Endometriosis classification, staging and reporting systems: a review on the road to a universally accepted endometriosis classification,

BACKGROUND: In the field of endometriosis, several classification, staging and reporting systems have been developed. However, endometriosis classification, staging and reporting systems that have been published and validated for use in clinical practice have not been systematically reviewed up to now. OBJECTIVES: The aim of the current review is to provide a historical overview of these different systems based on an assessment of published studies. MATERIALS AND METHODS: A systematic Pubmed literature search was performed. Data were extracted and summarised. RESULTS: Twenty-two endometriosis classification, staging and reporting systems have been published between 1973 and 2021, each developed for specific and different purposes. There is still no international agreement on how to describe the disease. Studies evaluating different systems are summarised showing a discrepancy between the intended and the evaluated purpose, and a general lack of validation data confirming a correlation with pain symptoms or quality of life for any of the current systems. A few studies confirm the value of the Enzian system for surgical description of deep endometriosis. With regards to infertility, the endometriosis fertility index has been confirmed valid for its intended purpose. CONCLUSIONS: Of the 22 endometriosis classification, staging and reporting systems identified in this historical overview, only a few have been evaluated, in 46 studies, for the purpose for which they were developed. It can be concluded that there is no international agreement on how to describe endometriosis or how to classify it, and that most classification/staging systems show no or very little correlation with patient outcomes. WHAT IS NEW? This overview of existing systems is a first step in working towards a universally accepted endometriosis classification

Contribution of machining to the fatigue behaviour of metal matrix composites (MMCs) of varying reinforcement size

The high cycle constant stress amplitude fatigue performance of metal matrix composite (MMC) components machined by a milling process was investigated in this study as a function of machining speed, feed rate and reinforcement particle size. The presence of reinforcement and particle size were found to be the most influential factors that affected the fatigue life. In contrast to this, the effect of feed and speed on tool-particle interaction, strain hardening and heat generation during milling of MMCs were balanced in such a way that the contributions of feed and speed on fatigue life were negligible. The interactions of different parameters contributed significantly to the fatigue life which indicated that the modelling of fatigue life based on these three parameters was relatively complex. The fatigue life of the machined MMC samples increased with decreasing particle size and increasing feed. However, the fatigue life was not influenced by speed variation. The presence of smaller or no particles induced a complete separation of failed samples, in contrast to that of specimens containing larger reinforcing particles where crack growth was arrested or deflected by the reinforcing particles

Endometriosis And Infertility: Cause Or Consequence? [endometriose E Infertilidade: Causa Ou Consequência?]

