"The sound of silence" Giving voice to endometriosis-related positional dyspareunia

Deep dyspareunia is one of the main symptoms of endometriosis. It appears to be submerged by a two-way disconnection between patients and their physicians. The aim of our review is to provide clear, ready-to-use advice on how to manage deep dyspareunia overcoming the gap in communication. Sexual history should always be taken as part of routine health care in these regards, using a patient-centered approach. An educational pelvic examination, which actively includes patients in the identification of painful areas, may prove useful to improve patients' understanding of their condition. Correlating painful pelvic areas with sexual positions and inviting patients to adopt alternative positions may represent a simple but extremely effective coping strategy to mitigate pain. Revealing and explaining to partners the nature of the pain is essential to allow them to take part in shared research of coping mechanisms, empowering the couple to make choices and changes. Couples who do not feel comfortable talking about intimacy by themselves may find that including a psychotherapist or a sexual therapist, may be a good way to start communication. Investigating and managing dyspareunia during medical encounters is a medical and ethical duty all healthcare practitioners should pursue.

Cytochalasins as Modulators of Stem Cell Differentiation

Regenerative medicine aims to identify new research strategies for the repair and restoration of tissues damaged by pathological or accidental events. Mesenchymal stem cells (MSCs) play a key role in regenerative medicine approaches due to their specific properties, such as the high rate of proliferation, the ability to differentiate into several cell lineages, the immunomodulatory potential, and their easy isolation with minimal ethical issues. One of the main goals of regenerative medicine is to modulate, both in vitro and in vivo, the differentiation potential of MSCs to improve their use in the repair of damaged tissues. Over the years, much evidence has been collected about the ability of cytochalasins, a large family of 60 metabolites isolated mainly from fungi, to modulate multiple properties of stem cells (SCs), such as proliferation, migration, and differentiation, by altering the organization of the cyto- and the nucleo-skeleton. In this review, we discussed the ability of two different cytochalasins, cytochalasins D and B, to influence specific SC differentiation programs modulated by several agents (chemical or physical) or intra- and extra-cellular factors, with particular attention to human MSCs (hMSCs).

"SO FAR AWAY" How Doctors Can Contribute to Making Endometriosis Hell on Earth. A Call for Humanistic Medicine and Empathetic Practice for Genuine Person-Centered Care. A Narrative Review

"SO FAR AWAY" * How Doctors Can Contribute to Making Endometriosis Hell on Earth [* by Knopfler M. In Dire Straits. Brothers in Arms. Vertigo Records, U.K., 1985].

Abstract

The distance physicians may create within the relationship with their patients by not having a humanistic approach to their practice may strongly influence clinical outcomes. The purpose of this paper is to convey the well-known narrative of patient dissatisfaction into pro-action by discussing the aspects of dehumanization, which may occur in the relationship between physicians and women with endometriosis. Eight dimensions of dehumanization are examined and related to everyday scenarios occurring in endometriosis care settings and the possible downstream consequences on patients' clinical outcomes are described. Objectification, which may come across as minimization of pain, may not only increase patients' perception of pain but also lead to undertreatment of unrecognized forms of endometriosis, especially among adolescents. Passivity, that is not favoring shared decision-making nor self-management, may compromise adherence to treatment, reducing patients' trust in physicians and quality of life. The same consequences may result from homogenization, that is giving for granted that all patients have the same access to care. Both isolation, ie not practicing therapeutic empathy, and loss of meaning, ie not supporting patients in the re-definition of their life plans, may affect women's psychological wellbeing and further increase pain perception. Ignoring women's personal journey by not providing clear information on the consequences endometriosis may have on their lives may favor women's self-silencing. Not promoting an un-biased communication and not setting aside scientific polarization are the main features of dislocation, which may jeopardize patient empowerment. Lastly, having a reductionist approach to the body may contribute to chronicization of pain, thus compromising quality of life. This considered, taking time to listen to women with endometriosis and tailoring decisions on the basis of their individual needs should be fostered as a moral duty. Physicians should always keep in mind that they are not only deliverers of treatment; they are a form of treatment themselves.

The neglected emotional drawbacks of the prioritization of embryos to transfer

In recent years, increasing efforts have been made to develop advanced techniques that could predict the potential of implantation of each single embryo and prioritize the transfer of those at higher chance. The most promising include non-invasive preimplantation genetic testing for aneuploidy and artificial intelligence-based algorithms using time lapse images. The psychological effect of these add-ons is neglected. One could speculate that embarking on another transfer after one or more failures with the prospect of receiving an embryo of lower potential may be distressing for the couple. In addition, the symbolic and mental representation of an embryo with 'lower capacity to implant' is currently unknown but could affect couples' choices and wellbeing. These emotional responses may also undermine adherence to the programme and, ultimately, its real effectiveness. Future trials aimed at evaluating the validity of prioritization procedures must also consider the emotional burden on the couples.

"Time is on my side". Disease trajectory of vulvodynia: a systematic review with a narrative synthesis

PURPOSE

The aim of this systematic review was to shed light on the disease-trajectory of vulvodynia and identify potential risk factors which may affect such trajectory.

METHODS

We searched Pubmed to identify articles providing evidence on vulvodynia trajectory (i.e., remission, relapse or persistence rates) with a minimum follow-up of 2 years. A narrative approach was used for data synthesis.

RESULTS

Four articles were included (total participants: 741 women with vulvodynia; 634 controls). At a 2-year follow-up, 50.6% of women reported remission, remission with relapse was observed in 39.7% and persistence throughout time occurred in 9.6%. A decrease in pain was observed in 71.1% of patients at a 7-year follow-up. Mean pain scores and depressive symptoms resulted lower at 2-year follow-up, whereas sexual function and satisfaction were increased. Factors associated with remission of vulvodynia were greater couple cohesion, decreased reporting of pain after intercourse and lower levels of worst pain. Risk factors for symptom persistence included marriage, more severe pain ratings, depression, pain with partner touch, interstitial cystitis, pain with oral sex, fibromyalgia, older age and anxiety. Recurrence was associated with: longer duration of pain, more severe ratings of the worst pain ever and pain described as provoked.

CONCLUSIONS

Symptoms of vulvodynia seem to improve over time, regardless of treatment. This finding contains a key message for patients and their physicians, considering the deleterious consequences of vulvodynia on women's lives.

Central Sensitization in Vulvodynia and Endometriosis: What Have We Been Overlooking So Far?

Importance

Women experience more frequent and greater pain than men, although they receive less adequate treatment and are perceived as more anxious than males. Recent clinical research has lead to hypothesize a common etiology for overlapping chronic pain conditions and mood disorders, namely, central sensitization, which originates from an alteration of pain processing pathways in the central nervous system.

Objective

The aim of this review was to collect all available evidence regarding the potential role of central sensitization in vulvodynia and endometriosis.

Evidence Acquisition

A systematic literature search was performed between July and August 2022 using the electronic database PubMed. The extracted data were summarized using a narrative approach.

Results

Ten articles were chosen for the review. Participants' mean age was 39.2 years (SD = 5.1). Among serum markers of central sensitization, nitric oxide levels were greater in women with endometriosis than in controls, whereas brain-derived neurotrophic factor and S100B levels differed among pain conditions with structural anomalies and those without. Functional magnetic resonance imaging showed different resting state networks between patients with endometriosis and controls. In neurophysiology studies, cases had reduced pain thresholds, compared with healthy controls. Lastly, self-reported questionnaires suggested a central component of pain in women with endometriosis-related dyspareunia and associated bladder/pelvic floor tenderness.

Conclusions and Relevance

The management of vulvodynia and endometriosis may benefit from a new perspective, which considers their possible central etiology. It is compelling that treatment of pain starts to be considered a therapeutic goal in its own right.

TLDc Domain-Containing Genes in Autism Spectrum Disorder: New Players in the Oxidative Stress Response

Oxidative stress (OS) plays a key role in autism spectrum disorder (ASD), a neurodevelopmental disorder characterized by deficits in social communication, restricted interests, and repetitive behaviors. Recent evidence suggests that the TLDc [Tre2/Bub2/Cdc16 (TBC), lysin motif (LysM), domain catalytic] domain is a highly conserved motif present in proteins that are important players in the OS response and in neuroprotection. Human proteins sharing the TLDc domain include OXR1, TLDC1, NCOA7, TBC1D24, and C20ORF118. This study was aimed at understanding whether TLDc domain-containing mRNAs together with specific microRNAs (200b-3p and 32-5p) and long noncoding RNAs (TUG1), known to target TLDc proteins, contributed to regulate the OS response in ASD. Data showed a significant increase in the levels of OXR1 and TLDC1 mRNAs in peripheral blood mononuclear cells (PBMCs) of ASD children compared to their neurotypically developing (NTD) counterparts, along with an increase in TUG1 mRNA expression levels, suggesting its possible role in the regulation of TLDc proteins. A positive correlation between the expression of some TLDc mRNAs and the Childhood Autism Rating Scale (CARS) global score as well as inflammatory gene expression was found. In conclusion, our data suggest a novel biological pathway in the OS response of ASD subjects that deserves further exploration.

