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Adiposity and Endometriosis Severity and Typology.

肥胖与子宫内膜异位症的严重程度和类型。

  • 影响因子:1.69
  • DOI:10.1016/j.jmig.2020.01.002
  • 作者列表:"Byun J","Peterson CM","Backonja U","Taylor RN","Stanford JB","Allen-Brady KL","Smith KR","Buck Louis GM","Schliep KC
  • 发表时间:2020-01-09
Abstract

STUDY OBJECTIVE:Prior research collectively shows that endometriosis is inversely related to women's adiposity. The aim of this study was to assess whether this inverse relationship holds true by disease severity and typology. DESIGN:Cross sectional study among women with no prior diagnosis of endometriosis. SETTING:Fourteen clinical centers in Salt Lake City, Utah and San Francisco, California. PATIENTS:Four hundred and ninety five women, ages 18-44 years, were enrolled in the operative cohort of the Endometriosis, Natural History, Diagnosis, and Outcomes (ENDO) Study. INTERVENTIONS:Gynecologic laparoscopy/laparotomy, regardless of clinical indication. MEASUREMENTS AND MAIN RESULTS:Participants underwent anthropometric assessments, body composition, and body fat distribution ratios before surgery. Surgeons completed a standardized operative report immediately after surgery to capture revised ASRM staging (I to IV) and typology of disease (superficial [SE], ovarian endometrioma [OE], and deep infiltrating endometriosis [DIE]). Linear mixed models, taking into account within-clinical-center correlation were used to generate least square means (95% confidence intervals) to assess differences in adiposity measures by endometriosis stage (no endometriosis, I-IV) and typology (no endometriosis, SE, DIE, OE, OE + DIE) adjusting for age, race/ethnicity, and parity. While the majority of confidence intervals were wide and overlapping, three general impressions emerged: 1) women with versus without incident endometriosis had the lowest anthropometric/body composition indicators; 2) women with stage I or IV had lower indicators compared to women with stage II or III; and 3) women with OE and/or DIE tended to have the lowest indicators, while women with SE had the highest indicators. CONCLUSION:Our research highlights that the relationship between women's adiposity and endometriosis severity and typology may be more complicated than prior research indicates.

摘要

研究目的: 以往的研究共同表明,子宫内膜异位症与女性肥胖呈负相关。本研究的目的是评估这种反向关系是否符合疾病严重程度和类型。 设计: 在既往无子宫内膜异位症诊断的妇女中进行横断面研究。 单位: 位于犹他州盐湖城和加利福尼亚州旧金山的 14 个临床中心。 患者: 子宫内膜异位症手术队列、自然史、诊断和结局 (ENDO) 研究入组了 4 95 例女性,年龄 18-44 岁。 干预措施: 妇科腹腔镜/开腹手术,不考虑临床指征。 测量和主要结果: 参与者在手术前接受了人体测量评估、身体成分和体脂分布比率。外科医生在手术后立即完成标准化手术报告,以捕获修订的 ASRM 分期 (I 至 IV) 和疾病类型 (浅表 [SE],卵巢子宫内膜异位囊肿 [OE], 和深部浸润型子宫内膜异位症 [死亡])。考虑到临床-中心内相关性的线性混合模型被用来产生最小二乘均值 (95% 置信区间) 来评估子宫内膜异位症分期 (无子宫内膜异位症, i-IV) 和类型 (无子宫内膜异位症、 SE 、 DIE 、 OE + DIE) 调整年龄、种族/种族和胎次。虽然大多数置信区间很宽且重叠,但出现了三种总体印象: 1) 子宫内膜异位症与无子宫内膜异位症的女性的人体测量/身体组成指标最低; 2) 与 II 期或 III 期妇女相比,I 期或 IV 期妇女的指标较低; 和 3)患有 OE 和/或死亡的女性往往指标最低,而患有 SE 的女性指标最高。 结论: 我们的研究强调了女性肥胖与子宫内膜异位症严重程度和类型之间的关系可能比以前的研究表明更复杂。

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相关文献
影响因子:1.41
发表时间:2020-01-09
DOI:10.1111/ajo.13112
作者列表:["Alhayo S","Leonardi M","Lu C","Gosal P","Reid S","Barto W","Condous G"]

