Global view of vasomotor symptoms and sleep disturbance in menopause: a systematic review.

Studies have shown racial/ethnic differences in the prevalence of vasomotor symptoms (VMS), sleep disturbance and VMS treatment in menopause. To assess the reproducibility of these differences, we systematically reviewed observational studies, published in 2000-2021, reporting the prevalence/incidence of VMS, sleep disturbance or treatment use in menopausal women stratified by race/ethnicity. We screened 3799 records from PubMed and Embase and included 27 papers (19 studies). No incidence data were found. Prevalence data varied widely, but some common patterns emerged. In all five studies comparing VMS between Black women and White, Hispanic and/or East Asian women, the prevalence was highest in Black women and lowest in East Asian women. The prevalence of sleep disturbance overall was compared among Black, White and East Asian women in two study populations, and was highest in White women in both papers. Sleep disturbance was more common than VMS in East Asian women. In all four studies comparing hormone therapy use between White women and Black and/or East Asian women, treatment use was more common in White women. These results highlight the need for individualized counseling and treatment, outreach to under-served minorities, and standardized definitions and outcome measures for VMS and sleep disturbance for future studies.

Development of a novel immobilisation protocol for black-faced impala (Aepyceros melampus ssp. petersi) in Etosha National Park.

Black-faced impala (Aepyceros melampus ssp. petersi) are endemic to Namibia where conservation management involves immobilisation and translocation, and mortality with current protocols is common. Critically evaluated field immobilisation protocols are needed to maximise animal safety. This prospective study was done in two phases: the first compared etorphine- and thiafentanil-based combinations, the second evaluated the influence of oxygen in impala receiving the thiafentanil-based combination. Animals (10 per group) received 50 mg ketamine (K) and 10 mg butorphanol (B), with either 2.0 mg etorphine (E) or 2.0 mg thiafentanil (T). A third group of ten impala were anaesthetised using TKB with supplemental nasal oxygen (O) at a rate of 5 L/minute. Behavioural, metabolic and physiological variables were assessed within five minutes of recumbency and at 10, 15, and 20 minutes post-recumbency. Statistical analyses for non-parametric data were performed to compare the treatment groups as well as time points; p ≤ 0.05 considered significant. Following darting, 7/10 EKB animals were standing when approached, compared to 2/20 in the thiafentanil treatment groups. Time to first effect was significantly higher for EKB (155 ± 105.7 seconds) compared to TKBO (61.5 ± 21.4 seconds). Time to sternal after darting was significantly higher with EKB (411.6 ± 174 seconds) compared to TKB (160.5 ± 85.4 seconds) and TKBO (166 ± 77.3 seconds). This study builds on previous work investigating the effects of potent opioids on impala and is the first evaluating their use in a field setting. The thiafentanil combination had a faster onset and resulted in a smoother induction than the etorphine combination. Additionally, oxygenation improved in animals receiving oxygen supplementation.

A Pockels cell enabled heterodyne phase contrast imaging diagnostic for detection of ion cyclotron emission.

This work describes a novel optical heterodyne detection scheme that significantly extends the frequency response of the phase contrast imaging method to detect electron density fluctuations in tens of megahertz frequency range. The system employs a variable frequency electro-optic modulator to allow operation at any frequency in the range 10-40 MHz without the need to realign the system. The frequency coverage of the system makes it suitable to measure the radial structure of the electron density component of ion cyclotron emission on devices having confining magnetic field of a few tesla, thus extending the purely temporal measurements provided so far by magnetic probes.

Complications after benign hysterectomy, according to procedure: a population-based prospective cohort study from the Danish hysterectomy database, 2004-2015.

