endometriosis

Neuroendocrine tumors (NETs) or carcinoid tumors are rare neoplasms originating from neuroendocrine cells, most commonly found in the appendix. While NETs are often asymptomatic, they may present with abdominal pain, flushing, and diarrhea and are frequently discovered incidentally during surgery for other conditions. Endometriosis has been associated with an increased risk of certain malignancies; however, its relationship with NETs remains unclear. Given the high frequency of laparoscopic surgeries for endometriosis, incidental NET findings pose unique clinical challenges.

This retrospective case report was conducted at Avicenna Fertility Center, Affiliated to Avicenna Research Institute, Tehran, Iran, from 2016 to 2024. Medical records of six patients (33-55 years old) who underwent laparoscopic surgery for endometriosis, with incidental NETs found in the appendix, were analyzed. Clinical presentation, intraoperative findings, histopathology, and postoperative outcomes were reviewed.

Six women (mean age: 43.7 years) with endometriosis-related symptoms (dysmenorrhea, dyspareunia, and pelvic pain) underwent laparoscopic surgery with appendectomy. The NETs (2–9 mm, all G1, Ki-67 <3%) exhibited invasion into the muscularis propria in three cases and into the subserosal fat in one case; lymph nodes were not evaluated, and no metastases were detected. Immunohistochemistry confirmed neuroendocrine differentiation, with positive chromogranin and synaptophysin staining. Follow-up over 1–5 years showed no evidence of recurrence.

Incidental NET detection during endometriosis surgery highlights the need for routine pathological examination of appendectomy specimens. While no direct link exists between NETs and endometriosis, recognizing these tumors may influence surgical decisions and postoperative management, emphasizing the importance of multidisciplinary care.

Endometriosis affects different aspects of women's life. Many women with endometriosis do not have social support. Family-centered empowerment model is one of the care models which its effect on perceived social support among women suffering from chronic diseases have been investigated less. Therefore, this study aimed to determine the effect of education based on family-centered empowerment model on perceived social support in women with endometriosis.

This is a randomized clinical trial, which was conducted on 64 women with endometriosis reffered to the endometriosis clinic of a training Hospital in Mashhad, Iran between March 2022 and September 2023. Sampling was done using the random allocation block method. The intervention group received five 45–60-minute education sessions based on the family-centered empowerment model and a final assessment session over two weeks. Before, immediately and 6 weeks after the intervention, the Sherbon Stewart Social Support Questionnaire (MOS-SSS) was completed. Data analysis was done using independent t-test, paired t-test, Mann-Whitney and Wilcoxon with SPSS software (version27).

Before the intervention, the mean of the total score of perceived social support in the intervention and control group was not significantly different (P = 0.684). After the intervention, the total perceived social support score was 67.1 ± 11.08 in the intervention and 57.63 ± 16.31 in the control group, which showed a significant difference between the two groups (P = 0.008).

Education based on the family-centered empowerment model could be effective on perceived social support enhancement among women with endometriosis.

Endometriosis is a chronic inflammatory disorder affecting about 10% of females in their reproductive years, characterized by endometrial tissue growing outside the uterus. Immune checkpoints play a crucial role in regulating the immune system and preserving homeostasis. T-cell immunoreceptor with immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domains (TIGIT), a newly discovered immune checkpoint, interacts with its ligand, cluster of differentiation 155 (CD155), to exert inhibitory effects on immune responses.

Though numerous studies have explored the immunological profile in endometriosis cases, limited information exists about the potential role of TIGIT/CD155 interaction.

This case-control study aimed to investigate the expression levels of TIGIT and CD155 genes in ectopic and eutopic tissues of 20 women diagnosed with endometriosis by a gynecologist with laparoscopy compared to the endometrium of 20 women without endometriosis, using real-time polymerase chain reaction.

Results showed that both TIGIT and CD155 gene expressions were significantly higher in ectopic endometrial tissues (p < 0.0001). CD155 is also upregulated in the eutopic endometrium of cases (p < 0.0001). However, no significant difference in TIGIT expression was observed between eutopic endometrium of cases and controls (p = 0.49).

