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Zhu J, Chen Y, Chen H, Sun Y, Yan L, Zhu M, Chen L, Wang Q, Zhang J. Comparison of microbial abundance and diversity in uterine and peritoneal fluid in infertile patients with or without endometriosis. BMC Womens Health 2024; 24:148. [PMID: 38424540 PMCID: PMC10903057 DOI: 10.1186/s12905-024-02985-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Endometriosis (EM) is a multifactorial disease that affects 10 - 15% of women of reproductive age. Additionally, 30-50% of women with EM suffer from infertility. The mechanism of infertility caused by EM has not yet been consistently explained. In recent years, studies have shown a link between infertility associated with EM and changes in the reproductive tract microbiota. METHODS In this study, we involved 26 EM patients (8 cases of stage I-II and 18 cases of stage III-IV) and 31 control subjects who were tubal obstruction-related infertility (TORI). The samples from peritoneal fluid (PF) and uterine fluid (UF) were collected and sequenced by 16 S rRNA amplicon. RESULTS In the comparison of microbial diversity, we found no significant differences in the microbial diversity of PF and UF between patients with stage I-II EM and those with TORI. However, there was a significant difference in microbial diversity among patients with stage III-IV EM compared to the previous two groups. Lactobacillus decreased in PF of EM compared to the control group, while it increased in UF. In PF, the abundance of Pseudomonas, Enterococcus, Dubosiella and Klebsiella was significantly higher in patients with stage III-IV compared to TORI patients. And in UF, the main differences existed between stage I-II EM compared to the other two groups. The abundance of pontibacter, aquabacterium, Rikenellaceae and so on at the genus level was significantly enriched in the EM patients with stage I-II. In the analysis based on KEGG database, EM may affect the receptivity related pathways of the endometrium by influencing changes in the uterine microbiota. CONCLUSION Our results indicated that as EM progresses, the microorganisms in UF and PF keep changing. These changes in the microbiota, as well as the resulting alternations in gene functional classification, may play an important role in the infertility associated with EM.
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Affiliation(s)
- Jue Zhu
- Department of Gynecology, Ningbo Women and Children's Hospital, #339 Liuting Road, Ningbo, Zhejiang, China
| | - Yichen Chen
- Department of Basic Research Laboratory, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
| | - Huan Chen
- Department of Medicine, Ningbo University, Zhejiang, China
| | - Yuhui Sun
- Department of Basic Research Laboratory, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
| | - Lifeng Yan
- Department of Gynecology, Ningbo Women and Children's Hospital, #339 Liuting Road, Ningbo, Zhejiang, China
| | - Miaohua Zhu
- Department of Gynecology, Ningbo Women and Children's Hospital, #339 Liuting Road, Ningbo, Zhejiang, China
| | - Liang Chen
- Department of Gynecology, Ningbo Women and Children's Hospital, #339 Liuting Road, Ningbo, Zhejiang, China
| | - Qiming Wang
- Department of Gynecology, Ningbo Women and Children's Hospital, #339 Liuting Road, Ningbo, Zhejiang, China
| | - Jing Zhang
- Department of Gynecology, Ningbo Women and Children's Hospital, #339 Liuting Road, Ningbo, Zhejiang, China.
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Effendi KY, Nasrul E, Zulqarnain I, Theodorus, Amran R, Manan H, Abadi A, Usman F, Kesty C. Diagnostic Test of Transforming Growth Factor-Beta 1 (TGF- β1) in Menstrual Blood with Endometriosis. Obstet Gynecol Int 2023; 2023:9970818. [PMID: 38116460 PMCID: PMC10728358 DOI: 10.1155/2023/9970818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 12/21/2023] Open
Abstract
Background Endometriosis is a benign disorder that is generally defined as the presence of endometrial glands and stroma outside their normal location. TGF-β1 is found in stromal cells and its expression is increased in epithelial cells of endometriotic cysts. Endometriosis diagnostics take a long time, so new markers are needed to diagnose endometriosis. This study aims to determine the diagnostic value of TGF-β1 in menstrual blood in diagnosing endometriosis. Method Diagnostic tests to compare eutopic endometrial TGF-β1 levels from menstrual blood of patients with suspected endometriosis were undertaken in the Obstetrics and Gynecology Department of Dr. Mohammad Hoesin General Hospital, Faculty of Medicine, Sriwijaya University, Palembang, from July 2019 to November 2020. 50 patients who were suspected with endometriosis met the inclusion criteria. Comparison of TGF-β1 levels between endometriosis and nonendometriosis patients was analyzed using the Mann-Whitney test. The cutoff point of the TGF-β1 level towards the histopathological outcome was obtained using the ROC curve. Data analysis was performed by using SPSS version 22.0. Results In this study, endometriosis patients were 31.6 ± 6.55 years of age with a range of 20 to 46 years. In statistical analysis, there was no difference in BMI (p = 0.181) and BMI classification (p = 0.207), the history of contraception (p = 0.097), infertility (p = 1.000), and dysmenorrhoea (p = 1.000) between endometriosis and nonendometriosis patients. In the study, there were differences in TGF-β1 between endometriosis and nonendometriosis patients (p ≤ 0.001). By using the ROC curve, the cutoff point for TGF-β1 levels has the best sensitivity and specificity, which is 515 ng/ml. The TGF-β1 level has a sensitivity of 80%, a specificity of 90%, a positive predictive value (PPV) of 0.969, a negative predictive value (NPV) of 0.529, a positive likelihood ratio of 8, a negative likelihood ratio of 0.222, and an accuracy of 0.820 to the endometriosis outcome. Conclusion It can be concluded that the TGF-β1 level has a very good diagnostic value in establishing endometriosis diagnostics. This trial is registered with ISRCTN72218532.
