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Slayden O, Luo F, Park Y, Moses AS, Demessie AA, Singh P, Korzun T, Taratula O, Taratula O. Targeted nanoparticles for imaging and therapy of endometriosis†. Biol Reprod 2024; 110:1191-1200. [PMID: 38738758 PMCID: PMC11180615 DOI: 10.1093/biolre/ioae073] [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: 02/29/2024] [Revised: 05/01/2024] [Accepted: 05/10/2024] [Indexed: 05/14/2024] Open
Abstract
In this brief review, we discuss our efforts to validate nanoplatforms for imaging and treatment of endometriosis. We specifically highlight our use of nonhuman primates and primate tissues in this effort. Endometriosis is a painful disorder of women and nonhuman primates where endometrium-like tissue exists outside of the uterus. There are no reliable, specific, and noninvasive diagnostic tests for endometriosis. Laparoscopic imaging remains the gold standard for identifying small endometriotic lesions in both women and monkeys. Visualizing and surgically removing microscopic lesions remains a clinical challenge. To address this challenge, we have created nanoparticle reagents that, when administered intravenously, enter endometriotic lesions both passively and by targeting endometriotic cells. The particles can carry payloads, including near-infrared fluorescent dyes and magnetic nanoparticles. These agents can be used for imaging and thermal ablation of diseased tissues. We evaluated this approach on macaque endometriotic cells, human and macaque endometrium engrafted into immunodeficient mice, in endometrium subcutaneously autografted in macaques, and in rhesus monkeys with spontaneous endometriosis. Employing these models, we report that nanoplatform-based reagents can improve imaging and provide thermal ablation of endometriotic tissues.
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Affiliation(s)
- Ov Slayden
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Fangzhou Luo
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Youngrong Park
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, USA
| | - Abraham S Moses
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, USA
| | - Ananiya A Demessie
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, USA
| | - Prem Singh
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, USA
| | - Tetiana Korzun
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, USA
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Olena Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, USA
| | - Oleh Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, USA
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Alboni C, Melegari S, Camacho Mattos L, Farulla A. Effects of osteopathic manipulative therapy on recurrent pelvic pain and dyspareunia in women after surgery for endometriosis: a retrospective study. Minerva Obstet Gynecol 2024; 76:264-271. [PMID: 37997320 DOI: 10.23736/s2724-606x.23.05351-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
BACKGROUND Surgical removal of deep infiltrating endometriosis is frequently associated with improvement in symptoms. However, because of the complex pathogenesis of pain in endometriosis that includes central sensitization and myofascial dysfunction, symptoms can persist after surgery. The aim of the present observational study is to explore the effectiveness of osteopathic manipulative treatment (OMT) in reducing persistent pelvic pain and dyspareunia in a sample of symptomatic women surgically treated for endometriosis. METHODS Retrospective cohort analysis of 69 patients treated with OMT, for persistent myofascial pain, chronic pelvic pain (CPP) and dyspareunia after surgical eradication of endometriosis. Surgical, clinical and osteopathic reports were retrospectively analyzed in a chart review. Osteopathic interventions included myofascial release, balanced ligamentous/membranous tension and indirect fluidic technique. RESULTS During the study period 345 patients underwent surgery for symptomatic endometriosis. Among them, 97 patients (28.1%) complained of post-operative persistent CPP and dyspareunia and 69 patients underwent osteopathic treatment. OMT reports showed a significant improvement of the symptoms after the first OMT session. Particularly, lower scores of CPP (mean NRS 4±4.2 vs. 0.2±0.7, P value. CONCLUSIONS OMT, breaking the cycle of pain and normalizing the musculoskeletal pelvic activity, could be a successful technique to treat persistent chronic pain in women surgically treated for endometriosis.
