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Dominoni M, Pasquali MF, Musacchi V, De Silvestri A, Mauri M, Ferretti VV, Gardella B. Neutrophil to lymphocytes ratio in deep infiltrating endometriosis as a new toll for clinical management. Sci Rep 2024; 14:7575. [PMID: 38555302 PMCID: PMC10981721 DOI: 10.1038/s41598-024-58115-6] [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: 11/22/2023] [Accepted: 03/25/2024] [Indexed: 04/02/2024] Open
Abstract
Several mechanisms, including altered local and systemic immune system, apoptosis, and new angiogenesis, are responsible for the development and progression of endometriosis. Over the years many markers have been studied, like CA 125 and, recently, neutrophil-to-lymphocyte ratio (NLR). This tool is cost-effectiveness and non-invasiveness as a marker of systemic inflammatory diseases. The aim of this study is to assess the role of NLR in the real-life management of patients with endometriosis in order to evaluate the possible association between this value and symptoms. We performed a retrospective analysis of 199 premenopausal women affected by endometriosis, from January 2013 to December 2020, evaluating the characteristics of disease, the symptoms and the NLR. Analyzing the neutrophiles, the mean ± SD value was 6.1 ± 4.5 × 103/ul, while for lymphocytes mean ± SD value was 1.8 ± 0.7.NLR was categorized according to its median value (> 2.62 vs ≤ 2.62). The comparison between NLR values and CA 125, endometriosis stage, dysmenorrhea and presence of chronic pelvic pain, adjusting for previous therapy did not find a significant association. An interesting result, although not significant, was the association between NLR and chronic pelvic pain (OR = 1.9). In the sub-group of patients without previous therapy this association is even stronger (OR = 4.8, 95% CI 0.5-50.2, p = 0.190). The link between NLR and chronic pelvic pain can provide a further hint to the clinician even when taking symptoms into account to develop a particular therapeutic treatment related to the various expressions of NLR. Finally, NLR may enable the creation of customized follow-up protocols that divide patients into high- and low-risk categories for endometriosis recurrence.
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Affiliation(s)
- Mattia Dominoni
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100, Pavia, Italy.
- Department of Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, 27100, Pavia, Italy.
| | - Marianna Francesca Pasquali
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100, Pavia, Italy
- Department of Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, 27100, Pavia, Italy
| | - Valentina Musacchi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100, Pavia, Italy
- Department of Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, 27100, Pavia, Italy
| | - Annalisa De Silvestri
- SSD Biostatistica e Clinical Trial Center, IRCCS Fondazione Policlinico San Matteo, 27100, Pavia, Italy
| | - Matteo Mauri
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100, Pavia, Italy
- Department of Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, 27100, Pavia, Italy
| | - Virginia Valeria Ferretti
- SSD Biostatistica e Clinical Trial Center, IRCCS Fondazione Policlinico San Matteo, 27100, Pavia, Italy
| | - Barbara Gardella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100, Pavia, Italy
- Department of Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, 27100, Pavia, Italy
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Akdaş Reis Y, Varlı EN, Özkan S, Dereli ML, Akay A, Tolunay HE, Üstün YE. Importance of hemogram parameters for predicting uterine scar dehiscence. J Turk Ger Gynecol Assoc 2024; 25:38-43. [PMID: 37936366 PMCID: PMC10921076 DOI: 10.4274/jtgga.galenos.2023.2022-11-5] [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: 12/14/2022] [Accepted: 07/25/2023] [Indexed: 11/09/2023] Open
Abstract
Objective The pathophysiology of uterine scar dehiscence is not yet clear. The aim of this study was to investigate whether preoperative hemogram parameters can be used as predictive markers of uterine scar dehiscence, thus improving prediction and contributing to management of repeat Cesarean section. Material and Methods Between 2015 and 2020, 36670 (47.6%) cesarean sections were delivered in our hospital and 16943 of them had a previous Cesarean section. All cases of uterine scar rupture detected during Cesarean section were identified, and a total of 40 patients were included after excluding cases with impairment of the systemic inflammatory response (SIR). Controls consisted of 40 randomly selected, age-and body mass index (BMI)-matched patients, and the groups were compared. Results Age, BMI, and gravidity were similar (p>0.05). Although the gestational week and Apgar scores were similar between the groups (p>0.05), the birth weight amongst controls was significantly higher than the uterine dehiscence group (p=0.028). Platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, and other hemogram values were similar in both groups (p>0.05). Mean platelet volume (MPV) in the control group was significantly higher than in the uterine rupture group (p=0.049). Regression analysis found no significant result between hemogram parameters, birth weight, and dehiscence. Conclusion In this study, which set out to identify predictors of the risk of uterine scar dehiscence with SIR parameters, only the MPV value was lower in the dehiscence group.
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Affiliation(s)
- Yıldız Akdaş Reis
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Erol Nadi Varlı
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Sadullah Özkan
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Murat Levent Dereli
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Arife Akay
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Harun Egemen Tolunay
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Yaprak Engin Üstün
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
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Tabatabaei F, Tahernia H, Ghaedi A, Bazrgar A, Khanzadeh S. Diagnostic significance of neutrophil to lymphocyte ratio in endometriosis: a systematic review and meta-analysis. BMC Womens Health 2023; 23:576. [PMID: 37936116 PMCID: PMC10631181 DOI: 10.1186/s12905-023-02692-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The purpose of this systematic review and meta-analysis was to compile existing evidence on the significance of the NLR in predicting endometriosis in order to aid clinical decision-making and outcomes. METHODS We searched ProQuest, Web of Science, and PubMed for related studies published before January 2, 2023. Standardized mean difference (SMD) with a 95% confidence interval (CI) was reported for each outcome. Because a significant level of heterogeneity was found, we used the random-effects model to calculate pooled effects. We used Newcastle-Ottawa Scale (NOS) for quality assessment. RESULTS Overall, 18 article with were included in the analysis. A random-effect model revealed that patients with endometriosis had elevated levels of NLR compared to healthy controls (SMD = 0.79, 95% CI = 0.33 to 1.25, P < 0.001). Patients with endometriosis had elevated levels of NLR compared to those with other benign tumors (SMD = 0.85, 95% CI = 0.17 to 1.53, P = 0.014). In addition, NLR level of patients with stage III and IV endometriosis was not different from that of patients with stage I and II endometrioma (SMD = 0.30, 95% CI = -0.14 to 0.74, P = 0.18). However, NLR level was not different between endometriosis patients with and without peritoneal lesions (SMD = -0.12, 95% CI = -0.34to 0.10, P = 0.28), between patients with and without endometrioma (SMD = 0.20, 95% CI = -0.15 to 0.55, P = 0.26) and between endometriosis patients with and without deep lesions (SMD = 0.04, 95% CI = -0.20 to 0.28, P = 0.72). The pooled sensitivity of NLR was 0.67 (95% CI = 0.60-0.73), and the pooled specificity was 0.68 (95% CI, 0.62-0.73). CONCLUSIONS NLR might be utilized in clinics as a possible predictor to help clinicians diagnose endometriosis in affected women.
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Affiliation(s)
- Fatemeh Tabatabaei
- Department of Obstetrics and Gynaecology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Gynaecologic Laparoscopic Surgeries, Al-Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Arshin Ghaedi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Bazrgar
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shokoufeh Khanzadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
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Guo C, Zhang C. Platelet-to-Lymphocyte Ratio and CA125 Level as a Combined Biomarker for Diagnosing Endometriosis and Predicting Pelvic Adhesion Severity. Front Oncol 2022; 12:896152. [PMID: 35800055 PMCID: PMC9255667 DOI: 10.3389/fonc.2022.896152] [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: 03/14/2022] [Accepted: 05/19/2022] [Indexed: 11/16/2022] Open
Abstract
Adhesion is a significant biological characteristic of endometriosis, and accurate evaluation of the pelvic adhesion is necessary for surgical treatment. Serum CA125 is yet the most common used biomarker in the diagnosis and follow-up of patients with endometriosis despite of its high false-positive rate and low specificity. Herein, we aimed to examine the diagnostic value of the combination of the platelet-to-lymphocyte ratio (PLR) and CA125 for patients with different stages of endometriosis and their correlations with pelvic adhesion. We retrospectively analyzed the clinical data and blood count parameters of patients with both endometriosis and other benign ovarian tumors. The mean level of CA125, the PLR and the combined marker (the CA125 level multiplied by the PLR) in the EMs group were significantly higher than those in the Cyst group (P < 0.05). ROC curve analysis was used to compare the diagnostic values of serum PLR, CA125, and the combined marker in ovarian endometriosis. The cut-off value of the PLR was 176.835, with 28.3% sensitivity and 96.9% specificity. The cut-off value of CA125 was 31.67 U/mL, with 84.1% sensitivity and 87.4% specificity. The cut-off value of the combined marker was 3894.97, with 83.4% sensitivity and 95.8% specificity. It was found that the severity of adhesion in endometriosis was positively correlated with the PLR (r = 0.286, P < 0.01), CA125 (r = 0.276, P < 0.01), and combined marker (r = 0.369, P < 0.01). The combined marker showed the highest AUC value (0.751, 95% CI: 0.666–0.837), with a sensitivity of 56.0% and a specificity of 89.6%, and the cut-off value was 9056.94. Besides, the levels of CA125, PLR, and their combination were significantly elevated in patients with endometriosis. The combined marker was not only positively correlated with pelvic adhesion but also showed a greater diagnostic value and specificity than CA125 alone. These findings indicate that the combined marker may be a potential inflammatory biomarker playing an important role in the diagnosis and assessment of adhesion in endometriosis.