Endometriosis is a benign gynecological disorder affecting women of reproductive age and can have a varied symptomatology including chronic pelvic pain, dysmenorrhea, and infertility. The association of endometriosis and infertility has been recognized for years, although definite evidence of causality still eludes us. It is clear that in the advanced stage of the disease with mechanical disruption of the pelvic anatomy, infertility is easly explained. Nevertheless, the link between early stage endometriosis and infertility remains a source of controversy. The mechanisms of infertility associated with endometriosis include abnormal folliculogenesis, elevated oxidative stress, altered immune function, and hormonal milieu in the follicular and peritoneal environments, and reduced endometrial receptivity. These factors lead to poor oocyte quality, impaired fertilization, and implantation. In this manuscript we review the medical literature concerning the pathophysiology of the endometriosis-related infertility.1323338Abaé, M., Glassberg, M., Majercik, M.H., Yoshida, H., Vestal, R., Puett, D., Immunoreactive endothelin-1 concentrations in follicular fluid of women with and without endometriosis undergoing in vitro fertilization-embryo transfer (1994) Fertil Steril, 61, pp. 1083-1087Agarwal, A., Gupta, S., Sikka, S., The role of free radicals and antioxidants in reproduction (2006) Curr Opin Obstet Gynecol, 18, pp. 325-332Aitken, R.J., Krausz, C., Oxidative stress, DNA damage and the Y chromosome (2001) Reproduction, 122, pp. 497-506Al-Azemi, M., Bernal, A.L., Steele, J., Gramsbergen, I., Barlow, D., Kennedy, S., Ovarian response to repeated controlled stimulation in in-vitro fertilization cycles in patients with ovarian endometriosis (2000) Hum Reprod, 15, pp. 72-75Amaral, V.F., Bydlowski, S.P., Peranovich, T.C., Navarro, P.A., Subbiah, M.T., Ferriani, R.A., Lipid peroxidation in the peritoneal fluid of infertile women with peritoneal endometriosis (2005) Eur J Obstet Gynecol Reprod Biol, 119, pp. 72-75Awadalla, S.G., Friedman, C.I., Haq, A.U., Roh, S.I., Chin, N.W., Kim, M.H., Local peritoneal factors: Their role in infertility associated with endometriosis (1987) Am J Obstet Gynecol, 157, pp. 1207-1214Burns, W.N., Schenken, R.S., Pathophysiology of endometriosis-associated infertility (1999) Clin Obstet Gynecol, 42, pp. 586-610Cahill, D.J., Wardle, P.G., Maile, L.A., Harlow, C.R., Hull, M.G., Ovarian dysfunction in endometriosis-associated and unexplained infertility (1997) J Assist Reprod Genet, 14, pp. 554-557Carlberg, M., Nejaty, J., Fröysa, B., Guan, Y., Söder, O., Bergqvist, A., Elevated expression of tumour necrosis factor alpha in cultured granulosa cells from women with endometriosis (2000) Hum Reprod, 15, pp. 1250-1255Díaz, I., Navarro, J., Blasco, L., Simón, C., Pellicer, A., Remohí, J., Impact of stage III-IV endometriosis on recipients of sibling oocytes: Matched case-control study (2000) Fertil Steril, 74, pp. 31-34Dlugi, A.M., Loy, R.A., Dieterle, S., Bayer, S.R., Seibel, M.M., The effect of endometriomas on in vitro fertilization outcome (1989) J In Vitro Fert Embryo Transf, 6, pp. 338-341Garrido, N., Navarro, J., Remohí, J., Simón, C., Pellicer, A., Follicular hormonal environment and embryo quality in women with endometriosis (2000) Hum Reprod Update, 6, pp. 67-74Gupta, S., Goldberg, J.M., Aziz, N., Goldberg, E., Krajcir, N., Agarwal, A., Pathogenic mechanisms in endometriosis-associated infertility (2008) Fertil Steril, 90, pp. 247-257Harlow, C.R., Cahill, D.J., Maile, L.A., Talbot, W.M., Mears, J., Wardle, P.G., Reduced preovulatory granulosa cell steroidogenesis in women with endometriosis (1996) J Clin Endocrinol Metab, 81, pp. 426-429Inoue, M., Kobayashi, Y., Honda, I., Awaji, H., Fujii, A., The impact of endometriosis on the reproductive outcome of infertile patients (1992) Am J Obstet Gynecol, 167, pp. 278-282Jha, P., Farooq, A., Agarwal, N., Buckshee, K., In vitro sperm phagocytosis by human peritoneal macrophages in endometriosis-associated infertility (1996) Am J Reprod Immunol, 36, pp. 235-237Khorram, O., Lessey, B.A., Alterations in expression of endometrial endothelial nitric oxide synthase and alpha(v)beta(3) integrin in women with endometriosis (2002) Fertil Steril, 78, pp. 860-864Lebovic, D.I., Mueller, M.D., Taylor, R.N., Immunobiology of endometriosis (2001) Fertil Steril, 75, pp. 1-10Lessey, B.A., Castelbaum, A.J., Buck, C.A., Lei, Y., Yowell, C.W., Sun, J., Further characterization of endometrial integrins during the menstrual cycle and in pregnancy (1994) Fertil Steril, 62, pp. 497-506Loh, F.H., Tan, A.T., Kumar, J., Ng, S.C., Ovarian response after laparoscopic ovarian cystectomy for endometriotic cysts in 132 monitored cycles (1999) Fertil Steril, 72, pp. 316-321Mahmood, T.A., Templeton, A., Folliculogenesis and ovulation in infertile women with mild endometriosis (1991) Hum Reprod, 6, pp. 227-231Marcoux, S., Maheux, R., Bérubé, S., Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis (1997) N Engl J Med, 337, pp. 217-222Mathur, S., Peress, M.R., Williamson, H.O., Youmans, C.D., Maney, S.A., Garvin, A.J., Autoimmunity to endometrium and ovary in endometriosis (1982) Clin Exp Immunol, 50, pp. 259-266Matson, P.L., Yovich, J.L., The treatment of infertility associated with endometriosis by in vitro fertilization (1986) Fertil Steril, 46, pp. 432-434Navarro, J., Garrido, N., Remohí, J., Pellicer, A., How does endometriosis affect infertility? (2003) Obstet Gynecol Clin North Am, 30, pp. 181-192Oosterlynck, D.J., Meuleman, C., Waer, M., Koninckx, P.R., Vandeputte, M., Immunosuppressive activity of peritoneal fluid in women with endometriosis (1993) Obstet Gynecol, 82, pp. 206-212Pal, L., Shifren, J.L., Isaacson, K.B., Chang, Y., Leykin, L., Toth, T.L., Impact of varying stages of endometriosis on the outcome of in vitro fertilization-embryo transfer (1998) J Assist Reprod Genet, 15, pp. 27-31Parazzini, F., Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: A randomized trial. Gruppo Italiano per lo Studio dell'Endometriosi (1999) Hum Reprod, 14, pp. 1332-1334Pellicer, A., Oliveira, N., Ruiz, A., Remohí, J., Simón, C., Exploring the mechanism(s) of endometriosis-related infertility: An analysis of embryo development and implantation in assisted reproduction (1995) Hum Reprod, 10 (SUPPL. 2), pp. 91-97Pellicer, A., Albert, C., Mercader, A., Bonilla-Musoles, F., Remohí, J., Simón, C., The follicular and endocrine environment in women with endometriosis: Local and systemic cytokine production (1998) Fertil Steril, 70, pp. 425-431Pellicer, A., Valbuena, D., Bauset, C., Albert, C., Bonilla-Musoles, F., Remohí, J., The follicular endocrine environment in stimulated cycles of women with endometriosis: Steroid levels and embryo quality (1998) Fertil Steril, 69, pp. 1135-1141Pellicer, A., Albert, C., Garrido, N., Navarro, J., Remohí, J., Simón, C., The pathophysiology of endometriosis-associated infertility: Follicular environment and embryo quality (2000) J Reprod Fertil Suppl, 55, pp. 109-119Pritts, E.A., Taylor, R.N., An evidence-based evaluation of endometriosis-associated infertility (2003) Endocrinol Metab Clin North Am, 32, pp. 653-667Qiao, J., Yeung, W.S., Yao, Y.Q., Ho, P.C., The effects of follicular fluid from patients with different indications for IVF treatment on the binding of human spermatozoa to the zona pellucida (1998) Hum Reprod, 13, pp. 128-131Said, T.M., Agarwal, A., Falcone, T., Sharma, R.K., Bedaiwy, M.A., Li, L., Infliximab may reverse the toxic effects induced by tumor necrosis factor alpha in human spermatozoa: An in vitro model (2005) Fertil Steril, 83, pp. 1665-1673Saito, H., Seino, T., Kaneko, T., Nakahara, K., Toya, M., Kurachi, H., Endometriosis and oocyte quality (2002) Gynecol Obstet Invest, 53 (SUPPL. 1), pp. 46-51Simón C, Gutiérrez A, Vidal A, de los Santos MJ, Tarín JJ, Remohí J, et al. 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The case for simplifying and using absolute targets for viral hepatitis elimination goals

