• The Journal of Korean Obstetrics and Gynecology
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• v.32 no.3
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• pp.162-173
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• 2019

Objectives: The purpose of this review was to overview and evaluate the efficacy of acupoint sticking therapy for women with endometriosis. Methods: We searched for randomized controlled clinical trials (RCTs) using acupoint sticking therapy on endometriosis in 5 electronic databases such as EMBASE, Pubmed, and CAJ. The results of the studies were analyzed and the risk of bias was assessed by using Cochrane risk of bias tool. Results: Two RCTs were included for analysis. In the selected studies, Treatment group was higher effective cure rate than any control group. In one RCT, Acupoint sticking therapy was only used, but the other RCT was treated acupoint sticking therapy combined with acupuncture. So, Interventions in 2 studies were not same, Quantitative synthesis was impossible. Conclusion: The limitation of this review is that the number of studies included is small. However, our systematic review provides a basis for acupoint sticking therapy for endometriosis. Acupoint sticking therapy was considered as one of external treatment method for patients with endometriosis.

• The Journal of Korean Obstetrics and Gynecology
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• v.34 no.2
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• pp.48-61
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• 2021

Objectives: This study was aimed to review the effect of acupuncture on endometriosis related pain in patients. Methods: Researchers searched data through 6 online databases up to November 2020. The data was limited to randomized controlled trial studies on endometriosis patients diagnosed with laparoscopy. Results: 7 Randomized controlled trials were included in this study. All of studies were published in Chinese, in China. Intervention of treatment group were composed of simple acupuncture and electroacupuncture. Intervention of control group were made up with mifepristone, herbal medicine and acupuncture. Outcome measurements were effective rate, serum Cancer antigen-125 (CA-125), Visual analogue scale (VAS)/pain score, and recurrence rate in 1 year. In all outcome measurements, treatment group were more effective than control group and it was statistically significant. Conclusions: Acupuncture therapy is effective in decreasing endometriosis related pain and preventing recurrence. However, because endometriosis is easy to recur, additional long-term research is needed.

• The Journal of Korean Obstetrics and Gynecology
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• v.28 no.4
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• pp.106-117
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• 2015

Objectives : This study is to report the clinical effect of oriental medicine on a patient suffering from endometriosis with chronic pelvic pain and other accompanied various symptoms. Methods : The 32 years old patient had suffered from endometriosis symptoms including pelvic pain, menstrual cramping, disuresia, and other pains over 8 years. The patient received herbal medication, acupuncture, abdominal moxibustion during 5 months of outpatient treatment. The clinical effects were evaluated through TSD (Total Symptom Distress) and EHP-5 (Short-From Endometriosis Health Profile Questionnaire). Results : The various clinical symptoms were improved during the treatment. The TSD and EHP-5 score also noticeably reduced. Conclusions : This case study showed that oriental medicine, acupuncture and moxibustion treatment appeared to effectively reduce various symptom of endometriosis.

• Clinical and Experimental Reproductive Medicine
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• v.26 no.3
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• pp.369-375
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• 1999

Objective: To evaluate the effect of serum obtained before and after treatment for endometriosis on in vitro fertilization and development of two cell mouse embryo. Design: Pretreatment and posttreatment comparoson of fertilization of mouse oocyte and embryo development in serum supplement from patients with endometriosis; result were compared using Stuent T-test analysis. Method: Infertility Clinic, Department of Obstetrics and Gynecology, Collage of Medicine, Won kwang university, Korea. Patients was chosed eleven consecutive women with endometriosis. Interventions was all patient underwent laparoscopic or conservative surgery. This was followed by a 6-month course of burserelin acetate $900{\mu}g/d$. Main outcome was measured total number of fertilization and embryo that was fertilization after 24 hours and reached blastocyst stage after 72 hours of incubation were compared before and after treatment. Result: Before treatment, 47% of the oocyte were fertilized and 31% of the embryo reached blastocyst stage. After treatment, Significantly more fertilized and Significantly more embryo developed to blastocyst on the stage I and II of endometriosis. Conclusion: The fertilization and embryo toxicity of serum samples from patients with endometriosis is lost after treatment.