Non-response to first-line hormonal treatment for symptomatic endometriosis: overcoming tunnel vision. A narrative review

One-fourth to one-third of women with endometriosis receiving first-line hormonal treatment lacks an adequate response in terms of resolution of painful symptoms. This phenomenon has been ascribed to "progesterone resistance", an entity that was theorized to explain the gap between the ubiquity of retrograde menstruation and the 10% prevalence of endometriosis among women of reproductive age.Nevertheless, the hypothesis of progesterone resistance is not free of controversies. As our understanding of endometriosis is increasing, authors are starting to set aside the traditionally accepted tunnel vision of endometriosis as a strictly pelvic disease, opening to a more comprehensive perspective of the condition. The question is: are patients not responding to first-line treatment because they have an altered signaling pathway for such treatment, or have we been overlooking a series of other pain contributors which may not be resolved by hormonal therapy?Finding an answer to this question is evermore impelling, for two reasons mainly. Firstly, because not recognizing the presence of further pain contributors adds a delay in treatment to the already existing delay in diagnosis of endometriosis. This may lead to chronicity of the untreated pain contributors as well as causing adverse consequences on quality of life and psychological health. Secondly, misinterpreting the consequences of untreated pain contributors as a non-response to standard first-line treatment may imply the adoption of second-line medical therapies or of surgery, which may entail non-negligible side effects and may not be free of physical, psychological and socioeconomic repercussions.The current narrative review aims at providing an overview of all the possible pain contributors in endometriosis, ranging from those strictly organic to those with a greater neuro-psychological component. Including these aspects in a broader psychobiological approach may provide useful suggestions for treating those patients who report persistent pain symptoms despite receiving first-line hormonal medical treatment.

Oxytocin Modulates Osteogenic Commitment in Human Adipose-Derived Stem Cells

Human adipose-derived stem cells (hASCs) are commonly harvested in minimally invasive contexts with few ethical concerns, and exhibit self-renewal, multi-lineage differentiation, and trophic signaling that make them attractive candidates for cell therapy approaches. The identification of natural molecules that can modulate their biological properties is a challenge for many researchers. Oxytocin (OXT) is a neurohypophyseal hormone that plays a pivotal role in the regulation of mammalian behavior, and is involved in health and well-being processes. Here, we investigated the role of OXT on hASC proliferation, migratory ability, senescence, and autophagy after a treatment of 72 h; OXT did not affect hASC proliferation and migratory ability. Moreover, we observed an increase in SA-β-galactosidase activity, probably related to the promotion of the autophagic process. In addition, the effects of OXT were evaluated on the hASC differentiation ability; OXT promoted osteogenic differentiation in a dose-dependent manner, as demonstrated by Alizarin red staining and gene/protein expression analysis, while it did not affect or reduce adipogenic differentiation. We also observed an increase in the expression of autophagy marker genes at the beginning of the osteogenic process in OXT-treated hASCs, leading us to hypothesize that OXT could promote osteogenesis in hASCs by modulating the autophagic process.

Mental Health Issues as a Consequence of the Pandemic: Group Psycho-Educational Intervention to Support Patients Recovered from COVID-19 Infection

Common psycho-physical symptoms have emerged in patients who were previously recovered for COVID-19 infection, including traumatic experience and enduring emotional disturbances. A group psycho-educational intervention of seven weekly sessions and a follow-up after three months was proposed to all Italian-speaking patients formally discharged from a public hospital in northern Italy and physically recovered from infection. Eighteen patients were recruited and divided into four age-homogenous groups, each led by two facilitators (psychologists and psychotherapists). The group sessions followed a structured format with thematic modules, including main topics, tasks, and homework assignments. Data were collected through recordings and verbatim transcripts. The objectives of the study were twofold: (1) to analyze the emerging themes and gain insight into the significant aspects of the participants' lived experience of COVID-19, and (2) to examine changes in how participants approached these themes throughout the intervention process. Semantic-pragmatic text analyses, specifically thematic analysis of elementary context and correspondence analysis, were conducted using T-LAB software. Linguistic analysis revealed a congruence between the intervention's objectives and the participants' experiences. The study highlighted an evolution in the narratives, as participants transitioned from a passive and concrete perspective on the disease to a more comprehensive cognitive and emotional elaboration of their personal illness stories. These findings hold potential relevance for healthcare services and professionals working in this field.

Plumbagin, a Natural Compound with Several Biological Effects and Anti-Inflammatory Properties

Phytochemicals from various medicinal plants are well known for their antioxidant properties and anti-cancer effects. Many of these bioactive compounds or natural products have demonstrated effects against inflammation, while some showed a role that is only approximately described as anti-inflammatory. In particular, naphthoquinones are naturally-occurring compounds with different pharmacological activities and allow easy scaffold modification for drug design approaches. Among this class of compounds, Plumbagin, a plant-derived product, has shown interesting counteracting effects in many inflammation models. However, scientific knowledge about the beneficial effect of Plumbagin should be comprehensively reported before candidating this natural molecule into a future drug against specific human diseases. In this review, the most relevant mechanisms in which Plumbagin plays a role in the process of inflammation were summarized. Other relevant bioactive effects were reviewed to provide a complete and compact scenario of Plumbagin's potential therapeutic significance.

Cytochalasin B Influences Cytoskeletal Organization and Osteogenic Potential of Human Wharton's Jelly Mesenchymal Stem Cells

Among perinatal stem cells of the umbilical cord, human Wharton's jelly mesenchymal stem cells (hWJ-MSCs) are of great interest for cell-based therapy approaches in regenerative medicine, showing some advantages over other MSCs. In fact, hWJ-MSCs, placed between embryonic and adult MSCs, are not tumorigenic and are harvested with few ethical concerns. Furthermore, these cells can be easily cultured in vitro, maintaining both stem properties and a high proliferative rate for several passages, as well as trilineage capacity of differentiation. Recently, it has been demonstrated that cytoskeletal organization influences stem cell biology. Among molecules able to modulate its dynamics, Cytochalasin B (CB), a cyto-permeable mycotoxin, influences actin microfilament polymerization, thus affecting several cell properties, such as the ability of MSCs to differentiate towards a specific commitment. Here, we investigated for the first time the effects of a 24 h-treatment with CB at different concentrations (0.1-3 μM) on hWJ-MSCs. CB influenced the cytoskeletal organization in a dose-dependent manner, inducing changes in cell number, proliferation, shape, and nanomechanical properties, thus promoting the osteogenic commitment of hWJ-MSCs, as confirmed by the expression analysis of osteogenic/autophagy markers.

Women's quality of sleep and in vitro fertilization success

Women undergoing in vitro fertilization (IVF) are emotionally challenged. Anxiety, depression, and sleep disturbances are common complaints. The impact of these symptoms on IVF outcome is however debated. In this study, we aimed at investigating whether sleep quality and psychological health can affect the chances of success of the procedure. Women undergoing IVF were recruited at the time of oocytes retrieval. Women's sleep quality and psychological health was assessed using the Pittsburgh Sleep Quality Index (PSQI), the Fertility Problem Inventory (FPI), and the Hospital Anxiety and Depression Scale (HADS). Baseline characteristics and results of the three scales were compared between women who did and did not succeed. Overall, 263 women were included, of whom 81 had a clinical pregnancy (31%). As expected, successful women were younger, and their ovarian reserve was more preserved. FPI and HADS scores did not differ. Conversely, a statistically significant difference emerged for the PSQI score, the median [interquartile range] in pregnant and non-pregnant women being 4 [3-5] and 5 [3-7], respectively (p = 0.004). The crude and adjusted OR of pregnancy in women with a PSQI > 5 (indicating impaired sleep quality) was 0.46 (95% CI 0.25-0.86, p = 0.02) and 0.50 (95% CI: 0.26-0.94, p = 0.03), respectively. In conclusion, low sleep quality is common in women scheduled for IVF and could influence the success of the procedure.

