Nan Fang Yi Ke Da Xue Xue Bao. 2013 Jun;33(6):926-9.

Effect of folic acid in preventing aberrant methylation of fetal endometriosissusceptibility gene HOXA10.

Liu M1Huang XXu SLi L.

 

Abstract

OBJECTIVE:

To detect aberrant methylation in the promoter region of fetal endometriosis susceptibility gene homeobox-10 (HOXA10) in women with and without folic acid supplementation and explore the effect of folic acid in optimizing intrauterine environment.

METHODS:

Thirty-six cord blood specimens were collected between January, 2010 and December, 2012 from pregnant women with endometriosis, including 22 with folic acid treatment and 15 without. Methylation-specific polymerase chain reaction (MSP) and bisulfite salt modified sequencing (BSP) were employed to detect aberrant methylation of HOXA10 gene in these specimens.

RESULTS:

The methylation rate of HOXA10 gene differed significantly between pregnant women with endometriosis taking folic acid and those who did (P<0.05).

CONCLUSION:

Folic acid treatment can significantly reduce the methylation rate of fetal endometriosissusceptibility gene HOXA10.

 

 

BMC Res Notes. 2013 Jun 26;6:243.

Myotonic dystrophy type 1 presenting with stroke-like episodes: a case report.

Rollnik JD1Heinz ULenz O.

 

Abstract

BACKGROUND:

It is well known that myotonic dystrophy type 1 (DM1)–Curschmann-Steinert disease–is associated with white matter lesions in the brain. Further, DM1 patients may suffer from cardiac involvement and cardioembolic strokes. We report on the unique case of an adult-onset DM1 without cardiac or vascular abnormalities presenting with stroke-like episodes.

CASE PRESENTATION:

A 40 y old white female was admitted twice to our stroke unit with apoplectic dizziness, nausea, headaches, and numbness in the right arm. She was suffering from type 2 diabetes, cataract, and endometriosis. Magnetic resonance imaging (MRI) revealed confluent white matter lesions in all cerebral lobes. There was no hyperintensity on diffusion-weighted imaging (DWI) and no gadolinium enhancement. Cerebrospinal fluid was normal. Surprisingly, myotonic discharges were detected in electromyography (EMG). Genetic testing revealed 200 ± 10 CTG repeats in the dystrophia myotonica protein kinase (DMPK) gene on chromosome 19 and DM1 was diagnosed.

CONCLUSIONS:

DM1 may be the cause of cerebral white matter lesions. This is the first case of DM1 presenting with stroke-like episodes.

 

 

Neuro Endocrinol Lett. 2013;34(4):278-81.

Deep endometriosis of the colon.

Ropacka-Lesiak M1Świder-Musielak JWójcicka MŁyczywek ASkrzypek MWaliszewski W.

Author information

Abstract

The article presents a case of deep intestinal endometriosis in a 27-year-old woman who complained of dysmenorrhea and infertility. The diagnostic process included ultrasonography as well as colonoscopy, barium enema and CT imaging. Because of the presence of two distant changes which involved nearly the full thickness of the rectal wall and the major part of its circumference, the decision to perform an anterior rectal resection with a simultaneous retroperitoneal colorectostomy was made. The Knight technique was implemented. The surgery involved the anterior rectal resection, the transverse rectal stump closure by use of a stapling device (TA50), and the creation of colorectal circular anastomosis with the CEEA 31 stapler.

 

 

Akush Ginekol (Sofiia). 2013;52(1):18-21.

Autofluorescence and endometriosis optical trap or new hope in dianosis of endometriosis?.

[Article in Bulgarian]

Kupker WKlenske JKornovski J.

Abstract

Laparoscopic autofluorescence imaging of endometriosis is a new method to properly detect the disease. Autofluorescence in contrast to conventional white light laparoscopy enables us to visualize the entire extent of disease and to recognize extremely small or occult lesions. Autofluorescence imaging in fact reveals a world behind the world, a substantial new representation of endometriosis, which will have much impact on our future therapeutic strategies.

 

 

J Proteome Res. 2013 Oct 4;12(10):4340-50.

Secretome-based identification of TFPI2, a novel serum biomarker for detection of ovarian clear cell adenocarcinoma.

Arakawa N1Miyagi ENomura AMorita EIno YOhtake NMiyagi YHirahara FHirano H.

 

Abstract

Of all of the epithelial ovarian cancers (EOC), clear cell adenocarcinoma (CCA) has the worst clinical prognosis. Furthermore, the conventional EOC biomarker CA125 is more often negative in CCA than in other subtypes of EOC. This study sought to discover a new diagnostic biomarker that would allow more reliable detection of CCA. Using mass spectrometry, we compared proteins in conditioned media from cell lines derived from CCA and other types of EOC. We identified 30 extracellular or released proteins specifically present in CCA-derived cell lines. Bioinformatics analyses identified a serine protease inhibitor, tissue factor pathway inhibitor 2 (TFPI2), as a potential biomarker for CCA. Real time RT-PCR and Western blot analyses revealed that TFPI2 was exclusively expressed in CCA-derived cell lines and tissues. For clinical validation, we measured levels of TFPI2 and CA125 in a set of sera from 30 healthy women, 30 patients with endometriosis, and 50 patients with CCA, using an automated enzyme-linked immunosorbent assay systems. Serum levels of TFPI2 were significantly elevated in CCA patients, even those with normal CA125 levels. In terms of area under the receiver operating characteristic curve (AUC), TFPI2 was superior to CA125 in discriminating CCA patients from healthy women (AUC 0.97 for TFPI2 versus AUC 0.80 for CA125), or from patients with endometriosis (AUC 0.93 for TFPI2 versus 0.80 for CA125). This is the first evidence for TFPI2 as a serum biomarker of CCA. We propose that this biomarker may be useful for detection of CCA and for monitoring the transformation from endometriosis into CCA.

 

 

Iran J Cancer Prev. 2013 Summer;6(3):123-32.

Fertility preservation among the cancer patients by ovarian tissue cryopreservation, transplantation, and follicular development.

Abedelahi A1Rezaei-Tavirani M2Mohammadnejad D1.

 

Abstract

Ovarian tissue freezing or cryopreservation might be the only acceptable method for preserving the young women fertility, before radiotherapy or chemotherapy. This technology might be used for patients with recurrent ovarian cysts or endometriosis, without ovarian stimulation. Many efforts have made to improve cryopreservation conditions that should be seriously considered for cancer patients. Vitrification is a process which prevents ovarian tissue from cryo damage, then preserves cell viability. Both methods have used for evaluating not only the follicular development, but also the fertility after freezing and thawing. In this manuscript, we have discussed the techniques of ovarian tissue vitrification, then graft and maturation or follicular development is also mentioned.

 

 

Stat Sin. 2013 Jul;23(4):1743-1759.

SEQUENTIAL TESTING OF MEASUREMENT ERRORS IN INTER-RATER RELIABILITY STUDIES.

Jin M1Liu A2Chen Z2Li Z3.

 

Abstract

Inter-rater reliability is usually assessed by means of the intraclass correlation coefficient. Using two-way analysis of variance to model raters and subjects as random effects, we derive group sequential testing procedures for the design and analysis of reliability studies in which multiple raters evaluate multiple subjects. Compared with the conventional fixed sample procedures, the group sequential test has smaller average sample number. The performance of the proposed technique is examined using simulation studies and critical values are tabulated for a range of two-stage design parameters. The methods are exemplified using data from the Physician Reliability Study for diagnosis of endometriosis.

 

 

Acta Obstet Gynecol Scand. 2013 Oct;92(10):1188-93

Polymorphic variants of CYP17 and CYP19A and risk of infertility in endometriosis.

Szczepańska M1Wirstlein PSkrzypczak JJagodziński PP.

 

Abstract

OBJECTIVE:

Endometriosis is recognized as an estrogen-dependent disease. There are conflicting data demonstrating single nuclear polymorphisms (SNPs) of CYP17 and CYP19 steroidogenic genes as related to endometriosis risk. We assessed the CYP17 5′-untranslated region -34 A/G (rs743572) and CYP19 Ex10 + C1558T (rs10046) SNPs in stage I-II endometriosis.

DESIGN:

Case-control study.

SETTING:

Division of reproduction at a university department in Poland.

POPULATION:

A total of 115 women with diagnosed stage I-II endometriosis according to the revised American Society for Reproductive Medicine (rASRM) classification and 197 fertile women as controls.

METHODS:

The SNPs CYP17 -34 A/G and CYP19 Ex10 + C1558T were identified by high-resolution melting curve analysis.

MAIN OUTCOME MEASURES:

Genotype prevalence and odds ratio for recessive and dominant genetic model for CYP17 and CYP19 SNPs.

RESULTS:

We observed a significantly increased CYP17 GG and GA genotype frequency in women diagnosed with rASRM stage I-II endometriosis compared with fertile women (OR = 2.4; 95% CI 1.4-4.2, p = 0.002). We also found a significantly increased CYP17 G allele frequency in cases compared with controls (OR = 1.6; 95% CI 1.2-2.2, p = 0.004). There were no significant differences in the distribution of the CYP17 GG genotype and CYP19 Ex10 + C1558T polymorphism between women diagnosed with rASRM stage I-II endometriosis and controls.

CONCLUSION:

The CYP17 -34 G variant, previously associated with increased 17β-estradiol production, displayed a contribution to stage I-II endometriosis in women from a Polish population. Increased 17β-estradiol concentration in carriers of the CYP17 -34 G variant might contribute to endometriosis and associated pathological processes.

 

 

J Minim Invasive Gynecol. 2013 Sep-Oct;20(5):708-9.

Splenosis: an uncommon differential diagnosis in gynecology.