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Affiliation(s)
- Carlo Alboni
- Unit of Minimally Invasive and Robotic Gynecologic Surgery, University Hospital of Modena, Modena, Italy
| | | | - Ludovica Camacho Mattos
- Unit of Minimally Invasive and Robotic Gynecologic Surgery, University Hospital of Modena, Modena, Italy
| | - Antonino Farulla
- Unit of Minimally Invasive and Robotic Gynecologic Surgery, University Hospital of Modena, Modena, Italy -
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Kunow A, Freyer Martins Pereira J, Chenot JF. Extravertebral low back pain: a scoping review. BMC Musculoskelet Disord 2024; 25:363. [PMID: 38714994 PMCID: PMC11075250 DOI: 10.1186/s12891-024-07435-9] [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] [Received: 12/24/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is one of the most common reasons for consultation in general practice. Currently, LBP is categorised into specific and non-specific causes. However, extravertebral causes, such as abdominal aortic aneurysm or pancreatitis, are not being considered. METHODS A systematic literature search was performed across MEDLINE, Embase, and the Cochrane library, complemented by a handsearch. Studies conducted between 1 January 2001 and 31 December 2020, where LBP was the main symptom, were included. RESULTS The literature search identified 6040 studies, from which duplicates were removed, leaving 4105 studies for title and abstract screening. Subsequently, 265 publications were selected for inclusion, with an additional 197 publications identified through the handsearch. The majority of the studies were case reports and case series, predominantly originating from specialised care settings. A clear distinction between vertebral or rare causes of LBP was not always possible. A range of diseases were identified as potential extravertebral causes of LBP, encompassing gynaecological, urological, vascular, systemic, and gastrointestinal diseases. Notably, guidelines exhibited inconsistencies in addressing extravertebral causes. DISCUSSION Prior to this review, there has been no systematic investigation into extravertebral causes of LBP. Although these causes are rare, the absence of robust and reliable epidemiological data hinders a comprehensive understanding, as well as the lack of standardised protocols, which contributes to a lack of accurate description of indicative symptoms. While there are certain disease-specific characteristics, such as non-mechanical or cyclical LBP, and atypical accompanying symptoms like fever, abdominal pain, or leg swelling, that may suggest extravertebral causes, it is important to recognise that these features are not universally present in every patient. CONCLUSION The differential diagnosis of extravertebral LBP is extensive with relatively low prevalence rates dependent on the clinical setting. Clinicians should maintain a high index of suspicion for extravertebral aetiologies, especially in patients presenting with atypical accompanying symptoms.
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Affiliation(s)
- Anna Kunow
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany.
| | | | - Jean-François Chenot
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany
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Sumbodo CD, Tyson K, Mooney S, Lamont J, McMahon M, Holdsworth-Carson SJ. The relationship between sleep disturbances and endometriosis: A systematic review. Eur J Obstet Gynecol Reprod Biol 2024; 293:1-8. [PMID: 38091847 DOI: 10.1016/j.ejogrb.2023.12.010] [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: 10/03/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Endometriosis is associated with a range of symptoms that can negatively impact a person's quality of life. While pain and infertility have received at lot of attention, sleep disturbances in individuals with endometriosis has been overlooked in both clinical practice and research. Therefore, the primary aim of this systematic review was to gather evidence from the current literature to illustrate the association between sleep disturbances and endometriosis. STUDY DESIGN A literature search was conducted using three electronic databases (OVID EMBASE, MEDLINE, and Web of Science). Observational studies, published in English, that involved participants aged 18 years or older that compared sleep outcomes between endometriosis patients and those without a history of endometriosis were included. The quality of each study was assessed using the Joanna Briggs Institute critical appraisal tools. RESULTS Nine studies (six case-control and three cross-sectional) were included in this review; 7 with low risk of bias and 2 with moderate risk of bias. The studies demonstrated heterogeneity in the assessment of sleep disturbances. However, 7 studies reported a significant positive association between endometriosis and sleep disturbances. Moreover, this impact on sleep was further complicated by the complex interaction between pain, fatigue and quality of life. CONCLUSION Current studies suggest an association between sleep disturbances and endometriosis, which may provide a blueprint for future clinical recommendations to screen and treat sleep disturbances in individuals with endometriosis to improve their quality of life. Future studies should aim to standardise the methods of assessing sleep disturbances and explore potential contributing factors.
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Affiliation(s)
- Chyntia Diva Sumbodo
- Melbourne Medical School, University of Melbourne, Parkville 3010, Australia; Faculty of Medicine, University of Indonesia, Jakarta 10430, Indonesia
| | - Kate Tyson
- Julia Argyrou Endometriosis Centre, Epworth HealthCare, Richmond 3121, Australia
| | - Samantha Mooney
- Julia Argyrou Endometriosis Centre, Epworth HealthCare, Richmond 3121, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Parkville 3052, Australia; Endosurgery (Gynaecology) Department, Mercy Hospital for Women, Heidelberg 3084, Australia
| | - Julie Lamont
- Women's and Children's Clinical Institute, Epworth HealthCare, Richmond 3121, Australia; Department of Gynaecological Oncology, Mercy Hospital for Women, Heidelberg 3084, Australia
| | - Marcus McMahon
- Epworth Internal Medicine Clinical Institute, Epworth HealthCare, Richmond 3121, Australia
| | - Sarah J Holdsworth-Carson
- Julia Argyrou Endometriosis Centre, Epworth HealthCare, Richmond 3121, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Parkville 3052, Australia.