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Affiliation(s)
- Kemas Yusuf Effendi
- Division of Reproductive, Endocrinology, and Infertility, Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital, Faculty of Medicine, Universitas Sriwijaya, Palembang, South Sumatera, Indonesia
| | - Excellena Nasrul
- Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital, Faculty of Medicine, Universitas Sriwijaya, Palembang, South Sumatera, Indonesia
| | - Iskandar Zulqarnain
- Division of Reproductive, Endocrinology, and Infertility, Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital, Faculty of Medicine, Universitas Sriwijaya, Palembang, South Sumatera, Indonesia
| | - Theodorus
- Medical and Health Research Unit, Faculty of Medicine, Universitas Sriwijaya, Palembang, South Sumatera, Indonesia
| | - Rizani Amran
- Division of Reproductive, Endocrinology, and Infertility, Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital, Faculty of Medicine, Universitas Sriwijaya, Palembang, South Sumatera, Indonesia
| | - Heriyadi Manan
- Division of Reproductive, Endocrinology, and Infertility, Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital, Faculty of Medicine, Universitas Sriwijaya, Palembang, South Sumatera, Indonesia
| | - Adnan Abadi
- Division of Reproductive, Endocrinology, and Infertility, Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital, Faculty of Medicine, Universitas Sriwijaya, Palembang, South Sumatera, Indonesia
| | - Fatimah Usman
- Division of Reproductive, Endocrinology, and Infertility, Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital, Faculty of Medicine, Universitas Sriwijaya, Palembang, South Sumatera, Indonesia
| | - Cindy Kesty
- Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital, Faculty of Medicine, Universitas Sriwijaya, Palembang, South Sumatera, Indonesia
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Liu S, Hou C, Tang S, Bai S, Deng Y. Patients with endometriosis may experience worse clinical manifestations and therapeutic outcomes during COVID-19 in western China- a case series comparative analysis. BMC Womens Health 2023; 23:206. [PMID: 37118752 PMCID: PMC10147352 DOI: 10.1186/s12905-023-02344-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/11/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Endometriosis is a crippling, ongoing, chronic inflammatory condition. The management of these patients has been impacted by the current COVID-19 pandemic, which is still controversial. This study compared the clinical therapy outcomes and psychological scores between before and during- the epidemic. METHOD The data of patients who were diagnosed with endometriosis in the Department of Gynecology, Chongqing Traditional Chinese Medicine Hospital from January 2018 to December 2022 were collected. The patients were divided into pre- and intra-COVID groups. The treatment results and psychological status of the two groups were compared. RESULTS A total of 1022 patients with endometriosis were enrolled, with a mean age of 33.16 ± 9.81 years and a BMI of 23.90 ± 3.04 kg/m2, of which 434 cases (434/1022, 42.5%) were in the pre-COVID group and 588 cases (588/1022, 57.5%) in the intra-COVID group. Both groups were well balanced for age, BMI, history of abdominopelvic surgery, family relationships, education level, and duration between initial diagnosis and admission. Compared to the Pre-COVID group, the intra-COVID group had a higher proportion of patients with chronic pelvic pain (297/434, 68.4% vs. 447/588, 76.0%, p = 0.007) and dysmenorrhea (249/434, 62.8% vs. 402/588, 70.0%, p < 0.001), more patients requiring surgery (93/434, 21.4% vs. 178/588, 30.3%, p = 0.002) and longer hospital stays (5.82 ± 2.24 days vs. 7.71 ± 2.15 days, p < 0.001). A total of 830 questionnaires were completed. In the Intra-COVID group, PHQ-2 (2 (2, 3) vs. 3 (2,4), p < 0.001), GAD-2 (2 (1, 2) vs. 3 (2, 3), p < 0.001), PHQ-4 (4 (3, 5) vs. 5 (4, 7), EHP-5 (20.26 ± 6.05 vs. 28.08 ± 7.95, p < 0.001) scores were higher than that in the pre-COVID group, while BRS (3.0 (2.2, 4.0) vs. 2.4 (1.8, 3.8), p = 0.470) were not significantly different. CONCLUSION During the COVID-19 epidemic, patients with endometriosis may have reduced visits to the hospital, more severe related symptoms, longer length of hospital stays, and worse quality of life, with the possible cause being a disturbance in hormone levels through increased anxiety and depression. This provides a valid clinical basis for optimizing the management of patients with endometriosis and for early psychological intervention during the epidemic.
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Affiliation(s)
- Sanhong Liu
- Department of Prevention, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400021, People's Republic of China
| | - Cong Hou
- Department of Gynecology, Chongqing Traditional Chinese Medicine Hospital, No. 6, Panxi 7 Branch Road, Jiangbei District, Chongqing, 400021, People's Republic of China
| | - Sisi Tang
- Department of Gynecology, Chongqing Traditional Chinese Medicine Hospital, No. 6, Panxi 7 Branch Road, Jiangbei District, Chongqing, 400021, People's Republic of China
| | - Shutong Bai
- Chongqing Key Laboratory of Traditional Chinese Medicine to Prevent and Treat Autoimmune Diseases, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400021, People's Republic of China
| | - Ying Deng
- Department of Gynecology, Chongqing Traditional Chinese Medicine Hospital, No. 6, Panxi 7 Branch Road, Jiangbei District, Chongqing, 400021, People's Republic of China.
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Gómez-Pereira E, Burgos J, Mendoza R, Pérez-Ruiz I, Olaso F, García D, Malaina I, Matorras R. Endometriosis Increases the Risk of Placenta Previa in Both IVF Pregnancies and the General Obstetric Population. Reprod Sci 2023; 30:854-864. [PMID: 35999442 DOI: 10.1007/s43032-022-01054-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 07/30/2022] [Indexed: 10/15/2022]
Abstract
Is there a relationship between endometriosis and placenta previa (PP)? To investigate if there is a relationship between endometriosis and PP, a retrospective study was carried out, using prospectively recorded data from two different databases from Cruces University Hospital. Two different populations were included in the study. The ART (assisted reproduction techniques) population consisted of 246 cesarean sections (CS), from a total of 1170 deliveries, and the obstetric population consisted of 7045 CS, from a total of 50,298 deliveries. A representative subset from the obstetric population was established selecting 4 CS without PP for each CS with PP. In our ART population, the PP rate was 1.71% among all deliveries and 8.13% among CS. In our general obstetric population, the PP rate was 0.34% among all deliveries and 2.41% among the CS. Among the CS in ART pregnancies, the PP rate was 20% in the women with endometriosis vs 5.47% in women without endometriosis (OR = 4.32; 95% CI = 1.67-11.17), while considering all ART deliveries, the PP rates were 6.43% and 1.07%, respectively (OR = 6.36; 95% CI = 2.59-15.65). In the CS-obstetric population, the rate of PP was 9.61% among women with endometriosis vs 2.19% among women without endometriosis (OR = 4.74; 95% CI = 2.91-7.73). Considering all deliveries, the PP rate was 1.35% among women with endometriosis vs 0.30% in women without endometriosis. Differences persisted when adjusting for age, IVF, multiplicity, and previous deliveries. In the CS-obstetric population with PP, mean surgical time and hospital stay were significantly higher in women with endometriosis. Endometriosis is associated with a higher risk of PP even after adjusting for other parameters.
