Bakgrund: Endometrios är en gynekologisk sjukdom som drabbar ett stort antal kvinnori hela världen. Ofta bemöts dessa kvinnor av kunskapsbrist, misstro och normaliserande attityder som förorsakar försening av diagnos, vård och behandling som skapar onödigt lidande för dessa kvinnor. Sjuksköterskor har en viktig funktion i bemötandet av dessa kvinnor genom att stödja kvinnan, skapa en god allians och ge relevant information. Syfte: Syftet med studien var att beskriva kvinnors upplevelser av livskvalitet vid endometrios samt att granska och beskriva de inkluderade artiklarnas datainsamlingsmetoder. Metod: Litteraturstudien har en deskriptiv design. Data insamlades via databaserna Medline/PubMed samt Cinahl och tolv artiklar återfanns, samtliga med kvalitativ ansats och ligger till grund för resultatet i studien. Resultat: Endometrios medför en kraftigt nedsatt livskvalitet som inverkar på deras parrelation samt sociala liv såsom arbete, skola och fritidsintressen. Kunskapsbrist inom vården leder till normalisering och fördröjd diagnos som skapar onödigt lidande för dessa kvinnor. Många av kvinnorna skapade egna strategier för att hantera sina symtom i  vardagen. Samtliga tolv artiklar med deskriptiv design, har samlat in data genom att intervjua kvinnorna om deras erfarenheter av att leva med endometrios. Slutsats: Endometrios påverkar markant kvinnornas vardag och samtliga relationer på ett negativt sätt. De påverkas både fysiskt, psykiskt och socialt vilket leder till att de får sin livskvalitet kraftigt sänkt. Med ökade kunskaper inom området kan stora ekonomiska besparingar göras om diagnos ställs i ett tidigare skede. Kvinnornas lidande skulle minska och deras livskvalitet öka avsevärt. / Background: Endometriosis is a gynaecological disease that affects a large number of women throughout the world. These women are often treated by the lack of knowledge, distrust and normalizing attitudes. That causes delay in diagnosis care and treatment, which creates unnecessary suffering. Nurses have an important function in the treatment of these women by supporting the woman, create a good alliance and provide relevant information. Aim: The aim of the study was to describe women's experiences of quality of life in endometriosis and to examine and describe the articles included data collection methods. Method: Literature study has a descriptive design. Data were collected through Medline / PubMed and CINAHL and twelve articles were found, all with qualitative approach. These articles were the basis for this study. Results: Endometriosis results in a greatly reduced quality of life that affects their partner, relationship and social life, such as work, school and hobbies. A lack of knowledge in health-care leads to normalization and delayed diagnosis that creates unnecessary suffering for these women. Many of the women created their own strategies to deal with their symptoms in daily life. All twelve articles with descriptive design have collected data by interviewing women about their experiences of living with endometriosis. Conclusion: Endometriosis affects significantly the women's daily lives, and all the relationships, in a negative way. Their health is affected physically, psychologically and socially with the result that they get their quality of life greatly reduced. Significant financial savings can be made by increased knowledge in the field and diagnosis at an earlier stage. Suffering from Endometriosis would be reduced, and the quality of life for those women’s will significantly increase.

