ming Yuan
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, No. 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| | - Dong Li
- Cryomedicine Lab, Qilu Hospital of Shandong University, No. 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| | - Zhe Zhang
- Department of Gynecology, The Central Hospital of Zibo, No. 54 Gongqingtuanxi Road, Zibo, Shandong 255036, China
| | - Huihui Sun
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, No. 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| | - Min An
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, No. 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| | - Guoyun Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, No. 107 Wenhuaxi Road, Jinan, Shandong 250012, China
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Lee JH, Lee BS. Updated guideline for clinical evaluation and management of endometriosis. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2019. [DOI: 10.5124/jkma.2019.62.10.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jae Hoon Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Seok Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Clinical evaluation and management of endometriosis: guideline for Korean patients from Korean Society of Endometriosis. Obstet Gynecol Sci 2018; 61:553-564. [PMID: 30254991 PMCID: PMC6137012 DOI: 10.5468/ogs.2018.61.5.553] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 03/30/2018] [Accepted: 04/24/2018] [Indexed: 12/04/2022] Open
Abstract
Endometriosis is one of the most common diseases in reproductive ages, and it affects patients' quality of life and fertility. However, few Korean guidelines are available for the evaluation and management of endometriosis. Korean Society of Endometriosis reviewed various literatures and trials, and to provide seventy-one evidence-based recommendations. This review presents guidelines for the diagnosis and management of endometriosis with emphasis on: it's role in infertility, treatment of recurrence, asymptomatic women, endometriosis in adolescents and menopausal women, and possible association of endometriosis with cancer.
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Long-term treatment of endometriosis with dienogest: retrospective analysis of efficacy and safety in clinical practice. Arch Gynecol Obstet 2018; 298:747-753. [DOI: 10.1007/s00404-018-4864-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/28/2018] [Indexed: 02/07/2023]
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Abstract
BACKGROUND Previous studies have evaluated the diagnostic value of serum intercellular adhesion molecule-1 (ICAM-1) in patients with endometriosis, but the results remained inconsistent. This meta-analysis aimed to clarify the overall diagnostic accuracy of serum ICAM-1 for endometriosis. METHODS A systematic search was performed of the Cochrane clinical trials database, PubMed, and Embase prior to December 2017. Sensitivity, specificity, and other measures were pooled and determined to evaluate the accuracy of serum ICAM-1 in the diagnosis of endometriosis. Summary receiver operating characteristic curve (SROC) analysis with calculation of the area under curve (AUC) was performed to summarize the overall test performance. RESULTS Nine studies including 878 patients were eligible for inclusion in the analysis. The summary estimates of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (95% confidence interval) were 0.65 (0.52-0.75), 0.78 (0.62-0.89), 3.0 (1.7-5.2), 0.45 (0.34-0.60), and 7 (3-13), respectively, and the AUC of the overall analysis was 0.76 (0.72-0.80). Subgroup analysis showed that the summary sensitivity and specificity for patients of Asian ethnicity was increased compared with those of Caucasian ethnicity. The summary specificity was increased in studies with a high ICAM-1 cut-off value compared to those with a low cut-off value. No publication bias was found across the studies. CONCLUSIONS Our results suggest that serum ICAM-1 has moderate diagnostic accuracy for endometriosis, while the diagnostic accuracy is higher in patients of Asian ethnicity compared with those of Caucasian ethnicity.
