75 results on '"Noga, H."'
Search Results
2. Electron Transport Properties of Eu(Cu1 − xAgx)2Si2 (0 ≤ x ≤ 1): Initiation of Transition Eu2+ ↔ Eu2.41+ in the Intermediate Valence State
- Author
-
Kuzhel, B., Belan, B., Gladyshevskii, R., Noga, H., Shcherba, I., and Serkiz, R.
- Subjects
ELECTRON transport ,COPPER ,SILVER ions ,LATTICE constants ,SOLID solutions ,ELECTRICAL resistivity ,SILICON isotopes ,BLOOD substitutes - Abstract
The article presents the results of studies of the chemical composition, crystal structure, lattice parameters, microstructure, the valence state of the europium ion (at 300 K), electrical resistivity, and differential thermopower (6–400 K) of samples in the Eu(Cu
1 − x Agx )2 Si2 (0 ≤ x ≤ 1) substitutional solid solutions. A transition of the europium ion from the valence-stable state of Eu2+ in EuAg2 Si2 to the state of intermediate (homogeneous) valence (IV) of the europium ion in EuCu2 Si2 with an effective valence ϑeff = 2.41 (300 K) has been initiated by a successive replacement of silver atoms by copper atoms. With appropriate sample compositions, the transition passes through a Kondo-type state. The research subject is the patterns of transformations (when the composition of the sample changes), the electronic state, and, accordingly, the electronic transport properties. The simultaneous coexistence of europium ions in different electronic states is assumed. The substitutional solid solution Eu(Cu1 − x Agx )2 Si2 (0 ≤ x ≤ 1) exhibits properties related to the competition between the state of the Kondo system, intermediate valence (IV), and magnetic ordering. [ABSTRACT FROM AUTHOR]- Published
- 2024
- Full Text
- View/download PDF
3. Possible Intelligent Materials Based on Compounds with Valence-Unstable Rare-Earth Elements.
- Author
-
Shcherba, I. D., Noga, H., and Bekenov, L. V.
- Subjects
VALENCE fluctuations ,MAGNETIC properties ,POLYHEDRA ,X-ray absorption ,SMART materials - Abstract
Intelligent materials occupy a special place among the huge number of known materials and those, which are being created all the time. Despite the impressive number of publications, no attempt has yet been made to classify compounds with a valence-unstable rare-earth element (R.E.) as smart materials. In this review paper, we show that the valence of the R.E. in some compounds can be changed by external and internal factors, such as temperature, pressure, changes in the occupation of d- and f-levels, and changes in the coordination polyhedra of atoms. Changing the valence of the R.E. may significantly alter the electrical and magnetic properties of compounds. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
4. 11820 Pain Worse with Orgasm, an Unexplored Symptom in Endometriosis.
- Author
-
Ding, A, Noga, H, Bouchard, KN, Bedaiwy, MA, Lee, C, Allaire, C, Orr, NL, and Yong, PJ
- Abstract
To assess the prevalence of pelvic pain worsened by orgasm in patients with endometriosis and its associated clinical features, focusing on those related to pelvic floor myalgia, central sensitization, and surgical findings. Prospectively collected data were analysed. Data were collected at three timepoints: pre-appointment patient questionnaire, initial appointment, and surgery. Surgery was done by gynecologists specializing in endometriosis. Tertiary referral centre for pelvic pain and endometriosis. Participants included were aged 18 to 50, pre-menopausal, diagnosed with endometriosis via specified criteria, and underwent surgery at our centre. A total of 358 participants referred to our centre between January 2018 and December 2019 completed the study. The median follow-up (duration between pre-appointment questionnaire and surgery) was 6 months, range 0-28 months. Participants who reported that orgasm worsened their pelvic or lower abdominal pain were compared to those who did not. Among 358 participants, 14% (n=49) reported pelvic pain worsened by orgasm. Pain with orgasm was significantly associated with pelvic floor myalgia (p = 0.01), higher scores on the Central Sensitization Inventory (p < 0.001), Patient Health Quality-9 (p < 0.001), and Generalized Anxiety Disorder-7 (p = 0.002). For surgical findings, there was no difference between the two groups for revised American Society for Reproductive Medicine scores (p=0.07). There was a trend towards ovarian endometriosis more commonly seen in participants without orgasm-associated pain (p=0.049). However, the prevalence of superficial peritoneal endometriosis, deep infiltrating endometriosis, and cul-de-sac obliteration were similar between the two groups. Pelvic pain worsened by orgasm in people with endometriosis may be associated with concurrent pelvic floor myalgia and central sensitization. Interventions targeting these factors may alleviate the symptom. There were no associations with more anatomically severe endometriosis found at surgery. Further research is needed to identify effective treatments. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
5. CloudCast: Characterizing Public Clouds Connectivity
- Author
-
Rotman, Noga H., Ben-Itzhak, Yaniv, Bergman, Aran, Cidon, Israel, Golikov, Igor, Markuze, Alex, and Zohar, Eyal
- Subjects
Networking and Internet Architecture (cs.NI) ,FOS: Computer and information sciences ,Computer Science - Networking and Internet Architecture - Abstract
Public clouds are one of the most thriving technologies of the past decade. Major applications over public clouds require world-wide distribution and large amounts of data exchange between their distributed servers. To that end, major cloud providers have invested tens of billions of dollars in building world-wide inter-region networking infrastructure that can support high performance communication into, out of, and across public cloud geographic regions. In this paper, we lay the foundation for a comprehensive study and real time monitoring of various characteristic of networking within and between public clouds. We start by presenting CloudCast, a world-wide and expandable measurements and analysis system, currently (January 2019)collecting data from three major public clouds (AWS, GCPand Azure), 59 regions, 1184 intra-cloud and 2238 cross-cloud links (each link represents a direct connection between a pair of regions), amounting to a total of 3422 continuously monitored links and providing active measurements every minute.CloudCast is composed of measurement agents automatically installed in each public cloud region, centralized control, measurement data base, analysis engine and visualization tools. Then we turn to analyze the latency measurement data collected over almost a year . Our analysis yields surprising results. First, each public cloud exhibits a unique set of link latency behaviors along time. Second, using a novel, fair evaluation methodology, termed similar links, we compare the three clouds. Third, we prove that more than 50% of all links do not provide the optimal RTT through the methodology of triangles. Triangles also provide a framework to get around bottlenecks, benefiting not only the majority (53%-70%) of the cross-cloud links by 30% to 70%, but also a significant portion (29%-45%) of intra-cloud links by 14%-33%., 15 pages
- Published
- 2022
6. X-ray spectra and electronic structure of the Ca3Ga2Ge3О12 compound
- Author
-
Shcherba, I.D., Kostyk, L.V., Noga, H., Bekenov, L.V., Uskokovich, D., and Jatsyk, B.M.
- Published
- 2017
- Full Text
- View/download PDF
7. X-RAY SPECTROSCOPIC PROPERTIES AND ELECTRONIC STRUCTURE OF Ca3Ga2Ge4O14.
- Author
-
Shcherba, I. D., Kostyk, L. V., Bekenov, L. V., Rudko, M., Uskoković, D., Noga, H., Bilyk, R. M., Yatcyk, B. M., and Denys, V. A.
- Subjects
X-rays ,PHOTOELECTRON spectra ,X-ray spectra ,VALENCE bands ,CONDUCTION electrons ,ELECTRONIC structure - Abstract
We have obtained X-ray emission spectra of Ga and Ge in Ca
3 Ga2 Ge4 O14 , X-ray emission OKα-spectra in Ca3 Ga2 Ge4 O14 , Ca3 Ga2 Ge4 O14 + Ce3%, and Ca3 Ga2 Ge4 O14 + Eu4% and Xray photoelectron spectra in Ca3 Ga2 Ge4 O14 . Our X-ray spectral studies of the Ca3 Ga2 Ge4 O14 gallogermanate have shown that the top of the valence band near the Fermi level is formed mainly by p states of gallium and germanium as well as p states of oxygen, whose intensity is sufficiently low. The middle of the valence band is formed by gallium 3d states with oxygen 2s states lying below them. These states are hybridized with 4p states of gallium and germanium because of which there are Kβ′′-satellites in the Kβ2 -subbands of gallium and germanium. The bottom of the valence band is formed by 3d states of germanium, whose contribution to chemical bonding is insignificant. The X-ray emission bands of Ga and Ge in Ca3 Ga2 Ge4 O14 and the photoelectron spectrum of the valence electrons of Ca3 Ga2 Ge4 O14 are in good agreement. The OKα-band changes its fine structure only slightly upon doping Ca3 Ga2 Ge4 O14 with Ce or Eu. The investigations of intrinsic luminescence under X-rays excitation of Ca3 Ga2 Ge4 O14 gallogermanate are presented. [ABSTRACT FROM AUTHOR]- Published
- 2022
- Full Text
- View/download PDF
8. Structural Study, Mössbauer Spectra and Electrical Properties of R5Fe6Sn18 (R = Tm, Lu) Compounds.
- Author
-
SHCHERBA, I., ROMAKA, L., SKOBLIK, A., KUZEL, B., NOGA, H., BEKENOVB, L., STADNYK, YU., DEMCHENKO, P., and HORYN, A.
- Subjects
LUTETIUM compounds ,ENERGY dispersive X-ray spectroscopy ,X-ray powder diffraction ,ELECTRICAL resistivity ,MOSSBAUER spectroscopy ,CRYSTAL structure - Abstract
Ternary intermetallic R
5 Fe6 Sn18 (R = Tm, Lu) compounds have been synthesized from the elements by arc melting, annealed at 670 K and characterized by X-ray powder diffraction and energy dispersive X-ray analyses. Performed structure refinements have shown that they crystallize in the cubic Tb5 Rh6 Sn18 structure type (space group Fm-3m, a = 13:55399(4) Å, a = 133.53243(5) Å for Tm and Lu compounds, respectively). Using57 Fe Mössbauer spectroscopy it has been found that the magnetic state of the Fe atoms in the Tm5 Fe6 Sn18 and Lu5 Fe6 Sn18 stannides is paramagnetic. The value of the isomer shifts for Lu5 Fe6 Sn18 and Tm5 Fe6 Sn18 is positive relative to pure Fe. The57 Fe Mössbauer spectra for Lu5 Fe6 Sn18 and Tm5Fe6Sn18 stannides have shown that the quadrupole splitting for the Fe position (24e) have magnitudes of 0.43 and 0.45 mm/s, respectively. The similarity of these values is consistent with a qualitative crystal structure analysis. The examined Tm5 Fe6 Sn18 and Lu5 Fe6 Sn18 compounds have been found to be characterized by metallic-like conductivity and high values of electrical resistivity (672.9 μΩ cm, 623.8 μΩ cm at 300 K for Tm and Lu, respectively). [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
- View/download PDF
9. ELECTRONIC STRUCTURE AND X-RAY SPECTROSCOPIC PROPERTIES OF THE HfFe2Si2 COMPOUND.
- Author
-
Shcherba, I. D., Antonov, V. N., Zhak, O. V., Bekenov, L. V., Kovalska, M. V., Noga, H., Uskokovic, D., and Yatcyk, B. M.
- Subjects
ELECTRONIC structure ,X-ray emission spectroscopy ,ELECTRON configuration ,X-ray spectra ,VALENCE bands ,ELECTRONIC band structure ,MOLECULAR spectra - Abstract
The valence band electronic structure of HfFe
2 Si2 has been established for the first time based on X-ray emission spectroscopy measurements. The band structure and X-ray emission spectra have been also obtained theoretically using the ab initio LMTO method in the non-relativistic approximation. The electron configuration of Si in the compound HfFe2 Si2 can be described as s1.1 p1.5 . The theoretical and experimental results are in satisfactory agreement. [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
- View/download PDF
10. 2426 Sliding Sign Testing Could be a Potential Alternative to Laparoscopy to Predict Endometriosis Fertility Index (EFI) in Endometriosis Associated Infertility
- Author
-
Alfaraj, SA, Bedaiwy, M, Yong, PJ, Allaire, C, Williams, C, Lisonkova, S, and Noga, H
- Published
- 2019
- Full Text
- View/download PDF
11. 072 Increased Central Sensitization among Women with Painful Bladder Syndrome and Deep Dyspareunia
- Author
-
Orr, N., Wahl, K., Noga, H., Albert, A., Smith, K., and Yong, P.