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Gstoettner M, Wenzl R, Radler I, Jaeger M. "I think to myself 'why now?'" - a qualitative study about endometriosis and pain in Austria. BMC Womens Health 2023; 23:409. [PMID: 37542309 PMCID: PMC10403941 DOI: 10.1186/s12905-023-02576-w] [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: 05/02/2023] [Accepted: 07/27/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Endometriosis is a chronic, benign, and oestrogen-dependent condition and about 10-15% of all women of reproductive age are affected by endometriosis worldwide. It is not curable and pain is one of the most common symptoms of endometriosis and leads to low quality of life in affected women. To our knowledge, in German-speaking countries, no studies with qualitative methods approaches are available concerning women who suffer from pain caused by endometriosis and possible associated coping strategies. Our study aims to familiarise ourselves with the individual pain experience of selected women who suffer from endometriosis in Austria and their coping strategies. METHODS A qualitative study design was based on problem-centred interviews for data collection and qualitative content analysis for data analysis. The research participants were women aged between 18 and 55 diagnosed with endometriosis and living in Austria. The interview period was from 27 February to 26 March 2019 and interviews lasted between 50 and 75 min. RESULTS Eight categories were formulated, of which category 3 (thoughts and feelings regarding endometriosis and pain - 'why?'), category 5 (effects and changes caused by endometriosis and pain - 'quality of life'), category 7 (taboos - 'don`t talk about it'), and category 8 (talking about it - 'contact with others in the same position') were relevant for this article. The remaining four categories [1-4] have already been published elsewhere. CONCLUSION Our data show that the social environment plays a fundamental role in coping strategies concerning pain caused by endometriosis. Women in our study reported that exchange with peers offers support. This opens a door for information events, patient organizations like support groups, and the inclusion of these in the supporting system. Involving occupational medicine and workplace health promotion departments in companies should be further goals to support affected women.
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Affiliation(s)
- Manuela Gstoettner
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna, 1090, Austria.
| | - René Wenzl
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna, 1090, Austria
| | - Ines Radler
- Krankenhaus der Barmherzigen Schwestern, Seilerstätte 4, Linz, 4010, Austria
| | - Margret Jaeger
- Research Department of Education Centre of Social Fund Vienna, Schlachthausgasse 37, Vienna, 1030, Austria
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Van Niekerk LM, Dell B, Johnstone L, Matthewson M, Quinn M. Examining the associations between self and body compassion and health related quality of life in people diagnosed with endometriosis. J Psychosom Res 2023; 167:111202. [PMID: 36812662 DOI: 10.1016/j.jpsychores.2023.111202] [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: 07/28/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE An understanding of the role that self and body compassion may play as protective mechanisms in the context of psychological and physical health conditions is steadily increasing. The availability of research pertaining to their role in mitigating the health-related quality of life (HRQoL) impacts associated with endometriosis is limited. The current study examined the influence of self and body compassion on HRQoL in people diagnosed with endometriosis. METHODS Individuals aged 18+ years (n = 318), assigned female at birth, with a self-reported diagnosis of symptomatic endometriosis completed an online cross-sectional survey. Participant demographics and endometriosis-related data was collected in addition to self and body compassion and HRQoL. Standard multiple regression analyses (MRA) were conducted to estimate the proportion of variance in HRQoL that can be accounted for by self and body compassion in endometriosis. RESULTS Self and body compassion were both associated with higher HRQoL across all domains. However, when both self and body compassion were entered into a regression, only body compassion was significantly associated with HRQoL domains of physical wellbeing, bodily pain, vitality, social engagement and general HRQoL; self-compassion explained no unique variance. In the domain of emotional wellbeing, when both self and body compassion were entered into a regression, both were significantly associated, and explained unique variance. CONCLUSIONS It is suggested that future psychological interventions for individuals living with endometriosis should emphasise building general self-compassionate abilities with a subsequent specific focus on strategies designed to improve body compassion.
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Affiliation(s)
- L M Van Niekerk
- University of Tasmania, College of Health & Medicine, School of Psychological Science, Hobart, Australia.
