The prediction of hypertensive disorders by maternal hemodynamic assessment in the first trimester of pregnancy

BACKGROUND

Hypertensive disorders of pregnancy and fetal growth restriction share common etiopathological origins and could be caused by maternal hemodynamic maladaptation to pregnancy.

OBJECTIVE

The aim of our study is to evaluate if there is a correlation between maternal hemodynamic detected by UltraSonic Cardiac Output Monitor (USCOM^®) during the first trimester and the pregnancy outcome.

STUDY DESIGN

We recruited a nonconsecutive series of women in the first trimester of pregnancy with no previous history of hypertensive disorders. We measured the pulsatility index uterine arteries and performed a hemodynamic evaluation by USCOM^® device. After delivery, we reported the development of hypertensive disorders or intrauterine fetal growth restriction later during gestation.

RESULTS

A total of 187 women were enrolled during the first trimester; 17 (9%) developed gestational hypertension or preeclampsia while 11 (6%) delivered a restricted growth fetus. Mean uterine artery pulsatility index above the 95th percentile was significantly more frequent in both women who developed hypertension and those with fetal growth restriction compared to controls. Hemodynamic parameters (reduced cardiac output and increased total vascular resistance) were significantly different in the group that developed hypertensive disorders, compared to uncomplicated pregnancy. ROC curves demonstrated the usefulness of uterine artery pulsatility index in the prediction of fetal growth restriction, while hemodynamic parameters were significantly associated to the development of hypertensive disorders.

CONCLUSIONS

Hemodynamic maladaptation to pregnancy may predispose to the development of hypertension, while we demonstrated a significative relationship between growth restriction and mean uterine pulsatility index. Further studies are needed to assess the value of hemodynamics evaluation in screening protocols of preeclampsia.

Increased nuchal translucency can be ascertained using transverse planes

BACKGROUND

The detection of increased nuchal translucency is crucial for the assessment risk of aneuploidies and other fetal anomalies.

OBJECTIVE

This study aimed to investigate the ability of a transverse view of the fetal head to detect increased fetal nuchal translucency at 11 to 13 weeks of gestation.

STUDY DESIGN

This was a prospective study enrolling a nonconsecutive series of women who attended our outpatient clinic from January 2020 to April 2021 for combined screening and were examined by operators certified by the Fetal Medicine Foundation. In each patient, nuchal translucency measurements were obtained both from a median sagittal view and from a transverse view. A second sonologist blinded to the results of the first examination obtained another measurement to assess intermethod and interobsever reproducibility.

RESULTS

A total of 1023 women were enrolled. An excellent correlation was found between sagittal and transverse nuchal translucency measurements, with a mean difference of 0.01 mm (95% confidence interval, -0.01 to 0.02). No systematic difference was found between the 2 techniques. The inter-rater reliability (intraclass correlation coefficient, 0.957; 95% confidence interval, 0.892-0.983) and intrarater reliability (intraclass correlation coefficient, 0.976; 95% confidence interval, 0.941-0.990) of axial measurements were almost perfect. Transverse measurements of 3.0 mm identified all cases with sagittal measurements of ≥3.0 with a specificity of 99.7%; transverse measurements of >3.2 mm identified all cases with sagittal measurements of 3.5 mm with a specificity of 99.7%. The time required to obtain transverse nuchal translucency measurements was considerably shorter than for sagittal measurements, particularly when the fetus had an unfavorable position.

CONCLUSION

When the sonogram is performed by an expert sonologist, the difference in nuchal translucency measurement obtained with a transverse or sagittal plane is minimal. Increased nuchal translucency can be reliably identified by using transverse views, and in some cases, this may technically be advantageous.

P312 A CASE OF TAKOTSUBO CARDIOMYOPATHY IN SARS–COV–2 INFECTION

Cardiovascular complications are a frequent occurrence in Sars–CoV–2 infection. Takotsubo cardiomyopathy is a possible cause of transient ST segment elevation (1–3% of total cases) and is characterized by a reversible left ventricular dysfunction with coronary arteries free from critical stenosis. The predominant echocardiographic pattern is an akinesia of the mid–apical myocardial segments with preserved kinetics of the basal segments. The incidence of Takotsubo cardiomyopathy showed a marked increase during the COVID–19 pandemic. Three factors mainly contribute to the onset of cardiomyopathy in patients with COVID–19: cytokine storm, adrenergic hyperactivation and microvascular dysfunction. A 79–year–old woman was hospitalized in the Pneumology department of our hospital for bilateral interstitial pneumonia Sars–CoV–2 related. In remote medical history: in 2010 diagnosis of breast cancer with negative follow–up for disease recovery, arterial hypertension, hypercholesterolemia and syndrome of reduced mobility as a result of a previous ischemic stroke. Non–invasive mechanical ventilation with c–PAP was started and, for the detection of anterolateral electrocardiographic anomalies (diffuse symmetrical negative T waves) and an increase in myocardionecrosis markers, echocardiographic evaluation was performed, which revealed an akinesia of the mid–apical segments of the left ventricle with preserved kinetics of the basal segments and severely depressed global systolic function (ejection fraction: 30%). BNP (18.100 pg /mL), interleukin–6 (339 pg /mL) and CRP (136 mg /L) were elevated on blood chemistry tests. In the suspicion of Takotsubo cardiomyopathy (InterTAK Score: 67, probability: 79.8%), cardioprotective therapy with ACE inhibitor, beta–blocker, diuretics, low molecular weight heparin, double antiaggregation and statin was started, deferring coronary angiography to improved clinical conditions. In the following days, due to the respiratory and haemodynamic worsening, the patient was transferred to an intensive setting, where she was intubated and treated with levosimendan and noradrenaline. Serial echocardiograms showed a progressive improvement of the global systolic function (ejection fraction at the last checkup: 55%), with complete regression of the kinetic anomalies, confirming of the diagnostic hypothesis of stress cardiomyopathy. For a pulmonary mycotic superinfection, complicated by iatrogenic pneumothorax, in the following days the patient died.

