Int J Womens Health. 2013 Dec 17;6:11-23.

Burden of menstrual symptoms in Japanese women – an analysis of medical care-seeking behavior from a survey-based study.

Tanaka E1Momoeda M2Osuga Y3Rossi B4Nomoto K5Hayakawa M5Kokubo K6Wang EC1.

 

Abstract

BACKGROUND:

Menstrual symptoms are associated with various health problems in women of reproductive age, and this may impact their quality of life. Despite this, Japanese women are likely to hesitate seeking a specialist’s medical help for their menstrual symptoms.

PURPOSE:

To study subject parameters including symptom severity, gynecological disorders, and treatments in medical care-seeking women (outpatient) and women opting for self-care (nonvisit), to identify reasons why Japanese women do not see a gynecologist, and to document the benefit of gynecologist visits by assessing the impact on women’s daily lives.

METHODS:

Two online surveys were conducted among women aged 15-49 years. Sampling was structured to approximate the age and geographic distribution in Japan. Results of the first survey and part of the second survey on the overall current burden of menstrual symptoms are reported in a separate publication. Further outcomes from the second survey reported in this paper included data from the outpatient (n=274) and nonvisit (n=500) groups on symptom severity, gynecological disorders, medical treatment use, reasons for not seeking medical care, and the improvement of daily life.

RESULTS:

The outpatient group tended to have greater symptom severity compared to the nonvisit group. Uterine fibroids, dysmenorrhea, endometriosis, and premenstrual syndrome were the most commonly self-reported diagnoses, and oral contraceptives were frequently prescribed at gynecologist visits. Nonvisit group subjects felt that gynecologist consultations were unnecessary or felt resistant to them. Daily life was significantly improved after medical treatment from a gynecologist visit with associated economic savings, whilst the nonvisit group had no change after taking over-the-counter drugs to relieve their menstrual symptoms.

CONCLUSION:

The present study results indicate that Japanese women who were suffering from menstrual symptoms could benefit from visiting a gynecologist for easing their symptoms, hence improving their daily life.

 

 

Int J Reprod Med. 2014;2014:179515.

Theories on the pathogenesis of endometriosis.

Sourial S1Tempest N2Hapangama DK2.

 

Abstract

Endometriosis is a common, chronic inflammatory disease defined by the presence of extrauterine endometrial tissue. The aetiology of endometriosis is complex and multifactorial, where several not fully confirmed theories describe its pathogenesis. This review examines existing theories on the initiation and propagation of different types of endometriotic lesions, as well as critically appraises the myriad of biologically relevant evidence that support or oppose each of the proposed theories. The current literature suggests that stem cells, dysfunctional immune response, genetic predisposition, and aberrant peritoneal environment may all be involved in the establishment and propagation of endometriotic lesions. An orchestrated scientific and clinical effort is needed to consider all factors involved in the pathogenesis of this multifaceted disease and to propose novel therapeutic targets to reach effective treatments for this distressing condition.

 

 

J Steroids Horm Sci. 2014;5(3):136.

Kaempferol Exhibits Progestogenic Effects in Ovariectomized Rats.

Toh MF1Mendonca E1Eddie SL1Endsley MP1Lantvit DD1Petukhov PA1Burdette JE1.

 

Abstract

OBJECTIVE:

Progesterone (P4) plays a central role in women’s health. Synthetic progestins are used clinically in hormone replacement therapy (HRT), oral contraceptives, and for the treatment of endometriosis and infertility. Unfortunately, synthetic progestins are associated with side effects, including cardiovascular disease and breast cancer. Botanical dietary supplements are widely consumed for the alleviation of a variety of gynecological issues, but very few studies have characterized natural compounds in terms of their ability to bind to and activate progesterone receptors (PR). Kaempferol is a flavonoid that functions as a non-steroidal selective progesterone receptor modulator (SPRM) in vitro. This study investigated the molecular and physiological effects of kaempferol in the ovariectomized rat uteri.

METHODS:

Since genistein is a phytoestrogen that was previously demonstrated to increase uterine weight and proliferation, the ability of kaempferol to block genistein action in the uterus was investigated. Analyses of proliferation, steroid receptor expression, and induction of well-established PR-regulated targets Areg and Hand2 were completed using histological analysis and qPCR gene induction experiments. In addition, kaempferol in silico binding analysis was completed for PR. The activation of estrogen and androgen receptor signalling was determined in vitro.

RESULTS:

Molecular docking analysis confirmed that kaempferol adopts poses that are consistent with occupying the ligand-binding pocket of PRA. Kaempferol induced expression of PR regulated transcriptional targets in the ovariectomized rat uteri, including Hand2 and Areg. Consistent with progesterone-l ke activity, kaempferol attenuated genistein-induced uterine luminal epithelial proliferation without increasing uterine weight. Kaempferol signalled without down regulating PR expression in vitro and in vivo and without activating estrogen and androgen receptors.

CONCLUSION:

Taken together, these data suggest that kaempferol is a unique natural PR modulator that activates PR signaling in vitro and in vivo without triggering PR degradation.

 

 

Cancer Inform. 2015 Mar 23;13(Suppl 3):113-23.

Design and Implementation of a Comprehensive Web-based Survey for Ovarian Cancer Survivorship with an Analysis of Prediagnosis Symptoms via Text Mining.

Sun J1Bogie KM2Teagno J3Sun YH4Carter RR1Cui L5Zhang GQ5.

 

Abstract

Ovarian cancer (OvCa) is the most lethal gynecologic disease in the United States, with an overall 5-year survival rate of 44.5%, about half of the 89.2% for all breast cancer patients. To identify factors that possibly contribute to the long-term survivorship of women with OvCa, we conducted a comprehensive online Ovarian Cancer Survivorship Survey from 2009 to 2013. This paper presents the design and implementation of our survey, introduces its resulting data source, the OVA-CRADLE™ (Clinical Research Analytics and Data Lifecycle Environment), and illustrates a sample application of the survey and data by an analysis of prediagnosis symptoms, using text mining and statistics. The OVA-CRADLE™ is an application of our patented Physio-MIMI technology, facilitating Web-based access, online query and exploration of data. The prediagnostic symptoms and association of early-stage OvCa diagnosis with endometriosis provide potentially important indicators for future studies in this field.

 

 

 

 

Clin Exp Obstet Gynecol. 2014;41(5):495-8.

Levonorgestrel-releasing intrauterine device used for dysmenorrhea: five-year literature review.

Imai AMatsunami KTakagi HIchigo S.

 

Abstract

Intrauterine devices (IUDs) provide highly effective, long-term, safe, reversible contraception, and are the most widely used reversible contraceptive method worldwide. The levonorgestrel-releasing IUD (LNG-IUD), originally designed for long-term contraceptives, is now recognized to provide non-contraceptive health benefits. These include severe dysmenorrhea and/or heavy menstrual bleeding associated with uterine myoma, endometriosis, and adenomyosis. This report aims to review the last five-year literature on the efficacy and safety of the LNG-IUD in women with dysmenorrhea. Dysmenorrhea has been reported to decrease in all women. LNG-IUD seems to be superior over copper-releasing IUD for improving dysmenorrhea. The LNG-IUD is beneficial for symptom recurrence and endometriotic cyst recurrence after conservative surgery for patients with severe pain related to endometriosis. There is also evidence to support its role in menstrual problems of severely obese adolescent females. Expulsion, one of the important factors for IUD acceptability, is rare but more common in women with distorted uterine cavity. In the treatment of dysmenorrhea, the LNG-IUD is equal or superior to treat with systemic progestins or oral contraceptives even in adolescent or menopausal women.

 

 

Clin Exp Obstet Gynecol. 2014;41(5):541-6.

The possible role of zinc in the etiopathogenesis of endometriosis.

Messalli EMSchettino MTMainini GErcolano SFuschillo GFalcone FEsposito EDi Donna MCDe Franciscis PTorella M.