These findings suggest an upregulation of the TIGIT/CD155 pathway in endometriosis, indicating its potential role in the disease's pathogenesis. Further research is necessary to fully understand this signaling pathway and explore its viability as a biomarker for diagnosis and immunotherapy.

The fundamental mechanisms behind the causes and development of endometriosis are still poorly understood. Therefore, identifying biomarkers that can help with early detection and targeted treatment is crucial for effective management of this disease. This study aimed to compare total antioxidant capacity (TAC), the activities of superoxide dismutase (SOD) and glutathione peroxidase (GPx), and the concentrations of interleukin-6 (IL-6) and phenylalanine (Phe) across different stages of endometriosis.

The plasma samples were collected from women with endometriosis who had undergone laparoscopic surgery. The stages were confirmed by a gynecologist, with 30 plasma samples from stages I-II (mild) and 30 from stages III-IV (severe). The obtained measurement data were first normalized and tested for normality, followed by analysis using the t-test and Mann-Whitney U test. The p-value below 0.05 was considered statistically significant. The sample size was determined based on Cohen's guideline of 30. Biomarker levels were assessed using ELISA and colorimetric techniques.

TAC levels, GPx, and SOD activities, as well as Phe concentration significantly differed between endometriosis stages I-II and III-IV (p<0.05). These measured biomarkers were higher in stage I-II. On the other hand, although IL-6 levels were higher in stages III–IV, the differences between stages were not statistically significant.

The potential of TAC, SOD, GPx, and Phe as biomarkers for the early diagnosis and treatment of endometriosis underscore the roles of inflammation and oxidative stress in the pathogenesis of the disease, providing insights that may aid in developing more targeted diagnostic and therapeutic strategies.

Epigenetic mechanisms, particularly the roles of DNA methylation and microRNAs, are increasingly recognized in the pathogenesis of endometriosis. DNA methyltransferase 3 (DNMT3) alpha, an important DNA methyltransferase, and miR-29b, a known suppressor of methyltransferase expression, may play a related role in this disease.
This study aims to analyze the DNMT3A and miR-29b expression in eutopic and ectopic endometrial tissues from women with endometriosis compared to endometrial tissues from healthy controls.
Endometrial tissue samples were collected from 15 women diagnosed with endometriosis (both eutopic and ectopic tissue) and 15 healthy controls during laparoscopic surgery. RNA was extracted, and the expression levels of DNMT3A and miR-29b were analyzed by real-time polymerase chain reaction. Glyceraldehyde 3-phosphate dehydrogenase was used as a normalization control.
DNMT3A expression was significantly increased in both eutopic and ectopic tissue compared to control endometrial tissue. In contrast, miR-29b expression was significantly decreased in the same tissues. These inverse patterns suggest a possible regulatory relationship between DNMT3A and miR-29b.
The altered expression of DNMT3A and miR-29b in endometriotic tissues suggests their involvement in the pathogenesis of the disease. These molecules could serve as potential diagnostic biomarkers or therapeutic targets in endometriosis.

Endometriosis, a common gynecological disorder involving ectopic endometrial tissue, leads to infertility and chronic pain. Dysregulated apoptosis and abnormal cell migration are key pathological features. Given current treatment limitations, novel strategies like mesenchymal stem cells (MSC) derived conditioned media (CM) are explored due to their rich secretome.
To investigate the effects of CM from healthy menstrual blood-derived MSCs (MenSCs-CM) and human adipose tissue-derived MSCs (ADSCs-CM) on apoptosis and migration in endometriotic MenSCs.
This in vitro study involved the isolation of endometriotic MenSCs from infertile women (25-35 yr) via menstrual blood. Mononuclear cells were cultured to passage 3, and characterized using flow cytometry (CD29, CD44, CD73, CD105 positive; CD34, CD38, CD45 negative). CM was prepared separately from healthy donor MenSCs and ADSCs. Endometriotic MenSCs were treated with healthy MenSCs-CM and ADSCs-CM independently. Cell migration (scratch assay), apoptosis (Annexin V), and Bax mRNA levels and Bax/Bcl‑2 ratio (real-time polymerase chain reaction) were evaluated.
Both ADSCs-CM and MenSCs-CM significantly increased during early and late apoptosis in endometriotic MenSCs (p < 0.001). Scratch assays showed significantly decreased MenSCs migration at 24, 48, and 72 hr (p < 0.001, p = 0.003, p < 0.001, respectively). Gene expression revealed significant increases in Bax mRNA (p = 0.013) and the Bax/Bcl‑2 ratio (p = 0.044).
CM from ADSCs and MenSCs of healthy women enhances apoptosis and inhibits endometriotic MenSCs migration in vitro, suggesting potential therapeutic strategies for endometriosis.

