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Khashchenko EP, Vysokikh MY, Marey MV, Sidorova KO, Manukhova LA, Shkavro NN, Uvarova EV, Chuprynin VD, Fatkhudinov TK, Adamyan LV, Sukhikh GT. Altered Glycolysis, Mitochondrial Biogenesis, Autophagy and Apoptosis in Peritoneal Endometriosis in Adolescents. Int J Mol Sci 2024; 25:4238. [PMID: 38673823 PMCID: PMC11050237 DOI: 10.3390/ijms25084238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Energy metabolism plays a pivotal role in the pathogenesis of endometriosis. For the initial stages of the disease in adolescents, this aspect remains unexplored. The objective of this paper was to analyze the association of cellular and endosomal profiles of markers of glycolysis, mitochondrial biogenesis, apoptosis, autophagy and estrogen signaling in peritoneal endometriosis (PE) in adolescents. We included 60 girls aged 13-17 years in a case-control study: 45 with laparoscopically confirmed PE (main group) and 15 with paramesonephric cysts (comparison group). Samples of plasma and peritoneal fluid exosomes, endometrioid foci and non-affected peritoneum were tested for estrogen receptor (Erα/β), hexokinase (Hex2), pyruvate dehydrogenase kinase (PDK1), glucose transporter (Glut1), monocarboxylate transporters (MCT1 and MCT2), optic atrophy 1 (OPA1, mitochondrial fusion protein), dynamin-related protein 1 (DRP1, mitochondrial fission protein), Bax, Bcl2, Beclin1, Bnip3, P38 mitogen-activated protein kinase (MAPK), hypoxia-inducible factor 1 (Hif-1α), mitochondrial voltage-dependent anion channel (VDAC) and transforming growth factor (TGFβ) proteins as markers of estrogen signaling, glycolysis rates, mitochondrial biogenesis and damage, apoptosis and autophagy (Western-Blot and PCR). The analysis identified higher levels of molecules associated with proliferation (ERβ), glycolysis (MCT2, PDK1, Glut1, Hex2, TGFβ and Hif-1α), mitochondrial biogenesis (OPA1, DRP1) and autophagy (P38, Beclin1 and Bnip3) and decreased levels of apoptosis markers (Bcl2/Bax) in endometrioid foci compared to non-affected peritoneum and that in the comparison group (p < 0.05). Patients with PE had altered profiles of ERβ in plasma and peritoneal fluid exosomes and higher levels of Glut1, MCT2 and Bnip3 in plasma exosomes (p < 0.05). The results of the differential expression profiles indicate microenvironment modification, mitochondrial biogenesis, estrogen reception activation and glycolytic switch along with apoptosis suppression in peritoneal endometrioid foci already in adolescents.
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Affiliation(s)
- Elena P. Khashchenko
- FSBI “National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov”, Ministry of Healthcare of the Russian Federation, 4, Oparina Str., 117997 Moscow, Russia; (M.Y.V.); (M.V.M.); (L.A.M.); (N.N.S.); (E.V.U.); (V.D.C.); (T.K.F.)
| | - Mikhail Yu. Vysokikh
- FSBI “National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov”, Ministry of Healthcare of the Russian Federation, 4, Oparina Str., 117997 Moscow, Russia; (M.Y.V.); (M.V.M.); (L.A.M.); (N.N.S.); (E.V.U.); (V.D.C.); (T.K.F.)
- A.N. Belozersky Research Institute of Physico-Chemical Biology MSU, Leninskye Gory, House 1, Building 40, 119992 Moscow, Russia
| | - Maria V. Marey
- FSBI “National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov”, Ministry of Healthcare of the Russian Federation, 4, Oparina Str., 117997 Moscow, Russia; (M.Y.V.); (M.V.M.); (L.A.M.); (N.N.S.); (E.V.U.); (V.D.C.); (T.K.F.)
| | - Ksenia O. Sidorova
- Faculty of Medicine and Biology, Pirogov Russian National Research Medical University, 1 Ostrovityanova Str., 117997 Moscow, Russia;
| | - Ludmila A. Manukhova
- FSBI “National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov”, Ministry of Healthcare of the Russian Federation, 4, Oparina Str., 117997 Moscow, Russia; (M.Y.V.); (M.V.M.); (L.A.M.); (N.N.S.); (E.V.U.); (V.D.C.); (T.K.F.)