| | - B Dell
- University of Tasmania, College of Health & Medicine, School of Psychological Science, Hobart, Australia
| | - L Johnstone
- University of Tasmania, College of Health & Medicine, School of Psychological Science, Hobart, Australia
| | - M Matthewson
- University of Tasmania, College of Health & Medicine, School of Psychological Science, Hobart, Australia
| | - M Quinn
- University of Tasmania, College of Health & Medicine, School of Psychological Science, Hobart, Australia
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Internet-based cognitive behavioral therapy for improving health-related quality of life in patients with endometriosis: study protocol for a randomized controlled trial. Trials 2022; 23:300. [PMID: 35414092 PMCID: PMC9006397 DOI: 10.1186/s13063-022-06204-0] [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: 11/16/2021] [Accepted: 03/26/2022] [Indexed: 12/25/2022] Open
Abstract
Background The trial investigates the efficacy of internet-based cognitive behavioral therapy (iCBT) in improving health-related QoL in patients with endometriosis, which is a chronic gynecological condition affecting up to 15% of people with female-assigned reproductive organs. Endometriosis is stress-related and comes with various physical symptoms such as pelvic pain and infertility. It has a substantial impact on health-related quality of life (QoL), and mind-body interventions seem promising in reducing the psychological burden. Methods This is a monocentric randomized-controlled trial recruiting 120 patients with endometriosis. The intervention consists of eight iCBT modules focusing on psychoeducation, cognitive restructuring, pacing, and emotion regulation. Participants will receive written feedback from a trained therapist weekly. The comparator is a waitlist control group. All participants will be followed up 3 months after the intervention, and the intervention group will additionally be followed up 12 months after the intervention. Trial participants will not be blinded to the allocated trial arm. Primary outcome measures are endometriosis-related QoL, pain, and pain-related disability. Secondary outcomes include coping, illness representations, and psychological flexibility. Statistical analyses will be performed following intention-to-treat principles. Discussion This randomized-controlled trial is the first trial to test the efficacy of iCBT for improving endometriosis-related QoL. Potential predictor variables and key mechanisms in treatment will be investigated to enable further progression in medical and psychological care for patients with endometriosis. Trial registration ClinicalTrials.gov, NCT05098444 Registered on October 28, 2021
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Troutman M, Chacko S, Petras L, Laufer MR. Informed Care for the Gynecologic Day Surgical Patient with a History of Sexual Trauma. J Pediatr Adolesc Gynecol 2022; 35:3-6. [PMID: 34302950 DOI: 10.1016/j.jpag.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/22/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
The field of Obstetrics and Gynecology is one that provides intersections between one's most private and intimate moments with scenarios that could potentially trigger significant emotional trauma. As providers, one must balance providing appropriate care with the respect and autonomy of the patient. The perioperative and operative space presents many ethical dilemmas in navigating these boundaries, particularly among individuals with a history of sexual trauma. In our commentary, we present one case of an adolescent patient, with a history of sexual trauma and pelvic pain, who underwent laparoscopic surgery. We explore the interplay of delegating autonomy during amnesia, chronic pelvic pain, post-traumatic stress disorder, and hyperarousal within this period. There is knowledge to be gained amongst Obstetrics and Gynecology providers in navigating perioperative services in individuals with complex history of social stress and trauma so that we can better understand the landscape of providing competent care.
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Affiliation(s)
- Michele Troutman
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
| | - Sabeena Chacko
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Lisa Petras
- Boston Children's Hospital, Boston, Massachusetts
| | - Marc R Laufer
- Boston Center for Endometriosis, Brigham and Women's Hospital and Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Jaeger M, Gstoettner M, Fleischanderl I. “A little monster inside me that comes out now and again”: endometriosis and pain in Austria. CAD SAUDE PUBLICA 2022; 38:e00226320. [DOI: 10.1590/0102-311x00226320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/29/2021] [Indexed: 11/22/2022] Open
Abstract
Abstract: The topics of endometriosis and pain imply far-reaching problems for women’s health. Using a qualitative research approach, this paper addresses the subjective experience and effects of pain, the methods for dealing with these issues, and the needs of affected women in Austria. Data were collected by problem-focused interviews conducted with ten women suffering from endometriosis, which were later transcribed and subjected to qualitative content analysis. Findings are therefore described using content-related categories. Results show that negative thoughts and feelings like fear, despair, and anger are associated with endometriosis and pain. Moreover, predominantly negative impacts and changes are found in various areas of life, such as the well-being and psyche of those affected, their attitude towards life in general, partnerships, social life, leisure time and work-life balance. In dealing with endometriosis and pain, both Western biomedicine and complementary medicine treatments are used. Support from one’s inner circle of friends and exchange and interaction with others affected by the disease are seen to be invaluable. Attending physicians as well as patients themselves and their private, social, and working environment should encourage open communication about endometriosis and the related pain.