 

Abstract

PURPOSE OF INVESTIGATION:

Aim of the study was to evaluate the possible involvement of zinc in the complex pathogenic process behind the onset and perpetuation of endometriotic lesions. To study the level of zinc serum between a group of patients affected by endometriosis and a group of healthy patients.

MATERIALS AND METHODS:

The study included 86 women: 42 patients whose histodiagnosis had revealed pelvic endometriosis and 44 healthy patients. The authors measured the serum zinc concentration for all patients.

RESULTS:

The group of patients with endometriosis presented serum zinc concentration of 1010 +/- 59.24 microg/l. The observation group presented a serum zinc concentration of 1294 +/- 62.22 microg/l.

CONCLUSION:

The results showed that serum zinc levels in women with endometriosis are decreased and this seems to actually confirm that this microelement can possibly affect the multifactorial pathogenesis of the disease. As a matter of fact, zinc interferes with many biological processes, among which inflammation and immunity, which seem to be the base of the development of the lesions. Therefore, the authors believe that this hypothesis requires more attention and further investigation to determine its reasonableness. If the results are confirmed, this study opens up future prospects as for the treatment of endometriosis, taking into account also the role of zinc in the onset of male sterility and the development of testicles. Zinc could in fact be used as marker to detect women at high risk of endometriosis and for the elaboration of a new treatment for sterility, from which these women often suffer.

 

 

Clin Exp Obstet Gynecol. 2014;41(5):547-50.

Relation of peritoneal fluid and serum vascular endothelial growth factor levels to endometriosis stage.

Kopuz AKurt SDemirtas OToz ETasyurt A.

 

Abstract

OBJECTIVE:

It is a well known fact that endometriosis is linked with apoptosis, extracellular matrix formation, and angiogenesis. In this study, the authors aim to investigate the relation between the extent of endometriosisand vascular endothelial growth factor (VEGF).

MATERIALS AND METHODS:

Twenty-one patients who received laparoscopic intervention due to endometriosisconstituted the patient group, whereas 19 patients who were operated due to extra-endometrial benign cyst were included in the control group. Following the laparoscopic pelvic assessment, peripheral blood samples and two cc of free peritoneal fluid from the Douglas pouch were obtained simultaneously. The samples were studied with regards to VEGF level via solid phase sandwich enzyme-linked immunosorbent assay (ELISA) method.

RESULTS:

In the patient group, eight cases were diagnosed with Stages I and II endometriosis, while 13 cases were diagnosed with Stages III and IV endometriosis. Among the Stage I and II cases, serum VEGF levels were statistically significantly higher, as compared to the Stage III and IV cases, as well as the control group. Discussion: In conclusion, the authors found a relationship between elevated serum VEGF levels and early stage endometriosis.

 

Ulus Cerrahi Derg. 2013 May 28;30(2):106-8.

Invagination of the appendix due to endometriosis presenting as acute appendicitis.

Soylu L1Aydın OU1Aydın S1Özçay N1.

 

Abstract

Appendicitis and endometriosis are commonly encountered surgical problems. Endometrial involvement of the appendix is rare and very few cases have been reported in the literature. True diagnosis of appendix invagination is highly difficult due to variable symptoms. Noting the findings which are in favour of invagination in patients diagnosed with acute appendicitis is of great significance in order to be prepared for changing surgical attempts. This case describes a 34 year old female patient diagnosed with infertility who was operated on for acute appendicitis. In the pathological assessment, endometrial involvement of the appendix was seen. The classification, symptoms, radiological appearance and treatment of appendix invagination described in the literature are discussed.

 

 

Ulus Cerrahi Derg. 2014 Sep 1;30(3):165-8.

Endometriosis externa within the rectus abdominis muscle.

Karaman H1Bulut F2Özaşlamacı A3.

 

Abstract

The presence of endometrial glands and stroma outside the uterine cavity is called “endometriosis”. Recklinghausen first defined this entity in 1896, and Sampson first named it in detail in 1921. Endometriosis is most often seen in the pelvis. Although extrapelvic endometriosis is rare, it can be seen in almost every organ. Endometriosis localized in the rectus abdominis muscle is very rare. A patient who had two previous cesarean sections presented with a 23 mm heterogeneous hypoechoic mass within the rectus abdominis muscle, approximately 1 cm superior to the Pfannenstiel incision that was diagnosed as endometriosis externa by fine-needle biopsy and excisional biopsy. Herein, we report this patient along with the literature.

 

 

J Indian Med Assoc. 2014 Jan;112(1):36-40.

Mifepristone: current knowledge and emerging prospects.

Kakade ASKulkarni YS.

 

Abstract

The first clinically available antiprogestin, mifepristone has generated immense interest in the research community since its’ discovery in 1980. Mifepristone is a synthetic orally active steroid with potent antiglucocorticoid, antiprogestogen and a weak anti-androgen activity, used primarily for termination of pregnancy. It acts as a competitive receptor antagonist at the progesterone receptor in the presence of progesterone, and acts as a partial agonist in the absence of progesterone. Extensive research has been carried out regarding its’ antiprogestogen activity for use in medical abortion. Lately other medical uses of mifepristone are being explored like for induction of labour in late preg- nancy, as oestrogen free oral contraceptive and for treatment of endometriosis, uterine fibroids, ovarian cancer, prostate cancer, meningiomas, Cushing’s syndrome and major psychotic depression.

 

 

Mol Cell Ther. 2014 Nov 19;2:36.

Targeting the Wnt/β-catenin pathway in endometriosis: a potentially effective approach for treatment and prevention.

Matsuzaki S1Botchorishvili R1Pouly JL2Canis M1.

 

Abstract

Endometriosis is a chronic, estrogen-dependent disease associated with infertility and pelvic pain. Endometriosis is defined by the presence of extra-uterine endometrial tissue. It affects approximately 10% of reproductive-aged women. However, the underlying etiology, pathogenesis and pathophysiology remain to be fully elucidated. Knowledge of these factors is indispensable for the development of targeted therapies for prevention and treatment of endometriosis. Several studies, including those from our laboratory, have suggested that aberrant activation of the Wnt/β-catenin pathway may be involved in the pathophysiology of endometriosis. This is a review of the literature focused on the aberrant activation of the Wnt/β-catenin pathway in patients with endometriosis, and on how targeting the Wnt/targeting pathway may be a potentially effective approach for treating and/or preventing endometriosis.

 

 

 

 

EXCLI J. 2014 Mar 13;13:252-64.

Imprinting genes associated with endometriosis.

Kobayashi H1.

 

Abstract

PURPOSE:

Much work has been carried out to investigate the genetic and epigenetic basis of endometriosisand proposed that endometriosis has been described as an epigenetic disease. The purpose of this study was to extract the imprinting genes that are associated with endometriosis development.

METHODS:

The information on the imprinting genes can be accessed publicly from a web-based interface at http://www.geneimprint.com/site/genes-by-species.

RESULTS:

In the current version, the database contains 150 human imprinted genes derived from the literature. We searched gene functions and their roles in particular biological processes or events, such as development and pathogenesis of endometriosis. From the genomic imprinting database, we picked 10 genes that were highly associated with female reproduction; prominent among them were paternally expressed genes (DIRAS3, BMP8B, CYP1B1, ZFAT, IGF2, MIMT1, or MIR296) and maternally expressed genes (DVL1, FGFRL1, or CDKN1C). These imprinted genes may be associated with reproductive biology such as endometriosis, pregnancy loss, decidualization process and preeclampsia.

DISCUSSION:

This study supports the possibility that aberrant epigenetic dysregulation of specific imprinting genes may contribute to endometriosis predisposition.

 

 

Int Sch Res Notices. 2014 Sep 18;2014:417042.

Obstetric Scar Endometriosis: Retrospective Study on 19 Cases and Review of the Literature.