| | - Natalya N. Shkavro
- FSBI “National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov”, Ministry of Healthcare of the Russian Federation, 4, Oparina Str., 117997 Moscow, Russia; (M.Y.V.); (M.V.M.); (L.A.M.); (N.N.S.); (E.V.U.); (V.D.C.); (T.K.F.)
| | - Elena V. Uvarova
- FSBI “National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov”, Ministry of Healthcare of the Russian Federation, 4, Oparina Str., 117997 Moscow, Russia; (M.Y.V.); (M.V.M.); (L.A.M.); (N.N.S.); (E.V.U.); (V.D.C.); (T.K.F.)
- Department for Obstetrics, Gynecology, Perinatology and Reproduction, Sechenov First Moscow State Medical University, Trubetskaya Str. 8, Bld. 2, 119991 Moscow, Russia
| | - Vladimir D. Chuprynin
- FSBI “National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov”, Ministry of Healthcare of the Russian Federation, 4, Oparina Str., 117997 Moscow, Russia; (M.Y.V.); (M.V.M.); (L.A.M.); (N.N.S.); (E.V.U.); (V.D.C.); (T.K.F.)
| | - Timur Kh. Fatkhudinov
- FSBI “National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov”, Ministry of Healthcare of the Russian Federation, 4, Oparina Str., 117997 Moscow, Russia; (M.Y.V.); (M.V.M.); (L.A.M.); (N.N.S.); (E.V.U.); (V.D.C.); (T.K.F.)
- Department of Histology, Cytology and Embryology, Peoples’ Friendship University of Russia (RUDN), Miklukho-Maklaya Str. 6, 117997 Moscow, Russia
| | - Leila V. Adamyan
- FSBI “National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov”, Ministry of Healthcare of the Russian Federation, 4, Oparina Str., 117997 Moscow, Russia; (M.Y.V.); (M.V.M.); (L.A.M.); (N.N.S.); (E.V.U.); (V.D.C.); (T.K.F.)
| | - Gennady T. Sukhikh
- FSBI “National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov”, Ministry of Healthcare of the Russian Federation, 4, Oparina Str., 117997 Moscow, Russia; (M.Y.V.); (M.V.M.); (L.A.M.); (N.N.S.); (E.V.U.); (V.D.C.); (T.K.F.)
- Department for Obstetrics, Gynecology, Perinatology and Reproduction, Sechenov First Moscow State Medical University, Trubetskaya Str. 8, Bld. 2, 119991 Moscow, Russia
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Nielsen LJ, Poulsen K, Funch AL, Petersen KS. The lived experiences of endometriosis in adolescence-A critical hermeneutic perspective. Scand J Caring Sci 2023; 37:1038-1047. [PMID: 37211900 DOI: 10.1111/scs.13176] [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: 10/31/2022] [Revised: 03/28/2023] [Accepted: 04/16/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Endometriosis is a condition that worldwide affects 10% of all women of childbearing age. Despite the large prevalence, it takes 4-11 years from the first onset of symptoms until the time of diagnosis, and the majority experience symptoms debut in adolescence. Endometriosis affects women's lives both physically, psychologically, socially and a lack of recognition from society causes the pain the women experience to be neglected, hidden and normalised. Preventative measures targeting endometriosis in adolescence are limited and there is a need to change the way these symptoms are viewed and affected by society at large. AIM The aim of this qualitative study was to explore the lived experiences of endometriosis in adolescence and the social reactions impact on the illness experience and quality of life. METHOD With a critical hermeneutic approach, individual interviews were conducted with women diagnosed with endometriosis. The analysis and interpretation were conducted inspired by Pedersen and Dreyer's (2018) method which is based on Ricoeur's critical theory. RESULTS The structural analysis shows that women experience a struggle for recognition of symptoms from their immediate surroundings including family, friends, schools and health professionals, as symptoms considered linked to menstruation are deemed to be normal for women to experience. The women's narratives are characterised into a before and after diagnosis. Therefore, the diagnosis is found to be important for the meaning that the women attach to their experiences in adolescence. CONCLUSION Social experiences have a substantial impact on women's illness experience and quality of life and affect how women perceive themselves and their symptoms. Through interventions at the social level, it might be possible to change the existing societal discourses surrounding women's menstruation pain to raise the awareness of endometriosis.