Anrique D1Anton AKrüger KNiedobitek-Kreuter GEbert AD.

 

Abstract

Splenosis consists of ectopic functioning splenic tissue that can be located anywhere within the abdomen or pelvis. It is a benign condition usually found incidentally and is usually asymptomatic. The need for therapy is controversial, and treatment is suggested only in symptomatic cases, primarily those related to pelvic or abdominal implants.

 

 

Clin Radiol. 2013 Sep;68(9):895-901.

Rectosigmoid endometriosis: comparison between CT water enema and video laparoscopy.

Stabile Ianora AA1Moschetta MLorusso FLattarulo STelegrafo MRella LScardapane A.

 

Abstract

AIM:

To evaluate the accuracy of water enema computed tomography (CT) for predicting the location of endometriosis in patients with contraindications to magnetic resonance imaging (MRI), focusing on rectosigmoid lesions and having laparoscopic and histological data as the reference standard.

MATERIALS AND METHODS:

Thirty-three women (mean age 33.4 ± 3.1 years) suspected of having deep pelvic endometriosis underwent 64-row CT and video laparoscopy within 4 weeks. Two radiologists blinded to the clinical data evaluated the CT images obtained after colonic retrograde distension using water as the contrast medium, and a comparison with laparoscopic and histological findings was performed. CT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. The radiation dose to patients was estimated. Cohen’s weighted kappa (κ) test was used to evaluate the interobserver agreement.

RESULTS:

In 23 out of 33 patients (69%) intestinal implants were found at surgery and pathological examinations. CT confirmed the diagnosis of rectosigmoid endometriosis in 20 out of 23 implants. Three nodules located on the proximal sigmoid colon (two serosal lesions and one infiltrating the muscularis layer) with a diameter of less than 1 cm were not diagnosed. CT sensitivity, specificity, PPV, NPV, and accuracy values were 87, 100, 100, 77, and 91%, respectively. The mean effective dose estimate was 6.30 ± 1.7 mSv. Almost perfect agreement between the two readers was found (k = 0.84).

CONCLUSION:

Water enema CT can play a role in the diagnosis of bowel endometriosis and represents another accurate potential tool for video laparoscopic approaches, especially in patients for whom MRI is contraindicated.

 

 

 

 

 

Eur J Pharmacol. 2013 Sep 5;715(1-3):72-5

Regression of endometrial implants treated with vitamin D3 in a rat model of endometriosis.

Abbas MA1Taha MODisi AMShomaf M.

 

Abstract

Endometriosis is one of the most frequent gynecological diseases. In addition to their side effects, available medical therapies may decrease fertility. Current understanding of endometriosis focuses on the role of the immune system in its pathophysiology. Recent research shed light on the immunomodulatory effect of vitamin D3. Thus, this study was designed to study the effect of vitamin D3 on regression of endometriotic implants in a rat surgical model. Vitamin D3 reduced cyst cross sectional area by 48.8%. Histologically, vitamin D treatment produced fibrosis as well as apoptosis in the stroma. The results of the present study suggest that vitamin D3 administration may have a beneficial effect in treating endometriosis.

 

 

Curr Opin Obstet Gynecol. 2013 Aug;25(4):308-11.

The role of the robot in treating urinary tract endometriosis.

Nezhat C1Modest AMKing LP.

 

Abstract

PURPOSE OF REVIEW:

To detail the recent advances in the use of computer-enhanced robotic technology to surgically treat urinary tract endometriosis.

RECENT FINDINGS:

Few studies have been published in this field. The studies are severely limited in scope. Further study is warranted.

SUMMARY:

Robotic-assisted laparoscopic techniques have proven useful in the treatment of extensive endometriosis and may prove useful in the treatment of urinary tract endometriosis.

 

 

 

 

 

Obstet Gynecol. 2013 Jun;121(6):1281-90.

Lack of transparency of clinical trials on endometriosis.

Guo SW1Evers JL.

 

Abstract

OBJECTIVE:

To estimate patterns of publication of clinical trials of endometriosis registered in ClinicalTrials.gov and their associated characteristics.

METHODS:

Information on interventional clinical trials on endometriosis that were registered at ClinicalTrials.gov and updated as having been completed by October 25, 2012, was retrieved and the publication status and time to publication in Medline-indexed journals were ascertained by searching PubMed and by sending e-mail inquiries to the principal investigators listed by the registry.

RESULTS:

Seventy-one interventional trials of endometriosis, testing various drugs and biologicals, were identified. Among them, 49.3% (35/71) were completed by October 25, 2012, 21.1% were either stopped or inactive in the past 2 years, and the remaining 29.6% were ongoing. Among the 35 completed trials, 25 (71.4%) were sponsored by industry and results were published for only 11 (31.4%; five industry-sponsored, and six nonindustry-sponsored). Trials sponsored by industry were nearly four times less likely to publish their results than nonindustry-sponsored trials, even though these trials typically had larger sample sizes and were completed faster. Compared with the publication rate of 20% found 4 years ago, the current rate has increased only marginally but still lies significantly below the reported 66.3% surveyed recently among 546 completed nonendometriosis trials registered at ClinicalTrials.gov (P<.001).

CONCLUSION:

Despite mounting pressure on more transparency of clinical trials, the current state of transparency or lack thereof of clinical trials on endometriosis is worrisome and does not benefit the trial sponsor or the public. Thus, we again call for more transparency for endometriosis trials.

 

 

 

 

 

J Ovarian Res. 2013 Jul 1;6(1):44.

The use of HE4, CA125 and CA72-4 biomarkers for differential diagnosis between ovarian endometrioma and epithelial ovarian cancer.

Anastasi E1Granato TFalzarano RStorelli PTicino AFrati LPanici PBPorpora MG.

 

Abstract

BACKGROUND:

Endometriosis is frequently associated with high levels of CA125. This marker is therefore not useful for discriminating ovarian endometrioma from ovarian malignancy. The aim of this study was to establish a panel of complementary biomarkers that could be helpful in the differential diagnosis between ovarian endometriosis or other ovarian benign masses and ovarian cancer.

METHODS:

Blood samples from 50 healthy women, 17 patients with benign ovarian tumors, 57 patients with ovarian endometrioma and 39 patients with ovarian cancer were analyzed and serum values were measured for the following biomarkers: CA125, HE4 and CA72-4.

RESULTS:

Serum CA125 concentration was elevated in both patients with ovarian endometriosis and ovarian cancer but not in patients with other benign ovarian masses. HE4 was never increased in patients with endometriosis or benign masses whereas it was significantly higher in all patients with ovarian cancer (p < 0.05). A marked difference in CA72-4 values was observed between women with ovarian cancer (67%) and those with endometriosis (p < 0.05).

CONCLUSIONS:

The results of the study suggest that HE4 and CA72-4 determination is the best approach to confirm the benign nature of ovarian endometrioma in women with high CA125 levels.

 

 

Ann Surg Innov Res. 2013 Jul 1;7(1):6.

The outcomes of laparoscopic resection of bowel endometriosis.

Ruffo G1Rossini R.

 

Abstract

PURPOSE OF REVIEW:

To present the outcome of laparoscopic resection for bowel endometriosis.

RECENT FINDINGS:

In the last 12 months, numerous articles have been published to demonstrate and underline the efficiency and feasibility of the laparoscopic approach in the treatment of bowel endometriosis.

SUMMARY:

Endometriosis is a common condition that can affect women in their reproductive age. It can have an intestinal involvement, and when it occurs rectum and rectosigmoid junction are the most frequent sites; other lesser frequent sites are the appendix, the distal ileum, and the cecum. It is widely agreed that surgical management is the primary treatment for symptomatic bowel endometriosis. Laparoscopic bowel resection has become increasingly popular because it represents a well tolerated and feasible technique.

 

 

Curr Opin Obstet Gynecol. 2013 Aug;25(4):302-7.

Current and future applications of GnRH, kisspeptin and neurokinin B analogues.

Millar RP1Newton CL.

 

Abstract

Reproductive hormones affect all stages of life from gamete production, fertilization, fetal development and parturition, neonatal development and puberty through to adulthood and senescence. The reproductive hormone cascade has, therefore, been the target for the development of numerous drugs that modulate its activity at many levels. As the central regulator of the cascade, gonadotropin-releasing hormone (GnRH) agonists and antagonists have found extensive applications in treating a wide range of hormone-dependent diseases, such as precocious puberty, prostate cancer, benign prostatic hyperplasia, endometriosis and uterine fibroids, as well as being an essential component of in vitro fertilization protocols. The neuroendocrine peptides that regulate GnRH neurons, kisspeptin and neurokinin B, have also been identified as therapeutic targets, and novel agonists and antagonists are being developed as modulators of the cascade upstream of GnRH. Here, we review the development and applications of analogues of the major neuroendocrine peptide regulators of the reproductive hormone cascade: GnRH, kisspeptin and neurokinin B.

 

 

 

Curr Opin Pediatr. 2013 Aug;25(4):454-62.

Endometriosis for the primary care physician.

Youngster M1Laufer MRDivasta AD.

 

Abstract

PURPOSE OF REVIEW:

This review will empower the primary care provider (PCP) to evaluate, manage, and refer as needed adolescents with dysmenorrhea and/or chronic pelvic pain (CPP) who are suspected to have endometriosis.

RECENT FINDINGS:

Endometriosis is a common cause of CPP in adolescents who do not respond to primary medical treatment. The presentation in adolescents is unique, causing high rates of misdiagnosis or delayed treatment. Endometriosis-related pain has a marked negative impact on social and mental health. Simple treatments that are available in the primary care setting can alleviate pain and improve quality of life for these young women if initiated in a timely fashion.