• Journal of Yeungnam Medical Science
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• v.37 no.2
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• pp.90-97
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• 2020

Background: To minimize damage to the ovarian reserve, it is necessary to evaluate the follicular density in the ovarian tissue surrounding endometriosis on preoperative imaging. The purpose of the present study was to evaluate the usefulness of subtraction pelvic magnetic resonance imaging (MRI) to detect ovarian reserve. Methods: A subtracted T1-weighted image (^subT1WI) was obtained by subtracting unenhanced T1WI from contrast-enhanced T1WI (^ceT1WI) with similar parameters in 22 patients with ovarian endometriosis. The signal-to-noise ratio (SNR) in ovarian endometriosis, which was classified into the high signal intensity and iso-to-low signal intensity groups on the T2-weighted image, was compared to that in normal ovarian tissue. To evaluate the effect of contrast enhancement, a standardization map was obtained by dividing ^subT1WI by ^ceT1WI. Results: On visual assessment of 22 patients with ovarian endometriosis, 16 patients showed a high signal intensity, and 6 patients showed an iso-to-low signal intensity on T1WI. Although SNR in endometriosis with a high signal intensity was higher than that with an iso-to-low signal intensity, there was no difference in SNR after the subtraction (13.72±77.55 vs. 63.03±43.90, p=0.126). The area of the affected ovary was smaller than that of the normal ovary (121.10±22.48 vs. 380.51±75.87 ㎟, p=0.002), but the mean number of pixels in the viable remaining tissue of the affected ovary was similar to that of the normal ovary (0.53±0.09 vs. 0.47±0.09, p=0.682). Conclusion: The subtraction technique used with pelvic MRI could reveal the extent of endometrial invasion of the normal ovarian tissue and viable remnant ovarian tissue.

• Experimental and Molecular Medicine
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• v.50 no.12
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• pp.9.1-9.12
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• 2018

Endometriosis is a disease characterized by implants of endometrial tissue outside the uterine cavity and is strongly associated with infertility. Focal adhesion of endometrial tissue to the peritoneum is an indication of incipient endometriosis. In this study, we examined the effect of various cytokines that are known to be involved in the pathology of endometriosis on endometrial cell adhesion. Among the investigated cytokines, transforming growth factor-${\beta}1$ ($TGF-{\beta}1$) increased adhesion of endometrial cells to the mesothelium through induction of ${\alpha}2-6$ sialylation. The expression levels of ${\beta}$-galactoside ${\alpha}2-6$ sialyltransferase (ST6Gal) 1 and ST6Gal2 were increased through activation of $TGF-{\beta}RI/SMAD2/3$ signaling in endometrial cells. In addition, we discovered that terminal sialic acid glycan epitopes of endometrial cells engage with sialic acid-binding immunoglobulin-like lectin-9 expressed on mesothelial cell surfaces. Interestingly, in an in vivo mouse endometriosis model, inhibition of endogenous sialic acid binding by a $NeuAc{\alpha}2-6Gal{\beta}1$-4GlcNAc injection diminished $TGF-{\beta}1$-induced formation of endometriosis lesions. Based on these results, we suggest that increased sialylation of endometrial cells by $TGF-{\beta}1$ promotes the attachment of endometrium to the peritoneum, encouraging endometriosis outbreaks.

• Clinical and Experimental Reproductive Medicine
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• v.46 no.3
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• pp.125-131
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• 2019

Objective: To investigate serum 25-hydroxyl vitamin D (25(OH)D) and vitamin D-binding protein (VDBP) concentrations in women with endometriosis according to the severity of disease. Methods: Women with mild endometriosis (n = 9) and advanced endometriosis (n = 7), as well as healthy controls (n = 16), were enrolled in this observational study. Serum total 25(OH)D concentrations were analyzed using the Elecsys vitamin D total kit with the Cobas e602 module. Concentrations of bioavailable and free 25(OH)D were calculated. Concentrations of VDBP were measured using the Human Vitamin D BP Quantikine ELISA kit. Variables were tested for normality and homoscedasticity using the Shapiro-Wilk test and Leven F test, respectively. Correlation analysis was used to identify the variables related to total 25(OH)D and VDBP levels. To assess the effects of total 25(OH)D and VDBP levels in the three groups, multivariate generalized additive modeling (GAM) was performed. Results: Gravidity and parity were significantly different across the three groups. Erythrocyte sedimentation rate (ESR) and CA-125 levels increased as a function of endometriosis severity, respectively (p= 0.051, p= 0.004). The correlation analysis showed that total 25(OH)D levels were positively correlated with gravidity (r = 0.59, p< 0.001) and parity (r = 0.51, p< 0.003). Multivariate GAM showed no significant relationship of total 25(OH)D levels with EMT severity after adjusting for gravidity and ESR. However, the coefficient of total 25(OH)D levels with gravidity was significant (1.87; 95% confidence interval, 0.12-3.63; p= 0.040). Conclusion: These results indicate that vitamin D and VDBP levels were not associated with the severity of endometriosis.

