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1.
Medicine (Baltimore) ; 101(45): e31529, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36397399

RESUMO

The diagnosis of endometriosis may delay for many years due to non-deterministic symptoms and avoiding surgical interventions. Kisspeptins are hormones that interact with endometrial tissue to limit invasions during placentation and various cancers and are suggested to be also associated with endometriosis. This study evaluated if serum kisspeptin levels are associated with the invasion depth in endometriosis. Forty patients between 18 and 45 years of age and admitted to a tertiary-care Obstetrics and Gynecology Department between 2020 and 2021 with a diagnosis of endometriosis, and 40 patients without endometrioma were included in the study. Demographic, obstetric, clinical, and biochemical characteristics were evaluated in patients with superficial (SE) and deep infiltrating (DIE) endometriosis and healthy controls. Twenty patients (50%) had SE, 14 (35%) had DIE, and 22 (55%) had endometrioma in the patient group. Fertility rates were higher among controls, but similar between patients with SE and DIE. CA125 levels were significantly higher in the DIE group. SE and DIE groups had similar kisspeptin values, significantly higher than controls. CA125 and kisspeptin levels were not correlated in study groups. Serum kisspeptin levels were significantly different between endometriosis patients and healthy controls. However, kisspeptin levels were unable to differentiate endometriosis severity. Our results suggest that kisspeptins might play a role in the pathogenesis of endometriosis, which needs further assessment in more comprehensive studies.


Assuntos
Endometriose , Kisspeptinas , Feminino , Humanos , Antígeno Ca-125/sangue , Endometriose/sangue , Endometriose/etiologia , Endometriose/patologia , Endometriose/fisiopatologia , Kisspeptinas/sangue , Ovário/patologia , Estudos Prospectivos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade
2.
Sci Rep ; 12(1): 2618, 2022 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-35173188

RESUMO

Endometriosis (EMs) is one of the most frequent diseases of reproductive-age women and is characterized by the growth of endometrial tissues beyond the uterus. The enhanced proliferative and migratory potential of endometrial stromal cells (ESCs) plays an important role in the progression of EMs. Mounting studies have demonstrated that long noncoding RNAs (lncRNAs) exert an important role in regulating the development and progression of EMs. Given the aberrant expression of lncRNA ADAMTS9-AS1 in ectopic endometrium (ecEM), we investigated the biological effect of ADAMTS9-AS1 on ESC proliferation and migration and explored the underlying mechanism. The current data showed that ADAMTS9-AS1 expression was significantly upregulated in ecEM compared with eutopic endometrium (euEM) in patients with EMs and in a murine model of EMs. Functionally, ADAMTS9-AS1 knockdown in ectopic ESCs (EESCs) decreased cell viability and migration, whereas ADAMTS9-AS1 overexpression in normal ESCs (NESCs) enhanced cell viability and migration. More importantly, the effect of ADAMTS9-AS1 inhibition on decreasing ESC viability was significantly blocked by ferrostatin-1 (Fer-1, a ferroptosis inhibitor), and ADAMTS9-AS1 overexpression repressed erastin (a ferroptosis activator)-induced cell death. Furthermore, the regulatory role of ADAMTS9-AS1 in ferroptosis was defined and evidenced by increased reactive oxygen species (ROS) levels and malonyl dialdehyde (MDA) content and decreased expression of glutathione peroxidase 4 (GPX4) after ADAMTS9-AS1 inhibition. Mechanistically, ADAMTS9-AS1 functioned as a competing endogenous RNA (ceRNA) by sponging miR-6516-5p to derepress the expression of GPX4, the critical repressor of ferroptosis. Taken together, these results demonstrate that upregulated ADAMTS9-AS1 accelerates ESC proliferation and migration by regulating miR-6516-5p/GPX4-dependent ferroptosis and may be a potential target for the treatment of EMs.