Resveratrol, um fitoestrógeno natural tem sido visto como um opção potencial de tratamento para mulheres com endometriose, porém nenhum estudo clínico adequado foi realizado. Objetivo: Em comparação com placebo, o resveratrol (40mg/dia) reduz níveis de dor após 42 dias de uso em mulheres com endometriose usando pílula anticoncepcional monofásica (PAM). Delineamento do estudo: Neste estudo clínico randomizado, duplo-cego, controlado com placebo clínico, as mulheres com endometriose foram randomizados para receber PAM por 42 dias, para ser tomado com 42 cápsulas idênticas contendo 40 mg de resveratrol ou placebo em frascos codificados Os escores médios de dor foram medidos utilizando uma escala visual analógica (EVA) nos dias 0, 7, 21 e 42. Resultados: Este estudo decorreu entre Junho e Setembro de 2015 envolvendo 44 pacientes. Um software foi utilizado para a geração da sequência da randomização. Foram utilizados envelopes opacos selados e codificados para o cegamento. O tamanho da amostra foi calculada para ter uma chance de 95% de detectar, como significativa ao nível de 1%, uma redução de 90% em comparação com placebo e resveratrol em uma escala de 0 a 10 dor. Uma redução significativa nos níveis de dor foi encontrada entre o dia 0 e o dia 42, no grupo placebo (P = 0.02- de Equações estimação generalizada - GEE) e no grupo de resveratrol (P = 0,003 -GEE). (95% IC) Os escores médios de dor no dia 0 foram de 5,4 (4,2-6,6) no placebo e 5,7 (4,8-6,6) no grupo de resveratrol. Após 42 dias de tratamento, os valores de dor mediana foram [3,5 (2,2-4,9); n = 22] e [2,9 (1,8 a 4); n = 22] em relação ao placebo e resveratrol, respectivamente (p = 0,8 - GEE); diferença média entre os grupos (95% CI) foi de 0,75 (-1,6 a 2,3). Conclusão: Em mulheres com endometriose fazendo uso de pílula anticoncepcional monofásica, os escores de dor após 42 dias de utilização diária de 40 mg de resveratrol não foram significativamente diferentes do placebo. / Background: Resveratrol, a natural phytoestrogen, has been suggested as a possible treatment option for women with endometriosis, but there are no proper randomized clinical trial. Objective : Compared to placebo, does resveratrol (40 mg/day) reduce pain scores after 42 days of use in women with endometriosis using monophasic contraceptive pill (COC). Study Design: In this randomized double-blinded, placebo controlled clinical trial, women with endometriosis were randomized to receive COC for 42 days, to be taken with 42 identical capsules containing 40 mg of resveratrol or placebo in coded bottles. Median pain scores measured with an analog visual scale (AVS) on day 42 was the primary outcome. Results: This trial took place between June and September 2015 and enrolled 44 subjects. A software generated the randomization sequence. Allocation sequence was concealed in coded sequenced opaque sealed envelopes. Sample size was calculated to have a 95% chance of detecting, as significant at the 1% level, a 90% reduction comparing placebo and resveratrol in a 0 to 10 pain scale. A significant reduction in pain levels was found between day 0 and day 42, in placebo ( P =0.02- Generalized Estimating Equations - GEE) and in the resveratrol group ( P =0.003 -GEE). Mean (95%CI) pain scores at day 0 were 5.4 (4.2 to 6.6) in placebo and 5.7(4.8 to 6.6) in resveratrol groups. After 42 days of treatment, median pain values were [3.5 (2.2 to 4.9); n=22] and [2.9 (1.8 to 4); n=22] in the placebo and in the resveratrol groups, respectively ( P =0.8 - GEE); median difference between groups (95%CI) was 0.75 ( -1.6 to 2.3). Conclusion : In women with endometriosis in use of monophasic contraceptive pill, pain scores after 42 days of daily use of 40 mg of resveratrol are not significantly different from placebo.

Orientador: Cláudia Aparecida Rainho / Banca: Maria Claudia Moura Campos / Banca: Ester Silveira Ramos / Resumo: 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)... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: 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) / Mestre

Endometriosis is a benign inflammatory disorder, defined by the presence of endometrial tissue outside the uterus with lesions typically found on the pelvic peritoneum in close association with the peritoneal mesothelium. The prevalence of endometriosis is estimated at 6-10% of women of reproductive age and it is associated with chronic pelvic pain, dysmenorrhoea, dyspareunia and infertility. Surgical excision can provide symptom relief, but symptoms recur in up to 75% of surgical cases and available medical treatments have undesirable side effects. New treatments are limited due to our poor understanding of the aetiology of endometriosis. To date, the majority of research has focused on changes within the ectopic endometrial tissue to explain the development of endometriosis lesions, however, there is increasing evidence that the peritoneal mesothelium plays an important role. According to Sampson’s theory of retrograde menstruation, ectopic endometrial cells must first have to attach to the surface of the peritoneum before undergoing invasion, proliferation, and neoangiogenesis. TGF-β1 is an inflammatory growth factor that regulates a variety of cellular functions including; cell adhesion, cell invasion and angiogenesis. Levels of