Clinical characteristics, treatment status and complications in women with tube ovarian abscess and endometriosis: a retrospective study

Clinical characteristics, treatment status and complications in women with tube ovarian abscess and endometriosis: a retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Clinical characteristics, treatment status and complications in women with tube ovarian abscess and endometriosis: a retrospective study Hui Li, Yan Zhao, Xiao-hong Chang, Yue Wang, Hong-lan Zhu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-38751/v3 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Mar, 2021 Read the published version in BMC Women's Health → Version 3 posted 2 You are reading this latest preprint version Show more versions Abstract Background : The aim of our present study was to investigate the clinical characteristics, treatment status and complications in women with endometriosis (EM) and tube ovarian abscess (TOA) to determine the possible association between TOA and EM. Methods: Medical records were used to analyze the clinical characteristics, treatment and complications. Twenty women who were diagnosed with TOA with EM were compared with 93 women diagnosed as having TOA without EM between January, 2008 and December, 2018. Results: In this study, TOA patients with EM were significantly more likely to have a lower age range (20–39years) than the non-EM group (11/20 (55.0%) vs 27/93 (29.0%)). In addition, TOA patients with EM were associated with a significantly lower rate of parity (11/20 (55.0%) vs 75/93 (80.6%),), higher rates of infertility (8/20(40%) vs 0/93(0%),) and a significantly lower incidence of elevated blood platelet counts (5/20 (25%) vs 43/93 (53.8%)). Furthermore, women with EM had greater blood loss (347±445.77 vs 204.67±289.46) and an increased complication rate (3/20(15%) vs 0/93(0%)). Among the 3 patients who had complications in the EM group, 2 patients had septic shock and 1 patient had intestinal obstruction. And 1 case who had septic shock followed by IVF treatment. There was no significance difference on other factors. Conclusions: The present study indicated that EM did not increase the difficulty and time of treatment in patients with TOA, but increased bleeding during surgery and serious complications. It is suggested that doctors should pay more attention to postoperative treatment and nursing in women with TOA and EM, especially those who have a history of recent infertility treatment and related procedures. Obstetrics & Gynecology EM tube ovarian abscess infertility adverse complications Background Tube ovarian abscess (TOA) is a complication of pelvic inflammatory disease (PID) that occasionally involves the adjacent tissues and organs in the pelvic cavity [1]. The presentations of TOA vary and include fever, lower abdominal-pelvic pain, and vaginal discharge. TOA often leads to long-term complications, such as pelvic adhesion, chronic pelvic pain, infertility and ectopic pregnancy [2]. The occurrence of TOA is affected by many factors, such as sexual activity, age, diabetes and some immune deficiency diseases. Although the incidence of TOA is still unclear, approximately one-third of patients with pelvic inflammatory disease have TOA [3]. Endometriosis (EM) is a chronic inflammatory estrogen-dependent disease and an immunologically aberrant condition that is prevalent in women of reproductive age. Impaired immune function is one of the causes of EM, which promotes the occurrence of infection [4-5]. Moreover, the cyst wall is not conducive to the treatment of infection, and periodic hemorrhage of the focus promotes the spread of infection [6-7]. In addition, EM often causes 30% to 50% of affected women infertility. Patients with EM and infertility are usually treated with artificial assisted reproductive technology (ART), which may increase the risk of TOA and make it difficult to treat [8]. Thus, the risk of TOA in EM patients may be increased [7-8]. One study reported the increased risk of PID in EM may prolong the hospitalization time and increase the difficulties in treatment [9]. However, the risk of TOA in EM still remain unclear. Few studies have reported the presence of EM in women with TOA, which mainly analyzed and compared clinical characteristics and antibiotic treatment [9-10]. However, whether TOA patients with EM increase the difficulty of treatment and the risk of possible complications during the process of treatment remains to be elucidated. The aim of our present study was to investigate the clinical characteristics, treatment status and complications in women with EM and TOA to determine the possible association between TOA and EM. In this study, we conducted a retrospective study to analyze whether TOA with EM tends to be more serious and difficult to treatment. Methods In this retrospective study, we reviewed medical records in 168 women who were hospitalized at Peking University People’s Hospital with the diagnosis of TOA between January 2008 and December 2018. The “gold standard” for the diagnosis of EM is laparoscopy, which show the presence of the disease and its extension [11]. The diagnosis of TOA is based on the imaging with sonography or confirmed by the laparoscopy [12]. The inclusion criteria of women with EM and controls: TOA was diagnosed based on direct visualization of a pelvic abscess during laparoscopy or exploratory laparotomy and ultrasonographic; EM were confirmed by histopathology and laparoscopy or laparotomy; women aged between 20 and 55 years. Women with EM confirmed by surgery were also ruled out from controls. In our study, patients with appendicular abscess, malignant disease, hydrosalpinx fluid, adenomyoma were excluded. We also excluded women who had TOA during perinatal period. Finally, a total of 113 records were reviewed. EM was evaluated according to the revised American Society for Reproductive Medicine (rASRM) classification [13].The type of EM combined with TOA mainly included 17 ovarian EM and 3 peritoneal EM. The study was approved by the Ethics Committee of the Peking University People’s Hospital. Data were collected from the patient’s information systems. The following clinical variables were retrieved: 1. demographic factors:: age, menarche age, marital status, BMI, parity and infertility; 2. risk factors: history of current or previous PID, recent insertion or removal of an intrauterine device (IUD) (within 3 months), and recent pelvic surgery (within 6 weeks), history of in vitro fertilization (IVF); 3. clinical factors (at the time of index admission): abdominal pain, vaginal discharge, fever, red blood cell, white blood cell (WBC) and neutrophil counts, blood platelet counts (BPC), CA125, fibrinogen, C-reactive protein (CRP), procalcitonin (PCT), bacterial vaginosis (BV) status on cervicovaginal swabs, blood culture, bacterial culture when applicable; 4. management factors: duration of intravenous injection (IV) /oral antibiotics, dura­tion of hospitalization, and management plan (medical, surgical), position of TOA, type of surgery (laparoscopy or laparotomy), complications. According to the diagnosis and treatment plan of pelvic abscess in our hospital, all patients were treated with intravenous antibiotics on admission. After 48 hours of antibiotic treatment, if there was no significant improvement in symptoms, invasive surgery would be performed. Statistics Statistics Package for Social Sciences (SPSS 20, IBM, USA) was used for statistical analysis in this study. The measurement data were analyzed with Student’s t test or the Mann–Whitney test for nonnormally distributed data. The count data are expressed as percentages, and chi-square tests were used for intergroup comparisons. P value < 0.05 was considered statistically significant. Results During the 10-year study period, a total of 168 patients were initially diagnosed with TOA or pelvic abscess. Of these, 113 patients fulfilled the inclusion criteria. The final analysis was performed in 113 patients, which included 20 women with EM as the study group and 93 women without EM as the control group in Supplementary Figure 1. Demographic data and clinical characteristics of the participants are shown in Table 1. Compared with the control group, women in the EM group were more likely to have lower pregnancy parities (45.0% vs 19.4%, p=0.021) and to have a higher risk of infertility history (40.0% vs 0.0%, p=0.000). However, there was no statistically significant differences with regard to age at menarche, menopause, marital status and BMI. We still found that the risk of TOA was significantly higher in patients with EM at the age of 20-39 (P = 0.036). As shown in Table 2, risk factors of increasing TOA were analyzed in the EM group and the non-EM group. The incidence for risk factors in the EM group compared to the non-EM group, such as history of gynecological surgery (40% vs 35.4%, p=0.799), history of previous PID (5.0% vs 21.5%, p=0.116), history of IVF (5.0% vs 0.0%, p=0.177), recent insertion or removal of an intrauterine device (IUD) (40.0% vs 47.3%, p=0.626), and the differences all had no statistical significance. The clinical symptoms and clinical characteristics of patients in the EM group and non-EM group are listed in Table 3. Fever (35% vs 37.6%) and abdominal pain (60.0% vs 76.3%) were common clinical symptoms in the EM group and non-EM group. The results shown the symptoms did not differ between the two groups. We also compared the red blood cell count and hemoglobin concentration between the two groups. We found the red blood cell count and hemoglobin concentration had no significance difference. Moreover, most of the elevated inflammatory markers did not differ between the EM group and the non-EM group, such as WBC count (45.0% vs 41.9%, p = 0.808), fibrinogen concentration (45.0% vs 58.4%, p=0.324), neutrophils (50.0% vs 51.6%, p=1.000), CRP (87.5% vs 89.7%, p=1.000), and PCT (40.0% vs 36.4%, p = 1.000) at admission, other than the BPCs. The incidence of elevated BPCs was notably increased than that in the control group (75% vs 46.23%, p=0.026). Table 3 shows that 75/113 (66.4%) of women had a CA-125 level drawn on presentation, 11/14 (71.4%) women