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Morales-Prieto DM, Herrmann J, Osterwald H, Kochhar PS, Schleussner E, Markert UR, Oettel M. Comparison of dienogest effects upon 3,3'-diindolylmethane supplementation in models of endometriosis and clinical cases. Reprod Biol 2018; 18:252-258. [PMID: 30001982 DOI: 10.1016/j.repbio.2018.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/15/2018] [Accepted: 07/05/2018] [Indexed: 11/26/2022]
Abstract
Dienogest (DNG) administration is a well-established treatment for endometriosis but bleeding irregularities remain its main disadvantage. Changes in diet, mainly to vegetable consumption, are beneficial in the treatment of estrogen-related pathologies but their use for endometriosis has been poorly studied. In this study, addition of the phytochemical 3,3'-diindolylmethane (DIM) to DNG therapy has been investigated in in vitro and ex vivo models for endometriosis and in a small cohort of women with endometriosis. Endometrial Ishikawa cells were treated with DNG or DIM at dosages from 10-10 M to 10-5 M for up to 72 h. Cell proliferation was measured by assessing BrdU incorporation. Endometrial tissue from women with endometriosis and controls was incubated with DNG or a combination of DNG and DIM. Tissue viability was determined using a modified colorimetric MTS assay. 17β-estradiol secretion was quantified by an electro-chemiluminescence immunoassay. Finally, DNG as monotherapy or in combination with DIM was randomly administered to women with endometriosis (n = 8) over 3 months. Bleeding patterns and associated pelvic pain were assessed by Visual Analogue Scale (VAS). DNG and DIM significantly reduced cell proliferation in Ishikawa cells. Ex vivo, DIM reduced viability and estradiol secretion specifically in endometriotic but not in normal endometrial tissue. This effect was enhanced by combination with DNG. Endometriosis associated pelvic pain was significantly reduced in patients taking the DNG-DIM combination therapy compared to those taking DNG alone. Bleeding pattern (number and duration of episodes) was significantly improved by addition of DIM to the DNG treatment. In conclusion, addition of DIM enhances effects of DNG ex vivo and may ameliorate bleeding patterns in endometriosis patients.
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Affiliation(s)
| | - Joerg Herrmann
- Klinik für Gynäkologie und Geburtshilfe, Sophien- und Hufeland-Klinikum, Weimar, Germany
| | | | | | - Ekkehard Schleussner
- Placenta-Labor, Klinik für Geburtsmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Udo R Markert
- Placenta-Labor, Klinik für Geburtsmedizin, Universitätsklinikum Jena, Jena, Germany.
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Ferrero S, Evangelisti G, Barra F. Current and emerging treatment options for endometriosis. Expert Opin Pharmacother 2018; 19:1109-1125. [DOI: 10.1080/14656566.2018.1494154] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Giulio Evangelisti
- Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
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Ma T, Chowdary P, Eskander A, Ellett L, McIlwaine K, Manwaring J, Readman E, Maher P. Can Narrowband Imaging Improve the Laparoscopic Identification of Superficial Endometriosis? A Prospective Cohort Trial. J Minim Invasive Gynecol 2018; 26:427-433. [PMID: 29775729 DOI: 10.1016/j.jmig.2018.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To assess the usefulness of narrowband imaging (NBI) to detect additional areas of endometriosis not identified by standard white light in patients undergoing laparoscopy for the investigation of pelvic pain. DESIGN A prospective cohort trial (Canadian Task Force classification II). Evidence obtained from a well-designed cohort study. SETTING A tertiary laparoscopic subspecialty unit in Melbourne, Australia. PATIENTS Fifty-seven patients undergoing laparoscopy for the investigation of pelvic pain were recruited. Fifty-three patients were eligible for analysis. INTERVENTIONS Patients underwent standard white-light laparoscopy of the pelvis followed by NBI survey to assess for any additional areas suspicious for endometriosis. MEASUREMENTS AND MAIN RESULTS All identified areas of possible endometriosis were resected and sent for blinded histopathological analysis. The additional predictive value of NBI was 0% if the preceding white-light survey was negative and 86% if the preceding white-light survey was positive. CONCLUSION The use of NBI at laparoscopy for the investigation of pelvic pain is beneficial in finding additional areas of endometriosis if endometriosis is already suspected after white-light survey in a tertiary laparoscopic unit. Further research in nonspecialized units may show additional benefit and requires further research. NBI may also be useful as a diagnostic aid for trainees.