TGF-β1 are increased in the peritoneal fluid of women with endometriosis compared to controls and research using a mouse model of endometriosis has demonstrated TGF-β1-null mice to develop smaller and fewer endometriosis lesions than their wild-type controls. Together these studies suggest that TGF-β1 plays a major role in the development of peritoneal endometriosis lesions and that targeting this pathway may be of therapeutic potential. However the functional role that TGF-β1 plays in peritoneal endometriosis is still unclear. The overall aim of this thesis was to determine if the peritoneal expression of TGF-β and its target genes are disrupted in women with endometriosis and whether this could contribute to the development of endometriosis lesions. Our first aim was to determine if the peritoneum was a source of TGF-β expression and if reception and/or signalling were altered in women with endometriosis. We found that the peritoneal fluid of women with endometriosis contained increased concentrations of TGF-β1 and that peritoneal mesothelial cells adjacent to endometriosis lesions expressed significantly higher levels of TGF-β1 mRNA. Analysis of TGF-β signalling targets within the peritoneum showed that women with endometriosis express significantly higher levels of TGF-β targeted genes associated with tumourigenesis processes including; EMT, invasion and angiogenesis. We next asked if there are changes in the metabolic phenotype of endometriosis lesions and peritoneum in women with endometriosis, similar to the metabolic changes seen in tumour cells. Endometriosis lesions expressed markers of aerobic glycolysis, including HIF-1α, suggesting that lesions may metabolise in a similar fashion to tumours. Furthermore, peritoneum adjacent to endometriosis lesions expressed significantly higher levels of markers of aerobic glycolysis, including HIF-1α, suggesting that the peritoneum may feed forward high-energy lactate, a by-product of glycolysis, to the endometriosis lesions. These observations were supported by significantly increased lactate concentrations within the peritoneal fluid of women with endometriosis that positively correlated with levels of TGF- β1. TGF-β1 was shown to increase expression of glycolysis markers and lactate expression in peritoneal mesothelial cells in-vitro, suggesting TGF-β may regulate this change. We then determined if TGF-β1 was responsible for the change in peritoneal mesothelial cell metabolism by signalling through the ID-HIF-1α pathway. ID proteins are transcription factors, whose expression is regulated by the TGF-β superfamily. We found expression of ID1 mRNA to be increased in the peritoneum of women with endometriosis and that TGF-β1 significantly increased ID1 but decreased ID2 expression in the peritoneal mesothelial cells in-vitro. ID1 siRNA knockdown decreased glycolysis initiator HIF-1α mRNA and ID2 siRNA knockdown increased HIF-1α mRNA and lactate expression, suggesting TGF-β1 regulates mesothelial cell metabolism, at least in part, through the ID pathway. ID transcription factors are also known to regulate VEGF-A expression, therefore we next determined if TGF-β1 induced ID1 and/or reduced ID2 expression in the peritoneum promoted VEGF-A mRNA and protein expression. VEGF-A, a cytokine essential for angiogenesis, was significantly increased in the peritoneal fluid of women with endometriosis and levels positively correlated with TGF-β1. TGF-β1 increased VEGF-A expression in-vitro and siRNA knockdown of ID1 decreased and siRNA knockdown of ID2 increased VEGF-A mRNA and protein expression in the peritoneal mesothelial cell. Lastly we aimed to determine if TGF-β1 induces EMT in peritoneal mesothelial cells. The peritoneum of women with endometriosis expressed higher levels of EMT markers. Exposure of peritoneal mesothelial cells to TGF-β1 in-vitro induced EMT-like changes, including; changes to cell morphology, gene expression and protein localisation. Peritoneal mesothelial cells were more migratory and invasive suggesting that TGF-β1 induced EMT may disrupt the mesothelial cell monolayer allowing ectopic endometrial cells to invade the peritoneal tissue or for peritoneal mesothelial cells to migrate into endometriosis lesions. In summary, the novel data presented in this thesis provides evidence that the pelvic peritoneum and in particular the peritoneal mesothelial cell may play a critical role in the aetiology of peritoneal endometriosis. Expression of TGF-β1 and its transcriptional target genes are dysregulated in the peritoneum of women with endometriosis. TGF-β regulated ID expression may induce changes in cell metabolism and promote neoangiogenesis, prompting peritoneal endometriosis lesion development. Furthermore other TGF-β1 transcriptional targets, such as those involved in EMT, are also altered in the peritoneum of women with endometriosis and may contribute the development and maintenance of lesion formation. These results point to a central role for TGF-β1 expression and signalling in the aetiology of peritoneal endometriosis. Furthermore it is likely that changes within the expression profile and morphology of the peritoneal mesothelial cells contribute to peritoneal lesion formation. Drugs that target these pathways may provide new therapies for women with endometriosis.