Assuntos
Proteína ADAMTS9/fisiologia , Endometriose/genética , Endometriose/fisiopatologia , Endométrio/citologia , Endométrio/fisiologia , Ferroptose/genética , Ferroptose/fisiologia , Expressão Gênica/genética , MicroRNAs/genética , MicroRNAs/metabolismo , Fosfolipídeo Hidroperóxido Glutationa Peroxidase/genética , Fosfolipídeo Hidroperóxido Glutationa Peroxidase/metabolismo , RNA Longo não Codificante/fisiologia , Células Estromais/fisiologia , Animais , Movimento Celular/genética , Proliferação de Células/genética , Células Cultivadas , Modelos Animais de Doenças , Endometriose/patologia , Endometriose/terapia , Feminino , Humanos , Camundongos Endogâmicos BALB C , Terapia de Alvo Molecular
3.
Int J Mol Sci ; 23(3)2022 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-35163699

RESUMO

Endometrial mesenchymal stromal cells (E-MSCs) extensively contribute to the establishment and progression of endometrial ectopic lesions through formation of the stromal vascular tissue, and support to its growth and vascularization. As E-MSCs lack oestrogen receptors, endometriosis eradication cannot be achieved by hormone-based pharmacological approaches. Quinagolide is a non-ergot-derived dopamine receptor 2 agonist reported to display therapeutic effects in in vivo models of endometriosis. In the present study, we isolated E-MSCs from eutopic endometrial tissue and from ovarian and peritoneal endometriotic lesions, and we tested the effect of quinagolide on their proliferation and matrix invasion ability. Moreover, the effect of quinagolide on E-MSC endothelial differentiation was assessed in an endothelial co-culture model of angiogenesis. E-MSC lines expressed dopamine receptor 2, with higher expression in ectopic than eutopic ones. Quinagolide inhibited the invasive properties of E-MSCs, but not their proliferation, and limited their endothelial differentiation. The abrogation of the observed effects by spiperone, a dopamine receptor antagonist, confirmed specific dopamine receptor activation. At variance, no involvement of VEGFR2 inhibition was observed. Moreover, dopamine receptor 2 activation led to downregulation of AKT and its phosphorylation. Of interest, several effects were more prominent on ectopic E-MSCs with respect to eutopic lines. Together with the reported effects on endometrial and endothelial cells, the observed inhibition of E-MSCs may increase the rationale for quinagolide in endometriosis treatment.


Assuntos
Aminoquinolinas/farmacologia , Proliferação de Células , Endometriose/tratamento farmacológico , Células-Tronco Mesenquimais/efeitos dos fármacos , Adulto , Aminoquinolinas/uso terapêutico , Agonistas de Dopamina/farmacologia , Endometriose/fisiopatologia , Endométrio/efeitos dos fármacos , Feminino , Humanos , Células-Tronco Mesenquimais/fisiologia , Pessoa de Meia-Idade , Proteínas Proto-Oncogênicas c-akt , Receptor 2 de Fatores de Crescimento do Endotélio Vascular
4.
Pain ; 163(2): e234-e245, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34030173

RESUMO

ABSTRACT: A key clinical problem is identifying the patient with endometriosis whose pain is complicated by central nervous system sensitization, where conventional gynecologic treatment (eg, hormonal therapy or surgery) may not completely alleviate the pain. The Central Sensitization Inventory (CSI) is a questionnaire previously validated in the chronic pain population. The objective of this study was an exploratory proof-of-concept to identify a CSI cutoff in the endometriosis population to discriminate between individuals with significant central contributors (identified by central sensitivity syndromes [CSS]) to their pain compared to those without. We analyzed a prospective data registry at a tertiary referral center for endometriosis, and included subjects aged 18 to 50 years with endometriosis who were newly or re-referred to the center in 2018. The study sample consisted of 335 subjects with a mean age of 36.0 ± 7.0 years. An increasing number of CSS was significantly correlated with dysmenorrhea, deep dyspareunia, dyschezia, and chronic pelvic pain scores (P < 0.001), and with the CSI score (0-100) (r = 0.731, P < 0.001). Receiver operating characteristic analysis indicated that a CSI cutoff of 40 had a sensitivity of 78% (95% CI: 72.7%-84.6%) and a specificity of 80% (95% CI: 70.3%-84.5%) for identifying a patient with endometriosis with ≥3 CSS. In the group with CSI ≥ 40, 18% retrospectively self-reported pain nonresponsive to hormonal therapy and 40% self-reported daily pain, compared with 6% and 20% in the CSI < 40 group (P = 0.003 and 0.002, respectively). In conclusion, a CSI ≥ 40 may be a practical tool to help identify patients with endometriosis with pain contributors related to central nervous system sensitization.


