***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND There is a need for a reliable marker of endometriosis , especially in early stages of peritoneal disease during which imaging is not effective . The use of serum interleukin (IL)-6 as a marker is controversial . To readdress the matter , patients undergoing laparoscopy  were prospect ively evaluated for serum IL-6 levels . MATERIAL S AND METHODS A total of 119 women 31 years old who underwent laparoscopy  were divided into groups : control patients ( n = 38 ) with no pathologic findings ; endometriosis sufferers ( n = 47 ) with minimal-mild ( MM , n = 11 ) or moderate-severe ( MS , n = 36 ) endometriosis ; uterine myomas ( n = 13 ) and benign ovarian pathologies ( n = 21 ) . Blood was drawn on cycles days 5 - 12 and stored for subsequent analysis of IL-6 and carbohydrate antigen (CA)-125 levels . RESULTS Serum IL-6 levels were significantly ( P = 0.002 ) higher in women with MM endometriosis ( 29.4 9.0 pg/ml ) than in controls ( 15.7 9.3 pg/ml ) . When all the non-endometriosis patients were grouped together ( n = 72 ) and serum IL-6 ( 17.8 12.1 pg/ml ) compared with MS ( n = 36 ; 17.6 10.3 pg/ml ) and MM ( n = 11 ; 29.4 9.0 pg/ml ) endometriosis significantly ( P < 0.01 ) higher levels in MM endometriosis were observed as compared to the other two groups . Serum Ca-125 levels were significantly ( P < 0.01 ) elevated in MS endometriosis . A serum IL-6 threshold of 25.75 pg/ml afforded a sensitivity of 75 % and specificity of 83 % in the diagnosis of MM endometriosis . Sensitivity and specificity for CA-125 in the diagnosis of MS endometriosis , using 35 IU/ml as the cut-off value , were 47 % and 97 % , respectively . CONCLUSIONS IL-6 is a reliable non-invasive marker of MM endometriosis , whereas Ca-125 is of use as a marker of severe cases OBJECTIVE This study was undertaken to evaluate serum leptin concentrations in women with endometriosis during treatment with danazol and with leuprolide depot . STUDY DESIGN Twenty patients aged 18 to 42 years with regular menses and documented pelvic endometriosis were recruited from a university hospital setting . Treatment was 200 mg danazol 3 times daily for 6 months or 3.75 mg leuprolide depot every 28 days for 6 months . Serum leptin concentrations were measured before , during , and after treatment . A single blood sample was taken from each of 10 control women without endometriosis for comparison . Serum leptin level was measured with a radioimmunoassay kit with human leptin , and analysis of variance and paired t tests were used for statistical analysis . RESULTS Serum leptin levels were almost the same among women with endometriosis as in the control group . Leptin levels were higher among women with endometriosis during treatment with danazol and leuprolide(P < .001 ) . Three months after treatment , leptin values remained moderately higher than before treatment . CONCLUSION Danazol and leuprolide increased serum leptin levels . The mechanism of leptin increase is unclear . Further studies are needed to determine whether an adipogonadal axis exists BACKGROUND Little is known about the precise nature of the relationship between dysmenorrhoea ( DM ) and endometriosis . Our aim was to evaluate the relationship between the severity of DM in women with posterior deep infiltrating endometriosis ( DIE ) and indicators of the extent of their disease . METHODS Various indicators of the extent of DIE were recorded during surgery in 209 women . The severity of their DM was assessed with a  pain scale .  The scale was retrospective for 155 women and prospect i ve for 54 . Correlations were sought with an ordinal logistic regression model with cumulative odds . RESULTS On univariate analysis the following variables were related to the severity of DM : number of previous surgical procedures for endometriosis ; revised American Fertility society classification ; extensiveness of adnexal adhesion ; Douglas obliteration ; size of the posterior DIE implant ; extent of the sub-peritoneal infiltration by the posterior DIE ( rectal , vaginal or both versus sub-peritoneal only ) . Current infertility was associated with less severe DM . After multiple regression analysis , presence of a rectal or vaginal infiltration by the posterior DIE and extensiveness of adnexal adhesion