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Gandhi AB, Supe PA. Evolution of Oral Contraceptive Pills. J Obstet Gynaecol India 2024; 74:109-112. [PMID: 38707879 PMCID: PMC11065849 DOI: 10.1007/s13224-024-01988-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/28/2024] [Indexed: 05/07/2024] Open
Affiliation(s)
- Ashwini Bhalerao Gandhi
- P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
- Dept of OBGY, TNMC & BYL Nair Hospital, Mumbai, India
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2
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Guha P, Sen K, Chowdhury P, Mukherjee D. Estrogen receptors as potential therapeutic target in endometrial cancer. J Recept Signal Transduct Res 2023; 43:19-26. [PMID: 36883690 DOI: 10.1080/10799893.2023.2187643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Endometrial cancer (EC) is one of the most common gynecological carcinomas in both developed and developing countries. Majority of the gynecological malignancies are hormonally driven where estrogen signaling acts as an oncogenic signal. Estrogen's effects are mediated via classical nuclear estrogen receptors; estrogen receptor alpha and beta (ERα and ERβ) and a trans-membrane G protein-coupled estrogen receptor (GPR30 and GPER). ERs and GPER through ligand binding triggers multiple downstream signaling pathways causing cell cycle regulation, cell differentiation, migration, and apoptosis in various tissues including endometrium. Although the molecular aspect of estrogen function in ER-mediated signaling is now partly understood, the same is not true for GPER-mediated signaling in endometrial malignancies. Understanding the physiological roles of ERα and GPER in EC biology therefore leads to the identification of some novel therapeutic targets. Here we review the effect of estrogen signaling through ERα-and GPER in EC, major types, and some affordable treatment approaches for endometrial tumor patients which has interesting implications in understanding uterine cancer progression.
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Affiliation(s)
- Payel Guha
- Department of Zoology, University of Kalyani, Kalyani, India.,Department of Molecular Biology and Bioinformatics, Tripura University, Suryamaninagar, India
| | - Koushik Sen
- Department of Zoology, University of Kalyani, Kalyani, India.,Department of Zoology, Jhargram Raj College, Jhargram, India
| | | | - Dilip Mukherjee
- Department of Zoology, University of Kalyani, Kalyani, India
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3
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Benagiano G, Primiero FM. Special Issue "New Insights into Contraception". J Clin Med 2022; 11:jcm11226651. [PMID: 36431128 PMCID: PMC9697539 DOI: 10.3390/jcm11226651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
Today, a diverse range of contraceptive techniques is available to women; this, coupled with continued positive trends in female children and adults' educational attainment, will hasten declines in fertility and continue to slow population growth [...].
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Affiliation(s)
- Giuseppe Benagiano
- Faculty of Medicine and Dentistry, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 115, 00161 Rome, Italy
- Correspondence:
| | - Francesco M. Primiero
- Faculty of Medicine and Psychology, Sapienza University of Rome, Ospedale Sant’Andrea, Via di Grottarossa 1035/1039, 00189 Rome, Italy
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4
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Sinha R, Maheshwari S, Gupta P, Roy D, Deepshikha .. Socio-economic Correlates of Body Mass Index, Blood Pressure and Contraceptive Use by Reproductive age-group Females. INDIAN JOURNAL OF COMMUNITY HEALTH 2022. [DOI: 10.47203/ijch.2022.v34i02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Oral Contraceptive use, BP and BMI are strongly associated variables in terms of socio economic conditions. Oral Contraceptives are an important and widely accepted contraceptive modality used throughout the world. Aim & Objective: This study aims to examine the effects of socio-economic factors on Body Mass Index (BMI), Blood pressure (BP) and contraceptive use by reproductive age-group females of Uttarakhand. Settings and Design: This study utilizes nationwide data from the Fourth National Family Health Survey (NFHS-IV). Methods and Material: Information was collected from Indian Institute of Population Sciences (IIPS) Mumbai and 17,300 women of Uttarakhand were considered for this study. Statistical analysis used: For inter age-group comparisons of blood pressure, BMI and socio-demographic indicators, analysis of variance (ANOVA) technique has been used. Results: The variation in mean age at menarche was found to be significant (p< 0.01, ANOVA). The numbers of live births over the women's total lifetime were lower in the younger age groups (p<0.01, ANOVA). Conclusions: The important findings of present study were that the use of contraceptive tended to have increased BMI and elevated blood pressure, even though the magnitude of these was little (equal to 4% and 40% respectively).
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Role of Estrogens in Menstrual Migraine. Cells 2022; 11:cells11081355. [PMID: 35456034 PMCID: PMC9025552 DOI: 10.3390/cells11081355] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
Migraine is a major neurological disorder affecting one in nine adults worldwide with a significant impact on health care and socioeconomic systems. Migraine is more prevalent in women than in men, with 17% of all women meeting the diagnostic criteria for migraine. In women, the frequency of migraine attacks shows variations over the menstrual cycle and pregnancy, and the use of combined hormonal contraception (CHC) or hormone replacement therapy (HRT) can unveil or modify migraine disease. In the general population, 18–25% of female migraineurs display a menstrual association of their headache. Here we present an overview on the evidence supporting the role of reproductive hormones, in particular estrogens, in the pathophysiology of migraine. We also analyze the efficacy and safety of prescribing exogenous estrogens as a potential treatment for menstrual-related migraine. Finally, we point to controversial issues and future research areas in the field of reproductive hormones and migraine.