in the EM group had an elevated CA-125 level, 36/61 (59.0%) women in the non-EM group had been elevated. While, no significance difference was shown on CA-125 level. In addition, bacteria cultures were sampled in 3/8 (27.3%) of the EM group and 23/46 (50.0%) of the non-EM group. Among the isolated organisms cultured from the aspirated abscess found in women with TOA, gram-negative bacteria were observed in 3 patients with EM and 13 patients without EM. Gram-negative bacteria were mainly E coli and bacteroides fragilis. Gram-positive bacteria were observed in 10 patients without EM. Gram-positive bacteria were mainly staphylococcus aureu and streptococcus. A total of 2/6 (33.3%) of blood cultures taken in the EM group and 2/13 (15.4%) in the non-EM group at admission were culture positive; 0/3 (0.0%) cervicovaginal isolate secretion cultures taken in the EM group and 5/11 (45.5%) in the non-EM group were positive. However, there was no significance difference in the bacteria cultures, blood cultures and secretion cultures. Table 4 shows a comparison of treatment between the EM group and the non-EM group. The duration of hospital stay, total treatment time, and antibiotic treatment time did not differ between the groups. Moreover, the approach did not differ between the groups, with a similar percentage of women undergoing laparotomy as compared to laparoscopic procedures (p=0.773). Compared with the non-EM group, the EM group was significantly associated with surgical complications during the perioperative period (15.0% vs 0.0%, p=0.000). Three patients had perioperative surgical complications in the EM group, of whom 2 patients had septic shock and 1 patient had intestinal obstruction. We also found significant differences between the EM group and the non-EM group with respect to operative blood loss (347±445.77 vs 204.67±289.46, p=0.014). There were no significant differences between the groups regarding antibiotic replacement times, abscess location, emergency surgery, or relapse. Discussions In our study, we compared the presenting characteristics and clinical outcomes of EM and non-EM groups in TOA. Among these women, we found that the abdominal pain, fever, a history of prior pelvic surgery and pelvic inflammation all have no obvious significant difference. While TOA patients with EM were more likely to have lower pregnancy parities and a higher risk of infertility history. Characteristics and treatment of women with TOA were similar regardless of whether they were complicated with EM. However, the EM group was significantly more likely to have operative blood loss and complications. A previous retrospective analysis was performed to evaluate the prevalence of the coexistence of EM and pelvic inflammatory disease (PID), which report that the prevalence of PID in women with EM is sufficiently higher than the general population [14]. Shai E. ELIZUR also reported the prevalence of women hospitalised with PID or TOA combined with EM is also higher than the prevalence of EM [9]. Our study found the prevalence EM in the study population (20/113, 17.70%) is higher than the reported prevalence of EM (6%-10%) [15]. The results shown that our study is consistent with previous studies. It is likely that EM is a risk factor for the development of TOA. We also analysed the type of EM combined with TOA which include ovary EM (17/20, 85%), peritoneal EM (3/20, 15%). Meanwhile, all EM patients were diagnosed with Stage III/IV EM according to rASRM classification. As previous study reported, a more severe EM (stage III and IV disease) seems to be found in women with diagnosis of PID and TOA [6]. There are two main theories to explain the reason, one is the bloody content of the endometrioma or in the peritoneal cavity. The other possible reason may be as the dysfunction of immune system. Whether the TOA associated with the pathogenesis of EM still remains unknown. Several classic theories have been proposed regarding the exact origin of EM. One of the most accepted theory is Sampson’s retrograde menstruation, which occurs in more than 90% of menstruating women [16]. Accumulating evidence suggests the multifactorial nature of the pathogenesis of EM, such as immune cells, adhesion molecules, extracellular matrix metalloproteinase and pro-inflammatory cytokines activate/alter peritoneal microenvironment, which created the conditions for differentiation, adhesion, proliferation and survival of ectopic endometrial cells [17-19]. The inflammatory conditions of TOA may support the point of view of new theories about the pathogenesis of EM. TOA is one of the most serious complications of PID and potentially life-threatening. Early diagnosis and appropriate treatment are important for preventing long-term morbidity, such as tubal factor infertility, ectopic pregnancy, chronic pelvic pain. Recent studies reported that the predictive markers of TOA [20-21]. Lee S.W et al reported that increased CRP and CA-125 level were the independent factors predictive of TOA [20]. Demirtas O et al found that the level of CRP and ESR was statistically significantly higher in TOA group, and associated with longer duration of hospitalization and disease severity of TOA [21]. While the predictive markers for the development of TOA in EM patients still remains unclear. In this study, we compared clinical risk factors and laboratory parameters of EM and non-EM groups in TOA. Clinical risk factors and inflammatory markers, including fibrinogen, C-reactive protein (CRP) and PCT levels, were found no significant difference in the EM group than the non-EM group. While the incidence of elevated blood platelet in EM group was notably higher than the non-EM group. It has been reported that EM is considered a hormonal disease and an inflammatory condition. Simultaneously, activated platelets play an important role in the occurrence and development of EM [22-23]. It is suggested that the result of our study is consistent with previous studies, which indicates the elevated blood platelet may be as a predictive marker. As we all know, CA125 is a glycoprotein in the blood, which is derived from coelomic epithelia in the female genital tract, including the fallopian tube, endometrium, ovary, and peritoneum [24]. In routine clinical practice, CA125 has been investigated extensively as a biomarker of EM. Several studies have found that CA-125 serum levels were related to the occurrence of TOA and have a prognostic role during conservative parenteral antibiotic therapy [25,26]. Whether CA125 can be used as the predictive marker for the development of TOA in EM patients. In this study, we also reported that the CA-125 levels in TOA patients with EM and non-EM. However, the results showed no obvious difference in the CA-125 level between the EM and non-EM group. It is possible that CA-125 may be elevated in benign ovarian cysts, hyperstimulation syndrome, ectopic pregnancy and fibroids, which imply it is nonspecific marker [24,26]. This study reported that patients with TOA and EM had more serious perioperative surgical complications than the non-EM group. Among the 3 patients who had complications in the EM group, most (2/3, 66.7%) had septic shock. Through further analysis, we found that 1 case had septic shock followed by IVF treatment. Infertility treatment and related procedures undermine the integrity of the ovarian sac, which increases the risk of TOA [27]. EM is a risk factor for the infection of pelvic organs. However, the incidence of TOA after in vitro fertilization and oocyte removal is very low in patients suspected of EM by ultrasound [28]. Several case reports described sporadic cases of abscesses as serious post-ART complications [29-31]. Consumptive coagulation dysfunction is a serious complication of septic shock. If not treated in time, it may be life-threatening. Therefore, we should pay more attention to patients with TOA and EM followed by infertility treatment and the associated procedures. The present study was not without any limitations. As this is a retrospective study, it is inherently limited by the possibility of type II error. Moreover, the sample size of patients is limited, and this was a single center study. This result needs to be further validated in a multicenter study for more patients. In addition, to be able to use antibiotics, the treating physicians may alter the management plan and may also change the clinical process. Conclusions In summary, the characteristics and treatment of TOA patients with EM are similar to those without EM. Both groups tend to be antibiotic resistant and often require surgery. However, EM more often causes serious complications and surgical bleeding in TOA patients. Doctors should pay more attention to postoperative treatment and nursing in women with TOA and EM, especially those who have a recent history of infertility treatment and associated procedures. Abbreviations TOA: Tube ovarian abscess; PID: pelvic inflammatory disease; Endometriosis: EM; ART: artificial assisted reproductive technology; IUD: intrauterine device; IVF: in vitro fertilization; WBC: white blood cell; BPC: blood platelet counts; CRP: C-reactive protein; BV: bacterial vaginosis; PCT: procalcitonin; IV: intravenous injection. Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee of the Peking University People’s Hospital. Administrative permissions were required to access and use the medical records described in our study by Scientific Research Center of the Peking University People’s Hospital. As this study is a retrospective study, there is no need for consent to participate to be obtained. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analyzed in the study are not publicly available due to potential for individual and organizational privacy to be compromised. Reasonable requests for parts of the data will be considered by the corresponding author. Competing interests The authors declare that they have no competing interests. Funding This study was supported by the National Natural Science Foundation of China (grant no. 81671431 and 81170544). The funding body was not involved in the design of the study, data collection, analysis, interpretation, or writing of the manuscript. Authors’ contributions All authors contributed to the study conception and design. HL: data collection, data analysis, manuscript writing. YZ: data management, manuscript editing. XC: data analysis, manuscript writing and editing. YW: data collection, manuscript editing. HZ: protocol development, data management, manuscript writing and editing. All authors read and approved the final manuscript. Acknowledgments The authors thank the patients who participated in this study. The authors also thank the refresher doctor Li-qing Yao from Fuding hospital of fujian traditional chinese medical university for her help in data collection. References 1.Granberg S, Gjelland K, Ekerhovd E. The management of pelvic abscess. Best Pract Res Clin Obstet Gynaecol. 2009; 23(5):667-78. 2. Bugg CW, Taira T. Pelvic inflammatory disease: diagnosis and treatment in the emergency department. Emerg Med Pract. 2016;18(12):1-24. 3. Shigemi D, Matsui H, Fushimi K, Yasunaga H. Laparoscopic Compared With Open Surgery for Severe Pelvic Inflammatory Disease and Tubo-Ovarian Abscess. Obstet Gynecol. 2019; 133(6):1224-1230. 4. Ho HN, Chao KH, Chen HF, Wu MY, Yang YS, Lee TY. 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A case of pregnancy complicated by the development of a tubo-ovarian abscess following in vitro fertilization and embryo transfer. Am J Perinatol. 2003; 20(6):277-82. 31. S.L. Padilla. Ovarian abscess following puncture of an endometrioma during ultrasound-guided oocyte retrieval. Hum Reprod.1993; 8(8):1282-3. Tables Table 1. The comparison of demographic factors between women endometriosis and non-endometriosis who were hospitalized for TOA. characteristics Endometriosis （ n=20 ） No endometriosis n=93 P Age 0.036* 20-39 11/20 (55.0%) 27/93 (29.0%) 40-55 9/20 (45.0%) 66/93 (71.0%) Menarche age 13.65±1.67 14.23±1.63 0.847 Menopause 1/20 (5.0%) 10/93 (10.8%) 0.686 Married 19/20 (95.0%) 91/93 (97.8%) 0.446 BMI 23.52±3.19 23.58±4.92 0.243 Parity 0.021* 0 9/20(45.0%) 18/93 (19.4%) ≥ 1 11(55.0%) 75/93 (80.6%) Infertility 8/20 (40.0%) 0/93 (0.0%) 0.000* Data are presented as mean±SD, n (%). BMI Body Mass Index, TOA tube ovarian abscess .* P< 0.05. Table 2. Analysis risk factors of in TOA women with endometriosis and without endometriosis. characteristics Endometriosis （ n=20 ） No endometriosis n=93 P History of gynecological surgery 8/20 (40.0%) 33/93 (35.4%) 0.799 History of pelvic inflammaton 1/20 (5.0%) 20/93 (21.5%) 0.116 IVF 1/20 (5.0%) 0/93 (0.0%) 0.177 Intrauterine ring 8/20 (40.0%) 44/93 (47.3%) 0.626 Data are presented as n (%). IVF in vitro fertilization, TOA tube ovarian abscess. Table3. Analysis of clinical symptoms and biochemical results between TOA women with and without endometriosis. characteristics Endometriosis （ n=20 ） No endometriosis (n=93) P Fever 7/20 (35.0%) 35/93 (37.6%) 1 Abdominal pain 12/20 (60.0%) 71/93 (76.3%) 0.164 Red blood cell count 3.77±0.52 3.93±0.61 0.404 Hemoglobin concentration 111.67±16.53 110.74±19.01 0.373 WBC increased 9/20 (45.0%) 39/93 (41.9%) 0.808 Blood platelet increased 5/20 (25.0%) 43/93 (46.2%) 0.026* Fibrinogen increased 9/20 (45.0%) 52/93 (58.4%) 0.324 Neutrophils increased 10/20 (50.0%) 48/93 (51.6%) 1.000 CRP increased 7/8 (87.5%) 35/39 (89.7%) 1.000 PCT increased 2/5 (40.0%) 4/11 (36.4%) 1.000 CA125 increased 10/14 (71.4%) 36/61 (59.0%) 0.546 Bacteria culture positive 3/8 (27.3%) 23/46 (50.0%) 0.200 Blood culture positive 2/6 (33.3%) 2/13 (15.4%) 0.557 Secretion culture positive 0/3 (0.0%) 5/11 (45.5%) 0.258 Data are presented as mean±SD, n (%). WBC white blood cell count, CRP C-reactive protein, PCT procalcitonin, TOA tube ovarian abscess . * P< 0.05 Table 4. Analysis management factors of TOA in women with endometriosis and without endometriosis. characteristics Endometriosis （ n=20 ） No endometriosis (n=93) P Hospital stay 10.60±8.56 11.76±9.05 0.825 Total treatment time 14.40±9.36 15.95±11.29 0.351 Antibioti treatment time 8.10±5.61 12.22±8.15 0.140 Antibiotic replacement times 0.196 0 10/20 (50.0%) 30/93 (32.3%) ≥ 1 10/20 (50.0%) 63/93 (67.7%) Abscess location 1.000 tube ovary abscess 12/20 (60.0%) 55/93 (59.1%) tube abscess 8/20 (40.0%) 38/93 (40.9%) Emergency surgery 2/20 (10.0%) 12/93 (13.3%) 0.773 Blood loss 347±445.77 204.67±289.46 0.014* Laparotomy 5/20 (25.0%) 20/93 (22.2%) 0.773 Complication 3/20 (15.0%) 0/93 (0.0%) 0.005* Relapse 1/20 (5.0%) 3/93 (3.1%) 0.547 Data are presented as mean±SD, n (%). TOA tube ovarian abscess . * P< 0.05 Supplementary Files SupplementaryMaterial.docx Cite Share Download PDF Status: Published Journal Publication published 18 Mar, 2021 Read the published version in BMC Women's Health → Version 3 posted Submission checks completed at journal 25 Nov, 2020 Editorial decision: Accept 03 Nov, 2020 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-38751","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":5367119,"identity":"9273f23c-e421-4e70-9643-f9d4bdbbcec7","order_by":0,"name":"Hui Li","email":"","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hui","middleName":"","lastName":"Li","suffix":""},{"id":5367120,"identity":"6666558b-98ac-4bac-bfa2-d09f7237101c","order_by":1,"name":"Yan Zhao","email":"","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Zhao","suffix":""},{"id":5367121,"identity":"7f0f9948-0213-42bf-b6a5-b8e98bd2b1f3","order_by":2,"name":"Xiao-hong Chang","email":"","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiao-hong","middleName":"","lastName":"Chang","suffix":""},{"id":5367122,"identity":"b48331b0-66c9-42c5-97ca-b50a2a53de5f","order_by":3,"name":"Yue Wang","email":"","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yue","middleName":"","lastName":"Wang","suffix":""},{"id":5367123,"identity":"22da9f96-1b2d-4bb1-a775-a50ba923137e","order_by":4,"name":"Hong-lan Zhu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYBACAxDxAERIMDA+gHCJ0ZIA0cJsQLIWNgmiHGbO3nv4RULNHQb52T1mlT8K7sgzsB8+ugGfFsuec2kWCceeMTDOOWN2m8fgmWEDT1raDbwOu5FjZpDAdpiBWSLH7DaDwWHGBgkeMyK0/DsM9EiOWeEPg8P2xGgxfpDYdpiBB6iFgcfgcCJhLWfOmDEk9h1mkJBIK5YGakluI+iX4z3GHz58O8wgPyN548cffw7b9rMfPoZXCxCAo6O+Ac4loBwEmD8QoWgUjIJRMApGMgAAg9FJ1PsO91gAAAAASUVORK5CYII=","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Hong-lan","middleName":"","lastName":"Zhu","suffix":""}],"badges":[],"createdAt":"2020-06-29 09:07:55","currentVersionCode":3,"declarations":"","doi":"10.21203/rs.3.rs-38751/v3","doiUrl":"https://doi.org/10.21203/rs.3.rs-38751/v3","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12905-020-01119-x","type":"published","date":"2021-03-18T15:00:33+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":13624276,"identity":"a890d4cd-0340-4ebb-8d47-1df59a580f73","added_by":"auto","created_at":"2021-09-17 07:21:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":321412,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-38751/v3/d2c805f0-14ff-4cf0-97cc-95bb8d30b883.pdf"},{"id":4076340,"identity":"c9c18fc2-43af-4484-8cb5-c06df70cc1dd","added_by":"auto","created_at":"2020-12-07 19:04:35","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":98936,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-38751/v3/8d06340929e459c0879fb4ff.docx"}],"financialInterests":"","formattedTitle":"Clinical characteristics, treatment status and complications in women with tube ovarian abscess and endometriosis: a retrospective study","fulltext":[{"header":"Background","content":"\u003cp\u003eTube ovarian abscess\u0026nbsp;(TOA) is a complication of pelvic inflammatory disease (PID) that occasionally involves the adjacent tissues and organs in the pelvic cavity [1]. The presentations of TOA vary and include fever, lower abdominal-pelvic pain,\u0026nbsp;and\u0026nbsp;vaginal discharge. TOA often leads to long-term complications, such as pelvic adhesion, chronic pelvic pain, infertility and ectopic pregnancy\u0026nbsp;[2].\u0026nbsp;The occurrence of TOA is affected by many factors, such as sexual activity, age, diabetes and some immune deficiency diseases. Although the incidence of TOA is still unclear,\u0026nbsp;approximately one-third of patients with pelvic inflammatory disease have TOA [3].\u003c/p\u003e\n\u003cp\u003eEndometriosis (EM) is\u0026nbsp;a chronic inflammatory estrogen-dependent disease and\u0026nbsp;an immunologically aberrant condition that is prevalent in women of reproductive age. Impaired immune function is one of the causes of EM, which promotes the occurrence of infection [4-5]. Moreover,\u0026nbsp;the cyst wall is not conducive to the treatment of infection, and periodic hemorrhage of the focus promotes the spread of infection\u0026nbsp;[6-7].\u0026nbsp;In addition, EM often causes\u0026nbsp;30%\u0026nbsp;to 50%\u0026nbsp;of affected\u0026nbsp;women infertility.\u0026nbsp;Patients with EM and infertility are usually treated with artificial assisted reproductive technology\u0026nbsp;(ART), which may\u0026nbsp;increase the risk of TOA and make it difficult to\u0026nbsp;treat\u0026nbsp;[8]. Thus,\u0026nbsp;the risk of TOA in EM patients may be increased [7-8]. One study reported the increased risk of PID in EM may\u0026nbsp;prolong the hospitalization time and increase the\u0026nbsp;difficulties\u0026nbsp;in treatment\u0026nbsp;[9]. However, the risk of TOA in EM still remain unclear.\u003c/p\u003e\n\u003cp\u003eFew\u0026nbsp;studies have reported the presence of EM in women with TOA, which mainly analyzed and compared clinical characteristics and antibiotic treatment [9-10].\u0026nbsp;However, whether\u0026nbsp;TOA patients with EM increase the difficulty of treatment and the risk of possible complications during the process of treatment\u0026nbsp;remains to be elucidated.\u003c/p\u003e\n\u003cp\u003eThe aim of our present study was to investigate the clinical characteristics, treatment status and complications in women with EM and TOA to determine the possible association between TOA and EM. In this study, we conducted a retrospective study to analyze whether TOA with EM tends to be more serious and difficult to treatment.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eIn this retrospective study, we reviewed medical records in 168 women who were hospitalized at\u0026nbsp;Peking University People\u0026rsquo;s Hospital\u0026nbsp;with the diagnosis of TOA between January 2008 and December 2018.