SUMMARY:

Adolescents usually turn to their PCP for evaluation of dysmenorrhea and CPP. By maintaining a high index of suspicion, initiating treatment, and referring when needed, the PCP can have a tremendous effect on the patient’s present and future quality of life.

 

 

J Matern Fetal Neonatal Med. 2014 Feb;27(3):303-8.

In utero exposure and endometriosis.

Benagiano G1Brosens I.

 

Abstract

Adverse living and nutritional conditions in utero and in early infancy may influence the risk of diseases in adult life, because fetal growth seems determined by interactions between the environment and the fetal genome and these interactions may determine the risk of postnatal disease and the capacity to react to and cope with the postnatal environment. It has been proven that massive fetal exposure to toxic agents causes an increased incidence of negative outcomes in pregnant women; of particular interest is the association between in utero exposure to toxic agents and the occurrence of endometriosis. There is evidence that exposure to dioxins can facilitate short-term survival of endometrial implants in non-human primates, but there is no solid evidence that it may lead to endometriosis in humans. In the case of diethylstilbestrol, an increased risk of developing endometriosis seems well established, although the mechanisms through which diethylstilbestrol can modify endometrial physiology remain uncertain. Finally, evidence that environmental and specific dietary factors may play a role in increasing the incidence of endometriosis and other pathologic conditions has accumulated over the years. Although the hypothesis may be valid, the most recent investigations have failed to find specific, significant correlations.

 

 

Hum Reprod. 2013 Sep;28(9):2502-10.

Expression of neuronal markers in the endometrium of women with and those without endometriosis.

Newman TA1Bailey JLStocker LJWoo YLMacklon NSCheong YC.

 

Abstract

STUDY QUESTION:

How do the expression patterns of neuronal markers differ in the endometrium of women with and without endometriosis?

SUMMARY ANSWER:

The neuronal markers, PGP9.5, NGFp75 and VR1, are expressed in the endometrium at levels that do not differ between women with and without endometriosis.

WHAT IS KNOWN ALREADY:

Aberrant neuronal growth within the uterus may contribute to abnormal fertility and uterine dysfunction. However, controversy still exists as to whether aberrant innervation in the endometrium is associated with gynaecological pathology such as endometriosis. This may reflect the use of subjective methods such as histology to assess the innervation of the endometrium. We, therefore, employed a quantitative method, western blotting, to study markers of endometrial innervation in the presence and absence of endometriosis.

STUDY DESIGN, SIZE, DURATION:

This study included 45 women undergoing laparoscopic examination for the diagnosis of endometriosis. Endometrial samples were analysed by western blot for the expression of neuronal and neurotrophic markers, PGP9.5, VR1 and NGFp75.

PARTICIPANTS/MATERIALS, SETTINGS, METHODS:

Endometrial pipelle biopsies were obtained from patients with (n = 20, study group) and without (n = 25, control group) endometriosis. Tissue was analysed by immunohistochemistry and western blot analysis for the expression of pan-neuronal marker, PGP9.5, sensory nociceptive marker, TPVR1, and low-affinity neurotrophic growth factor receptor, NGFRp75.

MAIN RESULTS AND THE ROLE OF CHANCE:

PGP9.5, NGFp75 and VR1 were expressed in the endometrium of women, independent of the presence of endometriosis. Furthermore, the expression level of PGP9.5, VR1 and NGFp75 did not alter between the two cohorts of women.

LIMITATIONS, REASONS FOR CAUTION:

Studies of this nature are subject to the heterogeneous nature of patient population and tissue samples despite attempts to standardize these parameters. Hence, further studies using similar methodology will be required to confirm our results.

WIDER IMPLICATIONS OF THE FINDINGS:

Our results highlight that sensory neuronal markers are present in women with and without endometriosis. Future work will assess what the targets of the endometrial nerves are and investigate their function, their impact on endometrial biology and, in particular, whether aberrant neuronal function, rather than the mere presence of neuronal function, could be the root cause of subfertility and/or pain affecting many endometriosis sufferers. Our results do not, however, confirm the previous paradigm of increased innervation in the endometrium of women with endometriosis, nor the use of nerve cell detection from pipelle biopsies to diagnose endometriosis.

 

 

Womens Health (Lond). 2013 Jul;9(4):387-95.

Immunology of normal and abnormal menstruation.

Berbic M1Fraser IS.

 

Abstract

Normal menstruation is an inflammatory process, where the endometrial concentrations and functions of several leukocyte types can change greatly through the menstrual cycle, especially during the premenstrual and menstrual phases. These leukocytes probably have a range of functions related to mucosal protection, decidualization, embryo implantation, and the process of menstrual tissue breakdown, repair and remodeling. Some of these leukocyte changes are apparently linked to changes in the pattern of circulating leukocytes. Many immune cells have been identified in the endometrium, and those with most relevance to the processes of menstruation include uterine natural killer cells, macrophages, mast cells, neutrophils, dendritic cells and Tregs. A range of disturbances in endometrial immune cell numbers, distributions and functions, and in a range of different inflammatory and other mediators, have been identified in women with heavy menstrual bleeding or endometriosis. Sufficient evidence exists to implicate these immune changes in some of the functional disturbances and symptoms identified in these women. This field is greatly under-researched, and ripe for the wider application of modern molecular and cellular techniques in human and animal model studies.

 

 

 

 

 

Eur J Obstet Gynecol Reprod Biol. 2013 Sep;170(1):206-10.

Theranekron for treatment of endometriosis in a rat model compared with medroxyprogesterone acetate and leuprolide acetate.

Dolapcioglu K1Dogruer GOzsoy SErgun YCiftci SSoylu Karapinar OAslan E.

 

Abstract

OBJECTIVES:

The aim of this study was to compare the effects of theranekron, medroxyprogesterone acetate (MPA), and leuprolide acetate (LA) on surgically induced endometriosis in a rat model.

STUDY DESIGN:

Endometriosis was surgically induced in forty female rats during estrus. After 3 weeks, a second operation was performed and the rats were randomized using a randomization table into theranekron, MPA, LA, and control groups. These treatments were continued for 3 weeks. A third operation was performed to evaluate treatment results. Then, the experimental treatments were halted and estrogen was initiated again to maintain estrus. After three additional weeks; i.e. after 9 weeks, the recurrence rate of endometrial foci was evaluated in a fourth operation and the rats were sacrificed. The volume of endometriotic foci and histopathology scores before and after treatment were compared.

RESULTS:

The respective mean volumes of the endometriotic foci after 3, 6, and 9 weeks were 86.4±21.2, 16.4±8.2, and 20.1±9.6 mm(3) in the theranekron group, 78.3±20.4, 42.6±13.5, and 66.7±16.2 mm(3) in the MPA group, and 91.8±30.2, 34.4±11.4, and 72.4±21.9 mm(3) in the LA group. The respective mean histopathology scores were 2.4±0.6, 1.8±0.6, and 1.6±0.6 in the theranekron group, 2.5±0.8, 2.0±1.1, and 2.7±1.0 in the MPA group, and 2.3±0.5, 2.1±1.2, 2.4±0.8 in the LA group. After 9 weeks, the mean volume of endometriotic foci and histopathology scores were significantly lower in the theranekron group.

CONCLUSIONS:

Theranekron caused more evident regression of endometriotic foci than MPA or LA in a rat model. After stopping the theranekron treatment, the recurrence rate was also lower than that of the other groups.

 

 

Hum Reprod Update. 2013 Sep-Oct;19(5):542-57.

The motile and invasive capacity of human endometrial stromal cells: implications for normal and impaired reproductive function.

Weimar CH1Macklon NSPost Uiterweer EDBrosens JJGellersen B.

 

Abstract

BACKGROUND Mechanisms underlying early reproductive loss in the human are beginning to be elucidated. The migratory and invasive capacity of human endometrial stromal cells (ESCs) is increasingly recognized to contribute to the intense tissue remodelling associated with embryo implantation, trophoblast invasion and endometrial regeneration. In this review, we examine the signals and mechanisms that control ESC migration and invasion and assess how deregulation of these cell functions contributes to common reproductive disorders. METHODS The PubMed database was searched for publications on motility and invasiveness of human ESCs in normal endometrial function and in reproductive disorders including implantation failure, recurrent pregnancy loss (RPL), endometriosis and adenomyosis, covering the period 2000-2012. RESULTS Increasing evidence suggests that implantation failure and RPL involve abnormal migratory responses of decidualizing ESCs to embryo and trophoblast signals. Numerous reports indicate that endometriosis, as well as adenomyosis, is associated with increased basal and stimulated invasiveness of ESCs and their progenitor cells, suggesting a link between a heightened menstrual repair response and the formation of ectopic implants. Migration and invasiveness of ESCs are controlled by a complex array of hormones, growth factors, chemokines and inflammatory mediators, and involve signalling through Rho GTPases, phosphatidylinositol-3-kinase and mitogen-activated protein kinase pathways. CONCLUSIONS Novel concepts are extending our understanding of the key functions of ESCs in effecting tissue repair imposed by cyclic menstruation and parturition. Migration of decidualizing ESCs also serves to support blastocyst implantation and embryo selection through discriminate motile responses directed by embryo quality. Targeting regulatory molecules holds promise for developing new strategies for the treatment of reproductive disorders such as endometriosis and recurrent miscarriage; and harnessing the migratory capacity of progenitor mesenchymal stem cells in the endometrium may offer new opportunities in regenerative medicine.

 

 

 

Med Sci Monit. 2013 Jul 5;19:534-9.

Effects of simvastatin in prevention of pain recurrences after surgery for endometriosis.

Almassinokiani F1Mehdizadeh ASariri ERezaei MAlmasi AAkbari HPazooki ASolaymani-Dodaran MAsadollah SAmirkhani JChaichian SVahdat MMoosavi AAshouri MTamannaei Z.