OBJECTIVE: To compare the risk of complications associated with benign hysterectomy according to surgical procedure. DESIGN: Register-based prospective cohort study. SETTING: Danish Hysterectomy Database, 2004-2015. POPULATION: All Danish women with benign elective hysterectomy (n = 51 141). METHODS: Multivariate log-binomial regression to compute relative risks (RRs) stratified by calendar period, and adjusted for age, height, weight, smoking habits, use of alcohol, comorbidity, indications, uterine weight and adhesions. Multiple imputation and 'intention to treat' analyses were performed. MAIN OUTCOME MEASURES: Major (grades III-V) and minor (grades I-II) Clavien-Dindo modified complications within 30 days. RESULTS: Overall, major complications occurred in 3577 (7.0%) hysterectomies and minor complications occurred in 4788 (9.4%). The proportions of major and minor complications according to type of hysterectomy were: 10.3 and 9.6% for abdominal hysterectomy (AH); 4.1 and 12.1% for laparoscopic hysterectomy (LH); and 4.9 and 8.0% for vaginal hysterectomy (VH) for non-prolapse, and 2.3 and 6.4% for prolapse. In multivariate analyses, compared with VH for non-prolapse, the risk of major complications was higher for AH (RR 1.82, 95% CI 1.63-2.03) but lower for both LH (RR 0.78, 95% CI 0.68-0.90) and VH for prolapse (RR 0.55; 95% CI 0.41-0.75). For LH, the risk of major complications reduced from a RR of 0.96 (95% CI 0.75-1.22) in the time period 2004-2009 to an RR of 0.72 (95% CI 0.60-0.87) between 2010 and 2015. CONCLUSION: Laparoscopic hysterectomy and VH for uterine prolapse are associated with fewer major complications, and AH is associated with more major complications, compared with VH performed in the absence of uterine prolapse. TWEETABLE ABSTRACT: Laparoscopic hysterectomy has fewer major complications compared with vaginal hysterectomy, in the absence of uterine prolapse.

Psychosocial and physical long-term outcome in patients with a history of takotsubo cardiomyopathy or myocardial infarction - a multi-centered case control study.

Physical long-term impacts of Takotsubo Cardiomyopathy (TTC) remain controversial and an underestimation of their severity becomes increasingly evident. Even less is known about mental long-term impacts of TTC. This study aims at a better understanding of the physical and mental long-term effects of TTC in comparison to myocardial infarctions (MI). On average 5 years after disease onset, 68 TTC patients and 68 age- and sex-matched MI patients were assessed for disease-related quality of life, depression, anxiety, chronic stress, social support, resilience, and life events prior to disease onset. Scores of TTC and MI patients were compared to each other and to normative references values. Regression analyses were used to evaluate the predictive value of the number of life events prior to disease onset for physical and mental long-term outcomes. Both groups displayed higher scores in depression and anxiety, higher levels of chronic stress, and lower scores in physical and mental quality of life in comparison to norm samples, while social support did not differ from norms. No differences between the two patient groups were observed. Within both groups, the majority of patients (TTC: 69.1%; MI: 60.3%) reported stressful life events prior to disease onset. In TTCs and MIs, the number of events had a significant impact on long-term mental health and chronic stress. Notably, both patient collectives scored higher in resilience than healthy controls. Results suggest negative long-term impacts of TTC on mental and physical wellbeing, comparable to those of MI. Besides a good somatic-medical care, psychotherapeutic support, including the development of functional coping strategies, might be warranted for TTC patients. The long-term impact of TTC should be taken as serious as that of MI.

Efficacy of a silver colloidal gel against selected oral bacteria in vitro.

Background: It is necessary to develop new strategies to protect against bacteria such as S treptococcus mutans, S treptococcus sanguis, and Streptococcus salivarius, which contribute to tooth decay and plaque formation. Our current study investigated the efficacy of a colloidal silver gel in inhibiting biofilm formation by these principal oral bacteria , in vitro. The aim of this study was to assess the efficacy of a colloidal silver gel formulation for inhibiting bacterial biofilm formation (Ag-gel) by the principal bacteria that cause plaque formation and tooth decay. Methods: The effect of Ag-gel on viability of S. mutans, S. sanguis, and S. salivarius was assessed by quantifying their colony forming units (CFU) in presence or absence of the test gel. The effect of this formulation on biofilm-forming ability of these bacteria was studied through scanning electron microscopy. Results: Using the CFU assays, over 6 logs of inhibition (100%) were found for S. mutans, S. sanguis, and S. salivarius for the Ag-gel-treated bacteria when compared with the control gel. In addition, the Ag-gel also inhibited biofilm formation by these three bacteria mixed together. These results were confirmed by scanning electron microscopy. Conclusions: The Ag-gel was effective in preventing biofilm formation by S. mutans, S. sanguis, and S. salivarius. This Ag-gel should be tested for the ability to block plaque formation in the mouth, through its use as a tooth paste.

