Factors associated with deep infiltrating endometriosis, adenomyosis and ovarian endometrioma.

INTRODUCTION: To compare epidemiological features and clinical presentations of deep infiltrating endometriosis with endometrioma and adenomyosis, as well as to identify risk factors for the respective histologically confirmed conditions. METHOD: Patients undergoing index surgery at the National University Hospital, Singapore for endometriosis or adenomyosis over a 7-year period-from 2015 to 2021-were identified from hospital databases using the Table of Surgical Procedures coding. Social and epidemiological features of cases with histologically confirmed diagnoses of endometrioma only, adenomyosis only, and deep infiltrating endometriosis were compared. Significant variables from univariate analysis were entered into 3 binary multivariate logistic regression models to obtain independent risk factors for: deep infiltrating endometriosis versus endometrioma only, deep infiltrating endometriosis versus adenomyosis only, and adenomyosis only versus endometrioma only. RESULTS: A total of 258 patients were included with 59 ovarian endometrioma only, 47 adenomyosis only, and 152 deep infiltrating endometrioses. Compared to endometrioma only, deep infiltrating endometriosis was associated with higher rates of severe dysmenorrhoea (odds ratio [OR] 2.80, 95% confidence interval [CI] 1.02-7.70) and out-of-pocket private surgical care (OR 4.72, 95% CI 1.85-12.04). Compared to adenomyosis only, deep infiltrating endometriosis was associated with a higher fertility desire (OR 13.47, 95% CI 1.01-180.59) and a lower body mass index (OR 0.89, 95% CI 0.79-0.99). In contrast, heavy menstrual bleeding was the hallmark of adenomyosis, being less common in patients with endometriosis. CONCLUSION: Deep infiltrating endometriosis is associated with severe dysmenorrhoea, pain related to urinary and gastrointestinal tracts, higher fertility desire and infertility rate. Patients with pain symptomatology and subfertility should be referred early to a tertiary centre with the capability to diagnose and manage deep infiltrating endometriosis.

Effect of using population-specific body mass index cutoff points in the risk assessment of pregnant Asian women for venous thromboembolism.

INTRODUCTION: Current international Royal College of Obstetricians and Gynaecologists (RCOG) guidelines list maternal obesity (body mass index [BMI] ≥ 30.0 kg/m2) as a risk factor for venous thromboembolism (VTE). Although the World Health Organization (WHO) has recommended lower BMI cutoff points for Asians when risk stratifying for diseases associated with obesity, this has not been extended to maternal obesity. In the present study, we compared the difference in using Asian-specific BMI cutoff points as opposed to those in international guidelines in determining the population at risk for VTE, as defined by RCOG guidelines. METHODS: All spontaneous deliveries (n = 94) and Caesarean sections (n = 41) over a three-week period, and instrumental deliveries (n = 15) over a two-month period, were reviewed and risk stratified based on Asian-specific, as well as international, BMI cut-off points. RESULTS: For the group that underwent spontaneous vaginal delivery, the percentage of patients at risk for VTE nearly doubled (from 8.5% to 16.0%) with the revised risk stratification, while that of patients who had instrumental delivery had more than a two-fold increase (250%). In the initial risk stratification of the post-Caesarean patients, none were at high risk of VTE. However, when the lower cut-off points of 27.5 kg/m2 and 23.0 kg/m2 were used, one and three patients were respectively identified to be at high risk. CONCLUSION: Further research and consideration regarding the adjustment of international risk stratification guidelines to accommodate population-specific differences are required so that at-risk patients are not missed.

Vasculogenic and osteogenesis-enhancing potential of human umbilical cord blood endothelial colony-forming cells.

Umbilical cord blood-derived endothelial colony-forming cells (UCB-ECFC) show utility in neovascularization, but their contribution to osteogenesis has not been defined. Cocultures of UCB-ECFC with human fetal-mesenchymal stem cells (hfMSC) resulted in earlier induction of alkaline phosphatase (ALP) (Day 7 vs. 10) and increased mineralization (1.9×; p < .001) compared to hfMSC monocultures. This effect was mediated through soluble factors in ECFC-conditioned media, leading to 1.8-2.2× higher ALP levels and a 1.4-1.5× increase in calcium deposition (p < .01) in a dose-dependent manner. Transcriptomic and protein array studies demonstrated high basal levels of osteogenic (BMPs and TGF-ßs) and angiogenic (VEGF and angiopoietins) regulators. Comparison of defined UCB and adult peripheral blood ECFC showed higher osteogenic and angiogenic gene expression in UCB-ECFC. Subcutaneous implantation of UCB-ECFC with hfMSC in immunodeficient mice resulted in the formation of chimeric human vessels, with a 2.2-fold increase in host neovascularization compared to hfMSC-only implants (p = .001). We conclude that this study shows that UCB-ECFC have potential in therapeutic angiogenesis and osteogenic applications in conjunction with MSC. We speculate that UCB-ECFC play an important role in skeletal and vascular development during perinatal development but less so in later life when expression of key osteogenesis and angiogenesis genes in ECFC is lower.