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Human Reproduction (Oxford, England) Sep 2022Ovulatory disorders are common causes of amenorrhea, abnormal uterine bleeding and infertility and are frequent manifestations of polycystic ovary syndrome (PCOS). There...
Ovulatory disorders are common causes of amenorrhea, abnormal uterine bleeding and infertility and are frequent manifestations of polycystic ovary syndrome (PCOS). There are many potential causes and contributors to ovulatory dysfunction that challenge clinicians, trainees, educators, and those who perform basic, translational, clinical and epidemiological research. Similarly, therapeutic approaches to ovulatory dysfunction potentially involve a spectrum of lifestyle, psychological, medical and procedural interventions. Collaborative research, effective education and consistent clinical care remain challenged by the absence of a consensus comprehensive system for classification of these disorders. The existing and complex system, attributed to the World Health Organization (WHO), was developed more than three decades ago and did not consider more than 30 years of research into these disorders in addition to technical advances in imaging and endocrinology. This article describes the development of a new classification of ovulatory disorders performed under the aegis of the International Federation of Gynecology and Obstetrics (FIGO) and conducted using a rigorously applied Delphi process. The stakeholder organizations and individuals who participated in this process comprised specialty journals, experts at large, national, specialty obstetrical and gynecological societies, and informed lay representatives. After two face-to-face meetings and five Delphi rounds, the result is a three-level multi-tiered system. The system is applied after a preliminary assessment identifies the presence of an ovulatory disorder. The primary level of the system is based on an anatomic model (Hypothalamus, Pituitary, Ovary) that is completed with a separate category for PCOS. This core component of the system is easily remembered using the acronym HyPO-P. Each anatomic category is stratified in the second layer of the system to provide granularity for investigators, clinicians and trainees using the 'GAIN-FIT-PIE' mnemonic (Genetic, Autoimmune, Iatrogenic, Neoplasm; Functional, Infectious and Inflammatory, Trauma and Vascular; Physiological, Idiopathic, Endocrine). The tertiary level allows for specific diagnostic entities. It is anticipated that, if widely adopted, this system will facilitate education, clinical care and the design and interpretation of research in a fashion that better informs progress in this field. Integral to the deployment of this system is a periodic process of reevaluation and appropriate revision, reflecting an improved understanding of this collection of disorders.
Topics: Endocrinology; Female; Gynecology; Humans; Polycystic Ovary Syndrome; Pregnancy; Uterine Diseases
PubMed: 35984284
DOI: 10.1093/humrep/deac180 -
Danish Medical Journal Apr 2016Low back pain (LBP) constitutes a major economic problem in many countries. The causes of LBP are still largely unknown and several risk factors have been suggested... (Review)
Review
Low back pain (LBP) constitutes a major economic problem in many countries. The causes of LBP are still largely unknown and several risk factors have been suggested including heavy lifting, which causes high compression forces of the tissues in the low back. Micro-fractures in the endplates of the vertebrae caused by compression forces have been suggested as a source of unspecific pain. Although airport baggage handlers exhibit a high prevalence of musculoskeletal complaints the amount of biomechanical research within this and similar areas is limited. The aims of this thesis were to perform a general description of the lumbar loading in baggage handlers (Paper I), to develop a generically useful tool to examine specific lumbar compression in a valid manner (Paper II & III), and to investigate the spinal loading in common work tasks for baggage handlers. (Paper III). We recorded electromyography during baggage handling in the baggage hall, by a conveyor, and inside the aircraft baggage compartment. Electromyography was analyzed using amplitude probability distribution functions (APDF) on both tasks and full day recordings and root mean square (RMS) values on tasks. Furthermore, we estimated L4/L5 compression and moment along with shoulder flexor moment with a Watbak model based on more specific subtasks. In addition, we built an inverse dynamics-based musculoskeletal computer model using the AnyBody Modeling System (AMS). Motion capture recorded the movements in 3D during a stooped and a kneeling lifting task simulating airport baggage handler work. Marker trajectories were used to drive the model. The AMS-models computed estimated compression forces, shear forces and the moments around the L4/L5 joint. The compression forces were used for comparison with the vertebral compression tolerances reported in the literature. The RMS muscle activity was high in all tasks. The average peak RMS muscle activity was up to 120% EMGmax in the erector spinae during the baggage hall task. There were no significant differences between the tasks in the APDF analyses. The L4/L5 compression and extensor moment from Watbak were significantly higher in the baggage compartment task than in both the conveyor and baggage hall tasks. The stooped lifting task produced 5,541 N compression in the L4/L5 joint and a kneeling task produced 4,197 N in the AMS models. These compression forces were close to the average compression tolerance and exceed the recommended limits for compression during lifting.