Plasma and amniotic fluid concentrations of nitric oxide: Effects on uterine artery and placental vasculature in women who underwent voluntary pregnancy termination and in women with missed and threatened abortion. A pilot study

OBJECTIVES

First trimester miscarriage is a multifactorial event. Various angiogenic factors have been proposed as possible early markers of non-viable pregnancies. The aim of the present study was to evaluate the systemic nitric oxide (NO) production in healthy early pregnancy and its possible role in first trimester miscarriage.

STUDY DESIGN

We prospectively enrolled women referred to our Unit for elective termination of pregnancy, threatened abortion or missed abortion. Blood samples were taken for testing circulating NO plasma levels. Subsequently, all patients underwent 2-D ultrasonographic analysis and Color Doppler imaging to assess the pulsatility index of the uterine arteries. 3-D ultrasonographic and power Doppler analysis allowed a volumetric and vascular reconstruction of the placenta. During dilatation and vacuum aspiration, amniotic fluid was collected.

RESULTS

Seventy-two patients were enrolled: 25 with elective termination of pregnancy (Group I); 17 with threatened abortion (Group II); 30 with missed abortion (Group III). Group II showed greater placental volume and lower uterine arteries PI than others. The plasma NO concentration resulted statistically higher in women with threatened abortion, while amniotic fluid NO concentration were higher in the viable pregnancies (Group I) than in the aborted fetuses (Group III). Plasma NO was inversely correlated with both mean arterial pressure and uterine artery PI and was positively correlated with amniotic fluid NO and CRL; amniotic fluid NO was positively correlated with placental Vascularization Index and Vascularization-Flow Index.

CONCLUSION

Amniotic NO concentration was higher in viable pregnancies and positively related to Doppler 3D indices of vascularization and blood flow within the placenta. Further studies are needed to elucidate its role in first trimester miscarriage.

The relationship between self-disorders (SDS) and depressive/anxious symptoms in a clinical sample of adolescents

Introduction

Self-disorders (SDs) have been described as a core feature of schizophrenia-spectrum disorders. Previous studies conducted on heterogeneous clinical adult and adolescents samples demonstrated that SDs aggregate selectively in the schizophrenia spectrum disorders compared to other disorders.

Objectives

To examine the specificity of SDs for schizophrenia spectrum disorders in adolescent inpatient sample.

Methods

Fifty-five adolescent inpatients admitted to the Child Psychiatry Unit at the Sapienza University in Rome were assessed for psychopathology using Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL), Structured Interview for Prodromal Syndromes (SIPS/SOPS),Examination of Anomalous Self-Experiences (EASE), Multidimensional Anxiety Scale for Children (MASC), Calgary depression scale for schizophrenia (CDSS)

Results

Patients, aged 14-18 years, were divided in four diagnostic groups: schizophrenia spectrum disorders (5 pts.), mood disorders (19 pts.), anxiety disorders (27 pts.) and other disorders (4 pts.). Frequency of self-disorders was different among the 4 groups. Including patients schizotypal personality disorder in the schizophrenia-spectrum disorder group, the difference is still significant. Mann-Whitney U test shows no differences between EOP and UHR patients in SD. Furthermore, correlations between EASE total score and Calgary and MASC total scores were significant.

Conclusions

Our results confirm the specificity of SDs for schizophrenia spectrum disorders and also the belonging of schizotypal personality disorder to schizophrenia-spectrum.

Metformin metabolic and vascular effects in normal weight hyperinsulinemic polycystic ovary syndrome patients treated with contraceptive vaginal ring. A pilot study

PURPOSE

The aim of this longitudinal, controlled, and retrospective pilot study was to assess how metformin, associated with a contraceptive vaginal ring, may influence lipid and carbohydrate metabolism, and surrogate markers of arterial function in normal weight polycystic ovary syndrome patients.

MATERIAL AND METHODS

Among 28 lean patients, 15 were treated with vaginal ring plus metformin and 13 women with only vaginal ring. The effects were assessed after six months. The patients were submitted to evaluation of lipid and carbohydrate metabolism; Doppler analysis of ophthalmic artery; brachial artery flow-mediated vasodilatation; and oral glucose tolerance test.

RESULTS

After six months, the fasting insulin, glucose/insulin ratio, and homeostatic model assessment estimates for insulin resistance were significantly improved in metformin group. The ophthalmic artery pulsatility index did not significantly improve in either group. The brachial artery vasodilation was better in metformin treated patients.

CONCLUSION

Metformin, associated with vaginal ring, improves the insulin and carbohydrate metabolism. This, associated with the significant improvements of surrogate markers of arterial function, may be responsible of a slight possible cardiovascular and cerebrovascular protective effect.