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6
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Reviewing the features and functionalities of contraception mPHRs. HEALTH POLICY AND TECHNOLOGY 2022. [DOI: 10.1016/j.hlpt.2022.100633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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7
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Gupta D, Prabhakar B, Wairkar S. Non-oral routes, novel formulations and devices of contraceptives: An update. J Control Release 2022; 345:798-810. [PMID: 35378212 DOI: 10.1016/j.jconrel.2022.03.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
Family planning enables society to prevent unintended pregnancies and helps in attaining desired spacing between the pregnancies. It is done with the use of contraceptive methods and infertility treatments. The use of contraceptives serves to ease maternal ill-health and reduce pregnancy-related deaths and helps to decrease the number of unsafe abortions and HIV transmission from mothers to newborns. The most popular contraception method is a daily dose of combined oral contraceptives pills. However, poor compliance and various adverse effects are common problems of oral contraceptives that considerably reduce their long-term use. Thus, several non-oral contraceptive options have been developed for better compliance, reduced side effects and improved therapeutic efficacy. This review presented the non-oral contraceptive formulations given by different routes such as transdermal, nasal, subcutaneous, intramuscular, intrauterine and vaginal routes. These formulations delivering contraceptives, mainly through devices, include transdermal patches and microneedles, nasal sprays, intrauterine devices and intrauterine systems, vaginal rings, contraceptive implants and contraceptive injections, which are unique in their specific advantages and drawbacks.
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Affiliation(s)
- Deepak Gupta
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, V.L.Mehta Road, Vile Parle (W), Mumbai, Maharashtra 400056, India
| | - Bala Prabhakar
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, V.L.Mehta Road, Vile Parle (W), Mumbai, Maharashtra 400056, India
| | - Sarika Wairkar
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, V.L.Mehta Road, Vile Parle (W), Mumbai, Maharashtra 400056, India.
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8
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Association between Oral Contraceptive Use and the High-Sensitivity C-Reactive Protein Level in Premenopausal Korean Women. Healthcare (Basel) 2022; 10:healthcare10020361. [PMID: 35206975 PMCID: PMC8872382 DOI: 10.3390/healthcare10020361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/04/2022] [Accepted: 02/10/2022] [Indexed: 12/04/2022] Open
Abstract
Although oral contraceptives (OCs) are widely used, few national epidemiological studies have evaluated the association between OC use and serum high-sensitivity C-reactive protein (hs-CRP) levels in Korean women. This population-based cross-sectional study was conducted with data from the 2015–2018 National Health and Nutrition Examination Survey. In the sample of 5332 premenopausal women aged ≥19 years, hs-CRP concentrations were 1.087 mg/L among OC users and 0.953 mg/L among OC non-users. After adjustment for confounders, OC users had an increased likelihood of having risky (>1.0 mg/L) hs-CRP levels (adjusted odds ratio (aOR) = 1.58; 95% confidence interval (CI), 1.25–1.98) compared with OC non-users. In addition, the aOR for high-risk (>3.0 mg/L) hs-CRP levels in OC users compared with non-users was 1.51 (95% CI, 1.06–2.16). These findings demonstrate that OC use alters the concentration of hs-CRP, a biomarker of chronic low-grade inflammation, and suggest that long-term OC use is a risk factor in the pathogenesis of inflammatory diseases, including cardiovascular diseases.
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Park H, Kim K. Trends and Factors Associated with Oral Contraceptive Use among Korean Women. Healthcare (Basel) 2021; 9:healthcare9101386. [PMID: 34683066 PMCID: PMC8544440 DOI: 10.3390/healthcare9101386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/07/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022] Open
Abstract
Although oral contraceptives (OC) are widely used, few national-level epidemiologic studies have evaluated the prevalence of OC use and factors related to their use in Korea. We performed a population-based cross-sectional study on OC use by premenopausal women aged 20–59 years residing in Korea. We used secondary data from the 2010–2019 National Health and Nutrition Examination Survey to examine trends in the annual prevalence of OC use between 2010 and 2019, and factors influencing OC use. Based on data from 14,386 premenopausal women, the average annual prevalence of OC use was 8.2–10.7% between 2010 and 2014; it increased to 12.6–14.4% during 2015–2019. The prevalence of OC use was significantly higher in women with higher (≥5) than lower gravidity (<5). In addition, among sociodemographic factors, education level, household income, cigarette smoking, and alcohol drinking were significantly associated with OC use in Korean women. As OC use is affected by sociodemographic factors, a contraceptive plan that considers sociodemographic factors is needed to establish an effective family planning policy.
