ABSTRACT
CONTEXT: Polycystic ovary syndrome (PCOS) is associated with disordered eating/eating disorders, but prior meta-analyses are limited by small numbers. OBJECTIVE: To inform the 2023 International PCOS Guideline, we performed a systematic review and meta-analysis evaluating the prevalence of disordered eating/eating disorders among women with and without PCOS. METHODS: Ovid MEDLINE, EMBASE, PsycInfo, and All EMB were searched from inception through February 1, 2024, for studies that compared prevalences of eating disordered/disordered eating in adolescent or adult women. Random effects meta-analyses were used to estimate the pooled odds ratios (OR) or standardized mean differences (SMD) of outcomes in women with PCOS compared to controls. Methodological quality was assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system, and included studies were assessed for risk of bias. RESULTS: Of 1352 articles identified, 20 were included, with a total of 28 922 women with PCOS and 258 619 controls. Individuals with PCOS had higher odds of any eating disorder (OR: 1.53 [1.29, 1.82], 8 studies), which persisted in studies where PCOS was diagnosed by Rotterdam criteria (OR: 2.88 [1.55, 5.34], 4 studies). Odds of bulimia nervosa, binge eating disorder, and disordered eating, but not anorexia nervosa, were increased in PCOS. Mean disordered eating scores were higher in PCOS (SMD: 0.52 [0.28, 0.77], 13 studies), including when stratified by normal and higher weight body mass index. Most included studies were of moderate quality, with no evidence of publication bias. CONCLUSION: Our study informs the 2023 PCOS Guideline recommendations for consideration of the risk of disordered eating/ eating disorders in care of women with PCOS, regardless of weight, especially during providing lifestyle counseling.
ABSTRACT
C-terminal cleaved tau at D421 (∆D421-tau) accumulates in the brains of Alzheimer's disease (AD) patients. However, it is unclear how tau truncation, an understudied tau post-translational modification, contributes to AD pathology and progression. Utilizing an adeno-associated virus (AAV) gene delivery-based approach, we overexpressed full-length tau (FL-tau) and ∆D421-tau in 4- and 12-month-old mice for 4 months to study the neuropathological impact of accumulation in young adult (8-month) and middle-aged (16-month) mice. Overall, we show that independent of the tau species, age was an important factor facilitating tau phosphorylation, oligomer formation, and deposition into silver-positive tangles. However, mice overexpressing ∆D421-tau exhibited a distinct phosphorylation profile to those overexpressing FL-tau and increased tau oligomerization in the middle-age group. Importantly, overexpression of ∆D421-tau, but not FL-tau in middle-aged mice, resulted in pronounced cognitive impairments and hippocampal long-term potentiation deficits. While both FL-tau and ∆D421-tau induced neuronal loss in mice with age, ∆D421-tau led to significant neuronal loss in the CA3 area of the hippocampus and medial entorhinal cortex compared to FL-tau. Based on our data, we conclude that age increases the susceptibility to neuronal degeneration associated with ΔD421-tau accumulation. Our findings suggest that ΔD421-tau accumulation contributes to synaptic plasticity and cognitive deficits, thus representing a potential target for tau-associated pathologies.
Subject(s)
Alzheimer Disease , Cognitive Dysfunction , Alzheimer Disease/genetics , Animals , Cognition , Cognitive Dysfunction/pathology , Humans , Mice , Mice, Inbred C57BL , Neuronal PlasticityABSTRACT
BACKGROUND: Morcellation at the time of minimally invasive hysterectomy or myomectomy for presumed benign indications carries a risk of disseminating undiagnosed uterine malignancies. CASE: A 57-year-old woman with a remote history of laparoscopic hysterectomy with morcellation of a cellular leiomyoma presented with a newly diagnosed complex pelvic mass. Owing to adherence of the mass to the rectum and numerous peritoneal tumor implants, a surgical cytoreductive procedure was performed. The pelvic mass, implants, and original hysterectomy specimen were histologically identical and consistent with low-grade endometrial stromal sarcoma. Owing to lack of tumor-myometrial interface on the original morcellated specimen, this malignant diagnosis was not made at the time of hysterectomy. CONCLUSION: Morcellation of the uterus can hinder an accurate pathologic diagnosis of uterine stromal neoplasms.
