Simultaneous Deep Endometriosis Affecting Abdominal Wall and Vermiform Appendix / Endometriosis Simultánea de Pared Abdominal y Apéndice Vermicular

SUMMARY: Endometriosis, defined as the presence of endometrial glands and stroma outside the uterine cavity, is a chronic inflammatory condition that affects between 8 % and 44 % of women of reproductive age. Occasionally it presents as a sensitive mass in the abdominal wall, in relation to a surgical scar. On the other hand, in the most severe stage of endometriosis, intestinal involvement is common, and endometriotic disease of the appendix may be present even in appendices with macroscopically normal appearance. Simultaneous affectation of both locations is very rare. Nevertheless, treatment of choice is the excision of both lesions with safety margins. The aim of this manuscript was to report a case of simultaneous deep endometriosis affecting the total abdominal wall and vermiform appendix, resected in a single surgical procedure, which subsequently required abdominal wall repair with mesh plasty. Since desmoid tumors and endometriosis share similar clinical signs and unspecific imaging exams, both options should be considered in case of abdominal wall mass in female patients of childbearing age, especially if they have a history of uterine-related surgery.

La endometriosis se define como la presencia de glándulas endometriales y estroma fuera del útero. Es una afección crónica que afecta entre el 8 % y el 44 % de las mujeres en edad reproductiva. Ocasionalmente se presenta como una masa sensible en la pared abdominal, en relación con una cicatriz quirúrgica. Por otro lado, en su estadio más grave de la endometriosis, la afectación intestinal es común y puede afectar al apéndice, pudiendo estar presente incluso en apéndices de apariencia macroscópicamente normal. La afectación de ambas localizaciones simultáneamente es muy infrecuente. Sin embargo, el tratamiento de ambas lesiones es su exéresis quirúrgica con márgenes de seguridad. El objetivo de este manuscrito fue reportar un caso de endometriosis profunda simultánea que afectaba la pared abdominal total y el apéndice vermiforme, las que fueron resecadas en un solo tiempo quirúrgico, incluyendo posteriormente reparación de la pared abdominal con uso de malla. Dado que los tumores desmoides y la endometriosis comparten signos clínicos similares y exámenes de imágenes inespecíficos, se deben considerar ambas opciones en caso de masas en la pared abdominal de mujeres en edad fértil, especialmente si tienen antecedentes de cirugía relacionada con el útero.

Epidemiologia, clínica y evolución en pacientes con endometriosis / Epidemiology, clinic and evolution in patients with endometriosis

Objetivo: Estudiar la relación que existe entre algunos factores predisponente a desarrollar endometriosis y síntomas más frecuentes que manifiestan las pacientes. Métodos: Estudio observacional longitudinal, retrospectivo y descriptivo, mediante la revisión de 455 historias tomadas 560 pacientes que acudieron a la consulta de endometriosis y realizando diagnóstico definitivo en el Hospital Universitario "Dr. Ángel Larralde" y consulta privada, en Venezuela, estado Carabobo, en el periodo de enero 2006 a mayo 2023. Resultados: El diagnóstico se realizó en un 47,1 % de las pacientes con edades entre 26 a 35 años. La menarquia se presentó entre los 8 y los 12 años (el 69 %). El 63 % no tenía embarazos. La dismenorrea primaria fue más frecuente en el 63,07 %. El dolor pélvico y dispareunia en el 48 %, los síntomas digestivos en el 21 %. La localización más frecuente fue en ovario (78,7 %). Conclusión: La endometriosis, enfermedad inflamatoria benigna, estrógeno dependiente, se caracteriza por presencia de glándulas y estroma endometrial ectópico, usualmente acompañados de fibrosis. Se manifiesta en el periodo reproductivo, su principal síntoma es el dolor. Se localiza con mayor frecuencia en la pelvis y de esta en los ovarios, en intestino, vejiga, hígado, pulmones, cerebro, pared abdominal y periné. No hay tratamiento para su cura, pero si para los síntomas y retardar su progreso. Su diagnóstico por su desarrollo multifactorial y manifestaciones clínicas en muchas oportunidades se realiza en forma tardía(AU)

Objective: To study the relationship that exists between some predisposing factors to develop endometriosis and the most frequent symptoms manifested by patients. Methods: Longitudinal, retrospective and descriptive observational study, through the review of 455 records taken from 560 patients who attended the endometriosis consultation and made a definitive diagnosis at the "Dr. Ángel Larralde" and private consultation, in Venezuela, Carabobo state, in the period from January 2006 to May 2023. Results: The diagnosis was made in 47.1% of the patients aged between 26 and 35 years. Menarche occurred between 8 and 12 years of age (69%). 63% did not have pregnancies. Primary dysmenorrhea was more frequent in 63.07%. Pelvic pain and dyspareunia in 48%, digestive symptoms in 21%. The most frequent location was in the ovary (78.7%). Conclusion: Endometriosis, a benign, estrogen-dependent inflammatory disease, is characterized by the presence of ectopic endometrial glands and stroma, usually accompanied by fibrosis. It manifests itself in the reproductive period, its main symptom is pain. It is located most frequently in the pelvis and from this in the ovaries, intestine, bladder, liver, lungs, brain, abdominal wall and perineum. There is no treatment to cure it, but there is treatment for the symptoms and slowing its progress. Its diagnosis due to its multifactorial development and clinical manifestations is often made late(AU)