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Önen Ö, Özek Erkuran H, Bağ Ö, Abacıgil F. Blood Count Parameters as Inflammation Indicators in Children and Adolescents Diagnosed with Depressive Disorder. PSYCHIAT CLIN PSYCH 2021; 31:425-433. [PMID: 38765642 PMCID: PMC11079696 DOI: 10.5152/pcp.2021.21137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/27/2021] [Indexed: 05/22/2024] Open
Abstract
Aim There is increasing evidence that immunological and inflammatory dysfunctions play an essential role in the initiation and progression of major psychiatric disorders. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume can be used as markers of systemic inflammation in different diseases. We aimed to investigate these blood count parameters in children and adolescents diagnosed with major depressive disorder. Methods Designed as a case-control study, our sample consisted of patients aged 9-16 years referred to Child and Adolescent Psychiatry and pediatrics outpatient clinics for the first time and diagnosed with major depressive disorder according to Diagnostic and Statistical Manual of Mental Disorders, 5th edition diagnostic criteria, and healthy children and adolescents matched at a ratio of 1 to 2. Data of 58 cases and 90 healthy controls evaluated between 01.07.2019 and 01.07.2020 were included. Results Platelet-to-lymphocyte ratio values were significantly higher in the case group. No significant difference was found between patient and control groups regarding other blood count parameters. When depression group was compared in terms of all parameters as those who committed suicide and those did not, significant difference was found between the 3 groups in terms of platelet-to-lymphocyte ratio values. The intergroup difference in platelet-to-lymphocyte ratio was found between the depression group without suicide and the control group. No significant relationship was found between other parameters and Children's Depression Inventory Scale scores. We determined a cut-off value of 112.5 for platelet-to-lymphocyte ratio (with sensitivity of 70% and specificity of 63%). Conclusion Platelet-to-lymphocyte ratio might be an important parameter in the clinical follow-up of major depressive disorder.
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Affiliation(s)
- Özlem Önen
- Child and Adolescent Psychiatry Unit, SBU Izmir Dr. Behcet Uz Children’s Research and Training Hospital, Izmir, Turkey
| | - Handan Özek Erkuran
- Child and Adolescent Psychiatry Unit, SBU Izmir Dr. Behcet Uz Children’s Research and Training Hospital, Izmir, Turkey
| | - Özlem Bağ
- Department of Social Pediatrics Unit, SBU Izmir Dr. Behcet Uz Children’s Research and Training Hospital, Izmir, Turkey
| | - Filiz Abacıgil
- Department of Public Health, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Turkey
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Moini A, Ghanaat M, Hosseini R, Rastad H, Hosseini L. Evaluating hematological parameters in women with endometriosis. J OBSTET GYNAECOL 2021; 41:1151-1156. [PMID: 33459084 DOI: 10.1080/01443615.2020.1845634] [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] [Indexed: 12/19/2022]
Abstract
In the present study, we aimed to evaluate the relationship between the level of hematological parameters and the presence and stage of endometriosis. We included medical records of patients diagnosed with endometriosis (endometriosis group) and patients diagnosed with benign non-endometriotic ovarian masses (control group), who were eligible based on inclusion and exclusion criteria and compared the preoperative level of hematological parameters between the two groups. According to our findings, neutrophil and WBC counts, mean platelet volume, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were significantly higher, and the haemoglobin concentration, platelet count, and absolute lymphocyte count were lower in women diagnosed with endometriosis compared to the control group. There was no significant difference in hematological parameters of patients with endometriosis stages III and IV. Finally, we found that the preoperative level of hematological parameters lacked sufficient power for the diagnosis of endometriosis. Also, our results indicate that endometriosis is associated with an inflammatory processes.IMPACT STATEMENTWhat is already known on this subject? Inflammatory factors are believed to be involved in the pathogenesis of endometriosis; however, there are inconsistent reports on the association between blood inflammatory markers and endometriosis.What do the results of this study add? The results of this study indicate that endometriosis is associated with inflammatory processes that lead to changes in hematological parameters; however, preoperative measurement of these parameters has not sufficient power for the diagnosis of endometriosis.What are the implications of these findings for clinical practice and/or further research? The preoperative level of hematological parameters lacks sufficient power for the diagnosis of endometriosis, but they may help doctors make a diagnosis in the clinical setting as auxiliary findings.
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Affiliation(s)
- Ashraf Moini
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Obstetrics and Gynecology Department, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Ghanaat
- Obstetrics and Gynecology Department, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reihaneh Hosseini
- Obstetrics and Gynecology Department, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadith Rastad
- Clinical Research Development Center of Kamali Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Ladan Hosseini
- Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Assessment of Coagulation Parameters in Women Affected by Endometriosis: Validation Study and Systematic Review of the Literature. Diagnostics (Basel) 2020; 10:diagnostics10080567. [PMID: 32784640 PMCID: PMC7460223 DOI: 10.3390/diagnostics10080567] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 07/29/2020] [Accepted: 08/05/2020] [Indexed: 01/01/2023] Open
Abstract
The presence of endometriosis determines an inflammatory response locally. The objective of this validation study and systematic review was to assess systemic levels of coagulation and inflammatory parameters in women with or without the disease. We conducted a retrospective analysis of a database prospectively collected from January 2017 to February 2020 including n = 572 women who underwent laparoscopic surgery for endometriosis (cases, n = 324) or other benign gynecologic diseases (controls, n = 248). Inflammatory markers and coagulation parameters were determined. An advanced systematic search of the literature on the same parameters was conducted up to April 2020. A significantly higher neutrophil count was found in endometriosis patients. Patients with endometriomas and stage III–IV disease had a significantly lower absolute lymphocyte count and shortened activated partial thromboplastin time (aPTT) values. In the final regression model, aPTT retained significant predictive value for stage III–IV endometriosis (odds ratio (OR) = 0.002, 95% confidence interval (CI) = 0.00–0.445; p = 0.024). Results from the n = 14 included studies in the systematic review are characterized by a high variability, but some consistency has been found for alterations in thrombin time, platelet-to-lymphocyte ratio, and neutrophil count associated with endometriosis. Modest systemic changes of some inflammatory and coagulation parameters are associated with endometriosis. Indeed, all the modifications detected are still within the normal reference intervals, explaining the high heterogeneity among studies.
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Topdagi Yilmaz EP, Topdagi YE, Al RA, Kumtepe Y. The relationship between C-reactive protein, carbohydrate antigen 125, and hematological parameters to endometriotic nodule localization in pelvis. J Chin Med Assoc 2020; 83:577-581. [PMID: 32502120 DOI: 10.1097/jcma.0000000000000307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Endometriosis is a pelvic inflammatory process, and hormonal, environmental, and genetic factors play a role in its etiopathogenesis; especially, deep pelvic endometriosis exhibits an extensive anatomical distribution. In the present study, we evaluated the contribution of routinely measured hematological parameters to the diagnosis as the number of endometriotic nodule localization increases, when evaluated with C-reactive protein (CRP) and carbohydrate antigen (CA) 125. METHODS The present study included patients with histopathologically confirmed diagnosis of endometriosis who underwent surgery at our hospital between January 2007 and December 2018. Their medical records were examined retrospectively. RESULTS In total, 205 patients were included in the study, of which 129 patients (62.9%) with ovarian endometrioma and 76 patients (37.1%) with deep infiltrative endometriosis were assigned to Group 1 and Group 2, respectively, and the two groups were compared. Endometriotic nodules were observed in several localizations in 71 patients (34.6%) of the 205 patients with endometriosis. Pelvic nodules were grouped as per their four different localizations: uterosacral, recto-vaginal, bladder, and ureteral. Because the anatomical localization of endometriotic nodules increased in the pelvis, the variability in the levels of CA 125 and CRP as well as hematological parameters was examined. There were significant differences in hemoglobin (p < 0.036), CA 125 (p < 0.000), and CRP (p < 0.007) levels between patients with nodules in ≤2 localizations and those with nodules in ≥3 localizations. CONCLUSION Our study included a total of 205 patients. There was a significant difference in the CRP, CA 125, and hemoglobin levels between Group 1 and Group 2, but it was concluded that coexistence of the endometriotic nodule had no effect on the other hematological parameters. For this purpose, prospective studies with a larger number of patients are needed.
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Affiliation(s)
| | - Yunus Emre Topdagi
- Department of Gynecology and Obstetrics, Sanko University School of Medicine, Gazinatep, Turkey
| | - Ragip Atakan Al
- Department of Gynecology and Obstetrics, Atatürk University School of Medicine, Erzurum, Turkey
| | - Yakup Kumtepe
- Department of Gynecology and Obstetrics, Atatürk University School of Medicine, Erzurum, Turkey
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Jing X, Li C, Sun J, Peng J, Dou Y, Xu X, Ma C, Dong Z, Liu Y, Zhang H, Shao Q, Zhang H, Wang L, Zhang Y, Qu X. Systemic Inflammatory Response Markers Associated with Infertility and Endometrioma or Uterine Leiomyoma in Endometriosis. Ther Clin Risk Manag 2020; 16:403-412. [PMID: 32494145 PMCID: PMC7229864 DOI: 10.2147/tcrm.s232849] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 02/04/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose The aim of this study was to find the most useful marker of endometriosis-related infertility and evaluate predictive and diagnostic values of systemic inflammatory response markers (preoperative white blood–cell subtypes, neutrophil:lymphocyte ratio [NLR], platelet:lymphocyte ratio [PLR], and monocyte:lymphocyte ratio [MLR]) and CA125 levels in endometriosis patients. Methods This study comprised 662 women who had undergone laparoscopic surgery and been pathologically confirmed as having endometriosis and 83 patients pathologically confirmed with benign ovarian tumors. Related inflammatory factors in endometriosis complicated by infertility were analyzed via logistic regression analysis. Diagnostic values of the inflammatory response markers were obtained by receiver operating–characteristic analysis. Results We firstly identified that lower NLR level was an independent risk factor of infertility. Serum lymphocytes were significantly higher in endometriosis patients, while serum CA125, NLR, MLR, and PLR were elevated. For differentiating endometriosis from other benign ovarian tumors, the combination of NLR and CA125 achieved greater sensitivity than CA125 alone. In addition, both CA125 and NLR were positively correlated with stage, oviduct adhesion, and diameter of ovarian ectopic cysts. Conclusion NLR may be used as a simple and easily obtained predictive marker for endometriosis with infertility. Moreover, NLR can be a neoadjuvant biomarker for serum CA125 to diagnose endometriosis.