 

Abstract

BACKGROUND:

To compare efficacy of simvastatin with GnRHa (Decapeptyl 3.75 mg) on endometriosis-related pains following surgery for endometriosis.

MATERIAL/METHODS:

Sixty women with pelvic endometriosis, after laparoscopic diagnosis and conservative laparoscopic surgery, were treated with either simvastatin (n=30) for 16 weeks or Decapeptyl (n=30) every 4 weeks for 4 doses.

RESULTS:

Using VAS, the score of dyspareunia, dysmenorrhea, and pelvic pain 6 months after laparoscopic surgery declined significantly in both groups (p=0.001), but the difference between results of the 2 groups was not significant (p>0.05).

CONCLUSIONS:

Both treatment modalities showed comparable effectiveness in the treatment of pains related to endometriosis.

 

 

Prog Urol. 2013 Jul;23(9):761-70

Sexual pain disorders in females and males.

Monforte M1Mimoun SDroupy S.

 

Abstract

INTRODUCTION:

The occurrence of pain during sex is one of the most common complaints in gynecological and sexological practice but nonetheless one of the most difficult problems to deal with and treat effectively.

METHODS:

A literature review was conducted on Medline considering the articles listed until January 2012 dealing with sexual pain in women and men.

RESULTS:

The different descriptions of painful intercourse (dyspareunia, vestibulo-vulvodynies, vaginismus) are not separate entities but the result of the interaction of many factors including genital pain, emotional and behavioral responses to penetration, caresses, desire and excitement, in a context of possible organic pathology (infection, endometriosis, inflammatory or dermatological disease, morphological or pelvic abnormality, hormonal deficiency) sometimes associated with chronic pain phenomena self-sustained by neurogenic inflammation. The clinical expression of sexual pain is as variable as its causes are many. The etiological investigation is essential but should not omit the sexological context and the need for appropriate management. The neurogenic inflammation and hypersensitivity impose an algological approach associated to etiological and sexological treatment.

CONCLUSION:

Chronic sexual pains, whether they are superficial or deep, can be the sign of organic or psycho-sexual (primary or secondary) disorders. The development of a “therapeutic program” helps patients, allows them to restore self-confidence and leads to the disappearance of the symptom in more than half cases.

 

 

J Assist Reprod Genet. 2013 Aug;30(8):1063-72.

Nitric oxide modulates mitochondrial activity and apoptosis through protein S-nitrosylation for preimplantation embryo development.

Lee TH1Lee MSHuang CCTsao HMLin PMHo HNShew JYYang YS.

 

Abstract

PURPOSE:

Previous studies reported that patients with endometriosis had excess nitric oxide (NO) in the reproductive tract and poor embryo development in IVF cycles. This study aims to elucidate the effects of NO on early embryo development.

METHODS:

Zygotes from superovulated B6CBF1 mice were cultured to blastocysts in a variety of media. Sodium nitroprusside (SNP) and N(G)-nitro-L-arginine (LNA) were added to the culture medium as a NO donor and a NO synthase inhibitor, respectively. The localization and fluorescence intensity of S-nitrosylated (SNO) proteins within 2-cell stage embryos were analyzed with confocal microscopy. Apoptosis and ATP production in the blastocysts were measured.

RESULT(S):

Subsequent to NO exposure, the SNO proteins mainly colocalized with the mitochondria and endoplasmic reticulum and the intensity of SNO proteins increased. The addition of a quanylate cyclase inhibitor and a cyclic GMP mimic agent induced nonsignificant changes in SNO proteins, whereas addition of a superoxide scavenger or a reduced form of glutathione rescued the embryos from the effects of NO. However, superoxide scavenger supplementation resulted in decreased blastocyst ATP production.

CONCLUSION(S):

Elevated NO exerts deleterious effects on embryo development, possibly through protein S-nitrosylation in the mitochondria and endoplasmic reticulum. Including glutathione as a component in the culture medium might counteract this effect.

 

 

J Clin Endocrinol Metab. 2013 Sep;98(9):E1474-82.

CCAAT/enhancer-binding protein α is epigenetically silenced by histone deacetylation in endometriosis and promotes the pathogenesis of endometriosis.

Kawano Y1Nasu KHijiya NTsukamoto YAmada KAbe WKai KMoriyama MNarahara H.

 

Abstract

CONTEXT:

Accumulating evidence suggests that various epigenetic aberrations play definite roles in the pathogenesis of endometriosis.

OBJECTIVE:

The objective of the study was to determine the epigenetically silenced genes by histone deacetylation in endometriosis.

DESIGN:

Histone deacetylase-1 target mRNAs that were up-regulated by valproic acid (VPA) treatment in endometriotic cyst stromal cells (ECSCs) were identified by a global mRNA microarray technique.

RESULTS:

We identified 5 candidate genes and chose CCAAT/enhancer-binding protein α (C/EBPα) for further functional experiments. C/EBPα mRNA and protein expression is attenuated in ECSCs, and the expression was up-regulated by VPA stimulation. Immunohistochemical stainings also confirmed the decreased staining for C/EBPα protein in endometriotic tissues. VPA treatment resulted in an accumulation of acetylated histones H3 and H4 in the promoter region of the C/EBPα gene in ECSCs. The compulsory expression of C/EBPα in ECSCs directed the inhibition of cell proliferation and the induction of apoptosis. C/EBPα knockdown by small interfering RNA directed the stimulation of cell proliferation and the resistance to apoptosis in normal eutopic endometrial stromal cells. The expressions of peroxisome proliferator-activated receptor-γ (PPARγ), period homolog 2 (PER2), p53, apoptosis-inducing factor, mitochondrion-associated 1 (AIFM1), Bax, caspase-8, caspase-10, p16(INK4a), p21(Waf1/Cip1), cyclin-dependent kinase (cdk) 2, and cdk4 were down-regulated by C/EBPα knockdown.

CONCLUSIONS:

Our findings suggest that an epigenetically suppressed tumor suppressor gene is involved in the pathogenesis of endometriosis by creating the proliferative, antiapoptotic, and other disease-specific characteristics of endometriosis. The results also suggest that histone deacetylase inhibitors are promising agents for the treatment of endometriosis.

 

 

BJOG. 2013 Oct;120(11):1308-20.

The effect of endometriosis on in vitro fertilisation outcome: a systematic review and meta-analysis.

Harb HM1Gallos IDChu JHarb MCoomarasamy A.

 

Abstract

BACKGROUND:

Endometriosis is found in 0.5-5% of fertile women and 25-40% of infertile women. It is known that endometriosis is associated with infertility, but there is uncertainty whether women with endometriosis have adverse pregnancy outcomes in in vitro fertilisation (IVF) treatment.

OBJECTIVES:

To explore the association between endometriosis and IVF outcome.

SEARCH STRATEGY:

Searches were conducted on MEDLINE, EMBASE, Cochrane Library and Web of Science (inception, December 2012) in all languages, together with reference lists of retrieved papers.

SELECTION CRITERIA:

Studies comparing IVF outcome in women with endometriosis with women without endometriosis. Patients were classified by stage of endometriosis. The outcomes were fertilisation, implantation, clinical pregnancy and live birth rates. Study selection was conducted independently by two reviewers. The Newcastle-Ottawa Quality Assessment Scale was used for quality assessment.

DATA COLLECTION AND ANALYSIS:

Data extraction was conducted independently by two reviewers. Relative risks from individual studies were meta-analysed.

MAIN RESULTS:

Twenty-seven observational studies were included, comprising 8984 women. Meta-analysis of these studies showed that fertilisation rates were reduced in stage I/II of endometriosis (relative risk [RR] = 0.93, 95% confidence interval [95% CI] 0.87-0.99, P = 0.03). There was a decrease in the implantation rate (RR = 0.79, 95% CI 0.67-0.93, P = 0.006) and clinical pregnancy rate (RR = 0.79, 95% CI 0.69-0.91, P = 0.0008) in women with stage III/IV endometriosis undergoing IVF treatment.

CONCLUSION:

The presence of severe endometriosis (stage III/IV) is associated with poor implantation and clinical pregnancy rates in women undergoing IVF treatment.

 

 

 

Ann Pharmacother. 2013 Jul-Aug;47(7-8):e32.

Occurrence of milnacipran-associated morbilliform rash and serotonin toxicity.

Huskey AM1Thomas CCWaddell JA.

 

Abstract

OBJECTIVE:

To report the development of morbilliform rash and serotonin toxicity after the addition of milnacipran to a patient’s medication therapy.

CASE SUMMARY:

A 57-year-old white female presented to the emergency department because of a full-body morbilliform rash, which appeared 9 days after initiation of milnacipran 50 mg twice daily. In the emergency department the patient’s vital signs were: heart rate 121 beats/min, blood pressure 180/100 mm Hg, and temperature 38.9 °C. The patient reported diarrhea, nausea, dizziness, restlessness, and increased muscle pain. Her history included recurrent breast cancer first diagnosed in 1999, hypertension, fibromyalgia, depression, osteopenia, gastroesophageal reflux disease, insomnia, and endometriosis. Her home medications included milnacipran, fluoxetine, alprazolam, zolpidem, zoledronic acid, anastrozole, doxepin, ranitidine, levocetirizine, doxazosin, tramadol, vitamin D, and ferrous gluconate. The patient’s increased heart rate, blood pressure, and temperature, as well as restlessness, self-reported diarrhea and nausea, and self-reported increase in muscle pain, indicated serotonin toxicity. Milnacipran, fluoxetine, and tramadol were discontinued, while doxepin was continued. Treatment consisted of acetaminophen, diphenhydramine, methylprednisolone, promethazine, and hydralazine 10 mg intravenously. The following morning all vital signs were within normal limits and the patient’s diarrhea, nausea, dizziness, restlessness, and muscle pain resolved. She was discharged the following morning. The rash had resolved after day 2 of hospital discharge, which was the fourth day after discontinuation of milnacipran.