• Journal of Yeungnam Medical Science
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• v.39 no.1
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• pp.24-30
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• 2022

Background: Texture analysis has been used as a method for quantifying image properties based on textural features. The aim of the present study was to evaluate the usefulness of magnetic resonance imaging (MRI) texture analysis for the evaluation of viable ovarian tissue on the perfusion map of ovarian endometriosis. Methods: To generate a normalized perfusion map, subtracted T1-weighted imaging (T1WI), T1WI and contrast-enhanced T1W1 with sequences were performed using the same parameters in 25 patients with surgically confirmed ovarian endometriosis. Integrated density is defined as the sum of the values of the pixels in the image or selection. We investigated the parameters for texture analysis in ovarian endometriosis, including angular second moment (ASM), contrast, correlation, inverse difference moment (IDM), and entropy, which is equivalent to the product of area and mean gray value. Results: The perfusion ratio and integrated density of normal ovary were 0.52±0.05 and 238.72±136.21, respectively. Compared with the normal ovary, the affected ovary showed significant differences in total size (p<0.001), fractional area ratio (p<0.001), and perfusion ratio (p=0.010) but no significant differences in perfused tissue area (p=0.158) and integrated density (p=0.112). In comparison of parameters for texture analysis between the ovary with endometriosis and the contralateral normal ovary, ASM (p=0.004), contrast (p=0.002), IDM (p<0.001), and entropy (p=0.028) showed significant differences. A linear regression analysis revealed that fractional area had significant correlations with ASM (r²=0.211), IDM (r²=0.332), and entropy (r²=0.289). Conclusion: MRI texture analysis could be useful for the evaluation of viable ovarian tissues in patients with ovarian endometriosis.

• IMMUNE NETWORK
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• v.23 no.2
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• pp.14.1-14.14
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• 2023

Immune status including the immune cells and cytokine profiles has been implicated in the development of endometriosis. In this study, we analyzed Th17 cells and IL-17A in peritoneal fluid (PF) and endometrial tissues of patients with (n=10) and without (n=26) endometriosis. Our study has shown increased Th17 cell population and IL-17A level in PF with endometriosis patients. To determine the roles of IL-17A and Th17 cells in the development of endometriosis, the effect of IL-17A, major cytokine of Th17, on endometrial cells isolated from endometriotic tissues was examined. Recombinant IL-17A promoted survival of endometrial cells accompanied by increased expression of anti-apoptotic genes, including Bcl-2 and MCL1, and the activation of ERK1/2 signaling. In addition, treatment of IL-17A to endometrial cells inhibited NK cell mediated cytotoxicity and induced HLA-G expression on endometrial cells. IL-17A also promoted migration of endometrial cells. Our data suggest that Th17 cells and IL-17A play critical roles in the development of endometriosis by promoting endometrial cell survival and conferring a resistance to NK cell cytotoxicity through the activation of ERK1/2 signaling. Targeting IL-17A has potential as a new strategy for the treatment of endometriosis.

• Clinical and Experimental Reproductive Medicine
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• v.51 no.2
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• pp.112-119
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• 2024

Objective: Endometriosis is a common gynecological disease among reproductive-age women. Numerous hypotheses exist regarding the pathogenesis of endometriosis. In Turkey, the consumption of Allium cepa (commonly known as the "onion cure") is a popular treatment employed to alleviate a variety of gynecological disorders. Methods: In this study, our objective was to assess the therapeutic mechanisms of the onion bulb A. cepa using an autologous endometriosis model in Sprague-Dawley rats. Previous research has shown that A. cepa possesses anti-inflammatory, antioxidant, and antiapoptotic properties. We evaluated the pathological condition of endometriotic implants by employing hematoxylin-eosin staining and Ki67 immunohistochemistry analysis. Transforming growth factor-beta 1 (TGF-β1) and alpha-smooth muscle actin (α-SMA) have been identified as profibrotic markers that are highly overexpressed in endometriotic tissues relative to eutopic endometrial tissue. Furthermore, TGF-β1 influences the differentiation and progression of endometriosis. To quantify profibrotic activity, we measured TGF-β1 and α-SMA using the immunosorbent assay method. Results: Lower histologic evaluation scores for endometriotic implants were observed in the group receiving high-dose A. cepa relative to the other groups. Ki67 expression was reduced following the high-dose A. cepa regimen, which consisted of 30% A. cepa and 70% normal feed. However, no statistically significant differences in TGF-β1 or α-SMA levels were observed among the groups (p=0.7 and p=0.778, respectively). Conclusion: The findings suggest that A. cepa could serve as a therapeutic agent in endometriosis treatment, as evidenced by the reduction in proliferative potential. Nevertheless, A. cepa was not associated with significantly lower levels of endometriosis-associated TGF-β1 or α-SMA.