Monitoring of sprint and change of direction velocity, vertical jump height, and repeated sprint ability in sub-elite female football players throughout their menstrual cycle

AIMS

The aim of this study was to investigate the associations between the early follicular (EF, i.e., menstruation), late follicular (LF), and middle luteal (ML) phases of the menstrual cycle and different factors that may influence football performance.

METHODS

To this end, 11 eumenorrheic sub-elite female football players underwent field tests to assess sprint speed, lower extremity power, repeated sprint ability, velocity on change of direction, and technical skills at each cycle phase.

RESULTS

Performance during the 15-m change of direction ability test, 15-m ball dribbling test, squat jump height, total sprint time [sum of 7 sprints] and decrement score [(mean sprint time/best sprint time × 100) - 100], maximum and mean heart rate, and perceived exertion did not significantly differ among menstrual cycle phases. Conversely, the linear sprint velocity over 10, 20, 30-m distances was decreased in EF vs LF (10-, 20- and 30-m) and in ML vs LF (10- and 20-m) (p < 0.05). The 40-m sprint velocity did not change in the different menstrual cycle phases.

CONCLUSION

Overall, our study suggests that sex hormone fluctuations during the menstrual cycle are not associated with vertical jump, velocity on change of direction, and repeated sprint ability, but may influence linear sprint velocity over short distances (10, 20, and 30 m).

Effects of resistance exercises on inhibitory control and plasma epinephrine levels: A registered report of a crossover randomized controlled trial

According to the locus coeruleus-norepinephrine (LC-NE) theory, activity of the LC, the major releaser of NE in the brain, regulates inhibitory control. As there is reciprocal communication between circulating epinephrine and the LC, plasma epinephrine is used as the index of LC-NE activity. The aim of this crossover randomized controlled trial is to expand on previous findings by investigating the effects of free-weight, multiple-joint, and structural barbell resistance exercises. Previous studies have had some methodological limitations, such as failure to report the process of randomization, absence of resistance exercise familiarization before the maximal strength testing, and lack of protocol publication. To address these issues, this study incorporates resistance exercise familiarization, transparent reporting of randomization, and submission as a registered report. The results suggest that a single session of resistance exercise (barbell squat, press, and deadlift) with an intensity of 65%-78% 1RM for five repetitions (70%-90% relative intensity) and three sets with 3-min rest intervals improved Stroop congruent reaction time (RT) only (t(27) = -2.663, mean reduction = -15 ms, p = .013, 95% CI [-26, -3]). No significant enhancements were observed in Stroop incongruent RT, inhibitory control as indexed by Stroop effect, or inhibitory control as indexed by the RT difference between the Stroop task and the simple reaction task. Moreover, the alterations in plasma epinephrine levels did not significantly associate with changes in any measure of cognitive performance.

Reversible female contraceptives: historical, current, and future perspectives†

Contraception is a practice with extensive and complicated social and scientific histories. From cycle tracking, to the very first prescription contraceptive pill, to now having over-the-counter contraceptives on demand, family planning is an aspect of healthcare that has undergone and will continue to undergo several transformations through time. This review provides a comprehensive overview of current reversible hormonal and non-hormonal birth control methods as well as their mechanism of action, safety, and effectiveness specifically for individuals who can become pregnant. Additionally, we discuss the latest Food and Drug Administration (FDA)-approved hormonal method containing estetrol and drospirenone that has not yet been used worldwide as well as the first FDA-approved hormonal over-the-counter progestin-only pills. We also review available data on novel hormonal delivery through microchip, microneedle, and the latest FDA-approved non-hormonal methods such as vaginal pH regulators. Finally, this review will assist in advancing female contraceptive method development by underlining constructive directions for future pursuits. Information was gathered from the NCBI and Google Scholars databases using English and included publications from 1900 to present. Search terms included contraceptive names as well as efficacy, safety, and mechanism of action. In summary, we suggest that investigators consider the side effects and acceptability together with the efficacy of contraceptive candidate towards their development.

Premenstrual disorders and PMDD - a review

Defining, diagnosing and managing premenstrual disorders (PMDs) remains a challenge both for general practitioners and specialists. Yet these disorders are common and can have an enormous impact on women. PMDD (premenstrual dysphoric disorder), one severe form of PMD, has a functional impact similar to major depression yet remains under-recognised and poorly treated. The aim of this chapter is to give some clarity to this area, provide a framework for non-specialists to work towards, and to stress the importance of MDT care for severe PMDs, including PMDD.

Combined oral contraceptives: update recommendations of the Latin American contraceptive association

Background: In recent years, new combined oral contraceptives (COCs) have become available, representing an advance in terms of individualization and compliance by users.Objective: To provide recommendations regarding COCs: formulations, use, efficacy, benefits and safety.Method: For these recommendations, we have used the modified Delphi methodology and carried out a systematic review of studies found in the literature and reviews performed in humans, published in English and Spanish in Pubmed, Medline and advanced medicine and computer networks until the year 2021, using the combination of terms: 'oral contraceptives', 'estroprogestins' and 'combined oral contraceptives'.Results: Regarding the estrogen component, initially switching from mestranol (the pro-drug of ethinylestradiol) to ethinylestradiol (EE) and then reducing the EE dose helped reduce side effects and associated adverse events. Natural estradiol and estradiol valerate are already available and represent a valid alternative to EE. The use of more potent 19-nortestosterone-derived progestins, in order to lower the dose and then the appearance of non-androgenic progestins with different endocrine and metabolic characteristics, has made it possible to individualize the prescription of COC according to the profile of each woman.Conclusion: Advances in the provision of new COCs have improved the risk/benefit ratio by increasing benefits and reducing risks. Currently, the challenge is to tailor contraceptives to individual needs in terms of safety, efficacy, and protection of female reproductive health.

Epidemiological profile of COVID-19 in patients with prostate cancer undergoing androgen deprivation therapy at a Brazilian Cancer Center

Older individuals with cancer constitute a high-risk group for COVID-19. Entry of the virus into cells occurs through the binding of the S protein with angiotensin-converting enzyme 2, which is mediated by the TMPRSS2 gene and regulated by androgen receptors. Androgen deprivation therapy in patients with prostate cancer inhibits AR-TMPRSS2 interactions, which in turn inhibits the aggressiveness of the infection. We were unable to prove an association between the use of androgen deprivation therapy and a reduction in factors associated with worse clinical outcomes. Most of the data presented show a tendency to favor the outcomes of patients who do not undergo androgen deprivation therapy, which can be explained by the fact that, in general, their clinical conditions are better and their performance status scores are lower than those of patients who undergo androgen deprivation therapy. Abstract presented to the oncology department of A.C.Camargo Cancer Center as a conclusion of the Scientific Initiation.

OBJECTIVE

To describe the epidemiological aspects of COVID-19 in patients with prostate cancer who received androgen deprivation therapy and those who did not.

METHODS

We retrospectively analyzed the medical records of patients with prostate cancer undergoing androgen deprivation therapy and those who did not undergo androgen deprivation therapy. These patients were treated at the A.C.Camargo Cancer Center between March 2020 and March 2021.

RESULTS

Of the 78 patients with prostate cancer and positive RT-PCR test results, 50% were undergoing androgen deprivation therapy, and 49% were experiencing a non-metastatic biochemical relapse. Of these, 80.6% were symptomatic on the day of examination compared to 97.2% in the Control Group. A total of 82.1% of the patients receiving androgen deprivation therapy required hospitalization, with 30.8% admitted to the intensive care unit compared to 21.6% in the Control Group. There was no statistically significant difference in the use of a high-flow oxygen cannula, the need for orotracheal intubation and mechanical ventilation, the need for dialysis, multiple organ failure, or death. A significant difference was found between the groups in terms of the average length of stay in the intensive care unit.

CONCLUSION

Androgen deprivation therapy was not associated with protective factors or potential treatments in patients with prostate cancer and COVID-19. Although the number of patients analyzed was limited, and there may have been a selection bias, this is a unique study that cannot be expanded or replicated in similar (unvaccinated) populations.

