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Coskun B, Ince O, Erkilinc S, Elmas B, Saridogan E, Coskun B, Doganay M. The feasibility of the platelet count and mean platelet volume as markers of endometriosis and adenomyosis: A case control study. J Gynecol Obstet Hum Reprod 2019; 49:101626. [PMID: 31499283 DOI: 10.1016/j.jogoh.2019.101626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/29/2019] [Accepted: 09/05/2019] [Indexed: 01/24/2023]
Abstract
INTRODUCTION The aim of the study is to investigate the role of platelet count (PC) and mean platelet volume (MPV) in determining adenomyosis and endometriosis. MATERIAL AND METHODS This was a retrospective case control study that included adenomyosis, endometriosis and control groups. The adenomyosis group included 84 women diagnosed between January 2013 and January 2015 based on hysterectomy specimen. The endometriosis group included 102 patients underwent diagnostic laparoscopy and confirmed by histopathologic examination. Lastly, the control group included 88 women had no medical problem and underwent tubal ligation. RESULTS MPV (fl) was significantly lower in adenomyosis group (8.5) compared to endometriosis (9, p<0.05) and control groups (9, p<0.01). Modified platelet activity (MPV/PC) was significantly lower in adenomyosis group compared to control group (p<0.01). Bivariate logistic regression model was used to assess the odds ratio of risk factors and serum markers related to endometriosis and adenomyosis. Variables showing significant differences based on post-hoc Bonferroni test were included in the logistic regression model for comparison of each disease with the control group. MPV was not found to be a risk factor both for presence of endometriosis and adenomyosis after adjusting for demographic and clinical characteristics. DISCUSSION Our study suggested that PC and MPV were not useful diagnostic markers for endometriosis or adenomyosis. Further research on how platelet indices and other inflammatory markers are related to inflammation might help better understand their potential as markers for these diseases.
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Affiliation(s)
- Bugra Coskun
- University of Health Sciences Gülhane Education and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Onur Ince
- Kutahya Health Sciences University, Faculty of Medicine, Department of Obstetrics and Gynecology, 43000, Kutahya, Turkey.
| | - Selcuk Erkilinc
- University of Health Sciences Tepecik Education and Research Hospital, Department of Gynecologic Oncology, İzmir, Turkey.
| | - Burak Elmas
- University of Health Sciences Zekai Tahir Burak Women's Health Education and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Erdinc Saridogan
- University of Health Sciences Zekai Tahir Burak Women's Health Education and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Bora Coskun
- University of Health Sciences Gülhane Education and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Melike Doganay
- University of Health Sciences Zekai Tahir Burak Women's Health Education and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
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Heard ME, Simmons CD, Simmen FA, Simmen RCM. Krüppel-like factor 9 deficiency in uterine endometrial cells promotes ectopic lesion establishment associated with activated notch and hedgehog signaling in a mouse model of endometriosis. Endocrinology 2014; 155:1532-46. [PMID: 24476135 PMCID: PMC3959595 DOI: 10.1210/en.2013-1947] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Endometriosis, a steroid hormone-dependent disease characterized by aberrant activation of estrogen receptor signaling and progesterone resistance, remains intractable because of the complexity of the pathways underlying its manifestation. We previously showed that eutopic endometria of women with endometriosis exhibit lower expression of Krüppel-like factor 9 (KLF9), a progesterone receptor coregulator in the uterus, relative to that of women without disease. Here we examined whether loss of endometrial KLF9 expression causes ectopic lesion establishment using syngeneic wild-type (WT) mice as recipients of endometrial fragments from WT and Klf9 null donors. We found significantly higher incidence of ectopic lesions with Klf9 null than WT endometria 8 weeks after tissue injection into the intraperitoneal cavity. The increased incidence of lesion establishment with Klf9 null endometria was associated with a higher expression ratio of estrogen receptor 2 isoform relative to that of estrogen receptor 1 and attenuated progesterone receptor levels in endometriotic stromal cells. PCR array analyses of Notch and Hedgehog signaling components in ectopic lesions demonstrated up-regulated expression of select genes (Jag 2, Shh, Gli1, and Stil 1) in Klf9 null lesions relative to that in WT lesions. Immunohistochemical analyses showed increased levels of Notch intracellular domain and Sonic Hedgehog proteins in Klf9 null lesions relative to that in WT lesions, confirming pathway activation. WT recipients with Klf9 null lesions displayed lower systemic levels of TNFα and IL-6 and higher soluble TNF receptor 1 than corresponding recipients with WT lesions. Our results suggest that endometrial KLF9 deficiency promotes endometriotic lesion establishment by the coincident deregulation of Notch-, Hedgehog-, and steroid receptor-regulated pathways.