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Affiliation(s)
- Eider Gómez-Pereira
- Reproduction Unit, Cruces Hospital, Biocruces Health Research Institute, Vizcaya, Spain
| | - Jorge Burgos
- Obstetrics Service, Cruces Hospital, Biocruces Health Research Institute, Vizcaya, Spain
| | - Rosario Mendoza
- Reproduction Unit, Cruces Hospital, Biocruces Health Research Institute, Vizcaya, Spain
| | - Irantzu Pérez-Ruiz
- Reproduction Unit, Cruces Hospital, Biocruces Health Research Institute, Vizcaya, Spain.
| | - Fátima Olaso
- Reproduction Unit, Cruces Hospital, Biocruces Health Research Institute, Vizcaya, Spain
| | - David García
- Reproduction Unit, Cruces Hospital, Biocruces Health Research Institute, Vizcaya, Spain
| | - Iker Malaina
- Applied Mathematics, Statistics, and Operative Research Department, University of the Basque Country, Biocruces Health Research Institute, Vizcaya, Spain
| | - Roberto Matorras
- Reproduction Unit, Cruces Hospital, Biocruces Health Research Institute, Vizcaya, Spain.,IVI, IVIRMA, Bilbao, Vizcaya, Spain
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Tang M, Yang W, Zhang H. Comparison of the efficacy of dienogest and GnRH-a after endometriosis surgery. BMC Womens Health 2023; 23:85. [PMID: 36829198 PMCID: PMC9960682 DOI: 10.1186/s12905-022-02118-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/07/2022] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVE To compare the efficacy of dienogest and GnRH-a after endometriosis surgery. METHODS Patients with endometriosis who were admitted to our hospital from December 2020 to March 2022 were randomly collected. A total of 81 patients were collected and divided into 40 cases in the control group and 41 cases in the observation group. Among them, the control group was treated with GnRH-a drug, and the observation group was treated with dienogest (DNG). RESULTS The study found that the therapeutic effects of the two drugs were basically the same in patients with endometriosis. The VAS and Kupperman scores of the control group were 0.78 ± 0.8, 3.9 ± 1.84, P < 0.05, respectively; the VAS and Kupperman scores of the observation group were 0.73 ± 0.78, 1.55, respectively ± 1.24, P < 0.05, the difference was statistically significant.In the case of postoperative recurrence, the observation group was better than the control group, with 8 cases of recurrence in the control group and 2 cases of recurrence in the observation group, P < 0.05. CONCLUSION In the comparison of postoperative efficacy of the two drugs on patients with endometriosis, dienogest is better than GnRH-a adjuvant drug in postoperative recurrence, and has a good improvement and application, which is worthy of further promotion in clinical practice.
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Affiliation(s)
- Mingjun Tang
- grid.489937.80000 0004 1757 8474Department of Gynaecology and Obstetrics, Baotou Central Hospital of Baotou Medical College, No. 61, Huancheng Road, Donghe District, Baotou, 014000 Inner Mongolia Autonomous Region China
| | - Wenhui Yang
- grid.489937.80000 0004 1757 8474Department of Gynaecology and Obstetrics, Baotou Central Hospital of Baotou Medical College, No. 61, Huancheng Road, Donghe District, Baotou, 014000 Inner Mongolia Autonomous Region China
| | - Haiyan Zhang
- Department of Gynaecology and Obstetrics, Baotou Central Hospital of Baotou Medical College, No. 61, Huancheng Road, Donghe District, Baotou, 014000, Inner Mongolia Autonomous Region, China.
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Mitchell JB, Chetty S, Kathrada F. Progestins in the symptomatic management of endometriosis: a meta-analysis on their effectiveness and safety. BMC Womens Health 2022; 22:526. [PMID: 36528558 PMCID: PMC10127994 DOI: 10.1186/s12905-022-02122-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Endometriosis is a complex chronic disease that affects approximately 10% of women of reproductive age worldwide and commonly presents with pelvic pain and infertility. METHOD & OUTCOME MEASURES A systematic review of the literature was carried out using the databases Pubmed, Scopus, Cochrane and ClinicalTrials.gov in women with a confirmed laparoscopic diagnosis of endometriosis receiving progestins to determine a reduction in pain symptoms and the occurrence of adverse effects. RESULTS Eighteen studies were included in the meta-analysis. Progestins improved painful symptoms compared to placebo (SMD = -0.61, 95% CI (-0.77, -0.45), P < 0.00001) with no comparable differences between the type of progestin. After median study durations of 6-12 months, the median discontinuation rate due to adverse effects was 0.3% (range: 0 - 37.1%) with mild adverse effects reported. CONCLUSION The meta-analysis revealed that pain improvement significantly increased with the use of progestins with low adverse effects. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021285026.
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Affiliation(s)
- Jon-Benay Mitchell
- Division of Pharmacology, Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarentha Chetty
- Division of Pharmacology, Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Fatima Kathrada
- Division of Clinical Pharmacy, Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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DEZZANI EO. The role of gynecological minimally invasive approach in the gynecologic oncology. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.22.04903-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Daniilidis A, Angioni S, Di Michele S, Dinas K, Gkrozou F, D’Alterio MN. Deep Endometriosis and Infertility: What Is the Impact of Surgery? J Clin Med 2022; 11:jcm11226727. [PMID: 36431203 PMCID: PMC9693611 DOI: 10.3390/jcm11226727] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/26/2022] [Accepted: 11/05/2022] [Indexed: 11/16/2022] Open
Abstract
In women with deep endometriosis, the spontaneous fertility rate might range from 2 to 10%. The optimal management of these women is still an area of debate. Therefore, this review aims to explore the literature on the impact of deep endometriosis surgery on reproductive outcomes and pregnancy rates in women with and without prior infertility. A total of 392 articles were identified through database searching. Twenty-three studies were eligible to be included in the review. A total of 1548 women were identified, 814 of whom became pregnant, with a mean pregnancy rate of 52.6% (95% CI 49.7-63%). Our review suggests that surgery may improve fertility outcomes. Due to the variability in the studies, it is impossible to stratify fertility outcomes of surgery by the localization of deep endometriosis. More investigations are needed to determine whether surgical management should be first-intention or limited to the failure of medically assisted reproduction treatment.
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Affiliation(s)
- Angelos Daniilidis
- Department of Obstetrics and Gynecology, Hippokratio Hospital, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece
- Correspondence: (A.D.); (M.N.D.); Tel.: +39-07051093399 (M.N.D.)
| | - Stefano Angioni
- Department of Surgical Science, University of Cagliari, Cittadella Universitaria Blocco I, Asse Didattico Medicna P2, Monserrato, 09042 Cagliari, Italy
| | - Stefano Di Michele
- Department of Surgical Science, University of Cagliari, Cittadella Universitaria Blocco I, Asse Didattico Medicna P2, Monserrato, 09042 Cagliari, Italy
| | - Konstantinos Dinas
- Department of Obstetrics and Gynecology, Hippokratio Hospital, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece
| | - Fani Gkrozou
- University Clinic in Obstetrics and Gynecology, University of Ioannina, 451 10 Ioannina, Greece
| | - Maurizio Nicola D’Alterio
- Department of Surgical Science, University of Cagliari, Cittadella Universitaria Blocco I, Asse Didattico Medicna P2, Monserrato, 09042 Cagliari, Italy
- Correspondence: (A.D.); (M.N.D.); Tel.: +39-07051093399 (M.N.D.)