Metformin metabolic and vascular effects in overweight/moderately obese hyperinsulinemic PCOS patients treated with contraceptive vaginal ring: a pilot study

The aim of this pilot study was to assess how metformin, associated with a contraceptive vaginal ring, may influence lipid and carbohydrate metabolism, fat distribution, and surrogate markers of arterial function. Among 62 patients, 25 were treated with vaginal ring plus metformin and 37 women with only vaginal ring. The effects were assessed after 6 months. The patients were submitted to evaluation of lipid and carbohydrate metabolism; extended view ultrasonographic evaluation of fat distribution; Doppler analysis of ophthalmic artery; brachial artery flow-mediated vasodilatation; oral glucose tolerance test. After 6 months, the body mass index and waist/hip ratio resulted significantly better in patients who associated metformin to vaginal ring. The fasting glucose, insulin, and glucose/insulin ratio, HOMA-IR, glucose, and insulin AUC 120 were significantly improved in metformin group. The ultrasonographic fat analysis resulted significantly better after metformin. The ophthalmic artery PI significantly improved in metformin group. The brachial artery vasodilation was better in metformin treated patients. In conclusion, metformin, associated with vaginal ring, improves the insulin and carbohydrate metabolism, reduces the body weight and android fat distribution. This, associated with the significant improvements of surrogate markers of arterial function, may be responsible of possible cardiovascular and cerebrovascular protective effects.

Oligosypthomatic ovarian hyperstimulation syndrome in a spontaneous uneventful pregnancy. A case report

Spontaneous hyperstimulation syndrome (spOHSS) is a rare event in pregnancies following natural conception. Only a few cases are reported in the scientific literature and result associated with massive ovarian enlargement with multiple cysts, dehydration, and fluid accumulation in the "third space". We report a novel case of spOHSS in a naturally conceived singleton pregnancy. The spOHSS was characterized by massive ovarian enlargement with multiple cysts. No dehydration and no signs of ascites were observed. The pregnancy uneventful evolved up to term.

Effect of Gallium Substitution on Lithium-Ion Conductivity and Phase Evolution in Sputtered Li7-3 xGa xLa3Zr2O12 Thin Films

Replacing the liquid electrolyte in conventional lithium-ion batteries with thin-film solid-state lithium-ion conductors is a promising approach for increasing energy density, lifetime, and safety. In particular, Li₇La₃Zr₂O₁₂ is appealing due to its high lithium-ion conductivity and wide electrochemical stability window. Further insights into thin-film processing of this material are required for its successful integration into solid-state batteries. In this work, we investigate the phase evolution of Li_{7-3 x}Ga _xLa₃Zr₂O₁₂ in thin films with various amounts of Li and Ga for stabilizing the cubic phase. Through this work, we gain valuable insights into the crystallization processes unique to thin films and are able to form dense Li_{7-3 x}Ga _xLa₃Zr₂O₁₂ layers stabilized in the cubic phase with high in-plane lithium-ion conductivities of up to 1.6 × 10^-5 S cm^-1 at 30 °C. We also note the formation of cubic Li₇La₃Zr₂O₁₂ at the relatively low temperature of 500 °C.

Synthesis, stability and Li-ion mobility of nanoconfined Li2B12H12

This communication presents the first synthesis of nanoconfined Lithium closo-borate, Li₂B₁₂H₁₂, using nanoporous SiO₂ as scaffold. The yield of Li₂B₁₂H₁₂ is up to 94 mol%. The as-synthesized nanoconfined Li₂B₁₂H₁₂ exhibits a structural transition around 380 °C and conversion to H-deficiency Li₂B₁₂H_12-x at 580 °C.

Weight gain, body image and sexual function in young patients treated with contraceptive vaginal ring. A prospective pilot study

INTRODUCTION

Oral contraceptives could induce mood changes. As far as our knowledge, there are no studies in literature that have examined the role of vaginal contraception in self-perceived body image.

AIM

To evaluate the effects of intravaginal contraception on weight gain and perceived body image in relation with the Beck's Depression Inventory questionnaire (BDI) and the McCoy Female Sexuality Questionnaire (MFSQ).

METHODS

Twenty-one adult (18-35 years old) eumenorrheic (menstrual cycle of 25-35 days), lean (body mass index - BMI - of 19-25 kg/m²) women who were referred for hormonal contraception were administered the Stunkard Figure Rating Scale (FRS), BDI and MFSQ. Subjects were studied in basal condition and after 6 months of therapy with vaginal contraception (NuvaRing®; Organon-Schering-Plough Italia, Milan, Italy).

MAIN OUTCOME MEASURES

BMI, FRS, MFSQ and BDI.

RESULTS

After 6 months of therapy with NuvaRing®, both body weight (60.0 ± 8.3; p = 0.050) and BMI (22.1 ± 3.1; p = 0.028) slightly, but statistically, increased. FRS and BDI showed no differences after the vaginal contraception. Hormonal contraception was associated with a significant decrease in the two-factor Italian MFSQ score.

CONCLUSIONS

Vaginal ring seems a good alternative to other hormonal contraceptive not significantly altering the female sexuality and not influencing the FRS and BDI.

A highly stable sodium solid-state electrolyte based on a dodeca/deca-borate equimolar mixture

Na₂(B₁₂H₁₂)_0.5(B₁₀H₁₀)_0.5, a new solid-state sodium electrolyte is shown to offer high Na⁺ conductivity of 0.9 mS cm⁻¹ at 20 °C.

Cardiometabolic Risk and Female Sexuality: Focus on Clitoral Vascular Resistance

INTRODUCTION

The relation between sexual and cardiovascular health in women is not well defined. Clitoral color Doppler ultrasound (CDU) with assessment of the pulsatility index (PI), reflecting resistance to blood flow, has been proposed as an objective measurement of sexual functioning.

AIM

To investigate associations between clitoral PI and cardiometabolic risk factors, sexual and intrapsychic parameters, and self-perception of body image.

METHODS

Seventy-one adult heterosexual women in a stable relationship attending our clinic for sexual dysfunction were consecutively recruited.

