bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of preoperative elevated serum creatinine on long-term outcome of patients undergoing aortic repair with Stanford A dissection: a retrospective matched pair analysis
Authors: Eghbalzadeh Kaveh , Sabashnikov Anton , Weber Carolyn , Zeriouh Mohamed , Djordjevic Ilija , Merkle Julia , Shostak Olga , Saenko Sergey , Majd Payman , Liakopoulos Oliver , Rahmanian Parwis B. , Madershahian Navid , Choi Yeong-Hoon , Kuhn-Régnier Ferdinand , Wippermann Jens , Wahlers Thorsten
Published: September 2018

Background:

The aim of the present study was to determine whether raised preoperative serum creatinine affected the long-term outcome in patients undergoing surgical aortic repair for Stanford A acute aortic dissection (AAD).

Methods:

A total of 240 patients diagnosed with Stanford A AAD underwent surgical repair from January 2006 to April 2015. A propensity score matching was applied, resulting in 73 pairs consisting of one group with normal and one group with preoperative elevated creatinine levels. The cohorts were well balanced for baseline and preoperative clinical characteristics. Both groups were compared regarding their early postoperative variables, as well as estimated survival with up to 9-year follow up. Also, the impact of acute postoperative kidney injury and its severity on long-term survival was analyzed.

Results:

The proportion of patients suffering Stanford A AAD with raised creatinine levels was 31.3% ( n = 75). After propensity matching, there were no statistically significant differences regarding demographics, comorbidities, preoperative baseline and clinical characteristics. Postoperatively matched patients with elevated creatinine had longer intensive care unit ( p < 0.001) and total hospital stay ( p = 0.002), prolonged intubation times ( p = 0.014), higher need for hemofiltration ( p < 0.001), higher incidence of temporary neurological disorders ( p = 0.16), infection ( p = 0.005), and trend toward higher incidence of sepsis ( p = 0.097). However, there were no significant differences regarding 30-day mortality (20.5% versus 20.5%, p = 1.000) and long-term overall survival. Further, neither the incidence nor the different stages of acute kidney injury according to the Acute Kidney Injury Network showed any statistically significant differences in terms of long-term survival for both groups [log rank p = 0.636, Breslow (generalized Wilcoxon) p = 0.470, Tarone–Ware p = 0.558].

Conclusions:

Patients with elevated creatinine levels undergoing surgical repair for Stanford A AAD demonstrate higher rate of early postoperative complications. However, 30-day mortality and long-term survival in this patient cohort is not significantly impaired.
Perceptions of preparedness and intimate partner violence screening practices amongst hand therapists
Authors: Sivagurunathan Marudan , Packham Tara , Dimopoulos Lindsay , Murray Robyn , Madden Kim , Bhandari Mohit , MacDermid Joy C
Published: September 2018

Introduction

While hand injuries are reported as common sequelae of intimate partner violence, there is limited attention to hand therapist’s screening practices and perceived preparedness to deal with intimate partner violence in hand therapy setting. The primary aim of the current study is to describe the intimate partner violence training, knowledge of referrals, perceived preparedness, and screening practices of hand therapists.

Methods

An online survey investigating the perceptions regarding issues pertaining to intimate partner violence was completed by a sample of 189 hand therapists. Areas addressed included intimate partner violence training, perceived preparedness to deal with intimate partner violence-related responsibilities, screening practices and knowledge of resources for referrals. Data were analyzed using descriptive statistics while comparisons of groups used non-parametric analyses to evaluate the impact of training, intimate partner violence experience and knowledge of referrals on preparedness and screening practices.

Results

Hand therapists reported low perceived preparedness scores (median = 2.1/7) and screening practices. The majority (73%) of hand therapists indicated having received no intimate partner violence training. Additionally, intimate partner violence training, intimate partner violence experience, and knowledge of referrals had significant impact on hand therapists’ perceived preparedness and screening practices.

Conclusion

Training is significantly related to perceived preparedness and screening practices. Intimate partner violence screening may result in clients receiving appropriate referrals leading to improved quality of life. Future research should seek out ideal methods for offering intimate partner violence training for hand therapists so that they can meet the needs of clients with intimate partner violence experience.
Early College Credit Programs Positively Impact Student Success
Authors: Burns Kathleen , Ellegood William A. , Bernard Bracy Jill M. , Duncan Mimi , Sweeney Donald C.
Published: September 2018

This article presents an exploratory case study examining the effects of different early college credit programs on time to baccalaureate degree attainment at a metropolitan Midwestern United States land grant university. We developed a Cox proportional hazards regression model of a students’ time to degree attainment as a function of their participation in different early college credit programs while controlling for each student’s preenrollment grade point average (GPA), American College Test (ACT) test score, gender, part or full-time enrollment status, ethnicity, and seasonal (Fall, Spring, or Summer) semester of initial matriculation. The most noteworthy finding of our analysis was that each early college credit program appeared to have a positive and statistically significant impact on reducing the time to degree attainment with all other factors being equal. However, the mechanisms through which these programs affect the time to degree attainment appeared to be differentiated by program.
The use of high-dose intrathecal diamorphine in laparoscopic bariatric surgery: a single-centre retrospective cohort study
Authors: Wojcikiewicz Thomas G , Jeans John , Karmali Anil , Nkhoma Jackline , Cousins Jonathan , Kynoch Michael
Published: September 2018

Introduction:

The use of intrathecal diamorphine is not commonplace in laparoscopic bariatric surgery. At our institution, a major UK bariatric centre, high-dose intrathecal diamorphine is routinely utilised.