Potential biomarkers to predict return to fertility after discontinuation of female contraceptives-looking to the future

Nowadays there are multiple types of contraceptive methods, from reversible to permanent, for those choosing to delay pregnancy. Misconceptions about contraception and infertility are a key factor for discontinuation or the uptake of family planning methods. Regaining fertility (the ability to conceive) after contraceptive discontinuation is therefore pivotal. Technical studies to date have evaluated return to fertility by assessing pregnancy as an outcome, with variable results, or return to ovulation as a surrogate measure by assessing hormone levels (such as progesterone, LH, FSH) with or without transvaginal ultrasound. In general, relying on time to pregnancy as an indicator of return to fertility following contraceptive method discontinuation can be problematic due to variable factors independent of contraceptive effects on fertility, hormone clearance, and fertility recovery. Since the ability to conceive after contraceptive method discontinuation is a critical factor influencing product uptake, it is important to have robust biomarkers that easily and accurately predict the timing of fertility return following contraception and isolate that recovery from extrinsic and circumstantial factors. The main aim of this review is to summarize the current approaches, existing knowledge, and gaps in methods of evaluating return-to-fertility as well as to provide insights into the potential of new biomarkers to more accurately predict fertility restoration after contraceptive discontinuation. Biomarker candidates proposed in this document include those associated with folliculogenesis, cumulus cell expansion, follicular rupture and ovulation, and endometrial transport and receptivity which have been selected and scored on predefined criteria meant to evaluate their probable viability for advancement. The review also describes limitations, regulatory requirements, and a potential path to clinically testing these selected biomarkers. It is important to understand fertility restoration after contraceptive method discontinuation to provide users and health providers with accurate evidence-based information. Predictive biomarkers, if easy and low-cost, have the potential to enable robust evaluation of RTF, and provide potential users the information they desire when selecting a contraceptive method. This could lead to expanded uptake and continuation of modern contraception and inform the development of new contraceptive methods to widen user's family planning choices.

Progress in Research on Key Factors Regulating Lactation Initiation in the Mammary Glands of Dairy Cows

Lactation initiation refers to a functional change in the mammary organ from a non-lactating state to a lactating state, and a series of cytological changes in the mammary epithelium from a non-secreting state to a secreting state. Like the development of the mammary gland, it is regulated by many factors (including hormones, cytokines, signaling molecules, and proteases). In most non-pregnant animals, a certain degree of lactation also occurs after exposure to specific stimuli, promoting the development of their mammary glands. These specific stimuli can be divided into two categories: before and after parturition. The former inhibits lactation and decreases activity, and the latter promotes lactation and increases activity. Here we present a review of recent progress in research on the key factors of lactation initiation to provide a powerful rationale for the study of the lactation initiation process and mammary gland development.

Associations of Hormonal and Metabolic Parameters with Bone Mineralization in Young Adult Females

Osteoporosis is characterized by impaired bone mineralization and microarchitecture. An important protective factor is a high peak bone mass (PBM), attained in the second and third decade of life. The aim of the study was to evaluate the effect of hormonal and metabolic parameters on bone mineralization in young adult female patients. A total of 111 participants qualified for the study. Bone mineral density of the lumbar spine (L1-L4) and whole skeleton was measured using dual-energy X-ray absorptiometry (DXA). Hormonal parameters were determined: the concentrations of androstendione, dihydroepiandrosterone sulphate, testosterone, sex hormone binding protein, 17-OH-progesterone, folliculotropic hormone, estradiol, thyrotropic hormone, free thyroxine and cortisol. Metabolic parameters were also examined. The study showed a statistically significant correlation between bone mineral density and estradiol concentration and a negative relationship between cortisol concentration and the bone mineral density (BMD) Z-score of the lumbar spine. Sclerostin measurements taken during this study were not related to bone mineral density. It has been shown that the concentration of the hormones tested, even within the reference range, may affect bone mineralization. We suggest observing the follow-up of the menstrual cycles, as well as analyzing the results of test patients in an annual examination system. However, each clinical case should be considered individually. The sclerostin test is currently not useful in the clinical evaluation of bone mineralization in young adult women.

Effects of the Combined Contraceptive Vaginal Ring on Female Sexual Function: A Systematic Review and Meta-analysis

There are controversial debates regarding the effects of contraceptive vaginal ring devices on females' sexual function. Therefore, the meta-analysis of before-after was conducted on the intervention studies published in the past years to clarify these contradictions. The existing literature on the subject was reviewed by searching through such databases as PubMed, Scopus, ISI Web of Sciences, Embase, Cochrane Library and Google Scholar up to July 2021. Before-after intervention studies that had examined the effect of vaginal rings on females' sexual function were collected as well. In total, five studies with 369 participants were included in quantitative syntheses. Pooled results from the random-effect model showed that NuvaRing had a positive effect on females' sexual function three months after insertion (WMD: 2.48; 95% CI: 0.30, 4.67; P = 0.026); however, this effect was not significant after 6 months (WMD: 4.38; 95% CI: -4.95, 13.72; P = 0.357). Meta-regression analysis suggested that the effect of this device is associated with users' age and body mass index 3 months after insertion. No publication bias was found by Egger's test or funnel plots. Overall, the results of this meta-analysis support the view that vaginal ring use is associated with a positive effect on the sexual function of women 3 months after insertion, while the effect of this device on the sexual function of women was insignificant after 6 months. However, given the dearth of available data, it is not possible to reach a definite conclusion on the effect of vaginal rings on females' sexual function.

Cell non-autonomous regulation of cerebrovascular aging processes by the somatotropic axis

Age-related cerebrovascular pathologies, ranging from cerebromicrovascular functional and structural alterations to large vessel atherosclerosis, promote the genesis of vascular cognitive impairment and dementia (VCID) and exacerbate Alzheimer's disease. Recent advances in geroscience, including results from studies on heterochronic parabiosis models, reinforce the hypothesis that cell non-autonomous mechanisms play a key role in regulating cerebrovascular aging processes. Growth hormone (GH) and insulin-like growth factor 1 (IGF-1) exert multifaceted vasoprotective effects and production of both hormones is significantly reduced in aging. This brief overview focuses on the role of age-related GH/IGF-1 deficiency in the development of cerebrovascular pathologies and VCID. It explores the mechanistic links among alterations in the somatotropic axis, specific macrovascular and microvascular pathologies (including capillary rarefaction, microhemorrhages, impaired endothelial regulation of cerebral blood flow, disruption of the blood brain barrier, decreased neurovascular coupling, and atherogenesis) and cognitive impairment. Improved understanding of cell non-autonomous mechanisms of vascular aging is crucial to identify targets for intervention to promote cerebrovascular and brain health in older adults.

Depigmenting topical therapy based on a synergistic combination of compounds targeting the key pathways involved in melasma pathophysiology

Melasma has a complex pathophysiology with different cell types and signalling pathways involved. Paracrine factors secreted by keratinocytes, fibroblasts and endothelial cells act on melanocytes and stimulate melanogenesis. These paracrine factors are involved in the oxidative stress, inflammatory, vascular and hormonal pathways, among others. Damage of the dermoepidermal barrier also occurs and facilitates melanin deposition in the dermis, also known as dermal or mixed melasma. We used artificial intelligence tools to define the best combination of compounds for skin pigmentation inhibition. Mathematical models suggested the combination of retinol, diosmin and ferulic acid to be the most effective one. In vitro cellular tyrosinase activity assay proved that this combination had a synergistic depigmenting effect. Further assays proved that the combination could inhibit key pathways involved in melasma by downregulating ET-1 and COX-2 gene expression and IBMX-induced dendricity in human melanocytes, and upregulated the gene expression of IL-1b, TIMP3 and several endogenous antioxidant enzymes. The combination also reduced melanin levels in a phototype VI 3D epidermis model. These results indicate that the combination of retinol, diosmin and ferulic acid is an effective synergistic complex for the treatment of melasma by regulating the key molecular pathways involved in skin hyperpigmentation pathophysiology.

Therapeutics of Alzheimer's Disease: Recent Developments

With increasing aging, dementia is a growing public health concern globally. Patients with dementia have multiple psychological and behavioral changes, including depression, anxiety, inappropriate behavior, paranoia, agitation, and hallucinations. The major types of dementia are Alzheimer's disease (AD), vascular dementia (VCID), Lewy body dementia (LBD), frontotemporal dementia (FTD), and mixed dementia (MiAD). Among these, AD is the most common form of dementia in the elderly population. In the last three decades, tremendous progress has been made in understanding AD's biology and disease progression, particularly its molecular basis, biomarker development, and drug discovery. Multiple cellular changes have been implicated in the progression of AD, including amyloid beta, phosphorylated tau, synaptic damage, mitochondrial dysfunction, deregulated microRNAs, inflammatory changes, hormonal deregulation, and others; based on these changes, therapeutic strategies have been developed, which are currently being tested in animal models and human clinical trials. The purpose of our article is to highlight recent therapeutic strategies' developments, critically discuss current strategies' failures, and propose new strategies to combat this devasting mental illness.