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Chen CJ, Livneh H, Chen WJ, Wang YH, Lu MC, Yeh CC, Yen CT, Tsai TY. The Prescription of Chinese Herbal Medicine and Risk of Endometriosis in Women with Rheumatoid Arthritis: A Population-Based Cohort Study. Int J Womens Health 2022; 14:1603-1612. [PMID: 36411747 PMCID: PMC9675347 DOI: 10.2147/ijwh.s386134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose The systemic inflammation is believed to provide an outline of the association between rheumatoid arthritis (RA) and endometriosis. This retrospective cohort study aimed to explore the association of Chinese herbal medicine (CHM) use with the prevention of endometriosis onset in women diagnosed with RA. Methods We utilized the claims data from the National Health Insurance of Taiwan from 2000 to 2009 and excluded individuals diagnosed with endometriosis before being diagnosed with RA, using age at clinical diagnosis. After selection and propensity-score matching, a total of 5992 females aged ≧20 years old and with newly diagnosed RA but without endometriosis at baseline were included, which contained 2996 CHM users and 2996 non-CHM users. All of them were followed until the end of 2013 to measure the incidence of endometriosis. Results During the study period, we noticed that CHM users had a substantially lower incidence of endometriosis compared to non-CHM users (2.54 vs 5.19 per 1000 person-years). Use of CHM correlated significantly with a lower endometriosis likelihood even after adjusting for potential covariates, with the adjusted hazard ratio of 0.47 (95% confidence interval, 0.35–0.65). A longer duration of CHM use was associated with a reduction in endometriosis risk, especially in those using CHM for more than 730 days. Uses of several herbal products may be associated with a lower risk of endometriosis, like Ge-Gen, Da-Huang, Huang-Qin, Ye-Jiao-Teng, Chuan-Niu-Xi, Shu-Jing-Huo-Xue-Tang, Du-Huo-Ji-Sheng-Tang, Ge-Gen-Tang, Shao-Yao-Gan-Cao-Tang, Ping-Wei-San, Gan-Lu-Yin, and Dang-Gui-Nian-Tong-Tang. Conclusion Taken together, adding CHM to conventional therapy may reduce the incidence of endometriosis in women with RA. The therapeutic mechanisms and safety of these natural products may be a direction for future clinical studies.
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Affiliation(s)
- Chia-Jung Chen
- Department of Chinese Medicine, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Hanoch Livneh
- Rehabilitation Counseling Program, Portland State University, Portland, OR, USA
| | - Wei-Jen Chen
- Department of Chinese Medicine, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
- Center of Sports Medicine, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Yu-Han Wang
- Center of Sports Medicine, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Ming-Chi Lu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chia-Chou Yeh
- Department of Chinese Medicine, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chieh-Tsung Yen
- Department of Neurology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- Correspondence: Chieh-Tsung Yen; Tzung-Yi Tsai, Tel +886-5-2648000-5003; +886-5-2648000-3209, Fax +886-5-2648006, Email ;
| | - Tzung-Yi Tsai
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan
- Department of Medical Research, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Sun M, Geng H, Bai J, Feng J, Xu N, Liu Y, Liu X, Liu G. Characterization of cervical canal and vaginal bacteria in pregnant women with cervical incompetence. Front Microbiol 2022; 13:986326. [PMID: 36246259 PMCID: PMC9556877 DOI: 10.3389/fmicb.2022.986326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Vaginal and cervical canal bacteria are associated with women’s health and pregnancy outcomes. Here, we compared their composition and characteristics in 37 reproductive-aged Chinese women including 24 pregnant women with cervical incompetence (vaginal and cervical canal bacteria formed Groups A and B, respectively) and 13 healthy pregnant women (vaginal and cervical canal bacteria formed Groups C and D, respectively) using high-throughput sequencing of the V4 region of 16S rRNA gene. The results of alpha and beta diversity analysis, respectively, indicated no statistical differences between Groups A and B (p = 0.32, 0.06), nor Groups B and D (p = 0.69, 0.74); however, differences were found between Groups C and D (p = 0.02, 0.01) and between Groups A and C (p = 0.04, 0.02). PLS-DA analysis showed that the individuals from each group were irregularly distributed according to their clade. Lactobacillus, Bifidobacterium and Ureaplasma were the dominant genera in all groups. Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSts) analysis identified 31 Kyoto Encyclopedia of Genes and Genomes (KEGG) orthologs associated with the bacterial communities from the four groups, including membrane transport, folding, sorting and degradation, xenobiotics biodegradation and metabolism, and nucleotide metabolism. We further determined relationships between pregnancy outcomes (Apgar scores) and certain bacterial species. A significant positive correlation was found between Apgar scores and Actinomyces neuii and Anoxybacillus flavithermus in the vagina and cervical canal of pregnant women with cervical incompetence while Bacteroides plebeius, Bifidobacterium pseudopodium and Staphylococcus petrasii in the cervical canal displayed negative correlations with Apgar scores. Moreover, Clostridium fimetarium, Methanobacterium congolense, Pseudomonas chlororaphis, and Psychrobacter nivimaris in the vagina were negatively correlated with Apgar scores. These bacteria may serve as potential biomarkers, however, additional research is warranted to verify their role in clinical outcomes.