Kaplanoglu M1Kaplanoğlu DK1Dincer Ata C2Buyukkurt S3.

 

Abstract

Endometriosis is defined as the presence of functioning endometrial tissue outside the uterine cavity. This disease is one of the most common gynecologic disorders in reproductive age women. It generally occurs in pelvic cavity. But extrapelvic location has been defined (such as extremities, central nervous system, lungs, pleurae, liver, umbilicus, pericardium, urinary tract, intestines, and surgical scar tissue). Scar endometriosis is a rare disease and defined as presence of endometriotic lesions on the abdominal (such as cesarean section and hysterectomy) or vaginal (episiotomy) excision line. It is difficult to diagnose due to the extreme variability in presentation. The symptoms are nonspecific, typically involving pain, swelling at the incision site at the time of menstruation. Excision and histopathologic examination are necessary for diagnosis. We present a case series of obstetric scar endometriosis and review of the literature.

 

 

W V Med J. 2013 Nov-Dec;109(6):16, 18-20.

Serum anti-endometrial antibodies and first trimester pregnancy loss.

Parry AR1Calhoun BC1Gantt P1Seybold DJ2Broce M3Randall GW4.

 

Abstract

Serum anti-endometrial antibodies (AEA) have been studied as a marker for endometriosis and implantation failure. We sought to determine if the presence of AEA in the serum of pregnant patients is associated with first trimester pregnancy loss including complete abortion. This is a prospective pilot case control study of 30 patients presenting with first trimester pregnancy loss compared to a control group of 30 first trimester pregnant patients with a normal course for the presence of serum AEA. The control group was selected using propensity matching of patient characteristics. AEA assays were performed by a single operator blinded to clinical status of patients. The mean maternal age in the study and control groups was not statistically significant (26.1 +/- 5.7 vs. 24.2 +/- 4.5 years, p < 0.155). A history of pregnancy loss was not significantly greater in the study group (12/30 = 40.0%) as compared to the control group (8/30 = 26.7%, p < 0.412). In both study and control groups, 40% of the samples tested positive for AEA; therefore, we found no evidence of an association between the presence of AEA and pregnancy loss. These findings in our pilot study suggest that presence of serum AEA does not appear to be a marker for early pregnancy loss.

 

Acta Obstet Gynecol Scand. 2014 Mar;93(3):239-47

Desogestrel-only contraceptive pill versus sequential contraceptive vaginal ring in the treatment of rectovaginal endometriosis infiltrating the rectum: a prospective open-label comparative study.

Leone Roberti Maggiore U1Remorgida VScala CTafi EVenturini PLFerrero S.

 

Abstract

OBJECTIVE:

To compare the efficacy of two hormonal therapies in treating symptoms caused by bowel endometriosis.

DESIGN:

Patient preference study.

SETTING:

University hospital.

POPULATION:

A total of 143 women with rectovaginal endometriosis infiltrating the rectum.

METHODS:

This study was performed between January 2008 and June 2011. Patients were treated with a desogestrel-only contraceptive pill or with the sequential combined contraceptive vaginal ring for 12 months.

MAIN OUTCOME MEASURES:

The primary endpoint of the study was the rate of satisfied patients at 12-month follow up. The changes in symptoms and in the volume of the nodules were secondary endpoints.

RESULTS:

At 12-month follow up, the rate of satisfied patients was higher in the group treated with the desogestrel-only contraceptive pill than in the group treated with the sequential combined contraceptive vaginal ring (p = 0.004). When only changes in gastrointestinal symptoms were considered, 50% of patients treated with the desogestrel-only contraceptive pill and 31.3% of those treated with the sequential combined contraceptive vaginal ring were satisfied (p = 0.037). The reduction in the volume of the nodules, the percentages of patients who discontinued the therapy after the completion of the study and of those who decided to undergo surgery were similar between the two groups.

CONCLUSIONS:

Both hormonal therapies are efficacious in treating symptoms caused by rectovaginal endometriosis infiltrating the rectum. Patient satisfaction is higher with the desogestrel-only pill than with a vaginal ring.

 

 

Hum Immunol. 2014 Mar;75(3):208-17.

Fetal programming theory: implication for the understanding of endometriosis.

Kobayashi H1Iwai K2Niiro E2Morioka S2Yamada Y2.

 

Abstract

Comparison of the transcriptomes and proteomes of the decidualization-specific genes that express high vs low levels of the eutopic and ectopic endometrium of women with endometriosis compared with controls, could be useful in understanding the pathogenesis of endometriosis. Genome-wide comparison between decidual tissue and non-decidual tissue identified many genes significantly modulated in the process of decidualization. Comparison of eutopic endometrium and endometriotic sites also revealed up- and down-regulated genes. A combined analysis of the experimental data showed specific genes up-regulated both at the endometriotic site and in the decidualization process, representing a broad diversity of molecular functions, including cell cycle regulation, angiogenesis and adhesion molecules. In contrast, down-regulated genes identified in endometriosisamong genes overexpressed in decidualization encode Müllerian embryogenesis, which includes transcription factors, hormonal regulation and cytokine expression. The mechanism responsible for insufficient decidualization in endometriosis may be mediated through down-regulation of the Müllerian embryogenesis-related genes. In conclusion, a range of decidualization resistance has been associated with endometriosis. Future study will identify the putative mechanisms relating epigenetic changes of decidualization susceptibility genes in early life to the risk of developing endometriosis in adulthood.

 

 

J Minim Invasive Gynecol. 2014 May-Jun;21(3):472-9.

Role of protective defunctioning stoma in colorectal resection for endometriosis.

Belghiti J1Ballester M1Zilberman S1Thomin A1Zacharopoulou C1Bazot M2Thomassin-Naggara I2Daraï E3.

 

Abstract

STUDY OBJECTIVE:

To evaluate the role of protective defunctioning stoma (PDS) on the occurrence of digestive tract complications after colorectal resection to treat endometriosis.

DESIGN:

Prospective cohort study (Canadian Task Force classification II-2).

SETTING:

University hospital.

PATIENTS:

All patients undergoing segmental colorectal resection to treat colorectal endometriosis with and without PDS between 2003 and 2011 at Tenon University Hospital, Paris, France.

MEASUREMENTS AND MAIN RESULTS:

Patients were assessed at 1, 6, and 12 months postoperatively and each year thereafter. Median follow-up was 60 months. Of 198 patients included for analysis, 53 (27%) had PDS. Overall, 15 (7.5%) digestive tract complications occurred: 9 (4.5%) rectovaginal fistulas and 6 (3%) anastomotic leakages. All rectovaginal fistulas occurred in patients with a low colorectal anastomosis (p < .001) and 88% (8 of 9) in patients with a partial colpectomy (p < .001). PDS was associated with a decrease in the number of rectovaginal fistulas in women undergoing partial colpectomy and low colorectal resection from 27% to 15%, without reaching significance (p = .4). No anastomotic leakage occurred in patients with PDS.

CONCLUSION:

Our results support that PDS can be omitted in patients with mid-colorectal anastomosis without partial colpectomy. In patients requiring partial colpectomy or partial colpectomy plus low colorectal anastomosis, PDS remains questionable.

 

 

Int J Womens Health. 2013 Dec 21;6:35-9.

Combining oral contraceptives with a natural nuclear factor-kappa B inhibitor for the treatment of endometriosis-related pain.

Maia H Jr1Haddad C2Casoy J2.