Assuntos
Sensibilização do Sistema Nervoso Central , Dor Crônica , Endometriose , Dor Pélvica , Adolescente , Adulto , Dor Crônica/etiologia , Dor Crônica/fisiopatologia , Constipação Intestinal/etiologia , Dispareunia/etiologia , Endometriose/complicações , Endometriose/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Dor Pélvica/etiologia , Dor Pélvica/fisiopatologia , Estudos Prospectivos , Estudos Retrospectivos , Adulto Jovem
5.
J Gynecol Obstet Hum Reprod ; 51(1): 102236, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34592437

RESUMO

INTRODUCTION: This study evaluates the clinical utility of magnetic resonance imaging (MRI) for the determination of presence and extent of DIE with special emphasis on effects of MRI reporting training MATERIAL AND METHODS: Data from 80 patients with clinically suspected DIE presented at our certified endometriosis center between 2015 and 2018 were analyzed. For all patients an ENZIAN score (describing DIE related to individual anatomical localizations) was obtained based on the preoperative MRI findings. The intraoperatively determined ENZIAN score served as the reference for assessment of diagnostic performance of the MRI. RESULTS: Overall, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the diagnosis of DIE by MRI were 76.9%, 53.3%, 87.7% and 34.8%, respectively. Analysis by compartment revealed a sensitivity, specificity, PPV and NPV of 59.5%, 88.2%, 86.2% and 63.9%, respectively, for compartment A, with similar values for compartment B, and 50.0%, 88.9%, 64.7% and 81.4%, respectively, for the less often affected compartment C. Expert training (n = 32 before, n = 48 after) led to a considerable increase in sensitivities for the overall detection of DIE (84.6% vs. 65.4%, p = 0.071) and for the detection of DIE in compartment A (71.4% vs. 35.7%, p = 0.026), compartment B (66.7% vs. 37.5%, p = 0.057) and compartment C (75.0% vs. 20.0%, p = 0.010), without significant loss in specificity (all p > 0.50). DISCUSSION: After expert training, MRI has a good sensitivity with fair specificity regarding preoperative assessment of presence, location and extent of DIE.


Assuntos
Endometriose/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/normas , Adolescente , Adulto , Endometriose/fisiopatologia , Feminino , Humanos , Imageamento por Ressonância Magnética/estatística & dados numéricos , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Cuidados Pré-Operatórios/estatística & dados numéricos , Estudos Retrospectivos , Sensibilidade e Especificidade
6.
Reprod Sci ; 29(2): 620-626, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34363198

RESUMO

The Pre-IVF Treatment with a GnRH Antagonist in Women with Endometriosis (PREGnant) Trial (clinicaltrials.gov no. NCT04173169) was designed to test the hypothesis that 60-day pre-treatment with an oral GnRH antagonist in women with documented endometriosis and planning an IVF cycle will result in a superior live birth rate to placebo. Eight hundred fourteen women are required from 4 national sites. To determine the feasibility of using an electronic medical record (EMR)-based strategy to recruit 204 participants at the Colorado site, we conducted a survey of women within the UCHealth system. Eligible women, identified using relevant ICD-10 codes, were invited to complete a 6-question survey to assess planned utilization of IVF, potential interest in participation, and whether delays in treatment due to COVID-19 would influence their decision to participate. Of 6354 age-eligible women with an endometriosis diagnosis, 421 had a concurrent infertility diagnosis. After eliminating duplicates, 212 were emailed a survey; 76 (36%) responded, 6 of whom reported no endometriosis diagnosis. Of the remaining 70, 29 (41%) were planning fertility treatment; only 19 planned IVF. All 19 expressed interest in participation. COVID-19 delays in treatment were not considered as a factor affecting participation by 8/19; the remaining 11 felt that it would "somewhat" affect their decision. None reported that they would not consider participation because of COVID-19. EMR-based recruitment for an endometriosis clinical trial is feasible although the overall yield of participants is low. Delays in treatment due to COVID-19 did not appear to overly influence potential recruitment.


Assuntos
COVID-19 , Endometriose/terapia , Fármacos para a Fertilidade Feminina/uso terapêutico , Fertilização In Vitro , Conhecimentos, Atitudes e Prática em Saúde , Antagonistas de Hormônios/uso terapêutico , Infertilidade Feminina/terapia , Seleção de Pacientes , Sujeitos da Pesquisa/psicologia , Adolescente , Adulto , Comportamento de Escolha , Método Duplo-Cego , Registros Eletrônicos de Saúde , Endometriose/diagnóstico , Endometriose/fisiopatologia , Feminino , Fármacos para a Fertilidade Feminina/efeitos adversos , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Antagonistas de Hormônios/efeitos adversos , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Nascido Vivo , Gravidez , Taxa de Gravidez , Resultado do Tratamento , Estados Unidos , Adulto Jovem
8.
Biomed Res Int ; 2021: 6464686, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34746304