The ability of a colloidal silver gel wound dressing to kill bacteria in vitro and in vivo.

OBJECTIVE: Inhibiting bacterial biofilms is of major significance for proper wound healing. The choice of the dressing material plays a key role, as bacteria can live in dressings and keep reinfecting the wound. This study examines the effectiveness of a colloidal silver gel (Ag-gel) wound dressing in inhibiting the growth of bacteria in a mouse wound model. METHOD: Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii and two different meticillin-resistant Staphylococcus aureus (MRSA) strains were examined. Bacteria were measured in vitro on the dressing, and in vivo studies were carried out to analyses both the dressing and the infected tissue. RESULTS: Using colony-forming unit (CFU) assays, over 7 logs of inhibition (100%) were found for Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii for the Ag-gel dressing when compared with the control dressing. In vivo, complete inhibition was observered for the three most common bacteria on the Ag-gel dressing and the tissue under that dressing. These results were confirmed by an in vivo live imaging system. However, with MRSA strains, only 2-3 logs of inhibition were recorded. CONCLUSION: The Ag-gel was effective in preventing biofilm infections caused by both Gram-negative and Gram-positive bacteria.

Effects of dienogest on surgically induced endometriosis in rats after repeated oral administration.

BACKGROUND: Dienogest demonstrates efficacy for lesion reduction and pain relief in clinical trials of endometriosis. The current study investigated an intraperitoneal animal model of endometriosis to further characterize the effects of dienogest. METHODS: Endometrial-like lesions were induced in rats by autotransplantation of uterine tissue into the peritoneal cavity. Dienogest 0.3 or 1.0 mg/kg/day, danazol 100 mg/kg/day, or vehicle control were administered orally for 28 days. Changes in endometrial-like lesion size during treatment were assessed at laparotomy. Uterine horn weight was also measured as an index of the estrogenic effects of treatment. RESULTS: Dienogest 0.3 mg/kg/day significantly reduced the total endometrial lesion area, with an effect equivalent to danazol 100 mg/kg/day. Unlike dienogest 1.0 mg/kg/day, dienogest 0.3 mg/kg/day had no effect on uterine horn weight, indicating an absence of estrogenic effects for this dose in rodents. CONCLUSION: Dienogest 0.3 mg/kg/day for 28 days demonstrated potent inhibitory activity on the growth of endometrial tissue in this model, providing supportive evidence for the efficacy of dienogest in lesion reduction.

Physiology of GDF9 and BMP15 signalling molecules.

Two related oocyte-derived members of the transforming growth factor-beta (TGF-beta) superfamily, namely growth differentiation factor 9 (GDF9) and bone morphogenetic protein 15 (BMP15, also known as GDF9B), have recently been shown to be essential for ovarian follicular growth. In addition, both proteins have been shown to regulate ovulation rate in sheep, and although it is evident that these growth factors interact both with one another and with other intra- and extra-ovarian factors, the precise mechanisms by which they influence follicular growth and ovulation rate have not been thoroughly elucidated.

Chronic exposure to dibromoacetic acid, a water disinfection byproduct, diminishes primordial follicle populations in the rabbit.

To determine if dibromoacetic acid (DBA) affects ovarian folliculogenesis, four groups of female Dutch-belted rabbits were exposed daily to 0, 1, 5, or 50 mg DBA/kg body weight in drinking water beginning in utero from gestation day 15 throughout life. Functionality of the endocrine axis was assessed by measuring serum concentrations of gonadotropins following an im injection of 10 microg GnRH at 12 (prepubertal; n = 6/dose group) and 24 (postpubertal; n = 10/dose group) weeks of age. A day after GnRH challenge, number of ovulation sites and ovarian weights were determined at necropsy. Left ovaries were processed for histopathology, serially sectioned at 6 microm, and every twelfth section stained with hematoxylin and eosin was evaluated. All healthy follicles were categorized as primordial, primary, small preantral, large preantral, or small antral follicles. The area of each section evaluated was measured and the number of follicles in each category expressed per mm2 unit area. In prepubertal animals, DBA caused a reduction in number of primordial follicles (p < 0.05) and total healthy follicles (p < 0.05) at 50 mg/kg dose level. In adult animals, there were fewer primordial follicles in both the 5 (p < 0.01) and 50 (p = 0.1) mg/kg dose groups. No profound changes in gonadotropin profiles were observed. Although chronic exposure to DBA did not appear to have an effect on late follicular development or ovulation, DBA did reduce the population of primordial follicles. The long-term health consequences of diminished primordial follicles are unknown, but it is very likely that reproductive senescence would occur earlier.