MAIN OUTCOME MEASURES

Patients underwent physical, laboratory, and clitoral color Doppler ultrasound examinations and completed the Female Sexual Function Index, the Middlesex Hospital Questionnaire, and the Body Uneasiness Test (BUT).

RESULTS

Clitoral PI was positively correlated with body mass index (r = 0.441, P < .0001), waist circumference (r = 0.474, P < .0001), glycemia (r = 0.300, P = .029), insulin (r = 0.628, P = .002), homeostatic model assessment index (r = 0.605, P = .005), triglycerides (r = 0.340, P = .011), total cholesterol (r = 0.346, P = .010), and low-density lipoprotein cholesterol (r = 0.334, P = .016). All relations, with the exception of glycemia, retained statistical significance after adjusting for age, smoking habit, and years since menopause (P < .0001 for body mass index, waist circumference, and triglycerides; P < .05 for all other associations). Analysis of covariance, after adjusting for confounders, showed that women with obesity or metabolic syndrome (MetS) showed significantly higher PI values (obesity: F = 17.79, P = .001; MetS: F = 7.37, P = .019). In particular, a stepwise increase of PI was found as a function of increasing MetS components (β = 0.434, P = .007). Clitoral PI was negatively associated with Female Sexual Function Index arousal (β = -0.321, P = .014) and satisfaction (β = -0.289, P = .026) scores and positively associated with Middlesex Hospital Questionnaire somatized anxiety symptoms, even after adjusting for age, smoking habit, years since menopause, and current use of psychiatric medication (β = 0.354, P = .011). A positive association also was observed between PI and the BUT positive symptom distress index (β = 0.322, P = .039) and BUT for dislike of the womb, genitals, and breast (β = 0.538, P < .0001; β = 0.642, P < .0001; β = 0.549, P < .0001, respectively). After introducing waist circumference as another covariate, the associations between clitoral PI and the BUT positive symptom distress index and BUT dislike of the womb, genitals, and breast retained statistical significance (P = .038 for positive symptom distress index; P < .0001 for dislike of womb, genitals, and breast).

CONCLUSION

Clitoral vascular resistance is positively associated with MetS (in particular insulin resistance), decreased sexual arousal, body image concerns, and increased somatized anxiety symptoms. Further studies are needed to establish whether treatment of metabolic abnormalities might improve clitoral color Doppler ultrasound indices and sexual outcomes.

“Water-in-salt” electrolytes enable the use of cost-effective aluminum current collectors for aqueous high-voltage batteries

Anodic aluminum dissolution is strongly suppressed in highly concentrated aqueous electrolytes.

The superparamagnetic iron oxide tracer: a valid alternative in sentinel node biopsy for breast cancer treatment

The European Union has determined that from 2016 breast cancer patients should be treated in Specialist Breast Units that achieve the minimum standards for the mandatory quality indicators as defined by Eusoma. The existing standard for axillary lymph node staging in breast cancer is sentinel node biopsy (SNB), performed using Technetium-sulphur colloid (^99m Tc) alone or with blue dye. The major limits of radioisotope consist in the problems linked to radioactivity, in the shortage of tracer and nuclear medicine units. Among existing alternative tracers, SentiMag^® , which uses superparamagnetic iron oxide particles, can represent a valid option for SNB. We conducted a paired, prospective, multicentre study to evaluate the non-inferiority of SentiMag^® vs. ^99m Tc. The primary end point was the detection rate (DR) per patient. The study sample consists of 193 women affected by breast carcinoma with negative axillary assessment. The concordance rate per patients between ^99m Tc and SentiMag^® was 97.9%. The DR per patient was 99.0% for ^99m Tc and 97.9% for SentiMag^® . SentiMag^® appears to be non-inferior to the radiotracer and safe. While ^99m Tc remains the standard, SentiMag^® DR appears adequate after a minimum learning curve. In health care settings where nuclear medicine units are not available, SentiMag/Sienna+^® allows effective treatment of breast cancer patients.

Autotransplantation of cryopreserved ovarian tissue in oncological patients: recovery of ovarian function

ABSTRACT: 

Aim: To present preliminary results of autotransplantation of cryopreserved ovarian tissue performed at Sant’Orsola-Malpighi Hospital, Bologna, Italy. Materials & methods: Orthotopic transplantation was performed in two women with colorectal and breast cancer, and heterotopic transplantation was performed in one Hodgkin’s lymphoma woman. The presence of micrometastasis in the ovarian tissue was checked, and morphological features of ovarian tissue were evaluated before transplantation. Ovarian function was monitored by hormonal and ultrasound-color Doppler examination after transplantation. Results: In all three women, no micrometastasis was found; light and transmission electron microscopy showed well-preserved thawed ovarian tissue. Ovarian function recovery was observed 2–4 months after transplantation. Spontaneous menstrual cycles occurred in two women with normal follicular densities. No periods occurred in the woman with low follicular density at the time of tissue collection. Conclusion: Ovarian tissue cryopreservation and transplantation is a promising approach for preserving ovarian function in women with cancer.