The 69th World Health Assembly endorsed the Global Health Sector Strategy for Viral Hepatitis, embracing a goal to eliminate hepatitis infection as a public health threat by 2030. This was followed by the World Health Organization's (WHO) global targets for the care and management of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. These announcements and targets were important in raising awareness and calling for action; however, tracking countries’ progress towards these elimination goals has provided insights to the limitations of these targets. The existing targets compare a country's progress relative to its 2015 values, penalizing countries who started their programmes prior to 2015, countries with a young population, or countries with a low prevalence. We recommend that (1) WHO simplify the hepatitis elimination targets, (2) change to absolute targets and (3) allow countries to achieve these disease targets with their own service coverage initiatives that will have the maximum impact. The recommended targets are as follows: reduce HCV new chronic cases to ≤5 per 100 000, reduce HBV prevalence among 1-year-olds to ≤0.1%, reduce HBV and HCV mortality to ≤5 per 100 000, and demonstrate HBV and HCV year-to-year decrease in new HCV- and HBV-related HCC cases. The objective of our recommendations is not to lower expectations or diminish the hepatitis elimination standards, but to provide clearer targets that recognize the past and current elimination efforts by countries, help measure progress towards true elimination, and motivate other countries to follow suit. © 2020 John Wiley & Sons Lt