- Published
- 2019
- Full Text
- View/download PDF
12. Negative sliding sign predicts low endometriosis fertility index(EFI) during dynamic ultrasonography
- Author
-
Alfaraj, S.A., Yong, P., Allaire, C., Williams, C., Lisonkova, S., Noga, H., and Bedaiwy, M.A.
- Published
- 2018
- Full Text
- View/download PDF
13. Progestin only medications for chronic pelvic pain: use patterns and causes of discontinuation
- Author
-
Alsowayan, N., Yong, P., Allaire, C., Noga, H., Bedaiwy, M.A., and Williams, C.
- Published
- 2018
- Full Text
- View/download PDF
14. 031 Bladder and Pelvic Floor Tenderness in Endometriosis Deep Dyspareunia
- Author
-
Orr, N., Noga, H., Smith, K., Williams, C., Allaire, C., Bedaiwy, M., and Yong, P.
- Published
- 2018
- Full Text
- View/download PDF
15. Iatrogenic endometriosis harbors somatic cancer-driver mutations.
- Author
-
Lac, V, Verhoef, L, Aguirre-Hernandez, R, Nazeran, T M, Tessier-Cloutier, B, Praetorius, T, Orr, N L, Noga, H, Lum, A, Khattra, J, Prentice, L M, Co, D, Köbel, M, Mijatovic, V, Lee, A F, Pasternak, J, Bleeker, M C, Krämer, B, Brucker, S Y, and Kommoss, F
- Abstract
Study Question: Does incisional endometriosis (IE) harbor somatic cancer-driver mutations?Summary Answer: We found that approximately one-quarter of IE cases harbor somatic-cancer mutations, which commonly affect components of the MAPK/RAS or PI3K-Akt-mTor signaling pathways.What Is Known Already: Despite the classification of endometriosis as a benign gynecological disease, it shares key features with cancers such as resistance to apoptosis and stimulation of angiogenesis and is well-established as the precursor of clear cell and endometrioid ovarian carcinomas. Our group has recently shown that deep infiltrating endometriosis (DE), a form of endometriosis that rarely undergoes malignant transformation, harbors recurrent somatic mutations.Study Design, Size, Duration: In a retrospective study comparing iatrogenically induced and endogenously occurring forms of endometriosis unlikely to progress to cancer, we examined endometriosis specimens from 40 women with IE and 36 women with DE. Specimens were collected between 2004 and 2017 from five hospital sites in either Canada, Germany or the Netherlands. IE and DE cohorts were age-matched and all women presented with histologically typical endometriosis without known history of malignancy.Participants/materials, Setting, Methods: Archival tissue specimens containing endometriotic lesions were macrodissected and/or laser-capture microdissected to enrich endometriotic stroma and epithelium and a hypersensitive cancer hotspot sequencing panel was used to assess for presence of somatic mutations. Mutations were subsequently validated using droplet digital PCR. PTEN and ARID1A immunohistochemistry (IHC) were performed as surrogates for somatic events resulting in functional loss of respective proteins.Main Results and the Role Of Chance: Overall, we detected somatic cancer-driver events in 11 of 40 (27.5%) IE cases and 13 of 36 (36.1%) DE cases, including hotspot mutations in KRAS, ERBB2, PIK3CA and CTNNB1. Heterogeneous PTEN loss occurred at similar rates in IE and DE (7/40 vs 5/36, respectively), whereas ARID1A loss only occurred in a single case of DE. While rates of detectable somatic cancer-driver events between IE and DE are not statistically significant (P > 0.05), KRAS activating mutations were more prevalent in DE.Limitations, Reasons For Caution: Detection of somatic cancer-driver events were limited to hotspots analyzed in our panel-based sequencing assay and loss of protein expression by IHC from archival tissue. Whole genome or exome sequencing, or epigenetic analysis may uncover additional somatic alterations. Moreover, because of the descriptive nature of this study, the functional roles of identified mutations within the context of endometriosis remain unclear and causality cannot be established.Wider Implications Of the Findings: The alterations we report may be important in driving the growth and survival of endometriosis in ectopic regions of the body. Given the frequency of mutation in surgically displaced endometrium (IE), examination of similar somatic events in eutopic endometrium, as well as clinically annotated cases of other forms of endometriosis, in particular endometriomas that are most commonly linked to malignancy, is warranted.Study Funding/competing Interest(s): This study was funded by a Canadian Cancer Society Impact Grant [701603, PI Huntsman], Canadian Institutes of Health Research Transitional Open Operating Grant [MOP-142273, PI Yong], the Canadian Institutes of Health Research Foundation Grant [FDN-154290, PI Huntsman], the Canadian Institutes of Health Research Project Grant [PJT-156084, PIs Yong and Anglesio], and the Janet D. Cottrelle Foundation through the BC Cancer Foundation [PI Huntsman]. D.G. Huntsman is a co-founder and shareholder of Contextual Genomics Inc., a for profit company that provides clinical reporting to assist in cancer patient treatment. R. Aguirre-Hernandez, J. Khattra and L.M. Prentice have a patent MOLECULAR QUALITY ASSURANCE METHODS FOR USE IN SEQUENCING pending and are current (or former) employees of Contextual Genomics Inc. The remaining authors have no competing interests to declare.Trial Registration Number: Not applicable. [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
- View/download PDF
16. Dielectric behaviour of BaTi 1-x Zr x O 3 ceramics obtained by means of a solid state and mechanochemical synthesis.
- Author
-
Dulian, P., Garbarz-Glos, B., Bąk, W., Antonova, M., Kajtoch, C., Wieczorek-Ciurowa, K., and Noga, H.
- Subjects
CERAMICS ,SOLID state chemistry ,DIELECTRIC devices ,OXIDE minerals ,STOICHIOMETRIC combustion - Abstract
In this study the comparison of dielectric behaviour of BaTi1-xZrxO3(BTZx) ceramic samples prepared by means of a solid state and mechanochemical synthesis was presented. A single phase of perovskite structure was identified in the samples at room temperature. No significant impurities were detected in an EDS spectrum and the samples had a good stoichiometric ratio. The morphology of the investigated samples was characterized by a scanning electron microscopy (SEM). The investigation of dielectric properties of the BTZx samples within the temperature range from 140 K to 600 K was performed by means of a dielectric spectroscopy method at the frequency ranging from 0.1 Hz to 10 MHz. The temperature dependences of real part of dielectric permittivity showed the changes of the character of the paraelectric–ferroelectric (PE–FE) phase transition for the ceramic samples obtained by means of both methods. [ABSTRACT FROM PUBLISHER]
- Published
- 2016
- Full Text
- View/download PDF
17. Neuro — Didactic perspective of creative attitude towards education in the third millennium — Examination of individual cases.
- Author
-
Depesova, J., Noga, H., Silarska, M. Piaskowska, and Pytel, K.
- Published
- 2014
- Full Text
- View/download PDF
18. Examination of the theta index during solving IT issues.
- Author
-
Depesova, J., Noga, H., Silarska, M. Piaskowska, and Pytel, K.
- Published
- 2014
- Full Text
- View/download PDF
19. Applying Chosen Teaching Methods in Technical Education.
- Author
-
Noga, H.
- Subjects
TEACHING methods ,TECHNICAL education ,TEACHER effectiveness ,INTELLECTUAL development ,ENGINEERING education - Abstract
Education, also the technical one, is supposed to prepare students for adult life, not only by providing them with ready-made knowledge, but first of all by equipping students with an ability to learn, gather and select information. Active methods influence students' senses, allowing for a better understanding and remembering the subject matter. The study shows some didactic methods used in technical education. The attention has been aid to inventive, exploratory, and inventive-exploratory methods. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
20. X-RAY SPECTROSCOPIC PROPERTIES AND ELECTRONIC STRUCTURE OF Ca3Ga2Ge4O14.
- Author
-
Shcherba, I. D., Kostyk, L. V., Bekenov, L. V., Rudko, M., Uskoković, D., Noga, H., Bilyk, R. M., Yatcyk, B. M., and Denys, V. A.
- Subjects
- *
X-rays , *PHOTOELECTRON spectra , *X-ray spectra , *VALENCE bands , *CONDUCTION electrons , *ELECTRONIC structure - Abstract
We have obtained X-ray emission spectra of Ga and Ge in Ca3Ga2Ge4O14, X-ray emission OKα-spectra in Ca3Ga2Ge4O14, Ca3Ga2Ge4O14 + Ce3%, and Ca3Ga2Ge4O14 + Eu4% and Xray photoelectron spectra in Ca3Ga2Ge4O14 . Our X-ray spectral studies of the Ca3Ga2Ge4O14 gallogermanate have shown that the top of the valence band near the Fermi level is formed mainly by p states of gallium and germanium as well as p states of oxygen, whose intensity is sufficiently low. The middle of the valence band is formed by gallium 3d states with oxygen 2s states lying below them. These states are hybridized with 4p states of gallium and germanium because of which there are Kβ′′-satellites in the Kβ2-subbands of gallium and germanium. The bottom of the valence band is formed by 3d states of germanium, whose contribution to chemical bonding is insignificant. The X-ray emission bands of Ga and Ge in Ca3Ga2Ge4O14 and the photoelectron spectrum of the valence electrons of Ca3Ga2Ge4O14 are in good agreement. The OKα-band changes its fine structure only slightly upon doping Ca3Ga2Ge4O14 with Ce or Eu. The investigations of intrinsic luminescence under X-rays excitation of Ca3Ga2Ge4O14 gallogermanate are presented. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
21. Electronic structure and X-ray spectroscopic properties of YbNi2P2.
- Author
-
Shcherba, I.D., Bekenov, L.V., Antonov, V.N., Noga, H., Uskokovic, D., Zhak, O., and Kovalska, M.V.