RESUMO

OBJECTIVE: To explore the mechanisms of follicular fluids (FFs) on granulose cell (GC) apoptosis in endometriosis-associated infertility. MATERIALS AND METHODS: 60 infertile women were enrolled. The FFs from 30 endometriosis-associated infertility (EI) patients were collected and processed by ELISA hormone assay and proteomic profiling. The ovary GCs collected from 30 tubal-associated infertility (TI) patients were cultured in follicular fluids of endometriosis-associated infertility patients (EI-FFs), and the apoptosis mechanisms were explored by flow cytometry assay, real-time PCR, Western blotting, and protein-protein interaction (PPI) network analysis. RESULTS: Our results showed that the expression of 22 specific proteins was significantly different in the FFs from EI and TI patients, and the level of testosterone and anti-Müllerian hormone was not obviously different between the two groups. EI-FFs could accelerate the apoptosis process of granulose cells of tubal-associated infertility patients (TI-GCs) by regulating the expression of 5 apoptosis-related proteins including BCL2, BAX, CASP3, CASP9, and TP53. The correlation of these 22 specific proteins and 5 apoptosis-related proteins was analyzed by PPI, and 5 protein biomarkers (INS, CXCL10, ICAM1, WIF1, and TNFRSF13C) and 5 signaling pathways (cytokine-cytokine receptor interaction, apoptosis, regulation of actin cytoskeleton, MAPK, and p53 signaling pathway) were predicted. CONCLUSION: This research clarified the effect and explored the mechanisms of EI-FFs on the apoptosis of TI-GCs and indicated the protein biomarkers and signaling pathways for further study.


Assuntos
Líquido Folicular/metabolismo , Células da Granulosa/metabolismo , Infertilidade Feminina/fisiopatologia , Adulto , Apoptose/fisiologia , Estudos de Casos e Controles , Endometriose/metabolismo , Endometriose/fisiopatologia , Feminino , Líquido Folicular/fisiologia , Humanos , Infertilidade Feminina/metabolismo , Proteômica
9.
Int J Mol Sci ; 22(21)2021 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-34768846

RESUMO

The diagnosis of endometriosis and fertility disorders is difficult; therefore, it is necessary to look for reliable biomarkers. Analysis of the molecular status of fibronectin as a key player in repair and wound healing processes, as well as in coagulation and fibrinolysis pathways, is justified. ELISA and SDS-agarose immunoblotting were applied to determine the fibronectin concentration and presence and occurrence of soluble FN-fibrin complexes in the blood plasma of women with endometriosis (n = 38), fertility disorders (n = 28) and the healthy group (n = 25). The concentration of fibronectin in the blood plasma of women with endometriosis (292.61 ± 96.17 mg/L) and fertility disorders (287.53 ± 122.68 mg/L) was significantly higher than in the normal group (226.55 ± 91.98 mg/L). The presence of FN-fibrin complexes of 750, 1000, 1300, 1600 and 1900 kDa in the plasma of women with endometriosis and fertility disorders was shown. The presence of FN-fibrin complexes with a molecular mass of more than 1300 kDa in women with endometriosis and infertility and the complete absence of these complexes in healthy women may indicate an increased and chronic activation of coagulation mechanisms in these patients. The presence of complexes of high molecular mass may be one of the biomarkers of fertility disorders in women.


Assuntos
Endometriose/metabolismo , Fibronectinas/metabolismo , Infertilidade Feminina/metabolismo , Adulto , Biomarcadores , Endometriose/diagnóstico , Endometriose/fisiopatologia , Feminino , Fibrina/metabolismo , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Fibronectinas/análise , Fibronectinas/sangue , Fibronectinas/fisiologia , Humanos , Infertilidade Feminina/fisiopatologia , Pessoa de Meia-Idade , Plasma/química
10.
J Chin Med Assoc ; 84(11): 1048-1053, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34747901