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Effectiveness of intracavitary monopolar dielectric radiofrequency in women with endometriosis-associated pain: A case series. Complement Ther Clin Pract 2021; 46:101517. [PMID: 34864492 DOI: 10.1016/j.ctcp.2021.101517] [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: 12/01/2020] [Revised: 08/04/2021] [Accepted: 11/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND and Purpose: Endometriosis-associated pain is the main cause of chronic pelvic pain in women. Endometriosis has a significant negative impact across different domains of patients' quality of life. This study aimed to evaluate the efficacy of an intracavitary application of monopolar dielectric radiofrequency in women with endometriosis-associated pain. PATIENT PRESENTATION Five women with endometriosis received 25 sessions of an intracavitary application of monopolar dielectric radiofrequency within three months. Outcomes, including quality of life, sex interference (Endometriosis Health Profile [EHP]-30 + section C), myofascial pain syndrome (myofascial trigger points), pain intensity (Visual Analogue Scale), frequency and referral pattern, pressure pain thresholds, allodynia and neuropathic pain (modified DN4), were examined both during and outside menses, after intervention and six months later. RESULTS Clinically meaningful improvements were achieved by most participants regarding pelvic pain intensity, abdominal sensitivity, and myofascial pain of the pelvic floor. CONCLUSION This study lays the foundation for future in-depth research, suggesting that monopolar dielectric radiofrequency could be helpful in improving the symptomatology and quality of life of women with endometriosis, also in patients who are unresponsive to medical and/or surgical treatments, or who cannot undergo them in the short term.
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Farahani ZK, Taherianfard M, Naderi MM, Ferrero H. Possible therapeutic effect of royal jelly on endometriotic lesion size, pain sensitivity, and neurotrophic factors in a rat model of endometriosis. Physiol Rep 2021; 9:e15117. [PMID: 34806344 PMCID: PMC8606856 DOI: 10.14814/phy2.15117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 01/07/2023] Open
Abstract
Endometriosis is the abnormal growth of endometrial tissue. The goals of the study are: (1) Is any correlation between endometriosis pain and neurotrophins in the serum, dorsal root ganglion (DRG), and peritoneal fluid (PF) in rat models of experimental endometriosis?, (2) Possible therapeutic effects of royal jelly (RJ) on pain scores, size of endometriotic lesion, and neurotrophic factors. Forty-eight Sprague Dawley female rats weighing 205.023 ± 21.54 g were maintained in a standard condition. The rats were randomly divided into one of the six groups: Control (no intervention), Sham-1 (remove of uterine horn), RJ (administration of 200 mg/kg/day RJ for 21 days), Endometriosis (induction of endometriosis), Treatment (induction of endometriosis+administration of 200 mg/kg/day RJ for 21 days), and Sham-2 (induction of endometriosis+administration of water). Formalin test performed for pain evaluation. The levels of Brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), substance P, and calcitonin gene-related peptide (CGRP) were measured by enzyme-linked immunosorbent assay. The mean pain scores in all three phases of the formalin test were significantly increased by endometriosis induction (p < 0.05). The concentrations of BDNF, NGF, and CGRP in DRG of the endometriosis group were significantly higher than these factors in the Control, Sham-1, and RJ groups (p < 0.05). RJ could significantly (p < 0.001) decrease the mean lesion size and the mean pain score in the late phase (p < 0.05). The present results determine that endometriosis pain may be related to nervous system neurotrophic factors. Treatment with RJ could decrease the size of endometriosis lesions as well as pain scores. The findings may shed light on other complementary and alternative remedies for endometriosis.
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Affiliation(s)
- Zahra K. Farahani
- Physiology Division of Basic Sciences DepartmentSchool of Veterinary MedicineShiraz UniversityShirazIran
- Maternal, Fetal, and Neonatal Research CenterTehran University of Medical SciencesTehranIran
| | - Mahnaz Taherianfard
- Physiology Division of Basic Sciences DepartmentSchool of Veterinary MedicineShiraz UniversityShirazIran
| | - Mohamad Mehdi Naderi
- Reproductive Biotechnology Research CenterAvicenna Research InstituteACECRTehranIran
| | - Hortensia Ferrero
- Institute of Treatment and Diagnosis of Uterine DiseasesIVI FoundationValenciaSpain
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Dückelmann AM, Taube E, Abesadze E, Chiantera V, Sehouli J, Mechsner S. When and how should peritoneal endometriosis be operated on in order to improve fertility rates and symptoms? The experience and outcomes of nearly 100 cases. Arch Gynecol Obstet 2021; 304:143-155. [PMID: 33537880 PMCID: PMC8164581 DOI: 10.1007/s00404-021-05971-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/12/2021] [Indexed: 12/18/2022]
Abstract
Purpose To analyze the follow-up results of patients suffering from symptomatic early-stage endometriosis after a consistent laparoscopic peritoneal stripping of the altered peritoneum (peritoneal endometriosis and surrounding inflamed tissue) was performed. This type of endometriosis is resistant to medical therapy and/or impairs fertility. Methods Using our prospectively maintained database, we were able to identify all symptomatic women with the suspicion of only peritoneal endometriosis who underwent laparoscopy at our endometriosis center over a period of 5 years. All procedures were carried out in a standardized fashion by one single surgeon, who is highly experienced in minimal invasive surgery, and included a suspended hormonal pretreatment for 2 months. Postoperative outcomes including complications, fertility and recurrence rates were analysed. Results Laparoscopic peritonectomy was performed on 94 women. Follow-up data were available in 87% of these cases. At the time of surgery, almost all patients tested showed signs of stage I or II endometriosis (44.7 and 48.9%, respectively). More than three-quarters of the women reported pain relief, inter alia, due to the post-surgical hormonal therapy. About one-third of the patients wanted to have children after the procedure. 62% of them became pregnant and the majority did so without the need for assisted reproductive therapy. In seven women a re-operation was performed. Conclusion According to our data, a consistent excision of altered peritoneum followed by adjuvant hormonal therapy and multimodal concepts results in better outcomes for the patient, particularly in regards to pregnancy and recurrence rates.