Persistent Testosterone Suppression After Cessation of Androgen Deprivation Therapy for Prostate Cancer

Introduction Many men receiving temporary androgen deprivation therapy (ADT) for localized prostate cancer fail to achieve baseline testosterone levels after cessation. Testosterone recovery in men with localized prostate cancer receiving temporary ADT was assessed. Methods A global federated health research network (TriNetX) was used to identify men diagnosed with prostate cancer undergoing temporary ADT. Two cohorts were identified: men receiving luteinizing hormone-releasing hormone (LHRH) antagonists or LHRH agonists, and men receiving combined ADT (LHRH agonist and antiandrogens). Further stratification was based on a treatment duration of six months (short-term) or 18 months (long-term) to compare testosterone (T) recovery profiles five years after ADT cessation. Results A total of 28,583 men received LHRH agonist or antagonist therapy alone, and 20,188 men received combination ADT. A total of 46.7% of men who received short-term LHRH agonists or antagonists and 40.6% of men who received short-term combined ADT, recovered to mean baseline T levels at five years. Only men who received short-term LHRH agonists/antagonists recovered to eugonadal levels at the five-year follow-up. Around 50% of men who received long-term LHRH agonist/antagonist therapy and 10.7% of men who received combined ADT, recovered to mean baseline T levels at five years. However, neither group recovered to eugonadal T levels. Conclusions At the five-year follow-up after ADT cessation, most patients failed to recover to their mean baseline and eugonadal T levels. Given that testosterone deficiency is associated with metabolically adverse changes in body composition, increased insulin resistance, impaired bone health, and hypogonadal symptoms, serum T levels must be closely monitored in men receiving ADT following treatment cessation.

Borderline indications for ovarian suppression: addressing uncertainties with patients

Ovarian function suppression (OFS) is a potentially life-saving treatment for young women diagnosed with high-risk hormonal-receptor (HR)+ early breast cancer (EBC), albeit one associated with significant side effects that may adversely affect quality of life. Of particular concern, this article raises a few borderline indications that were largely unaddressed in pivotal clinical trials but are still commonly encountered in daily practice. These, referred to here as 'borderline indications of OFS' remain a source of uncertainty for patients and physicians and are concisely addressed in this article.

A Comparative Clinical and Laboratory Study of Adolescent and Adult Acne in Iraqi Women

Background Acne vulgaris is a common chronic inflammatory disease of the pilosebaceous units associated with long-term sequelae and complications. Currently, acne in women is classified into adolescent and post-adolescent forms. However, comparative studies evaluating the clinical and laboratory parameters across various age groups in women with acne are lacking. The aim of the study is to compare the clinical and laboratory characteristics of different groups of women with acne vulgaris. Patients and methods Over 3 years (2018-2021), a cross-sectional study was carried out on 340 women with acne consulting the Dermatology and Venereology Outpatient Clinic, Basrah Teaching Hospital, Basrah, Iraq. Eligible patients were carefully evaluated and fully examined, emphasizing on signs of hyperandrogenism and scoring of acne severity. Hormonal assays of serum total testosterone (TST), dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicular stimulating hormone (FSH), and serum prolactin (PRL) were done. Pelvic ultrasonography was performed to identify any pelvic pathology. The patients were classified according to their age of onset. Clinical and laboratory data were compared among groups. Results Three groups were recognized: 160 patients (47%) with adolescent acne (AA) (mean age SD: 17.2±1.6 years), 80 (23.5%) with early adult-onset acne (EA) (mean age SD: 21.4±1.2 years), and 100 (29.4%) with post-adolescent acne (PA) (mean age SD: 28.7±2.9 years), which were further sub-grouped into late-onset acne (40 cases, 11.7%), and persistent acne (60 cases, 17.6%). The mean body mass index was normal in the AA group and overweight in the EA and PA groups. Moderate obesity was more frequent in PA (24%, p=0.03). While 78.5% of AA was mild to moderate acne, 77.5% of EA was moderate to moderately severe, and 72% of PA was moderately severe to severe. Clinical and biochemical markers of hyperandrogenism were seen in all groups, however, they were more frequent in PA and EA groups than in the AA group (p<005). Conclusion Clinical and biochemical hyperandrogenism were present in a significant proportion of women with acne; their prevalence was higher in post-adolescent acne than in adolescent acne. Acne that began between the ages of 20 and 25 was classified as "early adult-onset acne," and showed variable features of hyperandrogenism. A complete evaluation, regardless of age, for every female with acne, including a hormonal analysis and pelvic ultrasound examination to detect hormonal imbalances as early therapy, can help to prevent and reduce the risk of consequences.

An Observational Study of Clinical, Metabolic and Hormonal Profile of Pediatric Acne

Objectives

To study the biochemical, metabolic and hormonal profile among children presenting with acne and to determine the correlation of these parameters with acne grading.

Methods

The observational cross-sectional study was conducted for a duration of 18 months on a total of 50 children between 1 and 12 years of age with clinical features of acne. The detailed information regarding the type of acne, biochemical profile (lipid profile, blood sugar levels), hormonal profile and associated illnesses were recorded. Spearman's rank correlation coefficient was used to find out the correlation of acne grading with hormonal and metabolic changes.

Results

The mean age of the children was 11.4 years. Among the various lesions, comedones were seen in 98% cases, papules in 94.00% cases, a scar in 14.00% and pustule in 4.00% cases. As compared to children of age 1-7 years, those in age group 8-12 years had significantly more comedones (48 vs 1, P = 0.04), significantly fewer pustules (0.00% vs 100.00%, P = 0.001), and a comparable number of papules and scars. Most of the children (88.00%) had acne vulgaris grade 1. There was a significant negative correlation of Blood sugar-fasting (r = -0.312, P = 0.0275) and a significant positive correlation of HDL (r = 0.28, P = 0.0491) with acne grading.

Conclusion

Comedones and papules are the commonest and the earliest forms of pediatric acne. Severe forms of acne are rarely seen below 12 years, age group. Preadolescent acne is commoner than mid-childhood acne, with no difference between male and females. Blood sugar levels and lipid profile derangements have a weak correlation with acne grading.

Insulin Resistance in Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) is one of the readily recognised endocrine gland illnesses in women, with an incidence range from 2.2% to 26% in India. Patients experiencing PCOS experience issues involving irregular menstrual periods, hirsutism, acne, being overweight, and impotence. Long-term, low-grade inflammation has emerged as a crucial factor leading to PCOS. A rise in glucose levels may stimulate oxidative stress and a troubling reaction from mononuclear cells (MNC) of females with PCOS, which normally do not rely on fat. This is required because MNC-derived macrophages are the major source of cytokine synthesis in big adipose tissue and similarly encourage adipocyte cytokine production. In summary, data reveal the substantial risks of insulin resistance in obese people who are suffering from PCOS. The findings of this specific lesson indicated that individuals with the conventional PCOS phenotype had obesity and higher insulin levels and insulin resistance, neglecting the absence of BMI differences from other phenotypes. These data show that insulin resistance is the most significant pathophysiological trait in people with PCOS.

Subcategories of Fibromyalgia: A New Concept

Fibromyalgia has previously been categorized as primary, secondary, and juvenile fibromyalgia. However, these definitions do not adequately explain the etiopathology of disease, nor do they help direct new specific therapies. Herein, we review the previously known categorizations of fibromyalgia. Based on common patient characteristics and previously studied pathophysiologies, we propose new subcategorizations of fibromyalgia that we have self-narrated, including hormonal fibromyalgia, neuroendocrine fibromyalgia, psychologic fibromyalgia, inflammatory fibromyalgia, and lastly, neuropathic fibromyalgia. Future research needs to be done to verify, add to, and fully describe these self-narrated categories of fibromyalgia that we have proposed.