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Affiliation(s)
- Liv Juul Nielsen
- Department of Public Health, Aarhus University, Aarhus C, Denmark
- Public Health and Epidemiology Group, Department of Health Science and Technology Aalborg University, Aalborg East, Denmark
| | - Katja Poulsen
- Public Health and Epidemiology Group, Department of Health Science and Technology Aalborg University, Aalborg East, Denmark
| | - Anders Lundme Funch
- Public Health and Epidemiology Group, Department of Health Science and Technology Aalborg University, Aalborg East, Denmark
| | - Kirsten Schultz Petersen
- Public Health and Epidemiology Group, Department of Health Science and Technology Aalborg University, Aalborg East, Denmark
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Wüest A, Limacher JM, Dingeldein I, Siegenthaler F, Vaineau C, Wilhelm I, Mueller MD, Imboden S. Pain Levels of Women Diagnosed with Endometriosis: Is There a Difference in Younger Women? J Pediatr Adolesc Gynecol 2023; 36:140-147. [PMID: 36343859 DOI: 10.1016/j.jpag.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
STUDY OBJECTIVE Early diagnosis and treatment of endometriosis affecting adolescent women are important in preventing chronic pain. Our aim was to analyze the clinical characteristics and severity of symptoms in adolescent patients with endometriosis compared with older patients. METHODS This single-center retrospective cohort study in a tertiary referral hospital analyzed women whose first consultation at the certified endometriosis center of Bern University Hospital between January 2017 and December 2020 resulted in the clinical diagnosis of endometriosis. Patients, divided into 2 groups by age, reported visual analog scale (VAS) scores for noncyclic pelvic pain, dysmenorrhea, dyschezia, dysuria, and dyspareunia. The symptom types and severity in the 2 groups were compared. The young patients with endometriosis were analyzed in greater detail, comparing VAS scores and types of endometriosis. RESULTS From a total of 826 patients, 144 (17.4%) patients 24 years old or younger and 682 (82.6%) patients over 24 years old were compared. The younger patients reported significantly higher pain scores for dysmenorrhea (VAS 7.3 vs 6.6; P = .015), dyspareunia (VAS 4.6 vs 3.4; P = .001), and noncyclic pelvic pain (VAS 4.3 vs 3.7; P = .032) compared with the older patient collective. Similar results were found when excluding patients with hormonal treatment. CONCLUSION Young patients with clinically diagnosed endometriosis have significantly higher dysmenorrhea and dyspareunia pain levels than older patients. By acknowledging and understanding this, early diagnosis and adequate treatment can be promoted. Dyspareunia in adolescents in particular merits clinical attention.
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Affiliation(s)
- A Wüest
- Department of Gynecology and Obstetrics, Bern University Hospital and the University of Bern, Bern, Switzerland
| | - J M Limacher
- Department of Gynecology and Obstetrics, Bern University Hospital and the University of Bern, Bern, Switzerland
| | - I Dingeldein
- Department of Gynecology and Obstetrics, Bern University Hospital and the University of Bern, Bern, Switzerland
| | - F Siegenthaler
- Department of Gynecology and Obstetrics, Bern University Hospital and the University of Bern, Bern, Switzerland
| | - C Vaineau
- Department of Gynecology and Obstetrics, Bern University Hospital and the University of Bern, Bern, Switzerland
| | - I Wilhelm
- Department of Anesthesiology and Pain Medicine, Bern University Hospital and the University of Bern, Bern, Switzerland
| | - M D Mueller
- Department of Gynecology and Obstetrics, Bern University Hospital and the University of Bern, Bern, Switzerland
| | - S Imboden
- Department of Gynecology and Obstetrics, Bern University Hospital and the University of Bern, Bern, Switzerland.