Disfunciones sexuales en las mujeres con endometriosis: estudio de prevalencia / Sexual dysfunctions in women with endometriosis: prevalence study

Antecedentes: En las mujeres con endometriosis, son frecuentes las disfunciones sexuales, particularmente el dolor/dispareunia. Objetivo: Evaluar y caracterizar la prevalencia de disfunciones sexuales en las mujeres con endometriosis en Armenia (Quindío), Colombia. Método: Estudio de corte transversal, en 137 mujeres mayores de 18 años con diagnóstico de endometriosis confirmada histológicamente, atendidas en tres clínicas de alta complejidad entre 2017 y 2022. Se utilizó como instrumento el Índice de Función Sexual Femenina (IFSF). Resultados: La edad promedio de las participantes fue de 34,68 ± 7,32 años. La prevalencia de disfunciones sexuales fue del 75,91%, caracterizando en primer lugar el dolor/dispareunia (75,91%), seguido de disminución del deseo sexual (56,93%) y en tercer lugar problemas de lubricación (54,01%). El promedio en la puntuación del IFSF fue de 20,82 ± 7,22 y la proporción de mujeres con puntuación ≥ 26,55 fue del 24,08%. La mediana en el número de disfunciones sexuales fue 3 (rango: 1 y 6). Conclusiones: En las mujeres con endometriosis se evidencia una alta prevalencia de disfunciones sexuales, equivalente a tres cuartas partes de las afectadas. Al momento de atender una mujer con este padecimiento se requiere evaluar sus efectos en la función sexual para poder implementar intervenciones terapéuticas oportunas.

Background: Sexual dysfunctions, particularly pain/dyspareunia, are common in women with endometriosis. Objective: To evaluate and characterize the prevalence of sexual dysfunctions in women with endometriosis in Armenia (Quindío), Colombia. Method: Cross-sectional study in 137 sexually active women older than 18 years with a diagnosis of histologically confirmed endometriosis, attended in three highly complex clinics between 2017 and 2022. The Female Sexual Function Index (FSFI) was used as an instrument. Results: The average age of the participants was 34.68 ± 7.32 years. The prevalence of sexual dysfunctions reported 75.91%, characterizing pain/dyspareunia in the first place (75.91%), followed by decreased sexual desire (56.93%) and thirdly problems of lubrication (54.01%). The average score of the FSFI was 20.82 ± 7.22; the proportion of women with a score ≥ 26.55 was 24.08%. The median in the number of sexual dysfunctions reached 3 (range: 1 and 6). Conclusions: In women with endometriosis there is evidence of a high prevalence of sexual dysfunctions, equivalent to three-quarters of the affected women. When caring for a woman with this condition, it is necessary to evaluate its effects on sexual function in order to implement timely and effective therapeutic interventions.

Resultados de cirugía resectiva colorrectal por Endometriosis Infiltrante Profunda: 6 años de experiencia

Objetivo: Describir los resultados tempranos de la cirugía resectiva colorrectal por Endometriosis Infiltrante Profunda (EIP) en mujeres intervenidas en centro clínico privado, durante los últimos 6 años. Material y Método Estudio transversal que muestra la evolución clínica de pacientes intervenidas quirúrgicamente con resecciones colorrectales por diagnóstico de (EIP), entre los años 2016-2022 en Clínica Indisa. Se agruparon en resecciones discoidales (Grupo I) y segmentarias (Grupo II) Resultados: De los pacientes operados por (EIP) entre los años 2016 al 2022, 160 pacientes fueron sometidas a resecciones colorrectales, 56 en el Grupo I y 104 en el grupo II. Las características demográficas de ambos grupos fueron similares, con excepción del hábito tabáquico que mostró un predominio en el Grupo II. El análisis de las variables quirúrgicas (tipo de abordaje, tasa de conversión, altura de la anastomosis y ostomía de protección) mostró una distribución similar en ambos grupos. En relación a la evolución postoperatoria, el Grupo I presentó una disminución significativa en el tiempo de realimentación con sólidos de 2 vs 3 días (p = 0,001). El inicio del tránsito intestinal, días de hospitalización y presencia de complicaciones Clavien-Dindo > = 3, no presentó diferencias significativas entre ambos grupos. Discusión: La endometriosis afecta, significativamente, a mujeres en todo el mundo, existiendo escasa evidencia que reporte los resultados de las cirugías colorrectales que comparen ambas técnicas, demostrando que el manejo en centros especializados tiene mejores resultados. Conclusión: Al comparar estas dos técnicas de resección colorrectal en DIE, concluimos que los pacientes operados por resección discoidal tienen una realimentación más temprana sin diferencias significativas en el resto de las variables estudiadas.