The clinical relevance of unfolded protein response signaling in breast cancer

Protein homeostasis regulated by the Endoplasmic Reticulum (ER) is a recognized process involved in cancer progression. ER stress activates the Unfolded Protein Response (UPR) and has been implicated in a variety of cancers. Given the role of the UPR activation in carcinogenesis, we hypothesized that UPR activation could be associated with pathological progression, higher clinical stage, and worse survival in breast cancer. A total of 4,416 breast cancer patients from multiple independent cohorts were analyzed. We defined the UPR pathway score by the degree of enrichment by Gene Set Variant Analysis and median was used to divide high vs. low score groups in each cohort. High UPR breast cancer significantly enriched not only cell proliferation-related but also other pro-cancerous gene sets consistently in both METABIC and GSE96058 cohort. Majority of UPR pathway score high cells in the bulk tumor were tumor cells compared to other cells, including stromal, T-, B-, and myeloid-cells (P<0.001). UPR score was significantly associated with advanced stage, high grade, and triple negative breast cancer (TNBC) (all P<0.001). High UPR breast cancer was associated with worse patient survival in both cohorts (all P<0.001). Among breast cancer subtype, ER-positive/HER2-negative breast cancer with high UPR was significantly associated with worse survival, but neither HER-positive nor TNBC. High UPR ER-positive/HER2-negative breast cancer was infiltrated with high level of Th1 and Th2 cells, M1 macrophage, and plasma cells. On the other hand, they were significantly infiltrated with high level of several types of stromal cells in tumor microenvironment (all P<0.001). Finally, high UPR metastatic breast cancer was also associated with worse patient survival (P=0.041). UPR signaling is associated with cancer aggressiveness, and worse survival, especially ER-positive/HER2-negative breast cancer subtype.

Effectiveness, safety and overall satisfaction of early postpartum placement of hormonal IUD compared with standard procedure: An open-label, randomized, multicenter study

INTRODUCTION

In this open-label, randomized controlled, non-inferiority, multicenter study we aimed to study the risk of termination of pregnancy within 1 year postpartum, the safety profile and patient acceptability after early postpartum insertion of a hormonal intrauterine device (LNG-IUS, Mirena®) compared with standard placement 6-8 weeks postpartum.

MATERIAL AND METHODS

April 2018 to January 2020 women with uncomplicated vaginal delivery at four urban birth centers in Sweden, were randomized to either early placement within 48 h after delivery (early group) or standard placement 6-8 weeks postpartum (standard group) of a hormonal intrauterine device. The main outcome measure was the proportion of terminations of pregnancies in each group during the first year after placement of the intrauterine device. Registration EudraCT database no. 2017-001945-29.

RESULTS

The study was prematurely stopped according to the protocol due to an expulsion rate >20% in the early group. No pregnancies occurred. Fifty-two women were randomized to early and 49 women to standard insertion. In the early group, 23/52 (44.2%) of the intrauterine devices were expelled. After expulsion, 10 women chose to have another hormonal intrauterine device placed but still significantly fewer women (39/52, 75%, p = 0.22) in the early group used the hormonal intrauterine device method at study completion. No expulsions occurred in the standard group, but 5/49 (10.2%) requested removal and 41/49 (83.7%, p = 0.22) had used the hormonal intrauterine device method continuously for 1 year.

CONCLUSIONS

Early hormonal intrauterine device insertion after vaginal delivery is associated with high expulsion rates. Despite this, a high continuation rate of the hormonal intrauterine device method is seen among women once choosing the method. In the light of high continuation rates, the advantages of early insertion could balance the risk of expulsion for well-informed women.

Fertility of Cryptorchid Testis-An Unsolved Mistery

Cryptorchidism (undescended testis) is one of the most common diagnoses in the pediatric urologist office. Even in the modern era, there still are a lot of debates regarding the optimal time for surgery related to the expected results in relation with the testicular function, including fertility. The review below intends to clarify issues regarding the impact of cryptorchidism on testicular histology and function, semen analysis, the relation between hormonal and surgical treatment, future fertility, and paternity rate.

Ectopic Pregnancy in a Levonogestrel-Releasing Intrauterine Device User: A Case Report

Levonorgestrel-releasing intrauterine devices are considered to be a reliable contraceptive option with a low failure rate. The risk of ectopic pregnancy, however, if an unintended pregnancy occurs is significantly higher.

In this study, we present a case of a tubal ectopic pregnancy in a woman with a levonorgestrel-releasing intrauterine device in situ for one year. Our case emphasises the importance of having a high index of suspicion in women who have an intrauterine device in situ, presenting with a positive pregnancy test. We also discuss the importance of timely ultrasound examination and the management considerations of similar cases. The importance of urgent review and investigation of women with positive pregnancy test and intrauterine contraceptive device in situ, given the higher possibility of ectopic pregnancy, is highlighted by this case.

Vitamin D improves levels of hormonal, oxidative stress and inflammatory parameters in polycystic ovary syndrome: a meta-analysis study

BACKGROUND

Hyperandrogenism (HA), inflammation, and oxidative damage play key roles in the pathophysiology of polycystic ovary syndrome (PCOS). Whether vitamin D adjuvant therapy improves hormonal, inflammation, and oxidative damage in PCOS patients has aroused widespread interest, but the results are controversial. To evaluate the effect of vitamin D supplementation on hormonal, oxidative stress, and inflammatory parameters in patients with PCOS.

METHODS

A literature search was conducted in Medline, the Cochrane Library, EMBASE, and Web of Science for studies related to PCOS and vitamin D supplementation. All reports of randomized controlled trials (RCTs) published before December 2019 were identified. The fixed-effects model or random-effects model was used to calculate pooled estimates of standardized differences in means (SMD) with 95% confidence intervals (CI).

RESULTS

A total of 956 identified studies were retrieved, and eighteen RCTs involving 1,060 participants were ultimately included in the current meta-analysis. The pooled results demonstrated that vitamin D supplementation in patients with PCOS resulted in a significant improvement in serum total testosterone (TT), high sensitivity C-reactive protein (hs-CRP), total antioxidant capacity (TAC), and malondialdehyde (MDA). No significant effect on free testosterone (FT), dehydroepiandrosterone sulfate (DHEA-S), sex hormone-binding globulin (SHBG), free androgen index (FAI), nitric oxide (NO), and total glutathione (GSH) levels was found. Subgroup analysis showed that vitamin D supplementation reduced hs-CRP and MDA irrespective of the treatment course, type of vitamin D intervention, supplementation frequency, and dosage. Twelve weeks of vitamin D supplementation improved TT and TAC while low-dose vitamin D supplementation (≤1,000 IU/day) improved TT and DHEA-S. Vitamin D co-supplementation reduced TT, FT, and DHEA-S, while a daily supplementation regime improved TT, DHEA-S, and TAC in patients with PCOS.

CONCLUSIONS

The current meta-analysis demonstrates that vitamin D supplementation in patients with PCOS resulted in an improvement in the levels of TT, hs-CRP, TAC, and MDA, but did not affect FT, DHEA-S, SHBG, FAI, NO, and GSH levels. Vitamin D co-supplementation, low-dose vitamin D supplementation (≤1,000 IU/day), and daily supplementation frequency appeared to be more conducive to improving hormones, inflammation, and oxidative stress in PCOS patients.

Awareness of the Causes Leading to Surgical Ablation of Ovarian Function in Premenopausal Breast Cancer-A Single-Center Analysis

Background and Objectives: Ovarian surgical ablation (OSA) in estrogen receptor-positive (ER+) breast cancer is usually performed to halt ovarian function in premenopausal patients. Since alternative pharmacological therapy exists and few studies have investigated why surgery is still performed, we aimed to analyze the reasons for the use of OSA despite the remaining controversy. Materials and Methods: Premenopausal ER+ breast cancer patients treated at a tertiary center (2005–2011) were selected, and patients with germline mutations were excluded. Results: Seventy-nine patients met the inclusion criteria. Globally, the main reasons for OSA included: continued menstruation despite hormone therapy with or without ovarian medical ablation (OMA) (34.2%), patient informed choice (31.6%), disease progression (16.5%), gynecological disease requiring surgery (13.9%), and tamoxifen intolerance/contraindication (3.8%). In women aged ≥45 years, patient choice was significantly more frequently the reason for OSA (47.4% versus 17.1% (p = 0.004)). For those aged <45 years, salvation attempts were significantly more frequent as compared to older women (26.8% versus 5.3% (p = 0.01)). In 77.8% of women undergoing OSA with menstrual cycle maintenance, surgery was performed 1–5 years after diagnosis, while surgery was performed earlier (0–3 months after diagnosis) in patients undergoing OSA as an informed choice (56.0%), as a salvation attempt (53.8%), or due to gynecological disease (63.6%). The leading reason for OSA in women previously undergoing OMA was continued menstruation (60.0%). Conclusions: This study suggests a possible failure of pharmacological ovarian suppression and reinforces the need for shared decision-making with patients when discussing treatment strategies, although validation by further studies is warranted due to our limited sample size.