were the only factors that remained related to DM severity . CONCLUSIONS The concept of ' very deep infiltrating endometriosis ' , defined as implants invading the wall of the pelvic organ , should be tested in future classification systems specifically addressed to the prediction of endometriosis-related pain OBJECTIVE The pathogenesis of endometriosis is associated with an inflammatory process . Here , we assessed if the levels of high-sensitivity C-reactive protein ( hs-CRP ) in serum could constitute an effective method for detecting systemic inflammation during endometriosis . STUDY DESIGN This was a prospect i ve , laboratory-based study , which was carried out in a tertiary care university hospital . Patients with histologically proven endometriosis ( n = 370 ) and unaffected women ( n = 464 ) were enrolled from January 2005 through December 2009 . We performed complete surgical excision of endometriotic lesions with pathological analysis . In addition , hs-CRP levels were determined through a particle-enhanced immunoturbidimetric method . The hs-CRP levels were measured in both controls and women with endometriosis according to the established surgical classifications of endometriosis : superficial peritoneal endometriosis , endometrioma , and deep infiltration endometriosis . Also , hs-CRP levels were evaluated according to hormonal treatment and menstrual cycle . RESULTS The hs-CRP serum levels did not statistically differ between women with endometriosis and controls ( median in ng/mL [ range ] : 0.82 [ 0.04 - 42.89 ] vs 0.9 [ 0.03 - 43.73 ] , respectively ; P = .599 ) . Moreover , subgroup analysis revealed no difference among superficial peritoneal endometriosis , endometrioma , deep infiltration endometriosis , and controls : 0.8 ( 0.15 - 13.35 ) , 0.81 ( 0.04 - 38.82 ) , 0.83 ( 0.09 - 42.89 ) , and 0.9 ( 0.03 - 43.73 ) , respectively ; P = .872 . Furthermore , no effect was observed regarding hormonal treatment or menstrual cycle . CONCLUSION Although endometriosis is an inflammatory disease , we failed to identify any systemic changes in hs-CRP serum levels . Therefore , hs-CRP analysis appears to be irrelevant to the diagnosis and staging of endometriosis OBJECTIVE This study analyzed the relationship between clinical characteristics of endometriosis and Th1/Th2 immune response patterns . METHODS A prospect i ve study was performed with 65 patients with endometriosis ( Group A ) and 33 without the disease ( Group B ) .  Measurement of  IL 2 , 4 and 10 , TNF-alpha and IFN-gamma  was carried out in peripheral blood and peritoneal fluid . RESULTS Serum TNF-alpha was higher in patients with endometriosis who had deep dyspareunia compared to controls ( mean 4.5 pg/ml and 2.3 pg/ml , p<0.05 ) . Among these patients ( n=32 ) , 65.5 % had deep endometriosis . Patients with endometriosis and infertility had higher IL-2 concentrations in peritoneal fluid than controls ( mean 5.9 pg/ml and 0.2 pg/ml , p<0.05 ) . Among these patients ( n=22 ) , 63.5 % ( n=14 ) had deep endometriosis . A higher concentration of IL-10 was also observed in patients with ovarian endometriosis when compared to those without this type of disease , as well as when compared to control group patients ( mean 50 pg/ml , 18.7 pg/ml and 25.7 pg/ml , p<0.05 ) . CONCLUSIONS These results suggest that when specific clinical data are associated with a higher production of certain cytokines , there is a Th1 response pattern that may be related to deep infiltrating endometriosis The purpose of this study was to investigate the frequency of antibodies in the serum of patients with endometriosis reacting with endometrial , ovarian , thyroid and skeletal muscle antigens . A total of 55 fertile patients with pelvic pain who had endometriosis diagnosed by laparoscopy and confirmed by histology formed the study group , while 43 fertile patients without pelvic pain and undergoing tubal sterilization formed the control group .  