\u0026nbsp;The \u0026ldquo;gold standard\u0026rdquo; for the diagnosis of EM is laparoscopy, which show the presence of the disease and its extension [11]. The diagnosis of TOA is based on the imaging with sonography or confirmed by the laparoscopy [12]. The inclusion criteria of women with EM and controls: TOA was diagnosed based on direct visualization of a pelvic abscess during laparoscopy or exploratory laparotomy and ultrasonographic; EM were confirmed by histopathology and laparoscopy or laparotomy; women aged between 20 and 55 years. Women with EM confirmed by surgery were also ruled out from controls. In our study,\u0026nbsp;patients with appendicular abscess, malignant disease, hydrosalpinx fluid, adenomyoma were excluded. We also excluded women who had TOA during perinatal period.\u0026nbsp;Finally, a total of 113 records were reviewed. EM was evaluated according to the revised American Society for Reproductive Medicine (rASRM) classification [13].The type of EM combined with TOA mainly included 17 ovarian EM and 3 peritoneal EM. The study was approved by the Ethics Committee of the Peking University People\u0026rsquo;s Hospital.\u0026nbsp;Data were collected from\u0026nbsp;the\u0026nbsp;patient\u0026rsquo;s information systems.\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;following\u0026nbsp;clinical variables were retrieved: 1.\u0026nbsp;demographic factors::\u0026nbsp;age,\u0026nbsp;menarche age, marital status, BMI, parity and\u0026nbsp;infertility; 2. risk factors: history of current or previous\u0026nbsp;PID, recent insertion or removal of an intrauterine device (IUD) (within 3 months), and recent pelvic surgery (within 6 weeks), history of in vitro fertilization (IVF); 3. clinical factors (at the time of index admission): abdominal pain, vaginal discharge, fever, red blood cell, white blood cell (WBC) and neutrophil counts, blood platelet counts (BPC), CA125, fibrinogen,\u0026nbsp;C-reactive protein (CRP), procalcitonin (PCT),\u0026nbsp;bacterial vaginosis (BV) status on cervicovaginal swabs,\u0026nbsp;blood culture,\u0026nbsp;bacterial culture when applicable; 4. management factors: duration of intravenous injection (IV) /oral antibiotics, dura\u0026shy;tion of hospitalization, and management plan (medical, surgical), position of TOA, type of surgery (laparoscopy or laparotomy),\u0026nbsp;complications.\u0026nbsp;According to the diagnosis and treatment plan of pelvic abscess in our hospital, all patients were treated with intravenous antibiotics on admission. After 48 hours of antibiotic treatment, if there was no significant improvement in symptoms, invasive surgery would be\u0026nbsp;performed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistics Package for Social Sciences (SPSS 20, IBM, USA) was used for statistical analysis in this study. The measurement data were analyzed with Student\u0026rsquo;s t test or the Mann\u0026ndash;Whitney test for nonnormally distributed data. The count data are expressed as percentages, and chi-square tests were used for intergroup comparisons. P value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the 10-year\u0026nbsp;study period, a total of 168 patients were\u0026nbsp;initially\u0026nbsp;diagnosed with TOA\u0026nbsp;or pelvic abscess.\u0026nbsp;Of these,\u0026nbsp;113 patients fulfilled the inclusion criteria. The final analysis was performed in 113 patients, which included 20 women with EM as the study group and 93 women without EM as the control group in Supplementary Figure 1. Demographic data and clinical characteristics of the participants\u0026nbsp;are\u0026nbsp;shown in Table 1. Compared with\u0026nbsp;the\u0026nbsp;control group,\u0026nbsp;women in\u0026nbsp;the\u0026nbsp;EM group were more likely to have lower pregnancy parities (45.0% vs 19.4%, p=0.021) and to have a higher risk of infertility history\u0026nbsp;(40.0% vs 0.0%, p=0.000).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eHowever,\u0026nbsp;there\u0026nbsp;was no\u0026nbsp;statistically significant differences with regard to age at\u0026nbsp;menarche,\u0026nbsp;menopause, marital status and BMI.\u0026nbsp;We still found\u0026nbsp;that\u0026nbsp;the risk of TOA was significantly higher in patients with EM at the age of 20-39 (P = 0.036).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs shown in Table 2, risk factors of increasing TOA were analyzed in the EM group and the non-EM group. The incidence for risk factors in\u0026nbsp;the\u0026nbsp;EM group compared to the non-EM group,\u0026nbsp;such as history of gynecological surgery (40% vs 35.4%, p=0.799), history of previous PID\u0026nbsp;(5.0% vs 21.5%, p=0.116), history of IVF (5.0% vs 0.0%, p=0.177), recent insertion or removal of an intrauterine device (IUD)\u0026nbsp;(40.0% vs 47.3%, p=0.626),\u0026nbsp;and\u0026nbsp;the differences all had no statistical significance.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;clinical symptoms and clinical characteristics of patients in the EM group and non-EM group are listed in Table 3.\u0026nbsp;Fever (35% vs 37.6%) and abdominal pain (60.0% vs 76.3%) were common clinical symptoms in the\u0026nbsp;EM group and non-EM group. The results shown the\u0026nbsp;symptoms did not differ between the two groups.\u0026nbsp;We also compared the red blood cell count and hemoglobin concentration between the two groups. We found the red blood cell count and hemoglobin concentration had no significance difference.\u0026nbsp;Moreover, most of\u0026nbsp;the\u0026nbsp;elevated inflammatory markers did not differ between\u0026nbsp;the\u0026nbsp;EM group and the non-EM group,\u0026nbsp;such\u0026nbsp;as WBC count (45.0% vs 41.9%, p = 0.808),\u0026nbsp;fibrinogen\u0026nbsp;concentration (45.0% vs 58.4%, p=0.324), neutrophils (50.0% vs 51.6%, p=1.000),\u0026nbsp;CRP (87.5%\u0026nbsp;vs 89.7%, p=1.000), and PCT (40.0% vs\u0026nbsp;36.4%, p = 1.000) at admission, other than the\u0026nbsp;BPCs.\u0026nbsp;The incidence of\u0026nbsp;elevated\u0026nbsp;BPCs\u0026nbsp;was\u0026nbsp;notably increased than that in the control group (75% vs 46.23%, p=0.026).\u0026nbsp;Table 3 shows that\u0026nbsp;75/113 (66.4%) of women had a CA-125 level drawn on presentation,\u0026nbsp;11/14 (71.4%) women in\u0026nbsp;the\u0026nbsp;EM group had an elevated CA-125 level, 36/61\u0026nbsp;(59.0%) women in\u0026nbsp;the non-EM group had been elevated. While, no significance\u0026nbsp;difference\u0026nbsp;was shown on CA-125 level.\u003c/p\u003e\n\u003cp\u003eIn addition,\u0026nbsp;bacteria\u0026nbsp;cultures\u0026nbsp;were sampled in 3/8 (27.3%) of the EM group and 23/46 (50.0%) of the non-EM group. Among the isolated organisms cultured from the aspirated abscess found in women with TOA, gram-negative bacteria were observed in 3 patients with EM and 13 patients without EM. Gram-negative bacteria were mainly E coli and bacteroides fragilis. Gram-positive bacteria were observed in 10 patients without EM. Gram-positive bacteria were mainly staphylococcus aureu and streptococcus. A total of\u0026nbsp;2/6 (33.3%) of blood cultures taken in the EM group and 2/13 (15.4%) in the non-EM group at admission were culture positive; 0/3 (0.0%) cervicovaginal isolate secretion cultures taken in the EM group and 5/11 (45.5%) in the non-EM group were positive. However, there was no significance difference in the\u0026nbsp;bacteria cultures, blood cultures and secretion cultures. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4 shows a comparison of treatment between the EM group and the non-EM group. The duration of hospital stay, total treatment time, and antibiotic treatment time did not differ between the groups. Moreover, the approach did not differ between the groups, with a similar percentage of women undergoing laparotomy as compared to laparoscopic procedures (p=0.773). Compared with the non-EM group, the EM group was significantly associated with surgical complications during the perioperative period (15.0% vs 0.0%, p=0.000). Three patients had perioperative surgical complications in the EM group, of whom 2 patients had septic shock and 1 patient had intestinal obstruction. We also found significant differences between the EM group and the non-EM group with respect to operative blood loss (347\u0026plusmn;445.77 vs 204.67\u0026plusmn;289.46, p=0.014). There were no significant differences between the groups regarding antibiotic replacement times, abscess location, emergency surgery, or relapse.\u003c/p\u003e"},{"header":"Discussions","content":"\u003cp\u003eIn our study, we compared the presenting characteristics and clinical outcomes of EM and non-EM groups in TOA. Among these women, we found that the abdominal pain, fever, a history of prior pelvic surgery and pelvic inflammation all have no obvious significant difference. While TOA patients with EM were more likely to have lower pregnancy parities and a higher risk of infertility history. Characteristics and treatment of women with TOA were similar regardless of whether they were complicated with EM. However, the EM group was significantly more likely to have operative blood loss and complications.\u003c/p\u003e\n\u003cp\u003eA previous retrospective analysis was performed to evaluate the prevalence of the coexistence of EM and pelvic inflammatory disease (PID), which report that the prevalence of PID in women with EM is sufficiently higher than the general population [14]. Shai E. ELIZUR also reported the prevalence of women hospitalised with PID or TOA combined with EM is also higher than the prevalence of EM [9]. Our study found the prevalence EM in the study population (20/113, 17.70%) is higher than the reported prevalence of EM (6%-10%) [15]. The results shown that our study is consistent with previous studies. It is likely that EM is a risk factor for the development of TOA.\u003c/p\u003e\n\u003cp\u003eWe also analysed the type of EM combined with TOA which include ovary EM (17/20, 85%), peritoneal EM (3/20, 15%). Meanwhile, all EM patients were diagnosed with Stage III/IV EM according to rASRM classification. As previous study reported, a more severe EM (stage III and IV disease) seems to be found in women with diagnosis of PID and TOA [6]. There are two main theories to explain the reason, one is the bloody content of the endometrioma or in the peritoneal cavity. The other possible reason may be as the dysfunction of immune system. Whether the TOA associated with the pathogenesis of EM still remains unknown.