Objective: To describe the early outcomes of resective colorectal surgery for Deep Infiltrating Endometriosis (DIE) in women treated at private center over the past 6 years. Materials and Methods: This cross-sectional study presents the clinical evolution of surgically treated patients with colorectal resections for DIE diagnosis between 2016 and 2022 at Clínica INDISA. They were grouped into discoid resections (Group I) and segmental resections (Group II). Results: Of patients operated for DIE between 2016 and 2022, 160 underwent colorectal resections, with 56 in Group I and 104 in Group II. The demographic characteristics of both groups were similar, except for smoking habits, which showed a predominance in Group II. The analysis of surgical variables (approach type, conversion rate, anastomotic height, and protective ostomy) showed a similar distribution in both groups. Regarding postoperative outcomes, Group I showed a significant decrease in solid food resumption time, 2 vs 3 days (p = 0.001). The initiation of intestinal transit, hospitalization days, and presence of Clavien-Dindo complications >= 3 did not present significant differences between both groups. Discussion: Endometriosis significantly affects women worldwide, with limited evidence reporting colorectal surgery outcomes comparing both techniques, demonstrating that management in specialized centers yields better results. Conclusion: When comparing these two techniques of colorectal resection in DIE, we conclude that patients undergoing discoid resection have an earlier resumption of solid food intake without significant differences in the remaining studied variables.

Analysis of the metabolic profile and comorbidities in women with endometriosis before and after surgical treatment / Análise do perfil metabólico e comorbidades em mulheres com endometriose antes e depois do tratamento cirúrgico

Aim: this study aimed to evaluate the effects of surgical treatment for endometriosis on the metabolic profile of women diagnosed with deep endometriosis. Methods: we conducted a prospective observational study with a sample of 30 women in the menacme diagnosed with deep endometriosis who underwent videolaparoscopic surgery in a reference center in Brazil between October 2020 and December 2021. A total of 30 women performed clinical and laboratory tests regarding their metabolic profile on two occasions, during preoperative tests and six months after video-laparoscopy. Results: patients had lower average levels of Total Cholesterol (TC), Low-Density Cholesterol (LDL-c), Triglycerides (TGC), and Fasting Glycemia (FG) after the surgical procedure. The average TC level was 8.2% lower after surgery, LDL-c was 12.8% lower, TGC was 10.9% lower, and FG was 7.3% lower. The results showed a statistically significant difference for all these parameters (p < 0.001). Conclusions: video-laparoscopy was associated with a favorable lipid profile compared to the preoperative lipid profile, with a significant improvement in the average levels of LDL-c, HDL-c, TC, TGC, and FG. Long-term follow-up studies are needed to determine whether surgical treatment for endometriosis can improve the metabolic parameters of women with endometriosis and favor a lower predisposition to atherogenesis.

Objetivo: Aeste estudo teve como objetivo avaliar os efeitos do tratamento cirúrgico da endometriose no perfil metabólico de mulheres com diagnóstico de endometriose profunda. Métodos: foi realizado um estudo observacional prospectivo com uma amostra de 30 mulheres na menacme, com diagnóstico de endometriose profunda, que foram submetidas à videolaparoscopia em um centro de referência no Brasil, entre outubro de 2020 e dezembro de 2021. As mulheres realizaram exames clínicos e laboratoriais quanto ao seu perfil metabólico em duas ocasiões, durante exames pré-operatórios e seis meses após a videolaparoscopia. Resultados: as pacientes apresentaram níveis médios mais baixos de Colesterol Total (CT), Colesterol de Baixa Densidade (LDL-c), Triglicerídeos (TGC) e Glicemia de Jejum (GJ) após o procedimento cirúrgico. O nível médio de CT foi 8,2% menor após a cirurgia, o LDL-c foi 12,8% menor, o TGC foi 10,9% menor e a GJ foi 7,3% menor. Os resultados mostraram diferença estatisticamente significativa para todos esses parâmetros (p < 0,001). Conclusões: a videolaparoscopia foi associada a um perfil lipídico favorável em comparação ao perfil lipídico pré-operatório, com melhora significativa nos níveis médios de LDL-c, HDL-c, CT, TGC e GJ. Estudos de acompanhamento a longo prazo são necessários para determinar se o tratamento cirúrgico da endometriose pode melhorar os parâmetros metabólicos de mulheres com endometriose e favorecer uma menor predisposição à aterogênese.

Clinical Study on Yangxue Sanhan Tongmai Prescription for the Treatment of Endometriosis of Blood Deficiency and Cold Coagulation Type / 广州中医药大学学报

