Lipidomic analysis of mussel hemocytes exposed to polystyrene nanoplastics.

Plastics production and usage has exponentially increased in the last decades around the world. Due to the insufficient waste management, a significant amount of plastic ends up in the environment, where they tend to fragment into micro- and nano-plastics (NPs), and accumulate in aquatic organisms with still unknown effects. Although studies have indicated that lipid metabolism is a main target of NPs, this mechanism has not been extensively explored. In this study, we evaluated changes in the lipidome of mussel hemocytes after exposure to polystyrene (PS) NPs of 50 and 500 nm, at two different concentrations (106 and 109 particles/mL) for 24 h. The lipidome of hemocytes, analyzed by FIA-ESI (±) Orbitrap, was characterized by a relatively high abundance of cholesteryl esters (CEs) and phosphatidylcholine-plasmalogens (PC-Os/PC-Ps), involved in cell's defense against oxidative stress and membrane reorganization. In hemocytes exposed to PS NPs, a number of highly unsaturated membrane lipids were down-regulated, indicating a reorganization of the cell membranes after exposure to the particles and an oxidation of lipids with a high number of double bonds. This reduction was more evident after exposure to 50 nm NPs -both concentrations- and 500 nm NPs -high concentration-. The analysis of culture medium suggested increased release of vesicles enriched in triglycerides (TGs). The relevance of these responses to NP exposure on the immune function of hemocytes remains to be investigated.

A double-blind, randomized prospective study evaluating topical clobetasol propionate 0.05% versus topical tacrolimus 0.1% in patients with vulvar lichen sclerosus.

BACKGROUND: Vulvar lichen sclerosus is a chronic condition usually responsive to topical corticosteroids. OBJECTIVE: We sought to evaluate the efficacy (reduction of signs and symptoms) and safety of clobetasol propionate 0.05% and tacrolimus 0.1% in the treatment of vulvar lichen sclerosus. METHOD: This double-blind, randomized study comparing 2 treatments over a 3-month period, enrolled 58 female patients with newly diagnosed vulvar lichen sclerosus or untreated vulvar lichen sclerosus for at least 1 month. RESULTS: In all, 55 patients were included in the statistical analysis. A total of 28 patients were assigned to the tacrolimus group and 27 patients to the clobetasol group. Both groups showed a significant difference in the decrease of symptoms and signs of lichen sclerosus. At the end of the study, 28 participants (19 tacrolimus and 9 clobetasol) still had some clinical signs of lichen sclerosus (χ(2) = 6.56, P = .015). However, a significantly higher number of patients in the clobetasol group (n = 15) had absence of signs and symptoms of lichen sclerosus (χ(2) = 10.35, P = .002; χ(2) = 10.35, P = .002). No adverse events were reported. LIMITATIONS: Short length of trial and recruitment through our vulvar disease referral center are limitations. CONCLUSION: This study showed that topical clobetasol propionate was significantly more effective in treating vulvar lichen sclerosus than topical tacrolimus.

Evaluating the toxicity of estetrol, 17α-ethinylestradiol, and their combination with drospirenone on zebrafish larvae: A behavioural and proteomic study.

OBJECTIVE: To characterise and compare the toxicity of estetrol (E4) and 17α-ethinylestradiol (EE2), and their respective mixture with the progestin drospirenone (DRSP) in zebrafish (Danio rerio) embryos. METHODS: Zebrafish embryos were exposed to E4, EE2, DRSP, E4+DRSP, and EE2+DRSP in a fish embryo acute toxicity (FET) test. A second test examined behavioural responses and, using label-free proteomics, identified changes in protein expression in response to hormonal treatments, across a range of concentrations, including those that are considered to be environmentally relevant. RESULTS: In the FET test, no effects were found from E4 at concentrations ≤100 mg/L, while EE2 induced mortality and morphological abnormalities at concentrations of 1-2 mg/L. In the behavioural test, exposure to 30 ng/L EE2 (∼200 × predicted environmental concentration - PEC) resulted in hypoactivity in fish larvae and exposure to 0.3 ng/L EE2 (∼2 × PEC) led to quantitative changes in protein abundance, revealing potential impacts on RNA processing and protein synthesis machinery. Exposure to E4 did not alter behaviour, but several groups of proteins were modulated, mainly at 710 ng/L (∼200 × PEC), including proteins involved in oxidative phosphorylation. When combined with DRSP, EE2 induced reduced effects on behaviour and proteomic responses, suggesting an antagonistic effect of DRSP. E4+DRSP induced no significant effects on behaviour or proteomic profiles at tested concentrations. CONCLUSIONS: These findings suggest that E4-based combined oral contraceptives present a more favourable environmental profile than EE2-based contraceptives, particularly during the early developmental stages of fish.