- Subjects
- *
X-ray spectroscopy , *CRYSTAL structure , *CRYSTALLOGRAPHY , *X-ray absorption , *ELECTROMAGNETIC wave absorption - Abstract
X-ray absorption spectrum at the Yb L 3 edge and X-ray emission spectra of Ni and P at the K and L 2,3 edges have been studied experimentally and theoretically in the mixed valent compound YbNi 2 P 2 with ThCr 2 Si 2 type crystal structure. The electronic structure of YbNi 2 P 2 is investigated using the fully relativistic Dirac linear muffin-tin orbital (LMTO) band-structure method. The effect of the spin–orbit (SO) interaction and Coulomb repulsion U on the electronic structure of YbNi 2 P 2 is examined in the frame of the LSDA + SO + U method. The core-hole effect in the final states as well as the effect of the electric quadrupole E 2 transitions have been investigated. A good agreement between the theory and the experiment was found. Both the trivalent and the divalent Yb ions in YbNi 2 P 2 are reflected in the experimentally measured Yb L 3 X-ray absorption spectrum simultaneously. We found that the best agreement between the experimental spectrum and sum of the theoretically calculated Yb 2+ and Yb 3+ spectra is achieved with 73% ytterbium ions in 2+ state and 27% ions in 3+ state. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
22. Pain with orgasm in endometriosis: potential etiologic factors and clinical correlates.
- Author
-
Ding A, Noga H, Bouchard KN, Bedaiwy MA, Lee C, Allaire C, Orr NL, and Yong PJ
- Subjects
- Humans, Female, Adult, Middle Aged, Prospective Studies, Adenomyosis complications, Adenomyosis physiopathology, Myalgia etiology, Myalgia physiopathology, Central Nervous System Sensitization physiology, Young Adult, Pelvic Floor physiopathology, Prevalence, Adolescent, Endometriosis complications, Endometriosis physiopathology, Orgasm, Pelvic Pain etiology, Pelvic Pain physiopathology
- Abstract
Background: Pelvic pain worsened by orgasm is a poorly understood symptom in patients with endometriosis., Aim: To assess the prevalence of pelvic pain worsened by orgasm in patients with endometriosis and explore its association with potential etiologic factors, including pelvic floor myalgia, uterine tenderness and adenomyosis, and central nervous system sensitization., Methods: An analysis was done of a prospective data registry based at a tertiary referral center for endometriosis. Eligible participants were patients aged 18 to 50 years who were referred between January 1, 2018, and December 31, 2019, diagnosed with endometriosis, and subsequently underwent surgery at the center. Clinical features were compared between participants reporting worsening pelvic pain with orgasm and those without worsening pain with orgasm, including patient-reported variables, physical examination findings, and anatomic phenotyping at the time of surgery. Pelvic floor myalgia and uterine tenderness were assessed by palpation on pelvic examination, adenomyosis by ultrasound, and central nervous system sensitization via the Central Sensitization Inventory (range, 0-100)., Outcomes: Outcomes included pelvic or lower abdominal pain in the last 3 months that worsened with orgasm (yes/no)., Results: Among 358 participants with endometriosis, 14% (49/358) reported pain worsened by orgasm while 86% (309/358) did not. Pain with orgasm was significantly associated with pelvic floor myalgia (55% [27/49] vs 35% [109/309]; Cohen's h = 0.40, P = .01) and higher scores on the Central Sensitization Inventory (mean ± SD, 53.3 ± 17.0 vs 42.7 ± 18.2; Cohen's d = 0.60, P < .001) but not with uterine tenderness or adenomyosis. Other clinical features associated with pain with orgasm were poorer sexual health (higher scores: deep dyspareunia, Cohen's h = 0.60; superficial dyspareunia, Cohen's h = 0.34; and Female Sexual Distress Scale-Revised, Cohen's d = 0.68; all P < .05) and poorer mental health (higher scores: Patient Health Questionnaire-9, 12.9 ± 6.7 vs 9.1 ± 6.3, Cohen's d = 0.59, P < .001; Generalized Anxiety Disorder-7, 9.4 ± 5.6 vs 6.8 ± 5.5, Cohen's d = 0.48, P = .002). Anatomic findings at the time of surgery did not significantly differ between the groups., Clinical Implications: Interventions targeting pelvic floor myalgia and central nervous system sensitization may help alleviate pain worsened by orgasm in patients with endometriosis., Strengths and Limitations: A strength is that pain worsened by orgasm was differentiated from dyspareunia. However, pain with orgasm was assessed by only a binary question (yes/no). Also, the study is limited to a single center, and there were limited data on sexual function., Conclusion: Pelvic pain exacerbated by orgasm in people with endometriosis may be related to concurrent pelvic floor myalgia and central sensitization., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society of Sexual Medicine.)
- Published
- 2024
- Full Text
- View/download PDF
23. Ohnut vs waitlist control for the self-management of endometriosis-associated deep dyspareunia: a pilot randomized controlled trial.
- Author
-
Wahl K, Orr NL, Parmar G, Zhang SXJ, MacLeod RGK, Noga H, Albert A, Flannigan R, Brotto LA, and Yong PJ
- Abstract
Background: Deep dyspareunia affects 50% of people with endometriosis. The Ohnut is a set of interlocking rings that fit over the penis/insertive object. One or more rings can be used to limit insertion depth and reduce deep dyspareunia., Aim: We conducted a pilot, parallel, open-label randomized controlled trial (RCT) to investigate the feasibility of the study design and the acceptability and preliminary efficacy of the Ohnut., Method: Participants were recruited from a tertiary center for endometriosis. Eligibility criteria were surgically confirmed endometriosis, age 19-49 years, monogamous sexual relationship with a partner willing to participate in the study, and no comorbid superficial dyspareunia, anxiety, or depression. Couples were randomized into an intervention group or a waitlist control group using a 1:1 allocation ratio. All couples had sex as normal during weeks 1 to 4 (baseline period), and couples in the intervention group used the Ohnut with sex during weeks 5 to 10 (intervention period) while controls had sex as normal. Patient participants used daily diaries to record sexual activity and deep dyspareunia score (0-10) for the 10-week study. Intervention group participants completed an acceptability questionnaire at the end of the study., Outcomes: The primary outcomes were feasibility of the study and acceptability of the Ohnut. We also assessed differences in deep dyspareunia scores in the participants who used the Ohnut compared to the control participants who did not., Results: We recruited approximately 5 couples per month of active recruitment. Of 864 potentially eligible participants, we successfully contacted 44.7% (n = 386), of whom 8.0% (n = 31) consented, 64.8% (n = 250) were ineligible, and 27.2% (n = 105) declined. Thirty-one couples were randomly assigned to the intervention or control group, and 17 couples completed the study. Intervention group couples used the Ohnut for an average of 72.4% (32.7%) of sexual encounters during the intervention period. The mean acceptability index score for the Ohnut was 0.83 (0.078) among patients and 0.83 (0.049) among partners (index between 0 and 1). After controlling for baseline deep dyspareunia, there was a significant difference in the intervention period mean deep dyspareunia scores between the control and intervention group (4.69 (2.44) vs 2.46 (1.82), P = .012)., Clinical Implications: We identified preliminary evidence for the acceptability and efficacy of the Ohnut among both patients and partners, suggesting that the Ohnut may be a useful stand-alone or adjuvant management tool for endometriosis-associated deep dyspareunia., Strengths and Limitations: Strengths of this study were the "real-world" use of the Ohnut and data collection from both patients and partners. Limitations of the study design included the strict eligibility criteria that affected feasibility and generalizability., Conclusion: This pilot RCT indicated that the Ohnut may be an acceptable and effective intervention to reduce endometriosis-associated deep dyspareunia. We identified opportunities to improve design for a larger RCT., Clinical Trial Registration: This clinical trial was registered with clinicaltrials.gov (#NCT04370444)., Competing Interests: R.F. is co-owner of Teumo Health Technologies Inc, a digital health company in sexual medicine., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society for Sexual Medicine.)
- Published
- 2024
- Full Text
- View/download PDF
24. Women's Self-Management of Dyspareunia Associated With Endometriosis: A Qualitative Study.
- Author
-
Howard AF, Noga H, Kelly MT, Gholamian B, Lett S, Sutherland J, and Yong PJ
- Subjects
- Humans, Female, Adult, Young Adult, Adolescent, Dyspareunia therapy, Dyspareunia etiology, Endometriosis complications, Endometriosis therapy, Qualitative Research, Self-Management
- Abstract
Given the limitations of medical treatment for endometriosis, self-management is a critical component of symptom management, and providing patients with information and education is a necessary complement to medical interventions. Though 50 to 70% of people with endometriosis experience dyspareunia (painful sex), there is limited knowledge of self-management specific to painful sex. A comprehensive understanding of the self-management strategies used is foundational to developing supportive care interventions that help ease pain and related psychosocial sequelae. The objective was to describe people's experiences of navigating endometriosis-associated painful sex and developing self-management strategies. We analyzed interview data from 20 women using constant comparative and thematic analysis techniques, guided by qualitative interpretive description methodology. Participants (age range 18-44 years) all identified as women and were predominately Caucasian (90%) and heterosexual (80%). Throughout their lives, the women appeared to gradually develop self-management strategies while navigating painful sexual experiences. This complex journey encompassed four phases: 1) viewing painful sex as normal, 2) experiencing evolving thoughts and emotions, 3) coming to understand painful sex and seeking help, and 4) learning strategies to navigate painful sex, these include preparing mentally and physically for sex and communicating with intimate partner(s). Women in this study developed self-management strategies over time through engagement with others who understood their challenges. Future research is warranted regarding initiatives to counter the normalization of painful sex, develop and disseminate patient-facing information, provide education specific to dyspareunia, improve access to multidisciplinary care, facilitate social connections and support, and enhance communication with intimate partners. PERSPECTIVE: In this paper, we report on the experiences of women with endometriosis-associated painful sex and their self-management strategies. Clinicians may be interested in a qualitative exploration of endometriosis-associated painful sex as they seek to further understand their patient's experiences and what strategies can be implemented to alleviate dyspareunia. DATA AVAILABILITY: The data sets generated during and/or analyzed during the current study are not publicly available as participants did not consent to making their data publicly available but are available from the corresponding author on reasonable request., (Copyright © 2024 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
25. The Transformative Value of Collaboration: Patients as Research Partners in Pain Research.
- Author
-
Noga H, Howard AF, Sutherland J, Fernie E, Langer R, Larente M, Lett S, Merkt-Caprile K, Puri V, and Yong PJ
- Subjects
- Humans, Patient Participation, Pain, Pain Management, Cooperative Behavior, Biomedical Research
- Published
- 2024
- Full Text
- View/download PDF
26. Mental Health Outcomes of Endometriosis Patients during the COVID-19 Pandemic: Impact of Pre-pandemic Central Nervous System Sensitization.
- Author
-
Liu YD, Noga H, Allaire C, Bedaiwy MA, Lee CE, Williams C, Booth A, Galea LAM, Kaida A, Ogilvie GS, Brotto LA, and Yong PJ
- Subjects
- Humans, Female, Adult, Comorbidity, Chronic Pain epidemiology, Chronic Pain psychology, Prospective Studies, Pelvic Pain epidemiology, Pelvic Pain psychology, Pelvic Pain etiology, Middle Aged, Mental Health, Endometriosis psychology, Endometriosis epidemiology, Endometriosis complications, COVID-19 epidemiology, COVID-19 psychology, Central Nervous System Sensitization physiology, Depression epidemiology, Depression etiology, Anxiety epidemiology, Anxiety etiology
- Abstract
To correlate pain-related phenotyping for central nervous system sensitization in endometriosis-associated pain with mental health outcomes during the COVID-19 pandemic, the prospective Endometriosis and Pelvic Pain Interdisciplinary Cohort (ClinicalTrials.gov #NCT02911090) was linked to the COVID-19 Rapid Evidence Study of a Provincial Population-Based Cohort for Gender and Sex (RESPPONSE) dataset. The primary outcomes were depression (PHQ-9) and anxiety (GAD-7) scores during the pandemic. The explanatory variables of interest were the Central Sensitization Inventory (CSI) score (0-100) and endometriosis-associated chronic pain comorbidities/psychological variables before the pandemic. The explanatory and response variables were assessed for correlation, followed by multivariable regression analyses adjusting for PHQ-9 and GAD-7 scores pre-pandemic as well as age, body mass index, and parity. A higher CSI score and a greater number of chronic pain comorbidities before the pandemic were both positively correlated with PHQ-9 and GAD-7 scores during the pandemic. These associations remained significant in adjusted analyses. Increasing the CSI score by 10 was associated with an increase in pandemic PHQ-9 by .74 points (P < .0001) and GAD-7 by .73 points (P < .0001) on average. Each additional chronic pain comorbidity/psychological variable was associated with an increase in pandemic PHQ-9 by an average of .63 points (P = .0004) and GAD-7 by .53 points (P = .0002). Endometriosis patients with a history of central sensitization before the pandemic had worse mental health outcomes during the COVID-19 pandemic. As a risk factor for mental health symptoms in the face of major stressors, clinical proxies for central sensitization can be used to identify endometriosis patients who may need additional support. PERSPECTIVE: This article adds to the growing literature of the clinical importance of central sensitization in endometriosis patients, who had more symptoms of depression and anxiety during the COVID-19 pandemic. Clinical features of central sensitization may help clinicians identify endometriosis patients needing additional support when facing major stressors., (Copyright © 2024 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
27. Nerve Bundle Density and Expression of NGF and IL-1β Are Intra-Individually Heterogenous in Subtypes of Endometriosis.