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Affiliation(s)
- Melissa E Heard
- Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
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3
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Advances in endometriosis treatment. Nurse Pract 2013; 38:42-7. [PMID: 23598560 DOI: 10.1097/01.npr.0000425826.90435.a8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Endometriosis is a common problem characterized by abdominal pain, back pain, pain with intercourse, dysfunctional uterine bleeding, and infertility. The cause of endometriosis is not well understood, but advances in treatment have been made. Primary care clinicians are uniquely situated to improve patient outcomes by making informed treatment decisions.
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Kyama CM, Mihalyi A, Chai D, Simsa P, Mwenda JM, D'Hooghe TM. Baboon model for the study of endometriosis. ACTA ACUST UNITED AC 2012; 3:637-46. [PMID: 19804041 DOI: 10.2217/17455057.3.5.637] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endometriosis is a benign, estrogen-dependent disease and is now recognized as an enigmatic disease owing to its various clinical manifestations and locations. The lack of a reliable and specific method for the early detection of endometriosis often results in delayed diagnosis. So far, research has born inadequate findings regarding understanding the basic etiology or pathophysiology of endometriosis. Animal models that accurately represent the cellular and molecular changes associated with the initiation and progression of human endometriosis have significant potential to facilitate the development of better methods for the early detection and treatment of endometriosis. A number of animal model systems have been developed for the study of this disease. These models replicate many of the known salient features of human endometriosis. This review provides an insight into the use of the baboon model for studies focused on understanding human endometriosis.
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Affiliation(s)
- Cleophas M Kyama
- Leuven University Fertility Centre, Department of Obstetrics & Gynaecology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
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Vodolazkaia A, Bossuyt X, Fassbender A, Kyama CM, Meuleman C, Peeraer K, Tomassetti C, D'Hooghe TM. A high sensitivity assay is more accurate than a classical assay for the measurement of plasma CRP levels in endometriosis. Reprod Biol Endocrinol 2011; 9:113. [PMID: 21827658 PMCID: PMC3169460 DOI: 10.1186/1477-7827-9-113] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 08/09/2011] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Endometriosis is associated with chronic subclinical inflammation. C-reactive protein (CRP), a marker of inflammation, could serve as a biomarker of endometriosis. We tested the hypothesis that a high sensitivity CRP assay (hsCRP) is more accurate than a classical CRP assay in the detection of subclinical inflammation in plasma of women with endometriosis. METHODS CRP levels were measured by hsCRP and classical CRP assays in plasma of 204 women with endometriosis and 91 women without endometriosis. Both assays were compared with respect to their value for the diagnosis of endometriosis. RESULTS The number of plasma samples with detectable CRP was significantly higher (100%) using the hsCRP assay when compared to the classical CRP assay (42.7%) (p < 0.0001). Significantly increased CRP plasma levels were found in women with endometriosis when compared with controls when the hsCRP assay was used in samples obtained during the luteal phase (p = 0.008). The highest discriminative ability for the diagnosis of endometriosis was also obtained using the hsCRP assay during the luteal phase, especially for moderate -severe endometriosis. At a cut-off level of hsCRP > 0.71 mg/L, moderate-severe stages were diagnosed with 80.7% sensitivity and 63.9% specificity during the luteal phase. Using a similar cut-off value for CRP analyzed by the classical method, moderate-severe endometriosis was diagnosed with lower sensitivity (67.7%, p = 0.06) and comparable specificity (63.9%). CONCLUSIONS The hsCRP assay was superior to the classical CRP assay for the detection of low CRP levels and for revealing subclinical inflammation in plasma of women with endometriosis.