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Affiliation(s)
- Hyejin Park
- Department of International Healthcare Administration, Daegu Catholic University, Gyeongsan 38430, Korea;
| | - Kisok Kim
- College of Pharmacy, Keimyung University, Daegu 42601, Korea
- Correspondence: ; Tel.: +82-53-580-5932
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10
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Qiu Y, Hu Y, Xing Z, Fu Q, Zhu J, Su A. Birth control pills and risk of hypothyroidism: a cross-sectional study of the National Health and Nutrition Examination Survey, 2007-2012. BMJ Open 2021; 11:e046607. [PMID: 34162647 PMCID: PMC8230965 DOI: 10.1136/bmjopen-2020-046607] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The association between use of birth control pills and thyroid function in women has not ever been well studied, but potential risk has been implicated by small sample-sized studies. We aimed to determine this association using a large epidemiological survey. DESIGN Cross-sectional study. SETTING National Health and Nutrition Examination Survey conducted in the USA from 2007 to 2012. PARTICIPANTS Female respondents aged 18+ who had data on history of taking birth control pills and thyroid function were included. History of taking birth control pills was based on responses on the reproductive health questionnaire. Participants not on antithyroid medication with thyroid-stimulating hormone (TSH) >5.6 mIU/L and those on thyroid hormone replacement regardless of TSH were categorised as hypothyroid. Participants not on thyroid hormone replacement or antithyroid medication who had TSH between 0.34 mIU/L and 5.6 mIU/L were classified as euthyroid. PRIMARY AND SECONDARY OUTCOME MEASURES Association between use of birth control pills and hypothyroidism based on multivariate logistic regression analysis. RESULTS A total of 5116 female adults with history of taking birth control pills (n=3034) and without (n=2082) were included. A higher prevalence of hypothyroidism was found in those who have ever taken birth control pills (17.7% vs 14.1%; p=0.003). Multivariate logistic regression adjusted for confounding covariables, including age, race, education, body mass index, smoking status, alcohol use, history of thyroid disease, current thyroid disease, first menstrual age, pregnancy history, menopause status and history of hormone replacement use, demonstrated a significant association between history of taking birth control pills for more than 10 years and hypothyroidism (OR, 3.837; 95% CI 1.402 to 10.500; p=0.009). CONCLUSIONS Longer history of using birth control pills was strongly associated with hypothyroidism, especially for more than 10 years.
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Affiliation(s)
- Yuxuan Qiu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuanyuan Hu
- West China School of Medicine, Sichuan University, Chengdu, China
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhichao Xing
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qingyu Fu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jingqiang Zhu
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Anping Su
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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11
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Benagiano G, Benagiano M, Bianchi P, D'Elios MM, Brosens I. Contraception in autoimmune diseases. Best Pract Res Clin Obstet Gynaecol 2019; 60:111-123. [PMID: 31160225 DOI: 10.1016/j.bpobgyn.2019.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 11/18/2022]
Abstract
Autoimmune diseases (AIDs) affect women and men with a 2:1 ratio, which suggests that hormonal contraceptives play a role in their clinical course. Combined oral contraceptives have complex, sometimes contradictory, effects on AIDs; they can worsen the situation in women with systemic lupus erythematosus and with anti-phospholipid syndrome, conditions in which they are contraindicated. Early studies indicated a positive effect on rheumatoid arthritis (RA), whereas more recent trials failed to do so, possibly because of the lowering of oestrogen content. Evidence of effects on multiple sclerosis (MS) is conflicting: risk may vary depending on the progestin used. Minor adverse effects may exist on inflammatory bowel diseases, and no significant effect was found on autoimmune thyroid diseases. Women can become sensitised to sex hormones. Progestin-only contraceptives may be used, although copper-releasing intra-uterine devices represent the best option. Finally, several organisations have issued guidelines for contraceptive use in women with AIDs.
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Affiliation(s)
- Giuseppe Benagiano
- Department of Obstetrics, Gynaecology and Urology, Policlinico Umberto I°, Sapienza University of Rome, Rome, Italy
| | - Marisa Benagiano
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Paola Bianchi
- Surgical and Medical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Mario Milco D'Elios
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Ivo Brosens
- Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
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12
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Prossnitz ER. GPER modulators: Opportunity Nox on the heels of a class Akt. J Steroid Biochem Mol Biol 2018; 176:73-81. [PMID: 28285016 PMCID: PMC5591048 DOI: 10.1016/j.jsbmb.2017.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 12/14/2022]
Abstract
The (patho)physiology of estrogen and its receptors is complex. It is therefore not surprising that therapeutic approaches targeting this hormone include stimulation of its activity through supplementation with either the hormone itself or natural or synthetic agonists, inhibition of its activity through the use of antagonists or inhibitors of its synthesis, and tissue-selective modulation of its activity with biased ligands. The physiology of this hormone is further complicated by the existence of at least three receptors, the classical nuclear estrogen receptors α and β (ERα and ERβ), and the 7-transmembrane G protein-coupled estrogen receptor (GPER/GPR30), with overlapping but distinct pharmacologic profiles, particularly of anti-estrogenic ligands. GPER-selective ligands, as well as GPER knockout mice, have greatly aided our understanding of the physiological roles of GPER. Such ligands have revealed that GPER activation mediates many of the rapid cellular signaling events (including Ca2+ mobilization, ERK and PI3K/Akt activation) associated with estrogen activity, as opposed to the nuclear ERs that are traditionally described to function as ligand-induced transcriptional factors. Many of the salutary effects of estrogen throughout the body are reproduced by the GPER-selective agonist G-1, which, owing to its minimal effects on reproductive tissues, can be considered a non-feminizing estrogenic compound, and thus of potential therapeutic use in both women and men. On the contrary, until recently GPER-selective antagonists had predominantly found preclinical application in cancer models where estrogen stimulates cell growth and survival. This viewpoint changed recently with the discovery that GPER is associated with aging, particularly that of the cardiovascular system, where the GPER antagonist G36 reduced hypertension and GPER deficiency prevented cardiac fibrosis and vascular dysfunction with age, through the downregulation of Nox1 and as a consequence superoxide production. Thus, similar to the classical ERs, both agonists and antagonists of GPER may be of therapeutic benefit depending on the disease or condition to be treated.