There are few data available about the menstrual patterns of Australian teenagers and the prevalence of menstrual disorder in this age group. Aims To establish the typical experience of menstruation in a sample of 16-18 year old women attending ACT Secondary Colleges of Education. To determine the number of teenagers experiencing menstrual disorder that could require further investigation and management. Method The MDOT questionnaire was used to survey participants about their usual pattern of menstruation, signs and symptoms experienced with menses and how menstruation affected various aspects of their lives including school attendance, completion of school work, relationships, social, sexual and physical activity. Data analysis included exploration of aggregated data, as well as individual scrutiny of each questionnaire to determine menstrual disturbance requiring follow up. Those participants whose questionnaire indicated a requirement for further investigation, and who consented to being contacted, were followed up through an MDOT Clinic. Results One thousand and fifty one (1,05 1) completed questionnaires - 98% response rate. The typical experience of menstruation in the MDOT sample includes: bleeding patterns within normal parameters for this age group; menstrual pain, 94%; cramping pain, 71 %; symptoms associated with menstruation, 98.4%; PMS symptoms, 96%; mood disturbance before or during periods, 73%; school absence related to menstruation, 26%; high menstrual interference on one or more life activity, 55.8%; asymptomatic menstruation, 1 %; True response to 'My periods seem pretty normal' 7 1.4%. Statistically significant associations were found between each and all of: menstrual pain, symptoms, interference on life activities and school absence. The prevalence of significant menstrual disturbance in the sample is approximately 25% where: 2 1 % experienced severe pain; 26% reported school absence; 33% had seen a GP about periods; 26.9% think there is something wrong with periods; 23.5% require follow up based on individual scrutiny of each questionnaire; 10- 14% require further investigation to rule out endometriosis. Referral and investigation of menstrual pain, symptoms, and diagnosis of menstrual pathology in the sample was low. Conclusion The MDOT questionnaire has helped to establish a clearer picture of typical menstruation in the population sample. Where 1% of girls reported having asymptomatic menstruation, the majority of teenagers in the study reported menstrual pain and symptoms that could be experienced as part of the dysmenorrhoeic syndrome of symptoms, PMS, or underlying pathology such as endometriosis. Due to the overlap in symptoms and a propensity to be dismissive of menstrual pain and symptoms, many girls are suffering menstrual morbidities that could be well managed with NSAIDs and the oral contraceptive pill (OCP) if non-pathological, or investigated further if a menstrual pathology is suspected. Considering these results the reported school absence rate of 26% is not surprising. Whilst this study does not cost the true impact of menstrual disturbance on schooling, the results of the MDOT questionnaire reflect significant physical and emotional impact on a considerable number of teenager's lives which could also have repercussions on education, schooling performance and other areas of their lives. Future research is planned to determine the MDOT questionnaire's validity for identifying pathological menstrual disorder so it can act as a screening tool to facilitate earlier detection. Replication of the MDOT study should be done in younger teenagers (from menarche) to determine menstrual disturbance in the younger age group.