RESUMO

BACKGROUND: Ovarian clear cell carcinoma (OCCC) is frequently associated with endometriosis. Since serum levels of cancer antigen 125 (CA125) have limited diagnostic and prognostic value in this malignancy, there is an unmet need for reliable and specific biomarkers. Previous findings indicated that alpha 1-antitrypsin isoforms (isoAAT) are significantly increased in the peritoneal fluid of patients with endometriosis. This study was undertaken to examine whether serum isoAAT levels in patients with OCCC differ from those measured in women with endometriosis or benign ovarian tumors. We also investigated whether this biomarker may be useful for predicting survival in OCCC. METHODS: Paired serum samples before and after debulking surgery were collected from 27 patients with OCCC. All sera from patients with endometriosis (n = 44) and benign ovarian tumors (n = 32) were obtained in the pretreatment phase. Serum isoAAT levels were assayed using a proprietary ELISA kit. RESULTS: The highest levels of serum isoAAT (median, range) were identified in patients with OCCC (preoperative values: 160.9 ng/mL, range, 101.4-1098.8 ng/mL), followed by patients with endometriosis (125.0 and 83.4-473.2 ng/mL), and those with benign tumors (125.2 and 60.5-191.3 ng/mL). The differences in serum isoAAT levels between patients with OCCC and benign tumors were significant (p = 0.041). Debulking surgery of OCCC resulted in a significant decrease in serum isoAAT levels compared with the preoperative period (median, 160.9 versus 113.0 ng/mL, respectively, p = 0.012). As for prognostic prediction, we found that none of the nine patients with OCCC and serum isoAAT levels ≤130 ng/mL died of disease. CONCLUSION: Serum isoAAT levels may be diagnostically useful to distinguish OCCC from benign ovarian tumors and could also serve as a potential prognostic marker.


Assuntos
Adenocarcinoma de Células Claras , Neoplasias Ovarianas , Isoformas de Proteínas/sangue , alfa 1-Antitripsina/sangue , Biomarcadores Tumorais , Endometriose/fisiopatologia , Feminino , Humanos , Neoplasias Ovarianas/fisiopatologia , Estudos Retrospectivos
11.
Fertil Steril ; 116(6): 1436-1448, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34674825

RESUMO

Implantation is a critical step in human reproduction. The success of this step is dependent on a competent blastocyst, receptive endometrium, and successful cross talk between the embryonic and maternal interfaces. Recurrent implantation failure is the lack of implantation after the transfer of several embryo transfers. As the success of in vitro fertilization has increased and failures have become more unacceptable for patients and providers, the literature on recurrent implantation failure has increased. While this clinical phenomenon is often encountered, there is not a universally agreed-on definition-something addressed in an earlier portion of this Views and Reviews. Implantation failure can result from several different factors. In this review, we discuss factors including the maternal immune system, genetics of the embryo and parents, anatomic factors, hematologic factors, reproductive tract microbiome, and endocrine milieu, which factors into embryo and endometrial synchrony. These potential causes are at various stages of research and not all have clear implications or immediately apparent treatment.


Assuntos
Implantação do Embrião/fisiologia , Transferência Embrionária/métodos , Endométrio/fisiopatologia , Falha de Tratamento , Transferência Embrionária/tendências , Endometriose/genética , Endometriose/fisiopatologia , Feminino , Fertilização In Vitro/métodos , Fertilização In Vitro/tendências , Humanos , Gravidez , Taxa de Gravidez/tendências , Recidiva
13.
Medicine (Baltimore) ; 100(33): e26979, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414974

RESUMO

ABSTRACT: To map the distribution of the sites most affected by endometriosis in patients with unilateral ovarian endometriomas.A descriptive case series of 84 patients with unilateral endometriomas undergoing laparoscopy for the treatment of endometriosis. To evaluate the distribution of the sites of endometriosis lesions, the peritoneal compartments were divided into 5 zones: zone 1/the anterior compartment, including the anterior uterine serosa, vesicouterine fold, round ligament, and bladder; zone 2/the lateral compartment, including the left and right ovary, ovarian fossa, tubes, mesosalpinx, uterosacral ligaments, parametrium, and the ureter; zone 3/the posterior compartment, including posterior uterine serosa, the pouch of Douglas, posterior vaginal fornix, and bowel; zone 4 consisting of the abdominal wall; and zone 5 consisting of the diaphragm.Of the 5 zones evaluated, the lateral compartment (zone 2) was the most affected, with 60.7% of the patients having dense adhesions around the left ovarian fossa and 57.1% around the right ovarian fossa. The ovarian endometriomas were more commonly found on the left side (54.8%) compared to the right (45.2%). In the posterior compartment (zone 3), the posterior cul-de-sac was obliterated in 51.2% of the patients. In the anterior compartment (zone 1), there were lesions in the vesicouterine fold in 30.9% of the patients and in the bladder in 19%. Lesions were found in the abdominal wall (zone 4) and diaphragm (zone 5) in 21.4% and 10.7% of patients, respectively.Unilateral endometriomas are important markers of the severity of endometriosis.