Methods:

Data were analysed retrospectively. Fifty-three patients who had a spinal anaesthetic were matched against age, sex, body mass index and surgical procedure type to generate controls. Pain scores were recorded in the post-anaesthetic care unit on arrival, after 1 hour and on discharge to the ward. Post-operative nausea and vomiting; post-operative hypertension; pruritus; 24-hour morphine consumption and length of stay were measured.

Results:

Pain scores were better in the spinal anaesthetic group in all measured categories (p = 0.033, p < 0.01, p < 0.01); post-operative nausea and vomiting was less common in the spinal anaesthetic group (p < 0.01); post-operative hypertension was less common in the spinal anaesthetic group (p = 0.25); pruritus was more common in the spinal anaesthetic group (p < 0.01); morphine consumption was less common in the spinal anaesthetic group (p = 0.037). Length of hospital stay was reduced by 12.4 hours (p = 0.025).

Conclusion:

We propose that this is a practical and safe technique to adopt. A randomised-control trial will need to be conducted in order to find the most efficacious volume of local anaesthetic and dose of diamorphine
Historicizing the category of “religion” in sociological theories: Max Weber and Emile Durkheim
Authors: Horii Mitsutoshi
Published: September 2018

The generic notion of “religion” and its conceptual demarcation from “the secular” have been critically examined by a number of scholars from the “critical religion” perspective. The interrogation of the term “religion,” and other related terms, questions modern formations of knowledge and power in general. This paper constitutes part of the project which examines norms and imperatives which govern sociological discourse on religion. Max Weber and Emile Durkheim are particularly significant figures in sociology of religion. The aim of this paper is to historicize the category “religion” (and its opposition “the secular”) employed by Weber and Durkheim, in the specific social context of Germany and France in the late 19th and early 20th centuries. It hopes to contribute to a greater understanding of the ideological foundation of sociological theories of religion.
Audit of computed tomography brain findings in HIV-infected patients with space occupying infective lesions at a regional level hospital in KwaZulu-Natal
Authors: Pillay Somasundram , Ramchandre Kaveer
Published: September 2018

Background:

With the increased prevalence of HIV pandemic, more focus is placed on pathology involving the central nervous system secondary to HIV infection. Medical computerised tomography scans have become an integral investigation at a regional hospital level.

Objective:

To provide a description of central nervous system space occupying infective lesion found within this cohort of patients.

Setting:

Edendale Hospital, Pietermaritzburg, KwaZulu-Natal.

Methods:

This was a retrospective study in which the charts of all HIV-infected medical patients with findings of a space occupying infective lesion on computerised tomography brain seen for the time period 1 January 2015 up to and including 31 December 2015 were analysed. A total of 110 patient files were evaluated.

Results:

Most patients were in the third to fourth decade of life with mean cluster of differentiation 4 of 125 cells/mm3. A differential comprising toxoplasmosis or tuberculoma (80.9%) was the leading aetiology described. Most frequent clinical features in these patients included seizures (41.8%), confusion or altered mental state (38.2%), headaches (33.6%), hemiparesis (48.2%) and cranial nerve abnormality (22.7%). The most common central nervous system sites involved were, in order of decreasing prevalence was parietal, basal ganglia, frontal cortex (31.8% vs 31.8% vs 26.4%, respectively). Early initiation of co-trimoxazole and anti-tuberculosis treatment yielded better outcomes compared to the group who received delayed or no treatment with p-values (Pearson’s χ2) of 0.0002 and <0.0001, respectively.

Conclusion:

Computerised tomography scans to detect space-occupying infective lesion of the brain are invaluable for rapid diagnosis and to reduce morbidity and mortality.
Illness perception of adolescents with well-controlled type 1 diabetes mellitus
Authors: Jonker Deborah , Deacon Elmari , van Rensburg Esme , Segal David
Published: September 2018

In this study, to explore the illness perceptions of adolescents with well-controlled type 1 diabetes mellitus in South Africa, semi-structured interviews were conducted with nine, purposively selected adolescents (mean = 13.9 years; median = 12). Themes that emerged from the thematic analysis include the following: accepting diabetes and the diabetes care plan as part of their lives; viewing diabetes as manageable and as their responsibility; and the important role of gaining information on diabetes and diabetes management. These perceptions contributed to adherence to diabetes care plans and should be explored and developed among adolescents with type 1 diabetes mellitus to improve their diabetes management.
Emerging Adults’ Psychopathology in Seven Countries: The Impact of Identity-Related Risk Factors
Authors: Persike Malte , Seiffge-Krenke Inge , Cok Figen , Głogowska Karolina , Pavlopoulos Vassilis , Tantaros Spyridon , Perchec Cyrille , Rohail Iffat , Saravia Juan Carlos
Published: September 2018