ABSTRACT Background Cutaneous melanoma is a potentially lethal cancer for which incidence rates have risen dramatically in white-skinned populations worldwide over the past decades. While some risk factors for melanoma have been clearly established, such as pigmentary characteristics, sun exposure, and familial history of the disease, emerging evidence suggests that other factors, such as hormonal and genetic factors, may play a role in the aetiology of this cancer. The present work aimed at 1) examining the relationships between hormonal factors, benign gynaecological conditions, and the risk of melanoma, and 2) to explore shared risk factors for endometriosis and melanoma in a large French prospective cohort; and 3) to study the potential associations between novel naevus-associated gene variants and the risk of melanoma in a large Australian population-based study. Methods The E3N prospective cohort includes 98,995 French women insured by a national scheme mostly covering teachers, and aged 40-65 years at inclusion. Women were followed-up approximately every two years starting in 1990 through self-administered questionnaires. A first investigation focused on the potential association between a personal history of endometriosis or of other benign gynaecological conditions and the risk of melanoma, which was examined in the E3N cohort using Cox proportional hazards regression models. A second study explored the potential relationships between cutaneous phenotypic factors associated with melanoma and the risk of endometriosis in the E3N cohort, using unconditional logistic regression models. A third investigation used data from the Q-MEGA (an Australian study that followed-up four population-based samples of melanoma patients in Queensland, diagnosed between 1987 and 1995), as well as from the BTNS (a study including adolescent twins and their parents), from which the parents of the twins served as healthy controls in the present investigation. The association between novel naevus-associated gene variants and the site- and subtype-specific risk of melanoma was assessed using unconditional multinomial logistic regression models. Results A significantly positive association was observed between a personal history of endometriosis and the risk of melanoma in the E3N cohort, as well as a significantly positive association between a personal history of uterine fibroma and melanoma risk. The association between endometriosis and melanoma was even stronger when restricting to endometriosis reported as treated or diagnosed by laparoscopic surgery. However, a history of ovarian cyst, uterine polyp, breast adenoma/fibro-adenoma or breast fibrocystic disease was not significantly associated with the risk of melanoma. Also, significantly positive dose-effect relationships were found in the E3N cohort between the risk of endometriosis and skin sensitivity to sun exposure, number of naevi, and number of freckles, while no significant associations were found with hair or skin colour. Finally, variants of MTAP, PLA2G6 and IRF4 were significantly associated with the propensity to develop naevi in the Q-MEGA study. There was also a statistically significant association between MTAP rs10757257 and the risk of melanoma. Although there was no evidence that this association varied according to anatomical site of the tumour, the risk alleles of this polymorphism were more common in patients with superficial spreading melanoma or nodular melanoma than in controls, while patients with melanoma of the lentigo maligna type were no more likely than controls to carry these alleles. In contrast, no association was found between PLA2G6 and IRF4 variants and the risk of melanoma, globally or by site or type of melanoma. Conclusion The present findings suggest a positive association between endometriosis and melanoma, for which they constitute the strongest evidence to date. This finding may reflect the existence of shared risk factors between endometriosis and melanoma, which is supported by the finding of significant associations between endometriosis and some cutaneous phenotypic traits that are established risk factors for melanoma. Because these traits are mostly genetically determined, it can be speculated that endometriosis and melanoma share similar genetic characteristics. More research will be needed in order to clarify common pathways between endometriosis and melanoma. The finding of a positive association between uterine fibroma and melanoma risk had not been previously reported and warrants further investigation. The presented results also confirm an association between MTAP, PLA2G6 and IRF4 variants and naevus propensity, as well as an association between MTAP and melanoma. The findings suggest that the relationship is subtype-specific, which confirms and further refines the overarching “divergent pathways” model. Since MTAP is located at the same locus as CDKN2A, which has also been associated with naevus counts, further research will be necessary to determine whether these results can be attributed to MTAP independently of CDKN2A.

Thesis (Ph. D.)--University of Washington, 2006. / Vita. Includes bibliographical references (leaves 69-98).