 

Abstract

Endometriosis is a chronic disease in which a persistent state of heightened inflammation is maintained by nuclear factor-kappa B (NF-κB) activation. The progestins present in oral contraceptives are potent inhibitors of NF-κB translocation to cell nuclei, while Pycnogenol® (Pinus pinaster) acts by blocking post-translational events. In this study, the effects of Pycnogenol on pain scores were investigated in patients with endometriosisusing oral contraceptives containing either gestodene or drospirenone in extended regimens. Pain scores were determined using a visual analog scale before and after 3 months of treatment. Oral contraceptives, used alone (groups 1 and 3) or in association with Pycnogenol (groups 2 and 4), resulted in significant decreases in pain scores after 3 months of treatment; however, this reduction was significantly greater in the groups using oral contraceptives + Pycnogenol (groups 2 and 4) compared with those using oral contraceptives alone (groups 1 and 3). In the groups using oral contraceptives alone, 50% of patients became pain-free by the end of the third month of treatment. These results suggest that Pycnogenol increases the efficacy of oral contraceptives for the treatment of endometriosis-related pain.

 

 

Am J Reprod Immunol. 2014 Mar;71(3):278-85.

The cellular inhibitor of apoptosis protein-2 is a possible target of novel treatment for endometriosis.

Taniguchi F1Higaki HIzawa MAzuma YHirakawa EDeura IIwabe THata KHarada T.

 

Abstract

PROBLEM:

How is the tumor necrosis factor (TNF) α-induced inhibitor of apoptosis (IAP) protein expression in endometriotic stromal cells (ESCs) involved in cell viability and signaling pathways?

METHOD OF STUDY:

Endometriotic stromal cells were isolated from ovarian chocolate cysts in 20 patients who underwent laparoscopic surgery. IAP protein expression and IκB phosphorylation were evaluated by Western blot analysis. Interleukin (IL)-8 protein expression and cell proliferation were assessed by ELISA.

RESULTS:

Cellular IAP (cIAP)-2 protein expression in endometriotic tissue was higher than that of endometrium. TNFα markedly enhanced cIAP-2 protein expression in ESCs. Pretreatment with a nuclear factor (NF)-κB inhibitor attenuated TNFα-induced cIAP-2 expression. An antagonist of IAPs abrogated TNFα-induced cIAP-2 protein expression and showed a decrease in TNFα-induced IL-8 protein expression and BrdU incorporation in ESCs.

CONCLUSIONS:

TNFα and its downstream NFκB pathway have proven to be critical regulators of highly expressed cIAP-2 in ESCs. cIAP-2 may be a novel therapeutic target for endometriosis.

 

 

Histol Histopathol. 2014 Jul;29(7):903-12.

A GFP endometriosis model reveals important morphological characteristics of the angiogenic process that govern benign and malignant diseases.

Machado DE1Palumbo A Jr2Santos JM3Mattos RM2dos Santos TA3Seabra SH3Boldrini Lda C2Perini JA3Nasciutti LE4.

 

Abstract

Endometriosis involves the growth of endometriotic tissue outside the uterine cavity, and is frequently associated with different malignancies. A well-reported alteration in the disease microenvironment is the proliferation of new blood vessels around the lesions, as part of a necessary repertory to contribute to the invasiveness and development of infiltrating endometriosis. Therefore, the establishment of a reliable experimental model is essential to elucidate the contribution of angiogenesis and to develop new therapeutic approaches to endometriosis treatment. For this purpose we transplanted endometrial fragments from green fluorescent protein (GFP)-mice (n=20) into the peritoneal cavity of wild-type mice (n=20), and then analyzed the morphological changes and the process of angiogenesis. The lesions were cystic and vascularized, and showed morphological hallmarks such as endometrial glands and stroma. An increase in endometriotic lesion vascular density was revealed by immunostaining and RNAm expression for Vegf and its receptor Flk-1, and the lesions were confirmed as a tissue-donor source by GFP fluorescent cells. The same pattern was observed through staining of activated macrophages and an increase of about 25% in the number of macrophage-positive cells was also demonstrated in endometriotic lesions by flow cytometry, which concords with previous data that correlate endometriosis, angiogenesis and inflammation. According to our understanding, this is the first demonstration that the pattern of the angiogenic process in the GFP endometriosis model is very similar to that of cancer. These observations will be useful for investigation of the process of angiogenesis involved in the attachment and invasion of endometrial cells, as well as an in vivo platform model to study the effects of antiangiogenic drugs.

 

 

PLoS One. 2013 Dec 26;8(12):e82334

The effect of peritoneal fluid from patients with endometriosis on mitochondrial function and development of early mouse embryos.

Shu J1Xing L1Ding G2Luo Q2Liu X2Yan Q3Sheng J4Huang H2.

 

Abstract

BACKGROUND:

Peritoneal fluid (PF) from patients with endometriosis can inhibit early embryo development via probable functional changes of embryo mitochondria in the early stage of embryo development. The purpose of this study was to determine the effect of PF from patients with endometriosis on mitochondrial function and development of early mouse embryos.

METHODOLOGY/PRINCIPAL FINDINGS:

PF was collected from patients with infertility and endometriosis, infertility due to tubal factors, and normal control subjects, and the level of NO was measured. Early murine embryos were then cultured with PF from normal control subjects, those with endometriosis, and with human tubal fluid (HTF), respectively. Cleavage and blastulation rates, mitochondrial DNA (mtDNA) copy numbers, adenosine triphosphate (ATP) level, and mitochondrial membrane potential (ΔΨm) of the different groups were compared. The NO level in the PF of patients with endometriosis was significantly greater than in those without endometriosis and control patients. The embryos cultures with PF from patients with endometriosis had a lower cleavage rate and blastulation rate, and higher ATP and ΔΨm level at the 2- and 4-cell stages. No significant difference was found in mtDNA copies among the 3 groups.

CONCLUSIONS/SIGNIFICANCE:

PF from patients with endometriosis can inhibit early embryo development via probable functional changes of embryo mitochondria in the early stage of embryo development. Understanding the effects of PF on embryo development may assist in developing new methods of treatment for infertility.

 

 

Fertil Steril. 2014 Mar;101(3):740-9.

Overexpression of lysine-specific demethylase 1 in ovarian endometriomas and its inhibition reduces cellular proliferation, cell cycle progression, and invasiveness.

Ding D1Liu X1Guo SW2.

 

Abstract

OBJECTIVE:

To investigate whether lysine-specific demethylase 1 (LSD1) is aberrantly expressed in endometriomas and whether treatment with tranylcypromine, an LSD1 inhibitor, has any effect on cell viability, cell cycle, and invasiveness.

DESIGN:

Laboratory study using human tissues.

SETTING:

Academic hospital.

PATIENT(S):

Forty-two ectopic endometrial tissue samples, their homologue eutopic endometrial tissue samples, and 70 control endometrial tissue samples.

INTERVENTION(S):

Immunohistochemistry analysis of LSD1 of all human tissue samples, and Western blot analysis, quantitative real-time reverse-transcription polymerase chain reaction analysis, cell viability assay, cell cycle analysis, and invasion assay of eutopic and ectopic endometriotic stromal cells and normal endometrial stromal cells.

MAIN OUTCOME MEASURE(S):

Immunostaining levels of LSD1, gene and protein expression levels, cell viability, cell cycles, and invasiveness.

RESULT(S):

The expression of the LSD1 gene and protein in endometriosis was elevated. Treatment of endometriotic stromal cells with tranylcypromine statistically significantly reduced the cellular proliferation, cell cycle progression, and invasiveness.

CONCLUSION(S):

Because DNA and histones are intimately intertwined and work in concert in transcription regulation, conceivably histone demethylation activity of LSD1 could be wide ranging. The inhibition of LSD1 activity by tranylcypromine and the resultant inhibition of proliferation, cell cycle progression, and invasiveness suggest that LSD1 may be a candidate therapeutic target for endometriosis.

 

Eur J Obstet Gynecol Reprod Biol. 2014 Mar;174:117-22.

Norethisterone acetate versus norethisterone acetate combined with letrozole for the treatment of ovarian endometriotic cysts: a patient preference study.

Ferrero S1Remorgida V1Venturini PL1Leone Roberti Maggiore U2.