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Affiliation(s)
- Eric R Prossnitz
- Division of Molecular Medicine, Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States.
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13
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Liu H, Yao J, Wang W, Zhang D. Association between duration of oral contraceptive use and risk of hypertension: A meta-analysis. J Clin Hypertens (Greenwich) 2017; 19:1032-1041. [DOI: 10.1111/jch.13042] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/10/2017] [Accepted: 04/17/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Hui Liu
- Department of Epidemiology and Health Statistics; Qingdao University Medical College; Qingdao China
| | - Jie Yao
- Department of Epidemiology and Health Statistics; Qingdao University Medical College; Qingdao China
| | - Weijing Wang
- Department of Epidemiology and Health Statistics; Qingdao University Medical College; Qingdao China
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics; Qingdao University Medical College; Qingdao China
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Abstract
Migraine is prevalent in women during the fertile age. Indeed, both neuroendocrine events related to reproductive stages (menarche, pregnancy, and menopause) and menstrual cyclicity and the use of exogenous sex hormones, such as hormonal contraception and replacement therapy, may cause significant changes in the clinical pattern of migraine. Menstrual migraine may be more severe, long-lasting, and refractory to both acute and prophylactic treatment and, therefore, requires tailored strategies. The use of headache diaries, which makes it possible to record prospectively the characteristics of every attack, is of paramount importance for evaluating the time pattern of headache and for identifying a clear link with menstrual cycle-related features. Estrogen variations are highly implicated in modulating the threshold to challenges by altering neuronal excitability, cerebral vasoactivity, pain sensitivity, and neuroendocrine axes throughout the menstrual cycle and not only at the time of menstruation. On the other hand, estrogen withdrawal may really constitute a triggering factor for migraine in women with peculiar characteristics of vulnerability with menstruation or following the discontinuation of exogenous estrogen, as happens with hormonal contraception during the fertile age or with hormone therapy at menopause. In addition, exogenous estrogen may contribute to the occurrence of neurological symptoms, such as aura. When aura occurs, hormonal treatment should be discontinued.
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Affiliation(s)
- Rossella E Nappi
- Research Center of Reproductive Medicine and Unit of Gynecological Endocrinology and Menopause, Department of Internal Medicine and Endocrinology, IRCCS Maugeri Foundation, University of Pavia, Pavia, Italy.
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15
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Suchon P, Al Frouh F, Henneuse A, Ibrahim M, Brunet D, Barthet MC, Aillaud MF, Venton G, Alessi MC, Trégouët DA, Morange PE. Risk factors for venous thromboembolism in women under combined oral contraceptive. The PILl Genetic RIsk Monitoring (PILGRIM) Study. Thromb Haemost 2015; 115:135-42. [PMID: 26290123 DOI: 10.1160/th15-01-0045] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 07/03/2015] [Indexed: 11/05/2022]
Abstract
Identifying women at risk of venous thromboembolism (VTE) is a major public health issue. The objective of this study was to identify environmental and genetic determinants of VTE risk in a large sample of women under combined oral contraceptives (COC). A total of 968 women who had had one event of VTE during COC use were compared to 874 women under COC but with no personal history of VTE. Clinical data were collected and a systematic thrombophilia screening was performed together with ABO blood group assessment. After adjusting for age, family history, and type and duration of COC use, main environmental determinants of VTE were smoking (odds ratio [OR] =1.65, 95% confidence interval [1.30-2.10]) and a body mass index higher than 35 kg.m⁻² (OR=3.46 [1.81-7.03]). In addition, severe inherited thrombophilia (OR=2.13 [1.32-3.51]) and non-O blood groups (OR=1.98 [1.57-2.49]) were strong genetic risk factors for VTE. Family history poorly predicted thrombophilia as its prevalence was similar in patients with or without first degree family history of VTE (29.3% vs 23.9%, p=0.09). In conclusion, this study confirms the influence of smoking and obesity and shows for the first time the impact of ABO blood group on the risk of VTE in women under COC. It also confirms the inaccuracy of the family history of VTE to detect inherited thrombophilia.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Pierre-Emmanuel Morange
- Pierre-Emmanuel Morange, Laboratory of Hematology, CHU Timone, 264, Rue Saint-Pierre, 13385 Marseille cedex 05, France, Tel.: +33 4 91 38 60 49, Fax: +33 4 91 94 23 32, E-mail:
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16