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Affiliation(s)
- A M Dückelmann
- Department of Gynecology, Charité-Universitätsmedizin BerlinVirchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - E Taube
- Department of Pathology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - E Abesadze
- Department of Gynecology, Vivantes Clinic Berlin Hellersdorf, Myslowitzerstr. 45, 12621, Berlin, Germany
| | - V Chiantera
- Department of Gynecologic Oncology, University of Palermo, Piazza Marina, 61, 90133, Palermo, Italy
| | - J Sehouli
- Department of Gynecology, Charité-Universitätsmedizin BerlinVirchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S Mechsner
- Department of Gynecology, Charité-Universitätsmedizin BerlinVirchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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Poulos C, Soliman AM, Tekin S, Agarwal SK. Patient preferences for elagolix and leuprolide for treating endometriosis-related pain in the United States. Expert Rev Pharmacoecon Outcomes Res 2020; 21:1091-1099. [PMID: 33140977 DOI: 10.1080/14737167.2021.1832468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION We evaluated elagolix and leuprolide from the patient's perspective for the treatment of endometriosis-related pain. AREA COVERED Preference weights from a published discrete choice experiment were used to evaluate preferences for treatment profiles simulating elagolix (150 mg/day and 200 mg/twice-daily dosages) and leuprolide for the treatment of moderate to severe endometriosis-related pain. Sensitivity analyses were conducted by varying the range of risk for pregnancy-related problems, moderate to severe hot flashes, and bone fracture across scenarios. EXPERT OPINION The 200 mg twice daily dosage of elagolix is more likely to be preferred over leuprolide by patients with moderate to severe endometriosis-related pain in all scenarios explored in the evaluation and sensitivity analyses. The probability that an average respondent would select a treatment was sensitive to increases in risk of moderate to severe hot flashes for leuprolide and possible variations in the risk of pregnancy-related problems for both treatments but was not influenced by an increased risk of bone fracture. CONCLUSIONS Patients' preferences for treatment of endometriosis-related pain should be evaluated using the benefits and risks of each pharmacological option. Respondents were more likely to prefer the treatment profile similar to 200 mg twice daily elagolix over that of leuprolide in all scenarios.
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Affiliation(s)
- Christine Poulos
- Health Preference Assessment, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Ahmed M Soliman
- Health Economics and Outcomes Research (HEOR), AbbVie Inc, North Chicago, IL, USA
| | - Sibel Tekin
- Health Economics and Outcomes Research (HEOR), AbbVie Inc, North Chicago, IL, USA
| | - Sanjay K Agarwal
- Center for Endometriosis Research and Treatment, University of California San Diego, La Jolla, CA, USA
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Beco J, Mouchel J. Perineural dextrose injections in the treatment of lower urinary tract symptoms and dyspareunia induced by obturator neuralgia. Med Hypotheses 2020; 144:109991. [DOI: 10.1016/j.mehy.2020.109991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 12/18/2022]
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Endometriosis Associated Infertility: A Critical Review and Analysis on Etiopathogenesis and Therapeutic Approaches. ACTA ACUST UNITED AC 2020; 56:medicina56090460. [PMID: 32916976 PMCID: PMC7559069 DOI: 10.3390/medicina56090460] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 12/19/2022]
Abstract
Endometriosis represents a frequently diagnosed gynecological affliction in the reproductive timespan of women, defined by symptoms ranging from pelvic pain to infertility. A complex interplay between the genetic profile, hormonal activity, menstrual cyclicity, inflammation status, and immunological factors define the phenotypic presentation of endometriosis. To date, imaging techniques represent the gold standard in diagnosing endometriosis, of which transvaginal ultrasonography and magnetic resonance imaging bring the most value to the diagnostic step. Current medical treatment options for endometriosis-associated infertility focus on either stimulating the follicular development and ovulation or on inhibiting the growth and development of endometriotic lesions. Techniques of assisted reproduction consisting of superovulation with in vitro fertilization or intrauterine insemination represent effective treatment alternatives that improve fertility in patients suffering from endometriosis. Emerging therapies such as the usage of antioxidant molecules and stem cells still need future research to prove the therapeutic efficacy in this pathology.