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Affiliation(s)
- Xuanxuan Jing
- Institute of Basic Medical Sciences, Key Laboratory of Cardiovascular Remodeling and Function Research, Qilu Hospital of Shandong University, Jinan, Shandong 250012, People's Republic China
| | - Chen Li
- Institute of Basic Medical Sciences, Key Laboratory of Cardiovascular Remodeling and Function Research, Qilu Hospital of Shandong University, Jinan, Shandong 250012, People's Republic China.,Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, People's Republic of China
| | - Jintang Sun
- Institute of Basic Medical Sciences, Key Laboratory of Cardiovascular Remodeling and Function Research, Qilu Hospital of Shandong University, Jinan, Shandong 250012, People's Republic China
| | - Jin Peng
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, People's Republic of China
| | - Yu Dou
- Department of Stomatology and Institute of Stomatology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, People's Republic China
| | - Xiaofei Xu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, People's Republic of China
| | - Chao Ma
- Institute of Basic Medical Sciences, Key Laboratory of Cardiovascular Remodeling and Function Research, Qilu Hospital of Shandong University, Jinan, Shandong 250012, People's Republic China
| | - Zhaogang Dong
- Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong 250012, People's Republic China
| | - Yanguo Liu
- Department of Medical Oncology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, People's Republic of China
| | - Hui Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, People's Republic of China
| | - Qianqian Shao
- Institute of Basic Medical Sciences, Key Laboratory of Cardiovascular Remodeling and Function Research, Qilu Hospital of Shandong University, Jinan, Shandong 250012, People's Republic China
| | - Hui Zhang
- Department of Pathology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, People's Republic of China
| | - Lijie Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, People's Republic of China
| | - Yun Zhang
- Institute of Basic Medical Sciences, Key Laboratory of Cardiovascular Remodeling and Function Research, Qilu Hospital of Shandong University, Jinan, Shandong 250012, People's Republic China
| | - Xun Qu
- Institute of Basic Medical Sciences, Key Laboratory of Cardiovascular Remodeling and Function Research, Qilu Hospital of Shandong University, Jinan, Shandong 250012, People's Republic China
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Karadadas E, Hortu I, Ak H, Ergenoglu AM, Karadadas N, Aydin HH. Evaluation of complement system proteins C3a, C5a and C6 in patients of endometriosis. Clin Biochem 2020; 81:15-19. [PMID: 32325082 DOI: 10.1016/j.clinbiochem.2020.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Endometriosis is a disease that shows auto-immune and chronic characteristics, suggesting a role for proteins mediating immune interactions in its pathophysiology. The aim was to evaluate C3a and C5a for their role in inflammatory responses and C6 as the down-stream interactor following our previous findings on C5 mRNA expression changes in endometriosis [1]. METHODS Sera from 71 endometriosis patients and 77 women without endometriosis were taken. While the samples were taken only once from the controls, the patient samples were taken before, in 1st and in 7th days after laparoscopy. Levels of complement proteins C3a, C5a and C6 were measured with ELISA assays. MPV (Mean Platelet Volume), CRP (C-Reactive Protein) and NLR (Neutrophil-to-Leukocyte Ratio) were also analyzed from the retrospective data. RESULTS C6 levels of early-stage patients at postoperative 1st day were significantly higher than controls. Patients with high MPV measurements had significantly higher C3a (p < 0.0001) and C6 (p < 0.05) levels than controls at all times of measurement. CONCLUSIONS C6, an integral component of the membrane attack complex (MAC), could play a role at early disease-stage. The changes in levels of complement proteins and their relation to high MPV levels suggest a broader area of interplay for immune interactors in endometriosis. Although a bigger and longitudinal study design is needed to obtain more accurate results to evaluate these proteins as potential biomarkers, an important role of complement system within the pathophysiology of endometriosis is apparent.
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Affiliation(s)
- Elif Karadadas
- Faculty of Medicine, Department of Medical Biochemistry, Ege University, Bornova, Izmir 35100, Turkey
| | - Ismet Hortu
- Faculty of Medicine, Department of Gynecology and Obstetrics, Ege University, Bornova, Izmir 35100, Turkey
| | - Handan Ak
- Faculty of Medicine, Department of Medical Biochemistry, Ege University, Bornova, Izmir 35100, Turkey
| | - Ahmet Mete Ergenoglu
- Faculty of Medicine, Department of Gynecology and Obstetrics, Ege University, Bornova, Izmir 35100, Turkey
| | - Nedim Karadadas
- Faculty of Medicine, Department of Gynecology and Obstetrics, Ege University, Bornova, Izmir 35100, Turkey.
| | - Hikmet Hakan Aydin
- Faculty of Medicine, Department of Medical Biochemistry, Ege University, Bornova, Izmir 35100, Turkey.
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11
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Calapkulu M, Sencar ME, Sakiz D, Duger H, Ozturk Unsal I, Ozbek M, Cakal E. The prognostic and diagnostic use of hematological parameters in subacute thyroiditis patients. Endocrine 2020; 68:138-143. [PMID: 31865557 DOI: 10.1007/s12020-019-02163-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/11/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Subacute thyroiditis (SAT) is an acute inflammatory disease of the thyroid. Mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) values determined from peripheral blood, are accepted as available and practical indicators of systemic inflammation. The purpose of this study was to evaluate the value of hematological parameters in the diagnosis and prognosis of subacute thyroiditis patients. METHODS This retrospective study included 306 SAT patients and 102 healthy control subjects. Retrospective analyses were made of age, gender, complete blood counts, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), thyroid function tests, NLR, PLR, and thyroid volume of the patients and the results were compared with the control group. RESULTS The mean follow-up time of patients was 29.5 ± 14 months. The ESR, CRP, white blood cell (WBC) count, neutrophil count, hemoglobin, platelet counts, NLR, and PLR were significantly higher in the SAT patients. MPV and lymphocyte count were significantly lower in the SAT patients. The rates of recurrence and permanent hypothyroidism were 15.4% and 9.8%, respectively. The values of ESR, CRP, NLR, PLR, and MPV at the time of diagnosis were not determined to have any effect on recurrence or the development of permanent hypothyroidism. CONCLUSIONS The results of this study showed higher PLR and NLR values in SAT patients compared with healthy control subjects, and a lower MPV value. These findings demonstrate that the assessment of hematological parameters in conjunction with radiological and clinical findings will assist in establishing an accurate diagnosis, especially in complicated SAT cases.
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Affiliation(s)
- Murat Calapkulu
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
| | - Muhammed Erkam Sencar
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Davut Sakiz
- Department of Endocrinology and Metabolism, Mardin State Hospital, Mardin, Turkey
| | - Hakan Duger
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ilknur Ozturk Unsal
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Mustafa Ozbek
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Erman Cakal
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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12
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Ding S, Lin Q, Zhu T, Li T, Zhu L, Wang J, Zhang X. Is there a correlation between inflammatory markers and coagulation parameters in women with advanced ovarian endometriosis? BMC WOMENS HEALTH 2019; 19:169. [PMID: 31888633 PMCID: PMC6937785 DOI: 10.1186/s12905-019-0860-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 11/29/2019] [Indexed: 12/13/2022]
Abstract
Background Endometriosis is defined as a chronic inflammatory disease. Recent studies have shown that increased coagulation parameters including fibrinogen and platelets are associated with endometriosis. The objective of this study was to determine the levels of inflammatory markers and coagulation parameters and their correlations in women with endometriomas compared to those with benign ovarian cysts or normal pelvic anatomy. Methods Between June 2015 and June 2017, a total of 548 women who underwent laparoscopic/laparotomic surgery for ovarian endometriomas (OMA group, n = 226), non-endometriosis benign ovarian cysts (Cyst group, n = 210) and tubal reanastomosis (Control group, n = 112) were recruited in this study. Inflammatory markers including c-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and coagulation parameters including platelet count, thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time, and plasma fibrinogen as well as CA-125 were determined. Results Compared with Cyst group and Control group, TT and PT in OMA group were significantly shorter and plasma fibrinogen levels were significantly higher (P < 0.05). Moreover, the levels of plasma fibrinogen were positively correlated with CRP, NLR and PLR (P < 0.05). In addition, the confidence intervals for the area under the curve (AUC) for CA-125 × fibrinogen were significantly higher than those for CA-125 (0.904–0.952 vs. 0.899–0.949) in the diagnosis of endometrioma. Conclusions These results indicate that women with endometriomas demonstrate a hypercoagulable status due to the inflammatory nature of endometriosis. The combined determination for CA-125 and fibrinogen demonstrate a higher area under the curve than the single detection of CA-125 in those with endometriomas compared to these with benign ovarian cysts. Trial registration This study was approved by the Human Ethics Committee of the Women’s Hospital, School of Medicine, Zhejiang University (No.20170174) and all women provided written informed consent.