Oocyte-derived growth factors and ovulation rate in sheep.

The physiological mechanisms controlling ovulation rate in mammals involve a complex exchange of endocrine signals between the pituitary gland and the ovary, and a localized exchange of intraovarian hormones between the oocyte and its adjacent somatic cells. The discoveries in sheep of mutations in bone morphogenetic protein 15 (BMP15) and bone morphogenetic protein receptor type IB (BMPR-IB) together with recent findings on the physiological effects of growth differentiation factor 9 (GDF9) and BMP15 on follicular development and ovulation rate highlight some important differences in the way in which the oocyte may function in mammals with different ovulation rate phenotypes. In sheep, BMP15 and GDF9 have each been shown to be essential for the early and later stages of follicular development. In addition, ovulation rate is sensitive to changes in the dose of either of these two oocyte-derived growth factors. These findings are in contrast to those reported for mice in which GDF9, but not BMP15, is essential for follicular development. The evidence to date is consistent with the hypothesis that the oocyte plays a central role in regulating key events in the process of follicular development and hence, is important in determining ovulation rate. Moreover, it appears that the mechanisms that the oocyte uses to control these processes differ between species with low and high ovulation rate phenotypes.

Cloning and expression analysis of chicken Lix1, a founding member of a novel gene family.

Limb Expression 1 (Lix1), a founding member of a novel gene family, was identified in a screen for genes transiently and locally expressed during early chicken limb development. Most prominently, Lix1 is transiently expressed in the nascent hindlimb bud between Hamburger-Hamilton stages 15 and 19. Chicken Lix1 transcripts are also found in the basal plate of rhombomeres 3 and 5, in pharyngeal and in foregut mesenchyme and in all facial primordia except for the mandibular arches. Homologs of chick Lix1 exist in human, mouse and Drosophila.

Expression of growth and differentiation factor-9 in the ovaries of fetal sheep homozygous or heterozygous for the inverdale prolificacy gene (FecX(I)).

Abnormal follicular and oocyte growth in ovaries of sheep homozygous (II) for the Inverdale gene, FecX(I), suggest that this gene may influence a fundamental event in initiation of folliculogenesis, with two copies of the gene inhibiting growth at the primordial/primary stage. In addition, striking similarities in ovarian morphology between mice deficient in growth and differentiation factor-9 (GDF-9) and II sheep suggest a relationship between the FecX(I) gene and GDF-9 function in the ovary. Therefore, it was hypothesized that GDF-9 mRNA expression would be inhibited in ovaries of II fetal sheep. To test this hypothesis, in situ hybridization was used to characterize GDF-9 mRNA expression in ovaries of homozygous (II), heterozygous (I+), and control (++) fetal sheep at Day 135 of gestation. GDF-9 mRNA expression was localized exclusively to oocytes from the type 1 follicle stage onward in all genotypes and is the first demonstration of GDF-9 mRNA expression in ovaries of fetal sheep. In addition, GDF-9 mRNA expression was detected in oocytes of abnormal type 2 follicles in the ovaries of II sheep. Thus, it does not appear that inhibition of GDF-9 gene expression is the mechanism of action whereby the FecX(I) gene exerts its influence. However, the possibility of translation at specific stages of follicular development cannot presently be ruled out. In addition, the FecX(I) gene may be involved, either directly or indirectly, in regulating expression of receptors for GDF-9. At present, however, neither the FecX(I) gene product nor the GDF-9 receptor has been isolated or characterized.

Retrieval of geophysical parameters from moderate resolution imaging spectroradiometer thermal infrared data: evaluation of a two-step physical algorithm.