Predictors of Women’s Childbirth Experience: A Prospective Longitudinal Study on Italian New Mothers

BACKGROUND

Women’s memories of their childbirth experience tend to remain unchanged over time. This experience can be influenced by obstetric factors as well as by sociodemographic and psychological variables.

OBJECTIVE

To examine whether women’s perceived childbirth experience changes over time; to identify the predictors (obstetric, sociodemographic, and psychological variables) of this experience immediately after delivery and after 3 months.

METHODS

This prospective longitudinal study comprised two hundred and twenty-one Italian women who completed a self-report questionnaire at two assessment points: immediately (1–3 days) after birth (Time 1) and 3 months postpartum (Time 2). At Time 1, the questionnaire included some questions on sociodemographic, psychological, and obstetric information, and the Wijma Delivery Experience Questionnaire (WDEQ(B); at Time 2 women compiled again the WDEQ(B).

RESULTS

Repeated measures ANOVA revealed that the childbirth experience did not change from Time 1 to Time 2. However, predictors of this experience were different between Time 1 and Time 2: at Time 1, the childbirth experience (WDEQ(B)_t1) was significantly predicted nly by type of cesarean section; at Time 2, the childbirth experience (WDEQ(B)_t2) was significantly predicted by WDEQ(B)_t1, history of psychological disorders, and type of conception.

DISCUSSIONS

Our findings enhance the understanding of the main predictors of a woman’s childbirth experience. Identifying areas of vulnerability is important for clinical practice, as well as for developing maternal health policies to improve women’s birth experiences, postpartum well-being, and the baby’s development.

P-726 Women’s quality of sleep and in vitro fertilization success

Study question

Can sleep quality and psychological health of women undergoing In Vitro Fertilization (IVF) affect the chances of success of the procedure?

Summary answer

Psychological health doesn’t seem to affect IVF outcomes while sleep disturbances are common in women undergoing IVF and could influence the success of the procedure.

What is known already

IVF is saddled with a significant emotional burden causing anxiety, depression, and sleep disturbances. Baseline high levels of stress seem to be negatively associated with IVF success whereas studies evaluating the effect of anxiety and depression are discordant. Investigating sleep disorders in this setting is particularly attracting because of the significant association with anxiety and stress and because it is a simple information to collect. In addition, sleep disorders could negatively affect IVF success, as it does for natural conceptions, due to the well-established association between sleep and the hormonal system. Evidence on this issue is however scant and inconclusive.

Study design, size, duration

This is a single-center prospective cohort study designed to examine whether the sleep quality and psychological health of women undergoing IVF affect the chances of success of the procedure. Two hundred sixty-three women undergoing IVF between September to December 2019 were enrolled. Baseline characteristics and women’s sleep quality and psychological health were compared between women who did and did not have a live birth.

Participants/materials, setting, methods

Inclusion criteria were admission for oocyte pick-up. Women with neurologic or psychiatric disorders, obstructive sleep apnea syndrome, anatomical factors that can reduce embryo implantation and limited understanding of the Italian language were excluded. Women’s sleep quality and psychological health were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Fertility Problem Inventory (FPI), and the Hospital Anxiety and Depression Scale (HADS).

Main results and the role of chance

Overall, 81 women had a live birth (31%). As expected, successful women were younger, and their ovarian reserve was more preserved. No significant group differences were detected for education, employment, parity, smoking status, body mass index and indication to IVF. FPI and HADS scores did not differ. Conversely, our findings revealed that sleep disturbances were associated with lower chances of live birth in IVF: a statistically significant difference emerged for the PSQI score, the median [interquartile range] in pregnant and non-pregnant women being 4 [3-5] and 5 [3-7], respectively (p = 0.004). The crude and adjusted OR of pregnancy in women with a PSQI >5 (indicating impaired sleep quality) was 0.46 (95%CI: 0.25-0.86, p = 0.02) and 0.50 (95%CI: 0.26-0.94, p = 0.03), respectively.

Limitations, reasons for caution

Data were collected during treatment, which did not allow to properly investigate the association between sleep quality, infertility, and IVF itself. Sleep quality was assessed using a self-reported sleep measure (although validated and extensively used by clinicians and researchers), which does not ensure the objectivity of observations.

Wider implications of the findings

The assessment of sleep quality throughout the treatment period should be included as an important part of multidisciplinary clinical management of women undergoing IVF. Sleep quality of candidate mothers should be promoted by the implementation of prevention programmes and targeted interventions.

Trial registration number

not applicable

P-304 Sexual function in women with endometriosis: an online survey

Study question

What factors are associated with sexual function in women with endometriosis?

Summary answer

In this study, the most important variables associated with sexual function were dyspareunia (especially deep and introital dyspareunia combined), infertility, fatigue, and psychological comorbidities.

What is known already

Endometriosis is a chronic gynaecologic disease that affects women of reproductive age, with negative consequences on multiple life domains, including sexuality. Although it has been demonstrated that endometriosis-related sexual issues may negatively affect women’s intimate relationships, their subjective experience remains overlooked, either in research or clinical practice. In this regard, the impact of dyspareunia (especially deep dyspareunia) has been highlighted in several studies, but the role of symptoms other than pain, such as fatigue, infertility, and psychological comorbidities, has not been yet clarified. Moreover, little is known about how women deal with dyspareunia and the quality of doctor-patient communication.

Study design, size, duration

This observational study was conducted between 8 November and 21 December 2021 in collaboration with the largest Italian patient association, Associazione Progetto Endometriosi (APE [Endometriosis Project Association]). Data were collected through a self-administered online survey hosted on Qualtrics (Qualtrics Ltd.). Women were invited to participate in the study via APE’s Facebook page and newsletters. The online survey was anonymous, and women were allowed to complete it only after providing their electronic consent.

Participants/materials, setting, methods

Participants were 612 women (age: 36.41 ± 6.72 years) with a surgical or clinical diagnosis of endometriosis and a sexual partner. They completed the Female Sexual Function Index (FSFI), the Hospital Anxiety and Depression Scale (HADS), and the Rosenberg Self-Esteem Scale (RSES). Demographic and gynaecologic data – including endometriosis stage, type of lesions, symptoms (e.g., pelvic pain, fatigue, infertility), treatment –, and information regarding women’s subjective experience of dyspareunia were collected using a researcher-made questionnaire.

Main results and the role of chance

Dyspareunia was experienced by 524 (86%) women. Sexual dysfunction (FSFI total score < 26.55) was reported by 479 (78%) participants. Multiple regression analyses revealed that sexual function (FSFI total score) was associated with dyspareunia (β = −.108, P =  .008), infertility (β =  −.082, P =  .040), fatigue (β =  −.108, P =  .021), and symptoms of anxiety and depression (HADS total score; β =  −.127, P =  .021). Women with sexual dysfunction were more likely to report rectovaginal endometriotic lesions (59% vs. 47%, P = .016) and stage 4 endometriosis (43% vs. 32%, P =  .002), to experience deep and introital dyspareunia combined (50% vs. 21%, P <  .001), with greater symptoms of anxiety and depression (F [2,595] = 21.812, P <  .001, Wilk’s Λ = .932, η2p = .068) and lower self-esteem (t [589] = 5.111, P <  .001). Women with dyspareunia and sexual dysfunction reported greater fear of pain and consequent inability to relax during intercourse, avoidance of sex, worries about their sexual life, sexual dissatisfaction, and feelings of guilt towards the partner (Ps <  .001), along with poorer support and understanding from doctors (P =  .006) than women with dyspareunia who did not report sexual dysfunction.

Limitations, reasons for caution

This is one of the largest studies on sexual function in women with endometriosis. However, there are reasons for caution when interpreting our results due to the self-reported nature of all the data (including medical information) and the risk of selection bias due to our recruitment strategy.

Wider implications of the findings

Our results clearly indicate that the majority of women with endometriosis experience sexual problems that are mostly (but not solely) due to dyspareunia. The assessment of sexual function should be included in routine clinical practice with these patients, also considering its association with psychological symptoms and self-esteem.

Trial registration number

Not applicable

Assessing the experience of dyspareunia in the endometriosis population: the Subjective Impact of Dyspareunia Inventory (SIDI)

STUDY QUESTION

Is the Subjective Impact of Dyspareunia Inventory (SIDI) a reliable tool to examine the experience of dyspareunia in the context of endometriosis?