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Affiliation(s)
- Shaojie Ding
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, Zhejiang, 310006, People's Republic of China
| | - Qiao Lin
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, Zhejiang, 310006, People's Republic of China
| | - Tianhong Zhu
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, Zhejiang, 310006, People's Republic of China
| | - Tiantian Li
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, Zhejiang, 310006, People's Republic of China
| | - Libo Zhu
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, Zhejiang, 310006, People's Republic of China
| | - Jianzhang Wang
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, Zhejiang, 310006, People's Republic of China
| | - Xinmei Zhang
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, Zhejiang, 310006, People's Republic of China.
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13
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Chen L, Wang X, Shu J, Xu S, Wu Q, Yu Y. Diagnostic value of serum D-dimer, CA125, and neutrophil-to-lymphocyte ratio in differentiating ovarian cancer and endometriosis. Int J Gynaecol Obstet 2019; 147:212-218. [PMID: 31469423 DOI: 10.1002/ijgo.12949] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 04/09/2019] [Accepted: 08/28/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the utility of hematologic, inflammatory, and immunologic biomarkers for differentiating between ovarian cancer and endometriosis. METHODS Data were retrospectively reviewed from women diagnosed with ovarian cancer and endometriosis after ovarian cyst surgery in Zhejiang, China, 2014-2016. Serologic and hematologic biomarkers, including white blood cell count, lymphocyte count, neutrophil count, red blood cell count, hemoglobin, platelets, and D-dimer, albumin, globulin, cancer antigen 125 (CA125) and CA199 serum levels recorded pre-operatively were assessed by ROC curve and logistic regression analysis. RESULTS Overall, 49 women were diagnosed with ovarian cancer and 192 with endometriosis. For predicting ovarian cancer, the area under the curve (AUC) was 0.96 (95% confidence interval [CI], 0.94-0.99); sensitivity, 93.2%; specificity, 87.5%) for log(D-dimer), 0.95 (95% CI, 0.91-0.98; sensitivity, 81.3%; specificity, 96.3%) for log(CA125), and 0.92 (95% CI, 0.86-0.98; sensitivity, 92.6%; specificity, 79.2%) for neutrophil-to-lymphocyte ratio (NLR). The AUC for the combination of D-dimer, NLR, and CA125 was 0.96 (95% CI, 0.94-0.99; sensitivity, 91.6%; specificity, 89.6%). CONCLUSION Serum D-dimer, NLR, and CA125 were found to be potential diagnostic factors for ovarian cancer. Combined measurement of D-dimer, NLR, and CA125 might offer a convenient screening method.
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Affiliation(s)
- Lifeng Chen
- Department of Gynecology, , Zhejiang Provincial People's Hospital, People's Hospital Of Hangzhou Medical College, Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine Of Zhejiang Province, Hangzhou, China
| | - Xinyan Wang
- Department of Gynecology, , Zhejiang Provincial People's Hospital, People's Hospital Of Hangzhou Medical College, Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine Of Zhejiang Province, Hangzhou, China
| | - Jing Shu
- Department of Gynecology, , Zhejiang Provincial People's Hospital, People's Hospital Of Hangzhou Medical College, Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine Of Zhejiang Province, Hangzhou, China
| | - Sheng Xu
- Department of Gynecology, , Zhejiang Provincial People's Hospital, People's Hospital Of Hangzhou Medical College, Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine Of Zhejiang Province, Hangzhou, China
| | - Qing Wu
- Department of Gynecology, , Zhejiang Provincial People's Hospital, People's Hospital Of Hangzhou Medical College, Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine Of Zhejiang Province, Hangzhou, China
| | - Yan Yu
- Department of Gynecology, , Zhejiang Provincial People's Hospital, People's Hospital Of Hangzhou Medical College, Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine Of Zhejiang Province, Hangzhou, China
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Lee Y, Lee Y, Lee S, Jung S, Chon S. Correlation of preoperative biomarkers with severity of adhesion in endometriosis. J Gynecol Obstet Hum Reprod 2019; 49:101637. [PMID: 31520750 DOI: 10.1016/j.jogoh.2019.101637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/26/2019] [Accepted: 09/10/2019] [Indexed: 01/04/2023]
Abstract
This study was undertaken to evaluate the correlation between preoperative Serum markers and pelvic adhesions in endometriosis patients and to explore the markers' clinical value for outcome prediction. Preoperative blood Serum and CA 125 results were obtained and pelvic adhesion scores were calculated. The patient group with adhesion scores less than 28 points was defined as the mild adhesion group, and those with a score of 28 or more were members of the severe adhesion group. The CA 125 level was significantly higher in the severe adhesion group than in the mild adhesion group. The CA 125 level, size of the largest cyst, and WBC count were associated with the level of pelvic adhesion. Adhesion scores were significantly higher in the CA 125 ≥ 35 U/mL group than in the CA 125 < 35 U/mL group. Patients with a preoperative CA 125 level higher than 35 U/mL are at high risk for pelvic adhesion.
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Affiliation(s)
- Yoojung Lee
- Department of Obstetrics and Gynecology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Yaeheun Lee
- Department of Obstetrics and Gynecology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seungho Lee
- Department of Obstetrics and Gynecology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
| | - Sunyong Jung
- Department of Obstetrics and Gynecology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seungjoo Chon
- Department of Obstetrics and Gynecology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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Coskun B, Ince O, Erkilinc S, Elmas B, Saridogan E, Coskun B, Doganay M. The feasibility of the platelet count and mean platelet volume as markers of endometriosis and adenomyosis: A case control study. J Gynecol Obstet Hum Reprod 2019; 49:101626. [PMID: 31499283 DOI: 10.1016/j.jogoh.2019.101626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/29/2019] [Accepted: 09/05/2019] [Indexed: 01/24/2023]
Abstract
INTRODUCTION The aim of the study is to investigate the role of platelet count (PC) and mean platelet volume (MPV) in determining adenomyosis and endometriosis. MATERIAL AND METHODS This was a retrospective case control study that included adenomyosis, endometriosis and control groups. The adenomyosis group included 84 women diagnosed between January 2013 and January 2015 based on hysterectomy specimen. The endometriosis group included 102 patients underwent diagnostic laparoscopy and confirmed by histopathologic examination. Lastly, the control group included 88 women had no medical problem and underwent tubal ligation. RESULTS MPV (fl) was significantly lower in adenomyosis group (8.5) compared to endometriosis (9, p<0.05) and control groups (9, p<0.01). Modified platelet activity (MPV/PC) was significantly lower in adenomyosis group compared to control group (p<0.01). Bivariate logistic regression model was used to assess the odds ratio of risk factors and serum markers related to endometriosis and adenomyosis. Variables showing significant differences based on post-hoc Bonferroni test were included in the logistic regression model for comparison of each disease with the control group. MPV was not found to be a risk factor both for presence of endometriosis and adenomyosis after adjusting for demographic and clinical characteristics. DISCUSSION Our study suggested that PC and MPV were not useful diagnostic markers for endometriosis or adenomyosis. Further research on how platelet indices and other inflammatory markers are related to inflammation might help better understand their potential as markers for these diseases.
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Affiliation(s)
- Bugra Coskun
- University of Health Sciences Gülhane Education and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Onur Ince
- Kutahya Health Sciences University, Faculty of Medicine, Department of Obstetrics and Gynecology, 43000, Kutahya, Turkey.
| | - Selcuk Erkilinc
- University of Health Sciences Tepecik Education and Research Hospital, Department of Gynecologic Oncology, İzmir, Turkey.
| | - Burak Elmas
- University of Health Sciences Zekai Tahir Burak Women's Health Education and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Erdinc Saridogan
- University of Health Sciences Zekai Tahir Burak Women's Health Education and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Bora Coskun
- University of Health Sciences Gülhane Education and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Melike Doganay
- University of Health Sciences Zekai Tahir Burak Women's Health Education and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
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Alay I, Kaya C, Karaca I, Eren E, Hosgoren M, Aslanova F, Cengiz H, Ekin M, YaSar L. The effectiveness of neutrophil to lymphocyte ratio in prediction of medical treatment failure for tubo-ovarian abscess. J Obstet Gynaecol Res 2019; 45:1183-1189. [PMID: 30907061 DOI: 10.1111/jog.13946] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/11/2019] [Indexed: 01/15/2023]
Abstract
AIM We aimed to compare the neutrophil-to-lymphocyte ratio (NLR) in tubo-ovarian abscess (TOA) patients who responded to medical treatment or who underwent surgical intervention due to medical treatment failure. METHODS The files of the patients, hospitalized in our Obstetrics and Gynecology Department with TOA diagnosis between August 2015 and December 2017, were evaluated retrospectively. The conservative management group was comprised of 38 of the 81 patients (46.9%) who responded to sole medical treatment with the triple antibiotic regimen (gentamicin-clindamycin-ampicillin) and the surgical intervention group was comprised of 43 patients (53.1%) who did not respond to medical treatment and needed further surgery and/or interventional radiologic abscess drainage. Demographic and clinical data, imaging findings, and laboratory results including NLR were compared between two groups. RESULTS There were statistically significant differences between the groups in terms of age, TOA diameter, white blood cell and neutrophil counts, and NLR levels (P < 0.05). The mean NLR was 7.4 ± 5.8 for the conservative management group and 10.3 ± 5.8 for the surgical intervention group (P = 0.004). The area under the curve (AUC) for NLR was 0.69 (threshold value was ≥6.97, 95% confidence interval, sensitivity 79.1%, specificity 57.9%). On multiple regression analysis, a significant correlation was identified between age, NLR and resistance to the medical treatment. CONCLUSION Neutrophil-to-lymphocyte ratio and age are significantly higher in patients with medical treatment failure and NLR could be used as a novel marker in addition to white blood cell in the prediction of medical treatment failure in TOA patients.