The impact of identity-related risk factors on psychopathology was analyzed in 2,113 emerging adults ( M = 22.0 years; 66% female) from France, Germany, Turkey, Greece, Peru, Pakistan, and Poland. Identity stress, coping with identity stress, maternal parenting (support, psychological control, and anxious rearing), and psychopathology (internalizing, externalizing, and total symptomatology) were assessed. After partialing out the influence of stress, coping, and perceived maternal behavior, country did no longer exert a significant effect on symptom scores. The effect for gender remained, as did an interaction between country and gender. Rather unexpected, on average, males reported higher internalizing symptomatology scores than females. Potential causes for the higher scores of males are therefore discussed. Partialing out covariates resulted in a clearer picture of country-specific and gender-dependent effects on psychopathology, which is helpful in designing interventions.
Turning From Parents: Psychological Distancing and Attachment-Related Changes in Regret for Immediate Contact in Emerging Adulthood
Authors: Dykas Matthew J. , Siskind Demi G.
Published: September 2018

This longitudinal study examined how emerging adults psychologically distance themselves from parents. Every week during their first semester at college, participants ( n = 71, Mage= 18 years [ SD = 0.48]) read hypothetical vignettes describing emotionally salient situations they could encounter at college. Participants then provided information about whether they would regret not being in immediate contact with parents versus peers when dealing with the aftermath of these situations. Results suggested that participants were separating themselves from parents in a dynamic manner over time, which was revealed in varying levels of regret for not possibly being in immediate contact with parents following emotional events. Moreover, compared to participants with negative representational models of parents, participants with positive models reported more consistent patterns of regret for not having immediate parental contact. This study provides new insights into normative attachment dynamics beyond childhood and how emerging adults reorganize their attachment hierarchies.
Is Bangladesh Rolling towards Debt Stress? An Exploration of Debt Sustainability in the Context of Recent External Financial Flows
Authors: Bhattacharya Debapriya , Ashraf Zeeshan
Published: September 2018

This article examines the sustainability of public debt in Bangladesh under alternative future scenarios based on simulation exercises for the period of FY2017 to FY2026. It adopts the debt-stabilizing primary balance approach (DPSBA) and International Monetary Fund/World Bank Debt Sustainability Framework (DSF). The findings of the former indicate that Bangladesh will be able to service its increasing public debt as long as its economic growth rate remains higher than the real interest rate payable on debt. Public debt also appears to be sustainable according to variables tested under the DSF. However, findings indicate that Bangladesh has been and would continue allocating an increasing share of its revenue to external debt repayment, creating a trade-off with investment in growth-oriented sectors.

JEL Classification: H63, H68, H69, H81, G28
Decreased Concentrations of AMH in Follicular Fluid of Women with Endometriosis: A Hypothetical New Marker of Oocyte Quality
Authors: Garcia-Velasco Juan A. , Motta Laura , Rodriguez Sara , Toribio Monica , Martinez-Salazar Javier , Pacheco Alberto
Published: September 2018

Introduction

Anti-müllerian hormone (AMH) has been recently introduced as a new marker of ovarian reserve with a high sensitivity and with the added value of being independent of cycle day. Some authors have claimed that it may also provide information regarding oocyte quality. As endometriosis is a disease that mainly affects the ovary and thus, egg quality, we decided to evaluate AMH follicular fluid concentrations in three clinical groups: a) women with endometriosis and a visible endometrioma at ultrasound in one of the ovaries, b) same women with endometrioma-free contralateral ovary, and c) women without endometriosis.

Material and Methods

From August to December 2007, 28 women undergoing an IVF/ICSI cycle in whom an endometrioma > 2cm was clearly visible at ultrasound in one of the ovaries and not in the other, and 28 fertile egg donors as controls entered the study. Follicular fluid from the largest follicle of each ovary (with endometrioma and without endometrioma) was individually collected prior to the rest of the follicular aspiration at the time of egg retrieval, and similarly in the control group. After cumulus identification and short centrifugation to remove cells, fluids were stored at -80°C until assayed. AMH was evaluated by a commercially available ELISA. Kolmorov-Smirnov test was performed to test for normality, as well as a one-way ANOVA with Tukey test to evaluate differences among groups. Significance was set at 0.05.

Results

AMH follicular fluid concentrations were significantly lower in women with endometriosis versus control (4.5 ± 2.6 vs 6.2 ± 3.0 ng/mL, p=0.02). Interestingly, when the three groups were evaluated individually, the concentration of AMH in follicular fluid obtained from the ovaries where a large endometrioma was present was significantly lower than in the other two groups – a) 4.1 ± 2.7 ng/mL in the ovaries with the endometrioma, b) 4.9 ± 2.6 ng/mL in the contralateral ovary in the same patients, and c) 6.2 ± 3.0 ng/mL in control patients; (p=0.039).