SUMMARY ANSWER

In this study, the SIDI showed good structural and psychometric properties, and thus can be used as a reliable questionnaire to assess the impact of endometriosis-related dyspareunia on multiple dimensions, such as sexuality and intimate relationships.

WHAT IS KNOWN ALREADY

In the endometriosis population, dyspareunia has a tremendous negative impact on psychological health, overall sexual function and couple relationships. However, there is a paucity of tools that can be effectively used in either research or clinical practice to assess the subjective components of the dyspareunia experience, including coping strategies to deal with the pain.

STUDY DESIGN, SIZE, DURATION

In this cross-sectional study, the validity of the SIDI was examined by considering the responses provided by 638 participants with endometriosis and dyspareunia, who participated in an online survey conducted between 8 November and 21 December 2021. Participants were recruited using snowball sampling that involved posting the invitation to participate in the study on the social media of a patient association.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Participants were women aged ≥18 with clinical or surgical diagnosis of endometriosis. The SIDI measures the subjective impact of dyspareunia and is composed of 16 items focused on the frequency of dyspareunia-related experiences in the last 6 months, rated on a 5-point Likert scale. Sexuality was assessed using the Female Sexual Function Index. Psychological health was measured using the Hospital Anxiety and Depression Scale and the Rosenberg Self-Esteem Scale. Sociodemographic and endometriosis-related information was collected using a researcher-made questionnaire. Statistical significance was set at P < 0.05.

MAIN RESULTS AND THE ROLE OF CHANCE

Factor analysis revealed that the SIDI has a four-factor structure and allows for examining the impact of dyspareunia in terms of Sexual Concerns (Factor 1), Relationship Concerns (Factor 2), Partner Support (Factor 3) and Endurance of Pain (Factor 4). The SIDI showed good structural and psychometric properties (including internal consistency), was associated with sexual function and psychological health and was able to discriminate between participants with and without sexual dysfunction.

LIMITATIONS, REASONS FOR CAUTION

Reasons for caution are related to the risk of self-selection bias depending on the study population and recruitment strategy. Moreover, all the information provided by the participants was self-reported, which may have affected the accuracy of the data collected, especially with regards to endometriosis-specific information.

WIDER IMPLICATIONS OF THE FINDINGS

This study may provide a new brief tool that can be used by clinicians and researchers to assess the impact of dyspareunia from a multidimensional perspective and to consider subjective aspects that can be usefully integrated with information about pain severity, timing and localization.

STUDY FUNDING/COMPETING INTEREST(S)

There was no funding for this study. A.F. is the President of APE-Odv (Associazione Progetto Endometriosi-Organizzazione di volontariato (Endometriosis Project Association-Volunteer Organization)), the largest nonprofit endometriosis patient association in Italy. The other authors have no conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.

P30 CARDIAC ARRESTS IN SPORTS: WHAT IS DIFFERENT COMPARED TO OTHER PUBLIC PLACES?

Introduction

Cardiac arrests in sports can involve professional athletes, amateurs, but also spectators of sports competitions. Sports facilities are the only ones for which the current law provides for the presence of an automatic external defibrillator (AED) and trained personnel, unlike other public places (schools, work, street, station, general public buildings) where it is only recommended.

Objective

To compare patient characteristics, presentation rhythm, bystander cardiopulmonary resuscitation (CPR), AED use before emergency medical services (EMS) arrival, and return of spontaneous circulation (ROSC) longer than 30 seconds in the Utstein category of out–of–hospital cardiac arrests (OHCAs) in sports compared to events in other public places.

Materials and Methods

We considered all the OHCAs occurred from 01/01/2015 to 31/12/2020 in the provinces of Pavia, Lodi, Cremona, Mantua and Varese (2400000 inhabitants), excluding the OHCAs occurred at home, in long–term care facilities and witnessed by the EMS.

Results

During the study period, 22 OHCAs occurred in sports and 552 in other public places (school, work, street, station, public buildings). The age is similar in the two groups [sport 59 years (IQR 53.5–66.7) vs other 63 years (IQR 51–75), p = 0.2]. In sports, there is a trend in favor of shockable rhythms (13/22=59% vs 185/552=33%, p = 0.1). The percentage of CPR performed by bystanders in sports is significantly higher than in other public places (20/22=91% vs 299/552=54%, p = 0.003), as the bystander AED use (11/22=50% vs 64/552=12%, p &lt; 0.001) and bystander AED shock (7/22=31% vs 27/552=5%, p &lt; 0.001) before EMS arrival. A ROSC greater than 30 seconds was obtained in 59% of OHCAs in sports, with a statistically significant difference compared to events in other public places (13/22=59% vs 166/552=30%, p = 0.015).

Conclusions

During sports competitions there is a greater ability to intervene in case of cardiac arrest, which determines a higher probability of obtaining ROSC, although in terms of age or presentation rhythm the patients are comparable to OHCA victims in other places public. These results suggest the need for an AED and trained personnel in other public places as well.

Cytochalasin B Modulates Nanomechanical Patterning and Fate in Human Adipose-Derived Stem Cells

Cytoskeletal proteins provide architectural and signaling cues within cells. They are able to reorganize themselves in response to mechanical forces, converting the stimuli received into specific cellular responses. Thus, the cytoskeleton influences cell shape, proliferation, and even differentiation. In particular, the cytoskeleton affects the fate of mesenchymal stem cells (MSCs), which are highly attractive candidates for cell therapy approaches due to their capacity for self-renewal and multi-lineage differentiation. Cytochalasin B (CB), a cyto-permeable mycotoxin, is able to inhibit the formation of actin microfilaments, resulting in direct effects on cell biological properties. Here, we investigated for the first time the effects of different concentrations of CB (0.1–10 μM) on human adipose-derived stem cells (hASCs) both after 24 h (h) of CB treatment and 24 h after CB wash-out. CB influenced the metabolism, proliferation, and morphology of hASCs in a dose-dependent manner, in association with progressive disorganization of actin microfilaments. Furthermore, the removal of CB highlighted the ability of cells to restore their cytoskeletal organization. Finally, atomic force microscopy (AFM) revealed that cytoskeletal changes induced by CB modulated the viscoelastic properties of hASCs, influencing their stiffness and viscosity, thereby affecting adipogenic fate.

Intimate Partner Violence in the COVID-19 Era: A Health, Psychological, Forensic and Legal Perspective

This commentary aims to provide a multidisciplinary framework on intimate partner violence (IPV) during the COVID-19 pandemic (with a specific focus on the most predominant form of gender-based violence, i.e., male violence towards women), commenting on the multiple negative consequences of the pandemic on gender violence and providing elements of effective practice. We searched literature for reports/studies on the issue of IPV during the COVID-19 pandemic, focusing on health, psychological, forensic, and legal aspects. The combined effects of lockdowns, isolation at home with abusive partners, quarantine, and economic worries/loss of a job could significantly facilitate violence against women and, at the same time, diminish women’s chances to seek for help, with a strong negative impact on their life. The continued offer of clinical, psychological, forensic, and legal services for survivors of violence, despite the modifications to the provision of these services due to the new needs related to the COVID-19 pandemic, appears of utmost importance. All actions to support survivors of IPV are expected to be multidisciplinary, including the involvement of social and/or legal services and health systems, and woman-centred. Implementing these measures in the COVID-19 era appears challenging but is of primary importance.

Cell Responsiveness to Physical Energies: Paving the Way to Decipher a Morphogenetic Code

We discuss emerging views on the complexity of signals controlling the onset of biological shapes and functions, from the nanoarchitectonics arising from supramolecular interactions, to the cellular/multicellular tissue level, and up to the unfolding of complex anatomy. We highlight the fundamental role of physical forces in cellular decisions, stressing the intriguing similarities in early morphogenesis, tissue regeneration, and oncogenic drift. Compelling evidence is presented, showing that biological patterns are strongly embedded in the vibrational nature of the physical energies that permeate the entire universe. We describe biological dynamics as informational processes at which physics and chemistry converge, with nanomechanical motions, and electromagnetic waves, including light, forming an ensemble of vibrations, acting as a sort of control software for molecular patterning. Biomolecular recognition is approached within the establishment of coherent synchronizations among signaling players, whose physical nature can be equated to oscillators tending to the coherent synchronization of their vibrational modes. Cytoskeletal elements are now emerging as senders and receivers of physical signals, "shaping" biological identity from the cellular to the tissue/organ levels. We finally discuss the perspective of exploiting the diffusive features of physical energies to afford in situ stem/somatic cell reprogramming, and tissue regeneration, without stem cell transplantation.