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Affiliation(s)
- Meiguo Sun
- Department of Obstertrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Huiwu Geng
- School of Life Sciences, Anhui Medical University, Hefei, Anhui,China
| | - Jingjing Bai
- Department of Obstertrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jiahui Feng
- School of Life Sciences, Anhui Medical University, Hefei, Anhui,China
| | - Na Xu
- School of Life Sciences, Anhui Medical University, Hefei, Anhui,China
| | - Yunlong Liu
- Department of Obstertrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiaoying Liu
- School of Life Sciences, Anhui Medical University, Hefei, Anhui,China
- Translational Research Institute of Henan Provincial People’s Hospital and People’s Hospital of Zhengzhou University, Henan International Joint Laboratory of Non-coding RNA and Metabolism in Cancer, Henan Provincial Key Laboratory of Long Non-coding RNA and Cancer Metabolism, Zhengzhou, Henan, China
- *Correspondence: Xiaoying Liu,
| | - Gang Liu
- School of Life Sciences, Anhui Medical University, Hefei, Anhui,China
- Gang Liu,
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Lukács L, Kovács AR, Pál L, Szűcs S, Lampé R. Evaluating the Phagocytic Index of Peripheral Leukocytes in Endometriosis by Plasma Experiments. Medicina (B Aires) 2022; 58:medicina58070925. [PMID: 35888644 PMCID: PMC9316155 DOI: 10.3390/medicina58070925] [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: 06/07/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Endometriosis is a benign, chronic disease, that negatively influences the quality of life of affected women and is responsible for a remarkable amount of infertility. The pathophysiology of the disease is still not clarified, but the insufficient immune surveillance plays a significant role in it. The phagocyte function of innate immune cells may play a role in the elimination of ectopic endometrium. The purpose of this study is to examine the phagocyte function of neutrophil granulocytes and monocytes, incubated in heat-inactivated and not-inactivated plasma samples from healthy women and from women with endometriosis before and after the surgical treatment. Materials and Methods: Blood samples were collected from eight preoperative and eight postoperative patients with endometriosis before and after the surgical treatment, and from 16 healthy patients as controls. Neutrophil granulocytes, monocytes and blood plasma samples were isolated. Cells were incubated in different plasma samples, and the phagocytic index was determined with a fluorescence microscope. Results: The phagocytic index of granulocytes and monocytes isolated from patients with endometriosis was significantly decreased compared to healthy women after the cells were incubated in their own plasma. Preoperatively isolated cells from patients with endometriosis demonstrated an improved phagocyte function after incubating them in plasma samples from healthy controls. In contrast, the phagocytic activity of cells from healthy women significantly reduced after being incubated in the plasma of preoperative endometriosis patients. The heat-inactivation of plasma samples did not affect the results. Conclusions: Active endometriosis lesions may produce heat-stable systemic immunomodulatory factors, which reduced the phagocyte function of peripheral monocytes and neutrophil granulocytes. The phagocyte function of these cells can be normalized after the complete surgical removal of endometriosis, which then demonstrates similar values as in healthy women.
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Affiliation(s)
- Luca Lukács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 4031 Debrecen, Hungary; (L.L.); (A.R.K.)
| | - Anna Rebeka Kovács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 4031 Debrecen, Hungary; (L.L.); (A.R.K.)
| | - László Pál
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (L.P.); (S.S.)
| | - Sándor Szűcs
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (L.P.); (S.S.)
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 4031 Debrecen, Hungary; (L.L.); (A.R.K.)
- Correspondence:
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12
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Li Y, Cui S, Xu Z, Zhang Y, Wu T, Zhang J, Chen Y. Exosomal tRF-Leu-AAG-001 derived from mast cell as a potential non-invasive diagnostic biomarker for endometriosis. BMC Womens Health 2022; 22:253. [PMID: 35752827 PMCID: PMC9233364 DOI: 10.1186/s12905-022-01827-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The diagnosis of endometriosis (EMs) is still based on laparoscopic observation. This study tries to verify whether exosomal tRNA-derived fragments (tRFs) in leucorrhea can be used as non-invasive diagnostic markers. METHODS Endometrial tissues and leucorrhea were sampled from women hospitalized in Ningbo University Affiliated Hospital from January 2021 to July 2021 with (n = 26) and without endometriosis (n = 25). Exosomes were isolated from samples by differential centrifugation. The small RNA sequencing was performed to detect the exosomal tRNA halves (tiRNAs)&tRFs. RNA probe and immunofluorescence antibody were used to localize the origin of tRFs. From mast cell lines infected with tRF-Leu-AAG-001 siRNA, we observed the change in vascular capacity and expression of inflammatory factors. The specificity and sensitivity tRF were determined by receiver operating characteristic analyses. RESULTS 63 up-regulated and 45 down-regulated tRFs&tiRNAs were identified in ectopic exosomes. We selected tRF-Leu-AAG-001 as a candidate marker through KEGG pathway enrichment and PCR verification. We found that mast cells highly expressed tRF-Leu-AAG-001 in ectopic foci by immunofluorescence staining. We used siRNA to silenced tRF-Leu-AAG-001 expression in luva, qPCR analysis showed IL-6, IL-10, IL-1β, and TNF-α were significantly decreased. Meanwhile, tRF-Leu-AAG-001 siRNA dramatically reduced the angiogenic ability of luva. Finally, we examined the expression of exosomal tRF-Leu-AAG-001 in the leucorrhea. It was found exosomal tRF-Leu-AAG-001 had high specificity and sensitivity for predicting the occurrence of ectopic disease. CONCLUSIONS Exosomal tRF-Leu-AAG-001 derived from mast cells in ectopic foci might promote inflammation and angiogenesis. Meanwhile, leucorrhea exosomal tRF-Leu-AAG-001 could be a potential diagnostic biomarker for endometriosis.
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Affiliation(s)
- Yingxue Li
- Ningbo Institute of Medical Sciences, Ningbo, China.,Ningbo University, Ningbo, China
| | - Shuling Cui
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Zemin Xu
- Addiction Research of Zhejiang Province, Ningbo Kangning Hospital, School of Medicine, Ningbo University, Ningbo, China
| | | | - Tao Wu
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Jing Zhang
- Ningbo Women&Children's Hospital, Ningbo, China
| | - Yichen Chen
- Ningbo Women&Children's Hospital, Ningbo, China. .,Ningbo Institute of Medical Sciences, Ningbo, China. .,Ningbo University, Ningbo, China.
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13
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Xu P, Wang J, Zhang Y, Zhu L, Zhang X. Factors Affecting the Postoperative Bowel Function and Recurrence of Surgery for Intestinal Deep Endometriosis. Front Surg 2022; 9:914661. [PMID: 35774384 PMCID: PMC9239406 DOI: 10.3389/fsurg.2022.914661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study aims to evaluate the factors associated with complications and long-term results in the surgical treatment of intestinal deep endometriosis and to figure out the optimized treatment measures for bowel endometriosis.MethodsA retrospective study was performed in a single center in China. Medical charts were reviewed from 61 women undergoing surgical treatment for bowel endometriosis between January 2013 and August 2019 in the Department of General Gynecology, Women’s Hospital School of Medicine Zhejiang University. Multivariate regression analysis was utilized to investigate the impact of the stages of endometriosis and surgical steps (independent risk factors) on complications (and postoperative bowel dysfunction). The clinical characters, surgical procedures, postoperative treatment, complications, and recurrence rate were summarized and analyzed by using Lasso regression.ResultsSurgery type was the most important independent risk factor related to postoperative abnormal defecation in intestinal deep endometriosis patients (P < 0.05, OR = 34.133). Infection is the most important independent risk factor related to both postoperative complications (OR = 96.931) and recurrences after conservative surgery (OR = 4.667). Surgery type and age were significantly related to recurrences after conservative surgery.ConclusionsWe recommended conservative operation especially full-thickness disc excision to improve the quality of life of intestinal deep endometriosis patients. In addition, prevention of infection is very important to reduce the postoperative complications rate and the recurrence rate.