Urinary exosomes and diabetic nephropathy: a proteomic approach

Urinary exosomes (UE) are nanovesicles released by every epithelial cell facing the urinary space and they are considered a promising source of molecular markers for renal dysfunction and structural injury. Exosomal proteomics has emerged as a powerful tool for understanding the molecular composition of exosomes and has potential to accelerate biomarker discovery. We employed this strategy in the study of diabetic nephropathy (DN) and the consequent end stage renal disease, which represent the dramatic evolution of diabetes, often leading the patients to dialysis or kidney transplantation. The identification of DN biomarkers is likely to help monitoring the disease onset and progression. A label free LC-MS/MS approach was applied to investigate the alteration of the proteome of urinary exosomes isolated from the Zucker diabetic fatty rats (ZDF), as a model of type 2 DN. We collected 24 hour urine samples from 7 ZDF and from 7 control rats at different ages (6, 12 and 20 weeks old) to monitor the development of DN. Exosomes were isolated by ultracentrifugation and their purity assessed by immunoblotting for known exosomal markers. Exosomal proteins from urine samples of 20 week old rats were pooled and analyzed by nLC-ESI-UHR-QToF-MS/MS after pre-filtration and tryptic digestion, leading to the identification and label free quantification of 286 proteins. Subcellular localization and molecular functions were assigned to each protein by UniprotKB, showing that the majority of identified proteins were membrane-associated or cytoplasmic and involved in transport, signalling and cellular adhesion, typical functions of exosomal proteins. We further validated label free mass spectrometry results by immunoblotting, as exemplified by: Xaa-Pro dipeptidase, Major Urinary Protein 1 and Neprilysin, which resulted increased, decreased and not different, respectively, in exosomes isolated from diabetic urine samples compared to controls, by both techniques. In conclusion we show the potential of exosome proteomics for DN biomarker discovery.

Cigarette smoking and cardiovascular risk in young women with polycystic ovary syndrome

BACKGROUND

To verify if in lean polycystic ovary syndrome (PCOS) patients, the smok- ing habitude might increase the risk of cardiovascular (CV) disease.

MATERIALS AND METHODS

In this prospective observational study, eighty-one women were divided into the following three groups: group I with 27 non-smokers, group II with 26 light-smokers (1-10 cigarettes/day), and group III with 28 heavy smokers (>10 cigarettes/ day). They were submitted to fasting blood sampling; blood measurement of nitrites/ni- trates (NO2-/ NO3), biochemical and hormonal parameters; ovarian ultrasonographic (US) analysis; doppler evaluation of uterine and ophthalmic arteries; brachial artery flow-medi- ated vasodilatation; 24-hour ambulatory blood pressure monitoring; and oral glucose toler- ance test (OGTT).

RESULTS

Doppler analysis revealed higher uterine and ophthalmic arteries pulsatility in- dex (PI) and ophthalmic artery back pressure in group III compared with group I. The brachial artery diameter and PI, at baseline, was similar among all groups. After the re- active hyperemia, a more intense vasodilatation was observed in group I in comparison with group III. The 24-hour blood pressure demonstrated that, in group III patients, the 24-hour, day- and night-time diastolic blood pressure (DBP), was higher in comparison with non-smokers. The atherogenic index of plasma (AIP) was higher in heavy smokers than in non-smokers. The leukocytes and homocysteine (HCY) values were increased in group III. The NO2-/ NO3- plasma levels were reduced in heavy smokers in compari- son with non-smokers. The insulin, glucose and C-peptide plasma values were higher in group III than in other groups. In heavy smokers, the estimates of insulin sensitivity (ISI) and pancreatic β-cell function (HOMA-B) were higher compared to the other groups.

CONCLUSION

Smoking habitude in lean PCOS patients may increase the soft markers of CV risk.

Clitoral vascularization and sexual behavior in young patients treated with drospirenone-ethinyl estradiol or contraceptive vaginal ring: a prospective, randomized, pilot study

INTRODUCTION

Oral contraceptives (OC) are effective for birth control and have good cycle control and tolerability. However, the hormonal components could modify mood and libido.

AIM

The aim of this study is to evaluate the genital vascular effects and sexual behavior of an OC containing 30 μg ethinyl estradiol and 3 mg drospirenone in comparison with a flexible combined contraceptive vaginal ring.

METHODS

Forty women underwent a sonographic assessment of the clitoral anatomy and vascularization and were administered the McCoy Female Sexuality Questionnaire (MFSQ) and the Beck's Depression Inventory questionnaire (BDI). Estradiol, androstenedione, testosterone, and SHBG were assayed. Free Androgen Index (FAI) and Free Estrogen Index (FEI) were calculated. The patients were randomly submitted to OC (group I; n = 21) or vaginal ring (group II; n = 19).

MAIN OUTCOME MEASURES

Ultrasonographic clitoral volume, pulsatility index (PI) of dorsal clitoral arteries, MFSQ, BDI, and hormonal and biochemical assays were analyzed.

RESULTS

After therapy, the testosterone levels were reduced in both groups, whereas estradiol decreased only in group I women. The SHBG increased in all the subjects, and both FAI and FEI decreased. The clitoral volume decreased in all the women. The PI of the dorsal clitoral artery increased only in patients on OC. The hormonal contraception was associated, in both studied groups, with a significant decrease of the two-factor Italian MFSQ score, which was more marked in OC users. In group I subjects, there was a reduction of the number of intercourse/week and a reduction of orgasm frequency during intercourse. The pain during intercourse worsened after OC use. The vaginal ring users reported a vaginal wetness.

CONCLUSIONS

Six-month treatment with hormonal contraception is associated with a diminished MFSQ score. However, the frequency of sexual intercourse and orgasm was reduced only by the use of OC. The OC use was associated with increased pain during intercourse.

Body imaging and sexual behavior in lean women with polycystic ovary syndrome

INTRODUCTION

In women with polycystic ovary syndrome (PCOS), changes in body appearance may influence the feminine identity of the patients with possible consequent depression and sexual dysfunction.

AIM

The study aims to examine the differences in mood, perceived body image, sexual behavior, and clitoral vascularization between lean PCOS patients and healthy eumenorrheic controls.