Objective To observe the clinical efficacy of Yangxue Sanhan Tongmai Prescription(derived from the modification of Danggui Sini plus Wuzhuyu Shengjiang Decoction,i.e.,Danggui Sini Decoction with Euodiae Fructus and Zingiberis Rhizoma Recens added)for the treatment of endometriosis(EMS)of blood deficiency and cold coagulation type.Methods A total of 120 cases of EMS with blood deficiency and cold coagulation syndrome were randomly divided into the study group and the control group,with 60 cases in each group.The study group was treated with Yangxue Sanhan Tongmai Prescription,and the control group was treated with Shaofu Zhuyu Granules.Both groups were treated for a period of 3 months,and were followed up for one year after the completion of the treatment.The two groups were observed in the changes of the visual analogue scale(VAS)scores of menstrual abdominal pain,the grading scores of dysmenorrhea,non-menstrual pelvic pain,pain during sexual intercourse,pelvic pressure pain and sacral ligament tenderness,the size of ovarian endometriosis cysts,and the serum levels of carbohydrate antigen 125(CA125),vascular endothelial growth factor(VEGF),soluble intercellular adhesion molecule 1(SICAM-1),matrix metalloproteinase 9(MMP-9)and tissue inhibitor of metalloproteinase 2(TIMP-2).After treatment,the clinical efficacy and safety,recurrence and pregnancy in the two groups were evaluated.Results(1)In the course of the trial,3 cases fell off in the study group and 5 cases fell off in the control group,and a total of 112 patients were eventually included in the statistical analysis,including 57 cases in the study group and 55 cases in the control group.(2)After 3 months of treatment,the total effective rate in the study group was 92.98%(53/57)and that in the control group was 85.45%(47/55),and the intergroup comparison showed that the efficacy of the study group was significantly superior to that of the control group(P＜0.05).(3)After treatment,VAS scores of menstrual abdominal pain and the grading scores of dysmenorrhea,non-menstrual pelvic pain,pain during sexual intercourse,pelvic pressure pain and sacral ligament tenderness in the two groups were significantly reduced compared with those before treatment(P＜0.05),and the reduction in the study group was significantly superior to that in the control group(P＜0.05).(4)After treatment,the ovarian endometriosis cysts of the two groups were slightly reduced,but the intragroup pre-and post-treatment differences and the intergroup post-treatment differences were not statistically significant(P＞0.05).(5)After treatment,the levels of serum CA125,VEGF,SICAM-1 and MMP-9 were decreased and the serum TIMP-2 level was increased in both groups compared with those before treatment(P＜0.05).And the decrease of serum CA125,VEGF,SICAM-1 and MMP-9 as well as the increase of serum TIMP-2 in the study group were significantly superior to those in the control group(P＜0.05).(6)The results of one-year follow-up showed that the recurrence rate of the study group was 30.19%(16/53),which was significantly lower than that of the control group(68.09%,32/47),and the difference was statistically significant between the two groups(P＜0.05).In the study group,there were 21 patients having the fertility desire,and then 14 cases of them were pregnant after treatment,with a pregnancy rate of 66.67%(14/21);in the control group,there were 20 cases having fertility desire,and then 4 cases of them were pregnant after treatment,with a pregnancy rate of 20.00%(4/20).The intergroup comparison showed that the pregnancy rate of the study group was significantly higher than that of the control group,and the difference was statistically significant(P＜0.05).(7)During the treatment period,there were no obvious adverse reactions in the two groups,and there were no abnormal changes in the safety indexes of blood,urine,and stool routine test,electrocardiogram,and liver and kidney function.Conclusion Yangxue Sanhan Tongmai Prescription exerts certain effect in treating patients with endometriosis of blood deficiency and cold coagulation type,which can significantly alleviate various pain symptoms,improve pregnancy outcomes,and effectively regulate the levels of serum CA125,VEGF,SICAM-1,MMP-9 and TIMP-2 of the patients.

Mechanisms of Guizhi Fuling Pills Treating Polycystic Ovary Syndrome and Endometriosis with Homotherapy for Heteropathy Based on Network Pharmacology and Molecular Docking / 广州中医药大学学报

Objective To investigate the mechanism of Guizhi Fuling Pills in the treatment of polycystic ovary syndrome(PCOS)and endometriosis(EMT).Methods TCMSP was utilized to obtain the active ingredients and related targets of the constituent Chinese medicines of Guizhi Fuling Pills.GeneCards,PharmGKB,and TTD databases were used to screen PCOS and EMT disease targets,respectively.The Venn R diagram was drawn after obtaining the intersecting targets of drugs and diseases using the Venn R package in R software,the drug-active ingredient-potential target interactions network diagram was made in Cytoscape,the intersecting target protein-protein interactions(PPI)network diagram was drawn in the STRING platform,and Cytoscape was used to optimize the PPI network and screen the core targets.R language was applied for Gene Ontology(GO)enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis,and AutoDockTools was for molecular docking.Results A total of 85 active ingredients and 191 corresponding targets of Guizhi Fuling Pills were obtained,and 77 potential targets of Guizhi Fuling Pills for the treatment of PCOS and EMT.The core active ingredients of Guizhi Fuling Pills for PCOS and EMT were quercetin,β-sitosterol,kaempferol,hederagenin,baicalein,and the core targets were AKT1,EGFR,IL-6,TNF,and TP53.GO functional analysis yielded 2 020 biological process,34 cellular components,126 molecular functions,and KEGG enrichment analysis yielded 165 signaling pathways.Molecular docking showed that the core components in the formula docked well with the targets.Conclusion Guizhi Fuling Pills may regulate the signaling pathways of lipid and atherosclerosis,AGE-RAGE signaling pathway,fluid shear stress and atherosclerosis,and chemical carcinogenesis-receptor activation through quercetin,β-sitosterol,kaempferol,hederagenin,and baicalein,and act on AKT1,EGFR,IL-6,TNF,and TP53,thus treating PCOS and EMT with homotherapy for heteropathy.