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Prossnitz ER, Arterburn JB. International Union of Basic and Clinical Pharmacology. XCVII. G Protein-Coupled Estrogen Receptor and Its Pharmacologic Modulators. Pharmacol Rev 2015; 67:505-40. [PMID: 26023144 PMCID: PMC4485017 DOI: 10.1124/pr.114.009712] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Estrogens are critical mediators of multiple and diverse physiologic effects throughout the body in both sexes, including the reproductive, cardiovascular, endocrine, nervous, and immune systems. As such, alterations in estrogen function play important roles in many diseases and pathophysiological conditions (including cancer), exemplified by the lower prevalence of many diseases in premenopausal women. Estrogens mediate their effects through multiple cellular receptors, including the nuclear receptor family (ERα and ERβ) and the G protein-coupled receptor (GPCR) family (GPR30/G protein-coupled estrogen receptor [GPER]). Although both receptor families can initiate rapid cell signaling and transcriptional regulation, the nuclear receptors are traditionally associated with regulating gene expression, whereas GPCRs are recognized as mediating rapid cellular signaling. Estrogen-activated pathways are not only the target of multiple therapeutic agents (e.g., tamoxifen, fulvestrant, raloxifene, and aromatase inhibitors) but are also affected by a plethora of phyto- and xeno-estrogens (e.g., genistein, coumestrol, bisphenol A, dichlorodiphenyltrichloroethane). Because of the existence of multiple estrogen receptors with overlapping ligand specificities, expression patterns, and signaling pathways, the roles of the individual receptors with respect to the diverse array of endogenous and exogenous ligands have been challenging to ascertain. The identification of GPER-selective ligands however has led to a much greater understanding of the roles of this receptor in normal physiology and disease as well as its interactions with the classic estrogen receptors ERα and ERβ and their signaling pathways. In this review, we describe the history and characterization of GPER over the past 15 years focusing on the pharmacology of steroidal and nonsteroidal compounds that have been employed to unravel the biology of this most recently recognized estrogen receptor.
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Affiliation(s)
- Eric R Prossnitz
- Department of Internal Medicine (E.R.P.) and University of New Mexico Cancer Center (E.R.P., J.B.A.), The University of New Mexico Health Sciences Center, Albuquerque, New Mexico; and Department of Chemistry and Biochemistry, New Mexico State University, Las Cruces, New Mexico (J.B.A.)
| | - Jeffrey B Arterburn
- Department of Internal Medicine (E.R.P.) and University of New Mexico Cancer Center (E.R.P., J.B.A.), The University of New Mexico Health Sciences Center, Albuquerque, New Mexico; and Department of Chemistry and Biochemistry, New Mexico State University, Las Cruces, New Mexico (J.B.A.)
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17
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Nappi RE. Counseling on vaginal delivery of contraceptive hormones: implications for women's body knowledge and sexual health. Gynecol Endocrinol 2013; 29:1015-21. [PMID: 23992246 DOI: 10.3109/09513590.2013.830100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Healthcare providers (HCPs) have an important role in helping women select the contraceptive method that best matches their needs and lifestyle. Recent surveys outline the need of women to be informed about all available choices, including the newest methods (particularly those not requiring daily administration), such as vaginal contraception. METHODS The most relevant publications on combined contraceptive vaginal ring are revised in the context of counseling as an opportunity to empower women in term of vaginal health and sexual functioning. RESULTS HCPs should explain the main characteristics of the combined contraceptive vaginal ring including the anatomical and physiological implications that make the vagina an ideal route of hormonal administration and the basic notions about functional modifications of the vagina during reproductive life. Clinical data on the vaginal ring should be summarized with regard to efficacy, tolerability, pharmacokinetics, cycle control and user acceptability, including recent findings on extra-contraceptive benefits (also compared to other hormonal contraceptives) on the vaginal flora and on sexual function. CONCLUSION Vaginal contraception offers various benefits and should always be discussed during contraceptive counseling. An open dialogue about vaginal contraception will also help enhance body knowledge and sexual health.
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Affiliation(s)
- Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Obstetrics and Gynecology, Research Center for Reproductive Medicine, IRCCS San Matteo Foundation, University of Pavia , Pavia , Italy
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Park H, Kim K. Associations between oral contraceptive use and risks of hypertension and prehypertension in a cross-sectional study of Korean women. BMC Womens Health 2013; 13:39. [PMID: 24144402 PMCID: PMC3853233 DOI: 10.1186/1472-6874-13-39] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/17/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The effect of commonly used oral contraceptives (OCs) on blood pressure is still unclear. The aim of this study was to examine the relationship between OCs use and blood pressure and the prevalence of hypertension in a population-based sample of Korean women. METHODS A cross-sectional study was conducted using data from 3356 participants aged 35-55 years collected in the 2007-2009 Korea National Health and Nutrition Examination Surveys. OC use and demographic characteristics were obtained from participants using a questionnaire, and blood pressure was measured with a mercury sphygmomanometer. RESULTS Longer duration of OC use was positively associated with increasing levels of systolic blood pressure and diastolic blood pressure (p for trend <0.001). After adjusting for covariates, the odds ratio (OR) of hypertension was significantly increased in longer-term (>24 months) OC users (OR 1.96; 95% confidence interval (CI) 1.03-3.73) compared with those who had never used OCs. Additionally, use of OCs >24 months was associated with increased odds of prehypertension (adjusted OR 2.23; 95% CI 1.28-3.90) and hypertension or prehypertension (adjusted OR 2.13; 95% CI 1.37-3.32). CONCLUSION This study found a statistically significant association between OC use and blood pressure or hypertension among Korean women.