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Affiliation(s)
- Tony Ma
- Mercy Hospital for Women, Heidelberg, Victoria, Australia..
| | | | - Alex Eskander
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Lenore Ellett
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Kate McIlwaine
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | | | - Emma Readman
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Peter Maher
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
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Kaveh M, Tahermanesh K, Mehdizadeh Kashi A, Tajbakhsh B, Mansouri GH, Sadegi K. Endometriosis of Diaphragm: A Case Report. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2018; 12:263-266. [PMID: 29935074 PMCID: PMC6018178 DOI: 10.22074/ijfs.2018.5379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/05/2017] [Indexed: 11/26/2022]
Abstract
Endometriosis affects about 10% of women of reproductive age. Its main feature is the presence of stroma
and endometrial glands in sites other than the uterus, mainly in pelvis. Pelvic peritoneum, ovaries, uterine
ligaments, bladder, intestines, andcul-de-sac are among the affected areas. Sometimes endometriosis can be
found outside of the pelvis and even above abdominal cavity, like indiaphragm.Herein, we present a case of
an asymptomatic diaphragmatic endometriosis that was discovered incidentally during laparoscopy of pelvic
endometriosis, as well as our appropriately proposed treatment protocol.
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Affiliation(s)
- Mania Kaveh
- Endometriosis Research Center, Iran University of Medical Science, Tehran, Iran.,Department of Obstetrics and Gynecology, Zabol University of Medical Science, Zabol, Iran
| | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Science, Tehran, Iran
| | - Abolfazl Mehdizadeh Kashi
- Endometriosis Research Center, Iran University of Medical Science, Tehran, Iran. Electronic Address:
| | - Banafsheh Tajbakhsh
- Endometriosis Research Center, Iran University of Medical Science, Tehran, Iran
| | - G Hazal Mansouri
- Endometriosis Research Center, Iran University of Medical Science, Tehran, Iran.,Department of Obstetrics and Gynecology, Kerman University of Medical Science, Kerman, Iran
| | - Kambiz Sadegi
- Pain Research Center, Iran University of Medical Science, Tehran, Iran.,Department of Anesthesiology, Zabol University of Medical Science, Zabol, Iran
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Oladosu FA, Tu FF, Hellman KM. Nonsteroidal antiinflammatory drug resistance in dysmenorrhea: epidemiology, causes, and treatment. Am J Obstet Gynecol 2018; 218:390-400. [PMID: 28888592 DOI: 10.1016/j.ajog.2017.08.108] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/14/2017] [Accepted: 08/31/2017] [Indexed: 11/25/2022]
Abstract
Although nonsteroidal antiinflammatory drugs can alleviate menstrual pain, about 18% of women with dysmenorrhea are unresponsive, leaving them and their physicians to pursue less well-studied strategies. The goal of this review is to provide a background for treating menstrual pain when first-line options fail. Research on menstrual pain and failure of similar drugs in the antiplatelet category suggested potential mechanisms underlying nonsteroidal antiinflammatory drug resistance. Based on these mechanisms, alternative options may be helpful for refractory cases. This review also identifies key pathways in need of further study to optimize menstrual pain treatment.
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Abstract
Endometriosis is a common disease affecting reproductive age women. Pain is one of the most common symptoms associated with endometriosis. When medical therapy has failed or in known deeply infiltrating endometriosis, surgical management is warranted. Laparoscopy is the gold standard for diagnosis and treatment of endometriosis. Recent developments in surgery have shown the feasibility of robotic surgery for endometriosis, although these methods have not been shown to be superior to conventional laparoscopy. Enhanced imaging techniques including fluorescence imaging and narrow band imaging have also been studied. However, long-term clinical benefits have yet to be demonstrated.
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Mancini F, Milardi D, Carfagna P, Grande G, Miranda V, De Cicco Nardone A, Ricciardi D, Pontecorvi A, Marana R, De Cicco Nardone F. Low-dose SKA Progesterone and Interleukin-10 modulate the inflammatory pathway in endometriotic cell lines. Int Immunopharmacol 2017; 55:223-230. [PMID: 29272819 DOI: 10.1016/j.intimp.2017.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/03/2017] [Accepted: 12/06/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Francesca Mancini
- International Scientific Institute "Paul VI", L.go F. Vito, 1, 00168 Rome, Italy
| | - Domenico Milardi
- International Scientific Institute "Paul VI", L.go F. Vito, 1, 00168 Rome, Italy; Division of Endocrinology, Teaching and Research Hospital "Agostino Gemelli" Foundation, Rome, Italy
| | - Piero Carfagna
- Department of Obstetrics and Gynecology, Teaching and Research Hospital "Agostino Gemelli" Foundation, Rome, Italy
| | - Giuseppe Grande
- International Scientific Institute "Paul VI", L.go F. Vito, 1, 00168 Rome, Italy.