Peripartum complications associated with obsessive compulsive disorder exacerbation during pregnancy

Prior research has shown that onset or exacerbation of OCD is associated with menstruation, pregnancy, and the post-partum period. However, the underlying cause is unclear. The goal of this study was to assess whether pregnancy and birth complications were associated with OCD symptoms exacerbation, among women with established OCD. Two-hundred and five (n=205) women with OCD retrospectively reported information on their physical and mental health during their first pregnancy. Over a third of the sample (34%) reported an exacerbation in their OCD symptoms. History of pregnancy and birth complications in the first pregnancy were similar between women who did and did not experience symptom exacerbation, with the exception of gestational diabetes, which was significantly more common among women who experienced exacerbation (7% vs 1%, p=0.03). In a multivariable logistic regression model, gestational diabetes remained significantly associated with exacerbation of OCD symptoms (OR=8.44 [95% CI 1.37-77.27]; p=0.03), even after adjusting for maternal age, OCD severity and treatment, premenstrual OCD symptom increase, stress during pregnancy, and major depression or anxiety disorder diagnosis during pregnancy. We discuss potential explanations for this link. These findings should be treated as hypothesis-generating and need to be replicated in a larger, prospective study.

Predicted sensitivity to endocrine therapy for stage II-III hormone receptor-positive and HER2-negative (HR+/HER2-) breast cancer before chemo-endocrine therapy

BACKGROUND

We proposed that a test for sensitivity to the adjuvant endocrine therapy component of treatment for patients with stage II-III breast cancer (SET2,3) should measure transcription related to estrogen and progesterone receptors (SET_ER/PR index) adjusted for a baseline prognostic index (BPI) combining clinical tumor and nodal stage with molecular subtype by RNA4 (ESR1, PGR, ERBB2, and AURKA).

PATIENTS AND METHODS

Patients with clinically high-risk, hormone receptor-positive (HR+), human epidermal growth factor receptor 2 (HER2)-negative (HR+/HER2-) breast cancer received neoadjuvant taxane-anthracycline chemotherapy, surgery with measurement of residual cancer burden (RCB), and then adjuvant endocrine therapy. SET2,3 was measured from pre-treatment tumor biopsies, evaluated first in an MD Anderson Cancer Center (MDACC) cohort (n = 307, 11 years' follow-up, U133A microarrays), cut point was determined, and then independent, blinded evaluation was carried out in the I-SPY2 trial (n = 268, high-risk MammaPrint result, 3.8 years' follow-up, Agilent-44K microarrays, NCI Clinical Trials ID: NCT01042379). Primary outcome measure was distant relapse-free survival. Multivariate Cox regression models tested prognostic independence of SET2,3 relative to RCB and other molecular prognostic signatures, and whether other prognostic signatures could substitute for SET_ER/PR or RNA4 components of SET2,3.

RESULTS

SET2,3 added independent prognostic information to RCB in the MDACC cohort: SET2,3 [hazard ratio (HR) 0.23, P = 0.004] and RCB (HR 1.77, P < 0.001); and the I-SPY2 trial: SET2,3 (HR 0.27, P = 0.031) and RCB (HR 1.68, P = 0.008). SET2,3 provided similar prognostic information irrespective of whether RCB-II or RCB-III after chemotherapy, and in both luminal subtypes. Conversely, RCB was most strongly prognostic in cancers with low SET2,3 status (MDACC P < 0.001, I-SPY2 P < 0.001). Other molecular signatures were not independently prognostic; they could effectively substitute for RNA4 subtype within the BPI component of SET2,3, but they could not effectively substitute for SET_ER/PR index.

CONCLUSIONS

SET2,3 added independent prognostic information to chemotherapy response (RCB) and baseline prognostic score or subtype. Approximately 40% of patients with clinically high-risk HR+/HER2- disease had high SET2,3 and could be considered for clinical trials of neoadjuvant endocrine-based treatment.

The neuromuscular, physiological, endocrine and perceptual responses to different training session orders in international female netball players

AbstractThe 20 h responses of International female netball players to training days requiring two sessions (netball and strength, separated by two hours) ordered alternatively were examined. Eleven players completed strength followed by netball training two hours later (STR-NET), with the order reversed (NET-STR) on a separate day. Well-being, neuromuscular performance (jump height [JH], peak power output [PPO], peak velocity [PV]) and endocrine function (testosterone, cortisol concentrations) were measured before sessions one (PreS1) and two (PreS2), immediately after sessions one (IPS1) and two (IPS2), and 20 h post session one (20P). Session and differential ratings of perceived exertion (upper-body, cognitive/technical [RPE-T], lower-body, breathlessness) were collected, and accelerometry and heart rate measured netball load. Identification of clear between-order differences was based on the nonoverlap of the 95% confidence interval (95%CI) for mean differences relative to baseline. Compared to PreS1, greater increases in JH (percentage difference between trials; 95%CI: 9%; 4-14%), PPO (5%; 2-8%), PV (3%; 1-5%) and cortisol concentration (45%; 1-88%), and a greater decrease for testosterone/cortisol ratio (-35%; -72 to -2%) occurred at PreS2 in NET-STR. At 20P, greater decreases in JH (10%; 5-15%), PPO (4%; 1-8%) and PV (4%; 2-6%) were observed following STR-NET. No differences existed for well-being, whilst RPE-T was greater (15 AU; 3-26 AU) for strength training during NET-STR. Session order influenced neuromuscular and endocrine responses in International female netball players, highlighting session ordering as a key consideration when planning training.

High Expression of NRF2 Is Associated with Increased Tumor-Infiltrating Lymphocytes and Cancer Immunity in ER-Positive/HER2-Negative Breast Cancer

Simple Summary

The clinical relevance of Nuclear factor erythroid 2-Related Factor 2 (NRF2) in human breast cancer remains unclear. A total of 5443 breast cancer patients with transcriptomic profile were analyzed for the clinical relevance of NRF2 expression, including cancer aggressiveness, immune cell infiltration, patient survival, and drug response. We found that tumors with high NRF2 expression were associated with better survival in ER-positive/HER2-negative breast cancer. NRF2 expression was equivalent in immune, stromal, and cancer cells in tumor microenvironment. We found that high NRF2 expression was associated with enhanced tumor-infiltrating lymphocytes in ER-positive/HER2-negative breast cancer. NRF2 expression significantly correlated with drug sensitivity in multiple ER-positive breast cancer cell lines, but not associated with pathological complete response after neoadjuvant chemotherapy in breast cancer patients regardless of subtypes.

Abstract

Nuclear factor erythroid 2-related factor 2 (NRF2) is a key modifier in breast cancer. It is unclear whether NRF2 suppresses or promotes breast cancer progression. We studied the clinical relevance of NRF2 expression by conducting in silico analyses in 5443 breast cancer patients from several large patient cohorts (METABRIC, GSE96058, GSE25066, GSE20194, and GSE75688). NRF2 expression was significantly associated with better survival, low Nottingham pathological grade, and ER-positive/HER2-negative and triple negative breast cancer (TNBC). High NRF2 ER-positive/HER2-negative breast cancer enriched inflammation- and immune-related gene sets by GSEA. NRF2 expression was elevated in immune, stromal, and cancer cells. High NRF2 tumors were associated with high infiltration of immune cells (CD8⁺, CD4⁺, and dendritic cells (DC)) and stromal cells (adipocyte, fibroblasts, and keratinocytes), and with low fraction of Th1 cells. NRF2 expression significantly correlated with area under the curve (AUC) of several drug response in multiple ER-positive breast cancer cell lines, however, there was no significant association between NRF2 and pathologic complete response (pCR) rate after neoadjuvant chemotherapy in human samples. Finally, high NRF2 breast cancer was associated with high expression of immune checkpoint molecules. In conclusion, NRF2 expression was associated with enhanced tumor-infiltrating lymphocytes in ER-positive/HER2-negative breast cancer.