Topics: Adult; Humans; Image Processing, Computer-Assisted; Lifting; Low Back Pain; Lumbar Vertebrae; Middle Aged; Models, Biological; Occupational Injuries; Prevalence; Risk Factors; Task Performance and Analysis; Weight-Bearing; Young Adult
PubMed: 27034189
DOI: No ID Found -
Journal of Parkinson's Disease Jun 2016Camptocormia is a disabling pathological, non-fixed, forward bending of the trunk. The clinical definition using only the bending angle is insufficient; it should... (Review)
Review
Camptocormia is a disabling pathological, non-fixed, forward bending of the trunk. The clinical definition using only the bending angle is insufficient; it should include the subjectively perceived inability to stand upright, occurrence of back pain, typical individual complaints, and need for walking aids and compensatory signs (e.g. back-swept wing sign). Due to the heterogeneous etiologies of camptocormia a broad diagnostic approach is necessary. Camptocormia is most frequently encountered in movement disorders (PD and dystonia) and muscles diseases (myositis and myopathy, mainly facio-scapulo-humeral muscular dystrophy (FSHD)). The main diagnostic aim is to discover the etiology by looking for signs of the underlying disease in the neurological examination, EMG, muscle MRI and possibly biopsy. PD and probably myositic camptocormia can be divided into an acute and a chronic stage according to the duration of camptocormia and the findings in the short time inversion recovery (STIR) and T1 sequences of paravertebral muscle MRI. There is no established treatment of camptocormia resulting from any etiology. Case series suggest that deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) is effective in the acute but not the chronic stage of PD camptocormia. In chronic stages with degenerated muscles, treatment options are limited to orthoses, walking aids, physiotherapy and pain therapy. In acute myositic camptocormia an escalation strategy with different immunosuppressive drugs is recommended. In dystonic camptocormia, as in dystonia in general, case reports have shown botulinum toxin and DBS of the globus pallidus internus (GPi-DBS) to be effective. Camptocormia in connection with primary myopathies should be treated according to the underlying illness.
Topics: Humans; Muscular Atrophy, Spinal; Parkinson Disease; Spinal Curvatures
PubMed: 27314757
DOI: 10.3233/JPD-160836 -
Environmental Research Jun 2024Glyphosate is the most widely used herbicide worldwide, both in domestic and industrial settings. Experimental research in animal models has demonstrated changes in...
BACKGROUND
Glyphosate is the most widely used herbicide worldwide, both in domestic and industrial settings. Experimental research in animal models has demonstrated changes in muscle physiology and reduced contractile strength associated with glyphosate exposure, while epidemiological studies have shown associations between glyphosate exposure and adverse health outcomes in critical biological systems affecting muscle function.
METHODS
This study used data from a nationally representative survey of the non-institutionalized U.S. general population (NHANES, n = 2132). Urine glyphosate concentrations were determined by ion chromatography with tandem mass spectrometry. Hand grip strength (HGS) was measured using a Takei Dynamometer, and relative strength estimated as the ratio between HGS in the dominant hand and the appendicular lean mass (ALM) to body mass index (ALMBMI) ratio. Low HGS and low relative HGS were defined as 1 sex-, age- and race-specific SD below the mean. Physical function limitations were identified as significant difficulty or incapacity in various activities.
