The Thyroid Hormone Axis and Female Reproduction.

Thyroid function affects multiple sites of the female hypothalamic-pituitary gonadal (HPG) axis. Disruption of thyroid function has been linked to reproductive dysfunction in women and is associated with menstrual irregularity, infertility, poor pregnancy outcomes, and gynecological conditions such as premature ovarian insufficiency and polycystic ovarian syndrome. Thus, the complex molecular interplay between hormones involved in thyroid and reproductive functions is further compounded by the association of certain common autoimmune states with disorders of the thyroid and the HPG axes. Furthermore, in prepartum and intrapartum states, even relatively minor disruptions have been shown to adversely impact maternal and fetal outcomes, with some differences of opinion in the management of these conditions. In this review, we provide readers with a foundational understanding of the physiology and pathophysiology of thyroid hormone interactions with the female HPG axis. We also share clinical insights into the management of thyroid dysfunction in reproductive-aged women.

Breast Cancer Disparities and the Impact of Geography.

Neighborhood has significant implications for breast cancer screening, stage, treatment, and mortality. Patients residing in neighborhoods with high deprivation or rurality face barriers and challenges to accessing and receiving care. Consequently, they experience higher mortality rates than their financially affluent or urban counterparts. There are multiple gaps in the literature on the relationship between place of residence and the use of systemic therapies or emerging surgical strategies for disease management. As the management of breast cancer continues to evolve, additional studies are needed to understand the implications of place on the implementation and dissemination of new and emerging treatment modalities.

Automated multimodal segmentation of acute ischemic stroke lesions on clinical MR images.

Magnetic resonance (MR) imaging (MRI) is commonly used to diagnose, assess and monitor stroke. Accurate and timely segmentation of stroke lesions provides the anatomico-structural information that can aid physicians in predicting prognosis, as well as in decision making and triaging for various rehabilitation strategies. To segment stroke lesions, MR protocols, including diffusion-weighted imaging (DWI) and T2-weighted fluid attenuated inversion recovery (FLAIR) are often utilized. These imaging sequences are usually acquired with different spatial resolutions due to time constraints. Within the same image, voxels may be anisotropic, with reduced resolution along slice direction for diffusion scans in particular. In this study, we evaluate the ability of 2D and 3D U-Net Convolutional Neural Network (CNN) architectures to segment ischemic stroke lesions using single contrast (DWI) and dual contrast images (T2w FLAIR and DWI). The predicted segmentations correlate with post-stroke motor outcome measured by the National Institutes of Health Stroke Scale (NIHSS) and Fugl-Meyer Upper Extremity (FM-UE) index based on the lesion loads overlapping the corticospinal tracts (CST), which is a neural substrate for motor movement and function. Although the four methods performed similarly, the 2D multimodal U-Net achieved the best results with a mean Dice of 0.737 (95% CI: 0.705, 0.769) and a relatively high correlation between the weighted lesion load and the NIHSS scores (both at baseline and at 90 days). A monotonically constrained quintic polynomial regression yielded R2 = 0.784 and 0.875 for weighted lesion load versus baseline and 90-Days NIHSS respectively, and better corrected Akaike information criterion (AICc) scores than those of the linear regression. In addition, using the quintic polynomial regression model to regress the weighted lesion load to the 90-Days FM-UE score results in an R2 of 0.570 with a better AICc score than that of the linear regression. Our results suggest that the multi-contrast information enhanced the accuracy of the segmentation and the prediction accuracy for upper extremity motor outcomes. Expanding the training dataset to include different types of stroke lesions and more data points will help add a temporal longitudinal aspect and increase the accuracy. Furthermore, adding patient-specific data may improve the inference about the relationship between imaging metrics and functional outcomes.

Human Milk for Vulnerable Infants: Breastfeeding and Milk Sharing Practice among Ghanaian Women.

