Objective To determine the presence, differential expression and regulation of epidermal growth factor-containing fibulin-like extracellular matrix protein 1 (EFEMP1) in uterine leiomyomas. Design Laboratory in vivo and in vitro study using human leiomyoma and myometrial tissue and primary cells. Setting Academic medical center Samples Leiomyoma and myometrial tissue samples and cultured cells Intervention(s) 5-Aza-2′ deoxycytidine (5-Aza-dC) treatment. Main Outcome Measure Fold change difference between EFEMP1 and fibulin-3 expression in leiomyoma tissue and cells compared to matched myometrial samples, and fold-change difference in EFEMP1 expression with 5-Aza-dC treatment. Results In vivo, EFEMP1 expression was 3.19 fold higher in myometrial tissue versus leiomyoma tissue. EFEMP1 expression in vitro was 5.03 fold higher in myometrial cells versus leiomyoma cells. Western blot and IHC staining of tissue and cells confirmed similar findings in protein expression. Treatment of leiomyoma cells with 5-Aza-dC resulted in increased expression of EFEMP1 in vitro. Conclusion The EFEMP1 gene and its protein product, fibulin-3, are both significantly downregulated in leiomyoma as compared to myometrium when studied both in vivo and in vitro. The increase in EFEMP1 expression in leiomyoma cells with the 5-Aza-dC treatment suggest that differential methylation is, in part, responsible for the differences seen in gene expression.

Uterine leiomyomas are the most prevalent tumors in reproductive-aged women and are a major public health concern in the United States. Commonly known as fibroids, these benign tumors continue to be the leading cause of hysterectomy and are responsible for as much as $34 million in costs annually in the United States. Despite the increasing numbers of gains that are being made in understanding the pathophysiology of these tumors, relatively little work has been done to advance understanding of care delivery with regard to these tumors, specifically the patient perspective. Herein, we provide an overview of patient-centered care, a review of the available literature on the fibroid patient's perspective, and a discussion of opportunities to re-envision patient care with regard to fibroids.

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INTRODUCTION: Pelvic Inflammatory Disease (PID) is associated with long-term sequelae including infertility, ectopic pregnancy, and tubo-ovarian abscess. Although the emergency department (ED) is a common healthcare entry point, the extent of its utilization is unknown. Our objectives are to estimate utilization trends, determine economic burden and investigate factors affecting admission rates of women with PID presenting to EDs in the United States. METHODS: A retrospective analysis using the Nationwide Emergency Department Sample was used to assess ED visits of women ≥18 years old, between 2010 and 2014 with a primary diagnosis of PID, defined by the International Classification Diagnosis, 9th version. SAS 9.4 was used to perform chi-square and Z-tests. Admission rates were assessed by age, payer information, hospital characteristics and household income. Total charges were also analyzed. RESULTS: PID related ED visits decreased from 118,552 to 93,965 from 2010 to 2014 (-20.74%, P<.001). Total charges increased from $3,133.54 to $4,507.24 per visit from 2010 to 2014 (P<.0001); $1.926 billion total. In 2014, admission rates increased with age; 7.91%, 11.71%, 21.28%, 37.27% and 59.78% for women ages 18-24, 25-34, 35-44, 45-54 and 55+, respectively (P<.0001). Uninsured patients had the lowest admission rate (8.98% vs Medicaid 12.57%, private 20.99%, Medicare 27.21%, P<.0001). Admissions rates were nearly double for the highest income quartile compared to the lowest (23.41% vs 12.18%, P<.0001). CONCLUSION: Although the number of PID related ED visits decreased from 2010 to 2014, a significant economic burden still exists. Admission rate disparities are concerning for health inequities based on insurance status and household income.