Eutopic endometrial membrane antigen was prepared from biopsies taken from patients or controls by an ultracentrifugation technique and used in an enzyme-linked immunosorbent assay ( ELISA ) for immunoglobulin ( Ig ) G , IgA and IgM endometrial antibodies . Ovarian , thyroid and skeletal muscle antigens were prepared similarly and used in an ELISA . There was a significant difference in the prevalence of IgG antibodies to eutopic endometrial antigens derived from either control or endometriosis patients ( P < 0.05 ) . IgA or IgM antibodies against endometrial antigens were not detected . Endometrial antibodies were detectable in both the luteal and the follicular phases of the menstrual cycle . Immunoblot analysis demonstrated the presence of endometrial antigens with molecular weights of 60 and 66 kDa in the eutopic endometrium of patients with endometriosis . Antibodies to thyroid , ovary or skeletal muscle were not detected in these patients . These findings indicate that endometrial antibodies of the IgG class can be detected in approximately 50 % of patients with endometriosis but it remains unclear whether these represent a pathologically distinct subgroup of such patients OBJECTIVE To examine the expression of gremlin-1 ( GREM1 ) on the levels of messenger RNA ( mRNA ) and protein in eutopic endometrium and its serum level in patients with endometriosis . DESIGN Prospect i ve , experimental study using reverse-transcription polymerase chain reaction , Western blot , immunofluorescence , and ELISA . SETTING Gynecological oncology laboratory in a department of obstetrics and gynecology in a medical college in China . PATIENT(S ) Thirty-five patients with endometriosis and 23 healthy control women . INTERVENTION(S ) During surgery , the eutopic endometria and peripheral serum were obtained from the patients with endometriosis and the control women . MAIN OUTCOME MEASURE(S ) The cellular compartment location of GREM1 expression was examined by using immunofluorescent double staining . The expression levels of mRNA and protein for GREM1 were determined by reverse-transcription polymerase chain reaction and Western blot , respectively . The serum level of GREM1 was measured by indirect ELISA . RESULT ( S ) The expression of GREM1 was defined within endometrial blood vessel endothelium exclusively , with the concomitant expressions of GREM1 and CD146 . The expression of GREM1 on the levels of mRNA and protein was significantly higher in eutopic endometria of patients with endometriosis than in those from healthy control women . According to the ELISA established in our laboratory , the concentration of GREM1 in peripheral serum that was collected during the follicular menstrual phase of patients with endometriosis was significantly higher than that in serum from healthy control women . CONCLUSION ( S ) Gremlin-1 plays a role to some extent in the aberrant angiogenesis of eutopic endometrium in patients with endometriosis . It is possible that the peripheral serum level of GREM1 is a prospect i ve serum biomarker of endometriosis Vascular endothelial growth factor ( VEGF ) serum levels and VEGF and cellular expression were prospect ively analyzed in 60 patients ( group A consisted of asymptomatic patients or patients presenting mild dysmenorrhea ; 30 women comprised group B severe dysmenorrhea and /or chronic pelvic pain and /or dyspareunia ) who underwent surgery for cystic ovarian endometriosis  to asses whether a correlation exists among VEGF serum levels , VEGF cellular expression , and pelvic pain . No differences were found in VEGF serum levels and VEGF cellular expression between both groups . Therefore , we conclude that pain symptoms in ovarian endometriosis are not correlated with VEGF serum levels and VEGF cellular expression OBJECTIVE : To test the hypothesis that differential surface-enhanced laser desorption/ionization time-of-flight mass spectrometry protein or peptide expression in plasma can be used in infertile women with or without pelvic pain to predict the presence of laparoscopically and histologically confirmed endometriosis , especially in the sub population with a normal preoperative gynecologic ultrasound examination . METHODS : Surface-enhanced laser desorption/ionization time-of-flight mass spectrometry analysis was performed on 254 plasma 
    Output:
    
A subset of blood biomarkers could prove useful either for detecting pelvic endometriosis or for differentiating ovarian endometrioma from other benign ovarian masses , but there was insufficient evidence to draw meaningful conclusions .
Overall , none of the biomarkers displayed enough accuracy to be used clinical ly outside a research setting .