- Author
-
Sreya M, Tucker DR, Yi J, Alotaibi FT, Lee AF, Noga H, and Yong PJ
- Subjects
- Adult, Female, Humans, Middle Aged, Ubiquitin Thiolesterase metabolism, Neurons metabolism, Neurons pathology, Endometriosis metabolism, Endometriosis pathology, Interleukin-1beta metabolism, Nerve Growth Factor metabolism
- Abstract
Endometriosis is a gynecological disorder associated with local inflammation and neuroproliferation. Increased nerve bundle density has been attributed to increased expression of nerve growth factor (NGF) and interleukin-1β (IL-1β). Immunohistochemical analysis was carried out on 12 patients presenting with all three anatomic subtypes of endometriosis (deep, superficial peritoneal, endometrioma) at surgery, with at least two surgically excised subtypes available for analysis. Immunolocalization for nerve bundle density around endometriosis using protein gene product 9.5 (PGP9.5), as well as NGF and IL-1β histoscores in endometriosis epithelium/stroma, was performed to evaluate differences in scores between lesions and anatomic subtypes per patient. Intra-individual heterogeneity in scores across lesions was assessed using the coefficient of variation (CV). The degree of score variability between subtypes was evaluated using the percentage difference between mean scores from one subtype to another subtype for each marker. PGP9.5 nerve bundle density was heterogenous across multiple subtypes of endometriosis, ranging from 50.0% to 173.2%, where most patients (8/12) showed CV ≥ 100%. The percentage difference in scores showed that PGP9.5 nerve bundle density and NGF and IL-1β expression were heterogenous between anatomic subtypes within the same patient. Based on these observations of intra-individual heterogeneity, we conclude that markers of neuroproliferation in endometriosis should be stratified by anatomic subtype in future studies of clinical correlation.
- Published
- 2024
- Full Text
- View/download PDF
28. The use of Arts-Based Research in Chronic Pain: A Scoping Review.
- Author
-
Harasymchuk SJ, Howard AF, Noga H, Kelly MT, and Yong PJ
- Abstract
Background: As an emerging approach, arts-based research holds potential to advance understanding of the complex and multidimensional experiences of chronic pain and means of communicating this experiential evidence. This scoping review aimed to map and explore the extent of arts-based research in chronic non-cancer pain, understand the rationale behind using arts-based research methods, and identify directions for future research., Methods: Databases PsycINFO, MEDLINE, EMBASE, and CINAHL were searched for eligible English-language articles from inception to November 2022. Out of 1321 article titles and abstracts screened for eligibility, 18 articles underwent full-text screening, with 14 ultimately meeting all inclusion criteria. We conducted a narrative synthesis of data extracted from the 14 reviewed articles., Results: The review articles focused on a wide range of chronic non-cancer pain conditions, with 12/14 employing qualitative methods (86%), one repeated measures experimental design, and another a multiphase, multimethod design. Seven articles described the use of drawing, painting, or mixed-media artwork; four used photography; two used body mapping; and one used e-book creation. The rationale for arts-based research included exploring and better understanding patients' experiences with chronic non-cancer pain, constructing an intervention, and investigating or validating a clinical tool. Nine articles reported that their arts-based research methods produced unintended therapeutic benefits for participants. Recommendations for future research included using arts-based research to better understand and communicate with patients and providers, exploring convergence with art therapy, and designing creative and flexible multiphased studies involving collaboration across disciplines., Conclusions: Despite the wide variation in sample and art modalities across reviewed articles, arts-based methods were considered suitable and highly effective for investigating chronic non-cancer pain., Competing Interests: No potential conflicts of interest are reported by the author(s)., (© 2024 The Author(s). Published with license by Taylor & Francis Group, LLC.)
- Published
- 2024
- Full Text
- View/download PDF
29. Corrigendum to 'Outcomes After Surgery at an Interdisciplinary Centre of Expertise for Endometriosis and Pelvic Pain in Canada: A Prospective Cohort Study' [Journal of Obstetrics and Gynaecology Canada (JOGC). Volume 46, Issue 2 (2024) 102246].
- Author
-
Lee CE, Allaire C, Williams C, Bedaiwy MA, Noga H, Hanley GE, Lisonkova S, Albert A, and Yong PJ
- Published
- 2024
- Full Text
- View/download PDF
30. Patient-Centered Approaches for Designing Destigmatizing Sexual Pain-Related Web-Based Platforms: Qualitative Study.
- Author
-
Abdulai AF, Naghdali H, Noga H, and Yong PJ
- Abstract
Background: Sexual pain is a common but neglected disorder that affects approximately 3% to 18% of women and an unmeasured number of gender-diverse people worldwide. Despite its wide prevalence, many people feel reluctant to visit conventional health care services or disclose their symptoms due to the fear of stigmatization. To alleviate this stigma, various web-based interventions have been developed to complement and, in some cases, replace conventional sexual health interventions. However, the way these web-based interventions are developed could inadvertently reproduce, perpetuate, or exacerbate stigma among end user patients., Objective: The purpose of this study was to understand patients' perspectives on how sexual pain-related web platforms can be designed to alleviate stigma or prevent the unintended effects of stigma among patients who use web-based interventions., Methods: Individual semistructured interviews were conducted among 16 participants with lived experiences of painful sex in a large urban city in Western Canada. Participants were recruited via social media platforms, newsletters, and a provincial health volunteer website. Using a sample sexual pain website to provide context, participants were interviewed about their experiences of stigma and how they think web platforms could be designed to address stigma. The interviews were conducted via Zoom (Zoom Technologies Inc) and analyzed using thematic analysis., Results: The findings revealed 4 overarching themes that represented participants' perspectives on designing web platforms that may alleviate or prevent the unintended effects of stigma. These findings suggested the design of inclusive web platforms, having a nonprovocative and calming user interface, having features that facilitate connections among users and between users and providers, and displaying personal testimonials and experiences of sexual pain., Conclusions: This study highlighted patient-centered design approaches that could serve as a reference guide in developing web platforms that alleviate or prevent the unintended effects of stigma, particularly among nonheterosexual and gender-diverse people. While this study was conducted in the context of sexual pain, the results might also apply to web platforms on other potentially stigmatizing health-related disorders or conditions., (©Abdul-Fatawu Abdulai, Hasti Naghdali, Heather Noga, Paul J Yong. Originally published in JMIR Formative Research (https://formative.jmir.org), 15.03.2024.)
- Published
- 2024
- Full Text
- View/download PDF
31. Outcomes After Surgery at an Interdisciplinary Centre of Expertise for Endometriosis and Pelvic Pain in Canada: A Prospective Cohort Study.
- Author
-
Lee CE, Allaire C, Williams C, Bedaiwy MA, Noga H, Hanley GE, Lisonkova S, Albert A, and Yong PJ
- Subjects
- Female, Humans, Adult, Prospective Studies, Pelvic Pain etiology, Pelvic Pain surgery, Canada, Hysterectomy, Endometriosis complications, Endometriosis surgery
- Abstract
Objectives: To prospectively evaluate pain-related quality-of-life (Endometriosis Health Profile-30 [EHP-30] pain subscale) after surgery at an interdisciplinary centre of expertise for endometriosis and pelvic pain., Methods: A prospective cohort study was completed of persons undergoing surgical management for pelvic pain between December 2013 and July 2016 at an interdisciplinary tertiary referral centre for pelvic pain and endometriosis. We compared the change in EHP-30 scores for the following scenarios: (1) type of surgery (conservative surgery vs. hysterectomy), (2) stage of endometriosis (stage I/II vs. III/IV), and (3) age (age <40 vs. age ≥40 years). We used mixed-effects models to evaluate changes in pain during follow-up after surgery., Results: Overall, 595 individuals met our inclusion criteria; the follow-up rate was 65.9% (392/595). In total, 436 (73.3%) underwent conservative surgery, while 159 (26.7%) underwent hysterectomy. Improvements in pain-related quality-of-life were seen for both conservative surgery and hysterectomy but greater improvements were seen with hysterectomy (P < 0.001). For conservative surgery, similar improvements in quality-of-life were observed regardless of endometriosis stage (I/II vs. III/IV) (P = 0.84) or age (<40 or ≥40 years old) (P = 0.87). We also observed similar improvements in quality-of-life regardless of stage (P = 0.24) or age (P = 0.71) after hysterectomy., Conclusions: At an interdisciplinary centre of expertise, there were significant improvements in quality-of-life after endometriosis surgery. These improvements were seen for both conservative surgery and hysterectomy (although greater improvement with the latter), for early and advanced stage disease, and younger and older patients., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
32. The quality, suitability, and readability of web-based resources on endometriosis-associated dyspareunia: A systematic review.
- Author
-
Abdulai AF, Howard AF, Parmar G, Noga H, Abdul-Ghafoor AA, Lisonek M, and Yong PJ
- Subjects
- Female, Humans, Comprehension, Internet, Consumer Health Information, Endometriosis complications, Dyspareunia etiology, Dyspareunia therapy
- Abstract
People commonly and increasingly rely on the internet to search for health information, including those related to endometriosis-associated dyspareunia. Yet the content of such websites may be of variable accuracy and quality. This review aims to evaluate the quality, readability, and suitability of web-based resources on endometriosis-associated dyspareunia for patients. We searched 3 databases - Google, Bing, and Yahoo - to identify websites related to endometriosis-associated dyspareunia. Two independent reviewers screened the search results against inclusion and exclusion criteria. Another set of two reviewers evaluated the selected websites using validated measurement instruments. Out of 450 websites, 21 met the inclusion criteria and were evaluated. More than half of the websites had information on content updates, reported on authorship, or disclosed sponsorship information. The mean quality and suitability scores were 47.5 (SD = 13.3) and 65.2 (SD = 13.6) respectively, thus suggesting generally adequate quality and suitability levels. However, the mean readability scores exceeded the recommended level for health-related websites. The poor readability of the websites might limit accessibility for a significant proportion of patients with low educational levels. The findings of this review have implications for designing high-quality, readable and up-to-date web interventions for people who rely on web platforms as an alternative or complementary source of health information on dyspareunia., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2024
- Full Text
- View/download PDF
33. Acceptability, reliability, and validity of a vaginal insert for the self-assessment of endometriosis-associated deep dyspareunia: a cross-sectional study.