The influence of hormonal contraception on depression and female sexuality: a narrative review of the literature

OBJECTIVE

Over the past decades, an increasing number of women have been using hormonal contraception. The potential role of sex hormones in regulating vegetative, psychophysiological, and cognitive functions has been highlighted in several studies, and there is a need to further understand the impact of hormonal contraception on women's quality of life, especially as regards psychological health and sexuality.

METHODS

We conducted a narrative review aimed at clarifying the mechanisms involved in the interaction between sex hormones and the brain, also focusing on the association between hormonal contraception and mood and sexual function.

RESULTS

Our findings clarified that hormonal contraception may be associated with depressive symptoms, especially among adolescents, and with sexual dysfunction. However, the evidence included in this review was conflicting and did not support the hypothesis that hormonal contraception directly causes depressive symptoms, major depressive disorder, or sexual dysfunction.

CONCLUSIONS

The optimal hormonal contraception should be identified in the context of shared decision making, considering the preferences and needs of each woman, as well as her physical and psychosexual conditions.

A Tailored Lipid Supplement Restored Membrane Fatty Acid Composition and Ameliorates In Vitro Biological Features of Human Amniotic Epithelial Cells

Cell culture conditions influence several biological and biochemical features of stem cells (SCs), including the membrane lipid profile, thus limiting the use of SCs for cell therapy approaches. The present study aims to investigate whether the in vitro culture may alter the membrane fatty acid signature of human Amniotic Epithelial Cells (hAECs). The analysis of the membrane fatty acid composition of hAECs cultured in basal medium showed a loss in polyunsaturated fatty acids (PUFA), in particular in omega-6 (ω-6) content, compared to freshly isolated hAECs. The addition to the basal culture medium of a chemically defined and animal-free tailored lipid supplement, namely Refeed^®, partially restored the membrane fatty acid signature of hAECs. Although the amelioration of the membrane composition did not prolong hAECs culture lifespan, Refeed^® influenced cell morphology, counteracted the onset of senescence, and increased the migratory capacity as well as the ability of hAECs to inhibit Peripheral Blood Mononuclear Cell (PBMC) proliferation. This study provides new information on hAEC features during culture passages and demonstrates that the maintenance of the membrane fatty acid signature preserved higher cell quality during in vitro expansion, suggesting the use of lipid supplementation for SC expansion in cell-based therapies.

Sexual violence in adult women and adolescents: a narrative review

Sexual violence is a widespread phenomenon, as it has been estimated that about 35.6% of women have experienced some forms of sexual abuse, with variable prevalence estimates worldwide. Sexual violence has remarkable negative consequences on women's health and quality of life, with a specific harmful impact on women's psychological well-being and sexuality. In this narrative review, we provide an overview on the phenomenon of sexual violence against adult women and adolescents, discussing its associated multiple negative consequences with a specific focus on clinical and sexological aspects. ''Women centered care'' and a multidisciplinary approach appear of pivotal importance when working with sexual violence survivors. Woman should be engaged in all the clinical activities as equal partners in the decision-making process, and should be supported by multiple and different professional figures (i.e. gynecologists, psychologists, sexologists, forensic medical doctors, lawyers) working within the framework of a cooperative integrated model.

Predictors of Postpartum Depression among Italian Women: A Longitudinal Study

Introduction: Postpartum depression is commonly experienced by mothers worldwide and is associated with anxiety disorders, parenting stress, and other forms of distress, which may lead to a complex illness condition. Several studies have investigated the risk factors for this disorder, including biological and socio-demographic variables, medical and obstetric factors, and psychological and relational dimensions. The present study aimed to describe the psychological status of mothers up to 12 months postpartum, and to investigate the predictors of depressive symptoms at 12 months postpartum, considering obstetric factors along with psychological and relational variables. Methods: A sample of 137 women completed a questionnaire composed of a sheet on anamnestic and obstetric information and the following scales: Wijma Delivery Experience Questionnaire; State-Trait Anxiety Inventory; Edinburgh Postnatal Depression Scale; Parenting Stress Index (Short Form); Dyadic Adjustment Scale; and Multidimensional Scale of Perceived Social Support. Data were collected at four assessment times: 2–3 days, 3 months, 6 months, and 12 months postpartum. Results: Findings showed that the highest percentage of women with clinically significant symptoms of anxiety (state and trait) and depression was found at 12 months postpartum, which indicated that this was the most critical time. The quality of childbirth experience and trait anxiety at three months postpartum emerged as significant predictors of postpartum depression at 12 months. Conclusion: Our findings highlight the importance of providing stable programs (such as educational programs) to mothers in the first year postpartum. Furthermore, because the quality of the childbirth experience is one of the most important predictors of PPD at 12 months postpartum, effort should be made by healthcare professionals to guarantee a positive experience to all women to reduce possible negative long-term consequences of this experience.

The impact of COVID-19 perceived threat and restrictive measures on mental health in Italy, Spain, New York, and Hong Kong: An international multisite study

In the early stages of the COVID-19 pandemic, Italy, Spain, New York, and Hong Kong stood out for the ir high rates of infections. Given this scenario, a web-based international multisite and cross-sectional study was conducted between April and May 2020 to investigate the psychological impact of the pandemic and the restrictions imposed by the governments in these countries. We expected similar patterns in European countries, and no significant differences in terms of psychological impairment between Hong Kong (with a previous experience related to SARS, but subjected to restrictions for a longer time) and the other areas. Participants were 1955 adults from the above-mentioned areas. We assessed anxiety (GAD-7), depression (PHQ-9), COVID-19-related threats, and perceived burden of restrictive measures. Two-explorative factor analyses (EFAs) with Promax rotation identified COVID-19-related factors: personal physical threat, personal economic threat, global economic threat, and restriction-related burden. ANOVAs studied locations' differences and two-separate hierarchical multiple regression analyses by location determined whether and how COVID-19-related variables were associated with anxiety and depression, adjusting for age and sex. Italy and Hong Kong showed higher anxiety than Spain (p < 0.05); Hong Kong scored higher on depression than Italy and Spain (p < 0.001), which highlighted the lowest mean-score. New York participants showed the poorest mental health conditions. Anxiety was predicted by restriction-related burden (β_NY = 0.242; β_HK = 0.116) and personal economic threat (β_NY = 0.246; β_HK = 0.145) in New York (Adj.R ² = 0.125) and Hong Kong (Adj.R ² = 0.079); by global economic threat (β = 0.199) and restriction-related burden (β = 0.124) in Italy (Adj.R ² = 0.108); and by personal physical threat (β = 0.144) in Spain (Adj.R ² = 0.049). Depression was predicted by restriction-related burden (β_NY = 0.313; β_HK = 0.120) and personal economic threat (β_NY = 0.229; β_HK = 0.204) in New York (Adj.R ² = 0.161) and Hong Kong (Adj.R ² = 0.089); by global economic threat (β = 0.209) in Italy (Adj.R ² = 0.149); and no predictors emerged in Spain. Findings could contribute to understanding the specific impact of the pandemic on people's psychological health in each area, along with the factors that impacted mental health. This information may be useful to implementing prevention interventions in case of restrictions.

The Subjective Experience of Dyspareunia in Women with Endometriosis: A Systematic Review with Narrative Synthesis of Qualitative Research

Although dyspareunia (pain during intercourse) is common in women with endometriosis, there is poor qualitative evidence describing women’s subjective experience of this symptom. This systematic review of qualitative research aimed to provide an in-depth exploration of women’s lived experience of dyspareunia (i.e., how they perceive and describe their pain, how they deal with it, how it affects their psychological health and intimate relationships). A total of 17 published articles were included. Our findings, derived from thematic analysis, highlighted that endometriosis-related dyspareunia manifests itself in multiple forms (deep, introital, and/or positional dyspareunia, at orgasm, during and/or after intercourse). Women use a variety of coping strategies to deal with sexual pain, such as interrupting or avoiding intercourse, enduring pain to seek pregnancy, and/or finding alternative ways to enjoy sexuality. Dyspareunia impairs women’s psychological health, especially in terms of poor self-esteem and sense of femininity and has negative consequences on intimate relationships. Unfortunately, both women and physicians are often reluctant to discuss sexual issues. Sexual health should be routinely assessed during counselling with endometriosis patients. Helping women find targeted strategies to enjoy sexuality despite endometriosis may significantly improve their psychological health and quality of life.