| | | | - Alessandra De Cicco Nardone
- Department of Obstetrics and Gynecology, Teaching and Research Hospital "Agostino Gemelli" Foundation, Rome, Italy
| | - Domenico Ricciardi
- Department of Obstetrics and Gynecology, Teaching and Research Hospital "Agostino Gemelli" Foundation, Rome, Italy
| | - Alfredo Pontecorvi
- International Scientific Institute "Paul VI", L.go F. Vito, 1, 00168 Rome, Italy; Division of Endocrinology, Teaching and Research Hospital "Agostino Gemelli" Foundation, Rome, Italy
| | - Riccardo Marana
- International Scientific Institute "Paul VI", L.go F. Vito, 1, 00168 Rome, Italy; Department of Obstetrics and Gynecology, Teaching and Research Hospital "Agostino Gemelli" Foundation, Rome, Italy
| | - Fiorenzo De Cicco Nardone
- Department of Obstetrics and Gynecology, Teaching and Research Hospital "Agostino Gemelli" Foundation, Rome, Italy
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Kuessel L, Wenzl R, Proestling K, Balendran S, Pateisky P, Yotova, Yerlikaya G, Streubel B, Husslein H. Soluble VCAM-1/soluble ICAM-1 ratio is a promising biomarker for diagnosing endometriosis. Hum Reprod 2017; 32:770-779. [PMID: 28333208 DOI: 10.1093/humrep/dex028] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/01/2017] [Indexed: 01/28/2023] Open
Abstract
Study question Do cell adhesion molecules play a role in endometriosis, and can they be used as a biomarker for diagnosing endometriosis? Summary answer Altered expression of vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) in the endometrium and peritoneum may play a key role in endometriosis and the soluble VCAM-1/soluble ICAM-1 ratio is a promising biomarker. What is known already Cell adhesion molecules are cell surface proteins that mediate cellular adherence, inflammatory and immune responses, and cancer-related biological processes. Altered expression of VCAM-1 and ICAM-1 in women with endometriosis has been investigated previously; however, gene expression levels in tissues and protein levels in the serum have not been investigated in the same patients. Study design size, duration We performed a prospective, longitudinal study (the Endometriosis Marker Austria) in patients who underwent a laparoscopy for benign gynecological pathology in a university-based tertiary referral center for endometriosis. From a total of 138 women who were included in the study from July 2013 through September 2014, 97 had not received hormonal treatment for at least 3 months prior to recruitment and were included in the analysis; 49 (50.5%) of these women had endometriosis, and the 48 (49.5%) who did not have endometriosis served as a control group. Participants/materials setting methods During laparoscopy, tissue samples were obtained from ectopic and eutopic endometrium, and from normal pelvic peritoneum. In addition, serum samples were collected immediately before and 6-10 weeks after surgery. The mRNA levels of VCAM-1, ICAM-1 and epithelial cell adhesion molecule (EpCAM) were measured using quantitative real-time PCR, and serum protein levels of soluble VCAM-1 (sVCAM-1), ICAM-1 (sICAM-1) and EpCAM (sEpCAM) were measured using ELISA and correlated with endometriosis status. Main results and the role of chance The mRNA levels of both VCAM-1 and ICAM-1 were higher in ectopic endometriotic lesions than in eutopic endometrium (P < 0.001). Moreover, the mRNA levels of both VCAM-1 and ICAM-1 were higher in normal peritoneum samples obtained from women with endometriosis compared to those from controls (P = 0.038 and P = 0.009). The mRNA levels of VCAM-1 were also higher in the eutopic endometrium samples obtained from women with endometriosis compared to controls (P = 0.018). With respect to serum protein levels, compared to controls, the women with endometriosis had lower serum levels of sICAM-1 (P = 0.042) and higher levels of sVCAM-1 (P < 0.001). Our analysis revealed that the serum levels of sVCAM-1 were not affected by lesion entity, menstrual cycle phase or disease severity. An receiver operating characteristics curve, calculated to determine whether preoperative serum sVCAM-1 concentration can be used to predict endometriosis, found an AUC of 0.868 with 80% specificity and 84% sensitivity at a cutoff value of 370 pg/ml. This predictive performance can be further improved by calculation of the sVCAM-1/sICAM-1 ratio, leading to an AUC of 0.929 with 86.7% specificity and 90.3% sensitivity at a cutoff ratio value of 1.55. Large scale data Not applicable. Limitations reasons for caution The relatively small sample size in the expression analyses is a possible limitation of this study. Wider implications of the findings Our findings could contribute to an improved understanding of the pathogenesis of endometriosis and the role of cell adhesion molecules. In addition, the results may lead to the development of new, non-invasive tools for diagnosing endometriosis. The ability to diagnose patients by measuring serum sVCAM-1 levels or the sVCAM-1/sICAM-1 ratio would have considerable clinical value. Study funding/competing interest(s) The Ingrid Flick Foundation (Grant no. FA751C0801), which played no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. The authors declare no competing interests.