The diagnostic value of transvaginal ultrasound and thin-section oblique axial T2WI in deep infiltrating endometriosis of uterosacral ligaments / 实用放射学杂志

Objective To compare the diagnostic value of transvaginal ultrasound(TVS)and thin-section oblique axial T2WI in deep infiltrating endometriosis(DIE)of uterosacral ligaments(USL).Methods Retrospective analysis was conducted on preoperative TVS and MRI images from 74 patients with USL-DIE.The diagnostic efficacy of TVS and thin-section oblique axial T2WI for USL-DIE was evaluated using receiver operating characteristic(ROC)curve based on pathological findings,and area under the curve(AUC),sensitivity,specificity,accuracy,positive predictive value(PPV)and negative predictive value(NPV)were further calculated.The McNemar two-tailed test was used to analyze the difference in diagnostic accuracy between the two methods for USL-DIE.Results The AUCs of TVS and thin-section oblique axial T2WI for diagnosing left and right USL-DIE were 0.721 vs 0.842 and 0.640 vs 0.901,respectively.Thin-section oblique axial T2WI demonstrated higher sensitivity,accuracy,PPV,and NPV compared to TVS in diagnosing USL-DIE.The diagnostic accuracy was found to be statistically different between the two methods(Pleft =0.026,χ2=4.966;Pright<0.001,χ2=16.531).Conclusion Thin-section oblique axial T2WI outperformed TVS in terms of diagnostic value for USL-DIE,providing valuable imaging support for accurate clinical diagnosis.

Research progress of mesenchymal stem cells in endometriosis / 天津医药

Endometriosis is a common chronic gynecological disease,and its pathogenesis has not been fully elucidated.Mesenchymal stem cells are a kind of pluripotent stem cells with multi-directional differentiation potential derived from mesoderm,which can differentiate into a variety of tissues and organs.Endometrial mesenchymal stem cells,menstrual blood-derived mesenchymal stem cells,adipose mesenchymal stem cells,bone marrow mesenchymal stem cells and umbilical cord blood mesenchymal stem cells can participate in the pathogenesis of endometriosis from cell proliferation and differentiation,ectopic migration,angiogenesis,inflammatory response and fibrosis formation,and play a certain role in progression of the disease.Mesenchymal stem cells provide new ideas for elucidating the pathogenesis of endometriosis,and may also become a potential method for the treatment of endometriosis.

Distinct molecular targets of ProEGCG from EGCG and superior inhibition of angiogenesis signaling pathways for treatment of endometriosis / 药物分析学报

Endometriosis is a common chronic gynecological disease with endometrial cell implantation outside the uterus.Angiogenesis is a major pathophysiology in endometriosis.Our previous studies have demon-strated that the prodrug of epigallocatechin gallate(ProEGCG)exhibits superior anti-endometriotic and anti-angiogenic effects compared to epigallocatechin gallate(EGCG).However,their direct binding targets and underlying mechanisms for the differential effects remain unknown.In this study,we demonstrated that oral ProEGCG can be effective in preventing and treating endometriosis.Additionally,1D and 2D Proteome Integral Solubility Alteration assay-based chemical proteomics identified metadherin(MTDH)and PX domain containing serine/threonine kinase-like(PXK)as novel binding targets of EGCG and ProEGCG,respectively.Computational simulation and BioLayer interferometry were used to confirm their binding affinity.Our results showed that MTDH-EGCG inhibited protein kinase B(Akt)-mediated angiogenesis,while PXK-ProEGCG inhibited epidermal growth factor(EGF)-mediated angiogenesis via the EGF/hypoxia-inducible factor(HIF-1a)/vascular endothelial growth factor(VEGF)pathway.In vitro and in vivo knockdown assays and microvascular network imaging further confirmed the involvement of these signaling pathways.Moreover,our study demonstrated that ProEGCG has superior therapeutic effects than EGCG by targeting distinct signal transduction pathways and may act as a novel anti-angiogenic therapy for endometriosis.

Diagnosis and treatment of intestinal endometriosis: report of 12 cases / 中华普通外科杂志

Objective:To explore the diagnosis and treatment of intestinal endometriosis.Methods:The clinical data of 12 patients with intestinal endometriosis at the First Affiliated Hospital of Soochow University from Aug 2016 to Jan 2023 were retrospectively analyzed.Results:There were 8 cases of rectal endometriosis, 3 cases of sigmoid colon endometriosis and 1 case of ileal endometriosis. Nine cases underwent colonoscopy, 6 cases underwent CT examination, 3 cases underwent MRI examination, and 4 cases underwent transabdominal or vaginal ultrasnography. All 12 cases underwent operation, 8 cases were misdiagnosed as colorectal neoplasms and underwent intestinal resection, 1 case had right hemicolectomy because of ambiguous pathology, 2 cases with definite intestinal endometriosis underwent local intestinal resection, 1 case had transanal tumor excision with diagnosis confirmed by postoperative pathology; 5 cases underwent open surgery, 5 cases did laparoscopy, 1 case was done with robotic surgery, 1 case was by transanal surgery; 7 patients underwent more than 2 surgeries, with a maximal of 5 surgeries in one case. The hospital stay varied from 9 to 351 days, all 12 cases were cured, and follow-up found no recurrence.Conclusions:It is often difficult to make a clear diagnosis of intestinal endometriosis preoperatively.Many were misdiagnosed as colorectal neoplasms.Laparascopic exploration and biopsy help prevent inappropriate surgery.