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Endometriosis in Adolescents: Diagnostics, Clinical and Laparoscopic Features. J Clin Med 2023; 12:jcm12041678. [PMID: 36836214 PMCID: PMC9962715 DOI: 10.3390/jcm12041678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The early diagnosis of endometriosis in adolescents is not developed. OBJECTIVE We aim to conduct clinical, imaging, laparoscopic and histological analyses of peritoneal endometriosis (PE) in adolescents in order to improve early diagnosis. METHODS In total, 134 girls (from menarche to 17 years old) were included in a case-control study: 90 with laparoscopically (LS) confirmed PE, 44 healthy controls underwent full examination and LS was analyzed in the PE group. RESULTS Patients with PE were characterized with heredity for endometriosis, persistent dysmenorrhea, decreased daily activity, gastrointestinal symptoms, higher LH, estradiol, prolactin and Ca-125 (<0.05 for each). Ultrasound detected PE in 3.3% and MRI in 78.9%. The most essential MRI signs are as follows: hypointense foci, the heterogeneity of the pelvic tissue (paraovarian, parametrial and rectouterine pouch) and sacro-uterine ligaments lesions (<0.05 for each). Adolescents with PE mostly exhibit initial rASRM stages. Red implants correlated with the rASRM score, and sheer implants correlated with pain (VAS score) (<0.05). In 32.2%, foci consisted of fibrous, adipose and muscle tissue; black lesions were more likely to be histologically verified (0.001). CONCLUSION Adolescents exhibit mostly initial PE stages, which are associated with greater pain. Persistent dysmenorrhea and detected MRI parameters predict the laparoscopic confirmation of initial PE in adolescents in 84.3% (OR 15.4; <0.01), justifying the early surgical diagnostics and shortening the time delay and suffering of the young patients.
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Dixon S, Ranger TA, Burchardt J, Patone M, Snelling AJ, Vincent K, Hippisley-Cox J. Exploring the interface between adolescent dysmenorrhoea and endometriosis: a protocol for a cohort and nested case-control study within the QResearch Database. BMJ Open 2023; 13:e069984. [PMID: 36787972 PMCID: PMC9930556 DOI: 10.1136/bmjopen-2022-069984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Dysmenorrhoea affects up to 70%-91% of adolescents who menstruate, with approximately one-third experiencing severe symptoms with impacts on education, work and leisure. Dysmenorrhoea can occur without identifiable pathology, but can indicate underlying conditions, including congenital genital tract anomalies or endometriosis. There is a need for evidence about the management and incidence of dysmenorrhoea in primary care, the impact of treatments in adolescence on long-term outcomes and when to consider the possibility of endometriosis in adolescence. METHODS AND ANALYSIS This study aims to improve the evidence base for adolescents presenting to primary care with dysmenorrhoea. It comprises three interlinked studies. Using the QResearch Database, the study population includes all female at birth participants aged 10-19 years any time between 1 January 2000 and 30 June 2021. We will undertake (1) a descriptive study documenting the prevalence of coded dysmenorrhoea in primary care, stratified by demographic variables, reported using descriptive statistics; (2) a prospective open cohort study following an index cohort of all adolescents recorded as attending primary care with dysmenorrhoea and a comparator cohort of five times as many who have not, to determine the HR for a diagnosis of endometriosis, adenomyosis, ongoing menstrual pain or subfertility (considered singly and in combination) anytime during the study period; and (3) a nested case-control study for adolescents diagnosed with endometriosis, using conditional logistic regression, to determine the OR for symptom(s) preceding this diagnosis. ETHICS AND DISSEMINATION The project has been independently peer reviewed and received ethics approval from the QResearch Scientific Board (reference OX46 under REC 18/EM/0400).In addition to publication in peer-reviewed academic journals, we will use the combined findings to generate a resource and infographic to support shared decision-making about dysmenorrhoea in community health settings. Additionally, the findings will be used to inform a subsequent qualitative study, exploring adolescents' experiences of menstrual pain.