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Affiliation(s)
- L Kuessel
- Department of Gynecology and Obstetrics, Medical University of Vienna, Waehringer Guertel, Vienna, Austria
| | - R Wenzl
- Department of Gynecology and Obstetrics, Medical University of Vienna, Waehringer Guertel, Vienna, Austria
| | - K Proestling
- Department of Gynecology and Obstetrics, Medical University of Vienna, Waehringer Guertel, Vienna, Austria
| | - S Balendran
- Department of Pathology, Medical University of Vienna, Waehringer Guertel, Vienna, Austria
| | - P Pateisky
- Department of Gynecology and Obstetrics, Medical University of Vienna, Waehringer Guertel, Vienna, Austria
| | - Yotova
- Department of Gynecology and Obstetrics, Medical University of Vienna, Waehringer Guertel, Vienna, Austria
| | - G Yerlikaya
- Department of Gynecology and Obstetrics, Medical University of Vienna, Waehringer Guertel, Vienna, Austria.,Fetal Medicine Research Institute, King's College Hospital, Denmark Hill, London, UK
| | - B Streubel
- Department of Pathology, Medical University of Vienna, Waehringer Guertel, Vienna, Austria
| | - H Husslein
- Department of Gynecology and Obstetrics, Medical University of Vienna, Waehringer Guertel, Vienna, Austria
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When treating chronic pelvic pain in women, consider peripheral and central contributors. DRUGS & THERAPY PERSPECTIVES 2017. [DOI: 10.1007/s40267-017-0429-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Soto E, Luu TH, Liu X, Magrina JF, Wasson MN, Einarsson JI, Cohen SL, Falcone T. Laparoscopy vs. Robotic Surgery for Endometriosis (LAROSE): a multicenter, randomized, controlled trial. Fertil Steril 2017; 107:996-1002.e3. [DOI: 10.1016/j.fertnstert.2016.12.033] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/09/2016] [Accepted: 12/27/2016] [Indexed: 11/24/2022]
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Othman ER, Meligy FY, Sayed AAR, El-Mokhtar MA, Refaiy AM. Stem Cell Markers Describe a Transition From Somatic to Pluripotent Cell States in a Rat Model of Endometriosis. Reprod Sci 2017; 25:873-881. [PMID: 28325116 DOI: 10.1177/1933719117697124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study Thy1 as a fibroblast marker, SSEA1 as a marker of intermediate pluripotency, and Oct4 as a marker of established pluripotency in rat model of endometriosis. DESIGN In vivo animal study. MATERIALS AND METHODS Endometriosis was induced in 20 albino female rats through autologous transplantation of one uterine horn to mesentery of intestine. Other 20 rats had their horn removed without transplantation (controls). Rats were sacrificed 4 weeks after induction surgery. Ectopic, eutopic, and control endometria were harvested from endometriosis and control animals respectively. Quantitative syber green based RT-PCR was used to detect expression of Thy-1 (CD90), FUT4 (SSEA1), and POU5F1 (Oct4) genes in tissues. Relative expression was normalized to that of β actin. Thy1, SSEA1, and Oct4 protein expression were detected by immunohistochemistry. RESULTS Ectopic endometrium expressed significantly higher mRNA of Oct4 and SSEA1 as compared to control endometrium. Expression levels of Oct4 and SSEA1 were comparable between ectopic and eutopic endometria and between eutopic and control endometria. Thy1 (CD90) gene expression level was comparable among ectopic, eutopic, and control endometria. Oct4 immunoscore were significantly higher in ectopic (6.6±0.91) than eutopic (2.5±0.78) or control endometrium (3.7±0.1) (P value 0.02). Thy1 and SSEA1 immunoscores were comparable among all three types of endometria. CONCLUSIONS Using rat model of endometriosis, ectopic endometrium showed significantly higher Oct4, and SSEA1, but similar Thy1 gene expression to that of control endometrium. This indicates increased transition from somatic to pluripotent cell states in ectopic endometrium which may play a role in endometriosis pathogenesis.