Application of Allograft Endometriosis Rat Model in Pharmaco-dynamic Evaluation of GnRH Agonists / 实验动物与比较医学

Objective To establish an allogeneic rat model of endometriosis and to evaluate the effects of gonadotropin-releasing hormone (GnRH) agonist GenSci006 on experimental rat endometriosis. Methods Endometrium from SPF grade donor female SD rats were transplanted onto the abdominal wall of recipient female rats to construct an allogeneic endometriosis model. The rats undergoing sham surgery were divided into the sham group. Three weeks later, the length, width and height of the ectopic endometrium were measured, and the volume of the endometrium (V1) was calculated before drug administration. The modeling rats were randomly divided into four groups: model group, triptorelin group (0.25 mg/kg), GenSci006-1 group (0.125 mg/kg) and GenSci006-2 group (0.25 mg/kg). Each group had 16 rats and received a single dose of the corresponding drug. The sham group and model group were administered an equal volume of solvent. Three weeks after administration, ectopic endometrium was measured to calculate the volume V2 and inhibition rate. The effect of GenSci006 on rat uterus and ovarian tissues was assessed by comparing organ coefficients and changes in pathological sections. Enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of serum estradiol (E2), progesterone (P4), follicle stimulating hormone (FSH), and luteinizing hormone (LH). Real-time fluorescent quantitative PCR was used to detect the expression of GnRH receptor (GnRHR) mRNA in the hypothalamus and pituitary. Western blot was used to detect the expression of estradiol receptor alpha (ERα), beta (ERβ) and progesterone receptor (PR) in ectopic endometrium. Results Three weeks after administration, compared with the model group, the body weight of rats in the triptorelin and GenSci006-2 groups significantly increased (P < 0.05), while the volume of ectopic endometrium significantly decreased (P < 0.05). Compared with the sham group, the model group showed no significant changes in uterine and ovarian organ coefficients or endometrial thickness (P > 0.05). Compared with the model group, the uterine organ coefficients and endometrial thickness were significantly reduced in the triptorelin and GenSci006-2 groups (P < 0.05). Compared with the sham group, the serum levels of E2, P4, FSH and LH in the model group showed no significant changes (P > 0.05). Compared with the model group, the ovarian organ coefficient and serum P4 levels of rats in the Triptorelin, GenSci006-1, and GenSci006-2 groups were significantly reduced (P < 0.05), while the serum LH levels of rats in the GenSci006-1 group were significantly increased (P < 0.05). However, there were no significant changes in serum E2 and FSH levels in each group (P > 0.05). Compared with the model group, the expression levels of GnRHR mRNA in the pituitary tissue of rats in the triptorelin and GenSci006-2 groups were significantly downregulated (P < 0.05), with no significantly changes in the hypothalamus (P > 0.05). There were no significant changes in the expression level of GnRHR mRNA in the hypothalamus or the protein levels of ERα, ERβ and PR in the ectopic endometrial tissue in any group (P > 0.05). Conclusion The allogeneic endometriosis rat model is a suitable animal model for screening and evaluating drugs for treating endometriosis. The volume of ectopic endometrium, inhibition rate, uterine and ovarian organ coefficients, and serum E2 levels may serve as indicators for detecting drug efficacy.

Treatment of Endometriosis from the Perspective of "Retention due to Deficiency Qi" / 中医杂志

It is believed that retention due to deficient qi is an important pathogenesis of endometriosis （EMs）. Deficient qi is the root of the disease， mainly manifested as spleen deficiency， while retention is the branch pathogenesis of the disease， mainly with blood stasis， complicated with constraint， phlegm， heat， toxin and other pathological factors. Therefore， it is proposed to follow the treatment principle of supplementing deficiency and unblocking stagnation， and take the methods of replenishing qi and fortifying the spleen， removing stasis and eliminating concretions. Self-made Fuzheng Huayu Formula （扶正化瘀方） is taken as the basic formula， and can be modified with the symptoms in menstrual and non-menstrual periods. Additionally， the methods of moving qi， dispelling phlegm， clearing heat， relieving toxin and others can be combined， and it is recommended to treat the root and the branch simultaneously.

Exploring the Effects of Quyu Jiedu Formula （祛瘀解毒方） on the Ectopic Tissues of the Rat Uterus in An Endometriosis Model Based on Iron Autophagy Mediated by the NCOA4/NF-κB Signalling Pathway / 中医杂志