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Svensson A, Garcia-Etxebarria K, Åkesson A, Borgfeldt C, Roth B, Ek M, D'Amato M, Ohlsson B. Applicability of polygenic risk scores in endometriosis clinical presentation. BMC Womens Health 2022; 22:208. [PMID: 35659226 PMCID: PMC9166598 DOI: 10.1186/s12905-022-01788-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Risk prediction is an essential part of preventative medicine and in recent years genomic information has become an interesting factor in risk models. Polygenic risk scores (PRS) combine the effect of many genetic variations into a single score which has been shown to have predictive value for many diseases. This study aimed to investigate the association between PRS for endometriosis and the clinical presentation of the disease. Methods Women with endometriosis (N = 172) were identified at the Department of Gynecology. All participants answered questionnaires regarding sociodemographic factors, lifestyle habits and medical history, registered bowel symptoms on the Visual Analog Scale for Irritable Bowel Syndrome and passed blood samples. DNA was extracted and samples were genotyped, and a PRS was calculated based on previous genome-wide association studies of endometriosis. Inflammatory proteins and TSH receptor antibodies (TRAb) in serum were analyzed. Results Inverse associations were identified between PRS and spread of endometriosis, involvement of the gastrointestinal tract and hormone treatment. However, significance was lost when calculated as p for trend and the specificity and sensitivity were low. There were no correlations between PRS and TRAb or inflammatory proteins. Conclusion The findings indicate that specific PRS should be developed to predict clinical presentations in patient with endometriosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01788-w.
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Affiliation(s)
- Agnes Svensson
- Department of Internal Medicine, Skåne University Hospital, Lund University, Malmö, Sweden.
| | - Koldo Garcia-Etxebarria
- Biodonostia, Gastrointestinal Genetics Group, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas Y Digestivas (CIBERehd), 20014, San Sebastian, Spain
| | - Anna Åkesson
- Clinical Studies Sweden - Forum South, Skåne University Hospital, Lund, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Bodil Roth
- Department of Internal Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Malin Ek
- Department of Internal Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Mauro D'Amato
- Gastrointestinal Genetics Lab, CIC bioGUNE - BRTA, Derio, Spain.,Ikerbasque, Basque Foundation for Science, Bilbao, Spain.,Department of Medicine and Surgery, LUM University, Casamassima, Italy
| | - Bodil Ohlsson
- Department of Internal Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
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15
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Han L, Zhang B. Malignant transformation of endometriosis in a laparoscopic trocar site a case report. BMC Womens Health 2022; 22:163. [PMID: 35562703 PMCID: PMC9103296 DOI: 10.1186/s12905-022-01749-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malignant transformation of endometriosis is infrequent at the laparoscopic trocar site. Although malignant transformation is uncommon, it must be acknowledged in order to achieve radical resection. CASE PRESENTATION We report on a 54-year-old woman with trocar site endometriosis 2 years after laparoscopic ovarian endometrial resection. Physical examination revealed a subcutaneous solid tumor with a diameter of 3 cm surrounding the scar of laparoscopic surgery in the right lower abdomen. Transabdominal ultrasonography showed a cystic tumor in the subcutaneous adipose layer of the right lower abdomen. The pathological diagnosis was poorly differentiated endometrioid carcinoma. Hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy were then performed. Histological examination revealed mixed endometrioid carcinoma and clear cell carcinoma. After six cycles of chemotherapy, computed tomography showed no signs of recurrence. CONCLUSIONS Malignant transformation of laparoscopic endometriosis is very uncommon, and the diagnosis and stage are determined by clinical manifestations and imaging examination. The main therapy methods are radical surgery combined with neoadjuvant chemotherapy and adjuvant radiotherapy. At the same time, reducing iatrogenic abdominal incision implantation is an effective prevention method.
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Affiliation(s)
- Ling Han
- Department of Obstetrics and Gynecology, The People's Hospital of China Three Geoges University The People's Hospital of China Three Gorges University. The First People's Hospital of Yichang, Jiefang Road 4, Yichang City, 443003, Hubei Province, People's Republic of China.
| | - Bingyi Zhang
- Department of Ultrasound Imaging, The People's Hospital of China Three Gorges University. The First People's Hospital of Yichang, Yichang City, Hubei Province, People's Republic of China
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16
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Li J, Liu Y, Du K, Xiao L, He X, Dai F, Tang J. Endometriosis in para-aortic lymph node resembling a malignancy: a case report and literature review. BMC Womens Health 2022; 22:101. [PMID: 35379213 PMCID: PMC8981872 DOI: 10.1186/s12905-022-01659-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/11/2022] [Indexed: 11/21/2022] Open
Abstract
Background Endometriosis is a common benign gynecological disease characterized by growing-functioning endometrial tissue outside the uterus. Extra-pelvic endometriosis, which accounts for approximately 12% of endometriosis, is more challenging to diagnose because of its distance from the pelvic organs. Halban's theory of benign metastasis indicates that endometrial cells can appear in extra-pelvic organs via lymphatic and blood vessels, but endometrial lymph node metastasis cases are still rare. We report a case of endometriosis in a para-aortic lymph node whose clinical behavior mimicked a malignancy. Case presentation A 52-year-old perimenopausal woman underwent laparoscopic hysterectomy plus bilateral salpingectomy (the patient insisted on the preservation of her ovaries) at a local hospital 2 years earlier because of adenomyosis. The patient presented with a complaint of low back pain to the gastrointestinal outpatient department of our hospital. The carbohydrate antigen 125 (CA125) was abnormally elevated at 5280.20 U/ml, human epididymis 4 (HE4) was 86.0 pmol/L, while other tumor markers were normal. Serum female hormone results were in the postmenopausal range, and her gastroenteroscopy showed no abnormalities. Moreover, both enhanced magnetic resonance imaging and positron emission tomography-computed tomography showed a high possibility of a retroperitoneal malignant lymph node (metastasis possible, primary site unknown). One week after admission, she underwent laparoscopic exploratory surgery, during which we observed normal shape and size of both ovaries while the left ovary was cystic-solid. After opening the retroperitoneal space, an enlarged lymph node-like tissue measuring 8 × 4 × 3 cm3 was found near the abdominal aorta. When the surrounding adhesions were separated, lymph node-like tissue was poorly demarcated from the abdominal aorta and renal artery. Some lymph node samples and left ovary were sent for intraoperative frozen section, which revealed benign lesions, similar to endometrial tissue. The lymph node tissue was then excised as much as possible, and the second set of intraoperative frozen sections showed high probability of endometrial tissue. The final histopathology and immunohistochemistry staining reached a diagnosis of para-aortic lymph node endometriosis. Gonadotropin-releasing hormone antigen treatment was recommended every 28 days because of the high preoperative CA125 and imaging-based suspicion of malignancy. The serum CA125 subsequently decreased to normal levels, and no para-aortic lesions were detected on abdominal enhancement CT. She is being followed up regularly. Conclusion It is known that the incidence of lymph node metastasis in pelvic endometriosis is relatively rare. Our report shows that endometriotic tissue can metastasize via the lymphatic route and suggests that endometriotic tissue has the characteristics of invasion and metastasis.