Conclusions

AMH concentration in follicular fluid is diminished in women with endometriosis. The presence of the endometrioma itself may reduce even further AMH concentration in the surrounding follicles. These results may reflect oocyte quality and could be useful when counselling patients regarding their reproductive outcome.
Alterations in the Calcitonin and Calcitonin Modulated Proteins, E-Cadherin and the Enzyme Tissue Transglutaminase II during the Window of Implantation in a Baboon Model of Endometriosis
Authors: Jackson Kevin S. , Hastings Julie M. , Mavroganis Patricia A. , Bagchi Indrani , Fazleabas Asgerally T.
Published: September 2018

Endometriosis is a gynecological condition associated with infertility. We have previously demonstrated dysregulation of several molecular markers of uterine receptivity in a baboon model of induced endometriosis. Specifically, reduced levels of endometrial progesterone receptor (PR) and progesterone (P)-regulated genes, HOXA10 and FKBP52 were observed during the window of uterine receptivity in baboons with endometriosis, suggesting that this disease results in the development of an endometrial P resistance. In this study calcitonin (CALC) and CALC-modulated proteins, E-cadherin (E-Cad) and tissue Transglutaminase (tTgase-2) were evaluated in the eutopic endometrium of endometriotic animals throughout disease progression. Endometriosis was induced in normal cycling baboons by intraperitoneal inoculation of menstrual endometrium. Eutopic and ectopic endometrium was harvested consecutively from each animal at 1, 6 and 15 months of disease, during the window of receptivity. Control eutopic endometrium was similarly harvested from disease free baboons. Immunohistochemistry for CALC, E-cad and tTgase-2, was performed on formalin fixed tissues embedded in paraffin following antigen retrieval. CALC immunostaining was localized in the glandular and luminal epithelium as well as in the uterine stromal cells in disease free eutopic endometrium. However, in the eutopic endometrium from endometriotic baboons there was a reduction of CALC in the luminal and glandular epithelium as well as a reduction in the stromal cells. In the ectopic endometrium there was no immunostaining for the CALC protein. E-cad protein was immunolocalized primarily to the glandular epithelium of both control and endometriotic eutopic endometria. However, E-cad immunostaining was markedly increased in endometria of baboons with disease. The immunostaining was weak for E-Cad in the ectopic endometrial lesions regardless of color or location in the peritoneum. Strong immunostaining for tTgase-2 was observed in the stroma in disease free controls. Endometria from animals with endometriosis demonstrated a progressive loss of tTgase-2 immunostaining in the stroma throughout the time course of disease. There was strong immunostaining in the stroma of the ectopic endometrial collected throughout disease progression. The maintained levels of E-cad and reduced levels of tTgase-2 correlate with the reduction of CALC in eutopic endometria of baboons with endometriosis. These data suggest that the reduced fecundity associated with endometriosis is mediated, in part, by a progesterone resistance that affects not only genes directly regulated by progesterone, but those that are down-stream targets of progesterone regulated genes.
Endoscopic Laser Ablation of Ureteral Endometriosis
Authors: Djalali Schima , Peter Melanie , Wieser Fritz , Jocham Dieter , Diedrich Klaus , Hornung Daniela
Published: September 2018

A 37-year-old female with a known history of endometriosis presented with progressive dysmenorrhea and dyspareunia, and complaints of hematuria. After cystoscopy and bilateral retrograde pyelography was performed, distal stenosis in the right ureter without ureteral obstruction and renal impairment was diagnosed. Abdominal hysterectomy and excision of peritoneal endometriotic lesions on the surface of the right ureter and bladder wall was done preserving the ovaries. The intrinsic endometriotic lesion in the right ureter was detected ureteroscopically and histologically and treated successfully by holmium laser ablation avoiding ureteral resection and re-implantation.
Ovarian Endometrioma Associated with Very High Serum CA-125 Levels
Authors: Güven Davut , Kılıco Ismail , Yavuz Erhan , Üstün Cazip , Koçak Idris
Published: September 2018

The magnitude of the elevation is important and levels > 200 U/ml are potentially associated with ovarian malignancies, whereas slight increases in levels were associated with benign gynecologic conditions. However, serum CA-125 levels > 1000 U/ml have also been reported in patients with endometriosis. Herein, the authors report an additional case of high levels of CA-125 in large unruptured endometrioma. We present a patient with moderate sized bilateral ovarian endometrioma who was undergoing laparotomy and who had CA-125 levels of 3782 U/mL. Our case further emphasizes that very high levels of CA-125 are not always associated with malignant disease and no critical cutoff value for CA-125 is diagnostic of malignancy.
Diagnosis and Management of Bladder Endometriosis
Authors: Ferrero Simone , Bogliolo Stefano , Menada Mario Valenzano , Ragni Nicola , Biscaldi Ennio , Camerini Giovanni , Remorgida Valentino
Published: September 2018

Bladder endometriosis is defined as full-thickness infiltration of the detrusor; small sub-peritoneal implants and small nodules of the vesicouterine fold cannot be considered to be bladder endometriosis. In women with endometriosis, urinary tract involvement is rare (1% to 5% of cases) but the bladder is affected in 80% to 84% of these cases. Symptoms of bladder endometriosis are various and not specific: besides pain symptoms, patients may complain of urinary frequency, urgency, urge incontinence, dysuria, and hematuria. Although bladder endometriosis may be suspected at vaginal examination, the preoperative diagnosis is based on transvaginal ultrasonography and magnetic resonance imaging. Medical therapies may temporarily reduce the severity of symptoms related to the presence of vesical endometriosis; however, the symptoms may persist in cases of large bladder nodules or may recur after cessation of therapy. Surgery represents the gold standard for treatment of bladder endometriosis and laparoscopy should be preferred to laparotomy. Excision of bladder nodules may be performed either by partial-thickness resection or by partial cystectomy according to the size and depth of the infiltration of the lesions in the bladder wall. Persistent improvement of symptoms has been demonstrated at long-term follow-up, particularly when the lesions involve the vesical dome.
Surface-Enhanced Laser Desorption/Ionization Mass Spectrometry of Peritoneal Fluid Identifies Potential Biomarkers for Endometriosis
Authors: Wölfler Monika M. , Henkel Corinna , Hornung Daniela , Knüchel Ruth , Rath Werner , Maass Nicolai , Schwamborn Kristina
Published: September 2018

Purpose

Several markers for diagnosis of endometriosis that have been tested in clinical approaches so far lack in both sensitivity and specificity. Therefore, it is conceivable that a need exists to perform a cluster analysis in which the attributes of different markers are considered.