METHODS:BACKGROUND:Ultrasound has been demonstrated to accurately diagnose rectal deep endometriosis (DE) and pouch of Douglas (POD) obliteration. The role of ultrasound in the assessment of patients who have undergone surgery for rectal DE and POD obliteration has not been evaluated. AIM:To describe the transvaginal ultrasound (TVS) findings of patients who have undergone rectal surgery for DE. MATERIALS AND METHODS:An observational cross-sectional study at a tertiary care centre in Sydney, Australia between January and April 2017. Patients previously treated for rectal DE (low anterior resection vs rectal shaving/disc excision) were recruited and asked to complete a questionnaire on their current symptoms. On TVS, POD state and rectal DE were assessed. Correlating recurrence of POD obliteration and/or rectal DE to surgery type and symptoms was done. RESULTS:Fifty-six patients were contacted; 22/56 (39.3%) attended for the study visit. Average interval of surgery to study visit was 52.8 ± 24.6 months. Surgery type breakdown was as follows: low anterior resection (56%) and rectal shaving/disc excision (44%). The prevalence of POD obliteration was 16/22 (72.7%) intraoperatively and 8/22 (36.4%) at study visit, as per the sliding sign. Nine patients (39.1%) had evidence on TVS of recurrent rectal DE. Recurrence of POD obliteration and rectal DE was not associated with surgery type or symptomatology. CONCLUSION:Despite surgery for rectal DE, many patients have a negative sliding sign on TVS, representing POD obliteration, and rectal DE. Our numbers are too small to correlate with the surgery type or their current symptoms.

翻译标题与摘要 下载文献
影响因子:2.02
发表时间:2020-01-10
DOI:10.1007/s00261-019-02399-0
作者列表:["Burnett TL","Feldman MK","Huang JQ"]

METHODS::Minimally invasive surgery for complex endometriosis requires preoperative planning that intimately connects the gynecologic surgeon to the radiologist. Understanding the surgeon's perspective to endometriosis treatment facilitates a productive relationship that ultimately benefits the patient. We examine minimally invasive surgery for endometriosis and the key radiologic information which enable the surgeon to successfully negotiate patient counseling, preoperative planning, and an interdisciplinary approach to surgery.

影响因子:1.69
发表时间:2020-01-09
DOI:10.1016/j.jmig.2020.01.002
作者列表:["Byun J","Peterson CM","Backonja U","Taylor RN","Stanford JB","Allen-Brady KL","Smith KR","Buck Louis GM","Schliep KC"]

METHODS:STUDY OBJECTIVE:Prior research collectively shows that endometriosis is inversely related to women's adiposity. The aim of this study was to assess whether this inverse relationship holds true by disease severity and typology. DESIGN:Cross sectional study among women with no prior diagnosis of endometriosis. SETTING:Fourteen clinical centers in Salt Lake City, Utah and San Francisco, California. PATIENTS:Four hundred and ninety five women, ages 18-44 years, were enrolled in the operative cohort of the Endometriosis, Natural History, Diagnosis, and Outcomes (ENDO) Study. INTERVENTIONS:Gynecologic laparoscopy/laparotomy, regardless of clinical indication. MEASUREMENTS AND MAIN RESULTS:Participants underwent anthropometric assessments, body composition, and body fat distribution ratios before surgery. Surgeons completed a standardized operative report immediately after surgery to capture revised ASRM staging (I to IV) and typology of disease (superficial [SE], ovarian endometrioma [OE], and deep infiltrating endometriosis [DIE]). Linear mixed models, taking into account within-clinical-center correlation were used to generate least square means (95% confidence intervals) to assess differences in adiposity measures by endometriosis stage (no endometriosis, I-IV) and typology (no endometriosis, SE, DIE, OE, OE + DIE) adjusting for age, race/ethnicity, and parity. While the majority of confidence intervals were wide and overlapping, three general impressions emerged: 1) women with versus without incident endometriosis had the lowest anthropometric/body composition indicators; 2) women with stage I or IV had lower indicators compared to women with stage II or III; and 3) women with OE and/or DIE tended to have the lowest indicators, while women with SE had the highest indicators. CONCLUSION:Our research highlights that the relationship between women's adiposity and endometriosis severity and typology may be more complicated than prior research indicates.

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