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Affiliation(s)
- Ismail Alay
- Department of Obstetrics and Gynecology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Cihan Kaya
- Department of Obstetrics and Gynecology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ibrahim Karaca
- Department of Obstetrics and Gynecology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ecem Eren
- Department of Obstetrics and Gynecology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Murat Hosgoren
- Department of Obstetrics and Gynecology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Fidan Aslanova
- Department of Obstetrics and Gynecology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Huseyin Cengiz
- Department of Obstetrics and Gynecology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Murat Ekin
- Department of Obstetrics and Gynecology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Levent YaSar
- Department of Obstetrics and Gynecology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Tskhay VB, Schindler AE, Mikailly GT. Diffuse massive adenomyosis and infertility. Is it possible to treat this condition? Horm Mol Biol Clin Investig 2019; 37:hmbci-2018-0026. [PMID: 30753160 DOI: 10.1515/hmbci-2018-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/11/2018] [Indexed: 01/04/2023]
Abstract
Background Severe forms of adenomyosis are a serious gynecological problem. In most cases, conservative treatment of this pathology is unsuccessful. Adenomyomectomy by Osada's approach seems to be the most promising solution. The present study evaluated the follow-up results of this type of surgery in patients with adenomyosis and infertility. Materials and methods The prospective study included 26 patients with severe forms of adenomyosis who underwent an adenomyomectomy using Osada's approach. In 18 patients (69%), infertility was the main indication for surgical treatment. The follow-up period lasted from July 2012 to January 2018. Results The median post-operative follow-up period was 18 months. For the first 12 months patients received hormonal therapy. In all postoperative patients, the menstrual cycle had normalized, and other symptoms of the disease had disappeared. Seven patients continue to receive postoperative hormonal treatment. Three individuals got spontaneously pregnant; two of them delivered full-term babies by cesarean section. Six patients are planning a pregnancy with assisted reproductive technology. Conclusion In the present study, the organ-preserving surgery of severe adenomyosis performed using Osada's method appeared to be a good alternative to hysterectomy. It stopped the development of pathological symptoms of the disease and restored the patient's reproductive function.
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Affiliation(s)
- Vitaly B Tskhay
- Department of Perinatology, Obstetrics and Gynecology, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia, Phone: +7923287 21 34
| | | | - Gyulnar T Mikailly
- Department of Perinatology, Obstetrics and Gynecology, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
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Seckin B, Ates MC, Kirbas A, Yesilyurt H. Usefulness of hematological parameters for differential diagnosis of endometriomas in adolescents/young adults and older women. Int J Adolesc Med Health 2018; 33:/j/ijamh.ahead-of-print/ijamh-2018-0078/ijamh-2018-0078.xml. [PMID: 30256762 DOI: 10.1515/ijamh-2018-0078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/05/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Inflammatory processes have been considered to be involved in the pathogenesis of endometriosis. However, the predictive role of inflammatory hematological parameters in endometriosis is not clear. The aim of this study was to analyze the clinical value of hematologic markers in the differential diagnosis of endometriomas in younger and older reproductive age women. MATERIALS AND METHODS A retrospective chart review was done for 502 patients who underwent surgery: 267 with endometriomas (endometrioma group) and 235 with other benign adnexal cysts (control group). Patients were placed into subgroups as younger (adolescents/young adults, aged <25 years) and older (aged ≥25 years) women. Total and differential white blood cell count, neutrophil-to-lymphocyte ratio, platelet indices and platelet-to-lymphocyte ratio (PLR) were evaluated with receiver operating characteristic curve analysis for differential diagnosis of endometriomas. RESULTS The mean serum levels of PLR, plateletcrit (PCT), platelet count and CA-125 (reference range below 35 IU/mL) were significantly higher in the endometrioma group (p < 0.001). The area under the curve (AUC) for CA-125 was 0.85 [95% confidence interval (CI), 0.82-0.88] (p < 0.001) for the entire group. However, platelet count, PLR, and PCT showed poor discriminative ability for detecting endometriomas with AUC values of 0.59 (95% CI, 0.55-0.65, p < 0.001), 0.58 (95% CI, 0.53-0.63, p = 0.002) and 0.61 (95% CI, 0.56-0.66, p < 0.001), respectively. In age-stratified analysis, these platelet indices had also low diagnostic performance in both age groups. CONCLUSIONS Hematologic markers do not adequately differentiate ovarian endometriomas from other benign cysts in neither adolescents/young adults nor older women.
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Affiliation(s)
- Berna Seckin
- Department of Reproductive Endocrinology, Zekai Tahir Burak Women's Health Education and Research Hospital, Talatpasa Bulvarı, Hamamönü, Altındağ, 06230 Ankara, Turkey, Phone: +90-312-3103100, Fax: +90-312-3124931
| | - Mete Can Ates
- Department of Reproductive Endocrinology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Ayse Kirbas
- Department of Reproductive Endocrinology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Huseyin Yesilyurt
- Department of Reproductive Endocrinology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
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Abnormal activation of the sonic hedgehog signaling pathway in endometriosis and its diagnostic potency. Fertil Steril 2018; 110:128-136.e2. [DOI: 10.1016/j.fertnstert.2018.02.138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/27/2018] [Accepted: 02/27/2018] [Indexed: 12/13/2022]
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20
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Du Z, Dong J, Bi J, Bai R, Zhang J, Wu Z, Lv Y, Zhang X, Wu R. Predictive value of the preoperative neutrophil-to-lymphocyte ratio for the development of hepatocellular carcinoma in HBV-associated cirrhotic patients after splenectomy. PLoS One 2018; 13:e0195336. [PMID: 29621282 PMCID: PMC5886527 DOI: 10.1371/journal.pone.0195336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/20/2018] [Indexed: 12/18/2022] Open
Abstract
The neutrophil to lymphocyte ratio (NLR), a simple marker of inflammation, has recently been showed to predict tumor recurrence in hepatocellular carcinoma (HCC) patients after hepatic resection or liver transplantation. However, whether it can be used to predict HCC development in cirrhotic patients remained unknown. The aim of this study was to evaluate the predictive value of the preoperative NLR for the development of HCC in cirrhotic patients who underwent splenectomy. A total of 230 HBV-associated cirrhotic patients who underwent splenectomy in our hospital from January 2000 to December 2012 were included in this study. Detailed clinical data included patients’ general characteristics, laboratory tests and imaging studies, surgical procedures and complications. Information on patients’ follow-up data was also obtained. We found that 38 (16.52%) patients developed HCC after splenectomy during the follow-up period. An elevated preoperative NLR was associated with increased risk of developing HCC in cirrhotic patients after splenectomy. The optimal cutoff value of NLR for HCC development was 2.27. In patients who developed HCC during the follow-up period, NLR scores showed no predictive value in overall survival after splenectomy. However, NLR scores appeared to have a much better predictive value in overall survival in patients who did not develop HCC. In conclusion, cirrhotic patients who underwent splenectomy remain at a relatively high risk of developing HCC, and an elevated preoperative NLR is associated with HCC development in cirrhotic patients who underwent splenectomy for hypersplenism.
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Affiliation(s)
- Zhaoqing Du
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Xi’an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- Department of Hepatobiliary Surgery,First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Jian Dong
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Xi’an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- Department of Hepatobiliary Surgery,First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Jianbin Bi
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Xi’an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- Department of Hepatobiliary Surgery,First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Ruhai Bai
- Department of Epidemiology and Biostatistics, Xi’an Jiaotong University School of Public Health, Xi’an, Shaanxi Province, China
| | - Jia Zhang
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Xi’an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- Department of Hepatobiliary Surgery,First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Zheng Wu
- Department of Hepatobiliary Surgery,First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Yi Lv
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Xi’an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- Department of Hepatobiliary Surgery,First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Xufeng Zhang
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Xi’an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- Department of Hepatobiliary Surgery,First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- * E-mail: (WR); (ZX)
| | - Rongqian Wu
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Xi’an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- * E-mail: (WR); (ZX)
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21
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Arlıer S, Kayışlı ÜA, Arıcı A. Tumor necrosis factor alfa and interleukin 1 alfa induced phosphorylation and degradation of inhibitory kappa B alpha are regulated by estradiol in endometrial cells. Turk J Obstet Gynecol 2018; 15:50-59. [PMID: 29662717 PMCID: PMC5894537 DOI: 10.4274/tjod.47700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/24/2018] [Indexed: 12/11/2022] Open
Abstract
Objective: When bound to the inhibitory kappa B (IкB) protein, the transcription factor nuclear factor kappa B (NF-кB) remains inactively in the cytoplasm. Activated NF-кB upregulates the gene expression of many chemokines including monocyte chemoattractant protein-1 and interleukin (IL)-8. We hypothesized that estrogen may regulate IкB phosphorylation and degradation thus influencing NF-кB-dependent gene expression. Regulation of chemokines by estrogen is different in uterine endometrial cells when compared to ectopic endometrial cells of endometriosis. Materials and Methods: We investigated the in vivo expression of IкB in normal endometrium and in eutopic and ectopic endometrium of women with endometriosis. We then studied in cultured endometrial cells to assess the effects of estradiol on IкB and NF-кB function. Results: Normal endometrium from mid-late proliferative phase revealed the strongest IкB immunoreactivity throughout the cycle (p<0.05). When compared to paired homologous eutopic endometrium, ectopic endometrium revealed significantly less immunoreactivity for IкB (p<0.05). Moreover, estradiol induced a decrease in tumor necrosis factor-and IL-1-induced IкB phosphorylation, and also decreased the levels of active-NF-кB (p<0.05). Conclusion: Our results support the conclusion that one pathway for estradiol-mediated NF-кB inhibition occurs through the down-regulation of IкB phosphorylation. We propose that the estradiol-induced regulation of IкB and consequent reduction in active-NF-кB may affect inflammatory responses in human endometrial cells.