Methods

In this study, protein pattern profiling by surface-enhanced laser desorption/ionization time of flight (SELDI-TOF) mass spectrometry was performed to reveal differentially expressed pathognomonic proteins for endometriosis in peritoneal fluid samples of 106 symptomatic patients.

Results

At laparoscopy, 46 out of 106 (43.4%) patients exhibited endometriosis and 60 (56.6%) were proven disease-free. Using anionic affinity surfaces and a genetic algorithm for data analysis, 16 significantly different protein peaks were identified that allow for the prediction of endometriosis, with an overall recognition capability of 85.2%, exhibiting a sensitivity of 70.6% and a specificity of 80.8%.

Conclusions

Although lacking in sensitivity, this study provides highly significant information about differentially regulated proteins in endometriosis which might play a key role in the pathogenesis of this disease.
Pain Symptoms and Peritoneal Fluid Cytokine and Marker Concentrations in Women with and without Endometriosis
Authors: Bersinger Nick A. , McKinnon Brett , Kuhn Annette , Santi Alessandro , Mueller Michael D.
Published: September 2018

Purpose

Endometriosis is not only associated with infertility, it is also a common cause of pain in women, leading to work absenteeism and a reduced quality of life. The objective of this study was to confirm the increased peritoneal fluid (PF) concentration of several cytokines in endometriosis patients, to investigate their association with pain levels, and to identify new biological markers in the PF which are neurostimulatory and thus responsible for the appearance and severity of different types of pain.

Methods

Our sample group included 111 patients with histologically confirmed endometriosis and 47 controls undergoing laparoscopy for reasons of abdominal pain or infertility. They rated their pain during menstruation, during sexual intercourse and general lower abdominal pain prior to undergoing surgery in our clinic using a visual analogue scale. During laparoscopy, PF was aspirated. Marker cytokine concentrations were measured by immunoassay and correlated to the Revised American Fertility Society (rAFS) stage of endometriosis and to the pain level using non-parametric methods.

Results

Differences were found between the correlations of the peritoneal fluid levels of many cytokines with dysmenorrhea or lower abdominal pain, and with the presence of severe endometriosis (rAFS III+IV). Glycodelin and osteoprotegerin (OPG) show the strongest associations with menstrual pain, while IL-8, MCP-1 and OPG were correlated to the stage of endometriosis. Low density cytokine protein arrays did not contribute to finding new markers for endometriosis and pain.

Conclusions

These findings illustrate the large variation of cytokine levels between patients. Glycodelin, IL-8 and OPG are the most likely targets for further investigations towards their future clinical use.
Adolescent Physical Activity and Endometriosis Risk
Authors: Vitonis Allison F. , Maruti Sonia S. , Hankinson Susan E. , Hornstein Mark D. , Missmer Stacey A.
Published: September 2018

Background

In the one study examining the relationship, adolescent physical activity was not associated with risk for endometriosis. Case-control studies have shown 40–80% reductions in risk for adult activity, while only an 11% reduction in endometriosis risk was observed in a recent prospective analysis.

Methods

Using data collected from the Nurses’ Health Study II, a prospective cohort study of premenopausal US nurses that began in 1989, we have attempted to clarify this relation. Data are updated every 2 yrs with follow-up for these analyses through to 2001. Women reported the average amount of time per week spent in moderate and strenuous recreational activity during three age periods: ages 12–13, ages 14–17, and ages 18–22. A metabolic equivalent (MET) score was assigned to each activity and these were summed to estimate total activity.

Results

During 637,747 person-years of follow-up, 1,481 cases of laparoscopically confirmed endometriosis were reported among women with no past infertility. After adjusting for age, calendar time, birth weight, age at menarche, parity, oral contraceptive use, and body mass index (BMI), we observed a 16% increase in the risk for endometriosis comparing the greatest amount of activity (≥80 MET-h/wk) with the least (<20 MET-h/wk) during ages 12–13 (RR=1.16, 95% CI=0.98–1.37, p-value test for trend=0.02), and no associations for ages 14–17 or ages 18–22. In analyses of the individual activity types within each time period, only strenuous activity during ages 12–13 was associated with endometriosis.

