1
|
Moy J, Landon M, Vigilante J, Lehmann B, DeChambeau A, Rohlfing F, Marks R. An in-vivo study of the safety of copper-containing intrauterine devices in 3.0 Tesla magnetic resonance imaging. Abdom Radiol (NY) 2024:10.1007/s00261-024-04493-4. [PMID: 39023566 DOI: 10.1007/s00261-024-04493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/02/2024] [Accepted: 07/02/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE The aim of this study is to prospectively evaluate whether women with copper-containing intrauterine devices (Cu-IUD), currently listed as MR conditional, can safely undergo 3.0 Tesla (3 T) magnetic resonance imaging (MRI). METHODS 73 women, age 18-54 years old, with a Cu-IUD who were undergoing MRI for any reason were included consecutively. Pre- and post-MRI standard pelvic ultrasound examinations were completed to determine the appropriate pre- and post-MRI positioning of the Cu-IUD. Displaced IUDs were defined by IUD crossbars not in the fundal portion of the endometrial cavity, a visualized tip in the mid or lower uterus, any part of the device located in the cervical canal or outside of the endometrial canal, a fractured device, or a non-visualized IUD. Additionally, a questionnaire was completed by participants to determine the level of pre- and post-MRI pelvic pain. RESULTS There were zero observed displaced Cu-IUDs on post-MRI pelvic ultrasounds (p = 0/70, 95% CI 0, .043). Three participants were dropped from the study due to malpositioned IUDs on pre-MRI pelvic ultrasound. Six patients reported new or worsening pelvic pain/discomfort during or after their MRI examination. CONCLUSION Our results suggest that performing 3 T MRI using a low SAR setting does not cause displacement of Cu-IUDs, with zero out of 70 patients demonstrating IUD displacement.
Collapse
Affiliation(s)
- Jeffrey Moy
- Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 204, San Diego, CA, 92134, USA
| | - Matthew Landon
- Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 204, San Diego, CA, 92134, USA
| | - John Vigilante
- Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 204, San Diego, CA, 92134, USA
| | - Benjamin Lehmann
- Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 204, San Diego, CA, 92134, USA
| | - Amber DeChambeau
- Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 204, San Diego, CA, 92134, USA
- Department of Radiology, Sharp Rees-Stealy Medical Group, 300 Fir Street, San Diego, CA, 92101, USA
| | - Frederick Rohlfing
- Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 204, San Diego, CA, 92134, USA
| | - Robert Marks
- Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 204, San Diego, CA, 92134, USA.
- Department of Radiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA.
| |
Collapse
|
2
|
Kim H, Lee SH, Wentworth A, Babaee S, Wong K, Collins JE, Chu J, Ishida K, Kuosmanen J, Jenkins J, Hess K, Lopes A, Morimoto J, Wan Q, Potdar SV, McNally R, Tov C, Kim NY, Hayward A, Wollin D, Langer R, Traverso G. Biodegradable ring-shaped implantable device for intravesical therapy of bladder disorders. Biomaterials 2022; 288:121703. [PMID: 36030104 PMCID: PMC10485746 DOI: 10.1016/j.biomaterials.2022.121703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 11/26/2022]
Abstract
Intravesical instillation is an efficient drug delivery route for the local treatment of various urological conditions. Nevertheless, intravesical instillation is associated with several challenges, including pain, urological infection, and frequent clinic visits for catheterization; these difficulties support the need for a simple and easy intravesical drug delivery platform. Here, we propose a novel biodegradable intravesical device capable of long-term, local drug delivery without a retrieval procedure. The intravesical device is composed of drug encapsulating biodegradable polycaprolactone (PCL) microcapsules and connected by a bioabsorbable Polydioxanone (PDS) suture with NdFeB magnets in the end. The device is easily inserted into the bladder and forms a 'ring' shape optimized for maximal mechanical stability as informed by finite element analysis. In this study, inserted devices were retained in a swine model for 4 weeks. Using this device, we evaluated the system's capacity for delivery of lidocaine and resiquimod and demonstrated prolonged drug release. Moreover, a cost-effectiveness analysis supports device implementation compared to the standard of care. Our data support that this device can be a versatile drug delivery platform for urologic medications.
Collapse
Affiliation(s)
- Hyunjoon Kim
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Seung Ho Lee
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Adam Wentworth
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Sahab Babaee
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Kaitlyn Wong
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Joy E Collins
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jacqueline Chu
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Keiko Ishida
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Johannes Kuosmanen
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Joshua Jenkins
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Kaitlyn Hess
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Aaron Lopes
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Joshua Morimoto
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Qianqian Wan
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Shaunak V Potdar
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Ronan McNally
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Caitlynn Tov
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Na Yoon Kim
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Alison Hayward
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA; Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Daniel Wollin
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Robert Langer
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Giovanni Traverso
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.