Parthenolide (PTL) has significant anti-inflammatory and immunomodulatory effects, but its regulatory mechanisms in endometriosis (EMs) remain unclear. This study aimed to systematically evaluate the effects of PTL on cellular models and a murine EMs model, with a focus on its regulatory roles in autophagy and the NLRP3 inflammasome pathway. Human monocytic leukemia THP-1 cells, murine immortalized bone marrow-derived macrophages, and 30 female C57BL/6 mice were used. Autophagy-related proteins (Beclin1, LC3, p62) and inflammasome components (NLRP3, ASC, caspase-1) were detected by Western blotting, and the activation of the AMPK/ULK1 signaling pathway was assessed after treating with PTL at a concentration of 10 mg/ml for 1 hr. A murine EMs model was established by peritoneal implantation, followed by intraperitoneal injections of PTL (10 mg/ml). Immunohistochemical staining was performed to detect the expression of NLRP3, caspase-1, IL-1β, and GSDMD in ectopic lesions. In vitro, PTL (10 mg/ml) significantly inhibited the activation of NLRP3, caspase-1-p20, IL-1β, and GSDMD, while increasing the phosphorylation levels of Beclin1 and AMPK/ULK1, and decreasing the expression of p62 and LC3, indicating enhanced autophagic flux. In vivo, PTL treatment markedly reduced the number, surface area, and weight of ectopic lesions in mice, and significantly suppressed the expression of inflammatory proteins in the lesions. PTL exerts its therapeutic effect on EMs by simultaneously activating autophagy through the AMPK/ULK1 signaling pathway and inhibiting the NLRP3 inflammasome and its downstream effectors.

Endometriosis is an intricate gynaecological ailment characterized by the presence of tissue outside the uterus that resembles endometrial tissue, resulting in substantial discomfort and irritation. The exact cause of the condition is still uncertain; however, probable factors such as retrograde menstruation and immunological responses are believed to play a role. Psychological stress has been proposed to impact how endometriosis patients perceive pain and experience inflammatory reactions, thereby worsening their symptoms and overall quality of life. 

An extensive analysis of current literature was undertaken to investigate the interaction between psychological stress, pain perception, and inflammatory responses in women diagnosed with endometriosis. We conducted a thorough search of databases such as PubMed, Scopus, and Google Scholar to identify important papers and reviews that specifically examined the physiological and psychological factors involved in pain and inflammation associated with endometriosis. Data were analyzed to ascertain the influence of stress on these variables and to uncover probable pathways connecting stress with symptoms of endometriosis.

The review highlights how psychological stress exacerbates pain perception and inflammatory responses in women affected by endometriosis. The study revealed that stress activates the sympathetic nervous system (SNS) and leads to heightened levels of cortisol, which, in turn, contribute to increased inflammation and sensitivity to pain. Stress also impacts the secretion of naturally occurring pain-relieving substances in the body and alters the functioning of the central nervous system, thereby further affecting pain perception. Moreover, it has been demonstrated that chronic stress exacerbates symptoms and contributes to the growth of endometriotic lesions by triggering persistent inflammatory reactions.