A two-step physical algorithm that simultaneously retrieves geophysical parameters from Moderate Resolution Imaging Spectroradiometer (MODIS) measurements was developed. The retrieved geophysical parameters include atmospheric temperature-humidity profile, surface skin temperature, and two surface emissivities within the shortwave (3-5-microm) and the longwave (8-14.5-microm) regions. The physical retrieval is accomplished in two steps: (i) The Tikhonov regularization method is employed to generate a regularization solution along with an optimum regularization parameter; (ii) the nonlinear Newtonian iteration algorithm is carried out with the regularization solution as a first-guess profile to obtain a final maximum probability solution for geophysical parameters. The algorithm was tested with both simulated and real MODIS Airborne Simulator (MAS) data. Sensitivity studies on simulated MAS data demonstrate that simultaneous retrievals of land and atmospheric parameters improve the accuracy of the retrieved geophysical parameters. Finally, analysis and accuracy of retrievals from real MAS data are discussed.

Molecular cloning of the ovine Growth/Differentiation factor-9 gene and expression of growth/differentiation factor-9 in ovine and bovine ovaries.

Recently a novel member of the transforming growth factor beta (TGFbeta) superfamily termed growth/differentiation factor-9 (GDF-9) was shown to be expressed in ovaries of mice and humans, and to be essential for normal follicular development beyond the primary (type 2) follicle stage in mice. In the present study, the gene for ovine GDF-9 was isolated and characterized, and expression of GDF-9 mRNA in ovaries of domestic ruminants was examined. The predicted amino acid sequence of ovine GDF-9 is 77% and 66% homologous to human and mouse GDF-9, respectively. Specific hybridization using homologous 35S-antisense probes was restricted to oocytes. In contrast to similar studies in mice in which GDF-9 was first detected beginning at the primary (type 2) follicle stage, in ovine and bovine ovaries GDF-9 mRNA was expressed beginning at the primordial (type 1) follicle stage. The observed timing and pattern of GDF-9 expression in oocytes of domestic ruminants is consistent with a role for GDF-9 in the initiation and maintenance of folliculogenesis in these species, and supports the general concept that early stages of follicular growth and development are regulated by intraovarian factors.

Localization and quantification of binding sites for follicle-stimulating hormone, luteinizing hormone, growth hormone, and insulin-like growth factor I in sheep ovarian follicles.

In sheep, growth and development of ovarian follicles beyond 2 mm in diameter is acutely dependent on gonadotropin support. As a consequence, following hypophysectomy (HPX) or hypothalamic-pituitary stalk disconnection (HPD), growth of follicles beyond 2 mm is arrested and all follicles > 2 mm undergo atresia. Although administration of exogenous gonadotropins stimulates follicular growth and ovulation in HPD ewes, follicles in HPX ewes remain unresponsive unless growth hormone (GH) is also given. To determine whether the difference in follicular sensitivity to gonadotropins after HPD (gonadotropin sensitive) or HPX (gonadotropin insensitive) is related to the distribution and quantity of binding sites for FSH, LH, and/or insulin-like growth factor I (IGF-I), binding sites for these hormones were localized and quantified using topical autoradiography in healthy follicles from control (pituitary-intact), HPD, and HPX ewes. In addition, in situ hybridization was performed to localize mRNA for GH and FSH receptors. Irrespective of treatment, binding of FSH and mRNA for FSH receptor were greatest (p < 0.05) in the membrana granulosa; LH binding was greatest (p < 0.05) in the theca interna; and IGF-I binding was greatest (p < 0.05) in the theca externa. Although the relative number of binding sites for LH did not differ among treatments, those for FSH and IGF-I were lower (p < 0.05) in HPD and HPX ewes compared to controls. Attempts to quantify binding sites for GH were unsuccessful due to high nonspecific binding. However, mRNA for GH receptor was most abundant (p < 0.05) in the membrana granulosa and oocytes of small antral and preantral follicles. Compared to levels in controls and HPD ewes, the level of GH receptor mRNA was lower (p < 0.05) in follicles obtained from HPX ewes. On the basis of these data, failure of small antral follicles in HPX ewes to respond to exogenous gonadotropins is not due to a reduction in receptors for FSH, LH, or IGF-I. The observed reduction of mRNA for GH receptor in the membrana granulosa of follicles from HPX ewes provides evidence that GH may play an important role in early stages of folliculogenesis and that it is involved in the maintenance of sensitivity to gonadotropins.