During the normal menstrual cycle, the human endometrium undergoes extensive tissue remodelling under the influence of ovarian-derived hormones. The endometrium has well defined stromal and epithelial compartments with the former containing both a well-developed vasculature as well as a diverse population of immune cells. Mast cells (MCs) are long-lived tissue resident immune cells characterised by the presence of granules containing proteases. Mast cells have been detected in the human uterus but little is known about their regulation or the impact of steroids on their differentiation status. Recently MCs have been implicated as key players in physiological and pathological pain pathways but little is known about their role in endometrial pathologies. Endometriosis is a chronic incurable condition characterized by the presence of endometrial tissue outside the uterine cavity: women with endometriosis can suffer from a debilitating range of symptoms including chronic pain. Whilst the aetiology of endometriosis is uncertain, close proximity between MCs and nerves has implicated them in aberrant activation of pain pathways. The aims of the current project were: 1. To determine the spatial and temporal location of uterine MCs and to explore their phenotype including expression of steroid receptors. 2. To explore the activation status of MCs in women with endometriosis and/or pain, 3. To explore the use of cells and mice as models to investigate the phenotype of mast cells and their regulation by steroids. Mast cell proteases tryptase and chymase were detected by RTPCR and immunohistochemistry in “full thickness” (uterine lumen to endometrial-myometrial junction) biopsies from women undergoing hysterectomy. In agreement with previous findings MCs were most abundant in the myometrium. Uterine MCs were predominantly of the classical MC subtypes: tryptasepos/chymaseneg and tryptasepos/chymasepos but a rare third subtype was also identified as tryptaseneg/chymasepos. Mast cell activation/degranulation was cycle stage dependent and for the first time their steroid receptor phenotype was identified as ERαneg/ERβpos/GRpos, suggesting potential regulation by the uterine steroid microenvironment. Studies on tissue samples from women with endometriosis revealed MCs with an altered activation status in the pelvic peritoneal wall, compared to controls, which showed an intense diffuse immunoexpression of chymase suggestive of MC activation and release of this protease during normal physiology of the peritoneum. Surprisingly, analysis of peritoneal fluids from controls, women with pain but no endometriosis, and pain with endometriosis did not detect differences in numbers of MCs or concentrations of tryptase or chymase. Analysis of peritoneal biopsies also provided the first evidence for a striking increase in immunoexpression of PAR-2, a protease-activated receptor, in women suffering from chronic pelvic pain and/or endometriosis which may provide a mechanism by which mast cell derived factors may alter pain pathways. Studies in a mouse model of endometriosis identified MCs within endometria-llike lesions and offer a platform for future studies. In vitro explorations using MCs derived from peripheral blood precursors and HMC-1, a cell line derived from a patient with MC leukaemia confirmed expression of ERβ but did not support previous studies claiming cells were ERαpos. In summary, this study has provided novel insights into the phenotype of endometrial mast cells in the normal cycling endometrium and contrasted them with those in women with endometriosis and pelvic pain. This is the first study to identify MCs as ERβpos. Further studies are required to determine whether inhibition of PAR- 2 might offer a therapeutic target in women with chronic pelvic pain.