Conclusions

We did not find evidence of a beneficial association between adolescent physical activity and laparoscopically confirmed endometriosis, but in fact found a small increase in risk.
Creating Solutions in Endometriosis: Global Collaboration through the World Endometriosis Research Foundation
Authors: Adamson G. David , Kennedy Stephen , Hummelshoj Lone
Published: September 2018

Endometriosis affects an estimated 176 million women worldwide during the prime years of their lives. Yet many clinical questions remain unanswered, treatment failures are common, and there is little investment in investigating disease mechanisms. The World Endometriosis Research Foundation (WERF) has been created to provide a global platform where resources and intelligence are pooled to enable international collaboration in order to find answers so that treatments for endometriosis can be improved and prevention can become reality in future generations of women. WERF is now working with 30 centres in 19 countries conducting prospective studies investigating the impact of endometriosis, disease predictability, and personal and societal cost. (Journal of Endometriosis 2010; 2: 3–6)
Peculiar Aspects of Endometriosis in Adolescents
Authors: Candiani Massimo , Ronzoni Stefania , Gentilini Davide , Tandoi Iacopo , Somigliana Edgardo , Viganò Paola
Published: September 2018

Although documented rates of endometriosis in adolescent patients undergoing laparoscopy for chronic pelvic pain range from about 25% to 45%, adolescent endometriosis has received limited attention in terms of research activity and follow-up studies. In this manuscript, distinctive characteristics of adolescent and young endometriosis have been considered in order to define pathogenetic and scientific concepts that might be useful in clarifying some aspects of the adult disease as well. Some highlights relative to the cellular origin of the disease can be derived from reported cases before menarche, from the appearance of endometriotic lesions in teenagers (mostly stage I-II endometriosis), and from the relative infrequency of ovarian endometriotic cysts in this population. Adolescents and young patients might be also particularly useful for studying the natural course of the disease. To this end, clinical manifestations and recurrence patterns of the disease in adolescent patients need to be elucidated. Differences in clinical aspects of the disease between the adult and young populations are presented. Risk of recurrence and potential risk factors involved in the reappearance of the disease in teenagers are completely unknown. (Journal of Endometriosis 2010; 2: 19–25)
Sentinel Lymph Node Labeling of Patients with Deep Infiltrating Rectovaginal Endometriosis – Does this Make Sense?
Authors: Riedlinger Wolfram F. J. , Weichbrodt Miriam , Gericke Jessica , Gericke Christine , Schneider Achim , Köhler Christhard , Mechsner Sylvia
Published: September 2018

Purpose

Deep infiltrating endometriosis is a chronic disease of largely unresolved pathogenesis. Lymphatic dissemination of endometriotic cells has been shown in incidentally removed mesorectal lymph nodes (ILNs) and in pelvic sentinel lymph nodes (SLNs) but its significance is unknown. To evaluate this observation further, we compared occurrences and morphology of endometriotic lesions (EM-lesions) within pelvic SLNs with those within ILN.

Methods

From 18 patients, 58 pelvic SLNs and from additional 23 patients 105 ILNs, found in the resection specimens, were excised. All lymph nodes were examined for possible endometriotic lesions. Detection of endometriotic lesions were performed by immunohistochemical analysis of possible expression of estrogen and progesterone-receptors as well as CD10 and cytokeratin. Furthermore, two dimensional sizes of endometriotic lesions were measured.

Results

Endometriotic lesions were found in 14 patients: in 6 patients of the SLN-group (33%) and in 8 patients of the group of incidentally removed lymph nodes (28%). EM-lesions of the SLN-group were significantly larger than those of incidentally removed regional LN (size A: p= 0.014; size B: p=0.006).

Conclusion

Detection of endometriotic lesions in SLNs and in ILNs has demonstrated lymphatic dissemination of endometriosis. In comparison to the incidentally excised lymph nodes of patients with rectovaginal endometriosis, the sentinel lymph node concept is much more suitable for detection of potentially affected lymph nodes. Therefore, we postulate use of this system in future studies to evaluate the clinical significance of lymphatic dissemination of endometriotic cells. (Journal of Endometriosis 2010; 2: 33–40)
Ultrasonographic Aspects of Endometriosis
Authors: Ferreira Márcia Cristina , Carneiro Márcia Mendonça
Published: September 2018

Endometriosis is a chronic disease characterized by ectopic endometrial tissue that can cause pelvic pain and infertility. Almost 10% of reproductive age women have endometriosis. Definitive diagnosis requires surgical intervention and histological confirmation is advisable. As a result, there is a long delay between onset of symptoms and diagnosis. Ultrasound has been used for a long time to evaluate the pelvis and locate endometriotic lesions. Ovarian endometriotic cysts represent the classical form of endometriosis that can be sonographically seen and are correctly diagnosed by transvaginal ultrasound (TVUS) in almost 90% of the cases. Recently, TVUS has been reported as an excellent tool to diagnose deeply infiltrating lesions in different locations (rectovaginal septum, retrocervical and paracervical areas, rectum and sigmoid as well as vesical wall) with good accuracy. Present evidence suggest that TVUS should be the first-line exam in the workup of patients with suspected endometriosis.
Innate Immune Cells: Gatekeepers of Endometriotic Lesions Growth and Vascularization
Authors: Capobianco Annalisa , Cottone Lucia , Monno Antonella , Ferrari Stefano , Panina-Bordignon Paola , Manfredi Angelo A. , Rovere-Querini Patrizia
Published: September 2018