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Carlyle D, Khader T, Lam D, Vadivelu N, Shiwlochan D, Yonghee C. Endometriosis Pain Management: a Review. Curr Pain Headache Rep 2020; 24:49. [PMID: 32671581 DOI: 10.1007/s11916-020-00884-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the up-to-date pain management options and recommendations for the challenging disease, endometriosis. RECENT FINDINGS The mainstays of endometriosis advances of both surgical and medical management continue to evolve. Experimental pharmaceuticals include Gestirone, and aromatase inhibitors have shown promise but are still under scrutiny. Surgical techniques include laparoscopic uterosacral nerve ablation/resection and presacral neurectomy. No studies have directly compared medical versus surgical management, and as such, no one treatment modality can be recommend as superior to the other. Patients may initially be given a medical diagnosis and treated with nonsteroidal anti-inflammatory drugs, neurolepitcs, OCP, GNRH agonists/antagonists, and Danazol. Assessing the success of these regimens has proved difficult. Surgical management relies on various methods including excision/ablation of the lesions, nerve ablation, neurectomy, hysterectomy, and oophorectomy.
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Affiliation(s)
- Daniel Carlyle
- Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3, P.O. Box 208051, New Haven, CT, 06510, USA.
| | - Tarek Khader
- Department of Obstetrics and Gynecology, Yale University School of Medicine, 333 Cedar Street, TMP 3, P.O. Box 208051, New Haven, CT, 06510, USA
| | - David Lam
- Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3, P.O. Box 208051, New Haven, CT, 06510, USA
| | - Nalini Vadivelu
- Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3, P.O. Box 208051, New Haven, CT, 06510, USA
| | - Devina Shiwlochan
- Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3, P.O. Box 208051, New Haven, CT, 06510, USA
| | - Cho Yonghee
- Department of Obstetrics and Gynecology, Yale University School of Medicine, 333 Cedar Street, TMP 3, P.O. Box 208051, New Haven, CT, 06510, USA
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Urteaga I, McKillop M, Elhadad N. Learning endometriosis phenotypes from patient-generated data. NPJ Digit Med 2020; 3:88. [PMID: 32596513 PMCID: PMC7314826 DOI: 10.1038/s41746-020-0292-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/26/2020] [Indexed: 12/19/2022] Open
Abstract
Endometriosis is a systemic and chronic condition in women of childbearing age, yet a highly enigmatic disease with unresolved questions: there are no known biomarkers, nor established clinical stages. We here investigate the use of patient-generated health data and data-driven phenotyping to characterize endometriosis patient subtypes, based on their reported signs and symptoms. We aim at unsupervised learning of endometriosis phenotypes using self-tracking data from personal smartphones. We leverage data from an observational research study of over 4000 women with endometriosis that track their condition over more than 2 years. We extend a classical mixed-membership model to accommodate the idiosyncrasies of the data at hand, i.e., the multimodality and uncertainty of the self-tracked variables. The proposed method, by jointly modeling a wide range of observations (i.e., participant symptoms, quality of life, treatments), identifies clinically relevant endometriosis subtypes. Experiments show that our method is robust to different hyperparameter choices and the biases of self-tracking data (e.g., the wide variations in tracking frequency among participants). With this work, we show the promise of unsupervised learning of endometriosis subtypes from self-tracked data, as learned phenotypes align well with what is already known about the disease, but also suggest new clinically actionable findings. More generally, we argue that a continued research effort on unsupervised phenotyping methods with patient-generated health data via new mobile and digital technologies will have significant impact on the study of enigmatic diseases in particular, and health in general.