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Affiliation(s)
- Hyejin Park
- Department of International Medical Management, Catholic University of Daegu, Kyungbuk 712-702, Republic of Korea
| | - Kisok Kim
- Department of Pharmacy, Keimyung University, Daegu 704-701, Republic of Korea
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19
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The influence of steroid sex hormones on the cognitive and emotional processing of visual stimuli in humans. Front Neuroendocrinol 2013; 34:315-28. [PMID: 23988462 DOI: 10.1016/j.yfrne.2013.07.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 07/16/2013] [Accepted: 07/30/2013] [Indexed: 11/21/2022]
Abstract
Steroid sex hormones are responsible for some of the differences between men and women. In this article, I review evidence that steroid sex hormones impact on visual processing. Given prominent sex-differences, I focus on three topics for sex hormone effects for which there is most research available: 1. Preference and mate choice, 2. Emotion and recognition, and 3. Cerebral/perceptual asymmetries and visual-spatial abilities. For each topic, researchers have examined sex hormones and visual processing using various methods. I review indirect evidence addressing variation according to: menstrual cycle phase, pregnancy, puberty, and menopause. I further address studies of variation in testosterone and a measure of prenatal testosterone, 2D:4D, on visual processing. The most conclusive evidence, however, comes from experiments. Studies in which hormones are administrated are discussed. Overall, many studies demonstrate that sex steroids are associated with visual processing. However, findings are sometimes inconsistent, differences in methodology make strong comparisons between studies difficult, and we generally know more about activational than organizational effects.
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Chabbert-Buffet N, Gerris J, Jamin C, Lello S, Lete I, Lobo P, Nappi RE, Pintiaux A. Toward a new concept of "natural balance" in oral estroprogestin contraception. Gynecol Endocrinol 2013; 29:891-6. [PMID: 23931030 DOI: 10.3109/09513590.2013.824963] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Pill has undergone many changes since its first appearance some 50 years ago. Key developments included the reduction of ethinylestradiol doses and the synthesis of new progestins in order to increase safety, compliance and efficiency. Low-dose combined oral contraceptives (COCs) are currently the preferred option for millions of women. Due to this widespread use, it has been argued that the safety of COCs should be even better, raising the threshold for excellence. Yet in spite of major improvements, there is still an associated risk of venous thromboembolism (VTE). The next step in COCs' evolution should take total estrogenicity and hepatic estro-androgenic balance into account. The focus on the estrogen component--which has not changed in 50 years--has yielded a new class of natural estrogen pills. Following the introduction of a first quadriphasic pill, a monophasic estradiol pill based on the concept of "natural balance" was subsequently made available. These recent achievements could represent a step forward in the evolution of COCs and pave the way for better safety.
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Affiliation(s)
- Nathalie Chabbert-Buffet
- Department of Obstetrics and Gynecology, APHP Tenon Hospital, University Pierre and Marie Curie Paris 06, Paris, France
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21
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Little AC, Burriss RP, Petrie M, Jones BC, Roberts SC. Oral contraceptive use in women changes preferences for male facial masculinity and is associated with partner facial masculinity. Psychoneuroendocrinology 2013; 38:1777-85. [PMID: 23528282 DOI: 10.1016/j.psyneuen.2013.02.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 02/20/2013] [Accepted: 02/21/2013] [Indexed: 11/26/2022]
Abstract
Millions of women use hormonal contraception and it has been suggested that such use may alter mate preferences. To examine the impact of oral contraceptive (pill) use on preferences, we tested for within-subject changes in preferences for masculine faces in women initiating pill use. Between two sessions, initiation of pill use significantly decreased women's preferences for male facial masculinity but did not influence preferences for same-sex faces. To test whether altered preference during pill use influences actual partner choice, we examined facial characteristics in 170 age-matched male partners of women who reported having either been using or not using the pill when the partnership was formed. Both facial measurements and perceptual judgements demonstrated that partners of women who used the pill during mate choice have less masculine faces than partners of women who did not use hormonal contraception at this time. Our data (A) provide the first experimental evidence that initiation of pill use in women causes changes in facial preferences and (B) documents downstream effects of these changes on real-life partner selection. Given that hormonal contraceptive use is widespread, effects of pill use on the processes of partner formation have important implications for relationship stability and may have other biologically relevant consequences.
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Affiliation(s)
- Anthony C Little
- School of Natural Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK.