- Author
-
MacLeod RGK, Parmar G, Zhang S, Noga H, Allaire C, Albert A, Flannigan R, Brotto LA, Orr NL, Wahl K, and Yong PJ
- Subjects
- Female, Humans, Adult, Pelvic Pain complications, Cross-Sectional Studies, Self-Assessment, Prospective Studies, Reproducibility of Results, Endometriosis complications, Endometriosis diagnosis, Dyspareunia etiology, Dyspareunia complications
- Abstract
Background: Approximately half of people with endometriosis experience deep dyspareunia; however, there is no means of objective self-testing of endometriosis-associated deep dyspareunia., Aim: The aim of this study was to assess the acceptability, test-retest reliability, and validity of a vaginal insert for a self-assessment of endometriosis-associated deep dyspareunia., Methods: Participants were recruited from a tertiary endometriosis center. Inclusion criteria were: 19 to 49 years of age, self-reported deep dyspareunia of ≥4 of 10, and surgically confirmed endometriosis. Participants completed 2 self-assessments using the vaginal insert to self-assess tenderness at the right and left pelvic floor, bladder, cervix-uterus, and posterior cul-de-sac (vaginal fornix). The participants recorded tenderness at each pelvic site and completed a questionnaire regarding the acceptability of the vaginal insert to assess deep dyspareunia. Test-retest reliability was assessed by correlating the tenderness scores between the 2 assessment dates. Over a 4-week period, the participants also recorded deep dyspareunia severity at each penetrative vaginal sex encounter. Validity was assessed by correlating vaginal insert tenderness to deep dyspareunia severity, and also to tenderness reported on a prior gynecologic pelvic examination., Outcomes: The main outcome measures were the acceptability index score, tenderness (0-10) at each pelvic site, and prospective deep dyspareunia scores (0-10) over 4 weeks., Results: There were 19 participants (mean age 34 ± 7 years) who completed the study. The majority identified as female (94.7%), heterosexual (89.5%), and white (89.5%). The median acceptability index score was 0.72 (interquartile range, 0.66-0.81). For test-retest reliability, the intraclass correlation coefficients were 0.79 (P = .001) for the left pelvic floor, 0.82 (P < .001) for the right pelvic floor, 0.54 (P = .07) for the bladder, 0.89 (P < .001) for the cervix-uterus, and 0.77 (P = .003) for the cul-de-sac. The correlation between the highest self-assessed mean tenderness in each participant and self-reported deep dyspareunia over 4 weeks was r = 0.32, but correlations for each pelvic site varied significantly. Tenderness at each site on prior gynecologist pelvic exam was associated with higher self-assessed mean tenderness with the vaginal insert in each participant (effect sizes = 0.42-0.88)., Clinical Implications: The vaginal insert is acceptable and reliable for the objective self-assessment of endometriosis-associated deep dyspareunia, with initial evidence of validity., Strengths and Limitations: A strength was the inclusion of participants who were avoiding sexual activity and a limitation was the small sample size., Conclusion: Future studies with larger sample sizes are required to further establish the validity of the vaginal insert for the self-assessment of endometriosis-associated deep dyspareunia., (© The Author(s) 2023. Published by Oxford University Press on behalf of The International Society of Sexual Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2023
- Full Text
- View/download PDF
34. Standardized protocol for quantification of nerve bundle density as a biomarker for endometriosis.
- Author
-
Zoet G, Tucker DR, Orr NL, Alotaibi FT, Liu YD, Noga H, Köbel M, and Yong PJ
- Abstract
Introduction: We propose a standardized protocol for measurement of nerve bundle density in endometriosis as a potential biomarker, including in deep endometriosis (DE), ovarian endometriomas (OMA) and superficial peritoneal endometriosis (SUP)., Methods: This was a prospective cohort of surgically excised endometriosis samples from Dec 1st 2013 and Dec 31st 2017 at a tertiary referral center for endometriosis in Vancouver, BC, Canada. Surgical data were available from linked patient registry. Protein gene product 9.5 (PGP9.5) was used to identify nerve bundles on immunohistochemistry. PGP9.5 nerve bundles were counted visually. To calculate nerve bundle density, PGP9.5 nerve bundle count was divided by the tissue surface area (total on the slide). All samples were assessed using NHS Elements software for semi-automated measurement of the tissue surface area. For a subset of samples, high power fields (HPFs) were also counted as manual measurement of the tissue surface area. Intraclass correlation was used to assess intra observer and inter observer reliability. Generalized linear mixed model (GLMM) with random intercepts only was conducted to assess differences in PGP9.5 nerve bundle density by endometriosis type (DE, OMA, SUP)., Results: In total, 236 tissue samples out of 121 participants were available for analysis in the current study. Semi-automated surface area measurement could be performed in 94.5% of the samples and showed good correlation with manually counted HPFs (Spearman's rho = 0.781, p < 0.001). To assess intra observer reliability, 11 samples were assessed twice by the same observer; to assess inter observer reliability, 11 random samples were blindly assessed by two observers. Intra observer reliability and inter observer reliability for nerve bundle density were excellent: 0.979 and 0.985, respectively. PGP9.5 nerve bundle density varied among samples and no nerve bundles could be found in 24.6% of the samples. GLMM showed a significant difference in PGP9.5 nerve bundle density between the different endometriosis types (X
2 = 87.6, P < 0.001 after adjusting for hormonal therapy, with higher density in DE and SUP in comparison to OMA)., Conclusion: A standardized protocol is presented to measure PGP9.5 nerve bundle density in endometriosis, which may serve as a biomarker reflecting local neurogenesis in the endometriosis microenvironment., Competing Interests: MK is a consultant for Helix Biopharma, which has no relation to the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Zoet, Tucker, Orr, Alotaibi, Liu, Noga, Köbel and Yong.)- Published
- 2023
- Full Text
- View/download PDF
35. KRAS mutations and endometriosis burden of disease.
- Author
-
Orr NL, Albert A, Liu YD, Lum A, Hong J, Ionescu CL, Senz J, Nazeran TM, Lee AF, Noga H, Lawrenson K, Allaire C, Williams C, Bedaiwy MA, Anglesio MS, and Yong PJ
- Subjects
- Female, Humans, Proto-Oncogene Proteins p21(ras) genetics, Longitudinal Studies, Mutation, Endometriosis genetics, Endometriosis surgery, Endometriosis complications, Neoplasms
- Abstract
The clinical phenotype of somatic mutations in endometriosis is unknown. The objective was to determine whether somatic KRAS mutations were associated with greater disease burden in endometriosis (i.e. more severe subtypes and higher stage). This prospective longitudinal cohort study included 122 subjects undergoing endometriosis surgery at a tertiary referral center between 2013 and 2017, with 5-9 years of follow-up. Somatic activating KRAS codon 12 mutations were detected in endometriosis lesions using droplet digital PCR. KRAS mutation status for each subject was coded as present (KRAS mutation in at least one endometriosis sample in a subject) or absent. Standardized clinical phenotyping for each subject was carried out via linkage to a prospective registry. Primary outcome was anatomic disease burden, based on distribution of subtypes (deep infiltrating endometriosis, ovarian endometrioma, and superficial peritoneal endometriosis) and surgical staging (Stages I-IV). Secondary outcomes were markers of surgical difficulty, demographics, pain scores, and risk of re-operation. KRAS mutation presence was higher in subjects with deep infiltrating endometriosis or endometrioma lesions only (57.9%; 11/19) and subjects with mixed subtypes (60.6%; 40/66), compared with those with superficial endometriosis only (35.1%; 13/37) (p = 0.04). KRAS mutation was present in 27.6% (8/29) of Stage I cases, in comparison to 65.0% (13/20) of Stage II, 63.0% (17/27) of Stage III, and 58.1% (25/43) of Stage IV cases (p = 0.02). KRAS mutation was also associated with greater surgical difficulty (ureterolysis) (relative risk [RR] = 1.47, 95% CI: 1.02-2.11) and non-Caucasian ethnicity (RR = 0.64, 95% CI: 0.47-0.89). Pain severities did not differ based on KRAS mutation status, at either baseline or follow-up. Re-operation rates were low overall, occurring in 17.2% with KRAS mutation compared with 10.3% without (RR = 1.66, 95% CI: 0.66-4.21). In conclusion, KRAS mutations were associated with greater anatomic severity of endometriosis, resulting in increased surgical difficulty. Somatic cancer-driver mutations may inform a future molecular classification of endometriosis., (© 2023 The Authors. The Journal of Pathology: Clinical Research published by The Pathological Society of Great Britain and Ireland and John Wiley & Sons Ltd.)
- Published
- 2023
- Full Text
- View/download PDF
36. Ohnut Versus a Waitlist Control for the Self-management of Endometriosis-Associated Deep Dyspareunia: Protocol for a Pilot Randomized Controlled Trial.
- Author
-
Zhang SXJ, MacLeod RGK, Parmar G, Orr NL, Wahl KJ, Noga H, Albert A, Flannigan R, Brotto LA, and Yong PJ
- Abstract
Background: Endometriosis-associated deep dyspareunia is associated with reduced sexual quality of life, lower self-esteem, and impaired sexual function., Objective: The primary objective is to assess the acceptability of a phallus length reducer (brand name: Ohnut [OhnutCo]), which is a buffer worn over the penis or a penetrating object to reduce endometriosis-associated deep dyspareunia, and the feasibility of a definitive randomized controlled trial (RCT). The secondary objective is to obtain estimates of the effectiveness of the buffer. An embedded substudy will explore the acceptability and the preliminary validity and reliability of a vaginal insert for the self-assessment of deep dyspareunia., Methods: Ours is an investigator-initiated, 2-arm RCT. We will recruit 40 patient participants with diagnosed endometriosis between the ages of 19 and 49 years, as well as their sexual partners. The participating couples will be randomized in a 1:1 ratio into the experimental arm or the waitlist control arm. The length of the study period will be 10 weeks, during which time all participants will record deep dyspareunia severity following each episode of sexual intercourse. In weeks 1 to 4, all patient participants will record deep dyspareunia severity at each sexual encounter. In weeks 5 to 10, participants in the experimental arm will use the buffer during vaginal penetration; participants in the waitlist control arm will continue engaging in vaginal penetration as usual. Participants will complete questionnaires for assessing measures of anxiety, depression, and sexual function at baseline, at 4 weeks, and at 10 weeks. In the substudy, patient participants will self-assess dyspareunia by using a vaginal insert on 2 occasions, at least 1 week apart. The primary outcomes-the acceptability and feasibility of the buffer-will be assessed with descriptive statistics, and the secondary outcome-phallus length reducer effectiveness-will be assessed by using an analysis of covariance-based approach. For the vaginal insert, we will assess acceptability, test-retest reliability, and convergent validity via correlation analyses comparing the use of the insert to clinical examination in terms of dyspareunia assessment outcomes., Results: Our pilot will provide initial data on the acceptability and effectiveness of the buffer and the feasibility of the study methodology. The results from our study are expected to be submitted for publication by the spring of 2023. As of September 2021, we have consented 31 couples into the study., Conclusions: Our study will provide preliminary evidence for the self-assessment and management of endometriosis-associated deep dyspareunia. The findings will inform the decision to proceed to a definitive RCT., Trial Registration: ClinicalTrials.gov NCT04370444; https://clinicaltrials.gov/ct2/show/NCT04370444., International Registered Report Identifier (irrid): DERR1-10.2196/39834., (©Sandy X J Zhang, Rebecca G K MacLeod, Gurkiran Parmar, Natasha L Orr, Kate J Wahl, Heather Noga, Arianne Albert, Ryan Flannigan, Lori A Brotto, Paul J Yong. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 27.03.2023.)
- Published
- 2023
- Full Text
- View/download PDF
37. Web-Based Digital Storytelling for Endometriosis and Pain: Qualitative Pilot Study.
- Author
-
Howard AF, Noga H, Parmar G, Kennedy L, Aragones S, Bassra R, Gelfer L, Lopez de Arbina E, Sutherland J, Allaire C, Oliffe JL, Currie LM, Yager H, and Yong PJ
- Abstract
Background: Endometriosis is a complex chronic disease characterized by pain, including painful sex, that can contribute to considerable sexual function, self-esteem, and relationship challenges. Digital storytelling is an arts-based, participatory methodology wherein individuals create and share their illness experiences in detailing their lived experiences., Objective: The study objective was to pilot-test a web-based digital storytelling workshop focused on endometriosis to understand storytellers' experiences of workshop participation. We assessed the feasibility of story cocreation and sharing, including the emotional impact of workshop participation, the acceptability of the workshop for the subject matter, and the storytellers' willingness to share their stories with broader audiences as a method for knowledge translation., Methods: This study used a community-based participatory methodology supplemented with patient-oriented research and integrated knowledge translation. Study participants, referred to as storytellers, cocreated 3- to 5-minute individual digital stories about their lived experiences of endometriosis during a web-based workshop (comprising five 2-hour sessions over 6 weeks) facilitated by The Center for Digital Storytelling. Data were collected through participant observations at the workshop, storyteller weekly reflective journals, and an end-of-workshop focus group interview with storytellers. These data were analyzed using a qualitative interpretive description approach., Results: A total of 5 women and 1 nonbinary storyteller aged 19 to 39 years who had experienced endometriosis for 4 to 22 years participated in the study. We characterized storytelling workshop participation and the acceptability of story cocreation by describing participants' experiences of opportunity, commitment, and connection; complex emotions that were healing; and a desire to share. Feasibility was demonstrated through 100% engagement in the workshops. All 6 storytellers reported feeling empowered by publicly sharing their cocreated digital stories through social media and the Sex, Pain & Endometriosis website., Conclusions: Despite the complexities of the story-building process, the workshop and the cocreation and sharing of digital stories were feasible. The storytellers found that this process allowed for emotional healing and personal empowerment by offering a unique way to talk about painful sex, which also facilitated a connection among those in the workshop. The use of digital storytelling as a knowledge translation tool shows promise, and this approach also has potential as a therapeutic intervention., (©A Fuchsia Howard, Heather Noga, Gurkiran Parmar, Lan Kennedy, Sarah Aragones, Roop Bassra, Lauren Gelfer, Edurne Lopez de Arbina, Jessica Sutherland, Catherine Allaire, John L Oliffe, Leanne M Currie, Holly Yager, Paul J Yong. Originally published in JMIR Formative Research (https://formative.jmir.org), 14.03.2023.)