The effect and safety of Berberine on polycystic ovary syndrome: a systematic review

The aim of this systematic review is to assess the effect of Berberine (BBR) on women's health to provide greater insights about its effect on women with polycystic syndrome for both patients and health care providers. Electronic databases such as PubMed, Web of Science, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) were systematically searched from the base to July 1th, 2019 to identify clinical trials and randomised controlled trials that had explored the effect of BBR on the polycystic syndrome. With regard to the weight and composition body, BBR did not have any significant effect on reducing body weight and conflicting findings had been reported about waist circumference (WC) and body mass index (BMI). However, BBR led to a significant decrease in waist to hip ratio (WHR), profile hormonal insulin resistance (IR), and insulin resistance (HOMA-IR). Further, androstenedione dropped significantly following treatment with BBB. However, BBB did not have a significant effect on follicle stimulating hormone (FSH) and luteinizing hormone (LH).

Contextual complexity of chemical signals in callitrichids

In nearly four decades our research and that of others on chemical signaling in callitrichid primates suggest a high degree of contextual complexity in both the use of signals and the response to these signals. We describe our research including observational field studies, behavioral bioassays ("playbacks"), functional imaging, and conditioning studies. Scent marking in both captivity and the wild is used for more than just territorial marking. Social contextual effects are seen in responses by subordinate females responding with ovulatory inhibition only to chemical signals from familiar dominant reproductive females. Males detect ovulation through changes in scent marks. Males responded behaviorally and hormonally to chemical signals of novel ovulating females as a function of their reproductive status (fathers, males paired with a female but not fathers, and single males). Multiple brain areas are activated in males by female chemical signals of ovulation including areas relating to memory, evaluation, and motivation. Furthermore, males can be conditioned to respond sexually to a nonsexual odor demonstrating that learning plays an important role in response to chemical signals. Male androgen and estrone levels changed significantly in response to infant chemical signals as a function of whether the males were fathers or not, whether the odors were from their own versus other infants, as well as the infant's stage of development. Chemical signals in callitrichids are providing a rich source of understanding the context and function of the chemical sensory system and its stimulation of neural, behavioral, and hormonal actions in the recipients.

Changes in strength and power performance and serum hormone concentrations during 12 weeks of task-specific or strength training in conscripts

The purpose of this study was to investigate the effects of two different training programs on strength and power performance and serum hormone concentrations. A total of 104 male soldiers volunteered and took part in the 12‐week training period with baseline, mid‐, and post‐measurements of body composition, muscle strength, lower and upper body power, and blood samples to determine serum hormone concentrations. The mean (±SD) age of subjects was 20 ± 1 years, height 180 ± 6 cm and body mass 72.4 ± 8.8 kg. The subjects were divided into three different training groups: soldier task‐specific training (TS), strength training (ST), and control (CON). Each group had a total of 18 training sessions during the 12‐week study. In the muscle strength tests, most improvements could be observed in the TS and ST groups, especially, during the first weeks of the training period. Maximal isometric leg extension force increased significantly by 7.9 ± 12.2% (p < .05) in the TS and 7.1 ± 12.6% (p < .05) in the ST groups between the PRE and MID, as well as between the PRE and POST measurements by 8.1 ± 12.4% (p < .05) in TS and 12.3 ± 15.3% (p < .01) in ST. Serum TES concentration increased significantly in TS between the PRE and MID (16.8 ± 33.9%) and PRE and POST (11.2 ± 16.7%) measurements. Serum COR concentrations decreased in TS between the MID and POST (−7.8 ± 10.9%) and PRE and POST (−11.0 ± 14.3%) measurements. Although the differences observed were rather minor in magnitude, training in the TS and ST groups led to greater improvements in muscle strength and power performance compared to the training in the CON group. The development of strength and/or power of the lower and upper body was greater in the TS and ST groups, which is crucial for warfighter's performance. Therefore, it is important to have a structured resistance‐training program during military training to optimize the strength, power, and military‐specific performance.

Hormonal Male Contraception

The demand for availability of efficient and safe contraceptive methods is strengthened by the predictions made by the United Nations regarding the future growth of the human population. So far, women are not only the main victims of the unsafe procedures related to terminating unwished pregnancies but do also carry the main responsibility for family planning. There is a significant desire among men for sharing this responsibility and a substantial proportion of females are willing to trust their male partners in regard to the use of contraception. Therefore, there is a need for developing new reversible, safe, effective, acceptable, affordable and available methods of male contraception. Thus, hormonal manipulation resulting in the suppression of sperm production seems, so far, to be the most feasible approach to achieve the above-mentioned goal. Several strategies of such hormonal manipulation have been tested. Most of them are based on the administration of more or less supra-physiological doses of exogenous testosterone, alone or in combination with other means of endocrine suppression of gonadotropin secretion. Although, so far, the goal of hormonal male contraception fulfilling the above-mentioned criteria, has not yet been achieved; continuing development of new molecules, gives hope for the near future.

Menopausal Acne - Challenges And Solutions

Although acne is a disease predominant in adolescence, it is being increasingly observed in adult life, including the menopausal period. The etiology of menopausal acne is multifactorial, with hormonal imbalance being the major culprit. There is a relative increase of androgens in the menopausal female that leads to clinical hyperandrogenism manifesting as acne, hirsutism and androgenetic alopecia. Other endocrine disorders including thyroid abnormalities, hyperprolactinemia and insulin resistance also play a role. Genetics, stress, dietary changes, lack of sleep and exercise and other lifestyle changes are implicated as trigger factors. Most menopausal women with isolated few acne lesions have normoandrogenic serum levels and do not require extensive investigations. However, baseline investigations including total testosterone are useful. Patients must also be evaluated for associated comorbidities such as obesity, diabetes, hypertension and dyslipidemia. A detailed history can help to exclude polycystic ovarian syndrome, late-onset congenital adrenal hyperplasia or medications as a cause of acne. The evaluation of menopausal acne and the approach to treatment depend on the severity of acne and associated features. In patients with mild acne without virilization, prolonged topical therapy is the mainstay of treatment. Though combined oral contraceptives are effective, they are relatively contraindicated in the postmenopausal period. Spironolactone is the first choice of therapy in the subset of patients that require oral anti-androgen therapy. Procedural treatment can be useful as it can also help in the treatment of associated acne scars and concomitant skin aging. It is also important to focus on lifestyle changes such as reducing stress, controlling obesity, having a healthy diet, exercise and proper skin care routine to reduce acne. The focus of this article is on the clinical presentation and management challenges of menopausal acne, which represents a special subtype of acne.

Prevalence of and factors associated with female sexual dysfunction among women using hormonal and non-hormonal contraception at the AGA Khan University Hospital Nairobi

Background

Female sexual function (FSD) is a complex phenomenon. It integrates all body systems and is influenced by a variety of factors. Contraceptives have shown to have variable effects on FSD. In Kenya, the majority of women use hormonal contraception with high rates of discontinuation of use, attributed to related side effects such as weight loss and loss of libido.

Aim

To determine the prevalence of and the factors affecting FSD among women using contraception in our setting.

Setting

The study was carried out at the Aga Khan University Hospital, Nairobi, at various clinical sites.

Methods

A cross-sectional study was conducted. Consecutive sampling of women of reproductive age using either hormonal or non-hormonal contraception was conducted. Two questionnaires were completed after obtaining informed consent. Independent associations of factors with the outcome variables were assessed using the chi-square test of association, and variables with a p < 0.25 were used in the multivariate analysis. Factors associated with FSD were determined using binary logistic regression.

Results

A total of 566 participants were included. The prevalence of FSD among those using hormonal and those using non-hormonal contraception was 51.5% and 29.6%, respectively (p < 0.0001). We found that the factors associated with FSD were presence of chronic illness and use of chronic medication, being self-employed or unemployed, alcohol intake and history of miscarriage(s).