Review of 47 laparoscopic appendectomies.

STUDY OBJECTIVE: To assess the indications, technique, complications, and outcome of endoscopic appendectomies. DESIGN: Retrospective study with a follow-up of 2 years. SETTING: A gynecologic surgical center in Hamburg, Germany. PATIENTS: Forty-seven women who underwent laparoscopic appendectomy. INTERVENTIONS: Appendectomies were performed under general anesthesia with bipolar coagulation, loop-ligation, and transection. MEASUREMENTS AND MAIN RESULTS: Forty-seven patients have been followed for 2 years. Thirty laparoscopic appendectomies (LA) were incidental and 17 elective. The majority of LA were performed because of pain symptoms. More than 50% of the patients reported complete pain relief after LA. The average duration of surgery was 47 minutes. The average hospital stay was 66 hours. Use of analgesics was low; 19 women required no analgesia. A febrile reaction was registered in 6%. No wound infection occurred. Two serious complications were noted: one acute peritonitis after 4 days, and one stump abscess after 4 weeks. Both patients recovered uneventfully. CONCLUSIONS: Laparoscopic appendectomy is safe surgery if the described technique is followed. The complication rate is low, conversion rate is zero, and late results underline successful treatment of pain.

An increase in serum lipids increases luteal lipid content and alters the disappearance rate of progesterone in cows.

To determine whether an increase in serum lipids alters the area occupied by lipid droplets in steroidogenic luteal cells and(or) clearance rates of progesterone from serum, pregnant beef heifers received control (n = 6) or treatment (n = 5) diets. To increase serum lipids, the treatment diet contained calcium soaps of fatty acids. Control and treatment diets were formulated to be isocaloric and isonitrogenous. Feeding of diets was initiated approximately 100 d before parturition and continued through the third postpartum estrous cycle. On d 12 or 13 of the third postpartum cycle, corpora lutea were collected by ovariectomy and a center slice was processed for electron microscopy. Eight samples from each slice were sectioned, stained, and examined at a magnification of 2,500x. Five micrographs per sample were analyzed for area occupied by small (SLC) and large (LLC) luteal cells, percentage of the area of each steroidogenic cell type occupied by lipid, and total steroidogenic area (SLC + LLC) occupied by lipid. Jugular blood was collected before and after ovariectomy, and progesterone, cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were quantified. Cows consuming treatment diets had approximately twice (P < .05) the concentration of cholesterol, HDL, and progesterone in serum that controls had. The percentage of the area of SLC, LLC, and total area occupied by lipid was greater (P < .05) in treated than in control cows. The average time required for serum concentrations of progesterone to decrease by 50% after ovariectomy was greater (P < .05) in treated than in control cows (170 +/- 16 vs 113 +/- 15 min).(ABSTRACT TRUNCATED AT 250 WORDS)

Recombinant bovine somatotropin does not improve superovulatory response in sheep.

Although treatment of heifers and ewes with recombinant bovine somatotropin (rbST) does not increase ovulation rate, data for heifers indicate that the number of small antral follicles is approximately doubled. Accordingly, the objectives of this study were to determine whether 1) treatment of ewes with rbST would increase the number of small antral follicles, thereby increasing the number of follicles that could potentially respond to superovulation treatment, and 2) superovulatory responses could be improved in ewes with "synchronized" populations of follicles. Twenty-four ewes were divided into four groups: control, control+rbST, hypothalamic-pituitary stalk disconnected (HPD), and HPD+rbST. Beginning on d 5 of the estrous cycle, ewes were injected once daily for 13 d with either rbST (3 mg) or saline. The superovulatory regimen consisted of a single dose of PMSG followed by twice-daily injections of FSH for four consecutive days. After ovariectomy, ovulation sites and follicles were counted. Twice-daily blood samples were assayed for somatotropin (ST) and IGF-I. The concentrations of ST in rbST-treated ewes were greater (P < .05) than those in controls. Treatment with rbST increased (P < .05) the mean serum concentration of IGF-I in control but not in HPD ewes. There was no increase in ovulation rate or number of small antral follicles in response to rbST. Synchronizing follicle populations also failed to increase ovulation rate or reduce variability of response. We conclude that supplementation with rbST and synchronization of follicles does not increase the superovulatory response in sheep.