- Published
- 2023
- Full Text
- View/download PDF
38. Association of Central Sensitization Inventory Scores With Pain Outcomes After Endometriosis Surgery.
- Author
-
Orr NL, Huang AJ, Liu YD, Noga H, Bedaiwy MA, Williams C, Allaire C, and Yong PJ
- Subjects
- Female, Humans, Adult, Central Nervous System Sensitization, Cohort Studies, Longitudinal Studies, Prospective Studies, Pelvic Pain epidemiology, Pelvic Pain etiology, Pelvic Pain surgery, British Columbia epidemiology, Constipation, Endometriosis complications, Endometriosis surgery, Dyspareunia epidemiology, Dyspareunia etiology, Chronic Pain epidemiology, Chronic Pain etiology
- Abstract
Importance: A subset of people who undergo surgery for endometriosis have persistent pain, suggesting that other factors besides the endometriosis, such as central sensitization, may play a role in this pain. The Central Sensitization Inventory, a validated self-reported questionnaire of central sensitization symptoms, may identify individuals with endometriosis who have more pain after surgery due to pain sensitization., Objective: To examine whether greater baseline Central Sensitization Inventory scores are associated with postsurgical pain outcomes., Design, Setting, and Participants: This prospective, longitudinal cohort study performed at a tertiary center for endometriosis and pelvic pain in British Columbia, Canada, included all patients aged 18 to 50 years with diagnosed or suspected endometriosis and a baseline visit between January 1, 2018, and December 31, 2019, who underwent surgery after the baseline visit. Individuals who were menopausal, had a prior hysterectomy, or were missing data for outcomes or measures were excluded. Data analysis was performed from July 2021 to June 2022., Main Outcomes and Measures: The primary outcome was chronic pelvic pain at follow-up measured on a scale of 0 to 10, with 0 to 3 indicating no pain or mild pain, 4 to 6 indicating moderate pain, and 7 to 10 indicating severe pain. Secondary outcomes were deep dyspareunia, dysmenorrhea, dyschezia, and back pain at follow-up. The main variable of interest was baseline Central Sensitization Inventory score (measured from 0 to 100, consisting of 25 self-reported questions rated from 0 to 4 [never, rarely, sometimes, often, and always, respectively])., Results: A total of 239 patients (mean [SD] age, 34 [7] years; 189 [79.1%] White [11 (5.8%) identified as White mixed with another ethnicity], 1 [0.4%] Black or African American, 29 [12.1%] Asian, 2 [0.8%] Native Hawaiian or Pacific Islander, 16 [6.7%] other, and 2 [0.8%] mixed race or ethnicity) with follow-up data at more than 4 months after surgery were included in this study (71.0% follow-up rate). The mean (SD) baseline Central Sensitization Inventory score was 43.8 (18.2), and the mean (SD) follow-up was 16.1 (6.1) months. Higher baseline Central Sensitization Inventory scores were significantly associated with higher chronic pelvic pain (odds ratio [OR], 1.02; 95% CI, 1.00-1.03; P = .02), deep dyspareunia (OR, 1.03; 95% CI, 1.01-1.04; P = .004), dyschezia (OR, 1.03; 95% CI, 1.01-1.04; P < .001), and back pain (OR, 1.02; 95% CI, 1.00-1.03; P = .02) at follow-up, when controlling for baseline pain scores. The Central Sensitization Inventory scores themselves decreased slightly from baseline to follow-up (mean [SD] score, 43.8 [18.2] vs 41.7 [18.9]; P = .05); however, individuals with high baseline Central Sensitization Inventory scores still had high scores at follow-up., Conclusions and Relevance: In this cohort study of 239 patients with endometriosis, higher Central Sensitization Inventory scores at baseline were associated with worse pain outcomes after endometriosis surgery, when controlling for baseline pain scores. The Central Sensitization Inventory could be used to counsel patients with endometriosis on their expected outcomes after surgery.
- Published
- 2023
- Full Text
- View/download PDF
39. Developing an Educational Website for Women With Endometriosis-Associated Dyspareunia: Usability and Stigma Analysis.
- Author
-
Abdulai AF, Howard AF, Yong PJ, Noga H, Parmar G, and Currie LM
- Abstract
Background: Endometriosis is a chronic condition that affects approximately 10% of women worldwide. Despite its wide prevalence, knowledge of endometriosis symptoms, such as pelvic pain, and treatments remains relatively low. This not only leads to a trivialization of symptoms and delayed diagnosis but also fuels myths and misconceptions about pain symptoms. At the same time, the use of web-based platforms for information seeking is particularly common among people with conditions that are perceived as stigmatizing and difficult to discuss. The Sex, Pain, and Endometriosis website is an educational resource designed to provide evidence-based information on endometriosis and sexual pain to help people understand the condition, feel empowered, dispel myths, and destigmatize endometriosis-associated sexual pain., Objective: The study objective is to evaluate the usability of the website and assess for destigmatizing properties of sexual health-related web-based resources., Methods: We conducted a usability analysis by using a think-aloud observation, a postsystem usability questionnaire, and follow-up interviews with 12 women with endometriosis. The think-aloud data were analyzed using the framework by Kushniruk and Patel for analyzing usability video data, the questionnaire data were analyzed using descriptive statistics, and the follow-up interviews were analyzed using simple content analysis. We conducted a usability assessment by deductively analyzing the interview data via a trauma-informed care framework and a content analysis approach., Results: Through usability analysis, we found the website to be simple, uncluttered, satisfying, and easy to use. However, 30 minor usability problems related to navigation; website response; the comprehension of graphics, icons, and tabs; the understanding of content; and mismatch between the website and users' expectations were reported. In our stigma analysis, we found the web content to be nonstigmatizing. The participants suggested ways in which websites could be designed to address stigma, including ensuring privacy, anonymity, inclusiveness, and factual and nonjudgmental content, as well as providing opportunities for web-based engagement., Conclusions: Overall, the participants found the website to be useful, easy to use, and satisfying. The usability problems identified were largely minor and informed the website redesign process. In the context of the limited literature on stigma and website design, this paper offers useful strategies on how sexual health-related websites can be designed to be acceptable and less stigmatizing to individuals with sensitive health issues., (©Abdul-Fatawu Abdulai, A Fuchsia Howard, Paul J Yong, Heather Noga, Gurkiran Parmar, Leanne M Currie. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 03.03.2022.)
- Published
- 2022
- Full Text
- View/download PDF
40. Central sensitization inventory in endometriosis.
- Author
-
Orr NL, Wahl KJ, Lisonek M, Joannou A, Noga H, Albert A, Bedaiwy MA, Williams C, Allaire C, and Yong PJ
- Subjects
- Adolescent, Adult, Constipation etiology, Dyspareunia etiology, Female, Humans, Middle Aged, Prospective Studies, Retrospective Studies, Young Adult, Central Nervous System Sensitization, Chronic Pain etiology, Chronic Pain physiopathology, Endometriosis complications, Endometriosis physiopathology, Pelvic Pain etiology, Pelvic Pain physiopathology
- Abstract
Abstract: A key clinical problem is identifying the patient with endometriosis whose pain is complicated by central nervous system sensitization, where conventional gynecologic treatment (eg, hormonal therapy or surgery) may not completely alleviate the pain. The Central Sensitization Inventory (CSI) is a questionnaire previously validated in the chronic pain population. The objective of this study was an exploratory proof-of-concept to identify a CSI cutoff in the endometriosis population to discriminate between individuals with significant central contributors (identified by central sensitivity syndromes [CSS]) to their pain compared to those without. We analyzed a prospective data registry at a tertiary referral center for endometriosis, and included subjects aged 18 to 50 years with endometriosis who were newly or re-referred to the center in 2018. The study sample consisted of 335 subjects with a mean age of 36.0 ± 7.0 years. An increasing number of CSS was significantly correlated with dysmenorrhea, deep dyspareunia, dyschezia, and chronic pelvic pain scores (P < 0.001), and with the CSI score (0-100) (r = 0.731, P < 0.001). Receiver operating characteristic analysis indicated that a CSI cutoff of 40 had a sensitivity of 78% (95% CI: 72.7%-84.6%) and a specificity of 80% (95% CI: 70.3%-84.5%) for identifying a patient with endometriosis with ≥3 CSS. In the group with CSI ≥ 40, 18% retrospectively self-reported pain nonresponsive to hormonal therapy and 40% self-reported daily pain, compared with 6% and 20% in the CSI < 40 group (P = 0.003 and 0.002, respectively). In conclusion, a CSI ≥ 40 may be a practical tool to help identify patients with endometriosis with pain contributors related to central nervous system sensitization., (Copyright © 2021 International Association for the Study of Pain.)
- Published
- 2022
- Full Text
- View/download PDF
41. Application of Anti-Stigma Design Heuristics for Usability Inspection.
- Author
-
Abdulai AF, Howard AF, Noga H, Yong PJ, and Currie LM
- Subjects
- Heuristics
- Abstract
User interface evaluation has become important in developing usable health care technologies. Although usability engineering methods have been applied in the design and evaluation of health care software, available heuristics focus on task-work aspects and do not address stigma associated with many health conditions. We used a previous set of heuristics and propose a new set of anti-stigma heuristics to evaluate stigmatization in health care websites. The extended set of heuristics were concurrently applied in a heuristic evaluation and a cognitive walkthrough to evaluate an endometriosis and sexual pain website. The walkthrough involved 5 tasks that required 21 actions to execute. Twenty-six usability problems were identified and recommendations for re-design were made to the design team before end-user testing. The anti-stigma heuristics received worse ratings than the traditional heuristics, resulting in several design changes that might otherwise have been missed. Thus, the new anti-stigma heuristics were a valuable contribution.