Psychological stress is an important factor in influencing both pain perception and the body’s inflammatory responses in endometriosis. Effective stress management techniques are crucial for reducing discomfort and inflammation associated with the disease. Interventions targeting both the psychological and physiological components of stress have the potential to improve treatment outcomes and enhance the quality of life for women experiencing endometriosis. Subsequent investigations should prioritize the development of integrated methodologies that combine stress reduction strategies with traditional therapies for endometriosis.

Investigating the genetic influence of Protein Tyrosine Phosphatase Non-Receptor Type 22 (PTPN22) on key inflammatory biomarkers-Interleukin-1β, Interleukin-6, and high-sensitivity C-reactive protein (hsCRP) and to evaluate their association with disease progression in endometriosis. Specifically, this study aims to (i) assess differential expression of PTPN22 in cases versus controls, (ii) examine correlations between PTPN22 expression and inflammatory markers, and (iii) determine the predictive value of these biomarkers using ROC curve analysis.

This study involved 150 women with endometriosis and 150 matched controls. Blood samples were analyzed for inflammatory markers (IL-6, IL-1β, hsCRP) using ELISA and PTPN22 gene expression by real-time PCR. Statistical analyses were conducted using Stata 17.0, and ethical approval (01/2022/IECG) and informed consent was obtained.

PTPN22 expression was higher in endometriosis cases (p = 0.0001), suggesting a role in disease pathophysiology. ROC analysis showed moderate predictive accuracy (AUC = 0.63). Among the inflammatory markers, hs-CRP was the most diagnostic, followed by IL-6 and IL-1β, with stronger positive correlations observed in the endometriosis group.

These findings highlight the translational relevance of PTPN22 and hsCRP as candidate biomarkers for early detection and risk stratification in endometriosis, underscoring the interplay between genetic susceptibility and inflammatory signaling in its pathogenesis.

Endometriosis, a complex gynecological disorder characterized by ectopic endometrial-like tissue, affects over 10% of women, causing chronic pain and infertility. Despite extensive research, its pathophysiology remains incompletely understood, with proposed mechanisms including inflammation, hormonal dysregulation, and retrograde menstruation. Given ethical and practical challenges in human studies, animal models are essential for investigating endometriosis pathogenesis and evaluating therapeutic interventions. This review examines hormone-related animal models of endometriosis, comparing induction methods (autotransplantation, xenotransplantation, and spontaneous models) and their applications in studying sex steroid hormones (SSH) and the hypothalamic-pituitary-gonadal (HPG) axis. We analyzed 158 studies (2010–2024) from PubMed Central/Medline, focusing on SSH and HPG axis involvement. A novel scoring system was developed to assess the model’s suitability based on species, induction method, pharmacological effects, hormonal/genetic evaluations, histological confirmation, feasibility, ethics, and cost. Non-human primate models, particularly spontaneous and hormone-induced baboon models, scored highest due to their physiological resemblance to humans. However, rodent models remain widely used due to practicality. Our findings highlight the need for improved preclinical models to enhance translational research, ultimately aiding in the development of targeted therapies for endometriosis. This comprehensive analysis provides a framework for selecting optimal animal models in future endometriosis research.

Endometriosis carries remarkable social, public health, and financial consequences. Based on two theories of retrograde menstruation and stem cells, menstrual blood-derived stem cells (MenSCs) play a significant role in endometriosis since key genes of critical cellular processes are differentially expressed in the MenSCs of endometriosis and non-endometriosis women (E- and NE-MenSCs, respectively). In this study, E-MenSCs were isolated from the menstrual blood of women with various endometriosis subtypes. We tried to find the proper microRNA (miRNA) and assayed the effects of exosome-encapsulated miRNA on modulating the gene expression profile and functional pattern of E-MenSCs. After in silico selection of miR-149-3p using publicly accessible algorithm-based databases, E- and NE-MenSCs were cultured as controls, and the other experimental groups were as follows: E-MenSCs transfected with empty and miRNA vectors (E-MenSC+BB and E-MenSC+miR), and E-MenSCs treated with exosomes derived from non-transfected and miRNA-transfected NE-MenSCs (E-MenSC+Exo and E-MenSC+T-Exo). Then, the expression level of selected genes, the level of interleukins (ILs) and oxygen reactive species (ROS), the protein level of β-catenin and Ki-67, and the migratory ability were assessed through real-time PCR, ELISA, western blot, and scratching tests, respectively. Although both E-MenSCs+T-Exo and E-MenSC+miR showed down-regulation of IL-6, -8, and -10, neither had decreased IL-1β, vascular endothelial growth factor, IDO1, and KRAS levels. Furthermore, only the IL-6 protein level was significantly decreased in the E-MenSC+miR group, but the levels of IL-6, IL-8, ROS, β-catenin, and Ki67 were significantly lower in the E-MenSCs+T-Exo group compared to the E-MenSCs. The potential of exosomes as miRNA carriers could be considered in developing novel endometriosis therapies.