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Affiliation(s)
- Sharon Dixon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tom A Ranger
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Judith Burchardt
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Martina Patone
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrew Jhl Snelling
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health, Oxford University, Oxford, UK
| | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Duane M, Stanford JB, Porucznik CA, Vigil P. Fertility Awareness-Based Methods for Women's Health and Family Planning. Front Med (Lausanne) 2022; 9:858977. [PMID: 35685421 PMCID: PMC9171018 DOI: 10.3389/fmed.2022.858977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Fertility awareness-based methods (FABMs) educate about reproductive health and enable tracking and interpretation of physical signs, such as cervical fluid secretions and basal body temperature, which reflect the hormonal changes women experience on a cyclical basis during the years of ovarian activity. Some methods measure relevant hormone levels directly. Most FABMs allow women to identify ovulation and track this "vital sign" of the menstrual or female reproductive cycle, through daily observations recorded on cycle charts (paper or electronic). Applications Physicians can use the information from FABM charts to guide the diagnosis and management of medical conditions and to support or restore healthy function of the reproductive and endocrine systems, using a restorative reproductive medical (RRM) approach. FABMs can also be used by couples to achieve or avoid pregnancy and may be most effective when taught by a trained instructor. Challenges Information about individual FABMs is rarely provided in medical education. Outdated information is widespread both in training programs and in the public sphere. Obtaining accurate information about FABMs is further complicated by the numerous period tracking or fertility apps available, because very few of these apps have evidence to support their effectiveness for identifying the fertile window, for achieving or preventing pregnancy. Conclusions This article provides an overview of different types of FABMs with a published evidence base, apps and resources for learning and using FABMs, the role FABMs can play in medical evaluation and management, and the effectiveness of FABMs for family planning, both to achieve or to avoid pregnancy.
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Affiliation(s)
- Marguerite Duane
- Department of Family Medicine, Georgetown University, Washington, DC, United States.,Fertility Appreciation Collaborative to Teach the Science (FACTS), Washington, DC, United States.,Office of Cooperative Reproductive Health, Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, United States
| | - Joseph B Stanford
- Office of Cooperative Reproductive Health, Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, United States
| | - Christina A Porucznik
- Office of Cooperative Reproductive Health, Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, United States
| | - Pilar Vigil
- Reproductive Health Research Institute (RHRI), New York, NY, United States
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Parker MA, Kent AL, Sneddon A, Wang J, Shadbolt B. The Menstrual Disorder of Teenagers (MDOT) Study No. 2: Period ImPact and Pain Assessment (PIPPA) Tool Validation in a Large Population-Based Cross-Sectional Study of Australian Teenagers. J Pediatr Adolesc Gynecol 2022; 35:30-38. [PMID: 34171477 DOI: 10.1016/j.jpag.2021.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/09/2021] [Accepted: 06/03/2021] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To validate the Period ImPact and Pain Assessment (PIPPA) self-screening tool for menstrual disturbance in teenagers. DESIGN Cross-sectional study. SETTING Three senior high schools in the Australian Capital Territory (ACT), Australia. PARTICIPANTS A total of 1066 girls between 15 and 19 years of age. INTERVENTIONS AND MAIN OUTCOME MEASURES A quantitative paper survey collected self-reports of menstrual bleeding patterns, typical and atypical symptoms, morbidities, and interference with daily activities. Multiple correspondence analysis was used to examine associations between PIPPA questions. Generalized linear models compared total score and subscores by validation criteria: pain, school absence, and body mass index (BMI). Receiver operating characteristic curves were used to evaluate the predictiveness of menstrual disturbance indicators by total PIPPA score. RESULTS Reports of pain, interference, and concern within the PIPPA items and between both the MDOT and PIPPA questionnaires were significantly correlated (P < .0001). The indicator "missing school" was highly associated (P < .0001) with pain and interference. Obesity (BMI ≥30) was associated with higher PIPPA scores, as was underweight (BMI≤18.4). Where 0 = no disturbance, 5 = high disturbance, aggregated PIPPA scores found 75% scoring 0-2 (out of 5) and 25% scoring 3-5 (257/1037). High scores of 4 or 5 (out of 5) were 7% (72/1037) and 3.7% (38/1037), respectively. CONCLUSION PIPPA is a valid screening tool for pain-related menstrual disturbance that affects functioning in young women. PIPPA subdomains of pain/interference have good validity relative to indicators of pain and interference and are responsive to age, BMI, and school absence differences.
