{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:56:44Z","timestamp":1791219404470,"version":"4.1.0"},"reference-count":75,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,1,18]],"date-time":"2018-01-18T00:00:00Z","timestamp":1516233600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["24592474"],"award-info":[{"award-number":["24592474"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["15K10675"],"award-info":[{"award-number":["15K10675"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reprod Medicine &amp; Biology"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Endometriosis is a multifactorial disease that mainly affects women of reproductive age. The exact pathogenesis of this disease is still debatable. The role of bacterial endotoxin (lipopolysaccharide,\n                      <jats:styled-content style=\"fixed-case\">LPS<\/jats:styled-content>\n                      ) and Toll\u2010like receptor 4 (\n                      <jats:styled-content style=\"fixed-case\">TLR<\/jats:styled-content>\n                      4) in endometriosis were investigated and the possible source of endotoxin in the pelvic environment was examined.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The limulus amoebocyte lysate test was used to measure the endotoxin levels in the menstrual fluid and peritoneal fluid and their potential role in the growth of endometriosis was investigated. Menstrual blood and endometrial samples were cultured for the presence of microbes. The effect of gonadotrophin\u2010releasing hormone agonist (Gn\n                      <jats:styled-content style=\"fixed-case\">RH<\/jats:styled-content>\n                      a) treatment on intrauterine microbial colonization (\n                      <jats:styled-content style=\"fixed-case\">IUMC<\/jats:styled-content>\n                      ) and the occurrence of endometritis was investigated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main findings (Results)<\/jats:title>\n                    <jats:p>\n                      Lipopolysaccharide regulates the pro\u2010inflammatory response in the pelvis and growth of endometriosis via the\n                      <jats:styled-content style=\"fixed-case\">LPS<\/jats:styled-content>\n                      \/\n                      <jats:styled-content style=\"fixed-case\">TLR<\/jats:styled-content>\n                      4 cascade. The menstrual blood was highly contaminated with\n                      <jats:italic>Escherichea coli<\/jats:italic>\n                      and the endometrial samples were colonized with other microbes. A cross\u2010talk between inflammation and ovarian steroids or the stress reaction also was observed in the pelvis. Treatment with Gn\n                      <jats:styled-content style=\"fixed-case\">RH<\/jats:styled-content>\n                      a further worsens intrauterine microbial colonization, with the consequent occurrence of endometritis in women with endometriosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      For the first time, a new concept called the \u201cbacterial contamination hypothesis\u201d is proposed in endometriosis. This study's findings of\n                      <jats:styled-content style=\"fixed-case\">IUMC<\/jats:styled-content>\n                      in women with endometriosis could hold new therapeutic potential in addition to the conventional estrogen\u2010suppressing agent.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/rmb2.12083","type":"journal-article","created":{"date-parts":[[2018,1,18]],"date-time":"2018-01-18T22:08:59Z","timestamp":1516313339000},"page":"125-133","source":"Crossref","is-referenced-by-count":162,"title":["Bacterial contamination hypothesis: a new concept in endometriosis"],"prefix":"10.1002","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9493-3340","authenticated-orcid":false,"given":"Khaleque N.","family":"Khan","sequence":"first","affiliation":[{"name":"Graduate School of Medical Science Department of Obstetrics and Gynecology Kyoto Prefectural University of Medicine  Kyoto 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