DISCUSSION:

Given the patient’s symptoms, the timing of symptom onset, the patient’s history, and findings on physical examination, as well as use of the Naranjo probability scale, milnacipran was deemed the probable cause of the morbilliform reaction and serotonin toxicity. Only 1 case report of rash and 2 case reports of serotonin syndrome associated with milnacipran have been reported.

CONCLUSIONS:

It is important to increase awareness of the possibility of developing morbilliform rash and serotonin toxicity with milnacipran therapy, as both conditions can be associated with poor outcomes if not detected early and treated appropriately.

 

 

Hum Reprod. 2013 Oct;28(10):2794-803.

Additive effects of inflammation and stress reaction on Toll-like receptor 4-mediated growth of endometriotic stromal cells.

Khan KN1Kitajima MInoue TTateishi SFujishita ANakashima MMasuzaki H.

 

Abstract

STUDY QUESTION:

Is there any combined effect between inflammation and stress reaction on Toll-like receptor 4 (TLR4)-mediated growth of endometriotic cells?

SUMMARY ANSWER:

A combined effect of local inflammation and stress reaction in the pelvic environment may be involved in TLR4-mediated growth of endometriotic stromal cells.

WHAT IS KNOWN ALREADY:

In endometriosis, higher endotoxin levels in the menstrual fluid (MF) and peritoneal fluid (PF) and higher tissue concentrations of human heat shock protein 70 (HSP70) in the eutopic and ectopic endometria promote TLR4-mediated growth of endometriotic cells.

STUDY DESIGN, SIZE AND DURATION:

This is a case-controlled research study with prospective collection and retrospective evaluation of sera, MF, PF and endometrial tissues from 43 women with and 20 women without endometriosis.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

PF was collected from 43 women with endometriosis and 20 control women during laparoscopy. Sera and endometrial biopsy specimens were collected from a proportion of these women. MF was collected from a separate population of 20 women with endometriosis and 15 control women. HSP70 concentrations in sera, MF, PF and in culture media were measured by ELISA. Gene expression of HSP70 by endometrial cells in response to lipopolysaccharide (LPS) was examined by qRT-PCR. The individual and combined effects of LPS and HSP70 on the secretion of interleukin-6 (IL-6) and tumor necrosis factor α (TNFα) by PF-derived macrophages (M[Symbol: see text]) were examined by ELISA, while their effects on endometrial cell proliferation were examined by bromodeoxyuridine and [(3)H]-thymidine incorporation assay.

MAIN RESULTS AND THE ROLE OF CHANCE:

Concentrations of HSP70 were maximal in MF, intermediate in PF and the lowest in sera. In MF and PF, HSP70 levels were higher in women with endometriosis than in controls. LPS stimulated gene expression and secretion of HSP70 by eutopic endometrial stromal cells (ESCs) and this effect was abrogated after pretreatment of cells with an anti-TLR4 antibody. This effect was significantly higher for ESCs derived from women with endometriosis than for ESCs from control women. Exogenous treatment with either HSP70 or LPS significantly stimulated the production of IL-6 and TNFα by M[Symbol: see text] and promoted the proliferation of ESCs, and a significant additive effect between LPS and HSP70 was observed. While individual treatment with either polymyxin B, an LPS antagonist, or anti-HSP70 antibody was unable to suppress the combined effects of LPS and HSP70 on cytokine secretion or ESC proliferation, pretreatment of cells with the anti-TLR4 antibody was able to significantly suppress their combined effects.

LIMITATIONS, REASONS FOR CAUTIONS:

Further studies are needed to examine the mutual role between other secondary inflammatory mediators and endogenous stress proteins in promoting pelvic inflammation and growth of endometriotic stromal cells.

WIDER IMPLICATIONS OF THE FINDINGS:

Our findings suggest that endotoxin and HSP70 are mutually involved in a stress reaction and in inflammation. A combined effect between local inflammation and a stress reaction in pelvic environment may be involved in TLR4-mediated growth of endometriotic cells. Since endometriosis is a multi-factorial disease, it is difficult to explain uniformly its growth regulation by a single factor. Our findings may provide some new insights in understanding the physiopathology or pathogenesis of endometriosis and may hold new therapeutic potential.

STUDY FUNDING/COMPETING INTEREST(S):

This work was supported by Grants-in-Aid for Scientific Research (grant no. 16591671 and 18591837) from the Ministry of Education, Sports, Culture, Science and Technology of Japan (to K.N.K.). There is no conflict of interest related to this study.

 

 

 

Obstet Gynecol Int. 2013;2013:527041.

Interplay between Misplaced Müllerian-Derived Stem Cells and Peritoneal Immune Dysregulation in the Pathogenesis of Endometriosis.

Laganà AS1Sturlese ERetto GSofo VTriolo O.

 

Abstract

In the genetic regulation of Müllerian structures development, a key role is played by Hoxa and Wnt clusters, because they lead the transcription of different genes according to the different phases of the organogenesis, addressing correctly cell-to-cell interactions, allowing, finally, the physiologic morphogenesis. Accumulating evidence is suggesting that dysregulation of Wnt and/or Hox genes may affect cell migration during organogenesis and differentiation of Müllerian structures of the female reproductive tract, with possible dislocation and dissemination of primordial endometrial stem cells in ectopic regions, which have high plasticity to differentiation. We hypothesize that during postpubertal age, under the influence of different stimuli, these misplaced and quiescent ectopic endometrial cells could acquire new phenotype, biological functions, and immunogenicity. So, these kinds of cells may differentiate, specializing in epithelium, glands, and stroma to form a functional ectopic endometrial tissue. This may provoke a breakdown in the peritoneal cavity homeostasis, with the consequent processes of immune alteration, documented by peripheral mononuclear cells recruitment and secretion of inflammatory cytokines in early phases and of angiogenic and fibrogenic cytokines in the late stages of the disease.

 

 

Gynecol Endocrinol. 2013 Sep;29(9):863-6.

The vanishing endometrioma: the intriguing impact of pregnancy on small endometriotic ovarian cysts.

Benaglia L1Somigliana ECalzolari LBusnelli ACardellicchio LRagni GFedele L.

 

Abstract

There is a general belief that pregnancy has a beneficial effect on endometriosis but evidence is scanty. Moreover, some recent warning reports documented progression-growth of ovarian endometriomas during pregnancy. To further elucidate this aspect, we set up a prospective cohort study. We recruited 24 women carrying endometriomas at the time of in vitro fertilization who got pregnant. Selected women were contacted about 12-18 months after oocyte retrieval and invited to refer for ultrasound. The primary aim was to evaluate the modifications of endometriotic cysts after pregnancy. Twenty-four women carrying 40 endometriomas accepted to participate. The number of cysts per patient was significantly reduced following pregnancy (p = 0.003). It was unchanged in eight cases (33%), increased in two cases (8%) and reduced in three cases (13%). In the remaining 11 women (46%), no cyst could be detected. A comparison of the size of the endometrioma could be done in 21 cysts; the mean ± SD diameter before and after pregnancy was 20 ± 9 and 18 ± 7 mm, respectively (p = 0.27). In conclusion, pregnancy has a beneficial effect on endometriomas. A consistent proportion of cysts becomes undetectable after delivery. Further studies are warranted to clarify the mechanisms determining the disappearance of these cysts.

 

 

Hum Pathol. 2013 Oct;44(10):1973-81.

Epithelial-to-mesenchymal transition and stem cells in endometrial cancer.

Mirantes C1Espinosa IFerrer IDolcet XPrat JMatias-Guiu X.

 

Abstract

This review article describes the main features of epithelial-to-mesenchymal transition (EMT) and its possible role in understanding myometrial invasion in endometrial carcinoma (EC), as well as the development of malignant mixed Müllerian tumor (MMMT). Moreover, the article discusses the possible role of somatic (SSC) and cancer stem cells (CSC) in EC. Different transcriptional repressors of E-cadherin have been identified in EMT, including Snail and Slug, ZEB1 and ZEB2, and E47 and Twist. The expression of some of these genes is increased at the myoinvasive front and correlates inversely with E-cadherin inmunoreactivity. Whereas the transient occurrence of the EMT phenomenon is important for myometrial invasion in conventional EC, MMMT shows permanent expression of EMT leading to repression of E-cadherin and increased expression of mesenchymal markers including proteins involved in skeletal muscle development. An SSC population, identified as a side population, assessed by the Hoechst dye exclusion test has been identified in human endometrium. CSCs have been defined in analogy to SSC as cancer cells that have the capacity to self-renew, which means undergoing divisions that allow the generation of more identical CSCs and give rise to the variety of more differentiated cells found in the malignancy. Although published data show that CD133(+) cells retain the characteristics of CSC, there is no conclusive evidence showing that CD133 is the universal marker for EC stem cells. Finally, a possible role for endometrial stem cells in the development of ovarian endometriosis and ovarian endometrioid carcinoma is commented.

 

 

 

Hum Reprod. 2013 Oct;28(10):2695-708.

SSEA-1 isolates human endometrial basal glandular epithelial cells: phenotypic and functional characterization and implications in the pathogenesis of endometriosis.

Valentijn AJ1Palial KAl-Lamee HTempest NDrury JVon Zglinicki TSaretzki GMurray PGargett CEHapangama DK.

 

Abstract

STUDY QUESTION:

Can the basal epithelial compartment of the human endometrium be defined by specific markers?