Estetrol/drospirenone versus 17α-ethinylestradiol/drospirenone: An extended one generation test to evaluate the endocrine disruption potential on zebrafish (Danio rerio).

Combined oral contraceptives, comprising of both an oestrogen and a progestin component, are released in aquatic environments and potentially pose a risk to aquatic wildlife by their capacity to disrupt physiological mechanisms. In this study, the endocrine disruptive potential of two mixtures, 17α-ethinylestradiol (EE2), a synthetic oestrogen, or estetrol (E4), a natural oestrogen, with the progestin drospirenone (DRSP) have been characterised in three generations of zebrafish, according to an adapted Medaka Extended One Generation Reproduction Test. Zebrafish (Danio rerio) were exposed to a range of concentrations of EE2/DRSP and E4/DRSP (∼1×, ∼3×, ∼10× and ∼30× predicted environmental concentration, PEC). Survival, growth, hatching success, fecundity, fertilisation success, vitellogenin (VTG), gonad histopathology, sex differentiation, and transcriptional analysis of genes related to gonadal sex steroid hormones synthesis were assessed. In the F0 generation, exposure to EE2/DRSP at ∼10 and ∼30× PEC decreased fecundity and increased male VTG concentrations. The highest concentration of EE2/DRSP also affected VTG concentrations in female zebrafish and the expression of genes implicated in steroid hormones synthesis. In the F1 generation, sex determination was impaired in fish exposed to EE2/DRSP at concentrations as low as ∼3× PEC. Decreased fecundity and fertility, and abnormal gonadal histopathology were also observed. No effects were observed in the F2 generation. In contrast, E4/DRSP induced only minor histopathological changes and an increase in the proportion of males, at the highest concentration tested (∼30× PEC) in the F1 generation and had no effect on hatching success of F2 generation. Overall, this study suggests that the combination E4/DRSP has a more favourable environmental profile than EE2/DRSP.

Estetrol has a lower impact than 17α-ethinylestradiol on the reproductive capacity of zebrafish (Danio rerio).

Natural and synthetic oestrogens are commonly found in aquatic ecosystems. The synthetic oestrogen 17α-ethinylestradiol (EE2) is widely used in oral contraceptives and its ecotoxicological effects on aquatic organisms have been widely reported. The natural oestrogen estetrol (E4) was recently approved for use in a new combined oral contraceptive and, after therapeutic use, is likely to be found in the aquatic environment. However, its potential effects on non-target species such as fish is unknown. In order to characterize and compare the endocrine disruptive potential of E4 with EE2, zebrafish (Danio rerio) were exposed to E4 or EE2 in a fish short-term reproduction assay conducted according to OECD Test Guideline 229. Sexually mature male and female fish were exposed to a range of concentrations, including environmentally relevant concentrations of E4 and EE2, for 21 days. Endpoints included fecundity, fertilization success, gonad histopathology, head/tail vitellogenin concentrations, as well as transcriptional analysis of genes related to ovarian sex steroid hormones synthesis. Our data confirmed the strong impact of EE2 on several parameters including an inhibition of fecundity, an induction of vitellogenin both in male and female fish, an alteration of gonadal structures and the modulation of genes involved in sex steroid hormone synthesis in female fish. In contrast, only few significant effects were observed with E4 with no impact on fecundity. The results suggest that the natural oestrogen, E4, presents a more favorable environmental profile than EE2 and is less likely to affect fish reproductive capacity.