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Affiliation(s)
- Alexandra Vodolazkaia
- Leuven University Fertility Centre, Department of Obstetrics & Gynaecology, University Hospital Gasthuisberg, Leuven, Belgium
- Experimental Gynaecology Laboratory, Department of Obstetrics & Gynaecology, KU Leuven, University Hospital Gasthuisberg, Herestraat 49, B3000 Leuven, Belgium
| | - Xavier Bossuyt
- Department of Laboratory Medicine, Leuven University Hospital, Leuven, Belgium
| | - Amelie Fassbender
- Leuven University Fertility Centre, Department of Obstetrics & Gynaecology, University Hospital Gasthuisberg, Leuven, Belgium
- Experimental Gynaecology Laboratory, Department of Obstetrics & Gynaecology, KU Leuven, University Hospital Gasthuisberg, Herestraat 49, B3000 Leuven, Belgium
| | - Cleophas M Kyama
- Leuven University Fertility Centre, Department of Obstetrics & Gynaecology, University Hospital Gasthuisberg, Leuven, Belgium
- Division of Reproductive Biology, Institute of Primate Research, Nairobi, Kenya
- Experimental Gynaecology Laboratory, Department of Obstetrics & Gynaecology, KU Leuven, University Hospital Gasthuisberg, Herestraat 49, B3000 Leuven, Belgium
| | - Christel Meuleman
- Leuven University Fertility Centre, Department of Obstetrics & Gynaecology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Karen Peeraer
- Leuven University Fertility Centre, Department of Obstetrics & Gynaecology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Carla Tomassetti
- Leuven University Fertility Centre, Department of Obstetrics & Gynaecology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Thomas M D'Hooghe
- Leuven University Fertility Centre, Department of Obstetrics & Gynaecology, University Hospital Gasthuisberg, Leuven, Belgium
- Division of Reproductive Biology, Institute of Primate Research, Nairobi, Kenya
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Socolov R, Butureanu S, Angioni S, Sindilar A, Boiculese L, Cozma L, Socolov D. The value of serological markers in the diagnosis and prognosis of endometriosis: a prospective case–control study. Eur J Obstet Gynecol Reprod Biol 2011; 154:215-7. [DOI: 10.1016/j.ejogrb.2010.10.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 07/25/2010] [Accepted: 10/11/2010] [Indexed: 10/18/2022]
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Simsa P, Mihalyi A, Schoeters G, Koppen G, Kyama CM, Den Hond EM, Fülöp V, D'Hooghe TM. Increased exposure to dioxin-like compounds is associated with endometriosis in a case-control study in women. Reprod Biomed Online 2010; 20:681-8. [PMID: 20211585 DOI: 10.1016/j.rbmo.2010.01.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 09/10/2009] [Accepted: 12/17/2009] [Indexed: 10/19/2022]
Abstract
Although endometriosis is thought to be an environmental disorder initiated by dioxin exposure, this association is controversial. This study was performed to test the hypothesis that endometriosis occurs more often in women exposed to higher concentrations of dioxin-like compounds (DLC) than in those women exposed to lower concentrations. Plasma samples collected prior to laparoscopic surgery from 96 women with endometriosis and 106 control patients with a normal pelvis were measured for DLC concentrations using the dioxin-responsive chemical-activated luciferase expression bioassay. The results showed that concentration (mean+/-SD) of DLC was marginally higher in patients with endometriosis (22.3+/-9.3pg CALUX-TEQ/g lipid) than in controls (20.5+/-10.8pg). After categorization of patients in a group with 'low' plasma concentrations (<25th centile) and a group with 'high' plasma concentrations (>75th centile) of DLC, the age-adjusted odds ratio to have endometriosis was 2.44 (95% CI 1.04-5.70; P=0.04) for women with high concentrations of DLC and it increased to 3.01 (95% CI 1.06-9.04; P=0.03) when only women with moderate severe endometriosis were considered. In conclusion, women exposed to higher plasma concentrations of DLC were at higher risk of having endometriosis than women exposed to lower concentrations of DLC within normal environmental concentrations.
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Affiliation(s)
- Peter Simsa
- Leuven University Fertility Center, Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Leuven, Belgium
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Mihalyi A, Gevaert O, Kyama CM, Simsa P, Pochet N, De Smet F, De Moor B, Meuleman C, Billen J, Blanckaert N, Vodolazkaia A, Fulop V, D'Hooghe TM. Non-invasive diagnosis of endometriosis based on a combined analysis of six plasma biomarkers. Hum Reprod 2009; 25:654-64. [DOI: 10.1093/humrep/dep425] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Effect of recombinant human TNF–binding protein-1 and GnRH antagonist on mRNA expression of inflammatory cytokines and adhesion and growth factors in endometrium and endometriosis tissues in baboons. Fertil Steril 2008; 89:1306-13. [DOI: 10.1016/j.fertnstert.2006.11.205] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2006] [Revised: 11/21/2006] [Accepted: 11/27/2006] [Indexed: 11/15/2022]
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Simsa P, Járási ZE, Fülöp V. [Environmental dioxin compounds as the cause of endometriosis and other diseases]. Orv Hetil 2007; 148:1745-50. [PMID: 17827083 DOI: 10.1556/oh.2007.28172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
There has been much debate of late about whether or not dioxin, an industrial toxin, could be a causative agent in the onset of endometriosis, a gynaecological disease associated with infertility and pain. Studies found either no difference in serum dioxin concentrations when cases were compared to controls or a non-significant increase, or reached low statistical power. The introductory results on Rhesus monkey contradict with the observations on mice fed with dioxin and oestrogen simultaneously. Genetic comparison shows that human belongs to the dioxin resistant races so dioxin concentrations measured in the population could not cause disease especially not an oestrogen dependent one, like endometriosis.