SUMMARY ANSWER:

Human endometrial epithelial cells from the basalis express nuclear SOX9 and the cell-surface marker SSEA-1, with some cells expressing nuclear β-catenin. In vitro, primary endometrial epithelial cells enriched for SSEA-1+ show some features expected of the basalis epithelium.

WHAT IS KNOWN ALREADY:

The endometrial glands of the functionalis regenerate from the basalis gland stumps following menstruation. Endometriosis is thought to originate from abnormal dislocation of the basalis endometrium. In the highly regenerative intestinal epithelium, SOX9 and nuclear β-catenin are more highly expressed in the intestinal crypt, the stem/progenitor cell region.

STUDY DESIGN, SIZE, DURATION:

A large prospective observational study analysing full-thickness human endometrial hysterectomy samples from 115 premenopausal women, 15 post-menopausal women and ectopic endometriotic lesions from 20 women with endometriosis.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Full-thickness endometrium from hysterectomy tissues was analysed by immunohistochemistry for SSEA-1, SOX9 and β-catenin. Primary human endometrial epithelial cells from short-term cultures were sorted into SSEA1+/- fractions with a cell sorter or magnetic beads and analysed for markers of differentiation and pluripotency and telomere lengths (TLs) using qPCR, telomerase activity [telomere repeat amplification protocol (TRAP)] and growth in 3D culture.

MAIN RESULTS AND THE ROLE OF CHANCE:

Similar to the intestinal crypt epithelium, human endometrial basal glandular epithelial cells expressed nuclear SOX9 and contained a rare subpopulation of cells with nuclear β-catenin suggestive of an activated Wnt pathway. The embryonic stem cell-surface marker, SSEA-1, also marked the human endometrial basal glandular epithelial cells, and isolated SSEA-1(+) epithelial cells grown in monolayer showed significantly higher expression of telomerase activity, longer mean TLs, lower expression of genes for steroid receptors and produced a significantly higher number of endometrial gland-like spheroids in 3D culture compared with SSEA-1(-) epithelial cells (P = 0.009). Cells in ectopic endometriosis lesions also expressed SSEA-1 and nuclear SOX9, suggesting that the basalis contributes to ectopic lesion formation in endometriosis following retrograde menstruation.

LIMITATIONS, REASONS FOR CAUTION:

This is a descriptive study with only short-term culture of the primary human epithelial cells in vitro.

WIDER IMPLICATIONS OF THE FINDINGS:

The surface marker SSEA1 enriches for an endometrial epithelial cell subpopulation from the basalis. Since the functional endometrium originates from these cells, it is now possible to study basalis epithelium for stem/progenitor cell activity to extend our current understanding of endometrial biology in health and diseases.

STUDY FUNDING/COMPETING INTEREST(S):

The work included in this manuscript was funded by Wellbeing of Women project grant RG1073 (D.K.H. and C.G.). We also acknowledge the support by National Health and Medical Research Council, RD Wright Career Development Award 465121 and Senior Research Fellowship 1042298, and the Victorian Government’s Operation Infrastructure Support Program to C.G. and MRC G0601333 to T.V.Z. All authors have no conflict of interest to declare.

 

 

Hum Reprod. 2013 Oct;28(10):2677-85

The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey.

De Graaff AA1D’Hooghe TMDunselman GADirksen CDHummelshoj LWERF EndoCost ConsortiumSimoens S.

 

Abstract

STUDY QUESTION:

To what extent do the management of endometriosis and the symptoms that remain after treatment affect the quality of life in women with the disease?

SUMMARY ANSWER:

Many women with endometriosis had impaired quality of life and continued to suffer from endometriosis-associated symptoms even though their endometriosis has been managed in tertiary care centres.

WHAT IS KNOWN ALREADY:

The existing literature indicates that quality of life and work productivity is reduced in women with endometriosis. However, most studies have small sample sizes, are treatment related or examine newly diagnosed patients only.

STUDY DESIGN, SIZE, DURATION:

A cross-sectional questionnaire-based survey among 931 women with endometriosis treated in 12 tertiary care centres in 10 countries.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Women diagnosed with endometriosis who had at least one contact related to endometriosis-associated symptoms during 2008 with a participating centre were enrolled into the study. The study investigated the effect of endometriosis on education, work and social wellbeing, endometriosis-associated symptoms and health-related quality of life, by using questions obtained from the World Endometriosis Research Foundation (WERF) GSWH instrument (designed and validated for the WERF Global Study on Women’s Health) and the Short Form 36 version 2 (SF-36v2).

MAIN RESULTS AND THE ROLE OF CHANCE:

Of 3216 women invited to participate in the study, 1450 (45%) provided informed consent and out of these, 931 (931/3216 = 29%) returned the questionnaires. Endometriosishad affected work in 51% of the women and affected relationships in 50% of the women at some time during their life. Dysmenorrhoea was reported by 59%, dyspareunia by 56% and chronic pelvic pain by 60% of women. Quality of life was decreased in all eight dimensions of the SF-36v2 compared with norm-based scores from a general US population (all P < 0.01). Multivariate regression analysis showed that number of co-morbidities, chronic pain and dyspareunia had an independent negative effect on both the physical and mental component of the SF-36v2.

LIMITATIONS, REASONS FOR CAUTION:

The fact that women were enrolled in tertiary care centres could lead to a possible over-representation of women with moderate-to-severe endometriosis, because the participating centres typically treat more complex and referred cases of endometriosis. The response rate was relatively low. Since there was no Institute Review Board approval to do a non-responder investigation on basic characteristics, some uncertainty remains regarding the representativeness of the investigated population.

WIDER IMPLICATIONS OF THE FINDINGS:

This international multicentre survey represents a large group of women with endometriosis, in all phases of the disease, which increases the generalizability of the data. Women still suffer from frequent symptoms, despite tertiary care management, in particular chronic pain and dyspareunia. As a result their quality of life is significantly decreased. A patient-centred approach with extensive collaboration across disciplines, such as pain specialists, psychologists, sexologists and social workers, may be a valuable strategy to improve the long-term care of women with endometriosis.

STUDY FUNDING/COMPETING INTEREST(S):

The WERF EndoCost study is funded by the World EndometriosisResearch Foundation (WERF) through grants received from Bayer Schering Pharma AG, Takeda Italia Farmaceutici SpA, Pfizer Ltd and the European Society of Human Reproduction and Embryology. The sponsors did not have a role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript. L.H. is the chief executive and T.D. was a board member of WERF at the time of funding. T.D. holds the Merck-Serono Chair in Reproductive Medicine and Surgery, and the Ferring Chair in Reproductive Medicine at the Katholieke Universiteit Leuven in Belgium and has served as consultant/research collaborator for Merck-Serono, Schering-Plough, Astellas and Arresto.

 

 

Arch Med Sci. 2013 Jun 20;9(3):506-14.

Risk factors associated with endometriosis among infertile Iranian women.

Moini A1Malekzadeh FAmirchaghmaghi EKashfi FAkhoond MRSaei MMirbolok MH.

 

Abstract

INTRODUCTION:

Endometriosis is defined as overgrowth of endometrial tissue outside the uterine cavity. Endometriosis may be asymptomatic or associated with dysmenorrheal symptoms, dyspareunia, pelvic pain, abnormal uterine bleeding and infertility. The aim of this study was to explore the risk factors related to endometriosis among infertile Iranian women.

MATERIAL AND METHODS:

In this case control study, infertile women referred for laparoscopy and infertility workup to two referral infertility clinics in Tehran, Iran were studied. According to the laparoscopy findings, women were divided into case (women who had pelvic endometriosis) and control (women with normal pelvis) groups. The case group was divided into two subgroups: stage I and II of endometriosis were considered as mild while stage III and IV were categorized as severe endometriosis. A questionnaire was completed for each patient.

RESULTS:

Logistic regression showed that age, duration of infertility, body mass index (BMI), duration of menstrual cycle, abortion history, dyspareunia, pelvic pain and family history of endometriosis are independent predictive factors for any type of endometriosis. In addition, it was shown that education, duration of infertility, BMI, amount and duration of menstrual bleeding, menstrual pattern, dyspareunia, pelvic pain and family history of endometriosis are independent predictive factors of severe endometriosis. The AUCs for these models were 0.781 (0.735-0.827) and 0.855 (0.810-0.901) for any type of endometriosis and severe endometriosis, respectively.

CONCLUSIONS:

It seems that any type of endometriosis and severe ones could be predicted according to demographic, menstrual and reproductive characteristics of infertile women.

 

 

Eur J Obstet Gynecol Reprod Biol. 2013 Sep;170(1):211-3.

Ovarian carcinoma associated with endometriosis.

Boyraz G1Selcuk IYazıcıoğlu ATuncer ZS.

 

Abstract

OBJECTIVES:

Previous studies have suggested an association between endometriosis and development of ovarian cancer. A study was performed to evaluate the cases of ovarian carcinoma associated with endometriosis.

STUDY DESIGN:

The study includes patients with ovarian carcinoma associated with endometriosis diagnosed between 2000 and 2010 at Hacettepe University Hospital, Ankara, Turkey. A total of 1086 patients who underwent surgical staging for ovarian carcinoma were analyzed retrospectively for the presence of histologically documented endometriosis. The clinical and pathological characteristics of 45 ovarian carcinoma patients associated with endometriosis were evaluated including histologic subtype, stage and grade.

RESULTS:

Ovarian carcinoma was found to be associated with endometriosis in 4.1% (45/1086) of the cases. Of them, 17 patients (37.8%) had clear cell, 15 (33.3%) had endometrioid, 6 (13.3%) had serous papillary, 4 (8.9%) had mucinous and the remaining 3 patients had an undifferentiated subtype of ovarian carcinoma. Twenty-three (51.1%) patients had stage I, 4 (8.9%) had stage II and 18 (40.0%) had stage III disease. The frequency of coexistence of endometriosis was 20.4% (17/83) for clear cell carcinoma and 9.3% (15/161) for endometrioid cell carcinoma.