Biopsychosocial predictors of postmenopausal dyspareunia: the role of steroid hormones, vulvovaginal atrophy, cognitive-emotional factors, and dyadic adjustment.

INTRODUCTION: Although dyspareunia experienced after menopause is widely attributed to declining estrogen levels and vulvovaginal atrophy, critical reviews of the literature have suggested that these factors are incomplete as explanatory mechanisms. Little is known about psychosocial factors that may also be implicated in postmenopausal dyspareunic pain. AIM: To determine the extent to which levels of estrogens and progesterone, vulvovaginal atrophy, cognitive-emotional factors, and dyadic adjustment are predictive of postmenopausal dyspareunic pain intensity. METHODS: A total of 182 postmenopausal dyspareunia sufferers underwent a structured interview concerning sociodemographic status as well as medical and pain histories, gynecological examination, cytological evaluation, a blood draw, and answered a series of self-report questionnaires. Given the large number of genital and pelvic pain variables measured, a principal components analysis was undertaken to identify a smaller number of components representing meaningful dimensions of genital and pelvic pain. MAIN OUTCOME MEASURES: Pain severity ratings during intercourse were obtained using the McGill Pain Questionnaire. Pain ratings were also obtained during gynecological assessment. Serum estrone, estradiol, and progesterone levels were measured via immunoassay. The Vaginal Atrophy Index and maturation value were used to determine vulvovaginal atrophy severity. Participants completed the Pain Catastrophizing Scale, State-Trait Anxiety Inventory, The Beck Depression Inventory-II, and Dyadic Adjustment Scale. RESULTS: Hormone levels were not found to be consistent predictors of pain severity. Maturation value and cognitive-emotional variables (e.g., catastrophization, depression, anxiety) were significant predictors of vestibular pain, which affected over 90% of our sample. Relationship adjustment variables were inversely associated with pain severity within several genital locations. CONCLUSIONS: Results suggest that the traditional hypoestrogen and vulvovaginal atrophy conceptualization of postmenopausal dyspareunia is an insufficient explanatory model, and that pain is also influenced by cognitive, affective, and dyadic factors.

Challenging atrophied perspectives on postmenopausal dyspareunia: a systematic description and synthesis of clinical pain characteristics.

This study investigated the clinical attributes of postmenopausal dyspareunia. The authors obtained a systematic description of pain symptomatology from 182 postmenopausal dyspareunia sufferers using a structured interview, quantitative sensory testing, a standardized pain measure, and gynecological examination. The authors conducted a cluster analysis to examine whether sufferers could be categorized using clinical pain and gynecological factors. The authors delineated 6 subgroups, each exhibiting distinct combinations of pain and gynecological characteristics. The results support the hypothesis that, similarly to premenopausal dyspareunia, postmenopausal dyspareunia is a heterogeneous condition.

Impact of labor at prior cesarean on lower uterine segment thickness in subsequent pregnancy.

OBJECTIVE: The objective of the study was to identify the factors associated with sonographic lower uterine segment (LUS) thickness near term in women with prior low transverse cesarean. STUDY DESIGN: A prospective cohort study of women with a single prior low transverse cesarean was conducted. LUS thickness was quantified by transabdominal ultrasound with repeated transvaginal measurement when necessary. The thinnest measurement was considered as the dependent variable. Potential related factors were evaluated with nonparametric analyses and multivariate logistic regressions. RESULTS: Two hundred thirty-five women were recruited at a mean gestational age of 36.7 +/- 1.3 weeks. The full LUS was thicker in women who had their previous cesarean during the latent phase (2.8 mm; interquartile [IQ], 2.0-3.3 mm) or the active phase of labor (3.1 mm; IQ 2.5-3.9 mm) than in women with previous cesarean prior to labor (2.4 mm; IQ 2.0-3.2 mm). The association remained significant after adjustment for potential confounders. CONCLUSION: Presence of labor at previous cesarean is associated with a thicker LUS in a subsequent pregnancy.

Asymptomatic endometrial thickening.