\u003c/p\u003e\n\u003cp\u003eSeveral classic theories have been proposed regarding the exact origin of EM. One of the most accepted theory is Sampson\u0026rsquo;s retrograde menstruation, which occurs in more than 90% of menstruating women [16]. Accumulating evidence suggests the multifactorial nature of the pathogenesis of EM, such as immune cells, adhesion molecules, extracellular matrix metalloproteinase and pro-inflammatory cytokines activate/alter peritoneal microenvironment, which created the conditions for differentiation, adhesion, proliferation and survival of ectopic endometrial cells [17-19]. The inflammatory conditions of TOA may support the point of view of new theories about the pathogenesis of EM.\u003c/p\u003e\n\u003cp\u003eTOA is one of the most serious complications of PID and potentially life-threatening. Early diagnosis and appropriate treatment are important for preventing long-term morbidity, such as tubal factor infertility, ectopic pregnancy, chronic pelvic pain. Recent studies reported that the predictive markers of TOA [20-21]. Lee S.W et al reported that increased CRP and CA-125 level were the independent factors predictive of TOA [20]. Demirtas O et al found that the level of CRP and ESR was statistically significantly higher in TOA group, and associated with longer duration of hospitalization and disease severity of TOA [21]. While the predictive markers for the development of TOA in EM patients still remains unclear. In this study, we compared clinical risk factors and laboratory parameters of EM and non-EM groups in TOA. Clinical risk factors and inflammatory markers, including fibrinogen, C-reactive protein (CRP) and PCT levels, were found no significant difference in the EM group than the non-EM group. While the incidence of elevated blood platelet in EM group was notably higher than the non-EM group. It has been reported that EM is considered a hormonal disease and an inflammatory condition. Simultaneously, activated platelets play an important role in the occurrence and development of EM [22-23]. It is suggested that the result of our study is consistent with previous studies, which indicates the elevated blood platelet may be as a predictive marker.\u003c/p\u003e\n\u003cp\u003eAs we all know, CA125 is a glycoprotein in the blood, which is derived from coelomic epithelia in the female genital tract, including the fallopian tube, endometrium, ovary, and peritoneum [24]. In routine clinical practice, CA125 has been investigated extensively as a biomarker of EM. Several studies have found that CA-125 serum levels were related to the occurrence of TOA and have a prognostic role during conservative parenteral antibiotic therapy [25,26]. Whether CA125 can be used as the predictive marker for the development of TOA in EM patients. In this study, we also reported that the CA-125 levels in TOA patients with EM and non-EM. However, the results showed no obvious difference in the CA-125 level between the EM and non-EM group. It is possible that CA-125 may be elevated in benign ovarian cysts, hyperstimulation syndrome, ectopic pregnancy and fibroids, which imply it is nonspecific marker [24,26].\u003c/p\u003e\n\u003cp\u003eThis study reported that patients with TOA and EM had more serious perioperative surgical complications than the non-EM group. Among the 3 patients who had complications in the EM group, most (2/3, 66.7%) had septic shock. Through further analysis, we found that 1 case had septic shock followed by IVF treatment. Infertility treatment and related procedures undermine the integrity of the ovarian sac, which increases the risk of TOA [27]. EM is a risk factor for the infection of pelvic organs. However, the incidence of TOA after in vitro fertilization and oocyte removal is very low in patients suspected of EM by ultrasound [28]. Several case reports described sporadic cases of abscesses as serious post-ART complications [29-31]. Consumptive coagulation dysfunction is a serious complication of septic shock. If not treated in time, it may be life-threatening. Therefore, we should pay more attention to patients with TOA and EM followed by infertility treatment and the associated procedures.\u003c/p\u003e\n\u003cp\u003eThe present study was not without any limitations. As this is a retrospective study, it is inherently limited by the possibility of type II error. Moreover, the sample size of patients is limited, and this was a single center study. This result needs to be further validated in a multicenter study for more patients. In addition, to be able to use antibiotics, the treating physicians may alter the management plan and may also change the clinical process.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, the characteristics and treatment of TOA patients with EM are similar to those without EM. Both groups tend to be antibiotic resistant and often require surgery. However, EM more often causes serious complications and surgical bleeding in TOA patients. Doctors should pay more attention to postoperative treatment and nursing in women with TOA and EM, especially those who have a recent history of infertility treatment and associated procedures.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eTOA: Tube ovarian abscess; PID: pelvic inflammatory disease; Endometriosis: EM; ART: artificial assisted reproductive technology; IUD: intrauterine device; IVF: in vitro fertilization; WBC: white blood cell; BPC: blood platelet counts; CRP: C-reactive protein; BV: bacterial vaginosis; PCT: procalcitonin; IV: intravenous injection.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of the Peking University People\u0026rsquo;s\u003c/p\u003e\n\u003cp\u003eHospital. Administrative permissions were required to access and use the medical records described in our study by Scientific Research Center of the Peking University People\u0026rsquo;s Hospital. As this study is a retrospective study, there is no need for consent to participate to be obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed in the study are not publicly available due to potential for individual and organizational privacy to be compromised.\u003c/p\u003e\n\u003cp\u003eReasonable requests for parts of the data will be considered by the corresponding author.\u003cbr\u003e\u0026nbsp;\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the National Natural Science Foundation of China (grant no. 81671431 and 81170544). The funding body was not involved in the design of the study, data collection, analysis, interpretation, or writing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. HL: data collection, data analysis, manuscript writing. YZ: data management, manuscript editing. XC: data analysis, manuscript writing and editing. YW: data collection, manuscript editing. HZ: protocol development, data management, manuscript writing and editing. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the patients who participated in this study. The authors also thank the refresher doctor Li-qing Yao from Fuding hospital of fujian traditional chinese medical university for her help in data collection.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e1.Granberg S, Gjelland K, Ekerhovd E. The management of pelvic abscess. Best Pract Res Clin Obstet Gynaecol. 2009; 23(5):667-78.\u003c/p\u003e\n\u003cp\u003e2. Bugg CW, Taira T. Pelvic inflammatory disease: diagnosis and treatment in the emergency department. Emerg Med Pract. 2016;18(12):1-24.\u003c/p\u003e\n\u003cp\u003e3. Shigemi D, Matsui H, Fushimi K, Yasunaga H. Laparoscopic Compared With Open Surgery for Severe Pelvic Inflammatory Disease and Tubo-Ovarian Abscess. Obstet Gynecol. 2019; 133(6):1224-1230. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4. Ho HN, Chao KH, Chen HF, Wu MY, Yang YS, Lee TY. Peritoneal natural killer cytotoxicity and CD25_ CD3_ lymphocyte subpopulation are decreased in women with stage III\u0026ndash;IV endometriosis. Hum Reprod. 1995; 10(10):2671-5. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e5. Ho HN, Wu MY, Yang YS. Peritoneal cellular immunity and endometriosis.\u003c/p\u003e\n\u003cp\u003eAm J Reprod Immunol.1997; 38(6):400-12.\u003c/p\u003e\n\u003cp\u003e6. Chen MJ, Yang JH, Yang YS, Ho HN. Increased occurrence of tubo-ovarian abscesses in women with stage III and IV endometriosis. Fertil Steril. 2004; 82(2):498-9. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e7. I Grammatikakis, N Evangelinakis, G Salamalekis, V Tziortzioti, C Samaras, C Chrelias, et al. Prevalence of severe pelvic inflammatory disease and endometriotic ovarian cysts: a 7-year retrospective study. Clin Exp Obstet Gynecol. 2009;36(4):235-6.\u003c/p\u003e\n\u003cp\u003e8. Villette C, Bourret A, Santulli P, Gayet V, Chapron C, de Ziegler D. Risks of tube- ovarian abscess in cases of endometrioma and assisted reproductive technologiesare both under- and overreported. Fertil Steril. 2016;106(2):410-5.\u003c/p\u003e\n\u003cp\u003e9. Shai E Elizur, Oshrit Lebovitz, Adi Y Weintraub, Vered H Eisenberg, Daniel S Seidman, Mordechai Goldenberg, et al. Pelvic inflammatory disease in women with endometriosis is more severe than in those without. Aust N Z J Obstet Gynaecol 2014; 54(2):162-5. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e10. Liu YT, Shi HH, Yu X, Wang S, Fan QB, Liu HY. Clinical analysis of pelvic abscess with endometriosis. Zhonghua Fu Chan Ke Za Zhi. 2017; 52(3):164-167.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e11. Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019; 15(11):666-682.\u003c/p\u003e\n\u003cp\u003e12. Kairys N, Roepke C. Tubo-Ovarian Abscess. 2020. PMID: 28846347.\u003c/p\u003e\n\u003cp\u003e13. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997;67(5):817-21.\u003c/p\u003e\n\u003cp\u003e14. Kubota T, Ishi K, Takeuchi H. A study of tubo-ovarian and ovarian abscesses, with a focus on cases with endometrioma. J Obstet Gynaecol Res. 1997; 23(5):421-6.