 

Abstract

OBJECTIVE:

To compare the efficacy of norethisterone acetate (NETA; group N) or letrozole combined with NETA (group L) in treating endometriotic ovarian cysts.

STUDY DESIGN:

This patient-preference study included 20 patients in group N and 20 patients in group L. The primary aim of the study was to compare the volume of the endometriomas during and after treatment. The secondary outcome was the evaluation of the changes in pain symptoms during and after treatment.

RESULTS:

After six months of treatment, the volume of the endometriomas significantly decreased compared with baseline in both study groups; it was smaller in group L than in group N (p=0.026). The rate of satisfied patients at six months of treatment was similar between the study groups (p=0.451). No significant difference was reported between the two study groups in the amelioration of pain symptoms and in the incidence of adverse events.

CONCLUSIONS:

Letrozole combined with NETA is more efficacious than NETA alone in reducing the volume of endometriotic cysts but in none of the 40 patients included in the study did the endometriomas disappear. The efficacy of aromatase inhibitors, however, should be balanced with the need to administer long-term treatment.

 

 

J Ethnopharmacol. 2014 Feb 12;151(3):1218-1225.

Combination use of ferulic acid, ligustrazine and tetrahydropalmatine inhibits the growth of ectopic endometrial tissue: a multi-target therapy for endometriosis rats.

Tang Q1Shang F1Wang X1Yang Y1Chen G2Chen Y1Zhang J1Xu X3.

 

Abstract

ETHNOPHARMACOLOGICAL RELEVANCE:

Ferulic acid (FA), ligustrazine (LZ) and tetrahydropalmatine (THP) are separately isolated from Chinese Angelica, Szechwan Lovage Rhizome and Rhizoma in the Jiawei-Foshou-San formula, a popular traditional Chinese medicine for irregular menses. It has been reported that the combination use of FA+LZ+THP has similar effect on endometriosis, but the underlying mechanisms are unclear. This study was to investigate the combination effects and mechanisms of FA+LZ+THP on endometriosis rats.

MATERIALS AND METHODS:

Fifty endometriosis rats were intragastricly treated with FA+LZ+THP for 4 wk. The volume of ectopic endometrial tissue was measured to evaluate the effects. Then the changes in hypothalamic-pituitary-ovarian axis and ERE pathway were indicated by the levels of E2, GnRH, FSH and LH, and the expressions of ER, HSP90 and COX-2, respectively. In addition, peritoneal macrophages of each rat were cultured in vitro and treated with (FA+LZ+THP)-medicated serum for 24h. The proliferation and phagocytosis abilities, the levels of IL-1β and TNF-α, and the expression of IκBα were then measured for the changes of peritoneal macrophage activities.

RESULTS:

Combination use of FA+LZ+THP diminished the volume of the ectopic endometrial tissues (P<0.05 or P<0.01). It also decreased the E2 level, suppressed the expression of GnRH, FSH and LH, and decreased the protein expression of ER, HSP90 and COX-2 (all P<0.05 or P<0.01). The phagocytosis ability of peritoneal macrophage was enhanced by (FA+LZ+THP)-medicated serum (P<0.05) with no change of proliferation (P>0.05). Moreover, IL-1β and TNF-α were downregulated (both P<0.05 or P<0.01) and IκBα was upregulated by the (FA+LZ+THP)-medicated serum (P<0.01).

CONCLUSIONS:

The combination use of FA, LZ and THP could inhibit the growth of ectopic endometrial tissue in endometriosis rats. It might be related to the down-regulation of hypothalamic-pituitary-ovarian axis, the amelioration in ERE pathway and the improvement of peritoneal macrophage activities.

 

 

Front Biosci (Schol Ed). 2014 Jan 1;6:16-28.

Menstrual endometrial supernatant may induce stromal endometriosis in baboons.

Kyama CM1Falconer H2Cuneo S2Chai D2Mihalyi A1Mwenda J2D’Hooghe T3.

 

Abstract

We tested the hypothesis that endometriosis can be induced in baboons more successfully by intra-pelvic injection of the pellet of menstrual endometrium when compared to its supernatant. Menstrual endometrium, separated into pellet (n = 5) and supernatant fractions ( n = 8), or phosphate buffered saline (1 ml, n = 7, controls) was injected laparoscopically into the pelvis. During laparoscopy 25 days later, the number (ρ = 0.027) and surface area (ρ <0.0001) of endometriosis-like lesions were significantly higher in the pellet group, than in the supernatant group, or in the control group. Histological typical endometriosis was present only in the endometrial pellet group (1/15), whereas stromal endometriosis was observed in both the pellet group (6/15), and the supernatant group (6/20). Peritoneal endometrial like glands were observed in both the endometrial pellet group (3/15), and in the supernatant group (1/20). In conclusion, we confirmed our hypothesis that endometriosis can be induced in baboons more successfully by intrapelvic injection of the pellet of menstrual endometrium when compared to its supernatant.

 

 

Mod Pathol. 2014 Aug;27(8):1154-62.

Tubal origin of ovarian endometriosis.

Yuan Z1Wang L1Wang Y2Zhang T3Li L3Cragun JM4Chambers SK4Kong B5Zheng W6.

 

Abstract

Endometriosis is a puzzling and debilitating disease that affects millions of women around the world. Ovary is the most common organ site involved by endometriosis. Despite various hypotheses about its cell of origin, uncertainty remains. On the basis of our clinicopathologic observations, we hypothesize that fallopian tube may contribute the histogenesis of ovarian endometriosis. To examine if the hypothesis, tubal origin of ovarian endometriosis, has scientific supporting evidence, we identified a set of novel genes, which are either highly expressed in the normal fallopian tube or in the endometrium through a gene differential array study. Among many differentially expressed genes, FMO3 and DMBT1 were selected as the initial biomarkers to test the hypothesis. These biomarkers were then validated in ovarian sections with foci of endometriosis by comparing their expression levels in the fallopian tube and the endometrium within the same patients with real-time PCR, western blot and immunohistochemistry analysis. FMO3 was highly expressed in the tubal epithelia while low in the paired endometrium. In contrast, DMBT1 was high in the endometrium but low in the fallopian tube. In 32 ovarian endometriosis cases analyzed by real-time PCR, 18 (56%) showed a high level of FMO3 and a low level of DMBT1 expression. However, 14 (44%) endometriosis cases showed a reversed expression pattern with these two markers. Results were similarly seen in the methods of western blot and immunohistochemistry. The findings suggest that approximately 60% of the ovarian endometriosis we studied may be derived from the fallopian tube, whereas about 40% of the cases may be of endometrial origin. The fallopian tube epithelia may represent one of the tissue sources contributing to ovarian endometriosis. Such novel findings, which require confirmation, may have a significant clinical impact in searching for alternative ways of prevention and treatment of endometriosis.

 

Reprod Biol Endocrinol. 2014 Jan 6;12:4.

Endometriosis and physical exercises: a systematic review.

Bonocher CM1Montenegro MLRosa E Silva JCFerriani RAMeola J.

 

Abstract

Regular physical exercise seems to have protective effects against diseases that involve inflammatory processes since it induces an increase in the systemic levels of cytokines with anti-inflammatory and antioxidant properties and also acts by reducing estrogen levels. Evidence has suggested that the symptoms associated with endometriosis result from a local inflammatory peritoneal reaction caused by ectopic endometrial implants. Thus, the objective of the present review was to assess the relationship between physical exercise and the prevalence and/or improvement of the symptoms associated with endometriosis. To this end, data available in PubMed (1985-2012) were surveyed using the terms “endometriosis and physical exercises”, “endometriosisand life style and physical exercises” in the English language literature. Only 6 of the 935 articles detected were included in the study. These studies tried establish a possible relationship between the practice of physical exercise and the prevalence of endometriosis. The data available are inconclusive regarding the benefits of physical exercise as a risk factor for the disease and no data exist about the potential impact of exercise on the course of the endometriosis. In addition, randomized studies are necessary.