Human milk has the best impact on childhood survival. In Ghana, it is estimated that 43% of women exclusively breastfeed for 0-5 months and only 42% of breastfeeding mothers continue through 20-23 months. Although the Ghanaian government has implemented policies to facilitate exclusive breastfeeding, substantial gaps to achieve optimal newborn health and wellbeing remain. The purpose of this study was to evaluate breastfeeding prevalence and human milk sharing practices among Ghanaian women. Qualitative responses were received from Ghanaian females (n = 1050). In our sample, 81% indicated they breastfed their children and 8% reported ever sharing breastmilk with another mother. Reasons for sharing milk included (i) insufficient breastmilk production of the recipient mother, and (ii) mother's unavailability prompting women to offer their milk to a crying baby. About 60% of our sample reported that they were not concerned about sharing their milk. Findings present a strong indicator for milk donation towards the establishment of a human milk bank in Ghana. Health promotion efforts should aim at increasing education about the risks involved in milk sharing as well as the benefits of human milk donation through formal and safer channels such as a Human Milk Bank.

Application of magnetically actuated self-clearing catheter for rapid in situ blood clot clearance in hemorrhagic stroke treatment.

Maintaining the patency of indwelling drainage devices is critical in preventing further complications following an intraventricular hemorrhage (IVH) and other chronic disease management. Surgeons often use drainage devices to remove blood and cerebrospinal fluid but these catheters frequently become occluded with hematoma. Using an implantable magnetic microactuator, we created a self-clearing catheter that can generate large enough forces to break down obstructive blood clots by applying time-varying magnetic fields. In a blood-circulating model, our self-clearing catheters demonstrated a > 7x longer functionality than traditional catheters (211 vs. 27 min) and maintained a low pressure for longer periods (239 vs. 79 min). Using a porcine IVH model, the self-clearing catheters showed a greater survival rate than control catheters (86% vs. 0%) over the course of 6 weeks. The treated animals also had significantly smaller ventricle sizes 1 week after implantation compared to the control animals with traditional catheters. Our results suggest that these magnetic microactuator-embedded smart catheters can expedite the removal of blood from the ventricles and potentially improve the outcomes of critical patients suffering from often deadly IVH.

Chronic Stress and Cardiovascular Disease among Individuals Exposed to Lead: A Pilot Study.

Chronic stress and cardiovascular disease risk were explored in a predominately middle-aged adult population exposed to elevated lead levels in this cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) from the period 2007-2010. Elevated lead exposure was defined using the epidemiological threshold of a blood lead level (BLL) > 5 µg/dL as defined by the U.S. Centers for Disease Control and Prevention (CDC). Allostatic load (AL), a measure of chronic stress, was operationalized using 10 clinical markers. The geometric mean values for clinical cardiovascular disease risk markers of interest (a) Gamma glutamyl-transferase (GGT) (a marker of oxidative stress), and (b) non-HDL cholesterol (non-HDL-c) (a marker of cardiovascular disease risk) were explored among lead-exposed and less lead-exposed individuals with differential chronic stress (AL) levels. Associations between AL and GGT/non-HDL-C were analyzed using linear regression models. The likelihood of increased clinical markers in lead-exposed individuals with high compared to low AL was explored using binary logistic regression models. In analyzing lead-exposed as compared to less lead-exposed populations, the geometric mean of the variables of interest showed significant elevations among lead-exposed individuals as compared to less lead-exposed individuals. Simple linear regression revealed that AL was positively associated with the variables of interest among the lead-exposed. In binary logistic regression among the lead-exposed, those with high AL, as compared to those with low AL, had significantly higher odds of having elevated non-HDL-C. This study submits that those exposed to lead with increasing AL may experience adverse cardiovascular health outcomes.

Blood Pressure and Oxidative Stress among U.S. Adults Exposed to Lead in Military Environments-A Preliminary Study.

In this cross-sectional study, lead exposure among those with a history in military environments was examined. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) are clinical markers of blood pressure, while gamma-glutamyl transferase (GGT) is a marker of oxidative stress. These markers and their effects on those exposed to military environments were explored using National Health and Nutrition Examination Survey (NHANES) data from 2009 to 2016. Mean SBP and GGT were significantly elevated in those exposed to military environments, with a moderately significant association existing between blood lead levels (BLLs) and SBP. More attention must be given to lead exposure in military environments to mitigate the risk of exposure.