Assuntos
Endometriose/classificação , Laparoscopia/estatística & dados numéricos , Útero/anatomia & histologia , Adolescente , Adulto , Endometriose/fisiopatologia , Feminino , Humanos , Laparoscopia/métodos , Ovário/anatomia & histologia , Ovário/fisiopatologia , Útero/fisiopatologia
14.
J Gynecol Obstet Hum Reprod ; 50(10): 102208, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34418594

RESUMO

INTRODUCTION: Transvaginal ultrasound is fundamental for the mapping of endometriosis, and the imaging criteria have been clearly described for different organs study. However, no specific ultrasonographic signs of tubal endometriosis have been reported, with the exception of hydrosalpinx, which is the expression of an extreme tubal damage and obstruction. The detection of tubal pathology in infertile patients is fundamental, therefore the aim of the study was to evaluate incidence of tubal endometriosis in infertile patients, and to analyze ultrasonographic signs useful for detection of this condition. MATERIAL AND METHODS: It is a single-center, retrospective cohort study. All 500 consecutive infertile women who underwent laparoscopic surgery for endometriosis were included. The preoperative workup included transvaginal ultrasound and was compared to intraoperative findings and histologic study. RESULTS: The incidence of tubal endometriosis in our study was 8%. Using hydrosalpinx as the ultrasonographic marker for tubal involvement the overall pooled, sensitivity and specificity of TVU were 12% (95%CI, 5-23%) and 99% (95%CI, 98-100%), respectively. If at least one ultrasonographic parameter like hydrosalpinx, periadnexal adhesions or ovarian cyst was considered as a sign of tubal endometriosis, a sensitivity, VPN and specificity were 94% (95% IC, 85-98%), 97% (95%IC, 93-99%) and 31% (95%CI, 27-36%), respectively. DISCUSSION: Hydrosalpinx as ultrasonographic sign alone is characterized by a high specificity but low sensitivity for detection of tubal endometriosis; its sensitivity can be improved by the addition of other markers such as endometrioma and/or periadnexal adhesions.


Assuntos
Endometriose/complicações , Doenças das Tubas Uterinas/diagnóstico por imagem , Doenças das Tubas Uterinas/etiologia , Ultrassonografia/métodos , Adulto , Estudos de Coortes , Endometriose/fisiopatologia , Doenças das Tubas Uterinas/epidemiologia , Tubas Uterinas/diagnóstico por imagem , Feminino , Humanos , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/etiologia , Itália/epidemiologia , Estudos Retrospectivos , Ultrassonografia/estatística & dados numéricos
15.
Am J Reprod Immunol ; 86(5): e13482, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34218478

RESUMO

PROBLEM: Repeated implantation failure and recurrent pregnancy loss are associated with chronic endometritis, a persistent endometrial inflammation. Its diagnosis and treatment may increase pregnancy and live birth rates. The aim of this study was to assess the effectiveness of endometrial diagnostic biopsy and subsequent antibiotic treatment in cases of chronic endometritis on reproductive outcomes over a long observation period. METHOD OF STUDY: We conducted a historical cohort study (2014-2018) at our University-based infertility center that included women (n = 108) with repeated implantation failure or recurrent pregnancy loss without known pathologies associated with either condition. Forty-one women underwent a hysteroscopy only (reference group); the remaining 67 women underwent, in addition to the hysteroscopy, an endometrial diagnostic biopsy with immunohistochemically staining for CD138 to detect plasma cells (biopsy group). If one or more plasma cells were detected, the women were treated with doxycycline 100 mg twice a day orally for 2 weeks. We performed stratified survival analysis (Kaplan-Meier) and Cox regression. RESULTS: The biopsy group had higher chances of pregnancy (hazard ratio 2.28; 95% confidence interval 1.23-4.24; p = .009) and of live birth (hazard ratio 2.76; 95% confidence interval 1.30-5.87; p = .008) compared with the reference group. In the sensitivity analysis, repeated implantation failure or recurrent pregnancy loss did not affect the outcome. CONCLUSION: Endometrial diagnostic biopsy followed by antibiotic treatment in case of chronic endometritis in women with repeated implantation failure or recurrent pregnancy loss may increase the chances for live birth.