Conclusion

There was a high prevalence of and a strong association between hormonal contraception and FSD. More studies on this topic in different settings are recommended to investigate the effect of each type of hormonal method on FSD.

Disseminated Tuberculosis in a Healthy Adolescent Female

Disseminated tuberculosis (TB) is an uncommon sequela of Mycobacterium TB infection in which bacteria disseminate and form colonies outside of the lungs. Most reports of disseminated TB are found in immunocompromised patients, particularly in patients with human immunodeficiency virus (HIV) infection, malnutrition, genetic susceptibility, diabetes mellitus, smoking, and alcohol abuse. Few case reports describe the finding of disseminated TB in immunocompetent patients, especially in healthy adolescents. The purpose of this report is to present a case in which disseminated TB was found in an otherwise healthy adolescent, female patient, and to explore the effects of pubertal hormonal changes on the immune system. Several studies in the pediatric population have suggested that hormonal changes of estrogen and testosterone associated with puberty may influence the pathogenesis of active TB. While the exact pathogenesis of disseminated TB remains unknown, this case highlights the need for heightened awareness of TB among otherwise healthy adolescents, and specifically, the effect puberty has on disease progression.

Nonadherent behaviors among young women on adjuvant endocrine therapy for breast cancer

BACKGROUND

Young age is a known factor associated with suboptimal adherence to endocrine therapy (ET) for adjuvant breast cancer (BC) treatment. This study was aimed at assessing nonadherent behaviors and associated factors among young women with early-stage hormone receptor-positive BC.

METHODS

As part of a multicenter, prospective cohort of women with a diagnosis of BC at or under the age of 40 years, participants were surveyed 30 months after their diagnosis about adherent behaviors. Among those who reported taking ET, adherence was measured with a 3-item Likert-type scale: Do you ever forget to take your ET? If you feel worse when you take your ET, do you stop taking it? Did you take your ET exactly as directed by your doctor over the last 3 months? Women reporting at least 1 nonadherent behavior were classified as nonadherers. Variables with a P value <.20 were included in a multivariable logistic model.

RESULTS

Among 384 women, 194 (51%) were classified as nonadherers. Univariate factors that retained significance in the multivariable model included educational level (odds ratio [OR], 0.50 for high vs low; P = .04), level of social support according to the Medical Outcome Study Social Support Survey (OR, 0.98 per 1 point; P = .01), and confidence with the decision regarding ET measured on a 0 to 10 numerical scale (OR, 0.63 for high vs low; P = .04).

CONCLUSIONS

Findings from this study could help to identify young patients at higher risk for nonadherence. Interventions adapted to the level of education and aimed at reinforcing support and patients' confidence in their decision to take ET could improve adherence and associated outcomes in this population.

Biochemical, hematological, and hormonal profile of rats orally administered methanol stem bark extract of Napoleona vogelii Hook and Planch (Lecythidaceae)

Napoleona vogelii is used in traditional medicine for the management of stomach aches, ulcer, and cancers. This study was conducted to investigate the subchronic toxicological effect of methanol stem bark extract of N. vogelii on biochemical, hematological, and hormonal profile of male and female rats. Forty rats of both sexes were randomly divided into four groups of 10 rats each and were administered 100, 200, and 400 mg/kg of the extract p.o. for 90 d. Ten milliliter per kilogram of distilled water p.o. was administered to control rats. On hematological assessment, mean corpuscular hemoglobin concentration was significantly (p < 0.01) increased at 400 mg/kg compared to control. Biochemical assessment showed a significant increase (p < 0.05) in levels of alanine aminotransferase and aspartate aminotransferase at 200 and 400 mg/kg, respectively, compared to control. Hormonal assessment of male rats revealed a significantly (p < 0.0001) reduced level of testosterone at all treatment doses compared to control while estradiol was significantly (p < 0.05) reduced at 100 mg/kg, but significantly (p < 0.0001) increased at 200 and 400 mg/kg respectively compared to control in female rats. Findings from this study demonstrate that N. vogelli is relatively safe on oral acute exposure but may possess the potential to cause hepatic dysfunction and infertility in male rats by perturbations of the hypothalamic-pituitary axis while conversely enhancing fertility in female rats on subchronic administration.

[Male hormonal contraception: past, present, future]

In certain regions of the world the enormous rate of population growth raises economic and public health concerns and widely accessible contraceptive methods would be desired. In contrast, in other countries the use of effective contraception is a question of individual preferences. Today, most of the reliable contraceptive methods are applied by women, while the options for male methods are quite limited. It is well known that significant portion of pregnancies are still unplanned and several data revealed men's willingness to take part in family planning. Based on these needs, remarkable efforts have been made to develop a suitable hormonal contraceptive agent for men. With the exogenous suppression of follicle stimulating hormone and luteinizing hormone secretion, the inhibition of the testicular testosterone production and the spermatogenesis can be achieved. In the beginning, testosterone-derivatives, or testosterone-progestin combinations were administered, later synthetic androgen agents were developed. Despite of these efforts, unfortunately, there is no safe, widely feasible male hormonal contraception to date, but in the future this goal can be achieved by solving the key hurdles. Orv Hetil. 2017; 158(46): 1819-1830.

Adult-onset acne: prevalence, impact, and management challenges

Acne is a multifactorial and inflammatory disease of pilosebaceous follicles, which affects most adolescents. Recent epidemiological data revealed a difference in adults affected by this disease. Women have a high prevalence and incidence when compared with men, especially after 25 years of age. In contrast to what was initially thought, most of these patients do not present endocrinopathy capable of leading to the development of the lesions. When present, polycystic ovarian syndrome is the main cause. However, in these cases, acne is rarely the only dermatological manifestation; hirsutism and acanthosis nigricans are often present. The majority of the normoandrogenic acne patients present a history since adolescence, but in many cases the lesion distribution and intensity change with time. There is often a typical localization of the lesions in the lower third of the face and lateral region of the neck. Another interesting feature is related to the impact on quality of life (QoL), which is always intense. Often there are signs of depression, even when the lesions are mild. As most adult patients are women, in addition to the conventional options, there is also hormone treatment. Combined oral contraceptives and spironolactone are good options. Knowing more about the particularities in etiopathogenesis, impact on QoL, and specific treatment options is important to all dermatologists who face the challenge of treating acne in adults.

Exogenous Hormonal Application Regulates the Occurrence of Wheat Tillers by Changing Endogenous Hormones

Plant hormones play important roles in regulating the occurrence of crop tillers. However, little is known about the relationships and the underlying mechanisms between endogenous hormones and the occurrence of wheat tillers induced by exogenous hormones. In this study, two winter wheat cultivars, Xinong 979 and Xiaoyan 22, were used to investigate the effects of the exogenous application of indole-3-acetic acid (IAA) and zeatin (Z) on the occurrence of wheat tillers and investigate underlying mechanisms regulating the occurrence of tillers. The results showed that the application of IAA inhibited the occurrence of tillers, and external Z application promoted the occurrence rate of tillers under low nitrogen conditions. Further analysis of the results showed that exogenous IAA completely inhibited the growth of tiller buds, while exogenous Z significantly promoted the growth rate of tiller buds in low nitrogen conditions. Endogenous hormones exhibit important functions in regulating the growth of tiller buds, which contents were affected by exogenous hormones. Furthermore, according to the principal component analysis and correlation analysis, the growth of tiller buds was significantly positively correlated with the content of endogenous Z, whereas it was significantly negatively correlated with the ratios of endogenous IAA to endogenous Z (IAA:Z) and endogenous abscisic acid (ABA) to endogenous Z (ABA:Z). Moreover, no significant correlation was observed between the growth of the tiller buds and the endogenous IAA, endogenous gibberellins (GAs), and endogenous ABA content. These results suggested that Z played key roles in regulating the tiller occurrence, and exogenous hormones regulated the growth of wheat tiller buds via affecting the Z contents, thus regulating the occurrence of wheat tiller.

Androgen deprivation therapy for androgen receptor-positive advanced salivary duct carcinoma: A nationwide case series of 35 patients in The Netherlands

Background

Salivary duct carcinoma, an aggressive subtype of salivary gland cancer, is mostly androgen receptor‐positive. Only limited data are available on androgen deprivation therapy (ADT).