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Affiliation(s)
- Essam Rashad Othman
- 1 OB-GYN Department, Assiut University, Egypt.,2 Center of Excellence of Stem Cells and Regenerative Medicine (CESCRM), Assiut University, Egypt
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Abstract
Introduction The aim of this manuscript is to present a systematic review of characteristics and management of endometriosis in adolescents in order to gain some relevant insight into the most appropriate clinical management of the disease. Methods The literature review was done using electronic database PubMed focusing on the terms ‘adolescents’, ‘endometriosis’, ‘teenagers’, ‘pain’, ‘infertility’, ‘quality of life’, ‘medical’ and ‘surgical management’ from 1980 onward and was limited to articles in English. Articles were only included if they reported original relevant research. Results The 24 studies selected for review included 1148 adolescents with laparoscopic proven endometriosis. The diagnosis of endometriosis was histologically confirmed in 39.02% (448/1148) of cases. The results from trials have been tabulated and main results presented in a question and answer format. Conclusions The majority of adolescent girls with chronic pelvic pain not responding to conventional medical therapy have endometriosis (up to 80%). Laparoscopy with biopsy is the only way to diagnose endometriosis in the adolescent population, and depends on recognition of atypical manifestations of the disease. Surgical management (especially by an expert surgeon) has been shown to be beneficial in reducing pain, improving infertility, and preventing progression or recurrence of disease. Postoperative hormonal suppression helps reduce pain symptoms and recurrence of endometriomas, but it does not seem to prevent disease recurrence or progression of peritoneal endometriosis, and has not been shown to improve future fertility. Postoperative suppression until pregnancy is based on expert opinion only. There is a need for good quality properly randomized trials.
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Carey ET, Till SR, As-Sanie S. Pharmacological Management of Chronic Pelvic Pain in Women. Drugs 2017; 77:285-301. [DOI: 10.1007/s40265-016-0687-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril 2016; 106:1552-1571.e2. [DOI: 10.1016/j.fertnstert.2016.10.022] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 02/08/2023]
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Goodman LR, Goldberg JM, Flyckt RL, Gupta M, Harwalker J, Falcone T. Effect of surgery on ovarian reserve in women with endometriomas, endometriosis and controls. Am J Obstet Gynecol 2016; 215:589.e1-589.e6. [PMID: 27242204 DOI: 10.1016/j.ajog.2016.05.029] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/14/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many women who experience endometriosis and endometriomas also encounter problems with fertility. OBJECTIVE The purpose of this study was to determine the impact of surgical excision of endometriosis and endometriomas compared with control subjects on ovarian reserve. STUDY DESIGN This was a prospective cohort study of 116 women aged 18-43 years with pelvic pain and/or infertility who underwent surgical treatment of suspected endometriosis (n=58) or endometriomas (n=58). Based on surgical findings, the suspected endometriosis group was further separated into those with evidence of peritoneal disease (n=29) and those with no evidence of endometriosis (n=29). Ovarian reserve was measured by anti-Müllerian hormone and compared before surgery and at 1 month and 6 months after surgery. RESULTS Baseline anti-Müllerian hormone values were significantly lower in the endometrioma vs negative laparoscopy group (1.8 ng/mL [95% confidence interval, 1.2-2.4 ng/mL] vs 3.2 ng/mL [95% confidence interval, 2.0-4.4 ng/mL]; P<.02), but the peritoneal endometriosis group was not significantly different than either of these groups. Only patients with endometriomas had a significant decline in ovarian reserve at 1 month (-48%; 95% confidence interval, -54 to -18%; P<.01; mean anti-Müllerian hormone baseline value, 1.77-1.12 ng/mL at 1 month). Six months after surgery, anti-Müllerian hormone values continued to be depressed from baseline but were no longer significantly different. The rate of anti-Müllerian hormone decline was correlated positively with baseline preoperative anti-Müllerian hormone values and the size of endometrioma that was removed. Those with bilateral endometriomas (n=19) had a significantly greater rate of decline (53.0% [95% confidence interval, 35.4-70.5%] vs 17.5% [95% confidence interval, 3.2-31.8%]; P=.002). CONCLUSION At baseline, patients with endometriomas had significantly lower anti-Müllerian hormone values compared with women without endometriosis. Surgical excision of endometriomas appears to have temporary detrimental effects on ovarian reserve.