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Affiliation(s)
- M A Parker
- Canberra Endometriosis Centre, Department of Obstetrics and Gynaecology, ACT Health, Canberra, ACT, Australia.
| | - A L Kent
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, New York; Australian National University, College of Health and Medicine, Canberra, ACT, Australia
| | - A Sneddon
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - J Wang
- Ocular Genomics Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - B Shadbolt
- ACT Centre for Health and Medical Research, ACT Health, Canberra, ACT, Australia
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Fan X, Duan K, Zhang C, Guan X. Feasibility of two robotic single-site surgery techniques for adolescent endometriosis: Focal versus butterfly. Int J Med Robot 2021; 18:e2339. [PMID: 34661960 DOI: 10.1002/rcs.2339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/24/2021] [Accepted: 10/08/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study examined the feasibility of robotic laparoendoscopic single-site surgery (LESS) for the treatment of adolescent endometriosis (n = 36). Additionally, we assessed a novel technique known as butterfly resection for severe cases. METHODS This was a retrospective study of women from 12 to 21 years old who received therapeutic robotic LESS for symptomatic endometriosis by a single experienced surgeon. RESULTS There were 32 cases of peritoneal and four cases of deep infiltrating endometriosis (DIE). Focal resection was performed in 9/32 peritoneal and all DIE cases; butterfly resection was performed in the remaining 23/32 peritoneal. At 3 months, 16/23 had complete resolution of pelvic pain in the butterfly group versus 10/13 in the focal group (P = 0.64). CONCLUSION Robotic LESS produces safe outcomes with low complication rates. Butterfly resection may be considered for extensive lesions, with similar levels of pain relief compared to traditional focal resection techniques. CAPSULE Single-site robotic surgery produces safe outcomes with low complication rates in adolescents with endometriosis, with techniques customized based on disease severity.
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Affiliation(s)
- Xiaodong Fan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.,Tianjin Central Hospital of Gynecology Obstetrics Affiliated Hospital of Nankai University, Tianjin, China
| | - Kristina Duan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Chunhua Zhang
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.,Department of Obstetrics and Gynecology, Huai'an Maternity and Child Healthcare Hospital Affiliated to Yangzhou Medical University, Jiangshu, China
| | - Xiaoming Guan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
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9
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Yeung P, Sinervo K, Orbuch I. Regarding Surgical Management of Superficial Peritoneal Adolescent Endometriosis by Laufer and Einarsson. J Pediatr Adolesc Gynecol 2021; 34:238. [PMID: 33253863 DOI: 10.1016/j.jpag.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/10/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Patrick Yeung
- Obstetrics, Gynecology and Women's Health, Saint Louis University, Sunset Hills, Missouri.
| | | | - Iris Orbuch
- Advanced Gynecologic Laparoscopy Center, Los Angeles, CA
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10
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Birnie KA, Ouellette C, Do Amaral T, Stinson JN. Mapping the evidence and gaps of interventions for pediatric chronic pain to inform policy, research, and practice: A systematic review and quality assessment of systematic reviews. Can J Pain 2020; 4:129-148. [PMID: 33987493 PMCID: PMC7951164 DOI: 10.1080/24740527.2020.1757384] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/09/2020] [Accepted: 04/15/2020] [Indexed: 12/17/2022]
Abstract
Background: Reviews in pediatric chronic pain often focus on only one intervention or population, making it difficult for policymakers and decision makers to quickly synthesize knowledge to inform larger-scale policy and funding priorities. Aims: The aims of this study were to (1) create an evidence and gap map of interventions for pediatric chronic pain and (2) identify gaps between existing evidence and recently identified patient-oriented research priorities. Methods: We performed a systematic review of English-language peer-reviewed systematic reviews or clinical practice guidelines of pediatric chronic pain intervention published in the past 20 years. Database searches of Medline, Embase, PsycINFO, Web of Science, CINAHL, and SCOPUS were conducted inclusive to June 3, 2019. Review quality was assessed using the AMSTAR-2. Results: Of 4168 unique abstracts, 50 systematic reviews (including 2 clinical practice guidelines) crossing diverse pediatric chronic pain populations and intervention settings were included. One third were rated high quality, with half rated low to critically low quality. The largest proportion of reviews addressed psychological and pharmacological interventions, followed by interdisciplinary, other (e.g., dietary), and physical interventions. Most common outcomes included pain, physical, emotional, and role functioning and quality of life. Treatment satisfaction and adverse events were less common, with minimal report of sleep or economic factors. Most patient-oriented research priorities had not been investigated. Conclusions: Sufficient quality evidence is available to guide evidence-informed policies in pediatric chronic pain, most notably regarding psychological and pharmacological interventions. Numerous evidence gaps in patient-oriented research priorities and treatment outcomes should guide prioritization of research funds, as well as study aims and design.