Subject(s)
Endometrial Neoplasms/diagnosis , Hysterectomy/methods , Morcellation/methods , Sarcoma, Endometrial Stromal/diagnosis , Endometrial Neoplasms/pathology , Endometrial Neoplasms/surgery , Female , Humans , Hysterectomy/adverse effects , Laparoscopy/methods , Leiomyoma/surgery , Magnetic Resonance Imaging , Middle Aged , Morcellation/adverse effects , Sarcoma, Endometrial Stromal/pathology , Sarcoma, Endometrial Stromal/surgery , Uterine Myomectomy/methods , Uterine Neoplasms/surgery , Uterus/pathologyABSTRACT
BACKGROUND: Social determinants of health are known to contribute to disparities in health outcomes. Routine screening for basic social needs is not a part of standard care; however, the association of those needs with increased healthcare utilization and poor compliance with guideline-directed care is well established. OBJECTIVE: In this study, we aimed to assess the prevalence of basic social resource needs identified through a quality improvement initiative in a gynecologic oncology outpatient clinic. In addition, we aimed to identify clinical and demographic factors associated with having basic social resource needs. STUDY DESIGN: We performed a prospective cohort study of women presenting to a gynecologic oncology clinic at an urban academic institution who were screened for basic social resource needs as part of a quality improvement initiative from July 2017 to May 2018. The following 8 domains of resource needs were assessed: food insecurity, housing insecurity, utility needs, financial strain, transportation, childcare, household items, and difficulty reading hospital materials. Women with needs were referred to resources to address those needs. Demographic and clinical information were collected for each patient. The prevalence of needs and successful follow-up interventions were calculated. Patient factors independently associated with having at least 1 basic social resource need were identified using multivariable Poisson regression. RESULTS: A total of 752 women were screened in the study period, of whom 274 (36%) reported 1 or more basic social resource need, with a median of 1 (range, 1-7) need. Financial strain was the most commonly reported need (171 of 752, 23%), followed by transportation (119 of 752, 16%), difficulty reading hospital materials (54 of 752, 7%), housing insecurity (31 of 752, 4%), food insecurity (28 of 752, 4%), household items (22 of 752, 3%), childcare (15 of 752, 2%), and utility needs (13 of 752, 2%). On multivariable analysis, independent factors associated with having at least 1 basic social resource need were being single, divorced or widowed, nonwhite race, current smoker, nonprivate insurance, and a history of anxiety or depression. A total of 36 of 274 (13%) women who screened positive requested assistance and were referred to resources to address those needs. Of the 36 women, 25 (69%) successfully accessed a resource or felt equipped to address their needs, 9 (25%) could not be reached despite repeated attempts, and 2 (6%) declined assistance. CONCLUSION: Basic social resource needs are prevalent in women presenting to an urban academic gynecologic oncology clinic and can be identified and addressed through routine screening. To help mitigate ongoing disparities in this population, screening for and addressing basic social resource needs should be incorporated into routine comprehensive care in gynecologic oncology clinics.
Subject(s)
Economic Status/statistics & numerical data , Food Supply/statistics & numerical data , Gynecology , Housing/statistics & numerical data , Medical Oncology , Needs Assessment , Quality Improvement , Social Determinants of Health , Academic Medical Centers , Adult , Aged , Ambulatory Care , Child , Child Care/statistics & numerical data , Clothing/statistics & numerical data , Ethnicity/statistics & numerical data , Female , Genital Neoplasms, Female/diagnosis , Genital Neoplasms, Female/therapy , Hospitals, Urban , Household Articles/statistics & numerical data , Humans , Insurance, Health/statistics & numerical data , Literacy/statistics & numerical data , Marital Status/statistics & numerical data , Mass Screening , Middle Aged , Prospective Studies , Smoking/epidemiology , Transportation/statistics & numerical dataABSTRACT
Alzheimer's disease (AD) includes several hallmarks comprised of amyloid-ß (Aß) deposition, tau neuropathology, inflammation, and memory impairment. Brain metabolism becomes uncoupled due to aging and other AD risk factors, which ultimately lead to impaired protein clearance and aggregation. Increasing evidence indicates a role of arginine metabolism in AD, where arginases are key enzymes in neurons and glia capable of depleting arginine and producing ornithine and polyamines. However, currently, it remains unknown if the reduction of arginase 1 (Arg1) in myeloid cell impacts amyloidosis. Herein, we produced haploinsufficiency of Arg1 by the hemizygous deletion in myeloid cells using Arg1fl/fl and LysMcreTg/+ mice crossed with APP Tg2576 mice. Our data indicated that Arg1 haploinsufficiency promoted Aß deposition, exacerbated some behavioral impairment, and decreased components of Ragulator-Rag complex involved in mechanistic target of rapamycin complex 1 (mTORC1) signaling and autophagy. Additionally, Arg1 repression and arginine supplementation both impaired microglial phagocytosis in vitro. These data suggest that proper function of Arg1 and arginine metabolism in myeloid cells remains essential to restrict amyloidosis.