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Affiliation(s)
- Jinjin Li
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Yingwei Liu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Kaiwen Du
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Lin Xiao
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Xinyue He
- Department of Pathology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Fengqin Dai
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Junying Tang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China.
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Kim HG, Lim YS, Hwang S, Kim HY, Moon Y, Song YJ, Na YJ, Yoon S. Di-(2-ethylhexyl) Phthalate Triggers Proliferation, Migration, Stemness, and Epithelial-Mesenchymal Transition in Human Endometrial and Endometriotic Epithelial Cells via the Transforming Growth Factor-β/Smad Signaling Pathway. Int J Mol Sci 2022; 23:ijms23073938. [PMID: 35409294 PMCID: PMC8999884 DOI: 10.3390/ijms23073938] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 02/06/2023] Open
Abstract
Di-(2-ethylhexyl) phthalate (DEHP) is a frequently used plasticizer that may be linked to the development of endometriosis, a common gynecological disorder with a profound impact on quality of life. Despite its prevalence, vital access to treatment has often been hampered by a lack of understanding of its pathogenesis as well as reliable disease models. Recently, epithelial–mesenchymal transition (EMT) has been suggested to have a significant role in endometriosis pathophysiology. In this study, we found that DEHP treatment enhanced proliferation, migration, and inflammatory responses, along with EMT and stemness induction in human endometrial and endometriotic cells. The selective transforming growth factor-β (TGF-β) receptor type 1/2 inhibitor LY2109761 reversed the DEHP-induced cell proliferation and migration enhancement as well as the increased expression of crucial molecules involved in inflammation, EMT, and stemness, indicating that DEHP-triggered phenomena occur via the TGF-β/Smad signaling pathway. Our study clearly defines the role of DEHP in the etiology and pathophysiological mechanisms of endometriosis and establishes an efficient disease model for endometriosis using a biomimetic 3D cell culture technique. Altogether, our data provide novel etiological and mechanistic insights into the role of DEHP in endometriosis pathogenesis, opening avenues for developing novel preventive and therapeutic strategies for endometriosis.
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Affiliation(s)
- Hwi Gon Kim
- Department of Obstetrics and Gynecology, Pusan National University College of Medicine, Yangsan 626-870, Gyeongsangnam-do, Korea; (H.G.K.); (Y.J.S.); (Y.-J.N.)
| | - Ye Seon Lim
- Department of Anatomy and Convergence Medical Sciences, Pusan National University College of Medicine, Yangsan 626-870, Gyeongsangnam-do, Korea; (Y.S.L.); (S.H.); (H.-Y.K.)
- Immune Reconstitution Research Center of Medical Research Institute, Pusan National University College of Medicine, Yangsan 626-870, Gyeongsangnam-do, Korea;
| | - Seonyeong Hwang
- Department of Anatomy and Convergence Medical Sciences, Pusan National University College of Medicine, Yangsan 626-870, Gyeongsangnam-do, Korea; (Y.S.L.); (S.H.); (H.-Y.K.)
- Immune Reconstitution Research Center of Medical Research Institute, Pusan National University College of Medicine, Yangsan 626-870, Gyeongsangnam-do, Korea;
| | - Hye-Yoon Kim
- Department of Anatomy and Convergence Medical Sciences, Pusan National University College of Medicine, Yangsan 626-870, Gyeongsangnam-do, Korea; (Y.S.L.); (S.H.); (H.-Y.K.)
- Immune Reconstitution Research Center of Medical Research Institute, Pusan National University College of Medicine, Yangsan 626-870, Gyeongsangnam-do, Korea;
| | - Yuseok Moon
- Immune Reconstitution Research Center of Medical Research Institute, Pusan National University College of Medicine, Yangsan 626-870, Gyeongsangnam-do, Korea;
- Department of Convergence Medical Sciences, Pusan National University College of Medicine, Yangsan 626-870, Gyeongsangnam-do, Korea
| | - Yong Jung Song
- Department of Obstetrics and Gynecology, Pusan National University College of Medicine, Yangsan 626-870, Gyeongsangnam-do, Korea; (H.G.K.); (Y.J.S.); (Y.-J.N.)
| | - Yong-Jin Na
- Department of Obstetrics and Gynecology, Pusan National University College of Medicine, Yangsan 626-870, Gyeongsangnam-do, Korea; (H.G.K.); (Y.J.S.); (Y.-J.N.)
| | - Sik Yoon
- Department of Anatomy and Convergence Medical Sciences, Pusan National University College of Medicine, Yangsan 626-870, Gyeongsangnam-do, Korea; (Y.S.L.); (S.H.); (H.-Y.K.)
- Immune Reconstitution Research Center of Medical Research Institute, Pusan National University College of Medicine, Yangsan 626-870, Gyeongsangnam-do, Korea;
- Correspondence:
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A More Diverse Cervical Microbiome Associates with Better Clinical Outcomes in Patients with Endometriosis: A Pilot Study. Biomedicines 2022; 10:biomedicines10010174. [PMID: 35052854 PMCID: PMC8774211 DOI: 10.3390/biomedicines10010174] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
Infection-induced chronic inflammation is common in patients with endometriosis. Although microbial communities in the reproductive tracts of patients have been reported, little was known about their dynamic profiles during disease progression and complication development. Microbial communities in cervical mucus were collected by cervical swabs from 10 healthy women and 23 patients, and analyzed by 16S rRNA amplicon sequencing. The abundance, ecological relationships and functional networks of microbiota were characterized according to their prevalence, clinical stages, and clinical features including deeply infiltrating endometriosis (DIE), CA125, pain score and infertility. Cervical microbiome can be altered during endometriosis development and progression with a tendency of increased Firmicutes and decreased Actinobacteria and Bacteroidetes. Distinct from vaginal microbiome, upregulation of Lactobacillus, in combination with increased Streptococcus and decreased Dialister, was frequently associated with advanced endometriosis stages, DIE, higher CA125 levels, severe pain, and infertility. Significantly, reduced richness and diversity of cervical microbiome were detected in patients with more severe clinical symptoms. Clinical treatments against infertility can partially reverse the ecological balance of microbes through remodeling nutrition metabolism and transport and cell-cell/cell-matrix interaction. This study provides a new understanding on endometriosis development and a more diverse cervical microbiome may be beneficial for patients to have better clinical outcomes.