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Affiliation(s)
- Sefa Arlıer
- University of South Florida Faculty of Medicine, Department of Obstetrics and Gynecology, Tampa, USA.,University of Health Sciences, Adana Numune Training and Research Hospital, Clinic of Obstetrics and Gynecology, Adana, Turkey
| | - Ümit Ali Kayışlı
- University of South Florida Faculty of Medicine, Department of Obstetrics and Gynecology, Tampa, USA
| | - Aydın Arıcı
- Yale University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, New Haven, USA.,Anadolu Medical Center, Clinic of Reproductive Endocrinology and Infertility, İstanbul, Turkey
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22
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Izumi G, Koga K, Takamura M, Makabe T, Satake E, Takeuchi A, Taguchi A, Urata Y, Fujii T, Osuga Y. Involvement of immune cells in the pathogenesis of endometriosis. J Obstet Gynaecol Res 2018; 44:191-198. [PMID: 29316073 DOI: 10.1111/jog.13559] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/21/2017] [Indexed: 01/10/2023]
Abstract
Endometriosis is characterized by the implantation and growth of endometriotic tissues outside the uterus. It is widely accepted the theory that endometriosis is caused by the implantation of endometrial tissue from retrograde menstruation; however, retrograde menstruation occurs in almost all women and other factors are required for the establishment of endometriosis, such as cell survival, cell invasion, angiogenesis, and cell growth. Immune factors in the local environment may, therefore, contribute to the formation and progression of endometriosis. Current evidence supports the involvement of immune cells in the pathogenesis of endometriosis. Peritoneal neutrophils and macrophages secrete biochemical factors that help endometriotic cell growth and invasion, and angiogenesis. Peritoneal macrophages and NK cells in endometriosis have limited capability of eliminating endometrial cells in the peritoneal cavity. An imbalance of T cell subsets leads to aberrant cytokine secretions and inflammation that results in the growth of endometriosis lesions. It is still uncertain whether these immune cells have a role in the initial cause and/or stimulate actions that enhance disease; however, in either case, modulating the actions of these cells may prevent initiation or disease progression. Further studies are needed to deepen the understanding of the pathology of endometriosis and to develop novel management approaches of benefit to women suffering from this disease.
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Affiliation(s)
- Gentaro Izumi
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan
| | - Masashi Takamura
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan
| | - Tomoko Makabe
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan
| | - Erina Satake
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan
| | - Arisa Takeuchi
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan
| | - Ayumi Taguchi
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan
| | - Yoko Urata
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan
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23
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Gao Y, Wang WJ, Zhi Q, Shen M, Jiang M, Bian X, Gong FR, Zhou C, Lian L, Wu MY, Feng J, Tao M, Li W. Neutrophil/lymphocyte ratio is a more sensitive systemic inflammatory response biomarker than platelet/lymphocyte ratio in the prognosis evaluation of unresectable pancreatic cancer. Oncotarget 2017; 8:88835-88844. [PMID: 29179480 PMCID: PMC5687650 DOI: 10.18632/oncotarget.21340] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/26/2017] [Indexed: 12/23/2022] Open
Abstract
Multiple cancers arise from sites of infection, chronic irritation, and inflammation. It has been widely accepted that pancreatic cancer is an inflammation-driven cancer. In this study, we investigated the application value of systemic inflammatory markers, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), in the prediction of chemotherapy response and prognosis in patients with late pancreatic cancer. 122 patients with inoperable pancreatic cancers were included and separated into two groups according to median values of NLR or PLR (NLR low:<3.81 or NLR high:≥3.81, and PLR low:<142.14 or PLR high≥142.14, respectively). Baseline NLR and PLR levels were significantly higher in pancreatic cancer patients compared with the healthy subjects. Neither of the baseline NLR or PLR levels could predict outcomes. Patients with low baseline level of NLR, but not PLR, had better responses to chemotherapy. Changes in NLR, but not PLR levels, were associated with the therapeutic efficacy. Patients who stayed in or dropped into the low NLR level subgroup after first-line chemotherapy had better responses, comparing to those stayed in or jumped into the high NLR level group. No similar results could be observed when the PLR level was investigated. Therefore, NLR is a more sensitive biomarker than PLR in the prediction of chemotherapy response of patients.
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Affiliation(s)
- Yuan Gao
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wen-Jie Wang
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qiaoming Zhi
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Meng Shen
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Min Jiang
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaojie Bian
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fei-Ran Gong
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chong Zhou
- Department of Radiation Oncology, Xuzhou Central Hospital, Xuzhou, China
| | - Lian Lian
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Oncology, Suzhou Xiangcheng People's Hospital, Suzhou, China
| | - Meng-Yao Wu
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Feng
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Min Tao
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China.,PREMED Key Laboratory for Precision Medicine, Soochow University, Suzhou, China
| | - Wei Li
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China.,PREMED Key Laboratory for Precision Medicine, Soochow University, Suzhou, China.,Center for Systems Biology, Soochow University, Suzhou, China
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24
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Viganò P, Ottolina J, Sarais V, Rebonato G, Somigliana E, Candiani M. Coagulation Status in Women With Endometriosis. Reprod Sci 2017; 25:559-565. [PMID: 28681683 DOI: 10.1177/1933719117718273] [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: 01/02/2023]
Abstract
Subtle alterations in coagulation and fibrinolysis have been recently reported in patients with endometriosis supporting a potential hypercoagulable status associated with the disease. This cross-sectional study aimed at evaluating some variables of coagulation status and inflammatory markers in women with endometriosis. A total of 314 women who underwent surgery were considered. The case group (n = 169) included patients with a surgical diagnosis of endometriosis, at any stage of disease. The control group (n = 145) included women with a surgical diagnosis of benign gynecologic pathology. No difference was found for thrombin time, International Normalized Ratio (INR), platelet count, neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio (PLR) between women with endometriosis and controls. Conversely, patients with endometriosis had significantly shortened activated partial thromboplastin time (APTT) when compared to controls (1.08 ± 0.06 and 1.12 ± 0.19, respectively; P < .01). In the subgroup analysis, women with ovarian endometriosis had significantly shortened APTT values in comparison to women without this form and women with stage I to II endometriosis had significantly shorter APTT values and higher PLR than those with stage III to IV disease. In multivariate logistic regression analysis, after controlling for potential confounders, a shortened APTT remained associated with the disease. Activated partial thromboplastin time is shorter in women with endometriosis but still in the normal range. The evidence is insufficient to foresee a possible use of APTT as a diagnostic marker and to claim a crucial role of a systemic hypercoagulable state in the origin of the disease. A role of the local coagulation system in the pathogenesis of the disease cannot be excluded.
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Affiliation(s)
- Paola Viganò
- 1 Division of Genetics and Cell Biology, Reproductive Sciences Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jessica Ottolina
- 2 Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Veronica Sarais
- 2 Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgia Rebonato
- 2 Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Edgardo Somigliana
- 3 Infertility Unit, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Candiani
- 2 Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
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25
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Jiang C, Liu C, Guo J, Chen L, Luo N, Qu X, Yang W, Ren Q, Cheng Z. CA125 modified by PLT and NLR improves the predictive accuracy of adenomyosis-derived pelvic dense adhesion. Medicine (Baltimore) 2017; 96:e6880. [PMID: 28489790 PMCID: PMC5428624 DOI: 10.1097/md.0000000000006880] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
To explore the value of serum levels of CA125, platelet count (PLT), neutrophil-lymphocyte ratio (NLR), and modified CA125 markers CA125a and CA125b in predicting pelvic dense adhesion (PDA) associated with adenomyosis, CA125a = lg(CA125 × PLT × 10), CA125b = lg(CA125 × NLR).This retrospective study included 304 patients who underwent surgery for adenomyosis. Correlations of serum levels of CA125, PLT, NLR, and modified CA125 markers with adenomyosis-derived PDA were analyzed by Logistic regression. Receiver operating characteristic curve was applied to assess the utility of these parameters for predicting PDA.All the parameters including CA125, PLT, NLR, and modified CA125 markers were positively correlated with PDA (P < .05 or P < .01). More importantly, CA125a was more specific (85.03% vs. 83.00%) and more sensitive (47.56% vs. 47.47%) than CA125 alone for the prediction of PDA, and CA125b could also improve the predictive specificity of PDA (53.13% vs. 47.47%).Serum CA125, PLT, and NLR were all closely correlated with PDA in adenomyosis patients. CA125 modified by PLT and NLR could further improve the predictive accuracy of adenomyosis-derived PDA, thus providing more meaningful references for better-informed decisions about the mode of surgical access for the clinical treatment of adenomyosis.