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Affiliation(s)
- Iñigo Urteaga
- Department of Applied Physics and Applied Mathematics, Columbia University, New York, NY 10027 USA
- Data Science Institute, Columbia University, New York, NY 10027 USA
| | - Mollie McKillop
- Department of Biomedical Informatics, Columbia University, New York, NY 10032 USA
| | - Noémie Elhadad
- Data Science Institute, Columbia University, New York, NY 10027 USA
- Department of Biomedical Informatics, Columbia University, New York, NY 10032 USA
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Zegrea A, Kirss J, Pinta T, Rautio T, Varpe P, Kairaluoma M, Aho M, Böckelman C, Lavonius M. Outcomes of sacral neuromodulation for chronic pelvic pain: a Finnish national multicenter study. Tech Coloproctol 2020; 24:215-220. [PMID: 31965400 DOI: 10.1007/s10151-020-02148-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 01/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to report the outcomes of sacral neuromodulation (SNM) in chronic pelvic pain (CPP) patients in the Finnish national cohort. METHODS This was a register-based retrospective study, involving all the centers that provide SNM treatment in Finland. The data of all patients treated with SNM for CPP were gathered from Oulu-, Turku-, Tampere- and Helsinki University Hospitals, as well as Jyväskylä and Seinäjoki Central Hospitals. All patients who had been tested for SNM implantation prior to April 2017 were included in the study. RESULTS A total of 51 patients were selected for SNM treatment due to CPP from 2004 until 2017. The mean follow-up time was 13.8 months (SD 22.9 months). A total of 28 patients (57%) advanced from testing to permanent stimulator implantation. There were 21 patients (41%) who had a working modulator implanted at the end of follow-up. Patients with endometriosis-related pain had a significantly higher permanent implantation rate than the overall implantation rate (88% vs. 57%; p = 0.01). The endometriosis patients also had a higher overall success rate by the end of the follow-up (75% vs. 41%; p = 0.026) CONCLUSIONS: SNM may be a viable treatment option for patients with CPP due to endometriosis. Further research on SNM treatment for endometriosis patients with refractory CPP is needed.
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Affiliation(s)
- A Zegrea
- Seinäjoki Central Hospital, Hanneksenrinne 7, 60220, Seinäjoki, Finland.
| | - J Kirss
- Turku University Hospital, Turku, Finland.,Vaasa Central Hospital, Vaasa, Finland
| | - T Pinta
- Seinäjoki Central Hospital, Hanneksenrinne 7, 60220, Seinäjoki, Finland
| | - T Rautio
- Oulu University Hospital, Oulu, Finland
| | - P Varpe
- Turku University Hospital, Turku, Finland
| | | | - M Aho
- Tampere University Hospital, Tampere, Finland
| | - C Böckelman
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - M Lavonius
- Turku University Hospital, Turku, Finland
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Reis FM, Santulli P, Marcellin L, Borghese B, Lafay-Pillet MC, Chapron C. Superficial Peritoneal Endometriosis: Clinical Characteristics of 203 Confirmed Cases and 1292 Endometriosis-Free Controls. Reprod Sci 2020; 27:309-315. [DOI: 10.1007/s43032-019-00028-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/01/2019] [Indexed: 10/25/2022]
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Maia LM, Rocha AL, Del Puerto HL, Petraglia F, Reis FM. Plasma urocortin-1 as a preoperative marker of endometriosis in symptomatic women. Gynecol Endocrinol 2018; 34:202-205. [PMID: 28925754 DOI: 10.1080/09513590.2017.1380188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Accurate noninvasive diagnostic tests for endometriosis are still missing. This study evaluated the predictive value of the neuropeptide urocortin 1 (Ucn1) to detect pelvic endometriosis in symptomatic women. We enrolled prospectively 97 consecutive women submitted to gynecologic laparoscopy for chronic or acute pelvic pain, infertility or adnexal mass. Preoperative blood samples were assayed for Ucn1 using enzyme immunoassay. Patients with endometriosis had higher plasma Ucn1 levels compared to patients with no lesions (median 59 vs. 34 pg/ml, p < .01, Dunn's test). Elevated plasma Ucn1 levels were found among all endometriosis phenotypes (superficial peritoneal lesions, ovarian endometrioma, and deep infiltrating endometriosis, p < .05 vs. no lesions). Receiver operating characteristics curve analysis identified plasma Ucn1 > 46 pg/mL as the best cutoff point to detect endometriosis vs. no lesions, with 76% sensitivity and 88% specificity (area under the curve [AUC] 0.827, 95% confidence interval [CI] 0.695 - 0.959), but no cutoff could accurately distinguish endometriosis from other pathological conditions (AUC 0.593 [95% CI 0.474 - 0.711]). In women with chronic pelvic pain, infertility, or both symptoms, the probability of endometriosis (positive predictive value) increased consistently with the increase of plasma Ucn1 levels. The present findings suggest that high plasma Ucn1 levels increase the likelihood of endometriosis in symptomatic women.
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Affiliation(s)
- Laura M Maia
- a Department of Obstetrics and Gynecology , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Ana L Rocha
- a Department of Obstetrics and Gynecology , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Helen L Del Puerto
- b Department of Pathology , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Felice Petraglia
- c Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology , University of Florence, Careggi University Hospital , Florence , Italy
| | - Fernando M Reis
- a Department of Obstetrics and Gynecology , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
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