METHODS

Thirty-three lean PCOS women (Group I) and 22 healthy nonhirsute volunteers (Group II) were submitted, on day 3-5 of the cycle, to ultrasonographic (US) and Doppler analyses, to clinical, hormonal, and biochemical evaluations, and to psychometric tests.

MAIN OUTCOMES MEASURES

Main outcome measures are Ferriman-Gallwey score (FG), clitoral volume, clitoral artery Pulsatility Index, the two-factor Italian McCoy female questionnaire (MFSQ), the Stunkard Figure Rating Scale (FRS), and the Beck Depression Inventory (BDI) questionnaire.

RESULTS

The FG score and the androgens resulted, as expected, more elevated in PCOS patients than in controls. However, the US assessment of the clitoral body volume and the resistances registered at the level of the dorsal clitoral artery did not show any difference between Group I and Group II patients. Moreover, the two-factor Italian MFSQ, the FRS, and the BDI were similar in both groups.

CONCLUSIONS

It seems that in lean PCOS women, the moderate hirsutism and hyperandrogenism do not have any important influence on body image and self-esteem and, as a consequence, on sexual function.

Psychological well-being and social participation assessment in visually impaired subjects playing Torball: a controlled study

The aim of this study was to evaluate the differences in psychological well-being, symptomatic psychological disorders and social participation, between blind Torball players and non-players. Thirty blind male participants were recruited, 17 Torball players (aged 36.27±3.46) and 13 non-players (aged 34.80±2.53), and evaluated for social participation level, psychological well-being and symptomatic psychological disorders, using three validated self-report questionnaires: Participation Scale (PS), Psychological Well-Being Scale (PWBS) and Symptom Checklist 90 R (SCL-90-R) respectively. ANOVA showed significant overall differences between the two groups. The social restriction score in the non-player group was significantly higher (p<0.01) than the player group. The Torball player group showed significant better scores than non-player group in 5 of the 6 dimensions of the PWB Scale (p<0.01) and in 8 of the 10 dimensions of the SCL-90-R (7 dimensions p<0.01; 1 dimension p<0.05) and in the three global scores of the SCL-90-R (p<0.01). The results of this study showed a relationship between psychological well-being and social skills of visually impaired people and their Torball practice.

Ovulatory effects of flutamide in the polycystic ovary syndrome

The long-term effects and tolerability of flutamide (Flu) on the menstrual cycle and the ovulatory function of hyperandrogenic women with or without polycystic ovary syndrome (PCOS) were investigated. The study included 118 white women with the diagnosis of various forms of hyperandrogenism (80 PCOS and 38 non-PCOS patients). Patients received Flu for three years at dosages that declined each of the three years (250, 125 and 62.5 mg/day). Sex steroid, ovulatory function and menstrual profile at baseline and during each year of Flu treatment were evaluated. Flu therapy showed a significant increase in the percentage of cycles that were ovulatory (with progesterone concentrations greater than 4 ng/ml in mid-luteal phase) and concomitant regularization of the menstrual profile in PCOS patients. A luteinizing hormone decrease and an estrone, estradiol and 17-hydroxyprogesterone increase are also observed during treatment. Regular cycles persisted in non-PCOS patients. The results were maintained during the three years of treatment. The study suggests that Flu is a satisfactory therapeutic regimen of the chronic anovulation and the irregularities of the menstrual cycle in hyperandrogenic PCOS patients in the long run.

Differential protein profiling of renal cell carcinoma urinary exosomes

Renal cell carcinoma (RCC) accounts for about 3% of all human malignancies and its incidence is increasing. There are no standard biomarkers currently used in the clinical management of patients with renal cell carcinoma. A promising strategy for new biomarker detection is comparative proteomics of urinary exosomes (UE), nanovesicles released by every epithelial cell facing the urinary space, enriched in renal proteins and excluding high-abundance plasmatic proteins, such as albumin. Aim of the work is to establish the protein profile of exosomes isolated from urines of RCC patient compared with control subjects. We enrolled 29 clear cell RCC patients and 23 control healthy subjects (CTRL), age and sex-matched, for urine collection and vesicle isolation by differential centrifugation. Such vesicles were morphologically and biochemically characterized and proved to share exosome properties. Proteomic analysis, performed on 9 urinary exosome (UE) pooled samples by gel based digestion followed by LC-MS/MS, led to the identification of 261 proteins from CTRL subject UE and 186 from RCC patient UE, and demonstrated that most of the identified proteins are membrane associated or cytoplasmic. Moreover, about a half of identified proteins are not shared between RCC and control UE. Starting from these observations, and from the literature, we selected a panel of 10 proteins, whose UE differential content was subjected to immunoblotting validation. Results show for the first time that RCC UE protein content is substantially and reproducibly different from control UE, and that these differences may provide clues for new RCC biomarker discovery.

Clitoral changes, sexuality, and body image during the menstrual cycle: a pilot study

INTRODUCTION

A relationship between sexual function and all body image variables has been reported. However, there are no studies analyzing the relationship between menstrual cycle, body image, and sexuality.

AIM

To evaluate clitoral changes, sexual behavior, and perceived body image during the menstrual cycle.

METHODS

Twenty-four women underwent ultrasonographic (US) clitoral measurements, color Doppler evaluation of the clitoral artery, and hormonal testing. In addition, they were administered the McCoy Female Sexuality Questionnaire (MFSQ), the Stunkard Figure Rating Scale (FRS), and the Beck's Depression Inventory questionnaire (BDI).

MAIN OUTCOME MEASURES

The main outcome measures were clitoral volume, clitoral artery pulsatility index (PI), the MFSQ, the FRS, and the BDI.