Introdução: Endometriose é uma doença benigna que afeta mulheres em idade fértil. Tem caráter multifatorial estrogenodependente associado à resposta inflamatória generalizada na cavidade peritoneal e sendo a causa mais comum de dor pélvica crônica. Objetivos: O estudo comparou o efeito da melatonina (10 mg/dia) com placebo na dor e níveis séricos do Brainderived neurotrophic factor (BDNF) de pacientes com endometriose. Métodos: Foi realizado um ensaio clínico randomizado, duplo-cego, em paralelo, controlado com placebo. Foram incluídas mulheres com idade entre 24 e 52 anos com diagnóstico de endometriose por laparoscopia selecionadas a partir da agenda diária de consultas do ambulatório de Ginecologia e por chamamento na mídia local, no período de setembro de 2010 a abril de 2012. Foram utilizados questionários para avaliar a frequência e a intensidade da dor (na relação sexual, na micção e no trabalho), sintomas depressivos, nível de pensamento catastrófico e o Structured Clinical Interview for DSM-IV (SCID) para diagnósticos psiquiátricos.Resultados: Na analise por intenção de tratar a média de dor no período menstrual foi de 4,8 cm ± 0,15 no grupo que recebeu melatonina (n=20) e de 6,9 cm ± 0,13 no grupo placebo (n=20), com diferença média (ajustada para o efeito de cada paciente) de 2,147 cm na escala análogo visual de dor (EAV) (IC 95%; 1,767 a 2,527; p<0,001). Também houve diferença entre as médias de dor ao urinar (diferença média=0,660; IC 95%; 0,348 a 0,971; p<0,001) e dor ao evacuar (diferença média=0,515; IC 95%; 0,180 a 0,849; p=0,003). Pacientes que receberam melatonina tiveram redução nos níveis séricos de BDNF. Conclusões: O uso da melatonina foi associado à redução da dor mesmo fora do período menstrual em pacientes com endometriose. O tratamento também reduziu os níveis de BDNF, sugerindo mudança em sistemas moduladores de dor. Tais achados sugerem que a melatonina é eficaz no tratamento da endometriose. / Background: Endometriosis is a benign condition that affects women in childbearing age. It is a estrogen-dependent disease, multifactorial, associated with a generalized inflammatory response in the peritoneal cavity, being the most common cause of chronic pelvic pain. Objective: This study have compared the effect of melatonin 10 mg / day with placebo in pain and in serum levels of brain-derived neurotrophic factor (BDNF) in patients with endometriosis. Methods: We conducted a randomized, double-blind, parallel, placebocontrolled trial. We included women at aged between 24 and 52 years with the diagnosis of endometriosis by laparoscopy selected from the daily schedule of consultations of the Gynecology outpatient clinic and by calling the local media, for the period September 2010 to April 2012. Questionnaires were used to evaluate the frequency and intensity of pain (during intercourse, urination and work), depressive symptoms, level of catastrophic thinking and the Structured Clinical Interview for DSM-IV (SCID) for psychiatric diagnoses. Results: In the analysis by intention to treat, the mean pain during menstruation was 4.8 ± 0.15 cm in the group receiving Melatonin (n = 20) and 6.9 ± 0.13 cm in the group placebo (n = 20), with mean difference (adjusted for the effect of each patient) of 2.147 cm in VAS (95% CI 1.767 to 2.527, p <0.001). There were also differences between the means of pain when urinating (mean difference = 0.660 95% CI 0.348 to 0.971, p <0.001), and pain when defecating (mean difference = 0.515 95% CI 0.180 to 0.849, p = 0.003). Patients who received melatonin had reduced serum levels of BDNF. Conclusion: The use of melatonin was associated with reduced pain even outside the menstrual period in women with endometriosis. The treatment also reduced levels of BDNF, suggesting change in pain modulatory systems. These findings suggest that melatonin is effective in the treatment of endometriosis.

PEREIRA, Francisco Edson Ximenes Gomes. Desenvolvimento e validação de um modelo de endometriose subcutânea em ratas para estudo de prováveis mecanismos fisiopatológicos e do efeito de drogas. 2013. 78 f. Dissertação (Mestrado em Cirurgia) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2013. / Submitted by denise santos (denise.santos@ufc.br) on 2015-06-09T14:03:50Z No. of bitstreams: 1 2013_dis_fexgpereira.pdf: 2408184 bytes, checksum: 17fc1ad57840167dcb5d178662d0dedd (MD5) / Approved for entry into archive by denise santos(denise.santos@ufc.br) on 2015-06-09T14:11:04Z (GMT) No. of bitstreams: 1 2013_dis_fexgpereira.pdf: 2408184 bytes, checksum: 17fc1ad57840167dcb5d178662d0dedd (MD5) / Made available in DSpace on 2015-06-09T14:11:04Z (GMT). No. of bitstreams: 1 2013_dis_fexgpereira.pdf: 2408184 bytes, checksum: 17fc1ad57840167dcb5d178662d0dedd (MD5) Previous issue date: 2013 / Endometriosis is defined as the