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Xue HL, Yu N, Wang J, Hao WJ, Li Y, Liu MY. Therapeutic effects of mifepristone combined with Gestrinone on patients with endometriosis. Pak J Med Sci 2016; 32:1268-1272. [PMID: 27882034 PMCID: PMC5103146 DOI: 10.12669/pjms.325.10772] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To evaluate the clinical therapeutic effects of mifepristone combined with gestrinone on patients with endometriosis. Methods: A total of 150 endometriotic patients treated in our hospital between January 2014 and December 2015 were randomly divided into a control group and a treatment group (n=75). The control group began to orally take gestrinone capsules on the second day after menstruation started (2.5 mg/time, twice/week). The treatment group orally took mifepristone tablets (12.5 mg/time, once/day), and the dosage and administration of gestrinone capsules were the same as those of the control group. After 24 weeks of consecutive treatment, the clinical therapeutic effects of the two groups were assessed, and the pelvic symptom score, clinical sign score, serum sex hormone levels and pregnancy outcomes were compared. Results: The total effective rates of control and treatment groups were 77.3% and 90.7% respectively, between which the difference was statistically significant (P<0.05). After treatment, the scores of pelvic symptoms (dysmenorrhea, dyspareunia, pelvic pain) and clinical signs (pelvic tenderness, induration) significantly reduced (P<0.05). Each score of the treatment group decreased more significantly than that of the control group did (P<0.05). The serum follicle hormone, luteinizing hormone, estrogen and progesterone levels were significantly lower than those before treatment (P<0.05). Each level of the treatment group dropped more significantly than that of the control group did (P<0.05). The pregnancy rates in the 6th and 12th months of follow-up were 28.0% and 13.3% in the control group respectively, and 42.7% and 29.3% in the treatment group respectively. Such rates of the two groups were significantly different at each follow-up time point (P<0.05). Conclusion: Mifepristone combined with gestrinone had satisfactory clinical therapeutic effects on endometriosis by reducing hormone levels and improving pregnancy outcomes. Therefore, this regimen is worthy of promotion and application in clinical practice.
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Affiliation(s)
- Hui-Ling Xue
- Hui-Ling Xue, Department of Obstetrics and Gynecology, Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, P. R. China
| | - Ning Yu
- Ning Yu, Department of Obstetrics and Gynecology, People's Hospital of Yi County, Baoding 074200, Hebei Province, P. R. China
| | - Jing Wang
- Jing Wang, Department of Obstetrics and Gynecology, Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, P. R. China
| | - Wan-Jiao Hao
- Wan-Jiao Hao, Department of Obstetrics and Gynecology, Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, P. R. China
| | - Ye Li
- Ye Li, Department of Obstetrics and Gynecology, Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, P. R. China
| | - Mei-Yun Liu
- Mei-Yun Liu, Department of Obstetrics and Gynecology, Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, P. R. China
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Affiliation(s)
- Altay Gezer
- Reproductive Endocrinology & Infertility Division, Cerrahpaşa School of Medicine, Obstetrics & Gynecology Department, istanbul University, Cerrahpaşa PTT PK:31 34301 Fatih/istanbul, Turkey
| | - Engin Oral
- Reproductive Endocrinology & Infertility Division, Cerrahpaşa School of Medicine, Obstetrics & Gynecology Department, istanbul University, Cerrahpaşa PTT PK:31 34301 Fatih/istanbul, Turkey