ObjectiveTo investigate the possible mechanism of Quyu Jiedu Formula （祛瘀解毒方） in the treatment of endometriosis in terms of iron autophagy mediated by nuclear receptor coactivator 4/nuclear factor κB （NCOA4/NF-κB） signalling pathway. MethodsFifty female SD rats were randomly divided into sham surgery group， model group， mifepristone group， low- and high-dose Quyu Jiedu Formula group， with 10 rats in each group. In the sham surgery group， only operation of opening and closing abdomen was performed， and in the remaining groups， the rat with endometriosis was modelled by autotransplantation. On the next day after successful modelling， saline 2 ml/d was given by gavage to the sham surgery group and the model group； mifepristone 1.05 mg/（kg·d） was given by gavage to the mifepristone group； Quyu Jiedu Formula 12.23 g/（kg·d） and 48.92 g/（kg·d） were given to the low- and high-dosage Quyu Jiedu Formula groups， respectively administered for 4 weeks consecutively. In the remaining 4 groups， all ectopic endometrial tissues were removed from the rats. The volume of ectopic lesions was measured in the model group， the mifepristone group， and the low- and high-dose Quyu Jiedu Formula groups， and the pathological changes of endometrial/ectopic tissues were observed by HE staining， and the protein expression and expression of NCOA4， Ferritin Heavy Chain 1 （FTH1）， Panax quinquefolium （P62）， Microtubule-associated Protein 1 Light Chain 3β （LC3B）， and P-NF-κB protein expression and NCOA4， FTH1， LC3B， P62 mRNA expression were detected in the endometrium and ectopic tissues； the co-localisation of NCOA4 and LC3B， free iron content， and levels of interleukin 6 （IL-6） and tumour necrosis factor α （TNF-α） in endometrial/eutopic endometrial tissues were also detected. ResultsNo ectopic lesions were seen in the sham surgery group. The ectopic tissues of rats in the model group showed obvious pathological damage， while the pathological damage of the ectopic tissues of rats in each admi-nistration group was reduced to different degrees. Compared with the model group， the volume of ectopic lesions was reduced in the mifepristone group and the high- and low-dose Quyu Jiedu Formula groups， and the volume of ectopic lesions in the high-dose Quyu Jiedu Formula group and the mifepristone group was significantly smaller than that in the low-dose Quyu Jiedu Formula group （P＜0.01）. Compared with the sham surgery group， the ectopic tissues of the model group showed up-regulation of LC3BⅡ/LC3B I values， NCOA4， and P-NF-κB protein expression， down-regulation of P62 and FTH1 protein expression， increase in free iron content and IL-6 and TNF-α levels， and increase in the co-localisation positivity rate and co-localised cell density of NCOA4 and LC3B （P＜0.05 or P＜0.01）. Compared with the model group， the ectopic endothelial tissue LC3BⅡ/LC3BⅠ values and the expression of NCOA4 and P-NF-κB proteins were down-regulated in the low- and high-dose Quyu Jiedu Formula group and mifepristone group， the colocalisation positivity rate of NCOA4 and LC3B significantly reduced， and the content of free iron and the level of IL-6 decreased （P＜0.05 or P＜0.01）. Compared with the mifepristone group， P62 more obvious up-regulated and TNF-α level reduced in the high-dose Quyu Jiedu Formula group （P＜0.05）. Compared with the low-dose Quyu Jiedu Formula group， the free iron content of ectopic tissues and the levels of IL-6 and TNF-α reduced in the high-dose Quyu Jiedu Formula group （P＜0.01）. ConclusionThe mechanism of endometriosis treatment by Quyu Jiedu Formula may be related to the inhibition of iron autophagy mediated by the NCOA4/NF-κB signalling pathway in endometriotic tissues， which improves endometrial inflammation.

Stains:recent research progress for endometriosis / 中国临床药理学与治疗学

Defined as a common gynecologic en-docrine disease,endometriosis is characterized by the presence of endometrium outside of the uterus cavity,affecting about 10%to 15%of reproductive-aged women worldwide.Moreover,Asian women tend to have a nine-fold increased risk of endome-triosis compared with their white counterparts in Europe and the United States.Endometriosis not only causes chronic pelvic pain,dysmenorrhea,painful sex and other pain symptoms,but also leads to infertility,pushing the patients into a state of fatigue,high sensitivity and anxiety,thus reduc-ing their quality of life.As the aging of Chinese pop-ulation intensifies and the women's childbearing age delays,it is highly urgent to find solutions to those gynecological endocrine diseases such as en-dometriosis,which hamper women's fertility.In re-cent years,studies have shown that patients with endometriosis have abnormal serum lipid metabo-lism and an increased risk of cardiovascular diseas-es.At the same time,as a type of cholesterol-lower-ing drug,statins can inhibit the progression of en-dometriosis at the cellular and animal levels.Also,a few clinical studies have exhibited that statins ex-ert a positive effect on the treatment of endometri-osis.Therefore,this article aims to review the re-searches regarding the relationship between endo-metriosis and the cardiovascular disease,as well as the research progress of statin therapy on endome-triosis based on the level of cells,animals and hu-man beings.

A case analysis of medication adjustments on a moyamoya disease patient with endometriosis by DAPT treatment during perioperative period and formulation of DIE postoperative recurrence prevention / 中国临床药理学与治疗学

AIM:To explore the key points of per-sonalized treatment and medication monitoring by clinical pharmacists in the perioperative period of moyamoya disease patients with endometriosis.METHODS:This study showed a moyamoya disease patient with endometriosis who accepting dual an-tiplatelet therapy and how to adjust medication during the perioperative period.Besides,monitor-ing the use proton pump inhibitors in the perioper-ative period and the formulating a plan of DIE post-operative recurrence prevention are also our objec-tives.RESULTS:Through individualized assessment of the patient,a personalized medication adjust-ments for dual antiplatelet therapy was deter-mined.Individualized perioperative proton pump inhibitor regimen and postoperative prevention plan for endometriosis recurrence were developed.CONCLUSION:The development of individualized medication regimens and medication monitoring is the breakthrough point for clinical pharmacists to carry out pharmaceutical services.