Assuntos
Aborto Habitual/prevenção & controle , Antibacterianos/uso terapêutico , Endometriose/tratamento farmacológico , Histeroscopia , Aborto Habitual/diagnóstico , Aborto Habitual/fisiopatologia , Adulto , Biópsia , Doença Crônica , Implantação do Embrião , Endometriose/patologia , Endometriose/fisiopatologia , Feminino , Humanos , Nascido Vivo , Valor Preditivo dos Testes , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Tempo para Engravidar , Resultado do Tratamento
16.
Reprod Biomed Online ; 43(2): 310-318, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34193356

RESUMO

RESEARCH QUESTION: Is there a difference in the ovarian reserve 1 year post-operatively in those who used a haemostatic sealant or bipolar diathermy for haemostasis during laparoscopic ovarian cystectomy for ovarian endometriomas? DESIGN: This was an extended follow-up observational study of a previous randomized controlled trial where women aged 18 to 40 years with 3-8 cm unilateral or bilateral endometriomas were randomized to receive haemostasis by a haemostatic sealant or bipolar diathermy following ovarian cystectomy. The primary outcome was the ovarian reserve as assessed by antral follicle count (AFC) 1 year post-operatively. Secondary outcomes included the recurrence rate of ovarian endometrioma, the change in anti-Müllerian hormone (AMH) and FSH concentrations, and reproductive outcomes. RESULTS: The significant increase in AFC at 3 months after initial surgery (P = 0.025) in the haemostatic sealant group compared with the diathermy group was sustained at 1 year (P = 0.024) but there was no difference in AMH or FSH concentrations between the groups throughout the follow-up period. The recurrence rate in the FloSeal group was 7.7% (n = 3/39) compared with 22.2% (n = 8/36) in the diathermy group (P = 0.060). The recurrence rate in women who had bilateral lesions was significantly higher than those with unilateral lesions (risk ratio 5.33, interquartile range 1.55-18.38). No difference in reproductive outcomes was found between the two groups. CONCLUSIONS: Applying haemostatic sealant after laparoscopic cystectomy of ovarian endometriomas produces a significantly greater improvement in AFC, which was apparent at 3-month follow-up, and was sustained at 1-year follow-up without compromising the recurrence rate.


Assuntos
Diatermia/métodos , Esponja de Gelatina Absorvível/uso terapêutico , Recidiva Local de Neoplasia , Cistos Ovarianos/terapia , Reserva Ovariana , Adolescente , Adulto , Endometriose/patologia , Endometriose/fisiopatologia , Endometriose/terapia , Feminino , Seguimentos , Técnicas Hemostáticas , Hemostáticos/uso terapêutico , Hong Kong , Humanos , Laparoscopia/métodos , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/fisiopatologia , Cistos Ovarianos/patologia , Cistos Ovarianos/fisiopatologia , Doenças Ovarianas/patologia , Doenças Ovarianas/fisiopatologia , Doenças Ovarianas/terapia , Reserva Ovariana/efeitos dos fármacos , Período Pós-Operatório , Resultado do Tratamento , Adulto Jovem
17.
Int J Mol Sci ; 22(11)2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34199929

RESUMO

BMI-1 is a key component of stem cells, which are essential for normal organ development and cell phenotype maintenance. BMI-1 expression is deregulated in cancer, resulting in the alteration of chromatin and gene transcription repression. The cellular signaling pathway that governs BMI-1 action in the ovarian carcinogenesis sequences is incompletely deciphered. In this study, we set out to analyze the immunohistochemical (IHC) BMI-1 expression in two different groups: endometriosis-related ovarian carcinoma (EOC) and non-endometriotic ovarian carcinoma (NEOC), aiming to identify the differences in its tissue profile. METHODS: BMI-1 IHC expression has been individually quantified in epithelial and in stromal components by using adapted scores systems. Statistical analysis was performed to analyze the relationship between BMI-1 epithelial and stromal profile in each group and between groups and its correlation with classical clinicopathological characteristics. RESULTS: BMI-1 expression in epithelial tumor cells was mostly low or negative in the EOC group, and predominantly positive in the NEOC group. Moreover, the stromal BMI-1 expression was variable in the EOC group, whereas in the NEOC group, stromal BMI-1 expression was mainly strong. We noted statistically significant differences between the epithelial and stromal BMI-1 profiles in each group and between the two ovarian carcinoma (OC) groups. CONCLUSIONS: Our study provides solid evidence for a different BMI-1 expression in EOC and NEOC, corresponding to the differences in their etiopathogeny. The reported differences in the BMI-1 expression of EOC and NEOC need to be further validated in a larger and homogenous cohort of study.