The World Endometriosis Research Foundation (WERF) Endometriosis Phenome and BiobankingHarmonisation Project (EPHect) aims to facilitate international research on endometriosis by developinga standardized questionnaire. This study focuses on translating and validating the Persian version of the endometriosispatient questionnaire (EPQ), ensuring cultural compatibility and reliability for future studies inthe region. In this cross-sectional study, a total of 37 women aged between 18 and 45 years who wereassessed for endometriosis through diagnostic sonography or laparoscopy, or were suffering from symptoms suchas dysmenorrhea, dyspareunia, pelvic pain not associated with menstruation lasting more than six months, wereevaluated. The evaluation took place from May 2021 to December 2023. The research methodology was structuredinto two phases: translation and cross-cultural adaptation, followed by cross-cultural validation. The Persian versionof the WERF EPHect was translated and adapted in accordance with established guidelines. Content validitywas evaluated by six experts in the relevant fields, while face validity was assessed qualitatively by seven participants.To determine the reliability of the final version of the Persian questionnaire, 30 patients diagnosed withendometriosis completed it on two separate occasions that were two weeks apart, with the repeatability of eachquestion analyzed using Kappa statistics. The translated questionnaire was administered to 30 patients diagnosed with endometriosis, with an averagecompletion time of 55 minutes. Final modifications to the questionnaire were made to align with the Iranianculture, incorporating feedback from specialists and study participants. Overall, the findings suggest that the Persianversion demonstrates both validity and reliability in medical and cultural aspects. The recent study demonstrated that the Persian version of the WERF-EPHect questionnaire is bothvalid and reliable, with cultural relevance. Additional validation studies conducted in various languages will helpeliminate language and cultural disparities, facilitating collaborative, large-scale, prospective international researchon endometriosis.

There is a lack of reliable data or evidence-based protocol for the management of deep infiltrating endometriosis(DIE) lesions in reproductive age women. This study examines ovarian reserves in women who underwentendometriosis surgeries in an attempt to assist clinicians with decision-making for surgery and fertility preservation. This single-centre cross-sectional study included 508 women who underwent laparoscopicendometriosis surgery from June 2018 to December 2022. The women were divided into three groups: endometrioma(OMA; n=156), OMA+DIE (n=235), and DIE (n=117). Their anti-Müllerian hormone (AMH) levels were comparedto 50 healthy controls before surgery and at four and eight months post-surgery. The DIE group had lower baseline AMH levels compared to the other groups (P<0.0001) following surgery,AMH levels decreased notably across all groups (P<0.001). Reductions in AMH levels after surgery were as follows:OMA group (49.84%), OMA+DIE group (62.20%), and the DIE group (43.46%). The most substantial decline wasobserved in the OMA+DIE group. There was no significant difference in AMH levels between four and eight monthspost-surgery. Although the OMA+DIE group experienced the greatest drop in ovarian reserve after surgery, DIE is as effectiveas OMA in reducing ovarian reserve pre- and post-surgery. Hence, overlooked DIE lesions during an ultrasoundexamination can greatly impact ovarian reserve in these women.