Methods

Patients with advanced androgen receptor‐positive salivary duct carcinoma treated with first‐line ADT were retrospectively evaluated for clinical benefit (ie, partial response [PR] and stable disease, progression‐free survival [PFS] and overall survival [OS]). The OS was compared with patients with advanced salivary duct carcinoma who received best supportive care.

Results

Thirty‐four of 35 patients who were ADT‐treated were evaluable: 6 patients had a PR (18%) and 11 had stable disease (32%) leading to a clinical benefit ratio of 50%. The median PFS for the ADT‐treated patients was 4 months and the median duration of clinical benefit was 11 months. The median OS was 17 months versus 5 months in 43 patients receiving best supportive care (P = .02).

Conclusion

We recommend ADT in advanced androgen receptor‐positive salivary duct carcinoma given its response and clinical benefit. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

Clinical behavior of a cohort of adult women with facial acne treated with combined oral contraceptive: ethinylestradiol 20 µg/dienogest 2 mg

Acne vulgaris is the most common skin disease. It affects the young adult female population and generates great impact on physical and mental health. One of the treatments with good results for affected women is combined oral contraceptive pills (COCPs). The aim of this study was to determine the clinical effect of facial acne management with ethinylestradiol 20 µg/dienogest 2 mg in a cohort of Colombian adult women. A cohort of 120 female university students was followed for 12 months. These participants were enrolled in the Sexual and Reproductive Health Program of the Santiago de Cali University. This cohort admitted women between 18 and 30 years old who had chosen to start birth control with ethinylestradiol 20 µg/dienogest 2 mg COCPs, did not have contraindi cations to the use of COCPs, and had been diagnosed with acne. Monthly monitoring of facial acne lesion count was performed. Relative changes in facial lesion count were identified. At the end of follow-up, the percentage of reduction of lesions was 94% and 23% of women had a 100% reduction in acne lesions. In conclusion, the continued use of the ethinylestradiol 20 µg/dienogest 2 mg COCPs reduced inflammatory and non-inflammatory acne lesions in reproductive-age women between 18 and 30 years of age with no severe acne.

Risks of Serious Toxicities from Intermittent versus Continuous Androgen Deprivation Therapy for Advanced Prostate Cancer: A Population Based Study

PURPOSE

Randomized trials have shown that intermittent androgen deprivation therapy for patients with advanced prostate cancer may improve sexual and physical functioning compared to continuous androgen deprivation therapy without compromising survival. To our knowledge it is unknown whether intermittent androgen deprivation therapy alters the risk of serious toxicities associated with continuous androgen deprivation therapy.

MATERIALS AND METHODS

We performed a population based cohort study of 9,772 men 66 years old or older who were diagnosed with advanced prostate cancer from 2002 to 2011 and treated with androgen deprivation therapy. Intermittent androgen deprivation therapy was defined as a single 90-day interval between 2 androgen deprivation therapy sessions during which patients visited their physicians or underwent prostate specific antigen testing. Outcomes included acute myocardial infarction, stroke, heart failure, type 2 diabetes and fracture. We used Cox proportional hazard models to estimate the HRs of the comparative risk of serious toxicities between intermittent and continuous androgen deprivation therapy.

RESULTS

A total of 2,113 (22%), 769 (9%) and 899 men (9%) had a new cardiovascular event, diabetes or fracture, respectively, within 5 years of starting androgen deprivation therapy. Compared to the continuous androgen deprivation therapy group, the intermittent therapy group was at lower risk for serious cardiovascular events (HR 0.64, 95% CI 0.53-0.77), particularly in reducing the risk of heart failure (HR 0.62, 95% CI 0.49-0.78) and fracture (HR 0.52, 95% CI 0.38-0.70, each p <0.0001).

CONCLUSIONS

Intermittent androgen deprivation therapy was associated with a lower risk of heart failure and fracture compared to continuous androgen deprivation therapy. This raises toxicity concerns for continuous relative to intermittent therapy and suggests that intermittent androgen deprivation therapy may represent a safer therapeutic choice in elderly men with advanced prostate cancer.

Breast Ductal Carcinoma In Situ: A Literature Review of Adjuvant Hormonal Therapy

This review paper analyzed publications of adjuvant tamoxifen and aromatase inhibitor use following surgery for breast ductal carcinoma in situ (DCIS). Key endpoint analyses were risk of invasive and noninvasive malignancies and new contralateral breast cancers. Metaanalysis of three studies showed a relative risk of 0.69 (95% confidence interval, 0.60-0.79, P<0.05) for breast malignancies with tamoxifen treatment in a mixed radiotherapy treatment/naïve cohort. Subgroup analysis of DCIS populations in multiple studies showed a trend to benefit with aromatase inhibitor treatment.

The use of hormonal agents in the treatment of acne

Hormones and androgens play an important role in the pathogenesis of acne. Multiple hormonal modulators are now available for the treatment of acne. The efficacies and side effects of currently available hormonal agents are reviewed here including the use of oral contraceptives, spironolactone, flutamide, cyproterone acetate, finasteride, and cortexolone 17α-propionate. Hormonal therapies are an efficacious treatment option for acne among females. With the growing need to reduce antibiotic exposures, hormonal therapies should be more widely studied and incorporated into acne treatment strategies.

Effect of acute exposure to nonylphenol on biochemical, hormonal, and hematological parameters and muscle tissues residues of Nile tilapia; Oreochromis niloticus

Aim:

This study was aimed to evaluate some biochemical, hormonal, hematological, and histopathological changes in Nile tilapia, Oreochromis niloticus, after acute exposure to nonylphenol (NP). In addition to detection of NP residues in the fish, muscle tissues for human health concern.

Materials and Methods:

A total of 90 apparently healthy Nile tilapia, O. niloticus, were randomly divided into three equal groups; each containing 30 fish (three replicates). Groups 1 and 2 kept as a control and solvent control (acetone), respectively, and Group 3 exposed to NP at a dose level of 500 µg/L water for 7 successive days. Blood and tissue samples were collected 2 times randomly from each group after 7 days from fish exposure to NP and 10 days from exposure stopping.

Results:

Fish exposed to NP Group 3 showed anorexia, sluggish movement, erythema of the skin, areas of scales loss, and hemorrhagic ulcers in some areas of body region leading to exposing the viscera. Biochemical results revealed a significant increase in serum total proteins and globulins levels, a highly significant increase in serum alanine aminotransferase and aspartate aminotransferase activities, triglycerides, cholesterol, and creatinine levels, insignificant increase in serum uric acid level, and a highly significant decrease in serum testosterone and estradiol-β17 levels in Group 3 in compare with the control group. Histopathological finding confirms these results. While hematological results of the same group revealed a significant increase in red blood cells count and packed cell volume value, insignificant increase in hemoglobin concentration, leukopenia, lymphopenia, and monocytopenia in compared with the control group. All of these changes appeared after 7 days from fish exposure to NP. Most of these alterations returned toward the normal level after 10 days from stopping exposure to NP. NP residues detected in fish muscle tissues of Group 3 during exposure and after stopping exposure to it.

Conclusion:

It is concluded that NP is a toxic pollutant and has an adverse effect on fish health and reproduction as well as accumulates in fish muscle tissues which may cause human health hazard.

Effect of combined oral contraceptive use on serum 25-hydroxy vitamin D levels and ultrasound parameters in patients with polycystic ovary syndrome

PURPOSE

To investigate if there is an effect of combined oral contraceptive (COC) use on serum 25-hydroxy vitamin D [25(OH)D] levels in patients with polycystic ovary syndrome (PCOS).

METHODS

PCOS was defined by the 2003 Rotterdam criteria. All patients with PCOS were treated with a COC containing 0.035 mg ethinylestradiol and 2 mg cyproterone acetate for 6 months. Serum 25(OH)D levels, HOMA-IR, ovarian volume and antral follicule count were measured before and after the treatment.

RESULTS

The median 25(OH)D levels were 9.40 (range 4.40-24.50) μg/l and 7.00 (5.00-13.50) μg/l before and after COC use, respectively. Serum 25(OH)D levels decreased after the treatment; however, the difference was not statistically significant (p = 0.055).

CONCLUSION

This study seems to be the first prospective trial revealing the effect of COC use on serum 25(OH)D levels in women with PCOS. Although the decrease in serum 25(OH)D levels in patients with PCOS with the use of COC alone, did not reach to statistically significance level after 6 months treatment with COC.