Yu Yu

Dr. Yu holds her Ph.D. in experimental pharmacology from University of Sydney, Australia and was a postdoctoral research fellow at Gynecologic Pathology Laboratory at the Johns Hopkins University School of Medicine. She was the previous recipient of Outside-the-Box Grant from the HERA Women’s Cancer Foundation and Ann Schreiber Mentored Investigator Award from Ovarian Cancer Research Foundation. Dr. Yu is currently a senior research fellow at the School of Pharmacy and Curtin Health Innovation Research Institute, Curtin University, Western Australia where her studies focus on therapeutics and biomarkers development for gynecological conditions.

Exposure to organic pollutants and endometriosis

There is increasing evidence suggesting the associations between exposure to endocrine disrupting chemicals and gynecological diseases over the last decade. In rodent and primate experimental models, consistent associations have been previously found between exposure to dioxins and the onset of endometriosis. Despite previous investigative efforts, existing studies existing studies remains relatively inconclusive due to methodological and population heterogeneity. Ploteau et al. conducted a case-control study published in the journal named Environment International,  to assess the associations between the exposure to POPs…

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Cohort study on outcomes of laparoscopic endometriosis surgery

Laparoscopic surgery followed by histological confirmation is considered a standard for diagnosis, staging, and treatment of endometriosis. Radical and conservative surgical approaches are often required for the removal of endometriotic lesions in the case of vaginal or rectal wall deep infiltrative endometriosis, as well as for removal of bowel or bladder endometriosis. The high recurrence of pain and ovarian endometriomas are of most concern post-surgical treatment. This study aimed to investigate the effect of total resection of endometriosis lesions by…

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A Systematic Review of Guidelines for Diagnosis and Management of Endometriosis

Guidelines are systematically developed statements derived from best research evidence to improve patient care through informed clinical practice. Appropriate guidelines can reduce unwarranted variations health practice and the implementation of better interventions. Endometriosis commonly has three different manifestations, including peritoneal endometriosis, ovarian endometriosis, and deep infiltrating endometriosis. Treatment decision often varies significantly between severity and associated symptoms such as pain and infertility. Therefore, it can be difficult to produce accurate diagnostic tests and effective therapeutic interventions to inform unified patient…

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Human Endometrium-Derived Mesenchymal Stem Cells for Cell-based Therapies

Mesenchymal stem cells are a promising candidate for cell-based targeted therapies because they have characteristics such as self-renewal, multipotency, low immunogenicity, and non-oncogenicity. It has the capacity to migrate to sites of inflammation including in endometrial lesions and tumor. Most of these studies have examined MSCs and little studies have focused on endometrial mesenchymal stem cells, which have all these characteristics of MSCs. Hence, EMSCs can be explored for regenerative medicine and used to reduce inflammation such as in endometriosis.…

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The dose of the GnRHa after laparoscopic surgery

Laparoscopic surgery is considered a routine way to diagnose and remove endometriosis. The primary concern with laparoscopic surgery is the recurrence of endometriosis because of incomplete lesion excision. Hence, the challenge is to decrease endometriosis recurrence rate. Gonadotrophin-releasing hormone agonist (GnRHa) is a clinically available for treating endometriosis, however, the use after a certain period of time can suppress sex steroids, leading to reduction of bone mineral density, and an increase in symptoms of estrogen deficiency including hot flashes, and…

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Endometriosis and Ovarian Cancer Risk

Ovarian cancer prevalence in women with endometriosis is higher than the general population. It is often hypothesized that endometriosis-associated malignancies can occur from ovarian endometrioma. This systematic review by Taniguchi highlighted new insights on the relationship between endometriosis and ovarian cancer. On top of describing potential etiology of endometriosis-associated ovarian cancer according to histological findings, this article presented information from other relevant studies. These include: (i) Shizuoka Cohort Study on Endometriosis and Ovarian Cancer Programme in Japan where approximately 0.72%…

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DNA methylation changes in endometrium during the transition from pre-receptive to receptive phase

The endometrium is unique in that it undergoes remarkable changes during menstrual cycle under the control of hormones, estrogen, and progesterone. The function of the endometrium is crucial for embryo implantation, during which the endometrium is receptive around a week after ovulation. Previous gene transcription studies have demonstrated changes in endometrial gene expression during this transition from pre-receptive to receptive phase. This study by Kukushkina et al. published in Scientific Report is aimed at understanding how the endometrial DNA methylation…

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Ovarian Endometriomas vs Deep Infiltrating Endometriosis

Ovarian endometrioma (OMA) and deep infiltrating endometriosis (DIE) have been described as two disease entities, although they are both characterized by endometrial tissue located outside the uterus. As OMA and DIE look different histologically, it is puzzling what cause their differences. Importantly, among subtypes of endometriosis, OMA is most prevalently diagnosed, while DIE is thought to be less prevalent than OMA. Women with DIE, however, experienced more severe pain and challenging clinical management. Diagnosis for DIE includes endometriotic lesions infiltrating…

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Glycodelin and altered endometrial function in endometriosis

A laparoscopic examination is the only diagnostic tool for endometriosis to date. Since the procedure is invasive, there has been much effort by researchers to develop a biomarker for non-invasive diagnosis of endometriosis. To this end, there has been growing interest in studies on GdA, which was formerly known as "placental protein 14" as a candidate biomarker. However, little is known about its expression in the endometrium during the menstrual cycle and in endometriosis. GdA is a glycoprotein with several…

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Reduced vascularization in ovarian endometriomas associated with less pain