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Correa LF, Zheng Y, Delaney AA, Khan Z, Shenoy CC, Daftary GS. TGF-β Induces Endometriotic Progression via a Noncanonical, KLF11-Mediated Mechanism. Endocrinology 2016; 157:3332-43. [PMID: 27384304 DOI: 10.1210/en.2016-1194] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Endometriosis, a chronic disease of heterogeneous etiopathology affects 10% of young women and is characterized by ectopic implantation of endometrial cells. Growth and spread of endometriosis lesions involves biological interplay between intrinsic lesion-driven and extrinsic host-responsive mechanisms. We propose a role for TGFβ and its target transcription factor Krüppel-like factor 11 (KLF11) in mediating such mechanisms. Although TGFβ, a pleiotropic cytokine implicated in endometriosis potentially, mediates its pathological phenotypes, KLF11 is associated with endocrine and reproductive tract diseases, specifically progression of endometriosis. In Ishikawa cells, TGFβ1 treatment resulted in noncanonical SMAD-mediated transient up-regulation and sustained repression of KLF11. KLF11 recruits histone deacetylases to epigenetically repress multiple synthetic and metabolic cytochrome P450 (CYP) enzymes such as CYP3A4, which affects endometrial metabolism and pathophysiology. In contrast to KLF11, TGFβ1 treatment caused transient repression and sustained activation of CYP3A4 expression. CYP3A4 increased endometrial cell proliferation and was also increased in human endometriosis lesions compared with eutopic endometrium. To determine whether dysregulation of TGFβ/Klf11/Cyp3a signaling affected endometriotic progression, we treated wild-type control and Klf11-/- mice with a Tgfβ type 1 receptor inhibitor (TGFβR1I) that inhibits Tgfβ signaling upstream of the canonical Smad proteins or a combination of TGFβR1I and a histone acetyltransferase inhibitor that additionally inhibits Klf11 signaling. Disease progression and lesional Cyp3a expression was diminished in TGFβR1I-treated animals and more so in animals treated synergistically with TGFβR1I and histone acetyltransferase inhibitor. TGFβ and KLF11 thus mediate critical, translationally relevant host and lesion-driven responses that enable establishment and progression of endometriosis.
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Affiliation(s)
- Luiz F Correa
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905
| | - Ye Zheng
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905
| | - Abigail A Delaney
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905
| | - Zaraq Khan
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905
| | - Chandra C Shenoy
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905
| | - Gaurang S Daftary
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905
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Laschke MW, Menger MD. The gut microbiota: a puppet master in the pathogenesis of endometriosis? Am J Obstet Gynecol 2016; 215:68.e1-4. [PMID: 26901277 DOI: 10.1016/j.ajog.2016.02.036] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/01/2016] [Accepted: 02/13/2016] [Indexed: 02/08/2023]
Abstract
Endometriosis is a frequent gynecologic disease with a complex, multifactorial cause. It is characterized by the cyclic estrogen-driven proliferation and bleeding of endometriotic lesions (ie, ectopic endometrial glands and stroma) outside the uterus. These lesions induce a chronic activation of the innate immune system within the peritoneal cavity that is associated with the release of various inflammatory cytokines and angiogenic growth factors into the peritoneal fluid. This stimulates angiogenesis and the further spread of the lesions and triggers the typical pain that is symptomatic of the disease. Moreover, circulating stem and progenitor cells are recruited into the ectopic endometrial tissue and contribute to its growth and vascularization. In recent years, an increasing number of studies have indicated that the gut microbiota is not only essential for a physiologic gastrointestinal function but acts as a central regulator of a variety of inflammatory and proliferative conditions. Besides, the gut flora affects estrogen metabolism and stem-cell homeostasis. Based on these findings, we hypothesize that the gut microbiota may be involved crucially in the onset and progression of endometriosis. In the future, this novel view of the pathogenesis of endometriosis may be verified by analysis of the development of endometriotic lesions in animal models with a defined composition of the gut microbiota and by investigation of the microbiota of patients with endometriosis with modern next-generation sequencing tools. This could open the door for completely new preventive, diagnostic, and therapeutic approaches for endometriosis.
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