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22
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Lee JY, Ku SY, Kim SH, Hwang SS, Lee HW, Park SM. Oral contraceptive use and measurable cardiovascular risk factors in Korean women aged 20-50 years: the Fourth Korean National Health and Nutrition Examination Survey 2007-2009 (KNHANES IV). Gynecol Endocrinol 2013; 29:707-11. [PMID: 23772783 DOI: 10.3109/09513590.2013.797393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the effects of oral contraceptives (OCs) on cardiovascular risk factors according to the duration of use. METHODS This is a cross-sectional study using data from the Fourth Korean National Health and Nutrition Examination Survey of reproductive-age women. Subjects were classified into three groups based on OC use: non-users, short-term users (0-12 months) and long-term users (>12 months). Measurable cardiovascular risk factors, defined by 2009 consensus criteria, were included as metabolic syndrome components. RESULTS Of the 2225 women surveyed, 1924 (86.5%) were non-users of OCs, 186 (8.4%) were short-term users and 115 (5.2%) were long-term users. The use of OCs for longer durations was not associated with increased levels of blood pressure or fasting glucose, or larger waist circumference. After adjusting the covariates, long-term OC use was associated significantly with elevated triglycerides (TG, >150 mg/dL) compared with non-users (odds ratio, 2.16; 95% confidence interval, 1.18-3.97). In addition, the use of OCs for longer durations was associated negatively with the risk of low high-density lipoprotein cholesterol (<50 mg/dL) (p for trend = 0.038). CONCLUSION These results suggest that the long-term use of OCs is associated with elevated TG. With the exception of lipid profile, it may be concluded that OCs are unlikely to affect cardiometabolic risk.
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Affiliation(s)
- Jung-Yun Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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23
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Chabbert-Buffet N, Guigues B, Trillot N, Biron C, Morange P, Pernod G, Scheffler M, Brugere S, Hedon B. [DVT and combined oral contraceptives: update of the pluridisciplinary CNGOF-FNCGM-GEHT-SFMV group]. J Gynecol Obstet Hum Reprod 2013; 42:309-315. [PMID: 23642503 DOI: 10.1016/j.jgyn.2013.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 03/25/2013] [Accepted: 03/26/2013] [Indexed: 06/02/2023]
Abstract
Thrombotic risk among combined oral contraceptives (COC) users has recently been debated following a court action initiated by a patient. Recent epidemiological data, as well as accumulating biological data underlying these data, have led French Health authorities to modify COC prescription and reimbursement modalities. A short synthesis is proposed by a multidisciplinary group of experts from four French societies (CGOF, FNCGM, GHT, and SFMV).
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Affiliation(s)
- N Chabbert-Buffet
- Collège national des gynécologues-obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France.
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Girela JL, Gil D, Johnsson M, Gomez-Torres MJ, De Juan J. Semen parameters can be predicted from environmental factors and lifestyle using artificial intelligence methods. Biol Reprod 2013; 88:99. [PMID: 23446456 DOI: 10.1095/biolreprod.112.104653] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Fertility rates have dramatically decreased in the last two decades, especially in men. It has been described that environmental factors as well as life habits may affect semen quality. In this paper we use artificial intelligence techniques in order to predict semen characteristics resulting from environmental factors, life habits, and health status, with these techniques constituting a possible decision support system that can help in the study of male fertility potential. A total of 123 young, healthy volunteers provided a semen sample that was analyzed according to the World Health Organization 2010 criteria. They also were asked to complete a validated questionnaire about life habits and health status. Sperm concentration and percentage of motile sperm were related to sociodemographic data, environmental factors, health status, and life habits in order to determine the predictive accuracy of a multilayer perceptron network, a type of artificial neural network. In conclusion, we have developed an artificial neural network that can predict the results of the semen analysis based on the data collected by the questionnaire. The semen parameter that is best predicted using this methodology is the sperm concentration. Although the accuracy for motility is slightly lower than that for concentration, it is possible to predict it with a significant degree of accuracy. This methodology can be a useful tool in early diagnosis of patients with seminal disorders or in the selection of candidates to become semen donors.
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Affiliation(s)
- Jose L Girela
- Department of Biotechnology, University of Alicante, Alicante, Spain.
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Kim K, Park H. Effect of oral contraceptive use on lipid profile in Korean women aged 35-55 years. Contraception 2012; 86:500-5. [PMID: 22625865 DOI: 10.1016/j.contraception.2012.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 04/06/2012] [Accepted: 04/12/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although oral contraceptives (OCs) are widely used, their effects on lipid profile need monitoring according to current usage in different populations. STUDY DESIGN A cross-sectional study was conducted using data from 1541 participants aged 35-55 years collected by the 2005-2009 Korea National Health and Nutrition Examination Surveys. OC use, demographic characteristics and dietary intake were obtained from the participants by questionnaire, and lipid levels were determined by analysis of blood samples. RESULTS Longer duration of OC use was positively associated with increasing levels of high-density lipoprotein cholesterol (HDL-C) and decreasing levels of low-density lipoprotein cholesterol (LDL-C). After adjusting for demographic and dietary factors, the odds ratio (OR) of low HDL-C (<50 mg/dL) was significantly decreased in the longer-term (>12 months) OC users (OR=0.36, 95% confidence interval 0.24-0.52) compared with those who never used OCs. However, use of OCs was not associated with a risk of high total cholesterol (≥ 240 mg/dL), high LDL-C (≥ 130 mg/dL), high triglycerides (≥ 150 mg/dL) or high ratio of triglycerides to HDL-C (>3.8). CONCLUSIONS These data suggest that the use of OCs may reduce the risk of dyslipidemia, mainly due to the decreased risk of low HDL-C, in Korean women.
