Made available in DSpace on 2014-06-11T19:26:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-05-31Bitstream added on 2014-06-13T19:53:54Z : No. of bitstreams: 1 zimbardi_d_me_botib.pdf: 1403669 bytes, checksum: 19185c803cd5bc8168341c616f75325f (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A endometriose constitui uma doença de etiologia incerta, caracterizada pela presença de tecido endometriótico fora da cavidade uterina. E uma causa comum de morbidade, atingindo 5 a 10% das mulheres em idade reprodutiva. A metilção anormal na região promotora de genes especificos e os niveis de expressão alterados das DNA metiltransferases (DNMTs) compoem 0 conjunto de evidencias recentes indicando a endometriose como uma doença epigenetica. 0 presente estudo propos a investigaçao do perfil diferencial de metilaçao do DNA na endometriose, utilizando uma abordagem genomica de alta resoluçao baseada na metodologia de microarrays. Para isso, foram coletadas amostras pareadas de endometrio eutópico e de endometriose intestinal profunda de 18 pacientes. Foram selecionadas dez amostras pareadas para a hibridação do DNA: cinco casos foram submetidos ao enriquecimento das sequencias não metiladas (digerido com a enzima de restrição dependente de metilação McrBC ) e nove ao enriquecimento das sequencias metiladas (digerido com 0 coquetel de enzimas sensiveis a metilação do DNA Acil, HinP11, HpyCH41Ve Hpall). Os ensaios foram realizados em duplicatas totalizando 28 hibridações independentes na plataforma disponivel comercialmente Human CpG Island ChIP-on-Chip Set 244K (Agilent Technologies). Este protocolo foi previamente padronizada utilizando-se 0 DNA das linhagens derivadas de carcinomas de c610n HCT116 e DKO (celulas HCT116 duplo knockout para as DNMT1 e DNMT3b) usando marcação reversa (dye swap). Os dados foram avaliados nos software Agilent Technologies Genomic Workbench (DNA Analytics 5.0) e GeneSpring 7.3 (Agilent Technologies). Estre os 925 genes que apresentaram metila9ao diferencial, 55 foram recorrentes em dois ou mais casos. Varios destes genes mostram-se interessantes por exercerem funções relacionadas a fatores de transcrição (MSX1, EMX2, HOXB13, HOXD8 e HOXD9)... / Endometriosis is a disease of unknown etiology characterized by the presence of endometrial tissue outside the uterine cavity. It is a common cause of morbidity, affecting 5-10% of women in reproductive ages. The aberrant methylation in the promoter region of specific genes and the higher expression levels of DNA methyltransferases (DNMTs) in comparison with normal endometrium have been reported as evidences indicating that endometriosis is an epigenetic disease. The present study investigated the differential profile of DNA methylation in endometriosis using a high-resolution microarray-based assay. There were collected paired samples of eutopic endometrium and deep intestinal endometriosis from 18 patients and, subsequently, it was selected ten pairs to the DNA hybridization: five matched samples were submitted to the enrichment of unmethylated sequences (digested with the methylation-dependent restriction enzyme McrBG) and ten to the enrichment of methylated sequences (digested with the cocktail of enzymes sensitive to DNA methylation AGII, HinP1/, HpyGH4/V and Hpa/I). The assays were performed in duplicates totalizing 28 independent hybridizations in the commercially available platform Human CpG Island ChIP-on-Chip Set 244K (Agilent Technologies). The protocol was previously standardized using the DNA from the colon carcinomas cell lines HCT116 and DKO (HCT116 cells double-knockout for DNMT1 and DNMT3b) using reverse labeling (dye swap). The data were evaluated using the software Genomic Workbench (DNA Analytics 5.0) and GeneSpring 7.3. Among the 925 genes showing differential methylation, 55 genes were detected in at least two cases. Several of these gene could be considered good candidates to molecular biomarkers of endometriosis since that they act as transcription factors (MSX1, EMX2, HOXB13, HOXDB e HOXD9) , chromatin remodeling (MAD1L 1, WDR5 e BGOR)... (Complete abstract click electronic access below)