- Published
- 2021
- Full Text
- View/download PDF
42. Negative Sliding Sign during Dynamic Ultrasonography Predicts Low Endometriosis Fertility Index at Laparoscopy.
- Author
-
Alfaraj S, Noga H, Allaire C, Williams C, Lisonkova S, Yong PJ, and Bedaiwy MA
- Subjects
- Adult, British Columbia, Cohort Studies, Cross-Sectional Studies, Endometriosis pathology, Endometriosis surgery, Female, Humans, Infertility, Female etiology, Infertility, Female pathology, Infertility, Female surgery, Laparoscopy methods, Pelvic Pain diagnosis, Pelvic Pain pathology, Pelvic Pain surgery, Pregnancy, Pregnancy Rate, Prognosis, Endometriosis complications, Endometriosis diagnosis, Health Status Indicators, Infertility, Female diagnosis, Ultrasonography
- Abstract
Study Objective: Endometriosis fertility index (EFI) is a robust tool to predict the pregnancy rate in patients with endometriosis who are attempting non-in vitro fertilization conception. However, EFI calculation requires laparoscopy. Newly established imaging techniques such as sliding sign, which is used to diagnose pouch of Douglas obliteration, could provide a promising alternative. The objective of this study was to investigate the practicality of using ultrasound data to predict a low EFI (score ≤6)., Design: Observational study from a prospective registry (Endometriosis Pelvic Pain Interdisciplinary Cohort, clinicaltrials.gov #NCT02911090). Analyzed data were captured from December 2013 to June 2017., Setting: Tertiary referral center at British Columbia Women's Hospital., Patients: We analyzed data for 2583 participants from the Endometriosis Pelvic Pain Interdisciplinary Cohort. In this cross-sectional study, we included 86 women aged <40 years., Interventions: Dynamic ultrasonography for the sliding sign testing and EFI calculation during laparoscopic surgery., Measurements and Main Results: Logistic regression was used to obtain receiver operating characteristic area under the curve (AUC) for the prediction models. Significance was p <.05. Patients with a negative sliding sign were older and had severe endometriosis and longer duration of infertility. Patients with a negative sliding sign had significantly lower total EFI scores and lower surgical factors scores than patients with a positive sliding sign. Logistic regression showed that a negative sliding sign and EFI historic factors score can predict an EFI score ≤6 (sensitivity = 87.9%, specificity = 81.1%, AUC = 0.93 [95% confidence interval, 0.88-0.98]). Adding the diagnosis of endometrioma to the previous prediction model resulted in AUC = 0.95 (95% confidence interval, 0.90-0.995), sensitivity = 84.8%, and specificity = 92.5%., Conclusion: The sliding sign could be a potential alternative to the EFI surgical factors, and it could be used in combination with EFI historic factors and the diagnosis of endometrioma to predict an EFI score ≤6 for patients who are not scheduled for immediate surgery., (Copyright © 2020 AAGL. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
43. A Quantitative Analysis of Sleep Quality in Women with Endometriosis.
- Author
-
Arion K, Orr NL, Noga H, Allaire C, Williams C, Bedaiwy MA, and Yong PJ
- Subjects
- Adolescent, Adult, Chronic Pain epidemiology, Depression epidemiology, Endometriosis epidemiology, Endometriosis psychology, Female, Humans, Middle Aged, Pelvic Pain epidemiology, Prospective Studies, Young Adult, Depression psychology, Endometriosis complications, Pelvic Pain etiology, Quality of Life, Sleep physiology
- Abstract
Background: Endometriosis is a complex condition that can negatively affect a woman's quality of life, including her sleep. This study aims to assess the multifactorial variables associated with poorer quality of sleep in women with endometriosis. Materials and Methods: Data from the Endometriosis Pelvic Pain Interdisciplinary Cohort (EPPIC) data registry were analyzed for women who underwent surgery at the BC Women's Center for Pelvic Pain and Endometriosis with histopathological confirmation of endometriosis (June 2015 to June 2017). The primary outcome was quality of sleep preoperatively, from the Chronic Pain Sleep Inventory (0-100 VAS). Bivariate analysis and multivariable linear regression were done to determine any significant associations between preoperative patient variables and overall quality of sleep, based on p -value of 0.05. Results: Two hundred and seventy-five women met the study criteria. Poorer overall quality of sleep was independently associated with poorer functional quality of life (EHP-30) (b = -0.18, p = 0.0026), more depressive symptoms (PHQ-9) (b = -1.62, p < 0.001), and painful bladder syndrome (PBS) (b = -5.82, p = 0.035). This indicates that a 1 point increase in the EHP-30 (worsening quality of life), a 1 point increase in the PHQ-9 (worsening depression), and the presence of PBS increased the primary outcome ( i.e ., toward poorer quality of sleep) by 0.18, 1.62, and 5.82 points. Conclusions: Poorer quality of sleep in women with endometriosis is associated with poorer quality of life, more depressive symptoms, and bladder pain. Research into interventions that improve sleep is warranted as part of the management of some women with endometriosis.
- Published
- 2020
- Full Text
- View/download PDF
44. Deep Dyspareunia, Superficial Dyspareunia, and Infertility Concerns Among Women With Endometriosis: A Cross-Sectional Study.
- Author
-
Wahl KJ, Orr NL, Lisonek M, Noga H, Bedaiwy MA, Williams C, Allaire C, Albert AY, Smith KB, Cox S, and Yong PJ
- Abstract
Introduction: Deep dyspareunia is a cardinal symptom of endometriosis, and as many as 40% of people with this condition experience comorbid superficial dyspareunia., Aim: To evaluate the relationship between sexual pain and infertility concerns among women with endometriosis., Methods: This is a cross-sectional study conducted at a university-based tertiary center for endometriosis. 300 reproductive-aged participants in the prospective Endometriosis Pelvic Pain Interdisciplinary Cohort (ClinicalTrials.gov Identifier: NCT02911090) with histologically confirmed endometriosis were included (2013-2017)., Main Outcome Measure: The total score on the infertility concerns module of the Endometriosis Health Profile-30 categorized into 5 groups (0, 1-4, 5-8, 9-12, 13-16)., Results: The odds of infertility concerns did not increase with severity of deep dyspareunia (odds ratio = 1.02, 95% CI: 0.95-1.09, P = .58). However, the odds of infertility concerns increased with severity of superficial dyspareunia (odds ratio = 1.09, 95% CI: 1.02-1.16, P = .011); this relationship persisted after adjusting for endometriosis-specific factors, infertility risk factors, reproductive history, and demographic characteristics (adjusted odds ratio [AOR] = 1.14, 95% CI: 1.06-1.24, P < .001). Other factors in the model independently associated with increased infertility concerns were previous difficulty conceiving (AOR = 2.09, 95% CI 1.04-4.19, P = .038), currently trying to conceive (AOR = 5.23, 95% CI 2.77-9.98, P < .001), nulliparity (AOR = 3.21, 95% CI 1.63-6.41, P < .001), and younger age (AOR = 0.94, 95% CI: 0.89-0.98, P = .005)., Conclusion: Severity of superficial dyspareunia, but not deep dyspareunia, was associated with increased odds of infertility concerns among women with endometriosis. Strengths of the study included the use of a validated measure of infertility concerns and disaggregation of sexual pain into deep and superficial dyspareunia. Limitations included the setting of a tertiary center for pelvic pain, which affects generalizability to fertility clinic and primary care settings. Women experiencing introital dyspareunia, who can have difficulties with achieving penetrative intercourse, may be concerned about their future fertility and should be counselled appropriately. Wahl KJ, Orr NL, Lisonek M, et al. Deep Dyspareunia, Superficial Dyspareunia, and Infertility Concerns Among Women With Endometriosis: A Cross-Sectional Study. Sex Med 2020;8:274-281., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
45. Phenotyping Sexual Pain in Endometriosis Using the Central Sensitization Inventory.
- Author
-
Orr NL, Wahl KJ, Noga H, Allaire C, Williams C, Bedaiwy MA, Albert A, Smith KB, and Yong PJ
- Subjects
- Adult, Cohort Studies, Cross-Sectional Studies, Female, Humans, Pain Measurement, Pelvic Floor, Sexual Behavior, Surveys and Questionnaires, Central Nervous System Sensitization, Dyspareunia etiology, Endometriosis complications, Pelvic Pain etiology
- Abstract
Introduction: Deep dyspareunia, a common symptom in endometriosis, has previously been associated with bladder and/or pelvic floor tenderness (BPFT), which suggests a role for central nervous system sensitization. The Central Sensitization Inventory (CSI, 0-100) is a validated self-reported scale for patients with central sensitization., Aim: The objective of this study was to phenotype deep dyspareunia using BPFT and the CSI., Methods: The methods included cross-sectional analysis from a prospective registry from January 2018 to June 2018 at a tertiary center for endometriosis (ClinicalTrials.gov #NCT02911090). Included were women aged 18-50 years with endometriosis (previously surgically diagnosed, current visualized endometrioma on ultrasound, or current palpable or visualized nodule on ultrasound), who were newly or re-referred to the center. Severity of deep dyspareunia was self-reported using an 11-point numeric rating scale (0 = no pain; 10 = worst pain imaginable), categorized as no or low deep dyspareunia (0-4) and high deep dyspareunia (5-10). We identified the subgroup with high deep dyspareunia and presence of BPFT, where we hypothesized a central component of the sexual pain. This subgroup was compared with 2 other subgroups: no or low deep dyspareunia and high deep dyspareunia but no BPFT. The CSI was compared between the groups using analysis of variance, followed by post hoc testing (P < .05)., Main Outcome Measure: The main outcome measure was the CSI score ranging from 0 to 100., Results: Data from 163 women with endometriosis were analyzed. The mean age of this cohort was 36.4 ± 6.8 years, and the mean CSI score was 41.0 ± 18.6. 37 percent (61/163) had high deep dyspareunia and BPFT; 29% (47/163) had high deep dyspareunia and no BPFT; and 34% (55/163) had no or low deep dyspareunia. The CSI significantly differed between the 3 groups (analysis of variance: F = 22.4, P < .001). In post hoc testing, the CSI was higher in women with high deep dyspareunia and BPFT (51.3 ± 16.9), compared with women with no or low deep dyspareunia (30.9 ± 15.4, P < .001) and compared with women with high deep dyspareunia but no BPFT (39.4 ± 17.2, P = .001)., Clinical Implications: The CSI could be used to classify and phenotype patients with endometriosis-associated sexual pain., Strength & Limitations: Strengths include a prospective registry with integrated pain scores, validated questionnaires, and physical examination findings. Limitations include the lack of quantitative sensory testing for central sensitization., Conclusions: In women with endometriosis, the subgroup with high deep dyspareunia and bladder and/or pelvic floor tenderness had a significantly higher score on the CSI than other subgroups, suggesting that this group may have a central component to their sexual pain. Orr NL, Wahl KJ,Noga H, et al. Phenotyping Sexual Pain in Endometriosis Using the Central Sensitization Inventory. J Sex Med 2020;17:761-770., (Copyright © 2019 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
46. Endometriosis and Negative Perception of the Medical Profession.
- Author
-
Ng N, Wahl K, Orr NL, Noga H, Williams C, Allaire C, Bedaiwy MA, and Yong PJ
- Subjects
- Adult, Attitude of Health Personnel, Cross-Sectional Studies, Female, Humans, Perception, Prospective Studies, Quality of Health Care, Endometriosis therapy, Patient Satisfaction, Pelvic Pain physiopathology, Physician-Patient Relations, Physicians psychology
- Abstract
Objective: This study sought to identify factors independently associated with a negative impression of the medical profession in patients with endometriosis who were presenting to a tertiary referral centre., Methods: A cross-sectional analysis was conducted on a prospective data registry between December 2013 and June 2017 at a tertiary referral centre for pelvic pain and endometriosis. The main outcome variable, negative impression about the medical profession, was measured with the four-item subscale of the Endometriosis Health Profile-30 and divided into three groups: no (0), some (1-8), and many (9-16) negative impressions. Patients with a surgical and histological diagnosis of endometriosis were included. Postmenopausal women were excluded. Bivariate analyses determined significant associations (P < 0.05) between variables from the registry and the main outcome. Variables with a significant association were put into ordinal logistic regression with sequential backwards elimination., Results: Negative impression of the medical profession was independently associated with previous surgery that did not help symptoms (adjusted odds ratio [aOR] 1.77; 95% confidence interval [CI] 1.09-2.87; P = 0.021), presentation to an emergency room in the past 3 months (aOR 1.90; 95% CI 1.17-3.07; P = 0.009), and previous visits to a complementary health care provider (aOR 2.16; 95% CI 1.42-3.29; P < 0.0005), while controlling for an endometriosis pain-related morbidity composite variable., Conclusion: Negative perception of the medical profession in women with endometriosis was associated with surgical treatment failure, emergency room use, and accessing complementary health care. Each identified factor offers an opportunity for intervention to improve the perception of the medical profession among women with endometriosis., (Copyright © 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