Assuntos
Endometriose/fisiopatologia , Endométrio/fisiopatologia , Células Epiteliais/patologia , Neoplasias Ovarianas/patologia , Complexo Repressor Polycomb 1/metabolismo , Células Estromais/patologia , Índice de Massa Corporal , Estudos de Casos e Controles , Células Epiteliais/metabolismo , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/classificação , Neoplasias Ovarianas/metabolismo , Células Estromais/metabolismo
19.
Reprod Biomed Online ; 43(3): 370-378, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34272164

RESUMO

Endometriosis is a chronic oestrogen-dependent gynaecological disorder characterized by non-menstrual pelvic pain, infertility and the extrauterine growth of endometrial-like glands and stroma. It has been noted that the eutopic endometrium of women with endometriosis is functionally distinct from that of women without endometriosis. Moreover, ectopic endometrial implants are functionally different from the eutopic endometrium of women with endometriosis. However, the mechanisms directing these differences are ill-defined. It is proposed here that small membrane-bound extracellular vesicles called exosomes are important vehicles in the protection and transport of signalling molecules central to the dysregulation of endometrial function in women with endometriosis. Therefore, a critical review of the literature linking exosomes and their cargo to the pathobiology of endometriosis was conducted. Circulating peritoneal fluid and endometrial cell exosomes contained long non-coding RNA, miRNA and proteins involved in histone modification, angiogenesis and immune modulation that differed significantly in women with endometriosis compared with controls. Moreover, experimental evidence supports a role for exosomes and their cargo in angiogenesis, neurogenesis, immune modulation and endometrial stromal cell invasion. It is therefore suggested that exosomes play an important role in the pathophysiology of endometriosis.


Assuntos
Endometriose/fisiopatologia , Endométrio/fisiologia , Exossomos/fisiologia , Doenças Peritoneais/fisiopatologia , Endometriose/genética , Endometriose/metabolismo , Endometriose/patologia , Endométrio/citologia , Células Epiteliais/fisiologia , Exossomos/metabolismo , Feminino , Humanos , Sistema Imunitário/fisiopatologia , MicroRNAs/metabolismo , MicroRNAs/fisiologia , Neovascularização Patológica/fisiopatologia , Doenças Peritoneais/genética , Doenças Peritoneais/metabolismo , Doenças Peritoneais/patologia , Proteínas/metabolismo , Proteínas/fisiologia , RNA não Traduzido/metabolismo , RNA não Traduzido/fisiologia , Células Estromais/fisiologia
20.
Sci Rep ; 11(1): 11512, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34075189

RESUMO

Uterine inflammation is a very common and serious condition in domestic animals. To development and progression of this pathology often lead disturbances in myometrial contractility. Participation of ß1-, ß2- and ß3-adrenergic receptors (ARs) in noradrenaline (NA)-influenced contractility of the pig inflamed uterus was studied. The gilts of SAL- and E.coli-treated groups were administered saline or E.coli suspension into the uterine horns, respectively. Laparotomy was only done in the CON group. Compared to the period before NA administration, this neurotransmitter reduced the tension, amplitude and frequency in uterine strips of the CON and SAL groups. In the E.coli group, NA decreased the amplitude and frequency, and these parameters were lower than in other groups. In the CON, SAL and E.coli groups, ß1- and ß3-ARs antagonists in more cases did not significantly change and partly eliminated NA inhibitory effect on amplitude and frequency, as compared to NA action alone. In turn, ß2-ARs antagonist completely abolished NA relaxatory effect on these parameters in three groups. Summarizing, NA decreases the contractile amplitude and frequency of pig inflamed uterus via all ß-ARs subtypes, however, ß2-ARs have the greatest importance. Given this, pharmacological modulation of particular ß-ARs subtypes can be used to increase inflamed uterus contractility.


Assuntos
Endometriose/metabolismo , Endométrio/metabolismo , Infecções por Escherichia coli/metabolismo , Escherichia coli/metabolismo , Receptores Adrenérgicos beta/metabolismo , Contração Uterina , Animais , Endometriose/patologia , Endometriose/fisiopatologia , Endométrio/patologia , Endométrio/fisiopatologia , Infecções por Escherichia coli/patologia , Infecções por Escherichia coli/fisiopatologia , Feminino , Inflamação/metabolismo , Inflamação/patologia , Inflamação/fisiopatologia , Suínos
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