Made available in DSpace on 2014-06-11T19:32:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-08-10Bitstream added on 2014-06-13T19:02:56Z : No. of bitstreams: 1 ihlenfeld_mfk_dr_botfm.pdf: 6706392 bytes, checksum: 84cf4d5e562c51fba34d16bf95473913 (MD5) / Fundação para o Desenvolvimento Médico e Hospitalar (Famesp) / As dosagens da leptina, da interleucina-6 (IL-6) e do fator de necrose tumoral alfa (TNF-a) foram avaliadas no diagnóstico da endometriose peritoneal mínima e leve (estádios I e 11 - American Society for Reproductive Medicine). Participaram, deste estudo prospectivo e casocontrole, 29 mulheres, em idade reprodutiva, submetidas a videolaparoscopia. O grupo de estudo foi composto por 15 pacientes em investigação de esterilidade conjugal ou dor pélvica crônica (grupo E) e o grupo controle por 14 mulheres assintomáticas encaminhadas para realização de ligadura tubária (grupo C). Foram coletadas amostras de sangue periférico e líquido peritoneal para a dosagem laboratorial das citocinas determinadas por meio de testes ELlSA. No soro, não se observou diferenças significantes nas amostras de leptina, de IL-6 e do TNF-Q entre os grupos estudados (p>O,05). No líquido peritoneal, houve diferenças significantes nas dosagens da leptina e do TNF-Q entre os grupos estudados (p<O,05);não havendo diferenças significantes para as amostras de IL-6 (p>O,05). No líquido peritoneal, há evidências da possibilidade da utilização da leptina e do TNF-Q no diagnóstico da endometriose mínima ou leve, na amostra estudada. / The levels of leptin, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-o) were evaluated as a diagnostic tool for minimal and mild peritoneal endometriosis (stages I and II - American Society for Reproductive Medicine). lhe subjects of this prospective, case-control study were 29 women of reproductive age, who underwent laparoscopy. Subjects of the study-group were 15 women under investigation of infertility or chronic pelvic pain (E-group) and controls were patients with no symptoms in which tubal ligation would be performed (C-group). In ali these patients were collected samples of peripheral blood and peritoneal f1uid, in order to determine cytokine levels employing ELlSA tests. There were no statistical differences of the sera on the studied groups concerning the levels of leptin, IL-6 and TNF-o (p> 0.05). There were statistical differences in the peritoneal fluid of the studied groups, concerning the levels of leptin and TNF-o (p< 0.05) but not for IL-6 (p> 0.05). There is an evidence of using leptin and TNF-o in the peritoneal f1uid as a diagnostic tool for minimal and mild endometriosis.

Publicación a texto completo no autorizada por el autor / El documento digital no refiere asesor / Determina las características epidemiológicas de las pacientes con el diagnóstico de endometriosis atendidas en el departamento de ginecología del Hospital Nacional Docente Madre-Niño San Bartolomé en el periodo de Enero a Diciembre del 2011. El tipo de investigación es observacional descriptivo de corte transversal y retrospectivo. Se evaluaron a 103 pacientes del servicio de ginecología que se atendieron en el HONADOMANI desde Enero a Diciembre del 2011. Se aplicó los cálculos univariados para variables cualitativas de frecuencia absoluta y relativa. Para las variables cuantitativas se determinó medidas de tendencia central (mediana) y medidas de dispersión (desviación estándar). Se elaboraron gráficos en Excel utilizando diagrama de barras y/o diagrama circular, diagrama de cajas. Se aplicó la prueba estadística chi-cuadrado, con un nivel de significancia del 5%. El análisis se realizó con el programa estadístico SPSS versión 18.0. La edad que tuvo mayor predominio fue la que estuvo comprendida entre los rangos de 31-40 años (55.3%), seguido del rango entre 21-30 años, siendo el promedio de la edad de 34.6 ± 7.2 con una mínima de16 y una máxima de 58. El 57.3% de las pacientes tuvo un grado de instrucción superior y el 39.8% nivel secundaria. El promedio total de gestaciones de las pacientes fue de 1.4 ± 1.5, la media de número de partos fue de 0.9 ± 1.1, el promedio de número de abortos fue de 0.5. El promedio de la edad de la menarquia (primera menstruación) fue de 11.9 ± 1.7. El 49.5% de las pacientes refirió presentar infertilidad, el 24.5% presentó una masa anexial, el 31.1% describió que presentó dolor pélvico y del total de pacientes sólo el 14.6% fue gestante (15). De la muestra evaluada de mujeres el 37.9% se sometió a cirugía abierta (Laparotomía), el 55.3% a cirugía laparoscópica y sólo el 6.8% tuvo que ser sometida a una cesárea por ser gestante. Con respecto a tipo de endometriosis que presentaron las pacientes: el 37.9% tuvo un estadio III (grado moderado), el 31.1% presentó un estadio II (grado leve). El 96.1% en el ovario derecho y el 85.4% en el ovario izquierdo, el 91.3% de las pacientes presentó endometriosis en el peritoneo, el 63.7% en la trompa de Falopio derecha y el 60.2% en la trompa de Falopio izquierda. La edad promedio en general de las pacientes con diagnostico con endometriosis fue de 34.6 ± 7.2 (16-58). El porcentaje de pacientes con diagnóstico de endometritis que presentaron infertilidad en el año 2011 fue de 49.5% (51). Adicionalmente también el 24.5% (25) presento masa anexial y el 31.1% (32) presentó dolor pélvico. Las principales características clínicas con diagnosticó de endometriosis fueron hipermenorrea (11.7%) y dismenorrea (27.2%). El 37.9% se sometió a cirugía abierta (Laparotomía), el 55.3% a cirugía laparoscópica y solo el 6.8% tuvo que ser sometida a una cesárea por ser gestante. El estadio más frecuente fue el estadio III (grado moderado) con 37.9%. / Trabajo de investigación