CONCLUSIONS:

Only a small proportion of ovarian cancer cases were found to be associated with endometriosis. Endometriosis was most frequently associated with clear cell and endometrioid types of ovarian carcinoma. Ovarian carcinoma associated with endometriosis seems to represent a distinct disease entity with different histological subtypes, early presentation and a relatively favorable outcome.

 

 

 

Zhonghua Fu Chan Ke Za Zhi. 2013 Mar;48(3):180-2.

Efficacy and safety of GnRH-a combine with laparoscope conservative surgery in the treatment of the moderate or severe endometriosis.

Zhong YJ1Zhang WZhang WTCheng JLü QYZeng KK.

 

Abstract

OBJECTIVE:

To study the efficacy and safety of Gonadotropin-releasing hormone agonists (GnRH-a) combined with laparoscope conservative surgery in treatment of moderate or severe endometriosis.

METHODS:

From Jan. 2007 to Jan. 2010, 68 patients with moderate or severe undergoing treatment in Renmin Hospital of Wuhan University were enrolled in this retrospective study. Three groups were classified, which were 25 patients in GnRH-a group, subcutaneous injection Leuprorelin on the second day of menstruation, every 4 weeks for 3 months. Twenty-three patients in Marvelon group, orally one marvelon tablet on the second day of menstruation, continuous 21 days for one period of treatment for 3 courses. Twenty patients in surgery group, without any medicine used preoperatively. All patients were followed by 12 months and compare their surgery time, blood loss, recovery, visual analog scale (VAS), and recurrence and so on.

RESULTS:

The operating time were (68 ± 18) min in GnRH-a group, (80 ± 21) min in Marvelon group and (90 ± 24) min in surgery group. The amount of bleeding were (118 ± 15) ml in GnRh-a group, (161 ± 18) ml in Marvelon group and (193 ± 13) ml in surgery group. There was significant lower in the operating time and amount of bleeding in GnRH-a group than those in other two groups (P < 0.05). The activity time and the anus exhaust time were shorter in patients in GnRh-a group than those in the other two groups significantly (P < 0.05). When followed up in 12 months after treatment, visual analogue scale had dropped from 3.8 (1.9 – 6.8) to 1.9 (1.1 – 2.8) in GnRh-a group, from 2.7 (1.3 – 5.5) to 1.8 (1.2 – 3.2) in Marvelon group and from 1.9 (1.0 – 4.9) to 1.6 (1.0 – 3.6) in surgery group. It was showed the most remarkable decreased VAS in GnRHa group when compared with the other two groups (P < 0.05). The recurrence rates were 12% (3/25) in GnRH-a group, 22% (5/23)in Marvelon group and 25% (5/25) in surgery group. It was found that the most significant lower recurrence was in GnRH-a group when compared with the other two groups (P < 0.05).

CONCLUSIONS:

It was safe and efficacy that GnRH-a combined with laparoscopic conservative surgery were used in treatment of endometriosis. It could bring shorter operation time, less intraoperative blood loss, quick postoperative recover, the lower recurrence rate.

 

 

Fertil Steril. 2013 Oct;100(4):1144-50

Nerve fiber density in deep nodular endometriotic lesions induced in a baboon experimental model.

Donnez O1Soares MDefrère SDehoux JPvan Langendonckt ADonnez JDolmans MMColette S.

 

Abstract

OBJECTIVE:

To study the occurrence of nerve fibers in deep nodular endometriotic lesions after nodules were induced in baboons and nerve fiber densities measured 6 months after the grafting procedure.

DESIGN:

Experimental animal study.

SETTING:

Academic gynecology research unit.

ANIMALS:

Ten baboons (Papio anubis).

INTERVENTION(S):

Recovery of induced endometriotic nodules and eutopic endometrium.

MAIN OUTCOME MEASURE(S):

Protein gene product (PGP) 9.5 and nerve growth factor (NGF) immunohistochemistries were performed to evaluate nerve fiber density and NGF expression in induced endometriotic lesions and eutopic endometrium.

RESULT(S):

Eutopic (basalis) endometrium, myometrium, and invasive and noninvasive nodular lesions were analyzed separately. The highest nerve fiber densities were observed in normal myometrium and in the basal layer of eutopic endometrium. No significant differences were observed between the two lesion types. However, the NGF staining intensity score was found to be higher in glands of deep invasive lesions than in glands of eutopic baboon endometrium.

CONCLUSION(S):

This is the first study to show the presence of nerve fibers in eutopic baboon endometrium and induced deep endometriotic nodules. Long-term studies are now warranted to determine if nerves still grow in invasive and noninvasive lesions >6 months after grafting, and to evaluate the role of the lesion environment.

 

 

 

J Minim Invasive Gynecol. 2015 Mar-Apr;22(3):373-7

Noninvasive diagnosis of moderate to severe endometriosis: the platelet-lymphocyte ratio cannot be a neoadjuvant biomarker for serum cancer antigen 125.

Yang H1Zhu L2Wang S1Lang J1Xu T3.

 

Abstract

STUDY OBJECTIVE:

To investigate whether the combined value of the platelet-lymphocyte ratio (PLR) and serum cancer antigen 125 (CA 125) can be used in diagnosing moderate to severe endometriosis.

DESIGN:

A retrospective study (Canadian Task Force classification II-2).

SETTING:

A single center (Department of Obstetrics and Gynecology, Physical Examination Center of Peking Union Medical College Hospital, Beijing, China).

PATIENTS:

Two hundred ninety-nine premenopausal women who underwent laparoscopic surgery, 197 patients with moderate to severe endometriosis, 102 patients with benign tumor, and 112 healthy subjects.

INTERVENTIONS:

None.

MAIN OUTCOME MEASURES:

Analyses were performed using 1-way analysis of variance and receiver operating characteristic (ROC) curves.

RESULTS:

The mean absolute value of serum CA 125, PLR, and the combination values were significantly increased for patients in the moderate to severe endometriosis group (p = .000, p = .004, p = .009, respectively). The area under the curve (AUC) for CA 125 was 0.943 (95% confidence interval [CI], 0.918-0.967) with a sensitivity and specificity of 71.6% and 99.1%, respectively. The AUC for PLR was 0.587 (95% CI, 0.520-0.653) with a sensitivity of 65.0%, a specificity of 51.8%, and a cutoff value at 117.16. The combination, which was calculated by multiplying CA 125 levels by the PLR, with an AUC of 0.929 (95% CI, 0.900-0.958) and a cutoff value of 2812.40, showed the highest sensitivity of 90.4% but a lower specificity of 84.8%.

CONCLUSION:

Serum CA 125 is better than the PLR and the combination biomarkers in diagnosing moderate to severe endometriosis.

 

 

J Minim Invasive Gynecol. 2014 Jan-Feb;21(1):142-6.

Diagnosis and treatment of tubal diverticula: report of 13 cases.

Han H1Guan J1Wang Y1Zhang Q1Shen H2.

 

Abstract

Tubal diverticula is a rare disease, and the literature includes only a few reports of this condition. We tentatively summarized 13 cases to investigate the clinical characteristics, diagnosis, and treatment of tubal diverticula. The clinical manifestations, diagnosis at hysterosalpingography (HSG), surgical treatment, and pregnancy rates of the 13 cases were retrospectively analyzed. Tubal diverticula is more prevalent in women with endometriosis than in infertile patients (6.7% vs 2.1%; p = .000). Eleven patients (84.6%) had endometriosis, which was in an early stage (I or II) in 9 patients (81.8%). HSG may reveal accumulation of radiopaque contrast medium around the distal end of the tubes, suggesting the presence of diverticula. All 13 cases were diagnosed via laparoscopy, and the diverticula were resected during surgery. Eleven of the 13 patients (84.6%) had ≥2 subtle tubal abnormalities. The pregnancy rate in 9 of the 11 patients with tubal diverticula was 81.8%, with 1 ectopic pregnancy (11.1%) and 1 spontaneous abortion (12.5%). HSG may be helpful in enabling the diagnosis of tubal diverticula. It is important that tubal diverticula be diagnosed via laparoscopy with use of diluted methylene blue dye and careful evaluation.

 

 

Qual Life Res. 2014 Feb;23(1):103-17.

Validation of the SF-36 in patients with endometriosis.

Stull DE1Wasiak RKreif NRaluy MColligs ASeitz CGerlinger C.

 

Abstract

OBJECTIVES:

Endometriosis presents with significant pain as the most common symptom. Generic health measures can allow comparisons across diseases or populations. However, the Medical Outcomes Study Short Form 36 (SF-36) has not been validated for this disease. The goal of this study was to validate the SF-36 (version 2) for endometriosis.

METHODS:

Using data from two clinical trials (N = 252 and 198) of treatment for endometriosis, a full complement of psychometric analyses was performed. Additional instruments included a pain visual analog scale (VAS); a physician-completed questionnaire based on patient interview (modified Biberoglu and Behrman–B&B); clinical global impression of change (CGI-C); and patient satisfaction with treatment.

RESULTS:

Bodily pain (BP) and the Physical Component Summary Score (PCS) were correlated with the pain VAS at baseline and over time and the B&B at baseline and end of study. In addition, those who had the greatest change in BP and PCS also reported the greatest change on CGI-C and patient satisfaction with treatment. Other subscales showed smaller, but significant, correlations with change in the pain VAS, CGI-C, and patient satisfaction with treatment.

CONCLUSIONS:

The SF-36–particularly BP and the PCS–appears to be a valid and responsive measure for endometriosis and its treatment.