Endometriosis is a chronic gynecological condition defined by the ectopic presence of endometrial-like tissue outsidethe uterine cavity, often resulting in debilitating symptoms and significant impacts on quality of life. While the exactetiology of endometriosis remains elusive, emerging evidence suggests that diet and nutrition may play a crucial rolein its pathogenesis and management. This comprehensive review explores the complex interplay between variousfood substances and endometriosis, summarizing the latest research findings on both risk-enhancing and protectivenutritional factors. Notably, consumption of alcohol, red and processed meats, foods high in saturated and trans fats,and excessive caffeine has been correlated with increased systemic inflammation and hormonal dysregulation-keymechanisms implicated in endometriosis pathogenesis. In contrast, nutrients such as antioxidants, B-complex vitamins,vitamin D, calcium, polyunsaturated fatty acids (PUFAs, particularly omega-3 and omega-6), and dietary fiberhave shown promise in exerting anti-inflammatory and protective effects against endometriosis. The review emphasizesthe importance of promoting a balanced and nutritious diet rich in anti-inflammatory and antioxidant-rich foodwhile limiting the intake of pro-inflammatory substances for individuals with endometriosis. In addition to dietaryinterventions, lifestyle modifications, including regular physical activity, stress management, and optimizing sleephygiene, are highlighted as integral components of comprehensive treatment plans for endometriosis patients. Furtherresearch is required to clarify the precise mechanisms underlying the relationship between diet and endometriosis andto establish evidence-based dietary recommendations personalized for patients with endometriosis.

Elagolix, Linzagolix, and Relugolix, as oral gonadotropin-releasing hormone antagonists, have emerged as promising treatments for endometriosis-associated pain.

To evaluate pain intensity reduction as the primary outcome and assess side effects and quality of life as secondary outcomes through an updated meta-analysis.

A systematic search was conducted in Cochrane, Scopus, and PubMed/Medline. Study quality was assessed using the Cochrane risk of bias in non-randomized studies of interventions tool. The pooled standard mean difference and p-value were calculated using a random-effects model (DerSimonian-Laird method), and the inconsistency index was applied to evaluate heterogeneity.

7 randomized controlled trials were included. Gonadotropin-releasing hormone antagonists significantly reduced dysmenorrhea, dyspareunia, and non-menstrual chronic pelvic pain when measured with the verbal and numeric rating scales, but not with the modified Biberoglu and Behrman score. Secondary outcomes showed significant improvements in health status (endometriosis health profile and patient global impression of change). However, treatment was associated with increased hot flushes (3.61-fold higher), an 8.96% increase in low-density lipoprotein after 6 months, and a rise in high-density lipoprotein compared with placebo. Bone mineral density in the spine was significantly lower in the treatment group (p < 0.001).

This meta-analysis provides updated evidence on Elagolix, Linzagolix, and Relugolix, confirming their effectiveness in managing endometriosis-associated pain, while highlighting important considerations regarding metabolic and bone health.

Endometriosis is a common disease of the female genital system. Pelvic magnetic resonance imaging (MRI) is the best non-invasive diagnostic method for evaluating endometriosis.

This study aims to compare the findings of MRI with and without intravenous (IV) contrast in participants with endometriosis.

This cross-sectional study was conducted on 100 women of reproductive age with endometriosis at gynecology clinics of 22 Bahman and Ghaem hospital, Mashhad, Iran from April 2021-July 2023. All participants underwent pelvic MRI with and without IV contrast. The imaging findings of each participant were recorded in the study checklist. Vaginal and rectal gels were applied prior to imaging to improve anatomical delineation.

72% of the participants were aged between 26 and 40 yr. History of infertility was positive in 42% of the individuals. The frequency of ovarian endometrioma detection and its mean size before and after contrast injection did not show a significant difference. The mean depth of rectosigmoid wall and posterior uterine wall endometriosis was significantly higher in images with IV contrast than in images without IV (p = 0.026 and 0.04, respectively). Conversely, the detection of deep infiltrating endometriosis (DIE) in uterosacral ligaments and torus uterus was significantly higher in pre-contrast MRI (p = 0.016).

In cases with DIE in the rectal and posterior walls of the uterus, MRI with IV contrast is more accurate in the detection of the disease extent. DIE in the uterosacral ligaments and torus uterus is better detected in MRI without IV contrast.