Infiltration by inflammatory leukocytes is a hallmark of all forms of endometriosis. Conversely, the innate immune system plays a key role in regulating events such as cell adhesion, migration, survival and neoangiogenesis of transformed or ectopic tissue. All these features are involved, and possibly required, in the development of endometriotic lesions. Recent data suggest that infiltrating leukocytes are not a mere epiphenomenon but represent an actual requirement for the development of the disease. In this scenario, the functional plasticity of infiltrating macrophages is a key event in the origin and maintenance of endometriotic lesions: the erroneous polarization of macrophages towards cells sustaining angiogenesis and tissue remodeling represents a potential target for novel molecular therapies.
Accuracy of Clinical Signs and Symptoms in the Diagnosis of Endometriosis
Authors: Carneiro Márcia Mendonça , De Sousa Filogônio Ivone Dirk , Costa Luciana Maria Pyramo , De Ávila Ivete , Ferreira Márcia Cristina
Published: September 2018

Endometriosis is a benign gynecological disease afffecting about 10% of all reproductive-age women which can significantly impair quality of life. As the clinical presentation is variable, with some women experiencing several severe symptoms while others remain asymptomatic, there are no sufficiently sensitive and specific signs and symptoms or diagnostic tests for the clinical diagnosis of endometriosis. The aim of this article is to review the current literature regarding the accuracy of clinical signs and symptoms in the diagnosis of endometriosis. Besides the wide spectrum of symptoms, an overlap with other causes of pelvic pain such as irritable bowel syndrome and pelvic inflammatory disease is also reported. Moreover, most of the signs and symptoms of endometriosis do not correlate with the severity (staging) of the disease. Knowledge of the characteristics of pelvic pain symptoms is important in the preoperative assessment of patients with suspected endometriosis. Pelvic tenderness, a fixed retroverted uterus, tender uterosacral ligaments or enlarged ovaries identified during a standard pelvic exam are suggestive of endometriosis. Clinical examination during menstruation apparently improves diagnostic yield. Although the clinical diagnosis of endometriosis presents low sensitivity and specificity, it should be thoroughly performed as it is the first fundamental step in the diagnostic workup. Clinical assessment helps to identify patients at high risk of endometriosis and selects those who need further testing in order to reduce diagnostic delay. Laparoscopy preferably performed in conjunction with histologic evaluation of excised lesions, however, still remains the gold standard for diagnosis as well as staging of endometriosis.
Endometriosis Index: A Software-Derived Score to Predict the Presence and Severity of the Disease
Authors: Fasciani Alessandro , Repetti Felice , Binda Gian Andrea , Puntoni Matteo , Meroni Mario Giuseppe , Bocci Guido
Published: September 2018

Objective

To develop a clinical index that will positively predict the presence of endometriosis.

Design

Prospective single-center observational study. Setting: A hospital-based institute.

Patients

120 patients affected by chronic pelvic pain, infertility or with clinical suspicion of endometriosis. Interventions: Electronic processing of clinical data with software-assistance at the end of each consultation and digital video recording of surgeries.

Main Outcome Measures

Endometriosis Index (EI), the score calculated using clinical parameters correlated with macroscopic/microscopic presence or absence of endometriosis.

Results

Endometriosis was staged and treated in 95 cases, the remaining 25 women presented benign pathology with no endometriosis. Patients with positive operative findings of endometriosis had a mean (± standard deviation) pre-operative EI score of 22 ± 12, while mean EI value of patients with no operative findings of endometriosis was 8 ± 6 (p 28 (75th percentile value) versus women with EI score ≤ 28; with EI score > 28 this noninvasive test was predictive of DIE with a sensitivity of 72.4% and a specificity of 90.1%.

Conclusions

These data suggest that a dedicated Endometriosis Index is effective in identifying patients who would benefit from early surgical management. We propose the use of this non-invasive tool to reduce the delay between the onset of symptoms and a surgical diagnosis of endometriosis.
Assessment of Oocyte and Embryo Quality in Women with Endometriosis
Authors: Matalliotakis Ioannis , Cakmak Hakan , Sakkas Denny , Matalliotaki Charikleia , Arici Aydin
Published: September 2018

Objective

The aim was to determine the number and the grade of oocyte-corona-cumulus complex (OCCC) and the most viable embryos for transfer in women with endometriosis compared to those with tubal factor infertility.

Study methods

Patients underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) at the Yale IVF program. The endometriosis group of 135 patients was monitored in 262 consecutive cycles. The controls consisted of 103 patients with tubal factor infertility undergoing 203 consecutive assisted reproductive technology (ART) cycles. All the patients underwent laparoscopy before IVF treatment. Response to gonadotropins, the oocyte and embryo grade, fertilization, cleavage, implantation, pregnancy, delivery and abortion rates were noted.

Results

Oocyte-corona-cumulus complex (OCCC), two-pronuclear (2PN) oocytes, and the grade 1 and 2 embryos on days 2 and 3 were lower in women with endometriosis compared to those with tubal factor infertility. Higher total gonadotropin requirements, fewer mature follicles, lower peak E2, a lower number of oocytes collected, and higher cancellation rates were found with the endometriosis group compared to controls. However, no differences were found in fertilization, cleavage, implantation, pregnancy, miscarriage, and delivery rates between the endometriosis and tubal factor groups.