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e15. Giudice LC, Kao LC. Endometriosis. Lancet. 2004;364(9447):1789-99.\u003c/p\u003e\n\u003cp\u003e16. Sampson J. The development of the implantation theory for the origin of peritoneal endometriosis. Am J Obstet Gynecol 1940; 40:549\u0026ndash;557.\u003c/p\u003e\n\u003cp\u003e17. Antonio Simone Lagana, Simone Garzon, Martin Gotte, Paola Vigano, Massimo Franchi, Fabio Ghezzi, Dan C Martin. The Pathogenesis of Endometriosis: Molecular and Cell Biology Insights. Int J Mol Sci. 2019; 20(22):5615.\u003c/p\u003e\n\u003cp\u003e18. Antonio Simone Lagana, Francesca Maria Salmeri, Helena Ban Frangez, Fabio Ghezzi , Eda Vrtačnik-Bokal, Roberta Granese. Gynecol Endocrinol. 2020; 36(5):441-444.\u003c/p\u003e\n\u003cp\u003e19. Antonio Simone Lagana, Salvatore Giovanni Vitale, Francesca Maria Salmeri, Onofrio Triolo, Helena Ban Frangez, Eda Vrtacnik-Bokal, et al. Unus pro omnibus, omnes pro uno: A novel, evidence-based, unifying theory for the pathogenesis of endometriosis. Med Hypotheses. 2017; 103:10-20.\u003c/p\u003e\n\u003cp\u003e20. Lee SW, Rhim CC, Kim JH, Lee SJ, Yoo SH, Kim SY, et al. Predictive Markers of Tubo-Ovarian Abscess in Pelvic Inflammatory Disease. Gynecol Obstet Invest. 2015.\u0026nbsp;doi: 10.1159/000381772\u003c/p\u003e\n\u003cp\u003e21. Demirtas O, Akman L, Demirtas GS, Hursitoglu BS, Yilmaz H. \u0026nbsp;The role of the serum inflammatory markers for predicting the tubo-ovarian abscess in acute pelvic inflammatory disease: a single-center 5-year experience. Arch Gynecol Obstet. 2013; 287(3):519-23.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e22. Guo SW, Ding D, Geng JG, Wang L, Liu X. P-selectin as a potential therapeutic target for endometriosis. Fertil Steril. 2015; 103(4):990-1000.e8.\u003c/p\u003e\n\u003cp\u003e23.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Jacobs I. Screening for ovarian cancer by CA-125 measurement. Lancet.1988; 1(8590): 889.\u003c/p\u003e\n\u003cp\u003e24. Zeimet AG, Offner FA, Muller-Holzner E, Widschwendter M, Abendstein B, Fuith LC, et al. Peritoneum and tissues of the female reproductive tract as physiological sources of CA-125. Tumour Biol. 1998;19(4):275\u0026ndash;82.\u003c/p\u003e\n\u003cp\u003e25.Levin G, Herzberg S, Dior UP, Shushan A, Gilad R, Benshushan A, et al. The predictive role of CA-125 in the management of tubo-ovarian abscess. A retrospective study. Eur J Obstet Gynecol Reprod Biol. 2019; 238:20-24.\u003c/p\u003e\n\u003cp\u003e26. Park ST, Lee SW, Kim MJ, Kang YM, Moon HM, Rhim CC. Clinical characteristics of genital chlamydia infection in pelvic inflammatory disease. BMC Womens Health. 2017;17(1):5.\u003c/p\u003e\n\u003cp\u003e27. Vichinsartvichai P. Bilateral tubo-ovarian abscesses presenting with huge pelvic mass after repeated intrauterine inseminations in a woman with severe endometriosis. J Obstet Gynaecol Res. 2018; 44(4):792-796.\u003c/p\u003e\n\u003cp\u003e28. Benaglia L, Somigliana E, Iemmello R, Elisabetta Colpi, Anna Elisa Nicolosi, Guido Ragni Endometrioma and oocyte retrieval-induced pelvic abscess: a clinical concern or an exceptional complication? Fertil Steril. 2008; 89(5):1263-6. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e29. C F Wei, S C Chen. Pelvic abscess after ultrasound-guided aspiration of endometrioma: a case report. Zhonghua Yi Xue Za Zhi (Taipei). 1998; 61(10):603-7.\u003c/p\u003e\n\u003cp\u003e30. Close Y. Matsunaga, K. Fukushima, M. Nozaki, Naoyuki Nakanami, Yoshiaki Kawano, Toshiyuki Shigematsu, et al. A case of pregnancy complicated by the development of a tubo-ovarian abscess following in vitro fertilization and embryo transfer. Am J Perinatol. 2003; 20(6):277-82.\u003c/p\u003e\n\u003cp\u003e31. S.L. Padilla. Ovarian abscess following puncture of an endometrioma during ultrasound-guided oocyte retrieval. Hum Reprod.1993; 8(8):1282-3.\u003c/p\u003e"},{"header":"Tables","content":"\u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eTable 1. The comparison of\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:#211D1E;'\u003edemographic factors\u003c/span\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;between women endometriosis and non-endometriosis who were hospitalized for TOA.\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border: none;width:425.0pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:20.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height: 150%;font-family:\"Times New Roman\",serif;color:black;'\u003echaracteristics\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:20.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height: 150%;font-family:\"Times New Roman\",serif;color:black;'\u003eEndometriosis\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;line-height:150%;font-family:SimSun;color:black;\"\u003e（\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003en=20\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;line-height:150%;font-family:SimSun;color:black;\"\u003e）\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:20.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height: 150%;font-family:\"Times New Roman\",serif;color:black;'\u003eNo endometriosis n=93\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:20.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;line-height: 150%;font-family:SimSun;color:black;\"\u003eP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eAge\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style=\"font-size:16px;line-height:150%;font-family:SimSun;color:black;\"\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style=\"font-size:16px;line-height:150%;font-family:SimSun;color:black;\"\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.036*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e20-39\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd 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style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e40-55\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e9/20 (45.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e66/93 (71.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd 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style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e14.23\u0026plusmn;1.63\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.847\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New 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style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.686\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eMarried\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e19/20 (95.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e91/93 (97.8%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.446\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eBMI\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e23.52\u0026plusmn;3.19\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e23.58\u0026plusmn;4.92\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.243\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eParity\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.021*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e9/20(45.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e18/93 (19.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style=\"font-size:16px;line-height:150%;font-family:SimSun;color:black;\"\u003e\u0026ge;\u003c/span\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e11(55.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e75/93 (80.6%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eInfertility\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e8/20 (40.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0/93 (0.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.000*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"margin:0in;text-align:left;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eData are presented as mean\u0026plusmn;SD, n (%). \u003cem\u003eBMI\u0026nbsp;\u003c/em\u003e\u003c/span\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:#333333;background:white;'\u003eBody Mass Index,\u003c/span\u003e\u003cem\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;TOA\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:#211D1E;'\u003etube ovarian abscess\u003c/span\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e.* P\u0026lt; 0.05.\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin:0in;text-align:left;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:#211D1E;'\u003eTable 2. Analysis risk factors of in TOA women with endometriosis and without endometriosis.\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border: none;width:425.0pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:20.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height: 150%;font-family:\"Times New Roman\",serif;color:black;'\u003echaracteristics\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:20.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height: 150%;font-family:\"Times New Roman\",serif;color:black;'\u003eEndometriosis\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;line-height:150%;font-family:SimSun;color:black;\"\u003e（\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003en=20\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;line-height:150%;font-family:SimSun;color:black;\"\u003e）\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:20.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height: 150%;font-family:\"Times New Roman\",serif;color:black;'\u003eNo endometriosis n=93\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:20.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;line-height: 150%;font-family:SimSun;color:black;\"\u003eP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:46.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eHistory of gynecological surgery\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:46.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e8/20 (40.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:46.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e33/93 (35.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:46.