 

 

Postgrad Med. 2014 Jan;126(1):104-10.

1-alpha,25-dihydroxyvitamin D3 regresses endometriotic implants in rats by inhibiting neovascularization and altering regulation of matrix metalloproteinase.

Yildirim B1Guler TAkbulut MOztekin OSariiz G.

 

Abstract

BACKGROUND:

The exact pathogenesis of endometriosis has not been completely discerned. 1-alpha,25-dihydroxyvitamin D3 (1,25[OH][2]D[3]) has been shown to have an anti-angiogenic effect and extracellular matrix-proteases-degrading properties. We hypothesized that 1,25(OH)(2)D(3) may have therapeutic value in the treatment of endometriosis.

METHODS:

Endometrial tissue was implanted into the abdominal peritoneum of 21 Wistar albino rats; the rats were randomized into 3 groups. In Group A (simultaneous group), we simultaneously induced endometriosisand began 1,25(OH)(2)D(3) treatment. Group B rats (sequential group) were treated after endometriosis was documented. Animals in Group C (control group) were followed without any treatment after the development of endometriosis.

RESULTS:

Histologic score, mean volume, and weight of the explants in Group A and B were found to be significantly lower than those of the control group. Levels of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) immunoreactivities in Group A and B were also significantly lower compared with Group C. In contrast, intensities of immunoreactivity staining for tissue inhibitor of metalloproteinase-2 (TIMP-2) in Group A and B were significantly higher than that of the control group.

CONCLUSION:

1,25(OH)(2)D(3) regresses endometriotic implants in rat models by altering implant levels of VEGF, TIMP-2, and MMP-9.

 

 

BMJ Case Rep. 2014 Jan 6;2014.

Subcutaneous endometriosis: a rare cause of deep dyspareunia.

Nigam A1.

 

Abstract

Endometriosis is a growth of endometrial tissue outside the uterine cavity which is responsive to hormonal stimulation. Extrapelvic endometriosis is less common of which skin is the most common site. The patient presents with mass, pain and cyclic symptoms. Subcutaneous endometriosis is very rare and has been reported only thrice in the literature. We report a case where the patient with lower abdominal pain and dyspareunia. Dyspareunia due to subcutaneous endometriosis has not been reported before when there is no evidence of intrapelvic endometriosis on laparoscopy.

 

 

JSLS. 2013 Oct-Dec;17(4):503-7.

Characteristics of patients undergoing hysterectomy for failed endometrial ablation.

Riley KA1Davies MF2Harkins GJ3.

 

Abstract

BACKGROUND AND OBJECTIVES:

Endometrial ablation is a minimally invasive procedure for menorrhagia. High success rates are documented with >90% of patients experiencing satisfaction. However, adequate relief after endometrial ablation is not obtained in a cohort of patients. The purpose of this study is to identify the characteristics of patients for whom endometrial ablation fails due to persistent symptoms, causing them to choose hysterectomy for definitive treatment.

METHODS:

We conducted a retrospective chart review of patients who underwent hysterectomy for persistent menorrhagia, pain, or both, who previously had endometrial ablation. We reviewed medical records including pathology reports from hysterectomy. We compared demographics to a group previously studied at our institution that were identified as satisfied 5 years after ablation.

RESULTS:

The number of patients in our study group was 51 (n = 51). Median age of patients was 39 (range 29-50) years. Average body mass index was 31 (range 19-47) kg/m(2). Average parity was 1.9. Sixty-nine percent underwent tubal ligation. The majority were nonsmokers (75%). Ninety-six percent were Caucasian. Compared with the previously studied satisfied group, the only statistically significant difference was age. Of 51 patients, 11 (22%) noted pelvic pain as their chief concern. Menorrhagia was the chief concern in 22 (43%). Eighteen patients (35%) complained of both. The most common diagnosis was endometriosis, which was identified in 35 patients (68%). Leiomyomata were present in 33 patients (64%). Adenomyosis was identified in 22 patients (43%).

CONCLUSIONS:

Patients who present for hysterectomy after endometrial ablation have a high rate of endometriosis, adenomyosis, and leiomyomata, with endometriosis being the most common finding.

 

 

Ann Ital Chir. 2014 Jul-Aug;85(4):341-6.

Extra-genital endometriosis.

Pezzolla ALattarulo SFiore MGPiscitelli DFabiano GPalasciano N.

 

Abstract

BACKGROUND:

Even if endometriosis is usually an exclusively gynecological issue, atypical locations fall within the interest of general surgery. The aim of our retrospective study focuses on the need for surgeons to face this rare condition, in order to avoid unnecessary or inadequate treatment.

METHODS:

We retrospectively analyzed clinical presentations, previous endometriosis diagnosis and surgical acts on a group of 60 patients, whose mean age was 38.2 years old, with extra-genital endometriosis.

RESULTS:

Among the 60 cases of extra-genital endometriosis collected, bowel foci, 37 cases – 61,7% – were the most frequent; then we collected 13 (21.7%) skin, 7 (11.7%) urinary tract and 3 (5%) whole pelvis localizations. It’s important to underline the finding of 2 aggressive malignant transformations.

CONCLUSIONS:

Extra-genital endometriosis should be considered as a cause of otherwise inexplicable abdominal pain in young women. Since imaging techniques lack in specificity, we propose explorative laparoscopy as a powerful diagnostic means. Moreover laparoscopy can be turned into a therapeutic act, also limiting the adherences issue, which is associated with this illness and would worsen with open surgery. Extra-genital endometriosis should be treated also to avoid rare, but possible, risk of cancerization.

 

 

J Ovarian Res. 2014 Jan 8;7:1.

Impaired uterine artery flow associated with the presence of ovarian endometrioma: preliminary results of a prospective study.

Porpora MG1Tomao FManganaro LYazdanian DFuggetta EPiccioni MGBenedetti Panici PBenagiano G.

 

Abstract

BACKGROUND:

Aim of this prospective, case-control study was to evaluate uterine arteries’ blood flow before and after laparoscopic surgery in patients with ovarian endometriosis and its possible correlation with infertility.

METHODS:

We prospectively enrolled 110 women of reproductive age; 69 with ovarian endometriomas and scheduled for surgery, and 41 controls. At enrolment, a detailed medical, gynecologic and obstetric history was collected. Fertility and pregnancy desire were assessed. All patients underwent complete physical and gynecologic examination. Transvaginal ultrasound with Doppler color flow was performed to evaluate Resistance Index (RI) of uterine arteries during the secretory phase, at enrolment (T0) and 3 months after laparoscopic surgery (T1).

RESULTS:

Among cases, 27 patients were excluded because they did not meet the inclusion criteria. At enrolment (T0) unilateral or bilateral flow alterations (RI ≥ 0.8) were found in 38 out of 42 patients with ovarian endometriosis (90%), whereas in the control group only 17 women (41%) had Doppler alterations. The difference in uterine artery RI values between cases and controls was statistically significant (P < 0.0001). A statistically significant improvement in uterine artery flow (P <0.0001) was found 3 months after surgical treatment of endometriosis. Nineteen patients with endometriosis (45%) were infertile before surgery; all of them presented uterine artery Doppler alterations at T0. After surgery the pregnancy rate was significantly higher in patients who presented uterine artery flow normalization than in those with persistent uterine artery flow alterations (p = 0.002).

CONCLUSIONS:

A strong correlation was found between uterine artery flow abnormalities and ovarian endometriosis. Uterine artery flow improvement following surgery seems to increase the probabilities of achieving pregnancy.

 

 

J Ovarian Res. 2014 Jan 8;7:2.

Increased expression of the leptin receptor in human ovaries affected by endometrioma and detection of high levels of leptin in the ovarian endometriomal fluid.