Conclusions

Despite the lesser quality of oocytes and embryo grading and diminished ovarian reserve, the presence of endometriosis does not affect implantation and delivery rates in patients undergoing ART procedures.
Endometriosis: Diagnosis and Management
Authors: Leyland Nicholas , Casper Robert , Laberge Philippe , Singh Sukhbir S. , Allen Lisa , Arendas Kristina , Leyland Nicholas , Allaire Catherine , Awadalla Alaa , Best Carolyn , Contestabile Elizabeth , Dunn Sheila , Heywood Mark , Leroux Nathalie , Potestio Frank , Rittenberg David Allan , Singh Sukhbir S. , Soucy Renée , Wolfman Wendy Lynn , Senikas Vyta
Published: September 2018

Objective

To improve the understanding of endometriosis and to provide evidence-based guidelines for the diagnosis and management of endometriosis.

Outcomes

Outcomes evaluated include the impact of the medical and surgical management of endometriosis on women's experience of morbidity and infertility.

Methods

Members of the guideline committee were selected on the basis of individual expertise to represent a range of practical and academic experience in terms of both location in Canada and type of practice, as well as subspecialty expertise along with general gynaecology background. The committee reviewed all available evidence in the English and French medical literature and available data from a survey of Canadian women. Recommendations were established as consensus statements. The final document was reviewed and approved by the Executive and Council of the SOGC.

Results

This document provides a summary of up-to-date evidence regarding diagnosis, investigations, and medical and surgical management of endometriosis. The resulting recommendations may be adapted by individual health care workers when serving women with this condition.

Conclusions

Endometriosis is a common and sometimes debilitating condition for women of reproductive age. A multidisciplinary approach involving a combination of lifestyle modifications, medications, and allied health services should be used to limit the impact of this condition on activities of daily living and fertility. In some circumstances surgery is required to confirm the diagnosis and provide therapy to achieve the desired goal of pain relief or improved fecundity. Women who find an acceptable management strategy for this condition may have an improved quality of life or attain their goal of successful pregnancy.

Evidence

Medline and Cochrane databases were searched for articles in English and French on subjects related to endometriosis, pelvic pain, and infertility from January 1999 to October 2009 in order to prepare a Canadian consensus guideline on the management of endometriosis.

Values

The quality of evidence was rated with use of the criteria described by the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described by the Task Force. See Table 1.

Benefits, harms, and costs

Implementation of the guideline recommendations will improve the care of women with pain and infertility associated with endometriosis.
Brain-Derived Neurotrophic Factor in Plasma of Women with Endometriosis
Authors: Giannini Andrea , Bucci Fiorella , Luisi Stefano , Cela Vito , Pluchino Nicola , Merlini Sara , Casarosa Elena , Russo Marinella , Cubeddu Alessandra , Daino Diana , Artini Paolo G. , Genazzani Andrea R.
Published: September 2018

Purpose

Endometriosis is one of the most common benign gynecological diseases affecting women of reproductive age; it is characterized by the presence and growth of ectopic endometrial tissue outside the endometrial cavity. This complex disease is frequently associated with infertility and pelvic pain. Given the relationship and the apparent importance of the role that neurotrophins play in the reproductive system, and in particular brain-derived neurotrophic factor (BDNF) which is involved in both the central and peripheral pain pathways, we were interested in determining whether the presence of endometriosis is associated and correlated with plasma and follicular fluid variation of BDNF.

Methods

We determined BDNF level in plasma and in follicular fluid from infertile women with endometriosis and fertile women without the disease.

Results

BDNF plasma levels were significantly higher in endometriotic patients than in control women (p<0.001). After surgery this level decreased significantly (p<0.001), ranging within the values of control women in follicular phase. In follicular fluid, BDNF values were significantly lower in infertile women for endometriosis than in infertile women for male factors (p<0.001).

Conclusion

These data raise the possibility that neuroinflammatory reactions in endometriosis could have a neuroprotective effect and support the hypothesis that BDNF represents an important link in the networks of human homeostasis, thus providing an early marker for patients affected by endometriosis. Moreover, low BDNF levels in follicular fluid may refect an altered ovary production and may be a marker of poor oocyte quality and poor fertility in women suffering from endometriosis.
Predicting Pregnancy after Surgery for Pelvic Endometriosis: A Multivariate Analysis Based on Objective Clinical Data
Authors: Reis Fernando M. , Luisi Stefano , Calonaci Francesco , Carneiro Márcia M. , Razzi Sandro , Petraglia Felice
Published: September 2018

Background

Endometriosis is a common disorder in women of reproductive age and is a major cause of pelvic pain and infertility. Counseling women with endometriosis about their reproductive future remains a difficult task. Because many women are diagnosed with endometriosis before any attempt to conceive, they still are not considered infertile and therefore a thorough investigation of fertility parameters is not advisable at that time. The aim of the present study was to evaluate clinical factors that are promptly available upon diagnosis, to see which of them might predict a subsequent pregnancy in women with endometriosis.

Methods

Surgical and clinical data were obtained from 71 women who underwent laparoscopy for endometriosis in two tertiary medical centers and responded to a follow-up interview after an average of 18 months. Data were analyzed with multivariate logistic regression.

Results

The only independent predictors of becoming pregnant during the follow-up period were age (adjusted odds ratio for age >30 y=0.063, 95% confidence interval [CI] 0.015–0.262, p

Conclusions

While women reporting acyclic pelvic pain are less likely to achieve pregnancy after endometriosis surgery, age remains the only independent, strong predictor of time to pregnancy and of becoming pregnant.