OBJECTIVES: This study aims to explore the relationship between central pain amplification and persistent pelvic pain. No previous studies have utilized bimanual pelvic examination findings, in addition to pressure-pain analysis, in an effort to investigate the mechanisms contributing to Chronic Pelvic Pain (CPP) in women with endometriosis. METHODS: Participants included 144 women aged 18-50 years old, diagnosed with CPP and/or surgically-confirmed endometriosis compared to healthy controls. Participants were categorized into four groups, including pain-free endometriosis (Endo Ø Pain), painful endometriosis (Endo + Pain), Chronic Pelvic Pain without endometriosis (CPP Ø Endo), and healthy controls. Pressure-pain Quantitative Sensory Testing (QST) was conducted on all participants to determine levels of pain thresholds. External systemic tenderpoints were assessed utilizing standardized fibromyalgia tenderpoint criteria. A pelvic examination was performed on participants in the gynecological sample in order to assess internal tenderness. One-way ANOVA, chi-square analyses were conducted to assess descriptive variables. Correlation calculations were performed to assess the relationship between pressure-pain thresholds and tenderpoints. Generalized Linear Models (GLM) were conducted to analyze the differences on pressure-pain thresholds and pelvic exam tenderpoints between groups, while controlling for age and number of comorbid chronic pain syndromes (CPS). RESULTS: Endo Ø Pain had a significantly higher stage of endometriosis and were significantly older than the Endo + Pain group. Healthy controls had less external systemic tenderpoints than all patient subgroups. CPP Ø Endo and Endo + Pain had more CPS than healthy controls and Endo Ø Pain. Pelvic exam tenderpoints (r= -0.31, p < 0.01) and systemic external tenderpoints (r = -0.35, p <0.01) were negatively correlated with low pressure-pain threshold. Systemic external tenderpoints were negatively correlated with the high pressure staircase (r= -0.41, p < 0.01), but pelvic exam tenderpoints were not. The GLMs conducted revealed that Endo Ø Pain had significantly higher low pressure-pain threshold compared to both Endo + Pain (difference = 0.57, p < 0.01, CI= 0.12, 1.02) and healthy controls (difference = 0.55, p < 0.05, CI= 0.08, 1.02). The CPP Ø Endo group had significantly lower high pressure-pain threshold scores compared to healthy controls (difference = 0.38, p < 0.05, CI= 0.05, 0.71). The Endo + Pain group also had significantly lower high-pain thresholds as compared to healthy controls (difference= 0.31, p < 0.05, CI= 0.04, 0.58). CPP Ø Endo group had significantly more pelvic tenderpoints compared to Endo Ø Pain (difference = 2.81, p < 0.001, CI = 1.36, 4.27); Endo + Pain group also had significantly more pelvic exam tenderpoints than the Endo Ø Pain (difference= 2.10, p < 0.001, CI = 0.96, 3.24). CONCLUSIONS: The findings of this study suggest that pain thresholds, as measured by QST pressure-pain testing, are associated with persistent pelvic pain. CPP Ø Endo and Endo + Pain experienced more systemic tenderness, and more CPS than the Endo Ø Pain group and healthy controls. This indicates that chronic pain, not endometrial lesions, are likely responsible for the development of centralized pain amplification. Although the etiology of endometriosis and CPP is poorly understood, the findings of this study contribute to the idea that central sensitization is associated with the shared underlying pain mechanism in chronic pain syndromes. / 2020-07-03T00:00:00Z