RESULTS

The subjects had a mean age of 29.3 ± 4.5 years and a mean body mass index (kg/m(2)  = BMI) of 21.2 ± 2.0. US and color Doppler assessments showed significant increase in clitoral body volume (P = 0.039) and a decrease in the PI (P = 0.027) of the clitoral artery during the periovulatory phase of the menstrual cycle. These changes were significantly and positively correlated with estradiol levels (P = 0.009 and P = 0.017, respectively). The two-factor Italian MFSQ for sexuality and partnership was similar in all the phases of the cycle. The number of intercourses/week slightly increased in the periovulatory phase. The mean BDI was normal in all women and did not change during the cycle. The FRS showed no difference in all examined parameters during the three phases of the menstrual cycle.

CONCLUSIONS

In young, lean, eumenorrheic Italian women, there is no significant change, during the menstrual cycle, in sexual function, body image perception, and symptoms of depression, as assessed by the two-factor Italian MFSQ for sexuality and partnership, the FRS, and the total BDI score. However, our results suggest that estrogens, influencing clitoral anatomic and vascular changes, may favor genital arousability.

2D and 3D Ultrasound Examination of Labia Minora

The aim of the study was to prospectively evaluate, by using 2D/3D ultrasonography and 3D color Doppler analysis, the morphological and vascular changes in the labia minora during the menstrual cycle of women not sexually aroused. A total of 81 young, healthy eumenorrheic women, in a stable heterosexual relationship (>1 year) and without any sexual dysfunction, underwent 2D/3D ultrasound and color Doppler examination of the labia minora on Days 3-5 and 12-14 of the menstrual cycle. Estradiol serum levels were also evaluated. Estradiol plasma levels increased in the periovulatory phase. The labia minora thickness increased from the follicular (3.8 ± 0.3 mm) to the periovulatory phase (4.6 ± 0.4 mm; p = .005). Furthermore, in the periovulatory phase, the vaginal introitus area and the angles were wider than in the follicular phase. The Pulsatility Index of the posterior labial artery significantly decreased in the periovulatory period. Three-dimensional power Doppler indices of vascularization and blood flow in the labia minora significantly increased in the periovulatory period. The relationship between the different parameters showed that estradiol was positively correlated with labia minora thickness and vaginal introitus area and angles. Furthermore, the circulating levels of estradiol were negatively correlated with posterior labial artery PI and positively correlated with other indices of labia minora vascularization. In conclusion, it seems that estrogen production may influence the anatomic and vascular changes of the labia minora during the menstrual cycle and these changes can be easily identified by ultrasound.

Comparison between periodic and stochastic parabolic light trapping structures for thin-film microcrystalline Silicon solar cells

Light trapping is of very high importance for silicon photovoltaics (PV) and especially for thin-film silicon solar cells. In this paper we investigate and compare theoretically the light trapping properties of periodic and stochastic structures having similar geometrical features. The theoretical investigations are based on the actual surface geometry of a scattering structure, characterized by an atomic force microscope. This structure is used for light trapping in thin-film microcrystalline silicon solar cells. Very good agreement is found in a first comparison between simulation and experimental results. The geometrical parameters of the stochastic structure are varied and it is found that the light trapping mainly depends on the aspect ratio (length/height). Furthermore, the maximum possible light trapping with this kind of stochastic structure geometry is investigated. In a second step, the stochastic structure is analysed and typical geometrical features are extracted, which are then arranged in a periodic structure. Investigating the light trapping properties of the periodic structure, we find that it performs very similar to the stochastic structure, in agreement with reports in literature. From the obtained results we conclude that a potential advantage of periodic structures for PV applications will very likely not be found in the absorption enhancement in the solar cell material. However, uniformity and higher definition in production of these structures can lead to potential improvements concerning electrical characteristics and parasitic absorption, e.g. in a back reflector.

Cryopreservation of ovarian tissue in breast cancer patients: 10 years of experience

Aim: To present a decade of experience with ovarian tissue cryopreservation in breast cancer patients. Materials & methods: The safety of the procedure was histologically evaluated before and after freezing in 94 patients. Out of 94 patients, 48 prechemotherapy patients were randomly selected to determine stroma and follicle preservation and follicular density. Results: The ovarian tissue from 94 patients did not identify any micrometastases. After cryopreservation, morphology of the ovarian tissue and density of healthy follicles were similar in fresh and frozen tissue. Follicular density decreased with the increasing age of patients in both fresh and frozen tissue (p < 0.0001). A variation in follicular density was observed between fresh and frozen tissue (p < 0.05). Conclusion: These results suggest that ovarian tissue cryopreservation is highly feasible for preserving the fertility of young breast cancer patients.

Two- and three-dimensional sonographic and color Doppler techniques for diagnosis of polycystic ovary syndrome. The stromal/ovarian volume ratio as a new diagnostic criterion

OBJECTIVES

The purpose of this work was to study the role of 2-dimensional (2D) and 3-dimensional (3D) sonographic and Doppler techniques in the diagnosis of polycystic ovary syndrome.

METHODS

A total of 112 young adult lean women with polycystic ovary syndrome and 52 healthy volunteers with regular ovulatory cycles, matched for age and body mass index, underwent a detailed history, medical examination, hormonal assay, and 2D and 3D sonographic and Doppler flow ovarian evaluation during the early follicular phase.