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.799\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eHistory of pelvic inflammaton\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e1/20 (5.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e20/93 (21.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.116\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eIVF\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e1/20 (5.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0/93 (0.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.177\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eIntrauterine ring\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e8/20 (40.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e44/93 (47.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.626\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"margin:0in;text-align:left;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eData are presented as n (%). \u003cem\u003eIVF\u003c/em\u003e in vitro fertilization,\u003cem\u003e\u0026nbsp;TOA\u003c/em\u003e tube ovarian abscess.\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eTable3. Analysis of clinical symptoms and biochemical results between TOA women with and without endometriosis.\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border: none;width:425.0pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:20.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003echaracteristics\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:20.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eEndometriosis\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;line-height:150%;font-family:SimSun;color:black;\"\u003e（\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;color:black;'\u003en=20\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;line-height:150%;font-family:SimSun;color:black;\"\u003e）\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:20.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eNo endometriosis (n=93)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:20.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eFever\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e7/20 (35.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e35/93 (37.6%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:#333333;'\u003eAbdominal\u0026nbsp;pain\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e12/20 (60.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e71/93 (76.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.164\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eRed blood cell count\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e3.77\u0026plusmn;0.52\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e3.93\u0026plusmn;0.61\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.404\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eHemoglobin concentration\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e111.67\u0026plusmn;16.53\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e110.74\u0026plusmn;19.01\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.373\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eWBC increased\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e9/20 (45.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e39/93 (41.9%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.808\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:#333333;'\u003eBlood\u0026nbsp;platelet increased\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e5/20 (25.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e43/93 (46.2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.026*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eFibrinogen \u0026nbsp;increased\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e9/20 (45.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e52/93 (58.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.324\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eNeutrophils increased\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e10/20 (50.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e48/93 (51.6%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e1.000\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eCRP increased\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e7/8 (87.5%)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e35/39 (89.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e1.000\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003ePCT increased\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e2/5 (40.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e4/11 (36.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e1.000\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eCA125 increased\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e10/14 (71.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e36/61 (59.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e0.546\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:37.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp; Bacteria culture \u0026nbsp;positive\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:37.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e3/8 (27.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:37.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e23/46 (50.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:37.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e0.200\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eBlood culture positive\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e2/6 (33.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e2/13 (15.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.557\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eSecretion culture positive\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0/3 (0.0%)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e5/11 (45.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.258\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"margin:0in;text-align:left;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eData are presented as mean\u0026plusmn;SD, n (%).\u0026nbsp;\u003c/span\u003e\u003cem\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eWBC\u003c/span\u003e\u003c/em\u003e\u003cspan style=\"font-weight:bold;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003ewhite blood cell count,\u003c/span\u003e\u003cspan style=\"font-weight:bold;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003cspan style='font-family:\"STIX-Italic\",serif;color:black;font-weight:normal;font-style:italic;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eCRP\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003cspan style='font-family:\"STIX-Regular\",serif;color:black;font-weight:normal;font-style:normal;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eC-reactive protein,\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003cspan style='font-family:\"STIX-Regular\",serif;color:black;font-weight:normal;font-style:normal;'\u003e\u003cem\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003ePCT\u003c/span\u003e\u003c/em\u003e\u003c/span\u003e\u003cspan style='font-family:\"STIX-Regular\",serif;color:black;font-weight:normal;font-style:normal;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:#333333;background:white;'\u003eprocalcitonin,\u003c/span\u003e\u003cem\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;TOA\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:#211D1E;'\u003etube ovarian abscess\u003c/span\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:#333333;background:white;'\u003e.\u003c/span\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;* P\u0026lt; 0.05\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin:0in;text-align:justify;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:#211D1E;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:#211D1E;'\u003eTable 4. Analysis\u003c/span\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003cspan style=\"color:#211D1E;\"\u003emanagement factors of TOA in women with endometriosis and without endometriosis.\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border: none;width:425.0pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height: 150%;font-family:\"Times New Roman\",serif;color:black;'\u003echaracteristics\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height: 150%;font-family:\"Times New Roman\",serif;color:black;'\u003eEndometriosis\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;line-height:150%;font-family:SimSun;color:black;\"\u003e（\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003en=20\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;line-height:150%;font-family:SimSun;color:black;\"\u003e）\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height: 150%;font-family:\"Times New Roman\",serif;color:black;'\u003eNo endometriosis (n=93)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height: 150%;font-family:\"Times New Roman\",serif;color:black;'\u003eP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eHospital stay\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e10.60\u0026plusmn;8.56\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e11.76\u0026plusmn;9.05\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.825\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eTotal treatment time\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e14.40\u0026plusmn;9.36\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e15.95\u0026plusmn;11.29\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.351\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eAntibioti treatment time\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e8.10\u0026plusmn;5.61\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e12.22\u0026plusmn;8.15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.140\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eAntibiotic replacement times\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.196\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:right;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e10/20 (50.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e30/93 (32.