Zendron C1Gonçalves HFCavalcante FSPereira TREvangelista ARamos CFOliveira MA.

 

Abstract

BACKGROUND:

This study was designed to investigate leptin levels in the fluid in ovarian endometriomas (OEs) and to compare the expression of leptin and its receptors (OBR) in ovarian tissue affected by endometrioma in infertile women to its expression in the normal ovarian tissue of fertile controls without endometriosis.

METHODS:

In this case-control observational study, ovarian tissue, blood samples and peritoneal fluid were obtained from 20 women (10 fertile controls without endometriosis or any ovarian disease, who were undergoing tubal ligation surgery, and 10 infertile women with severe endometriosis and OE). The ovarian endometriomal fluid (EF) was aspirated, and peritoneal-implant (PI) biopsies were performed. The tissues removed during the surgeries were immediately frozen in liquid nitrogen to determine expression levels by western blot and leptin levels by ELISA.

RESULTS:

OBR was expressed at higher levels in the ovarian tissue affected by endometrioma than in the normal ovarian tissue (control = 0.38 ± 0.05, study = 0.60 ± 0.09, p = 0.03), but there was no significant difference in leptin levels between these groups (control = 0.57 ± 0.1, study = 0.35 ± 0.1, p = 0.18). Positive and significant correlations were observed between leptin and OBR in the OE (r = 0.85, p = 0.004) and in the PI (r = 0.87, p = 0.001). ELISA results demonstrate a greater leptin concentration within the EF compared with the serum and the PF (serum = 14.25 ± 1.63, PF = 5.98 ± 2.0, EF = 73.8 ± 16.2, p = 0.0001), but there was no correlation between these variables. A positive, significant and strong correlation was observed between PF leptin levels and the expression of leptin and OBR in PI (leptin: r = 0.78, p = 0.007/OBR: r = 0.68, p = 0.04) and between the EF leptin levels and the expression of leptin and OBR in the OE (leptin: r = 0.88, p = 0.008/OBR: r = 0.89, p = 0.005).

CONCLUSIONS:

These data suggest that leptin may play an important role in the physiopathology of OE through a modulatory interaction with its active receptor.

 

 

Rev Med Interne. 2014 Jun;35(6):365-71.

Non-cirrhotic ascites: pathophysiology, diagnosis and etiology.

Carrier P1Jacques J2Debette-Gratien M2Legros R2Sarabi M2Vidal E3Sautereau D2Bezanahary H3Ly KH3Loustaud-Ratti V4.

 

Abstract

Ascites, in 20% of cases, is not linked to liver cirrhosis. The pathophysiology is most often different. The understanding of these pathophysiological mechanisms can lead to etiologic diagnosis. The diagnostic approach is mainly based on the biological study of ascites, especially protein concentration and albumin gradient between serum and ascites. In Western countries, tumors and heart diseases are the predominant causes, while developing countries are mainly concerned by infectious diseases, among which tuberculosis is the leading cause. Other uncommon causes must be recognized, as ascites may be the presenting feature of the disease. Their knowledge will facilitate the therapeutic approach.

 

 

Arch Gynecol Obstet. 2014 Jun;289(6):1241-7.

Feasibility and first long-term results after laparoscopic rectal segment resection and vaginal specimen retrieval for deep infiltrating endometriosis.

Fleisch MC1Hepp PKaleta TSchulte Am Esch JRein DFehm TBeyer I.

 

Abstract

INTRODUCTION:

Radical resection of deep infiltrating endometriosis (DIE), including bladder and bowel resection, provides relief from pain in symptomatic patients. The laparoscopic approach to treatment is well established for bowel resection but normally requires additional abdominal incisions for specimen retrieval. Here we describe our technique of laparoscopically assisted rectal resection and transvaginal specimen retrieval (LARRT) and provide follow-up information on pain scores and complications.

MATERIALS AND METHODS:

Retrospective observational monocentric study on all DIE patients with rectal infiltration treated between 2008 and 2010 with LATRR at our department. Follow-up was obtained for at least 3 years, including baseline 1-year and 3-year pain scores.

RESULTS:

We identified four patients undergoing LARRT available for follow-up. DIE was confirmed by histology in all cases. There were no intraoperative complications. Two patients had transient postoperative urinary retention, one patient developed recto-vaginal fistula and required transient colostomy. One patient suffered from persistent vaginal dryness. All patients, however, reported persistent pain relief, including at the end of follow-up period.

CONCLUSION:

LARRT is a feasible variation of laparoscopic bowel resection for DIE with rectal infiltration. In our study it has promising results with respect to pain control. Larger studies will, however, be required to determine the safety of this procedure.

 

 

Gynecol Endocrinol. 2014 Apr;30(4):307-10.

Prevalence of fibromyalgia and quality of life in women with and without endometriosis.

Nunes FR1Ferreira JMBahamondes L.

 

Abstract

The objectives of the study were to assessed if there is any difference in the prevalence of fibromyalgia and in quality of life (QoL) between women with and without endometriosis. A cross-sectional study was conducted in 2011-2013, involving 257 women with surgically and histopathologically confirmed endometriosis and 253 women with no history of endometriosis and no endometriosis-related symptoms. Women were recruited both at the family planning and endometriosis clinic, Department of Obstetrics and Gynecology, University of Campinas, Brazil. The Short Form 36 questionnaire (SF-36) was used to assess QoL, while the 1990 and 2010 American College of Rheumatology (ACR) criteria were used to evaluate fibromyalgia. According to the 1990 ACR criteria, there were no cases of fibromyalgia in either group. Nevertheless, according to the 2010 ACR criteria, four women, two with endometriosis and two without the disease, were diagnosed with fibromyalgia. Scores were significantly lower in all the domains of the QoL questionnaire for the women with endometriosis compared to those without the disease. This study reports no difference in the prevalence of fibromyalgia between women with and without endometriosis; however QoL was poorer among women with endometriosis when compared to women without the disease.

 

Nutr Cancer. 2014;66(2):206-13.

Antiangiogenic agents in natural products for the treatment of gynecologic disorders.

Aghamohammadi A1Hosseinimehr SJ.

 

Abstract

Angiogenesis is the formation of new capillaries from existing vessels. Vascular endothelial growth factor (VEGF) promotes this growth by stimulating endothelial cells, which form vessel walls and transport nutrients and oxygen to tissues. VEGF has been implicated in several diseases, such as cancer and gynecologic disorders. Antiangiogenic agents prevent VEGF from binding to its receptors on the endothelial cell surface, which inhibits vessel development. Antiangiogenic agents have been found to be effective in treating several gynecologic diseases, such as endometriosis and uterine fibroids. Natural products with respect to finding new compounds with antiangiogenic effects are interested. In this review, we have focused on the importance of natural products with antiangiogenic activity in treating some malignant and benign angiogenesis-related gynecological disorders, including endometriosis and uterine fibroids.

 

 

Taiwan J Obstet Gynecol. 2013 Dec;52(4):485-92.

Screening of a panel of steroid-related genes showed polymorphisms of aromatase genes confer susceptibility to advanced stage endometriosis in the Taiwanese Han population.

Wu CH1Yang JG2Chang YJ3Hsu CC4Kuo PL5.

 

Abstract

OBJECTIVE:

To establish a multilocus model for studying the effect of steroid-related genes on advanced stage endometriosis.

MATERIALS AND METHODS:

A total of 121 patients with advanced stage endometriosis and 171 control women were included. Eighteen single-nucleotide polymorphisms (SNPs) from nine genes (HSD17B1, HSD17B2, HSD17B5, HSD17B6, CYP17, CYP19, ERα, ERβ, and PGR) were genotyped using the TaqMan assays. Logistic regression models were used to evaluate the genetic effects, with adjustment for other covariates.

