In the thicket of fears, doubts, and murky facts: some reflections on treatment modalities for endometriosis-associated pain.

Endometriosis-associated pain can be managed by either surgery or hormonal therapy. The final decision as to which treatment modality to take is based on efficacy and possible complications of different treatment modalities, risk of recurrence, and the patient's wishes and preferences. But in the thicket of fears, doubts, and murky facts, the choice may ultimately be the trade-off between irrational fears and ignorance versus scientific evidence. We elaborate some pros and cons of the two treatment modalities and highlight some notable downsides of hormonal therapy, in particular the possible yet unquantified risk of long-term hormonal therapy for malignant transformation, perhaps with the only exception of combined oral contraceptives. Thus, when discussing with patients, we advocate the approach of discussing the advantages and disadvantages of all treatment options in detail, accounting for the known pros and cons with a full understanding of the predictive irrationality of human beings. For endometriosis-associated pain, surgery is definitely not a failure of medicine but, rather, a viable option, especially given the recently surfaced undercurrent of wariness and dissatisfaction with the current hormonal drugs among patients with endometriosis. Above all, there is a pressing need to fill the knowledge gap of perioperative interventions intended to reduce the risk of recurrence and to fulfill the demand for the development of safe and efficacious non-hormonal therapeutics.

Issues in transgender dermatology: A systematic review of the literature.

BACKGROUND: Transgender patients have many unique dermatologic needs, yet the literature concerning dermatologic care of transgender individuals is lacking. OBJECTIVE: We aimed to provide a systematic review of the literature on dermatology care in transgender individuals to provide a foundation for future research and education. METHODS: We systematically reviewed peer-reviewed published studies that examined dermatologic treatment of transgender patients. RESULTS: A total of 110 articles met the inclusion criteria for systematic review. LIMITATIONS: Because of a lack of quantitative research in transgender dermatology, much of the available literature included in this review relies on case reports and expert opinions. CONCLUSION: Dermatologists have the ability to greatly affect the care of transgender patients, and there are ample opportunities for dermatologists to expand the literature pertaining to this population.

Effects of gonadal hormones on cognitive behaviour in elderly men and women.

Over the last four decades, animal and cell culture studies have shown that sex steroids can have protective effects on the ageing brain. Limited short-term positive effects (2-4 months) of oestrogen treatment were found in women without (as well as with) dementia. By contrast to these initial promising findings, several large treatment studies showed that longer-term oestrogen treatment, particularly when given in combination with progesterone, could exert negative effects on cognitive function in women aged over 65 years. Several observational studies of older women and men also suggest that longer exposure to higher endogenous oestrogen levels at an older age might confer risk for accelerated cognitive decline and dementia. However, health of participants may modify this association and, in women closer to the age at the onset of menopause, positive associations of oestrogens with cognition were also found. The 'healthy cell bias' theory suggests that oestrogens have protective effects in healthy neurones, although cells undergoing pathological change show acceleration in their demise when exposed to oestrogens. In older men, most studies reported higher bioavailable testosterone levels to be associated with better cognitive function. Other studies have reported optimal testosterone levels for better global cognitive function and a reduced risk of cognitive decline. Variation in health status over time and the use of (in)sensitive cognitive tests and hormone assays may explain why this was not always found. In older women, this association (of testosterone with cognition) is less clear. Small studies reported some benefits of testosterone treatment in combination with oestrogen on cognition, although these were of short duration. Several observational studies, on the other hand, found negative associations between high testosterone levels and worse cognitive function in older women. Age, health status, duration of treatment and sex may thus modify effects of longer-term elevated sex steroid levels on brain function.

[Exacerbations of asthma--precipitating factors: drugs]. / Facteurs déclenchants : médicaments.

Asthmatic exacerbations are sometimes triggered by medications, primarily the non-steroidal anti-inflammatory agents (NSAIDS) and beta-blockers. Asthma attacks induced by NSAIDS occur rapidly and can be severe. Widal syndrome is a specific disease entity whose physiopathology remains incompletely explained. Asthma is characteristically severe and steroid dependent; desensitisation with aspirin has been proposed, but this remains controversial. Beta-blockers are contra-indicated in asthma; the ß1 "cardioselectivity" of some agents is not absolute, disappearing at high doses and the "partial agonists" are not better tolerated. However, certain authors have called into question the harmful effect of beta-blockade in moderate and stable asthma. More studies are needed, but the current data suggest that in some cases beta-blockers may be safe but their use requires close supervision. Other molecules can pose problems in asthmatics (dipyridamole, synthetic sex hormones and certain excipients). On the whole, there has been little innovation concerning the hazard that drugs can pose for some asthmatics. The task for the future will be to specify the physiopathology of Widal syndrome, and to clarify the categories of patients in whom beta-blockers can be safely employed as the public health consequences of cardiovascular pathologies make this an important issue for lung specialists.

Long-term deprivation of gonadal hormone accelerates brain aging in mice.

OBJECTIVE: The purpose of this study was to assess the effect of long-term deprivation of gonadal hormone on brain aging in mice to develop a model of gonadectomy-accelerated brain aging. METHODS: Male and female mice at 2 months old were orchiectomized (ORX) or ovarectomized (OVX) bilaterally or sham operated, and then they were fed for 10 months. The spatial learning and memory ability was tested using Morris Water Maze. The biomarkers of brain neuropathology were examined by Western blotting and immunohistochemistry. RESULTS: Ovarectomy mildly impaired spatial learning and memory of mice, while the impairment in ORX-mice was not significant. The amount of Nissl bodies decreased in the hippocampus and cortex of gonadectomied mice. The expression of beta-amyloid (Aß), beta-site APP cleaving enzyme 1 and phosphorylated-Tau increased in gonadectomied mice. Nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) decreased in the brain of OVX-mice, but neurotrophin-3 (NT-3) showed no change. We detected no decrease of NGF, BDNF or NT-3 in ORX-mice. TrkA expression decreased and p75(NTR) increased in the brain of gonadectomied mice. In all the above tests, there were no significant differences between young (2 months old) and sham operated (12 months old) mice. Alternations in the brain aging parameters were more obvious in OVX-mice than in ORX-mice. CONCLUSION: Long-term gonadal hormone deprivation by young-age gonadectomy accelerated mouse brain aging, which could serve as a valuable mouse model to study brain aging and aging-related pathological changes.