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Affiliation(s)
- Kisok Kim
- Department of Pharmacy, Keimyung University, Daegu 704-701, Republic of Korea.
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Goyette SR, McCoy JG, Kennedy A, Sullivan M. Sex differences on the judgment of line orientation task: a function of landmark presence and hormonal status. Physiol Behav 2011; 105:1045-51. [PMID: 22154804 DOI: 10.1016/j.physbeh.2011.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 11/17/2011] [Accepted: 11/18/2011] [Indexed: 10/15/2022]
Abstract
It has been well-established that men outperform women on some spatial tasks. The tools commonly used to demonstrate this difference (e.g. The Mental Rotations Task) typically involve problems and solutions that are presented in a context devoid of referents. The study presented here assessed whether the addition of referents (or "landmarks") would attenuate the well-established sex difference on the judgment of line orientation task (JLOT). Three versions of the JLOT were presented in a within design. The first iteration contained the original JLOT (JLOT 1). JLOT 2 contained three "landmarks" or referents and JLOT 3 contained only one landmark. The sex difference on JLOT 1 was completely negated by the addition of three landmarks on JLOT 2 or the addition of one landmark on JLOT3. In addition, salivary testosterone was measured. In men, gains in performance on the JLOT due to the addition of landmarks were positively correlated with testosterone levels. This suggests that men with the highest testosterone levels benefited the most from the addition of landmarks. These data help to highlight different strategies used by men and women to solve spatial tasks.
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Affiliation(s)
- Sharon Ramos Goyette
- Biology Department & Neuroscience Program, Stonehill College, Easton, MA 02357, USA.
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Abstract
On the 50th birthday of the pill, it is appropriate to recall the milestones which have led to its development and evolution during the last five decades. The main contraceptive effect of the pill being inhibition of ovulation, it may be called a small miracle that this drug was developed long before the complex regulation of ovulation and the menstrual cycle was elucidated. Another stumbling block on its way was the hostile climate with regard to contraception that prevailed at the time. Animal experiments on the effect of sex steroids on ovulation, and the synthesis of sex steroids and orally active analogues were the necessary preliminaries. We owe the development of oral contraceptives to a handful of persons: two determined feminists, Margaret Sanger and Katherine McCormick; a biologist, Gregory Pincus; and a gynaecologist, John Rock. Soon after the introduction of the first pills, some nasty and life-threatening side effects emerged, which were due to the high doses of sex steroids. This led to the development of new preparations with reduced oestrogen content, progestins with more specific action, and alternative administration routes. Almost every decade we have witnessed a breakthrough in oral contraception. Social and moral objections to birth control have gradually disappeared and, notwithstanding some pill scares, oral contraceptives are now one of the most used methods of contraception. Finally, all's well that ends well: recent reports have substantiated the multiple noncontraceptive health benefits paving the way for a bright future for this 50-year-old product.
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Affiliation(s)
- Marc Dhont
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Gent, Belgium.
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Spona J, Binder N, Höschen K, Feichtinger W. Contraceptive efficacy and safety of a low-dose oral contraceptive, (0.03 mg ethinyl oestradiol and 2 mg chlormadinone acetate) Belara®, over three medication cycles. EUR J CONTRACEP REPR 2009; 13:39-48. [PMID: 17886154 DOI: 10.1080/13625180701619247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe the modulation of ovarian function during three medication cycles with 0.03 mg ethinyl oestradiol (EE) and 2 mg chlormadinone acetate (CMA), leading to inhibition of conception in healthy women. METHODS Phase II, single-centre, open, non-controlled trial. The main outcome measure was inhibition of ovarian activity, assessed by frequent monitoring of the presence, size and persistence of follicle-like structures using ultrasonography. Secondary parameters included: cervical reaction score (CRS-probability of fertilization), endometrial thickness (probability of nidation), and serum levels of the sex hormones oestradiol, progesterone, luteinizing hormone and follicle stimulating hormone. Safety was primarily assessed by monitoring the occurrence of adverse events. RESULTS Thirty-three subjects were eligible for the trial and were included in the efficacy assessment (per protocol analysis, PPA). All subjects ovulated during the pretreatment cycle, but none during the three medication cycles. Follicular growth was profoundly suppressed during the medication phase, with residual ovarian activity occurring in only 12/83 (14.5%) treatment cycles. The CRS was negative during each medication cycle and endometrial thickness was suppressed on each medication day, with median values of 4.0-6.0 mm. EE/ CMA was well tolerated, with few adverse events reported; most were typically cycle-related and included headache, breast discomfort, nausea and vomiting. CONCLUSION During the administration of EE/CMA follicular development, cervical reaction and endometrial thickness are profoundly suppressed, resulting in unfavourable conditions for fertilization, implantation and, thus, pregnancy.
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Benagiano G, Bastianelli C, Farris M. Selective progesterone receptor modulators 2: use in reproductive medicine. Expert Opin Pharmacother 2008; 9:2473-85. [PMID: 18778185 DOI: 10.1517/14656566.9.14.2473] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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