Prevalence and health correlates of Onine Fatigue: A cross-sectional study on the Italian academic community during the COVID-19 pandemic

Background

During the COVID-19 pandemic, many people had to shift their social and work life online. A few researchers and journalists described a new form of fatigue associated with a massive use of technology, including videoconferencing platforms. In this study, this type of fatigue was referred to as Online Fatigue. A new tool (the Online Fatigue Scale) was developed, and its psychometric properties were evaluated. This tool was used to assess Online Fatigue among Italian academics and to examine its associations with psychological and physical health.

Methods

An online survey was conducted in December 2020 on a sample of Italian academics. Besides the Online Fatigue Scale (11 items) used to assess Online Fatigue, the survey was composed of questionnaires (including validated measures) focused on sociodemographic and job-related information, technostress creators, health status, psychological well-being, and COVID-related perceived distress. The psychometric properties of the Online Fatigue Scale were evaluated, and statistical analyses were conducted to examine the associations between Online Fatigue and all the other variables.

Results

Participants were 307 academics aged 24–70 years old (mean age = 40.7; SD = 10.1). The Online Fatigue Scale showed good psychometric properties. Two subscales were identified: Off-Balance Fatigue and Virtual Relations Fatigue. High levels of Off-Balance Fatigue were associated with a greater use of technology, female gender, and presence of minor children. Participants with high scores on both subscales reported a greater frequency of psychosomatic symptoms, unhealthy habits, poorer psychological well-being, and greater Covid-related perceived distress.

Conclusions

The Online Fatigue Scale can be considered a reliable tool to assess Online Fatigue, which was significantly detected in our sample of Italian academics, along with its negative effects on physical and psychological health. Being a woman and having young children represent important risk factors. Universities should promote the separation between work and private life by encouraging self-care activities.

Out-of-hospital cardiac arrest and ambient air pollution: a dose-effect relationship and a predictive role in OHCA risk

Background

Pollution has been suggested as a precipitating factor for cardiovascular diseases via a series of different mechanisms. However, data about the link between the different air pollutants and the risk of out-of-hospital cardiac arrest (OHCA) are limited and controversial.

Purpose

The primary aim of this study is to examine the impact of short-term exposure to particulate and gaseous pollutants on the incidence of OHCA in a vast metropolitan and rural area that encompasses four provinces of the Po Valley in Northern Italy, one of the most polluted areas in Italy and Europe due to its levels of industrialization and high population density. The secondary aim of this study is to look for a dose-effect curve, which could help predict OHCA incidence based on the concentration of pollutants in a specific area.

Methods

This is a retrospective analysis of prospectively collected data both in the OHCA registry (Lombardia CARe) and in the database of the regional agency for environmental protection (ARPA) of the Lombardy region. All medical OHCAs and the mean daily concentration of pollutants including fine particulate matter (PM10, PM2.5), benzene (C6H6), carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2) and ozone (O3) were considered from January 1st to December 31st, 2019 in the southern part of the Lombardy region (provinces of Pavia, Lodi, Cremona and Mantua; 7863 km2; about 155ehab724.2654 inhabitants). Days were divided into high or low incidence of OHCA according to the median daily incidence. A Probit dose-response analysis and both uni- and multivariable logistic regression models were provided for each pollutant.

Results

The median daily incidence of OHCA was 0.3 cases/100,000 inhabitants. Benzene was the pollutant with the greatest difference between days at high and low incidence of OHCA [0.7 (IQR 0.4–1.2) vs 0.4 (IQR 0.3–0.7), p&lt;0.001], whereas SO2 had the lowest and least significant difference between the two periods [3.2 (IQR 2.8–3.6) vs 3.1 (IQR 2.7–3.5), p=0.046]. O3 showed a countertrend, being significantly higher in the low-incidence period [29.9 (IQR 10.9–61.7) vs 56.1 (IQR 25.5–74.1), p&lt;0.001] as well as temperature [10.1— (IQR 5.2–14.8) vs 15.1 (IQR 8.9–23.3), p&lt;0.001]. By using the Probit regression analysis and after adjusting for temperature, a dose-response relationship was demonstrated for all the tested pollutants.

Conclusions

Our results clarify the link between pollutants and the acute risk of cardiac arrest suggesting the need of both improving the air quality and integrating pollution data in future models.

Funding Acknowledgement

Type of funding sources: None.

Medical Treatment for Endometriosis: Tolerability, Quality of Life and Adherence

Endometriosis is associated with painful symptoms, infertility, sexological difficulties, and psychological suffering. All these symptoms have a negative impact on the overall quality of life of women with the disease, with significant personal, social and economic costs. Several medical options are available to manage symptomatic endometriosis. The pharmacological treatment for endometriosis-related pain may be necessary for decades, or at least until there is a desire for pregnancy or physiologic menopause occurs. In this perspective, clinicians should consider not only the efficacy, but also side effects, tolerability, and costs, along with women's preferences toward different treatments. In this mini-review, we analyzed the pros and cons of the available drugs for the medical therapy of endometriosis, such as estrogen-progestins, progestins, GnRH agonist and GnRH antagonists.

Sleep disturbances, fatigue and psychological health in women with endometriosis: a matched pair case-control study

RESEARCH QUESTION

What are the associations between endometriosis, pelvic pain symptoms, fatigue and sleep? Psychological health and quality of life in endometriosis patients with good versus bad quality of sleep were also examined.

DESIGN

This matched pair case-control study included 123 consecutive endometriosis patients and 123 women without a history of endometriosis (matched to patients for age and body mass index). Endometriosis-related pelvic pain severity was rated on a 0-10 numerical rating scale. Fatigue was measured on a 1-5 Likert scale. Women also completed a set of self-report questionnaires for assessing sleep disturbances (Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Insomnia Severity Index), psychological health (Hospital Anxiety and Depression Scale) and quality of life (Short Form-12).

RESULTS

Painful endometriosis had an impact on fatigue (P = 0.006; η²_p = 0.041) and sleep (P < 0.001; η²_p = 0.051). Women with painful endometriosis reported significantly greater fatigue, poorer quality of sleep, higher daytime sleepiness and more severe insomnia than women without significant pain symptoms and controls. Poorer quality of sleep among endometriosis patients was associated with greater fatigue (P < 0.001; η²_p = 0.130), poorer psychological health (P < 0.001; η²_p = 0.135), and lower quality of life (P < 0.001; η²_p = 0.240).

CONCLUSIONS

Pelvic pain (rather than endometriosis in itself) is associated with fatigue and sleep disturbances, with poor sleep having a detrimental impact on women's psychological health and quality of life.

Quality of intimate relationships, dyadic coping, and psychological health in women with endometriosis: Results from an online survey

OBJECTIVE

To explore the associations between intimate relationships, psychological health, and endometriosis-related variables such as pelvic pain and infertility.

METHODS

In this cross-sectional study, data were collected with an online survey delivered through Qualtrics and posted on the Facebook page and website of a patient association (Associazione Progetto Endometriosi-APE) in August 2020. The survey was composed of a researcher-made questionnaire and four validated questionnaires assessing relational satisfaction (adapted Quality of Marriage Index), dyadic coping (Dyadic Coping Questionnaire), and psychological health (Hospital Anxiety and Depression Scale and Rosenberg Self-Esteem Scale).

RESULTS

Participants were 316 women (age: 35.9 ± 6.7) with endometriosis, who reported being in an intimate relationship from at least one year. A greater perceived negative impact of the disease on past and current intimate relationships was associated with poorer psychological health, lower relational satisfaction and worse dyadic coping. Women who perceived their partner as more informed about endometriosis, more informed about and interested in their health conditions, and more likely to accompany them to the medical appointments, showed greater relational satisfaction and dyadic coping. Relational satisfaction and dyadic coping were associated with psychological health. A greater perceived negative impact of endometriosis on intimate relationships was associated with more severe pelvic pain (especially dyspareunia).

CONCLUSION

Endometriosis has a negative impact on intimate relationships, which is associated with poorer psychological health. For the women with the disease, partner's support is important, and our findings suggest that effort should be made to involve both members of the couple in multidisciplinary treatment.