RESULTS

The Ferriman-Gallwey score, circulating androgen levels, ovarian volume, and mean number of small subcapsular follicles on 2D and 3D sonography were significantly higher in the patients with polycystic ovary syndrome than the controls (P < .001). A stromal score of 1 or 2 was found in all of the patients but none of the controls. The ovarian stromal/total area ratio was 0.32 or higher in 104 of 112 of the patients (93%), which was significantly higher than in the controls (P < .001). On Doppler analysis, the lowest ovarian stromal resistance levels were found in the patients. On 3D sonography, the total ovarian stromal volume, ovarian stroma/total ovarian volume ratio, and stromal mean grayness were significantly higher in the patients than the controls. With 3D power Doppler imaging, ovarian vascularization measurements were significantly lower in the controls than the patients. The ovarian stroma/total ovarian volume ratio was the most accurate predictor of both hyperandrogenemia (area under the curve, 0.915; P < .0001) and hirsutism (area under the curve, 0.891; P < .0001).

CONCLUSIONS

Our data strongly support the use of 3D sonography with analysis of stromal volume and vascularization in the diagnosis of polycystic ovary syndrome.

Retrospective, observational study on the effects and tolerability of flutamide in a large population of patients with acne and seborrhea over a 15-year period

The long-term effects and tolerability of flutamide (Flu) in women with acne and seborrhea were evaluated. Over the 15-year period, which spans from January 1991 to January 2006, a total of 230 Caucasian women with acne, 211 of which also with seborrhea, received yearly reducing doses (250, 125, and 62.5 mg/day) of Flu alone or combined with oral contraceptive for a period varying from 3 to 6 years and more. Clinical and endocrine evaluations were performed half-yearly and yearly, respectively, in the first 3 years of the study, and yearly in the following years. Liver function evaluations were performed quarterly. Both the groups of patients under Flu therapy showed a similar, marked decrease in acne and seborrhea scores after 6 months of treatment compared with basal values. The maximum drug effect was observed after 1 year, and it was maintained during the following years of treatment. Androgens were strongly suppressed during treatment. During the first year of treatment with 250 mg/day, 4.8% of patients interrupted the study due to hepatic disorders. During the following years on the 125 and 62.5 mg/day doses, no transaminase elevation was observed. The study supports very low-dose Flu as a first-line therapy for women with acne and seborrhea.

Moderate alcohol intake, genital vascularization, and sexuality in young, healthy, eumenorrheic women. A pilot study

INTRODUCTION

The relationship between alcohol and sexual function is complex and not completely understood.

AIM

To evaluate (in the early follicular phase and independently from sexual stimulation) in young, eumenorrheic, healthy, lean women the genital vascular effects of the light and moderate use of alcohol.

METHODS

Eighty-four women undertook, in the early follicular phase of the menstrual cycle (days 3-5), the administration of the two-factor Italian McCoy Female Sexuality (MFSQ) and the Beck Depression Inventory (BDI) questionnaires; ultrasonographic measurement of the carotid intima-media thickness (IMT); and color Doppler evaluation of the carotid, clitoral, and labia minora arteries. Hormonal (estradiol, androstenedione, and testosterone) and biochemical (lipids, glucose, and insulin) parameters were tested.

MAIN OUTCOME MEASURES

The MFSQ and BDI questionnaires; the carotid IMT; the Pulsatility Index of internal carotid, clitoral, and labia minora arteries; blood pressure measurement; and hormonal and biochemical assays.

RESULTS

The subjects were divided in: nondrinkers (group I); current (>1 year) light drinkers--1-10 drinks/month (group II); and current moderate drinkers--11-20 drinks/month (group III). The majority of the studied parameters did not vary among the different groups. The mean BDI was normal in the studied women. However, the lowest values were observed in the moderate drinkers group. The MFSQ did not show any difference among all the studied women. However, the number of intercourses/week and the incidence of vaginal orgasm were significantly higher in group III (moderate drinkers). The relationship between the drinking habits and different parameters showed an inverse relationship with the BDI. Furthermore, the BDI inversely correlated with orgasm frequency and with orgasm intensity.

CONCLUSIONS

Chronic slight/moderate alcohol consumption has no effects on genital vessels and vaginal lubrication. However, a moderate consumption of alcohol, through psychological and social disinhibiting effects, may favor sexual activities.

Prospective Cohort Study on the Effects and Tolerability of Flutamide in Patients with Female Pattern Hair Loss

Background

Flutamide has been rarely used (or the treatment of female pattern hair loss (FPHL). Flutamide treatment for FPHL has not been evaluated in long-term studies with sufficiently large numbers of women.

Objective:

To evaluate long-term effects, safety, and tolerability of flutamide in women with FPHL.

Methods:

A prospective cohort study was conducted in our tertiary care university hospital. The cohort included 101 women diagnosed with FPHL from January 1991 to January 2006. These women received yearly reducing doses (250, 125, and 62.5 mg/day) of flutamide for 4 years. The cohort included 33 patients treated with flutamide alone and 68 treated with flutamide combined with an oral contraceptive. Clinical and endocrine evaluations were assessed semiannually and annually, respectively, in the first 3 years of the study, and once in the following year. Liver function was evaluated quarterly.

Results:

Both groups showed a marked decrease in alopecia scores after 12 months of flutamide therapy, compared with baseline values. The maximum drug effect occurred after 2 years and was maintained during the following 2 years of treatment. Androgens were strongly suppressed. During the first year of treatment, 4% of patients abandoned the study due to hepatic disorders related to the drug. During the following years, with the lower treatment regimen, no patient abandoned the study because of hepatic alterations.

Conclusions:

Flutamide is a satisfactory therapeutic regimen for treatment of FPHL in the long run. Moreover, the use of very low doses (62.5 mg/day) of flutamide is associated with complete hepatic tolerability and high adherence.