<p>The purpose of this constructivist grounded theory study was to explore women's experiences with endometriosis through diagnosis, treatment, and coping. Conducted using a health geography, medical sociology, and medical anthropology theoretical framework and a constructivist grounded theory methodology, the following research objectives guided this study: (a) document the experiences and consequences of receiving a medical diagnosis of endometriosis from the perspective of a group of women living in Hamilton, Ontario; (b) explore the iterative process the women experienced while seeking relief from the symptoms of endometriosis; (c) interpret the meaning of 'coping' that women on the journey for a reliable diagnosis and effective treatment for endometriosis experienced; and (d) formulate a coherent, middle-range interpretive substantive theory of the women's journey, in order to help others better understand the endometriosis experience from the patient's perspective.</p> <p>Seventy women were interviewed, and the middle-range substantive theory that emerged from this study is grounded in their experiences. The results indicate that the women experienced endometriosis as a journey through constant interaction with the social worlds they had defined through diagnosis, treatment, and ultimately coping. Studying their everyday life experiences and mapping those in the context of their biomedical, personal, and informational social worlds allow for a broader understanding of the varying ways that the women interviewed perceived the treatment processes and their treatment options, made sense of their symptoms, and experienced uncertainty about the influence change could have on their everyday lives. By incorporating their individual experiences and knowledge, their social world and descriptions of these worlds reflect the entirety of the endometriosis experience. Finally, if one examines endometriosis only from the perspective of being diagnosed, treated, and learning to cope with the disease, many facets of the journey are missed. Understanding these individual experiences as a journey, instead of just diagnosis, treatment, and coping, has practical implications for healthcare providers treating endometriosis.</p> / Thesis / Doctor of Philosophy (PhD)

Endometriosis is a pervasive, widespread disease that affects millions of women worldwide. The number of women affected by endometriosis is increasing at a staggering rate. Endometriosis impacts women in a variety of ways; it often gradually strips away their resistance to pain, their emotional strength, their concept of femininity and their ability to cope with challenges. This study aimed to provide a voice for women diagnosed with endometriosis. The study allowed the participants to share their experiences from diagnosis through to treatment and to explain the ways in which endometriosis influences their daily lives. In this research report the psychological impact of this disease is discussed, and factors that are not currently addressed by medical professionals treating women with endometriosis are highlighted. Social constructionism provided the theoretical framework for the study. One-on-one, in-depth interviews were conducted with five women who have been diagnosed with endometriosis by a gynaecologist through means of laparoscopic surgery. The method of analysis involved thematic network analysis. The participants’ narratives were converted into interview transcripts. These transcripts were analysed by the researchers and themes were identified. Themes that repeated were elaborated and were linked to available literature. The researcher hopes that this dissertation will contribute to existing knowledge regarding the psychological effects of endometriosis. It is hoped that it will help both the medical community and future and existing patients understand this disease and the effect that it has on the lives of women around the world, but particularly the lives of women in South Africa. / Psychology / M. Sc. (Psychology)

Endometriosis is a pervasive, widespread disease that affects millions of women worldwide. The number of women affected by endometriosis is increasing at a staggering rate. Endometriosis impacts women in a variety of ways; it often gradually strips away their resistance to pain, their emotional strength, their concept of femininity and their ability to cope with challenges. This study aimed to provide a voice for women diagnosed with endometriosis. The study allowed the participants to share their experiences from diagnosis through to treatment and to explain the ways in which endometriosis influences their daily lives. In this research report the psychological impact of this disease is discussed, and factors that are not currently addressed by medical professionals treating women with endometriosis are highlighted. Social constructionism provided the theoretical framework for the study. One-on-one, in-depth interviews were conducted with five women who have been diagnosed with endometriosis by a gynaecologist through means of laparoscopic surgery. The method of analysis involved thematic network analysis. The participants’ narratives were converted into interview transcripts. These transcripts were analysed by the researchers and themes were identified. Themes that repeated were elaborated and were linked to available literature. The researcher hopes that this dissertation will contribute to existing knowledge regarding the psychological effects of endometriosis. It is hoped that it will help both the medical community and future and existing patients understand this disease and the effect that it has on the lives of women around the world, but particularly the lives of women in South Africa. / Psychology / M. Sc. (Psychology)