47. CHC for pelvic pain in women with endometriosis: ineffectiveness or discontinuation due to side-effects.
- Author
-
Yong PJ, Alsowayan N, Noga H, Williams C, Allaire C, Lisonkova S, and Bedaiwy MA
- Abstract
Study Question: What are the use patterns and factors associated with combined hormonal contraception (CHC) ineffectiveness or discontinuation due to side-effects in patients with endometriosis and pelvic pain?, Summary Answer: Worse chronic pelvic pain (CPP) severity and pelvic floor myalgia were associated with continuous CHC ineffectiveness, while poorer quality-of-life was associated with continuous CHC discontinuation due to side-effects., What Is Known Already: CHC is a first line of therapy for endometriosis-associated pelvic pain in women. However, some patients state that CHC is ineffective for their pain, while others have to discontinue CHC due to side-effects., Study Design Size Duration: Analysis of a prospective patient database from a tertiary care referral center for patients with endometriosis and pelvic pain between December 2013 and April 2015 was carried out., Participants/materials Setting and Methods: A total of 373 patients of reproductive age with endometriosis from the database were included in the study. Data included patient self-reported questionnaires, physical examination findings and validated instruments. There were four variables of interest: history of cyclical CHC ineffectiveness (yes/no), history of cyclical CHC discontinuation due to side-effects (yes/no), history of continuous CHC ineffectiveness (yes/no) and history of continuous CHC discontinuation due to side-effects (yes/no). The primary outcome was CPP severity for the past 3 months (score of 0-10), and secondary outcomes were other pelvic pain scores, quality-of-life on the Endometriosis Health Profile 30 (EHP-30) and underlying conditions including irritable bowel syndrome, painful bladder syndrome, abdominal wall pain, pelvic floor myalgia and depression, anxiety and pain catastrophizing., Main Results and the Role of Chance: Among the 373 cases in the dataset, prior cyclical CHC use was reported by 228 (61.1%) women, of which 103 (27.6%) stated it was ineffective for their pain and 94 (25.2%) stated they discontinued CHC due to side-effects. Previous continuous CHC use was reported by 175 (46.9%) women, of which 67 (18.0%) stated it was ineffective and 59 (15.8%) stated they discontinued due to side-effects. Worse CPP severity in the last 3 months was associated with a history of continuous CHC ineffectiveness ( P < 0.001). Poorer quality-of-life was present in women who reported a history of continuous CHC discontinuation due to side-effects ( P = 0.005). Among the underlying conditions, pelvic floor tenderness (as a marker of pelvic floor myalgia) was associated with CHC ineffectiveness., Limitations and Reasons for Caution: This study involved patient recall and no longitudinal follow-up. Also, we do not have data on the type of side-effect that led to discontinuation. Medication ineffectiveness was reported subjectively by the patient rather than using standardized criteria. Finally, the diagnosis of endometriosis was based on previous surgery or a current nodule or endometrioma on examination/ultrasound; without prospective surgical data on all the patients, it was not possible to do a sub-analysis by current surgical features (e.g. stage)., Wider Implications of the Findings: In women with endometriosis, CHC ineffectiveness was associated with worse CPP and pelvic floor myalgia, which suggests myofascial or nervous system contributors to CPP that does not respond to hormonal suppression. A tender pelvic floor, as a sign of pelvic floor myalgia, may be a clinical marker of patients with endometriosis who are less likely to have an optimal response to hormonal suppression. For women who discontinue CHC due to side-effects, research is needed to help alleviate these side-effects as these patients report worse quality-of-life., Study Funding/competing Interests: This work was supported by a Canadian Institutes of Health Research (CIHR) Transitional Open Operating Grant (MOP-142273) as well as BC Women's Hospital and the Women's Health Research Institute. PY is also supported by a Health Professional Investigator Award from the Michael Smith Foundation for Health Research. MB/CA has financial affiliations with Abbvie and Allergan; the other authors have no conflicts of interest., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
- Published
- 2020
- Full Text
- View/download PDF
48. Plasminogen activator inhibitor-1 (PAI-1) expression in endometriosis.
- Author
-
Alotaibi FT, Peng B, Klausen C, Lee AF, Abdelkareem AO, Orr NL, Noga H, Bedaiwy MA, and Yong PJ
- Subjects
- Adult, Dysmenorrhea metabolism, Dysmenorrhea pathology, Endometriosis pathology, Epithelial Cells metabolism, Epithelial Cells pathology, Female, Humans, Immunohistochemistry, Middle Aged, Peritoneal Diseases metabolism, Peritoneal Diseases pathology, Rectal Diseases metabolism, Rectal Diseases pathology, Stromal Cells metabolism, Stromal Cells pathology, Uterine Diseases metabolism, Uterine Diseases pathology, Vaginal Diseases metabolism, Vaginal Diseases pathology, Young Adult, Endometriosis metabolism, Plasminogen Activator Inhibitor 1 metabolism
- Abstract
Purpose: Deep infiltrating endometriosis (DIE) is defined as an endometriotic lesion penetrating to a depth of >5 mm and is associated with pelvic pain, but the underlying mechanisms are unclear. Our objective is to investigate whether plasminogen activator inhibitor-1 expression (PAI-1) in endometriotic tissues is increased in women with DIE., Methods: In this blinded in vitro study, immunohistochemistry and Histoscore were used to examine the expression of PAI-1 in glandular epithelium (GECs) and stroma (SCs) in a total of 62 women: deep infiltrating uterosacral/rectovaginal endometriosis (DIE; n = 13), ovarian endometrioma (OMA; n = 14), superficial peritoneal uterosacral/cul-de-sac endometriosis (SUP; n = 23), uterine (eutopic) endometrium from women with endometriosis (UE; n = 6), and non-endometriosis eutopic endometrium (UC; n = 6). The following patient characteristics were also collected: age, American Fertility Society stage, hormonal suppression, phase of menstrual cycle, dysmenorrhea score and deep dyspareunia score., Results: PAI-1 expression in GECs and SCs of the DIE group was significantly higher than that of SUP group (p = 0.01, p = 0.01, respectively) and UE group (p = 0.03, p = 0.04, respectively). Interestingly, increased PAI-1 expression in GECs and SCs was also significantly correlated with increased dysmenorrhea (r = 0.38, p = 0.01; r = 0.34, p = 0.02, respectively)., Conclusions: We found higher expression of PAI-1 in DIE, and an association between PAI-1 and worse dysmenorrhea., Competing Interests: Dr. Bedaiwy received lecture fees and served on advisory boards for Abbvie and Allergan, and received funding for research unrelated to the present study from Allergan (CAPTURE fibroid registry). This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development, or marketed products to declare.
- Published
- 2019
- Full Text
- View/download PDF
49. Prediction of Pouch of Douglas Obliteration: Point-of-care Ultrasound Versus Pelvic Examination.
- Author
-
Arion K, Aksoy T, Allaire C, Noga H, Williams C, Bedaiwy MA, and Yong PJ
- Subjects
- Adult, Cohort Studies, Douglas' Pouch pathology, Endometriosis pathology, Female, Humans, Middle Aged, Pelvis diagnostic imaging, Pelvis pathology, Peritoneal Diseases pathology, Predictive Value of Tests, Sensitivity and Specificity, Ultrasonography methods, Vagina diagnostic imaging, Vagina pathology, Douglas' Pouch diagnostic imaging, Endometriosis diagnosis, Gynecological Examination methods, Palpation methods, Peritoneal Diseases diagnosis, Point-of-Care Systems
- Abstract
Study Objective: To evaluate the point-of-care preoperative transvaginal ultrasound (TVUS) sliding sign in comparison with palpation of a nodule on digital pelvic examination for the prediction of pouch of Douglas (POD) obliteration., Design: Analysis of data from a prospective data registry (Canadian Task Force classification II-2)., Setting: A tertiary referral center., Patients: Women with suspected endometriosis who had preoperative pelvic examination and point-of-care TVUS followed by laparoscopic surgery between August 2015 and December 2016., Interventions: Women were preoperatively assessed for the prediction of POD obliteration with pelvic examination for a nodule and point-of-care TVUS uterine/cervix sliding sign., Measurements and Main Results: The study included 269 women, 15.2% (41/269) of whom had POD obliteration at the time of surgery. A preoperative negative sliding sign had a sensitivity of 73.2% (95% confidence interval, 57.1%-85.8%) and a specificity of 93.9% (95% CI, 89.9%-96.6%) in the prediction of POD obliteration compared with preoperative palpation of a nodule on pelvic examination, which had a sensitivity of 24.4% (95% CI, 12.4%-40.3%) and a specificity of 93.4% (95% CI, 89.4%-96.3%). The difference in sensitivity was statistically significant (McNemar test, p <.001). A negative sliding sign was also associated with longer operating times and more difficult surgery including the need for ureterolysis., Conclusion: The point-of-care TVUS sliding sign showed significantly improved sensitivity compared with palpation of a nodule on pelvic examination for the prediction of POD obliteration. Therefore, the point-of-care TVUS sliding sign improves the preoperative assessment of POD disease and thus may lead to more optimal surgical planning in women with suspected endometriosis., (Copyright © 2018 AAGL. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
50. Provoked Vestibulodynia in Women with Pelvic Pain.
- Author
-
Bao C, Noga H, Allaire C, Williams C, Bedaiwy MA, Sadownik LA, Brotto LA, Smith KB, and Yong PJ
- Abstract
Introduction: Pelvic pain and vulvar pain are common conditions in women. In this study, we sought to characterize the clinical picture of patients with concurrent pelvic pain and provoked vestibulodynia (PVD)., Aim: To analyze the association between sexual/clinical characteristics and a diagnosis of PVD among women with pelvic pain., Methods: Cross-sectional analysis of a prospective registry at a tertiary referral center for pelvic pain and endometriosis, involving consecutive non-menopausal sexually active patients 18-49 years-old seen by a single gynecologist from January 2016-December 2017. The sample was divided into 2 groups: pelvic pain with PVD; and pelvic pain alone (without PVD)., Main Outcome Measures: Superficial dyspareunia and deep dyspareunia on a 11-point numeric rating scale, and the sexual quality-of-life subscale of the Endometriosis Health Profile-30 (0-100%)., Results: There were 129 patients that met study criteria: one third with pelvic pain and PVD (n = 42) and two-thirds with pelvic pain alone (without PVD) (n = 87). Women with pelvic pain and PVD had significantly more severe superficial dyspareunia ≥7/10 (OR = 12.00 (4.48-32.16), P < .001), more severe deep dyspareunia ≥7/10 (OR = 4.08 (1.83-9.10), P = .001), and poorer sexual quality of life (Endometriosis Health Profile-30 ≥50%) (OR = 4.39 (1.67-11.57), P = .002), compared with the group with pelvic pain alone. Women with pelvic pain and PVD also had more anxiety, depression, and catastrophizing, more frequent tenderness of the bladder and pelvic floor, and more common diagnosis of painful bladder syndrome. On the other hand, there were no significant differences between the 2 groups in terms of dysmenorrhea, chronic pelvic pain, abdominal wall allodynia, positive Carnett test for abdominal wall pain, functional quality of life, endometriosis, and irritable bowel syndrome., Conclusions: In the pelvic pain population, PVD may be associated with more negative impact on dyspareunia, sexual quality of life, and bladder/pelvic floor function, but it may not significantly impact abdominopelvic pain or day-to-day function in general. Bao C, Noga H, Allaire C, et al. Provoked Vestibulodynia in Women with Pelvic Pain. Sex Med 2019;7:227-234., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.