presence of endometrial tissue (gland and stroma) outside the uterus. The objective of this study was to design a model of subcutaneous endometriosis in rats for the evaluation of the effect of drugs and the pathophysiology of endometriosis. Initially, female Wistar rats (Rattus norvergicus) were implanted subcutaneously with 4x4 mm uterine fragments to evaluate endometrioma growth after 1, 7, 14 and 21 days. Endometrial tissue implants were confirmed by histological analysis. The greatest relative weight gain was observed on the 14th day (wet weight 29.17 ± 6.79 mg%; dry weight 5.36 ± 0.97 mg%). Subsequently, animals were assigned to treatment groups and given either estradiol (2.5 mg/kg, 5 mg/kg, 10 mg/kg sc), medroxyprogesterone acetate (0.5 mg/kg, 2 mg/kg, 5 mg/kg sc), triptorelin pamoate (0.18 mg/kg, 0.56 mg/kg sc) and acetylsalicylic acid (3 mg/kg gavage) on the fifth day following implantation. Wet and dry relative weight of the endometrioma were used as a indicator of growth for model of endometriosis. In the group treated with estradiol, the average wet weight and dry weight on the 14 th day following implantation was 36.62 ± 4.97 mg% and 3.97 ± 1 mg% (2.5 mg), 56.37 ± 20.19 mg% and 9.11 ± 3.85 mg% (5 mg), and 173.89 ± 69.53 mg% and 27.67 ± 10.27 mg% (10 mg), respectively. In the group treated with medroxyprogesterone acetate, the corresponding figures were 13.58 ± 2.53 mg% and 2.67 ± 0.5 mg% (0.5 mg), 14.29 ± 2.07 mg% and 3.71 ± 1.31 mg% (2 mg), and 15.33 ± 7.08 mg% and 2.68 ± 1.44 mg% (5 mg). In the group treated with triptorelin pamoate, the corresponding figures were 20.04 ± 4.02 mg% and 5.21 ± 1.54 mg% (0.18 mg), and 10.86 ± 1.88 mg% and 1.89 ± 0.29 mg% (0.56 mg). In the group treated with 3 mg acetylsalicylic acid, the corresponding figures were 12.81 ± 2.04 mg% and 2.09 ± 0.4 mg%. In the estradiol group, growth gain was dose-dependent: animals receiving 10 mg differed significantly from animals receiving lower doses and from untreated animals (p<0.0001). In conclusion, the model was found to be reproducible and easy to use. / A endometriose é definida como a presença de tecido endometrial (glândula e estroma) fora do útero (mais precisamente revestimento endometrial). O objetivo foi desenvolver e validar um modelo de endometriose subcutânea em ratas para estudo de prováveis mecanismos fisiopatológicos e do efeito de drogas. Inicialmente, as ratas (Rattus norvergicus, linhagem Wistar) foram implantadas subcutaneamente com fragmentos uterinos 4x4 mm para avaliar o crescimento de endometrioma após 1, 7, 14 e 21dias. Implantes de tecido endometrial foram confirmados por análise histológica. O maior ganho de peso relativo do endometrioma foi observado no dia 14 (peso úmido relativo 29,1 ± 6,79 mg%, peso seco relativo 5,36 ± 0,97 mg%). Posteriormente, os animais foram divididos em grupos e receberam estradiol (2,5 mg/kg, 5 mg/kg, 10 mg/kg sc), acetato de medroxiprogesterona (0,5 mg/kg, 2 mg/kg, 5 mg/kg sc), pamoato de triptorrelina (0,18 mg/kg, 0,56 mg/kg sc) e ácido acetilsalicílico (3 mg/kg gavagem) no quinto dia após a implantação. Peso úmido relativo e seco relativo do endometrioma foram usados como um indicador de crescimento para o modelo de endometriose. No grupo tratado com estradiol, o peso úmido relativo médio e peso seco relativo médio no dia 14 após a implantação foi de 36,62 ± 4,97 mg% e 3,97 ± 1mg % (2,5 mg/kg), 56,37 ± 20,19 mg% e 9,11 ± 3,85 mg% (5 mg/kg), 173,89 ± 69,53 mg% e 27,67 ± 10,27 mg% (10 mg/kg), respectivamente. No grupo tratado com acetato de medroxiprogesterona, os valores correspondentes foram 13,58 ± 2,53 mg% e 2,67 ± 0,5 mg% (0,5 mg/kg), 14,29 ± 2,07 mg% e 3,71 ± 1,31 mg% (2 mg/kg), e 15,33 ± 7,08 mg% e 2,68 ± 1,44 mg% (5 mg/kg). No grupo tratado com pamoato de triptorrelina, os valores correspondentes foram 20,04 ± 4,02 mg% e 5,21 ± 1,54 m% (0,18 mg/kg), e 10,86 ± 1,88 mg% e 1,89 ± 0,29 mg% (0,56 mg/kg). No grupo tratado com ácido acetilsalicílico 3 mg/kg, os valores correspondentes foram 12,81 ± 2,04 mg% e 2,09 ± 0,4 mg%. No grupo de estradiol, o ganho de crescimento foi dependente da dose: os animais que receberam 10 mg/kg diferiram significativamente dos animais que receberam doses mais baixas e a partir de animais não tratados (p < 0,0001). Em conclusão, o modelo mostrou ser reprodutível e fácil de usar.