| |
Collapse
|
3
|
Handayani S, Damayanti R, Ariawan I, Yelda F, Harlan S, Wahyuningrum Y, Storey D. Improving Communication Messages by Using Perceptual Mapping: Family Planning Survey in East Java and West Nusa Tenggara, Indonesia. SAGE Open Med 2021; 9:2050312121993288. [PMID: 33738099 PMCID: PMC7934029 DOI: 10.1177/2050312121993288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/11/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives: Contraceptive methods vary in effectiveness, actions required of users, and side effects. This article aims to analyze the perceptions about contraceptive methods among family planning clients of the East Java and West Nusa Tenggara (NTB) provinces in Indonesia. Methods: The data were obtained from the operational research of the Improving Contraceptive Method Mix Project in Indonesia, conducted in 2015–2016 in six districts in East Java and West Nusa Tenggara. The total sample size was 12,190 women aged 15–49 years. The perceptual mapping method uses cross-sectional surveys that require the respondent to rate the level to which they associate specific elements with each other, based on similarities and differences of perceived association. The correlation matrices for six contraceptive methods and five attributes were subjected to a multidimensional scaling analysis. Results: The results showed injectable to be the most preferred method, which was positioned closest to the attributes ‘easy to use’ and ‘easy to get’, followed by pills. Implants ranked higher than other long-acting and permanent method. Conclusion: Injectables and pills were the most preferred because people believe that they were ‘easy to use’ and ‘easy to get’. The least preferred methods were tubectomy and vasectomy because the respondents thought those were not close to any attributes at all. To increase the demand for the long-acting and permanent method choice in the provinces of East Java and West Nusa Tenggara, the attributes ‘easy to use’ and ‘easy to get’ should be emphasized in the long-acting and permanent method Information Education and Communication messages.
Collapse
Affiliation(s)
- Sarah Handayani
- Public Health Science Doctoral Study Program, Faculty of Public Health, University of Indonesia, Depok, Indonesia
- Faculty of Health Sciences Universitas Muhammadiyah Prof Dr. HAMKA (UHAMKA), Jakarta Selatan, Indonesia
- Sarah Handayani, Faculty of Health Sciences Universitas Muhammadiyah Prof Dr. HAMKA (UHAMKA), Jalan Limau II/1, Kebayoran Baru, Jakarta Selatan, DKI Jakarta 12130, Indonesia.
| | - Rita Damayanti
- Center for Health Research, Universitas Indonesia, Depok, Indonesia
| | - Iwan Ariawan
- Center for Health Research, Universitas Indonesia, Depok, Indonesia
| | - Fitra Yelda
- Center for Health Research, Universitas Indonesia, Depok, Indonesia
| | - Sarah Harlan
- John Hopkins University Center for Communication Programs, Baltimore, MD, USA
| | | | - Douglas Storey
- John Hopkins University Center for Communication Programs, Baltimore, MD, USA
| |
Collapse
|
5
|
Lovett JL, Chima MA, Wexler JK, Arslanian KJ, Friedman AB, Yousif CB, Strassmann BI. Oral contraceptives cause evolutionarily novel increases in hormone exposure: A risk factor for breast cancer. Evol Med Public Health 2017; 2017:97-108. [PMID: 28685096 PMCID: PMC5494186 DOI: 10.1093/emph/eox009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/22/2017] [Indexed: 01/14/2023] Open
Abstract
Background and objectives: In the evolutionary past, women spent most of their reproductive lives either pregnant or in lactational amenorrhea, and rarely menstruated. The current pattern of frequent menses, and the associated increase in endogenous hormonal exposure, has been implicated in the current breast cancer epidemic. It is not known, however, whether oral contraceptives further increase, or actually decrease, hormonal exposure over one menstrual cycle. Here, we examined variation in hormonal exposure across seven oral contraceptive (OC) formulations, and produced the first quantitative comparison of exogenous versus endogenous hormone exposure. Methodology: Data from 12 studies of serum estradiol (E2) and progesterone (P4) were aggregated to create a composite graph of endogenous hormone levels over one menstrual cycle in European or American women (age 19-40 years). Pharmacokinetic package insert data, also from Western women, were used to calculate exposures for hormones in seven different OC formulations. Endogenous and exogenous hormone levels were compared after adjusting for the relative binding affinity (RBA) of progestin to the progesterone receptor and ethinyl estradiol (EE) to the estrogen receptor. Results: After adjusting for RBA, median ethinyl estradiol exposure across 28 days in the OCs was 11.4 nmol/l, similar to median E2 exposure. One formulation, however, was 40% higher in ethinyl estradiol exposure relative to median endogenous estradiol. Median exposure from progestins in OCs (1496 nmol/l) was 4-fold higher than the median endogenous exposure from P4 (364 nmol/l). Exposure from OC progestins ranged from one sixtieth to 8-fold median endogenous P4 over 28 days. Conclusions and implications: Given that breast cancer risk increases with hormonal exposure, our finding that four widely prescribed formulations more than quadruple progestin exposure relative to endogenous progesterone exposure is cause for concern. As not all formulations produce the same exposures, these findings are pertinent to contraceptive choice. We also identify critical gaps in the provision of relevant data on pharmacokinetics and carcinogenicity by drug manufacturers.
Collapse
Affiliation(s)
- Jennie L Lovett
- Department of Anthropology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Margo A Chima
- Department of Anthropology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Juliana K Wexler
- Department of Anthropology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kendall J Arslanian
- Department of Anthropology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Andrea B Friedman
- Department of Anthropology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Chantal B Yousif
- Department of Anthropology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Beverly I Strassmann
- Department of Anthropology, University of Michigan, Ann Arbor, MI 48109, USA
- Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, MI 48106, USA
| |
Collapse
|