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Heidari S, Kolahdouz-Mohammadi R, Khodaverdi S, Tajik N, Delbandi AA. Expression levels of MCP-1, HGF, and IGF-1 in endometriotic patients compared with non-endometriotic controls. BMC Womens Health 2021; 21:422. [PMID: 34930225 PMCID: PMC8686524 DOI: 10.1186/s12905-021-01560-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/02/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To study the concentrations of monocyte chemoattractant protein-1 (MCP-1), hepatocyte growth factor (HGF), and insulin-like growth factor-1 (IGF-1) in peritoneal fluid (PF) and serum, and to evaluate their expressions by PF and peripheral blood mononuclear cells (PFMCs and PBMCs, respectively), and ectopic and eutopic endometrial stromal cells of patients with endometriosis (EESCs and EuESCs, respectively) compared with controls. METHODS The concentrations of mentioned cytokines in serum and PF, as well as their expression in PBMCs, PFMCs, EuESCs and EESCs from endometriosis patients and controls were assessed. RESULTS The levels of MCP-1, HGF, and IGF-1 in serum and PF in women with endometriosis were significantly higher than the controls (P < 0.05-P < 0.001). Gene expression of MCP-1 and IGF-1 in the PFMCs, PBMCs and EESCs also showed an increased level compared to controls (P < 0.05-P < 0.01). The protein expression of MCP-1 and IGF-1 by PFMCs was statistically higher in endometriotic women (P < 0.05 and P < 0.01, respectively). The gene and protein expression of HGF in PFMCs and its gene expression by EESCs were significantly higher in endometriotic women compared to controls (P < 0.05-P < 0.01). CONCLUSIONS The higher concentrations of mentioned cytokines in serum and PF and their higher expression by PFMCs and EESCs in endometriosis patients may contribute to the development of endometriosis.
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Affiliation(s)
- Sahel Heidari
- Immunology Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran.,Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Roya Kolahdouz-Mohammadi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sepideh Khodaverdi
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Tajik
- Immunology Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Ali-Akbar Delbandi
- Immunology Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran. .,Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Birke L, Baston-Büst DM, Kruessel JS, Fehm TN, Bielfeld AP. Can TSH level and premenstrual spotting constitute a non-invasive marker for the diagnosis of endometriosis? BMC Womens Health 2021; 21:336. [PMID: 34544404 PMCID: PMC8454006 DOI: 10.1186/s12905-021-01474-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background To date, there is no reliable non-invasive marker for the early detection and diagnosis of endometriosis available possibly resulting in a delayed diagnosis and consequently an unnecessary long ordeal for the individual woman. Therefore, the primary objective of the current study was to evaluate whether the combination of a thyroid-stimulating hormone (TSH) level > 2.5 µlU/ml and premenstrual spotting could serve as non-invasive markers of endometriosis. A secondary objective was to determine whether typical symptoms of endometriosis like dysmenorrhea and/or dyspareunia could increase the diagnostic reliability. Methods We conducted a retrospective, case–control study with 167 female patients at the Department of OB/GYN and REI (UniKiD) of the medical center of the University of Düsseldorf, between January 2015 and December 2016. 107 women with surgically confirmed endometriosis were compared to 60 without endometriosis (controls). To evaluate the diagnostic accuracy, we considered sensitivity, specificity and predictive values. In order to assess the association between the non-invasive markers and endometriosis an odds ratio (OR) with a 95% confidence interval was calculated. Results In our cohort, diagnosis of endometriosis with non-invasive markers according to their sensitivity yielded the following ranking: increased TSH level, premenstrual spotting, combination of both previous parameters, addition of dysmenorrhea, addition of dyspareunia and combination of all parameters. Conclusion The existence of endometriosis should be taken into consideration when a patient suffers from thyroid dysfunction and premenstrual spotting. Apart from an increased TSH level, the presence of premenstrual spotting underlines the possible diagnosis of endometriosis with non-invasive markers and therefore, the patient´s history needs to be taken into account carefully. Trial registration The retrospective study was approved by the Ethics Committee of the medical faculty of the Heinrich-Heine University, Düsseldorf, Germany, Registration number Düsseldorf: 5371R (approved: April 04th, 2016). Since the design of the study was retrospective no written informed consent was necessary.
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Wessels JM, Domínguez MA, Leyland NA, Agarwal SK, Foster WG. Endometrial microbiota is more diverse in people with endometriosis than symptomatic controls. Sci Rep 2021; 11:18877. [PMID: 34556738 PMCID: PMC8460742 DOI: 10.1038/s41598-021-98380-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/02/2021] [Indexed: 02/08/2023] Open
Abstract
Endometriosis is a chronic, estrogen-dependent gynecological condition affecting approximately 10% of reproductive age women. The most widely accepted theory of its etiology includes retrograde menstruation. Recent reports suggest the uterus is not sterile. Thus, the refluxed menstrual effluent may carry bacteria, and contribute to inflammation, the establishment and growth of endometriotic lesions. Here, we compared and contrasted uterine bacteria (endometrial microbiota) in people with surgically confirmed presence (N = 12) or absence of endometriosis (N = 9) using next-generation 16S rRNA gene sequencing. We obtained an average of > 9000 sequence reads per endometrial biopsy, and found the endometrial microbiota of people with endometriosis was more diverse (greater Shannon Diversity Index and proportion of 'Other' taxa) than symptomatic controls (with pelvic pain, surgically confirmed absence of endometriosis; diagnosed with other benign gynecological conditions). The relative abundance of bacterial taxa enriched in the endometrial microbiota of people with endometriosis belonged to the Actinobacteria phylum (Gram-positive), Oxalobacteraceae (Gram-negative) and Streptococcaceae (Gram-positive) families, and Tepidimonas (Gram-negative) genus, while those enriched in the symptomatic controls belonged to the Burkholderiaceae (Gram-negative) family, and Ralstonia (Gram-negative) genus. Taken together, results suggest the endometrial microbiota is perturbed in people with endometriosis.
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Affiliation(s)
- Jocelyn M Wessels
- Department of Obstetrics & Gynaecology, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Miguel A Domínguez
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Tamaulipas, 87000, Cd. Victoria, TAMPS, Mexico
| | - Nicholas A Leyland
- Department of Obstetrics & Gynaecology, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Sanjay K Agarwal
- Department of Reproductive Medicine, University of California San Diego, La Jolla, CA, 92037, USA
| | - Warren G Foster
- Department of Obstetrics & Gynaecology, McMaster University, Hamilton, ON, L8S 4K1, Canada.
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22
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Monti M. Gynecological minimally invasive approach and medical therapy. Minerva Obstet Gynecol 2021; 73:125-126. [PMID: 33851802 DOI: 10.23736/s2724-606x.21.04810-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Marco Monti
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy -
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