"Lights and Shadows": An Interpretative Phenomenological Analysis of the Lived Experience of Being Diagnosed With Breast Cancer During Pregnancy

Cancer diagnosed during pregnancy is a rare event. The most common type of malignancy diagnosed in pregnant women is breast cancer, whose incidence is expected to raise in the next future due to delayed childbirth, as well as to the increased occurrence of the disease at young age. Pregnant women diagnosed with breast cancer are exposed to multiple sources of stress, which may lead to poorer obstetric outcomes, such as preterm birth and low birth weight. In addition, pregnancy involves physiological changes in the breasts that may blur the signs of cancer, with delayed diagnosis and poor prognosis. However, the lived experience of these women was investigated in very few studies. Given this scenario, we conducted this qualitative study to describe and understand women’s subjective experience of being diagnosed with breast cancer during pregnancy. The study was conducted following the principles of Interpretative Phenomenological Analysis. Participants were five women with breast cancer diagnosed during pregnancy, purposefully recruited at a public hospital during medical visits and interviewed at treatment initiation. The interview transcripts were analyzed using thematic analysis. The textual analysis led to the identification of three main themes related to: (1) the emotional storm experienced after cancer diagnosis, and the importance of receiving appropriate information and being focused on treatment decisions; (2) physical changes and comparisons with healthy women, associated with feelings of sadness and inadequacy; (3) being positive, feeling free to disclose all kinds of emotions, religion and spirituality as sources of strength. The paradoxical coexistence of pregnancy and cancer represents a stressful experience for women and their loved ones. Adopting a systemic perspective may be important to understand the effects of such a complex condition, also considering its impact on healthcare workers.

First Case Report of Pregnancy on Alectinib in a Woman With Metastatic ALK-Rearranged Lung Cancer: A Case Report

This is the first case report of a patient with ALK-rearranged metastatic lung adenocarcinoma who became pregnant during treatment with alectinib. A multidisciplinary team of gynecologists, neonatologists, oncologists, psychologists, and pharmacologists was set up to handle the case. According to patient's preference, the study drug was continued throughout pregnancy and the woman delivered a healthy baby girl at 35 weeks and 5 days of gestation. Fetal parameters remained normal during pregnancy. At birth, alectinib levels were 14 times higher in maternal plasma than in the fetus (259 versus 18 ng/mL). The average concentration of alectinib in the placenta was 562 ng/g. The baby was followed during her first 20 months, and no developmental anomalies were observed. After 32 months from diagnosis, the mother is well and in partial remission.

In the Eye of the Covid-19 Storm: A Web-Based Survey of Psychological Distress Among People Living in Lombardy

In March 2020, the World Health Organization announced the Covid-19 outbreak a pandemic and restrictive measures were enacted by the Governments to fight the spread of the virus. In Italy, these measures included a nationwide lockdown, with limited exceptions including grocery shopping, certain work activities, and healthcare. Consistently with findings from previous studies investigating the psychological impact of similar pandemics [e.g., Severe Acute Respiratory Syndrome (SARS)], there is evidence that Covid-19 is associated with negative mental health outcomes. Given this background, we conducted a cross-sectional study aimed at investigating the impact of the Covid-19 pandemic and the subsequent restrictive measures imposed by the Government on the psychological health of Italian men and women aged = 18 years and living in Lombardy, one of the worst-hit regions. The study also aimed at identifying what factors are associated with specific psychological outcomes. Thus, we developed an online survey that included a researcher-made questionnaire to collect sociodemographic, household, general health, and pandemic-related information. The Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9 and the Perceived Stress Scale were used to assess anxiety, depression, and perceived stress, respectively. We found that younger age, greater concerns about the pandemic, female gender, being unmarried, not having children, and being a student were associated with worse psychological health. These findings may provide further insight into the risk factors associated with negative psychological outcomes during the current pandemic, with identification of vulnerable groups. This body of evidence may help professionals implement targeted psychosocial treatment and prevention programs.

Working With Infertile Couples Seeking Assisted Reproduction: An Interpretative Phenomenological Study With Infertility Care Providers

Although most studies investigated the impact of infertility and its treatment on the couple, a small body of evidence suggested that infertility care providers may experience different sources of stress related for instance to excessive workload, the complexity of the technique, and relational difficulties with patients. The current study aimed at providing further insight into the understanding of the subjective experience of infertility care providers by highlighting their feelings and emotions, personal meanings, challenges, and opportunities. Following the methodological guidelines of Interpretative Phenomenological Analysis, we conducted individual semi-structured interviews with 23 members of two different fertility units. Interviews were audiotaped and transcribed verbatim. Textual analysis was then conducted to identify emerging dominant themes and subthemes. Three main themes were extracted: (i) dealing with infertile patients and their specificities, (ii) performing assisted reproductive technology (ART), (iii) being part of a team. These themes related to participants experiencing: (i) difficulties in establishing an empathic connection and communicating with couples, such that women were sometimes perceived as "particular patients" and men as poorly involved in the process; (ii) difficulties in dealing with a complex procedure in which errors are not allowed (as reported by embryologists), with a growing number of women aged > 40 seeking assisted reproduction, despite the risks for their health; (iii) being part of a team as a resource, although the huge amount of time spent together can involve conflicts and organizational problems. These findings suggested that patients' overpersistence (rather than just dropout) represents an important source of stress for infertility care providers. At the same time, the concept of particular or difficult patient derives from the combination of multiple factors, including providers' own history and subjective experience. The presence of mental health professionals in fertility units is essential to help providers improve the quality of doctor-patient communication and relieve the stress related to organizational issues and conflicts.

COVID-19, Lockdown, and Intimate Partner Violence: Some Data from an Italian Service and Suggestions for Future Approaches

Intimate partner violence (IPV)-defined as physical, psychological, sexual, and/or economic violence typically experienced by women at home and perpetrated by their partners or expartners-is a pervasive form of violence that destroys women's feelings of love, trust, and self-esteem, with important negative consequences on physical and psychological health. Many reports from several countries have underlined a remarkable increase in the cases of IPV during the COVID-19 emergency. In this opinion article, we discussed the hypothesis that such an increase may be related to the restrictive measures enacted to contain the pandemic, including women's forced cohabitation with the abusive partner, as well as the exacerbation of partners' pre-existing psychological disorders during the lockdown. In addition, we retrospectively analyzed some data derived from our practice in a public Italian referral center for sexual and domestic violence (Service for Sexual and Domestic Violence [SVSeD]). These data interestingly revealed an opposite trend, that is, a decrease in the number of women who sought assistance since the beginning of the COVID-19 outbreak. Such a reduction should be interpreted as a negative consequence of the pandemic-related restrictive measures. Although necessary, these measures reduced women's possibilities of seeking help from antiviolence centers and/or emergency services. Owing to the COVID-19 outbreak, there is an urgent need for developing and implementing alternative treatment options for IPV victims (such as online and phone counseling and telemedicine), as well as training programs for health care professionals, especially those employed in emergency departments, to facilitate early detection of IPV.

Partners' perspective in endometriosis research and treatment: A systematic review of qualitative and quantitative evidence

OBJECTIVE

To summarize the available qualitative and quantitative evidence regarding the impact of endometriosis on women's partners.

METHODS

A systematic electronic search of PubMed and PsycINFO was conducted. All the available evidence regarding partners' psychological condition, quality of life, social and intimate relationships, and sexuality was included, and a narrative synthesis of the findings was provided.

RESULTS

Of 127 studies retrieved through electronic search, only 5 (3 qualitative/semi-qualitative and 2 quantitative studies) matched the inclusion criteria and were included in our review. In total, participants were 399 male partners. Endometriosis negatively affects partners' psychological wellbeing and quality of life, with significant individual differences. Partners of women with endometriosis may experience isolation and lack of engagement in treatment decision-making. Partners also experience the economic burden of the disease, with negative consequences on work functioning and daily life. Sexuality is also negatively affected, although with contradictory findings. Positive aspects of personal and relationship growth were also reported.

CONCLUSION

Endometriosis is an important cause of physical and psychological pain for women, but it may also have a negative impact on their partners. Although the effects of other chronic diseases on partners and caregivers have been largely explored, the small number of articles included in this review indicates that this topic remains understudied in endometriosis research. Endometriosis should be investigated and managed within a systemic framework, with a specific focus on the complex dynamic interaction between individual, relational, sociocultural and environmental factors.

Infertility-related distress and female sexual function during assisted reproduction

STUDY QUESTION

Is infertility-related distress a risk factor for impaired female sexual function in women undergoing assisted reproduction?

SUMMARY ANSWER

Infertility-related distress, and especially social, sexual, and relationship concerns, is associated with female sexual dysfunction.