RESULTS:

Only the presence of the mutant CYP19 (aromatase gene) was associated with a significantly increased risk of endometriosis after adjusting for age, BMI, and parity (p = 0.002, OR = 2.69; 95% CI = 1.44-5.02). No association was ascertained between the other investigated SNPs and endometriosis.

CONCLUSION:

Polymorphisms of the aromatase gene confer susceptibility to advanced stage endometriosis in the Taiwanese Han population.

 

 

Taiwan J Obstet Gynecol. 2013 Dec;52(4):512-5.

Pelvic endometriosis with peritoneal fluid reduces pregnancy rates in women undergoing intrauterine insemination.

Wu HM1Tzeng CR1Chen CH1Chen PH2.

 

Abstract

OBJECTIVE:

This study investigated the occurrence of peritoneal fluid in women undergoing intrauterine insemination (IUI) and its correlation with the stage of pelvic endometriosis and its influence on pregnancy outcomes.

MATERIALS AND METHODS:

A retrospective case-control design was used to recruit 272 infertile women with pelvic endometriosis. The treatment protocol consisted of controlled ovarian hyperstimulation with downregulation and gonadotropin for IUI treatment following ultrasound and laparoscopic intervention. The amount and color of the peritoneal fluid were determined during laparoscopy.

RESULTS:

The mean amount of peritoneal fluid with pelvic endometriosis that was detected using transvaginal ultrasound was ~ 15.1 mL. Women whose cycles contained more peritoneal fluid had significantly lower pregnancy rates (17.2% and 31.3%, respectively). The total clinical pregnancy rate was not significantly different between the two groups with reddish and yellowish peritoneal fluid who had pelvic endometriosis.

CONCLUSION:

Pelvic endometriosis and peritoneal fluid, detected through vaginal ultrasound, have negative effects on the pregnancy outcome of IUI treatment.

 

 

Taiwan J Obstet Gynecol. 2013 Dec;52(4):540-5

Metalloestrogen cadmium stimulates proliferation of stromal cells derived from the eutopic endometrium of women with endometriosis.

Silva N1Tennekoon K2Senanayake H3Samarakoon S2.

 

Abstract

OBJECTIVE:

To assess the effect of metalloestrogen cadmium (Cd) on the proliferation of endometrial stromal cells (ESC) isolated from the eutopic endometrium of women with endometriosis

MATERIALS AND METHODS:

ESC were isolated from eutopic endometrial samples from 10 women with endometriosis and 10 women without endometriosis. ESC cultures were established and maintained in RPMI medium. Cultures were treated with Cd at a concentration of 10(-6) M and after 24 hours and 48 hours, cell number was counted using the Neubauer hemocytometer to calculate the relative cell proliferation. At 48 hours, the 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide (MTT) assay was used to test the effect of different concentrations (10(-8) M to 10(-3) M) of Cd on ESC cultures. Relative cell proliferation and MTT assay results were analyzed with ANOVA.

RESULTS:

At 48 hours, Cd-induced ESC proliferation was higher (p = 0.02) in women with endometriosis than in women without endometriosis, which was confirmed by the MTT assay.

CONCLUSION:

The results of this study demonstrate the ability of metalloestrogen Cd to induce the proliferation of stromal cells derived from the eutopic endometrium of women with endometriosis.

 

 

Arch Bronconeumol. 2014 Oct;50(10):454-5.

Thoracic pulmonary endometriosis: two reports of a rare disease.

Ucvet A1Sirzai EY1Yakut FC1Yoldas B2Gursoy S1.

 

Abstract

Endometriosis is characterized by the growth of endometrium outside the uterine cavity or myometrium. There is no specific radiologic finding that defines endometriosis. Parenchymal lesions, nodules or blebs are reported in the literature, although this clinical entity is rare. Definitive diagnosis and treatment are often possible with surgery. We report here two cases: a forty-two-year-old female patient with a 2-year history of intermittent hemoptysis associated with her menstrual cycle was diagnosed as having endometriosis and treated via thoracotomy; another 30-year-old female referred to our department due to recurrent pneumothorax caused by underlying endometriosis underwent surgical treatment which revealed endometrial foci on the diaphragm.

 

 

J Mol Endocrinol. 2014 Feb 24;52(2):169-79.

Glucose transporter expression in eutopic endometrial tissue and ectopic endometriotic lesions.

McKinnon B1Bertschi DWotzkow CBersinger NAEvers JMueller MD.

 

Abstract

Endometriosis is an extremely prevalent disorder characterized by the growth of endometrial tissue at ectopic locations. Glycolysis is an energy-producing mechanism that occurs in almost all cells and requires an adequate uptake of glucose mediated by glucose transporter (GLUT) proteins. At present, however, very little is known about their expression in either the endometrium or the endometriotic lesions. The objective of this study was to examine the expression of SLC2A genes in the endometrium of women with and without endometriosis and in the matching ectopic tissue, and to confirm the presence of the GLUT proteins in ectopic lesions. There was a significantly higher expression of SLC2A3 and a significantly lower expression of SLC2A4 in women with endometriosis compared with those without. In women with endometriosis, the ectopic expression of SLC2A3, SLC2A4 and SLC2A5 was significantly higher than that observed in the matching eutopic tissue. GLUT1 protein expression was present in both epithelial and stromal cells and GLUT3 was confined to CD45-positive leukocytes. GLUT4 expression was strong in both ectopic epithelial and stromal cells and localized to the cellular membrane in epithelial cells. These results show that GLUT expression is altered between eutopic and ectopic tissue and between women with and without endometriosis, and that GLUT4 may represent a significant entry route for glucose into the endometriotic epithelial cells. The inducible nature of GLUT4 and its limited cellular expression may make GLUT4 an attractive target for non-hormone-based treatments of endometriosis.

 

 

BMJ Case Rep. 2014 Jan 10;2014.

Bowel endometriosis.

Galazis N1Arul DWilson JPisal N.

 

Abstract

Bowel obstruction accounts for 20% of hospital admissions due to acute abdominal pain. We report a case of acute bowel obstruction in a 31-year-old woman with a history of endometriosis diagnosed on laparoscopy a year before this presentation. Her clinical and biochemical picture suggested peritonitis and CT revealed an irregular soft tissue mass compressing a dilated rectosigmoid. Pockets of intraperitoneal gas were also documented and presumed to be secondary to bowel perforation at the level of the mass. Exploratory laparotomy was performed and the affected bowel was resected. Histology revealed extensive stricturing and fibrosis secondary to intestinal endometriosis. General practitioners, gastroenterologists and general surgeons are likely to encounter endometriosis, need to be competent in its diagnosis and management and collaborate promptly with the gynaecologist. Endometriosis should be considered in the differential diagnosis of every woman of childbearing age who presents with any gastrointestinal or abdominal symptom.

 

 

Curr Genet Med Rep. 2013 Dec 1;1(4)

The Genetics of Infertility: Current Status of the Field.

Zorrilla M1Yatsenko AN1.

 

Abstract

Infertility is a relatively common health condition, affecting nearly 7% of all couples. Clinically, it is a highly heterogeneous pathology with a complex etiology that includes environmental and genetic factors. It has been estimated that nearly 50% of infertility cases are due to genetic defects. Hundreds of studies with animal knockout models convincingly showed infertility to be caused by gene defects, single or multiple. However, despite enormous efforts, progress in translating basic research findings into clinical studies has been challenging. The genetic causes remain unexplained for the vast majority of male or female infertility patients. A particular difficulty is the huge number of candidate genes to be studied; there are more than 2,300 genes expressed in the testis alone, and hundreds of those genes influence reproductive function in humans and could contribute to male infertility. At present, there are only a handful of genes or genetic defects that have been shown to cause, or to be strongly associated with, primary infertility. Yet, with completion of the human genome and progress in personalized medicine, the situation is rapidly changing. Indeed, there are 10-15 new gene tests, on average, being added to the clinical genetic testing list annually.

 

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