Research progress on the regulation of endometriosis by PI3K/Akt signaling pathway and the intervention effect of traditional Chinese medicine / 中国临床药理学与治疗学

Endometriosis(Endometriosis,EMs)is a disease caused by abnormal colonization of the endometrial stroma or glands to sites other than the coated mucosa of the uterine cavity.Phospho-lipid inositol 3 kinase(phosphoinositide 3-kinase,PI3K)/protein kinase B(protein kinase B,Akt)sig-naling pathway is involved in the process of focal blood vessel formation,cell autophagic apoptosis,migration and invasion,and is one of the classic pathways regulating the pathological characteris-tics of EMs.The characteristics of multi-compo-nent,multi-target and multi-pathway of TCM have significant advantages in the treatment of EMs.Some TCM active components and TCM com-pounds can interfere with the PI3K/Akt signaling pathway,thus inhibiting the treatment of endome-triotic tissues,reducing pain and alleviating fibrotic lesions.By explaining the connection between the key targets of PI3K/Akt signaling pathway and EMs,this paper summarizes and summarizes the re-search status of EMs by regulating PI3K/Akt signal pathway in home and abroad,aiming to provide a new perspective and idea for the use of traditional Chinese medicine and compound to treat EMs.

Rapid health technology assessment of dienogest in the treatment of endometriosis / 中国临床药理学与治疗学

AIM:To rapidly evaluate the effective-ness,safety and economy of dienogest in the treat-ment of endometriosis so as to provide evidence-based reference for clinical drug selection and deci-sion.METHODS:Retrieved from PubMed,Embase,Cochrane Library,CNKI,SinoMed,Wanfang and health technology assessment(HTA)organization websites,HTA report,systematic review/Meta-anal-ysis and pharmacoeconomic study were included during the inception to Sep 2023.Data extraction and quality evaluation were carried out for the lit-erature that met the inclusion and exclusion crite-ria,and the research results were summarized and analyzed qualitatively.RESULTS:Nine systematic re-view/Meta-analyses,and 2 pharmacoeconomic studies were included.The quality of Meta-analysis literatures was low,and the quality of economic re-search was good.In terms of effectiveness,com-pared with no treatment,dienogest can significant-ly reduce postoperative recurrence rate,VAS score,and improve pregnancy rate and effective rate;Di-enogest has similar therapeutic effects in terms of recurrence rate as GnRHa and COC;With regard to recurrence rate and pregnancy rate,dienogest is superior to danazol,gestrinone,and mifepristone.In terms of safety,compared with placebo,the inci-dence of vaginal bleeding and headache was signifi-cantly increased with dienogest,and there was no difference in bone loss;The incidence of vaginal bleeding caused by dienogest was significantly high-er than that of GnRHa,but the incidence of hot flashes and bone loss was lower.In terms of econo-my,dienogest has a more cost-effective advantage comparing with GnRHa,but does not have econom-ic benefits comparing with COC.CONCLUSION:Di-enogest has good effectiveness and safety in the treatment of endometriosis,and economically su-perior to GnRHa,but inferior to COC.

Multidimensional analysis of endometriosis clinical trials based on the ClinicalTrials.gov database / 中国临床药理学与治疗学

AIM:To perform a multidimensional analysis of the clinical study characteristics of endo-metriosis based on the ClinicalTrials.gov,providing comprehensive and objective information for re-searchers,clinicians,and clinical pharmacists.METHODS:A thorough investigation was conduct-ed on clinical trials related to endometriosis,regis-tered on the ClinicalTrials.gov from its inception to October 20,2023.Relevant trial data were extract-ed and statistically analyzed using bibliometrics and comparative research methods.RESULTS:A to-tal of 667 endometriosis clinical studies were regis-tered globally,showing an annual increase.The United States(127 trials),France(70 trials),and Ita-ly(57 trials)had the highest number of registered trials.Interventional studies were predominant(416 trials,62.4%),followed by observational stud-ies(251 trials,37.6%).Within interventional stud-ies,drug therapy was the primary intervention(223 trials,53.6%).Despite endometriosis being a female condition,male subjects were also consid-ered,with 6 trials specifically requiring male partici-pants and 37 trials not restricting gender.Compa-nies/corporations were the main funding sources,while public and governmental organizations pro-vided relatively less funding.CONCLUSION:Clinical trial research on endometriosis is in a phase of growth,with drug therapy being the main treat-ment approach.However,there is a relative lack of investment and attention from public funds and governmental organizations.

Comparison of clinical effectiveness and safety between generic and branded dienogest tablets in the treatment of endometriosis / 中国临床药理学与治疗学

AIM:To evaluate the clinical effective-ness and safety of generic and branded dienogest in the treatment of endometriosis.so as to provide the basis for clinical use of dienogest.MEHTODS:The data of patients admitted to Third Affiliated Hospital of Zhengzhou University from August 2022 to August 2023 who received dienogest(2 mg/d,orally,for 6 months)for treatment of endometrio-sis were collected.The clinical efficacy and adverse reactions of generic drugs and original drugs in the treatment of endometriosis-related pain were com-pared through follow-up surveys of the two groups of patients at 3 months and 6 months respectively.RESULTS:There was highly significant reduction in pelvic pain in both groups with mean of similar in generic group(34.0±3.0)mm and branded group(34.5±3.9)mm.The most frequent drug-related ad-verse effects in generic dienogest was vaginal bleeding(93%)which was no statistical difference with branded dienogest(90%).CONCLUSION:The generic and branded dienogest have the same clini-cal effectiveness and similar safety.