OBJECTIVE: To formulate clinical recommendations for the assessment of endometrial thickening when it is found on ultrasound in a postmenopausal patient without bleeding. OUTCOMES: Ensure that women with asymptomatic thickening and endometrial polyps found on ultrasound are managed appropriately. EVIDENCE: Published literature was retrieved through searches of English language articles from the EMBASE, Cochrane, and PubMed databases for relevant peer-reviewed articles dating from 1970 to 2009, using appropriate controlled vocabulary (e.g., "asymptomatic endometrial thickness," "endometrial cancer," "postmenopausal bleeding," "transvaginal ultrasonography," "endometrial biopsy" and "endometrial polyp"). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Searches were updated on a regular basis and incorporated in the guideline to April 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES: The level of evidence was determined according to the criteria established by the Canadian Task Force on Preventative Health Care (Table). Recommendations are ranked according to this method. BENEFITS, HARMS, AND COSTS: It is anticipated that the adoption of these recommendations would save postmenopausal women unnecessary anxiety, pain, and risk of procedural complication. It is also expected to decrease the cost to the health system by eliminating unnecessary interventions.

Impact of chromic catgut versus polyglactin 910 versus fast-absorbing polyglactin 910 sutures for perineal repair: a randomized, controlled trial.

OBJECTIVE: The goal of our study was to compare the impact of 3 suture materials on perineal pain and on resumption of sexual intercourse. STUDY DESIGN: This randomized, controlled trial compared 3 types of suture materials (chromic catgut, polyglactin 910, fast-absorbing polyglactin 910) for second-degree perineal laceration or uncomplicated episiotomy. Patients were enrolled in early labor and assigned randomly to 1 of the 3 suture materials. Pain was evaluated at 48 hours, 6 weeks, and 3 months. The study subjects were questioned about residual perineal pain, resumption of sexual activity, and pain-free sexual intercourse. Logistic regression analyses were undertaken. RESULTS: Of the 192 patients who were assigned randomly to groups, 66 patients had their perineal laceration repaired with chromic catgut; 60 patients had repair with polyglactin 910, and 66 patients had repair with fast-absorbing polyglactin 910. At 48 hours, there was no significant difference according to the pain measurement scores, but the median consumption of analgesics was significantly lower with fast-absorbing polyglactin 910 than with standard polyglactin 910. There was no difference in the resumption of sexual intercourse at 6 weeks after the delivery between chromic catgut (42%) compared with standard polyglactin 910 group (56%; P = .23). However, it was more frequent for women in the fast-absorbing polyglactin 910 group (66%; P = .02). After adjustment for confounding variables, perineal repair with fast-absorbing polyglactin 910 was associated with a higher rate of sexual intercourse (odds ratio, 2.55; 95% CI, 1.07-6.10) and a higher rate of pain-free sexual intercourse (odds ratio, 2.51; 95% CI, 1.03-6.10) at 6 weeks after delivery. CONCLUSION: Fast-absorbing polyglactin 910 for perineal repair is associated with earlier resumption of sexual intercourse when compared with chromic catgut.

SOGC clinical practice guidelines: Adhesion prevention in gynaecological surgery: no. 243, June 2010.

OBJECTIVES: To review the etiology and incidence of and associative factors in the formation of adhesions following gynaecological surgery. To review evidence for the use of available means of adhesion prevention following gynaecological surgery. OPTIONS: Women undergoing pelvic surgery are at risk of developing abdominal and/or pelvic adhesive disease postoperatively. Surgical technique and commercial adhesion prevention systems may decrease the risk of postoperative adhesion formation. OUTCOMES: The outcomes measured are the incidence of postoperative adhesions, complications related to the formation of adhesions, and further intervention relative to adhesive disease. EVIDENCE: Medline, EMBASE, and The Cochrane Library were searched for articles published in English from 1990 to March 2009, using appropriate controlled vocabulary and key words. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, cohort studies, and meta-analyses specifically addressing postoperative adhesions, adhesion prevention, and adhesive barriers. Searches were updated on a regular basis and incorporated in the guideline to March 2009. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care.