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Affiliation(s)
- Caixia Jiang
- Department of Gynecology and Obstetrics, Yangpu Hospital, Tongji University School of Medicine
| | - Chao Liu
- Department of Gynecology and Obstetrics, Yangpu Hospital, Tongji University School of Medicine
| | - Jing Guo
- Department of Gynecology and Obstetrics, Yangpu Hospital, Tongji University School of Medicine
| | - Li Chen
- Department of Gynecology and Obstetrics, Yangpu Hospital, Tongji University School of Medicine
| | - Ning Luo
- Department of Gynecology and Obstetrics, Yangpu Hospital, Tongji University School of Medicine
| | - Xiaoyan Qu
- Department of Gynecology and Obstetrics, Yangpu Hospital, Tongji University School of Medicine
| | - Weihong Yang
- Department of Gynecology and Obstetrics, Yangpu Hospital, Tongji University School of Medicine
| | - Qing Ren
- Department of Gynecology and Obstetrics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
| | - Zhongping Cheng
- Department of Gynecology and Obstetrics, Yangpu Hospital, Tongji University School of Medicine
- Institute of Gynecological Minimal Invasive Medicine, Tongji University School of Medicine, Shanghai, China
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26
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Mayda H, Ahsen A, Bağcioğlu E, Öztürk A, Bahçeci B, Soyuçok E, Başpinar E, Ulu MS. Effect of Increased Neutrophil-to-Lymphocyte Ratio (NLR) and Decreased Mean Platelet Volume (MPV) Values on Inflammation in Acute Mania. Noro Psikiyatr Ars 2016; 53:317-320. [PMID: 28360805 DOI: 10.5152/npa.2016.10272] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 08/15/2015] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV) are simple, low-cost, and useful inflammatory markers detected in routine complete blood count (CBC), and their use has recently become widespread. In this study, we aimed to investigate the presence of an inflammatory state in manic patients on the basis of NLR and MPV values. METHODS This retrospective study was performed on 76 patients with acute mania who were admitted to the Inpatients Psychiatry Clinic of Afyon Kocatepe University Hospital in Turkey. Diagnoses were based on Diagnostic and Statistical Manuel of Mental disorder (DSM-IV). The control group consisted of 74 healthy individuals recruited from the community. They were age- and sex-matched with the study group. RESULTS NLR values of the manic patient group were 2.2±1.4 and those of the control group were 1.6±0.5. NLR values were significantly higher (p=0.004) and MPV values were significantly lower in the manic patient group than in the control group (10.0±1.2 vs. 10.9±2.3, p=0.027). CONCLUSION Increased NLR and decreased MPV levels may reflect inflammation in manic patients, and inflammation may play a role in the complex pathophysiology of acute mania.
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Affiliation(s)
- Hasan Mayda
- Department of Psychiatry, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
| | - Ahmet Ahsen
- Department of Internal Medicine, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
| | - Erman Bağcioğlu
- Department of Psychiatry, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
| | - Ahmet Öztürk
- Department of Psychiatry, Dumlupınar University School of Medicine, Kütahya, Turkey
| | - Bülent Bahçeci
- Department of Psychiatry, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Etem Soyuçok
- Department of Psychiatry, Dumlupınar University School of Medicine, Kütahya, Turkey
| | - Erol Başpinar
- Department of Psychiatry, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
| | - Memnune Sena Ulu
- Department of Internal Medicine, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
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Nisenblat V, Bossuyt PMM, Shaikh R, Farquhar C, Jordan V, Scheffers CS, Mol BWJ, Johnson N, Hull ML. Blood biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2016; 2016:CD012179. [PMID: 27132058 PMCID: PMC7076288 DOI: 10.1002/14651858.cd012179] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND About 10% of reproductive-aged women suffer from endometriosis, a costly chronic disease causing pelvic pain and subfertility. Laparoscopy is the gold standard diagnostic test for endometriosis, but is expensive and carries surgical risks. Currently, there are no non-invasive or minimally invasive tests available in clinical practice to accurately diagnose endometriosis. Although other reviews have assessed the ability of blood tests to diagnose endometriosis, this is the first review to use Cochrane methods, providing an update on the rapidly expanding literature in this field. OBJECTIVES To evaluate blood biomarkers as replacement tests for diagnostic surgery and as triage tests to inform decisions on surgery for endometriosis. Specific objectives include:1. To provide summary estimates of the diagnostic accuracy of blood biomarkers for the diagnosis of peritoneal, ovarian and deep infiltrating pelvic endometriosis, compared to surgical diagnosis as a reference standard.2. To assess the diagnostic utility of biomarkers that could differentiate ovarian endometrioma from other ovarian masses. SEARCH METHODS We did not restrict the searches to particular study designs, language or publication dates. We searched CENTRAL to July 2015, MEDLINE and EMBASE to May 2015, as well as these databases to 20 April 2015: CINAHL, PsycINFO, Web of Science, LILACS, OAIster, TRIP, ClinicalTrials.gov, DARE and PubMed. SELECTION CRITERIA We considered published, peer-reviewed, randomised controlled or cross-sectional studies of any size, including prospectively collected samples from any population of reproductive-aged women suspected of having one or more of the following target conditions: ovarian, peritoneal or deep infiltrating endometriosis (DIE). We included studies comparing the diagnostic test accuracy of one or more blood biomarkers with the findings of surgical visualisation of endometriotic lesions. DATA COLLECTION AND ANALYSIS Two authors independently collected and performed a quality assessment of data from each study. For each diagnostic test, we classified the data as positive or negative for the surgical detection of endometriosis, and we calculated sensitivity and specificity estimates. We used the bivariate model to obtain pooled estimates of sensitivity and specificity whenever sufficient datasets were available. The predetermined criteria for a clinically useful blood test to replace diagnostic surgery were a sensitivity of 0.94 and a specificity of 0.79 to detect endometriosis. We set the criteria for triage tests at a sensitivity of ≥ 0.95 and a specificity of ≥ 0.50, which 'rules out' the diagnosis with high accuracy if there is a negative test result (SnOUT test), or a sensitivity of ≥ 0.50 and a specificity of ≥ 0.95, which 'rules in' the diagnosis with high accuracy if there is a positive result (SpIN test). MAIN RESULTS We included 141 studies that involved 15,141 participants and evaluated 122 blood biomarkers. All the studies were of poor methodological quality. Studies evaluated the blood biomarkers either in a specific phase of the menstrual cycle or irrespective of the cycle phase, and they tested for them in serum, plasma or whole blood. Included women were a selected population with a high frequency of endometriosis (10% to 85%), in which surgery was indicated for endometriosis, infertility work-up or ovarian mass. Seventy studies evaluated the diagnostic performance of 47 blood biomarkers for endometriosis (44 single-marker tests and 30 combined tests of two to six blood biomarkers). These were angiogenesis/growth factors, apoptosis markers, cell adhesion molecules, high-throughput markers, hormonal markers, immune system/inflammatory markers, oxidative stress markers, microRNAs, tumour markers and other proteins. Most of these biomarkers were assessed in small individual studies, often using different cut-off thresholds, and we could only perform meta-analyses on the data sets for anti-endometrial antibodies, interleukin-6 (IL-6), cancer antigen-19.9 (CA-19.9) and CA-125. Diagnostic estimates varied significantly between studies for each of these biomarkers, and CA-125 was the only marker with sufficient data to reliably assess sources of heterogeneity.The mean sensitivities and specificities of anti-endometrial antibodies (4 studies, 759 women) were 0.81 (95% confidence interval (CI) 0.76 to 0.87) and 0.75 (95% CI 0.46 to 1.00). For IL-6, with a cut-off value of > 1.90 to 2.00 pg/ml (3 studies, 309 women), sensitivity was 0.63 (95% CI 0.52 to 0.75) and specificity was 0.69 (95% CI 0.57 to 0.82). For CA-19.9, with a cut-off value of > 37.0 IU/ml (3 studies, 330 women), sensitivity was 0.36 (95% CI 0.26 to 0.45) and specificity was 0.87 (95% CI 0.75 to 0.99).Studies assessed CA-125 at different thresholds, demonstrating the following mean sensitivities and specificities: for cut-off > 10.0 to 14.7 U/ml: 0.70 (95% CI 0.63 to 0.77) and 0.64 (95% CI 0.47 to 0.82); for cut-off > 16.0 to 17.6 U/ml: 0.56 (95% CI 0.24, 0.88) and 0.91 (95% CI 0.75, 1.00); for cut-off > 20.0 U/ml: 0.67 (95% CI 0.50 to 0.85) and 0.69 (95% CI 0.58 to 0.80); for cut-off > 25.0 to 26.0 U/ml: 0.73 (95% CI 0.67 to 0.79) and 0.70 (95% CI 0.63 to 0.77); for cut-off > 30.0 to 33.0 U/ml: 0.62 (95% CI 0.45 to 0.79) and 0.76 (95% CI 0.53 to 1.00); and for cut-off > 35.0 to 36.0 U/ml: 0.40 (95% CI 0.32 to 0.49) and 0.91 (95% CI 0.88 to 0.94).We could not statistically evaluate other biomarkers meaningfully, including biomarkers that were assessed for their ability to differentiate endometrioma from other benign ovarian cysts.Eighty-two studies evaluated 97 biomarkers that did not differentiate women with endometriosis from disease-free controls. Of these, 22 biomarkers demonstrated conflicting results, with some studies showing differential expression and others no evidence of a difference between the endometriosis and control groups. AUTHORS' CONCLUSIONS Of the biomarkers that were subjected to meta-analysis, none consistently met the criteria for a replacement or triage diagnostic test. A subset of blood biomarkers could prove useful either for detecting pelvic endometriosis or for differentiating ovarian endometrioma from other benign ovarian masses, but there was insufficient evidence to draw meaningful conclusions. Overall, none of the biomarkers displayed enough accuracy to be used clinically outside a research setting. We also identified blood biomarkers that demonstrated no diagnostic value in endometriosis and recommend focusing research resources on evaluating other more clinically useful biomarkers.