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Affiliation(s)
- Péter Simsa
- Országos Gyógyintézeti Központ, Nogyógyászati Osztály, Budapest.
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Simsa P, Mihalyi A, Kyama CM, Mwenda JM, Fülöp V, D'Hooghe TM. Future of endometriosis research. WOMEN'S HEALTH (LONDON, ENGLAND) 2007; 3:647-654. [PMID: 19804042 DOI: 10.2217/17455057.3.5.647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In women of reproductive age, health economic costs are estimated to be considerably higher for endometriosis than for conditions such as Crohn's disease, migraine and hypertension, and similar to the cost of diabetes. However, more awareness of endometriosis among patients and politicians is needed to create a better climate for research funding in the area of endometriosis in particular, and women's health in general. Recent collaboration between patients, physicians and politicians in the EU has shown that such efforts can be successful. Many arguments exist to organize the clinical care for women with advanced endometriosis in centers of excellence, but continuing education of primary-care physicians also remains a priority. New molecular techniques are resulting in new hormonal and nonhormonal targets for the noninvasive diagnosis and treatment of endometriosis. A future diagnostic serum assay might contain various elements from inflammatory serum markers to genetic/microarray/proteomics markers, owing to the multifactorial features of endometriosis.
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Affiliation(s)
- Peter Simsa
- Leuven University, Leuven University Fertility Centre, Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Leuven, Belgium.
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Simoens S, Hummelshoj L, D'Hooghe T. Endometriosis: cost estimates and methodological perspective. Hum Reprod Update 2007; 13:395-404. [PMID: 17584822 DOI: 10.1093/humupd/dmm010] [Citation(s) in RCA: 259] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This article aims to provide a systematic review of estimates and methodology of studies quantifying the costs of endometriosis. Included studies were cost-of-illness analyses quantifying the economic impact of endometriosis and cost analyses calculating diagnostic and treatment costs of endometriosis. Annual healthcare costs and costs of productivity loss associated with endometriosis have been estimated at $2801 and $1023 per patient, respectively. Extrapolating these findings to the US population, this study calculated that annual costs of endometriosis attained $22 billion in 2002 assuming a 10% prevalence rate among women of reproductive age. These costs are considerably higher than those related to Crohn's disease or to migraine. To date, it is not possible to determine whether a medical approach is less expensive than a surgical approach to treating endometriosis in patients presenting with chronic pelvic pain. Evidence of endometriosis costs in infertile patients is largely lacking. Cost estimates were biased due to the absence of a control group of patients without endometriosis, inadequate consideration of endometriosis recurrence and restricted scope of costs. There is a need for more and better-designed studies that carry out longitudinal analyses of patients until the cessation of their symptoms or that model the chronic nature of endometriosis.
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Affiliation(s)
- S Simoens
- Research Centre for Pharmaceutical Care and Pharmaco-Economics, Faculty of Pharmaceutical Sciences, Katholieke Universiteit Leuven, Onderwijs en Navorsing 2, PO Box 521, Herestraat 49, 3000 Leuven, Belgium.
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Mihalyi A, Simsa P, Mutinda KC, Meuleman C, Mwenda JM, D'Hooghe TM. Emerging drugs in endometriosis. Expert Opin Emerg Drugs 2006; 11:503-24. [PMID: 16939388 DOI: 10.1517/14728214.11.3.503] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Endometriosis is a common, estrogen-dependent, gynaecological disease, defined as the presence of endometrial-like tissue outside the uterus. Although several medications are used for treatment of the disease, they are associated with high recurrence rates, considerable side effects and limited duration of application. Due to these limitations and to the impact of endometriosis on the quality of life of affected women, their environment and the society, there is a great need for new drugs able to abolish endometriosis and its symptoms. Studies in recent years investigating the (patho)physiological mechanisms involved in disease aetiology have fostered the development of novel therapeutic concepts for endometriosis, by targeting the hypothalamic-pituitary-gonadal axis, by selective modulation of estrogenic and progestogenic pathways, by inhibiting angiogenesis or by interfering with inflammatory and immunological factors. This article presents a brief summary of the currently available medications and an overview regarding the development of some of the most interesting and/or most promising novel drug candidates for endometriosis.
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Affiliation(s)
- Attila Mihalyi
- Leuven University Fertility Centre, Department of Obstetrics & Gynaecology, University Hospitals Gasthuisberg, Herestraat 49B-3000 Leuven, Belgium
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