Endometriosis is a prevalent condition among women, often leading to infertility. Laparoscopic surgery is widely employed as a therapeutic intervention for endometriosis. This study investigated the prognostic factors influencing the outcome of laparoscopic surgery for endometriosis.

This cross-sectional study included 60 women with endometriosis referred for laparoscopic surgery at Amiralmomenin Hospital, Zabol, Iran, between 2022 and 2024. Pain intensity was measured using a visual analog scale (VAS). Statistical analyses were performed using SPSS version 26. Descriptive statistics summarized the data, while univariate analyses (t-tests and chi-square tests) assessed relationships between variables. Multivariate logistic regression identified independent predictors of pain reduction and pregnancy outcomes.

Patients with moderate endometriosis showed statistically significant pain reduction from 8.8 preoperatively to 1.8 at 9 months (p<0.001) and 2.2 at 12 months post-surgery (p=0.003). Those with severe endometriosis had non-significant pain reduction (8 to 6 at 12 months, p=0.12). Both intrauterine (9 to 1.1 at 12 months, p<0.001) and extrauterine involvement groups (8.6 to 3.3, p=0.004) demonstrated significant pain improvement, with no significant difference between the groups (p=0.779). Regarding fertility outcomes, treatment before the age of 30 significantly increased pregnancy likelihood (AOR=20.57, 95%CI 1.4-295.3), while other factors including BMI, CA125 levels, and parity showed no significant associations (all p>0.05).

These preliminary findings suggest that laparoscopic surgery may reduce pain in moderate endometriosis, while the age under 30 may be associated with improved pregnancy outcomes. However, given the study’s limited sample size and wide confidence intervals, these results require validation in larger, multicenter cohorts.

Superior hypogastric plexus block (SHPB) is an established treatment for chronic pelvic pain (CPP). Anatomical variations can significantly complicate interventional pain procedures.

We present a case of a 44-year-old woman with CPP secondary to endometriosis and unique lumbosacral (L-S) anatomy, including enlarged and bifid transverse processes, which posed a challenge to standard SHPB techniques. This necessitated a tailored approach to ensure success and patient safety. Successful bilateral blockade was achieved using a combination of posterolateral and trans-discal approaches under fluoroscopic guidance. The patient reported substantial pain relief and improved quality of life.

This case underscores the clinical relevance of recognizing and adapting to anatomical variations during SHPB to optimize procedural success and patient outcomes. Despite the limitations inherent in its retrospective design and reliance on existing clinical data, this study reinforces the need for individualized approaches in similar interventions.

The role of microRNAs (miRNAs) in human reproduction represents an area of research, as these regulatory molecules appear to play essential roles in reproductive function. However, the current understanding of miRNAs’ regulatory mechanisms in male and female reproduction remains incomplete, with considerable contradictory evidence in the literature. This targeted review aimed to analyze high-quality studies published to date on miRNA expression patterns in female and male reproduction to elucidate their biological roles and associations with infertility, thereby updating knowledge in this field. A comprehensive review of the literature was conducted using different electronic databases and search engines, including PubMed Central, MEDLINE, and Google Scholar from the earliest available records up to 2023. This search identified 18,100 articles related to miRNA expression in infertility, polycystic ovary syndrome (PCOS), endometriosis, and biomarkers, of which 72 met our criteria for further analysis. The findings of the present study revealed that specific, stable miRNA populations exist in different tissues and cells, potentially influencing spermatogenesis and oogenesis. The extensive review of studies suggested a consistent relationship between aberrant miRNA expression patterns and infertility. Consequently, the miRNAs identified in this review might serve as valuable biomarkers for both male and female infertility and could lead to the development of novel and specialized treatments.