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Affiliation(s)
- Kathryn A. Birnie
- Department of Anesthesiology, Perioperative and Pain Medicine, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Carley Ouellette
- Faculty of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Tamara Do Amaral
- Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Jennifer N. Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Sieberg CB, Lunde CE, Borsook D. Endometriosis and pain in the adolescent- striking early to limit suffering: A narrative review. Neurosci Biobehav Rev 2019; 108:866-876. [PMID: 31862211 DOI: 10.1016/j.neubiorev.2019.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 12/17/2022]
Abstract
Endometriosis, a condition in which uterine tissue grows outside the uterus, is a debilitating disease, affecting millions of women and costing the United States approximately $78 billion annually in pain- related disability. It is also the leading cause of chronic pelvic pain (CPP), which is often unresponsive to existing treatments. Adolescent women with the disease are at particular risk as there are often significant diagnostic delays, which in turn can exacerbate pain. Research and treatment guidelines for adolescents with endometriosis are largely based on studies for adult women due to the limited number of studies focusing on adolescents. The current paper critically reviews the literature as it pertains to endometriosis pathophysiology, mechanisms contributing to CPP, and treatment implications and recommendations with a focus on gaps related to adolescents.
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Affiliation(s)
- Christine B Sieberg
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, USA; Biobehavioral Pediatric Pain Lab, Department of Psychiatry, Boston Children's Hospital, USA; Department of Psychiatry, Harvard Medical School, USA; Department of Anesthesiology, Harvard Medical School, USA.
| | - Claire E Lunde
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, USA; Biobehavioral Pediatric Pain Lab, Department of Psychiatry, Boston Children's Hospital, USA; Nuffield Department of Women's and Reproductive Health, Medical Sciences Division, University of Oxford, UK
| | - David Borsook
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, USA; Department of Anesthesiology, Harvard Medical School, USA
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As-Sanie S, Black R, Giudice LC, Gray Valbrun T, Gupta J, Jones B, Laufer MR, Milspaw AT, Missmer SA, Norman A, Taylor RN, Wallace K, Williams Z, Yong PJ, Nebel RA. Assessing research gaps and unmet needs in endometriosis. Am J Obstet Gynecol 2019; 221:86-94. [PMID: 30790565 DOI: 10.1016/j.ajog.2019.02.033] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/11/2019] [Accepted: 02/14/2019] [Indexed: 12/29/2022]
Abstract
Endometriosis, a systemic disease that is often painful and chronic, affects ∼10% of reproductive-age women. The disease can have a negative impact on a patient's physical and emotional well-being, quality of life, and productivity. Endometriosis also places significant economic and social burden on patients, their families, and society as a whole. Despite its high prevalence and cost, endometriosis remains underfunded and underresearched, greatly limiting our understanding of the disease and slowing much-needed innovation in diagnostic and treatment options. Due in part to the societal normalization of women's pain and stigma around menstrual issues, there is also a lack of disease awareness among patients, health care providers, and the public. The Society for Women's Health Research convened an interdisciplinary group of expert researchers, clinicians, and patients for a roundtable meeting to review the current state of the science on endometriosis and identify areas of need to improve a woman's diagnosis, treatment, and access to quality care. Comprehensive and interdisciplinary approaches to disease management and increased education and disease awareness for patients, health care providers, and the public are needed to remove stigma, increase timely and accurate diagnosis and treatment, and allow for new advancements.
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