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style=\"font-size:16px;line-height:150%;font-family:SimSun;color:black;\"\u003e\u0026ge;\u003c/span\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e10/20 (50.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e63/93 (67.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.0pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eAbscess location\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e1.000\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003etube ovary abscess\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e12/20 (60.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e55/93 (59.1%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003etube abscess\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e8/20 (40.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e38/93 (40.9%)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eEmergency surgery\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e2/20 (10.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e12/93 (13.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.773\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eBlood loss\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:131.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e347\u0026plusmn;445.77\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:143.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e204.67\u0026plusmn;289.46\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:48.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e0.014*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:103.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.5pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New 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Roman\",serif;color:black;'\u003eTOA\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:#211D1E;'\u003etube ovarian abscess\u003c/span\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e.\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e* P\u0026lt; 0.05\u003c/span\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"EM, tube ovarian abscess, infertility, adverse complications","lastPublishedDoi":"10.21203/rs.3.rs-38751/v3","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-38751/v3","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: The aim of our present study was to investigate the clinical characteristics, treatment status and complications in women with endometriosis (EM) and tube ovarian abscess (TOA) to determine the possible association between TOA and EM.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Medical records were used to analyze the clinical characteristics, treatment and complications.\u003cstrong\u003e \u003c/strong\u003eTwenty women who were diagnosed with TOA with EM were compared with 93 women diagnosed as having TOA without EM between January, 2008 and December, 2018. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e In this study, TOA patients with EM were significantly more likely to have a lower age range (20–39years) than the non-EM group (11/20 (55.0%) vs 27/93 (29.0%)). In addition, TOA patients with EM were associated with a significantly lower rate of parity (11/20 (55.0%) vs 75/93 (80.6%),), higher rates of infertility (8/20(40%) vs 0/93(0%),) and a significantly lower incidence of elevated blood platelet counts (5/20 (25%) vs 43/93 (53.8%)). Furthermore, women with EM had greater blood loss (347±445.77 vs 204.67±289.46) and an increased complication rate (3/20(15%) vs 0/93(0%)). Among the 3 patients who had complications in the EM group, 2 patients had septic shock and 1 patient had intestinal obstruction. And 1 case who had septic shock followed by IVF treatment. There was no significance difference on other factors.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThe present study indicated that EM did not increase the difficulty and time of treatment in patients with TOA, but increased bleeding during surgery and serious complications. It is suggested that doctors should pay more attention to postoperative treatment and nursing in women with TOA and EM, especially those who have a history of recent infertility treatment and related procedures.\u003c/p\u003e","manuscriptTitle":"Clinical characteristics, treatment status and complications in women with tube ovarian abscess and endometriosis: a retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":3,"date":"2020-12-07 19:04:33","doi":"10.21203/rs.3.rs-38751/v3","editorialEvents":[{"type":"communityComments","content":0},{"type":"checksComplete","content":"","date":"2020-11-26T00:21:57+00:00","index":"","fulltext":""},{"type":"decision","content":"Accept","date":"2020-11-04T00:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":2,"date":"2020-09-23 11:15:41","doi":"10.21203/rs.3.rs-38751/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2020-11-02T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-10-29T00:00:00+00:00","index":1,"fulltext":"Recommendation: Accept without revision\nForm responses:\n---\n\nComments to Author:\n---\nIn the current study, authors aimed to investigate the clinical characteristics, treatment status and complications in women with endometriosis and tube ovarian abscess and to determine the possible association between two condition.\nThe authors addressed all comments adequately in the revised form of manuscript and the paper has been improved. I have no additional comments\n\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please publish my name with my report.**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2020-10-04T12:00:00+00:00","index":2,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-10-04T12:00:00+00:00","index":2,"fulltext":"Recommendation: Accept without revision\nForm responses:\n---\n\nComments to Author:\n---\nI carefully evaluated the revised version of this manuscript.\nAuthors have performed the required changes, improving significantly the quality of the paper.\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare that I have no competing interests.**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2020-10-02T12:00:00+00:00","index":1,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-09-23T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-09-21T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-09-20T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-09-20T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-07-21 15:49:16","doi":"10.21203/rs.3.rs-38751/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-08-19T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-08-18T12:00:00+00:00","index":2,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-08-18T12:00:00+00:00","index":2,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n\nComments to Author:\n---\nI read with great interest the manuscript, which falls within the aim of this Journal. In my honest opinion, the topic is interesting enough to attract the readers' attention. Nevertheless, authors should clarify some points and improve the discussion, as suggested below.\nAuthors should consider the following recommendations:\n- Manuscript should be further revised in order to correct some typos and improve style.\n- Accumulating evidence suggests that immune cells, adhesion molecules, extracellular matrix metalloproteinase and pro-inflammatory cytokines activate/alter peritoneal microenvironment, creating the conditions for differentiation, adhesion, proliferation and survival of ectopic endometrial cells. I would discuss these points in the light of new theories about the pathogenesis of endometriosis, referring to: PMID: 31717614; PMID: 31663401; PMID: 28571791.\n- Although peritoneal superficial lesions and ovarian endometriomas represent the majority of endometriotic implants within the pelvis, deep infiltrating endometriosis and extrapelvic endometriosis are the most challenging conditions to face off. Despite sometimes medical therapy is enough to reduce symptoms and signs (PMID: 28537213; PMID: 30074068), in a large number of patients a complete eradication, with nerve-sparing and vascular sparing approach (PMID: 27579309; PMID: 30415128) is needed to restore the normal pelvic anatomy and its functions. I would add few lines to discuss these points, referring to the abovementioned works.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"editorInvitedReview","content":"","date":"2020-08-12T12:00:00+00:00","index":1,"fulltext":"Recommendation: Reject\nForm responses:\n---\n\nComments to Author:\n---\nDear Authors,\nI read the article entitled 'Clinical characteristics, treatment status and complications in women with tube ovarian abscess and endometriosis: a retrospective study'.\nAbstract\n1. Please delete p value in Abstract.\n2. Please delete the sentence 'Statistical analysis was performed using 17 SPSS Version 20' in Abstract\n\nBackground\n1. Please ad some references for the sentence. 'Thus, the risk of TOA in endometriosis patients may be increased.'\n2. Please add some sentences about the risk of TOA in women with endometriosis.\nMethods\n1. Please correct the sentence 'In our study, patients with appendicular abscess, a combination 78 of malignant disease, pregnancy or puerperal period abscess, adenomyoma, 79 hydrosalpinx fluid age over 55 or under 20 years and abandoned treatment were 80 excluded.'\n2. Please add the inclusion criteria of women with endometriosis and controls. How the authors ruled out endometriosis in the controls?\n3. Please add the diagnostic criteria both of TOA and endometriosis.\n4. Please add the number of types of endometriosis (peritoneal, ovarian, or deep infiltrating?)\n5. Power analysis and sample size calculation must be done?\n6. Multivariate analysis must be done?\nResults\n1. Please create a flow chart?\n2. Please add the microbiological results of the cultures.\nDiscussion\n1. The discussion section is very complex. Please rewritten this section?\n\nYours sincerely,\n\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare that I have no competing interests'**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. 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