 

 

Int J Endocrinol Metab. 2013 Winter;11(1):41-7.

Non-contraceptive benefits of oral hormonal contraceptives.

Schindler AE1.

 

Abstract

It is becoming evident that oral hormonal contraceptives-besides being well established contraceptives-seem to become important medications for many functional or organic disturbances. So far, clinical effectiveness has been shown for treatment as well as prevention of menstrual bleeding disorders and menstrual-related pain symptoms. Also this is true for premenstrual syndrome (PMS) and premenstrual disphoric disorder (PMDD). Particular oral contraceptives (OCs) containing anti-androgenic progestogens were shown to be effective medications for treatment of androgenisation symptoms (seborrhea, acne, hirsutism, alopecia). Through perfect suppression of the hypothalamic-pituitary-ovarian axis OCs have proven to be effective in elimination of persistent follicular cysts. Endometriosis/adenomyosis related pain symptoms are well handled similar to other drugs like Gonadotropine Releasing Hormone agonists but are less expensive, with less side effects, and possibility to be used for longer periods of time. This is also true for myoma. Pelvic inflammatory disease, rheumatoid arthritis, menstrual migraine, and onset of multiple sclerosis are prevented or delayed. Bone density is preserved and asthma symptoms improved. Endometrial hyperplasia and benign breast disease can be controlled. There is definitely a significant impact on risk reduction regarding endometrial, ovarian, and colon cancers. In conclusion, it needs to be recognized that oral combined hormonal contraceptives (estrogen/ progestogen combination) are – besides being reliable forms of contraception – are cost-effective medications for many medical disorders in women. Therefore, these contraceptives drugs are important for female and global health and should be used in clinical practice.

 

 

ISRN Obstet Gynecol. 2013 Jun 19;2013:361489.

Mullerian inhibiting substance suppresses proliferation and induces apoptosis and autophagy in endometriosis cells in vitro.

Borahay MA1Lu FOzpolat BTekedereli IGurates BKaripcin SKilic GS.

 

Abstract

Objective. To determine the effects of Mullerian inhibiting substance (MIS) treatment on endometriosis cells through study of apoptosis and autophagy. Design. Experimental in vitro study. Setting. University research laboratory. Cell Line. CRL-7566 endometriosis cell line. This line was established from a benign ovarian cyst taken from a patient with endometriosis. Interventions. In vitro treatment with MIS. Main Outcome Measures. The main outcome measures were cellular viability, proliferation, cell-cycle arrest, and induction of apoptosis and autophagy in endometriotic cells. Results. MIS treatment inhibited proliferation of endometriosis cells and induced apoptosis, as indicated by Annexin V staining, and induced caspase-9 cleavage and cell-cycle arrest, as evidenced by increased expression of p27 CDK-inhibitor. MIS treatment also induced autophagy in endometriosiscells as demonstrated by a significant increase in LC3-II induction, a hallmark of autophagy. Conclusions. MIS inhibits cell growth and induces autophagy, as well as apoptosis, in ectopic endometrial cell lines. Our results suggest that MIS may have a potential as a novel approach for medical treatment of endometriosis. Further studies may be needed to test the efficacy of MIS treatment in animal models and to develop MIS treatment specifically targeted to the endometriosis.

 

 

J Thromb Haemost. 2013 Jun;11 Suppl 1:170-9.

Hemostatic disorders in women.

Kadir RA1Davies J.

 

Abstract

The past few decades have seen major advances in multidisciplinary obstetric care and management of gynecological conditions in women with bleeding disorders. Awareness of the impact of bleeding disorders has improved among the obstetric and gynecological community. Undiagnosed bleeding disorders can be the underlying cause for a significant proportion of women with heavy menstrual bleeding. They may also be the cause or a contributory factor for other gynecological problems, such as dysmenorrhea, intermenstrual bleeding, and endometriosis. Hemostatic assessment should be considered in women referred for menstrual abnormalities if they have a positive bleeding history as quantified by bleeding assessment tools. The reproductive choices and options for prenatal diagnosis are also expanding for families with hemophilia with a drive toward achieving a non-invasive approach. Current non-invasive prenatal diagnostic techniques are limited to identification of fetal gender. Research is ongoing to overcome the specific diagnostic challenges of identifying hemophilia mutations, utilizing free fetal DNA circulating in maternal plasma. The management of obstetric hemorrhage has recently evolved to include a greater focus on the identification of and early treatment for coagulation disorders. Deficiencies in certain hemostatic variables are associated with progression to more severe bleeding; therefore, specific interventions have been proposed to target this. Evidence is still lacking to support such strategy, and future research is required to assess the efficacy and the safety of these hemostatic interventions in women with persistent PPH.

 

 

 

Reprod Biol Endocrinol. 2013 Jul 15;11:64.

CAPN 7 promotes the migration and invasion of human endometrial stromal cell by regulating matrix metalloproteinase 2 activity.

Liu H1Jiang YJin XZhu LShen XZhang QWang BWang JHu YYan GSun H.

 

Abstract

BACKGROUND:

Matrix metalloproteinase 2 (MMP-2) has been reported to be an important regulator of cell migration and invasion through degradation of the extracellular matrix (ECM) in many diseases, such as cancer and endometriosis. Here, we found calcium-activated neutral protease 7 (CAPN 7) expression was markedly upregulated in the eutopic endometrium and endometrial stromal cells of women diagnosed with endometriosis. Our studies were carried out to detect the effects of CAPN 7 on human endometrial stromal cell (hESC) migration and invasion.

METHODS:

Western blotting and quantitative real-time PCR were used to detect the expression of CAPN 7 in endometriosis patients and normal fertile women. Scratch-wound-healing and invasion chamber assay were used to investigate the role of CAPN 7 in hESC migration and invasion. Western blotting, quantitative real-time PCR and zymography were carried out to detect the effect of CAPN 7 on the expressions and activity of MMP-2.

RESULTS:

CAPN 7 was markedly up-regulated in endometriosis, thereby promoting the migration and invasion of hESC. CAPN 7 overexpression led to increased expression of MMP-2 and tissue inhibitor of metalloproteinases 2 (TIMP-2); CAPN 7 knockdown reversed these changes. CAPN 7 increased MMP-2 activity by increasing the ratio of MMP-2 to TIMP-2. We also found that OA-Hy (an MMP-2 inhibitor) decreased the effects of CAPN 7 overexpression on hESC migration and invasion by approximately 50% and 55%, respectively. Additionally, a coimmunoprecipitation assay demonstrated that CAPN 7 interacted with activator protein 2α (AP-2α): an important transcription factor of MMP-2.

CONCLUSIONS:

CAPN 7 promotes hESC migration and invasion by increasing the activity of MMP-2 via an increased ratio of MMP-2 to TIMP-2.

 

 

J Obstet Gynaecol Res. 2013 Nov;39(11):1513-7.

Allen-Masters syndrome: do the classic risk factors also apply in patients with endometriosis?

Haas D1Oppelt PShebl OChvatal RShamiyeh AMayer RBinder H.

 

Abstract

AIM:

To evaluate whether the classic risk factors for Allen-Masters syndrome, such as body mass index (BMI) and spontaneous births, are in fact responsible for the condition in patients with endometriosis.

METHODS:

A total of 26 women who underwent a laparoscopic procedure due to chronic pelvic pain, Allen-Masters syndrome and endometriosis from 2009-2011 were enrolled in this study from an endometriosiscompetence center specializing in minimally invasive surgery. This was a retrospective cohort study (Canadian Task Force classification II-2).

RESULTS:

Only eight of the 26 patients (30.77%; 95% confidence interval [CI], 14.33-51.79%) had the classic risk factors (BMI >25 kg/m(2) and/or at least one spontaneous birth). The mean age in the study group was 32.08 years (SD ± 5.45). The patients had a mean BMI (kg/m(2) ) of 19.61 (SD ± 3.07). The means for the patients’ clinical data were 0.88 (SD ± 1.53) pregnancies, 0.81 (SD ± 1.23) for parity, 0.27 (SD ± 0.60) for cesareans and 0.54 (SD ± 0.99) for spontaneous births. The revised American Society for Reproductive Medicine (rASRM) stage showed a median of grade III. The left side of the posterior compartment was more often affected (73.1% of cases) than the right side in all patients.

CONCLUSION:

In all, 69.23% of the cases (95% CI, 48.21-85.67%) were not explained by the classic risk factors. In view of the absence of other diseases and otherwise unremarkable parameters, we consider mechanical damage of the lesser pelvis not to be solely responsible for AMS. Further observations in patients with AMS, with and without endometriosis, may be able to contribute to research into the actual etiology of the condition.

 

 

J Obstet Gynaecol Res. 2013 Aug;39(8):1281-92.

Toll-like receptor system and endometriosis.

Khan KN1Kitajima MFujishita ANakashima MMasuzaki H.

 

Abstract

Endometriosis is an estrogen-dependent chronic inflammatory condition associated with variable degrees of pelvic pain and infertility. Studies have showed that the growth and progression of endometriosis continue even in ovariectomized animals. This indicates that besides ovarian steroid hormones, the growth of endometriosis can be regulated by the innate immune system in the pelvic environment. As a component of innate immune system, increased infiltration of macrophages has been described in the intact tissue and peritoneal fluid of women with endometriosis. Different immune cells and dendritic cells express Toll-like receptors (TLR) and exhibit functional activity in response to microbial products. In this review article, we discuss the role of the TLR system in endometrium and endometriosis and outline the involvement of cytokines/endotoxin in causing adverse reproductive outcome. In the first part of this review article, the fundamentals of innate immune system, functional characteristics of TLR and signaling pathways of TLR4 are discussed for easy understanding by the readers.

 

 

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