Bakgrund: Endometrios är en kronisk gynekologisk sjukdom som drabbar mellan 5-10% av alla kvinnor i fertil ålder. Det finns okunskap inom området hos både vårdgivare och allmänheten. Syfte: Syftet med litteraturstudien var att beskriva kvinnors erfarenheter av att leva med endometrios.                                         Metod: Via databaserna CINAHL, PubMed och EBSCO valdes nio kvalitativa studier ut. Resultaten har kvalitetsgranskats, analyserats och sammanställts. Resultat: Litteraturstudien visade att leva med endometrios innebar negativ påverkan på kvinnors fysiska, psykiska och emotionella hälsa. Tre huvudkategorier ”Att hantera sin vardag”, ”Att möta hälso- och sjukvården” och ”Att oroa sig för framtiden” sammanfattade olika aspekter av kvinnornas upplevelser. Socialt liv och relationer påverkades av sjukdomen till följd av mycket smärta. Tillståndet togs inte heller på allvar vid kontakter med hälso-och sjukvården vilket medförde att de drabbade inte fick den vård eller behandling som behövdes. Konklusion: Att leva med endometrios innebär en stor påfrestning för de drabbade. Kvinnorna är i behov av mer stöd och information från vården och det är viktigt att sjuksköterskan har den kunskap som behövs för att känna igen sjukdomen. / Background: Endometriosis is a chronic gynecological disease that affects 5-10% of all women of reproductive age. There is ignorance in public and in health care concerning this disease. Aim: The aim of this study was to describe women’s experiences of living with endometriosis. Method: Nine qualitative studies were selected through the databases CINAHL, PubMed and EBSCO. The results have been quality reviewed, analyzed and compiled. Results: The literature review showed that living with endometriosis meant negative impact on women's physical, mental and emotional health. Three main categories of "Coping with everyday life ", "Meeting the health service " and " Worry about the future," summarized the various aspects of women's experiences. Social life and relationships were affected by the disease as a result of a lot of pain. The health care didn’t take the illness seriously, which meant that the women did not get the care or treatment needed. Conclusion: Living with endometriosis results in great emotional distress in those affected. These women are in need of more support and information from health care providers. It is important that nurses have the knowledge needed to identify the disease.

Endometriosis is a gynecological disease defined as the growth of endometrium outside of the uterus. Although linked to 50% of female infertility cases, current medical treatments fail to maintain fecundity. Since the survival of endometriotic lesions is dependent on their early neovascularization, antiangiogenic therapies specifically targeting blood vessel growth could be a promising therapeutic option for the treatment of endometriosis. Angiogenesis, the branching of new blood vessels from existing vasculature, promotes robust vascularization of lesions. ABT-898 (Abbott Laboratories), a thrombospondin-1 analog, induces endothelial cell apoptosis while sequestering pro-angiogenic growth factors. We postulated that ABT-898 would reduce endometriotic lesion vascularization while physiological angiogenesis and pregnancy remained unaffected in a murine model of endometriosis. The antiangiogenic effect of ABT-898 was tested in a human umbilical vein endothelial cell line revealing disruption of endothelial tube branching. Two in vivo experiments were conducted in which endometriosis was induced in female alymphoid BALB/c-Rag2-/-Il2rg-/- mice by adhering sections of human endometrium to the abdominal wall. Lesions from ABT-898 treated mice contained a reduced number of CD31+ endothelial cells and a decrease in blood flow supplying the lesion compared to 5% dextrose controls. Reproductive status was evaluated through maintenance of pregnancies up to gestation day 12 revealing unaffected implantation site structure and physiological angiogenesis. In a trans-generational study, pregnant F0 generation mice received ABT-898 or 5% dextrose injections on gestation days 7, 9, 11, 13, 15, 17, and 19. F1 generation mice were raised to reproductive age and bred resulting in litters (F2 generation) comparable in size to the F0 generation litters. Chronic exposure to ABT-898 did not affect angiogenic plasma cytokine levels in F0 generation mice. In addition, physiological angiogenesis was unaffected within the uteri of ABT-898 treated mice. Histological examination of the kidney, liver, ovary, and uterus revealed no structural abnormalities in F0 and F1 generations exposed to ABT-898. These results suggest that ABT-898 inhibits pathological angiogenesis within endometriotic lesions without affecting physiological angiogenesis involved in pregnancy and organ function across three generations of mice. Further research will establish the effects of ABT-898 on embryonic development, organ toxicity, and physiological angiogenesis in all organs. / Thesis (Master, Anatomy & Cell Biology) -- Queen's University, 2013-05-07 15:19:10.967

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