Scar endometriosis is a rare type of extra pelvic endometriosis characterized by functional endometrial tissue in surgical wounds, often occurring after obstetric or gynecological surgeries. It typically presents as a painful lump near the surgical scar, with symptoms worsening during menstruation. We report a case of a 28-year-old multiparous woman who experienced cyclical pain and bleeding at the site of a previous tubal ligation for two years. Clinical examination showed a tender, nodular swelling with active bleeding during menses. Imaging revealed a vascular lesion near the rectus muscle, confirming scar endometriosis. A wide surgical excision was performed, and histopathology confirmed endometrial tissue in the scar. The patient's recovery was smooth, with no recurrence noted. This case underscores the need to recognize cyclical symptoms at surgical scars as important indicators of scar endometriosis, highlighting the significance of prompt diagnosis and treatment to prevent complications.

Endometriosis is among the leading causes of morbidity in the female population worldwide. Currently, the definite diagnosis of endometriosis depends on laparoscopy as the gold-standard method. Potential biomarkers, such as inflammatory biomarkers, cancer antigens, and hormones, offer non-invasive alternatives. This study was de signed to investigate the utility of some hematological markers, including white blood cell (WBC) count, neutrophil to lymphocyte ratio (NLR), platelet count, cancer antigen 19-9 (CA 19-9), and 125 (CA-125), carcinoembryonic antigen (CEA), and anti Müllerian hormone (AMH), as non-invasive methods for endometriosis diagnosis. In this retrospective study, which was performed on 346 females, the case group consisted of 230 endometriosis patients. The data of 116 patients with benign tumors or other benign conditions such as Mülle rian anomalies, were used as the control group. Receiver-operating characteristic (ROC) analysis was implemented to calculate specificities and sensitivities of CA-125, CA 19-9, CEA, NLR, WBC count, platelet (PLT) count, and AMH. Significantly higher mean values were observed for CA-125, CA 19-9, WBC count, and NLR in the case group compared with the control group (P<0.001). The combination of NLR and CA-125 demonstrated the highest diagnostic performance with an area under the curve (AUC) of 0.903. However, the AUC for CA-125 (0.896) was lower and the value of 12.7 IU/mL was the most appropriate cut-off point (sensitivity=93.9%, specificity=60.9%). The cut-off value of 35 for CA-125 was also evaluated (sensitivity=61.4%, specificity=98.3%). The AUC for NLR was 0.699 and the best cut-off point was 1.5 (sensitivity=83.4%, specificity=52.6%). Combined measurement of CA-125 and NLR showed the highest performance in the diagnosis of endo metriosis and can be considered as a diagnostic marker. However, it is necessary to conduct more research to evaluate the applicability of these biomarkers.

Endometriosis is a prevalent women's health disorder that lacks a definitive cure. Numerous studies have been conducted to identify the underlying causes of this disease and select the most effective pharmaceutical intervention. ISL LIM homeobox 2 (ISL2) plays a significant role in promoting angiogenesis. Contemporary investi gations strongly suggest that inhibiting angiogenesis could lead to the modulation of endometriosis and reduce associ ated symptoms. This study aims to repurpose drugs to target ISL2 for endometriosis treatment. In this computational study, we sought to confirm that ISL2 is an appropriate target for this study by evaluating its expression in the endometrial tissues of patients diagnosed with endometriosis, as well as in tissues from a control group of healthy women. Subsequently, we used computational techniques to select the best inhibitor for ISL2 from among select food and drug administration (FDA)-approved drugs. There was a significant increase ISL2 gene expression in the tissues of women with endometriosis. Therefore, we selected the ISL2 protein as a target for drug repurposing. Initial docking results revealed that, out of 2471 FDA-approved drugs, six (Dactinomycin, Paritaprevir, Ivermectin, Ergotamine, Alectinib, and Simeprevir) exhibited the most favourable binding energy (ΔG ≤-8 kcal/mol) with ISL2. Molecular dynamics (MD) simulations of these six complexes showed that Ivermectin displayed the lowest root mean square fluctuation (RMSF) and root mean square deviation (RMSD), as well as the highest count of hydrogen bonds and number of contacts, which indicated a more stable forma tion of this complex with ISL2. Although these six drugs appear to be promising candidates for modulating endometriosis, Ivermectin is more likely to effectively inhibit ISL2.