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Affiliation(s)
- Vicki Nisenblat
- The University of AdelaideDiscipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research InstituteLevel 6, Medical School North,Frome RdAdelaideSAAustralia5005
| | - Patrick MM Bossuyt
- Academic Medical Center, University of AmsterdamDepartment of Clinical Epidemiology, Biostatistics and BioinformaticsRoom J1b‐217, PO Box 22700AmsterdamNetherlands1100 DE
| | - Rabia Shaikh
- IVF AustraliaWestmead Fertility ClinicLevel 2 20‐22 Mons Road, WestmeadSydneyVictoriaAustralia2145
| | - Cindy Farquhar
- University of AucklandDepartment of Obstetrics and GynaecologyFMHS Park RoadGraftonAucklandNew Zealand1003
| | - Vanessa Jordan
- University of AucklandDepartment of Obstetrics and GynaecologyFMHS Park RoadGraftonAucklandNew Zealand1003
| | - Carola S Scheffers
- University of GroningenWenckebachlaan 53GroningenGroningenNetherlands9728 JL
| | - Ben Willem J Mol
- The University of AdelaideDiscipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research InstituteLevel 6, Medical School North,Frome RdAdelaideSAAustralia5005
| | - Neil Johnson
- The University of AdelaideDiscipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research InstituteLevel 6, Medical School North,Frome RdAdelaideSAAustralia5005
| | - M Louise Hull
- The University of AdelaideDiscipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research InstituteLevel 6, Medical School North,Frome RdAdelaideSAAustralia5005
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Guo SW, Du Y, Liu X. Platelet-derived TGF-β1 mediates the down-modulation of NKG2D expression and may be responsible for impaired natural killer (NK) cytotoxicity in women with endometriosis. Hum Reprod 2016; 31:1462-74. [PMID: 27130956 DOI: 10.1093/humrep/dew057] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/29/2016] [Indexed: 12/15/2022] Open
Abstract
STUDY QUESTION Does platelet-derived transforming growth factor-β1 (TGF-β1) have any role in the reduced cytotoxicity of natural killer (NK) cells in women with endometriosis? SUMMARY ANSWER Platelet-derived TGF-β1 suppresses the expression of NK Group 2, Member D (NKG2D) on NK cells, resulting in reduced cytotoxicity in women with endometriosis, but neutralization of TGF-β1 reverses the reduction. WHAT IS KNOWN ALREADY NK cells are cytotoxic lymphocytes that play an important role in peritoneal immune surveillance, and their function is known to be impaired in women with endometriosis. There is increased platelet aggregation in endometriotic lesions and increased platelet activation rate in the peripheral blood in women with endometriosis, yet activated platelets release copiousTGF-β1, which is known to be a potent immunosuppressive molecule that suppresses NK cell function and NKG2D expression. STUDY DESIGN, SIZE, DURATION Cross-sectional clinical studies of 30 women with endometriosis and 33 women without endometriosis and in vitro experimentation with and without TGF-β1 blockade. PARTICIPANTS/MATERIALS, SETTING, METHODS Peritoneal fluid (PF) samples from premenopausal women with endometriosis and age- and menstrual phase-matched controls were collected. Platelet count, white blood cell (WBC) count, mean platelet volume (MPV), platelet activation rate, TGF-β1 concentration, expression levels of NKG2D on NK cells in the PF were evaluated. The apoptosis of freshly isolated NK cells treated with PF from women with endometriosis, the NK cytotoxicity and NKG2D expression treated with PF in the presence or absence of an anti-TGF-β1 antibody were also determined. MAIN RESULTS AND THE ROLE OF CHANCE The platelet count, WBC count, MPV, platelet activation rate and the TGF-β1 concentration in the PF from women with endometriosis were significantly elevated when compared with those of women without endometriosis. The TGF-β1 concentration correlated positively with the platelet activation rate (r = 0.59, P < 0.01), suggesting that activated platelets are responsible, at least in part, for the increased TGF-β1 concentration. The cytotoxicity of freshly isolated NK cells treated with PF of women with endometriosis is significantly reduced when compared with that of women without endometriosis. Both the platelet activation rate and the TGF-β1 concentration in the PF correlated negatively with the NKG2D expression in NK cells isolated from the PF (r = -0.36, P < 0.01, and r = -0.45, P < 0.01, respectively). In addition, the NKG2D expression level and the cytotoxicity in freshly isolated NK cells were found to be significantly reduced if co-cultured with PF from women with endometriosis, but the TGF-β1 blockade effectively reverses the reduction. LIMITATIONS, REASONS FOR CAUTION This study is limited by the cross-sectional nature of the study. WIDER IMPLICATIONS OF THE FINDINGS NKG2D is known to potently activate NK cells, so potent that it even overrides inhibitory signals transduced by other inhibitory receptors. This is the first time we demonstrate that platelet-derived TGF-β1 may be responsible for reduced NKG2D expression as well as reduced cytotoxicity of NK cells in women with endometriosis. This study provides yet another piece of evidence that platelets play critical roles in the development of endometriosis, and anti-platelet treatment should improve NK cell functionality in treating endometriosis. Equally important, this study highlights the critical role of the lesion microenvironment in shaping NK cell-mediated anti-endometriotic immunity. STUDY FUNDING/COMPETING INTERESTS This research was supported in part by grants 81270676 (S.-W.G.), 81471434 (S.-W.G.), 81530040 (S.-W.G.), and 81370695 (X.L.) from the National Natural Science Foundation of China, and grant 2013ZYJB0019 (X.L.) from Shanghai Municipal Commission of Health and Family Planning. None of the authors has anything to disclose.
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Affiliation(s)
- Sun-Wei Guo
- Shanghai Obstetrics and Gynecology Hospital, Fudan University, 419 Fangxie Road, Shanghai 200011, China Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China
| | - Yanbo Du
- Shanghai Obstetrics and Gynecology Hospital, Fudan University, 419 Fangxie Road, Shanghai 200011, China
| | - Xishi Liu
- Shanghai Obstetrics and Gynecology Hospital, Fudan University, 419 Fangxie Road, Shanghai 200011, China Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China
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Guo SW, Du Y, Liu X. Endometriosis-Derived Stromal Cells Secrete Thrombin and Thromboxane A2, Inducing Platelet Activation. Reprod Sci 2016; 23:1044-52. [PMID: 26902428 DOI: 10.1177/1933719116630428] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Platelets have been recently revealed to play important roles in the development of endometriosis. However, it is unclear whether endometriotic lesions can secrete any platelet inducers outside the menstruation window. Hence, this study was undertaken to see whether endometriosis-derived stromal cells secrete platelet activators and cause platelet activation. We employed in vitro experimentation using primary ectopic endometrial stromal cells (EESCs) and platelets from healthy male volunteers and evaluated the extent of platelet aggregation by aggregometer and the platelet activation rate by flow cytometry using supernatants harvested from EESCs of different cell densities. We also measured the concentration of thromboxane B2 (TXB2), a metabolite of thromboxane A2 (TXA2), and thrombin activity in supernatants harvested from EESCs of different densities and evaluated the extent of platelet aggregation after treatment of EESCs with hirudin, Ozagrel, and apyrase. Finally, the concentration of TXB2, thrombin, and transforming growth factor β1 (TGF-β1) in platelets cocultured with different densities of EESCs is measured by enzyme-linked immunosorbent assay. We found that EESCs secrete thrombin and TXA2 and induce platelet activation and aggregation in a density-dependent fashion. Treatment of platelets with EESCs resulted in increased concentration of TXB2, thrombin, and TGF-β1 in a density-dependent manner. Treatment of EESCs with hirudin and Ozagrel, but not apyrase, resulted in significant suppression of platelet aggregation. Thus, given recently reported effects of activated platelets on the cell behaviors of EESCs and endometriotic lesions in general, our findings establish that endometriotic lesions and platelets engage active cross-talks in the development of endometriosis, highlighting the importance of lesion microenvironment in endometriosis.
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Affiliation(s)
- Sun-Wei Guo
- Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Yanbo Du
- Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai, China
| | - Xishi Liu
- Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
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Tokmak A, Yildirim G, Öztaş E, Akar S, Erkenekli K, Gülşen P, Yilmaz N, Uğur M. Use of Neutrophil-to-Lymphocyte Ratio Combined With CA-125 to Distinguish Endometriomas From Other Benign Ovarian Cysts. Reprod Sci 2015; 23:795-802. [DOI: 10.1177/1933719115620494] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Aytekin Tokmak
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Gulçin Yildirim
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Efser Öztaş
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Serra Akar
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Kudret Erkenekli
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Pınar Gülşen
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Nafiye Yilmaz
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Mustafa Uğur
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
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31
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The Relationship Between Inflammatory Marker Levels and Pulmonary Tuberculosis Severity. Inflammation 2014; 38:691-6. [DOI: 10.1007/s10753-014-9978-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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