WHAT IS KNOWN ALREADY

Women with infertility are more likely to present sexual dysfunction relative to those without infertility. Moreover, assisted reproduction is associated with increased risk for female sexual problems. To date, this higher proportion of sexual impairment in infertile women has been simplistically linked to the stress associated with the condition and investigated risk factors included mainly demographic and clinical variables. Quantitative studies aimed at identifying risk factors for sexual dysfunction that also included the evaluation of infertility-related distress are conversely lacking.

STUDY DESIGN, SIZE, DURATION

This observational study was conducted at the Infertility Unit of the Fondazione Ca' Granda, Ospedale Maggiore Policlinico of Milan between 2017 and 2018.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We included 269 consecutive patients with infertility aged 24-45 (37.8 ± 4.0 years). Sexual function outcomes were sexual dysfunction (assessed with the Female Sexual Function Index), sexual distress (evaluated with the Female Sexual Distress Scale-Revised), dyspareunia, and number of intercourses in the month preceding ovarian stimulation. Infertility-related distress was measured with the Fertility Problem Inventory (FPI). The effects of potential confounders such as demographic variables (women's and partners' age and level of education) and infertility-related factors (type and cause of infertility, number of previous IVF cycles, and duration of infertility) were also examined.

MAIN RESULTS AND THE ROLE OF CHANCE

Women with higher infertility-related distress were more likely to report sexual dysfunction (odds ratio = 1.02 per point of score; 95% CI, 1.01-1.03; P = 0.001). Three FPI domains (i.e. social, relational, and sexual concerns) were correlated with almost all sexual function outcomes (Ps < 0.05).

LIMITATIONS, REASONS FOR CAUTION

Women who were not sexually active were not included, thus reasons for sexual inactivity should be further explored in future studies. Data regarding men (e.g. sexual function and infertility-related distress) were lacking, thus cross-partner effects were not examined. Recall bias (also due to the fact that questionnaires were administered on the day of oocytes retrieval) and social desirability bias may have also affected women's responses to the questionnaires.

WIDER IMPLICATIONS OF THE FINDINGS

Social, relational, and sexual concerns should be assessed and addressed in psychological counselling with the infertile couple.

STUDY FUNDING/COMPETING INTEREST(S)

None.

TRIAL REGISTRATION NUMBER

Not applicable.

Psychological impact and health-related quality-of-life outcomes of Mayer-Rokitansky-Küster-Hauser syndrome: A systematic review and narrative synthesis

Mayer-Rokitansky-Küster-Hauser syndrome causes absence or underdevelopment of uterus and vagina, but women's subjective experience remains understudied. This systematic review was conducted to examine the psychological and health-related quality-of-life outcomes of Mayer-Rokitansky-Küster-Hauser syndrome. In total, 22 articles identified through electronic search matched the inclusion criteria and were included in our review. Mayer-Rokitansky-Küster-Hauser syndrome may be associated with psychological symptoms and impaired quality of life, but especially with poor sexual esteem and genital image. Women may experience difficulties managing intimacy and disclosing to partners. Mothers may be perceived as overinvolved, with consequent negative emotions in women with the disease.

Intracrine Endorphinergic Systems in Modulation of Myocardial Differentiation

A wide variety of peptides not only interact with the cell surface, but govern complex signaling from inside the cell. This has been referred to as an "intracrine" action, and the orchestrating molecules as "intracrines". Here, we review the intracrine action of dynorphin B, a bioactive end-product of the prodynorphin gene, on nuclear opioid receptors and nuclear protein kinase C signaling to stimulate the transcription of a gene program of cardiogenesis. The ability of intracrine dynorphin B to prime the transcription of its own coding gene in isolated nuclei is discussed as a feed-forward loop of gene expression amplification and synchronization. We describe the role of hyaluronan mixed esters of butyric and retinoic acids as synthetic intracrines, controlling prodynorphin gene expression, cardiogenesis, and cardiac repair. We also discuss the increase in prodynorphin gene transcription and intracellular dynorphin B afforded by electromagnetic fields in stem cells, as a mechanism of cardiogenic signaling and enhancement in the yield of stem cell-derived cardiomyocytes. We underline the possibility of using the diffusive features of physical energies to modulate intracrinergic systems without the needs of viral vector-mediated gene transfer technologies, and prompt the exploration of this hypothesis in the near future.

A woman’s worth: The psychological impact of beliefs about motherhood, female identity, and infertility on childless women with endometriosis

In this study, we examined whether beliefs regarding motherhood, female identity, and infertility affected the psychological health of 127 childless endometriosis patients. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale, while self-esteem was assessed using the Rosenberg Self-Esteem Scale. A set of six Likert-type items (1 = “Not at all”; 5 = “To a very great extent”) was developed to explore women’s beliefs. Women who were more likely to believe that childless and infertile women were less appreciated by others reported poorer psychological health. Patients’ beliefs should be explored during psychological counseling. Dysfunctional beliefs about female identity, especially as regards others’ perceptions, should be restructured to improve patients’ psychological health.

Physical energies to the rescue of damaged tissues

Rhythmic oscillatory patterns sustain cellular dynamics, driving the concerted action of regulatory molecules, microtubules, and molecular motors. We describe cellular microtubules as oscillators capable of synchronization and swarming, generating mechanical and electric patterns that impact biomolecular recognition. We consider the biological relevance of seeing the inside of cells populated by a network of molecules that behave as bioelectronic circuits and chromophores. We discuss the novel perspectives disclosed by mechanobiology, bioelectromagnetism, and photobiomodulation, both in term of fundamental basic science and in light of the biomedical implication of using physical energies to govern (stem) cell fate. We focus on the feasibility of exploiting atomic force microscopy and hyperspectral imaging to detect signatures of nanomotions and electromagnetic radiation (light), respectively, generated by the stem cells across the specification of their multilineage repertoire. The chance is reported of using these signatures and the diffusive features of physical waves to direct specifically the differentiation program of stem cells in situ, where they already are resident in all the tissues of the human body. We discuss how this strategy may pave the way to a regenerative and precision medicine without the needs for (stem) cell or tissue transplantation. We describe a novel paradigm based upon boosting our inherent ability for self-healing.

Early Developmental Zebrafish Embryo Extract to Modulate Senescence in Multisource Human Mesenchymal Stem Cells

Stem cells undergo senescence both in vivo, contributing to the progressive decline in self-healing mechanisms, and in vitro during prolonged expansion. Here, we show that an early developmental zebrafish embryo extract (ZF1) could act as a modulator of senescence in human mesenchymal stem cells (hMSCs) isolated from both adult tissues, including adipose tissue (hASCs), bone marrow (hBM-MSCs), dental pulp (hDP-MSCs), and a perinatal tissue such as the Wharton’s Jelly (hWJ-MSCs). In all the investigated hMSCs, ZF1 decreased senescence-associated β-galactosidase (SA β-gal) activity and enhanced the transcription of TERT, encoding the catalytic telomerase core. In addition, it was associated, only in hASCs, with a transcriptional induction of BMI1, a pleiotropic repressor of senescence. In hBM-MSCs, hDP-MSCs, and hWJ-MSCs, TERT over-expression was concomitant with a down-regulation of two repressors of TERT, TP53 (p53), and CDKN1A (p21). Furthermore, ZF1 increased the natural ability of hASCs to perform adipogenesis. These results indicate the chance of using ZF1 to modulate stem cell senescence in a source-related manner, to be potentially used as a tool to affect stem cell senescence in vitro. In addition, its anti-senescence action could also set the basis for future in vivo approaches promoting tissue rejuvenation bypassing stem cell transplantation.

Zebrafish embryo extract counteracts human stem cell senescence

Human adult stem cells hold promise for regenerative medicine. They are usually expanded for multiple passages in vitro to increase cell yield prior to transplantation. Unfortunately, prolonged culture leads to cell senescence, a major drawback from successful outcomes in cell therapy approaches. Here, we show that an extract from early Zebrafish embryo (ZF1) counteracted senescence progression in human adipose-derived stem cells (hASCs) along multiple culture passages (from the 5th to the 20th). Exposure to ZF1 strongly reduced the expression of senescence marker beta-galactosidase. Both stemness (NANOG, OCT4, and MYC) and anti-senescence (BMI1, and telomerase reverse transcriptase - TERT) related genes were overexpressed at specific experimental points, without recruitment of the cyclin-dependent kinase Inhibitor 2A (CDKN2A, ali-as p16). Increased telomerase activity was associatt-ed with TERT overexpression. Both osteogenic and adipogenic abilities were enhanced. In conclusion, hASCs exposure to ZF1 is a feasible tool to counteract and reverse human stem cell senescence in long-term culturing conditions.