Angiogenesis, i.e., the development of new blood vessels is believed to play an important role in endometriosis pathogenesis and symptoms. Endometriosis is associated and requires neovascularization to proliferate, invade surrounding normal structure in order to establish an endometriotic lesion. Ovarian endometriomas occur when small endometrial tissue is transplanted, and grow/enlarges inside the ovaries. Its presence is often associated with pelvic pain in women. To better understand the impact of angiogenesis in painful symptoms associated with endometriomas, Rizzello et al. evaluated…

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Sexual Pain in Endometriosis

Pelvic pain during sexual intercourse (deep dyspareunia) is a major concern for women with endometriosis. As many as half of women with endometriosis experience deep dyspareunia and has been shown to have a detrimental impact on quality of life. The mechanism of endometriosis-associated deep dyspareunia is not well understood. However, cul-de-sac/uterosacral (i.e., the cul-de-sac peritoneal fold between the uterus and the rectum) endometriosis is more likely to be associated with deep dyspareunia. To understand deep dyspareunia, Peng et al. studied…

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Is it Estrogen that Regulates Endometriosis Pain?

Endometriosis-associated pain is a debilitating condition; however, it is surprising that the perceived pain has no correlation to the endometriosis extent. The mechanism that causes the pain is also poorly understood. Nerve growth factor is enhanced in endometriosis and may increase sensory hypersensitivity by modulating inflammatory processes. Inflammatory components such as interleukins, tumor necrosis factor alpha and interferon are elevated in endometriosis and tend to associate with severity of pain experienced by patients. A disturbed hormonal homeostasis can alter pain perception…

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Dienogest for endometriosis pain in clinical practice

Dienogest is a synthetic progestogen that has been marketed as a medical treatment for endometriosis. Previous randomized controlled clinical trials have shown that it is effective in women with endometriosis at different stages of the disease. Given its recent introduction, more reports on its effectiveness in routine clinical practice will be useful. Maiorana et al reported an observational, single-center, cohort study in the medical journal Archives of Gynecology and Obstetrics, where the authors examined the efficacy and tolerability of Dienogest…

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New Genetic Variants Associated with Endometriosis May Offer New Opportunities

Endometriosis is a heritable gynecological condition. Its etiology and pathogenesis remain complex with multiple genetic and environmental risk factors. Previous studies based on female twins and common SNPs have suggested the heritability of endometriosis. In the May 2017 issue of Nature Communication, Sapkota et al. reported genome-wide association studies to gain a better understanding of the genetic background of endometriosis. This meta-analysis studies combined genome-wide association data from eleven individual case–control datasets, covering around 7 million SNPs. The total number…

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How ERα is regulated in endometriosis?

Endometriosis pathogenesis is largely influenced by estrogen. Ectopic endometrium has altered expression of ERα compared to the eutopic endometrium. It is unclear what biological processes regulate such alteration. The article by Toderow et al. in Archives of Gynecology and Obstetrics examined the mechanism regulating ERα expression by analyzing the promoter, which is a DNA region that initiates gene expression. Previous analyses have suggested ERα expression changes due to DNA methylation in Estrogen Receptor 1 promoter of several malignant and non-malignant…

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Immune Response in Endometriosis and Regulatory T cells

The adaptive immune system is crucial for many diseases. Lymphocytes, including T cells, are particularly important in the adaptive immune system. Previous research suggested that defective immune response could play a role in endometriosis. The hypothesis proposes that the immune system may fail to scavenge endometrial cells at ectopic sites, thus triggering inflammation and fibrosis.  Thia systematic review article by de Barros IBL et al. in Journal of Reproductive Immunology summarized the results from twelve studies on regulatory T cells…

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Treatment of Endometriosis-Associated Pain with Elagolix, an Oral GnRH Antagonist.  

Taylor et al. presented an exciting recent study in The New England Journal of Medicine. This article reported the results from a multicentre, double-blind, randomized, placebo-controlled phase 3 trials of elagolix for the treatment of endometriosis-associated pain. As women with endometriosis can relate, these painful symptoms include dysmenorrhea, non-menstrual pelvic pain, and dyspareunia, which can significantly affect the quality of life. Current therapies include nonsteroidal anti-inflammatory drugs (NSAIDs), progestin-containing oral contraceptives, and gonadotropin-releasing hormone (GnRH) agonists, such as leuprolide acetate.…

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Endometriosis Micrometastasis

Micrometastasis is used to describe the migration of a small number of cancer cells from its original location to the other organs within the body. While endometriosis is not cancer, it occurs when endometrial cells migrate outside of the uterus and implant on other sites of the body. Current theories describing how endometrial cells metastasize are: Sampson’s theory (most well-known), proposes that endometrial cells are shed out of the uterus during menstruation in a retrograde manner, and implant on pelvic structures. Vascular…

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Platelets Promote the Development of Endometriosis

One hallmark of endometriosis is the recurrent or cyclical bleeding, which is indicative of vascular injury that often requires the wound healing or tissue repair system. To heal a wound, our body starts coagulation achieved by recruitment of activated platelet cells to the wound site where they adhere, aggregate and form clots to stop blood flow out of the tissue. In a research article published in Human Reproduction (2015, vol. 30, page 812), Ding et al. hypothesized that platelets may…

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Immune substances in peritoneal fluid for endometriosis diagnosis and armamentarium

Cytokines are immune substances secreted by a broad range of cells within the body, including immune cells like the macrophages, B lymphocytes, T lymphocytes, mast cells, and non-immune cells such as the endothelial cells and fibroblasts. They are important in mediating tissue inflammation, and are therefore, crucial to be studied in women with endometriosis since the condition is highly associated with inflammatory response. In a recent report by Jørgensen et al in Fertility and Sterility, the authors investigated the concentrations…

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