RESULTS
In fully-adjusted models, the Mean Differences (MD) and 95% confidence intervals [95%CI] per doubling increase in glyphosate concentrations were -0.55 [-1.09, -0.01] kg for HGS in the dominant hand, and -0.90 [-1.58. -0.21] kg for HGS/ALMBMI. The Odds Ratios (OR) [95% CI] for low HGS, low relative HGS and functional limitations by glyphosate concentrations were 1.27 [1.03, 1.57] for low HGS; 1.43 [1.05; 1.94] for low relative HGS; 1.33 [1.08, 1.63] for stooping, crouching or kneeling difficulty; 1.17 [0.91, 1.50] for lifting or carrying items weighting up to 10 pounds difficulty; 1.21 [1.01, 1.40] for standing up from armless chair difficulty; and 1.47 [1.05, 2.29] for ascending ten steps without pause difficulty.
CONCLUSIONS
Glyphosate exposure may be a risk factor for decreased grip strength and increased physical functional limitations. More studies investigating the influence of this and other environmental pollutants on functional aging are needed.
Topics: Glyphosate; Glycine; Humans; Male; Middle Aged; Female; Aged; Herbicides; Hand Strength; Environmental Exposure; Nutrition Surveys
PubMed: 38452917
DOI: 10.1016/j.envres.2024.118547 -
Neuron Sep 2018The neuropeptide oxytocin (OT) attracts the interest of neuroscientists, psychologists, and psychiatrists due to its capacity to modulate emotional and social behavior.... (Review)
Review
The neuropeptide oxytocin (OT) attracts the interest of neuroscientists, psychologists, and psychiatrists due to its capacity to modulate emotional and social behavior. Although much has been published on the effects of OT on brain regions and mechanisms at the core of these processes, its role in sensory processing, so important for detecting social context with sufficient accuracy and sensitivity, has been much less studied. In the present review, we summarize evidence for OT modulation of sensory processing and, conversely, effects of sensory input on endogenous OT signaling. We concentrate on mammals, aiming to provide a systematic analysis of the current knowledge on this reciprocal regulation and the role it may play in social and emotional behaviors.
Topics: Animals; Brain; Emotions; Humans; Nerve Net; Oxytocin; Sensation; Social Behavior
PubMed: 30189208
DOI: 10.1016/j.neuron.2018.07.016 -
IScience Jul 2023Galectins are a group of carbohydrate-binding proteins with a presumed immunomodulatory role and an elusive function on antigen-presenting cells. Here we analyzed the...
Galectins are a group of carbohydrate-binding proteins with a presumed immunomodulatory role and an elusive function on antigen-presenting cells. Here we analyzed the expression of galectin-1 and found upregulation of galectin-1 in the extracellular matrix across multiple tumors. Performing an in-depth and dynamic proteomic and phosphoproteomic analysis of human macrophages stimulated with galectin-1, we show that galectin-1 induces a tumor-associated macrophage phenotype with increased expression of key immune checkpoint protein programmed cell death 1 ligand 1 (PD-L1/CD274) and immunomodulator indoleamine 2,3-dioxygenase-1 (IDO1). Galectin-1 induced IDO1 and its active metabolite kynurenine in a dose-dependent manner through JAK/STAT signaling. In a 3D organotypic tissue model system equipped with genetically engineered tumorigenic epithelial cells, we analyzed the cellular source of galectin-1 in the extracellular matrix and found that galectin-1 is derived from epithelial and stromal cells. Our results highlight the potential of targeting galectin-1 in immunotherapeutic treatment of human cancers.
PubMed: 37534161
DOI: 10.1016/j.isci.2023.106984 -
Movement Disorders Clinical Practice 2016Stooped posture was mentioned in the original description of the characteristic features of Parkinson's disease (PD). Since then, a variety of postural, bone, and joint... (Review)
Review
BACKGROUND
Stooped posture was mentioned in the original description of the characteristic features of Parkinson's disease (PD). Since then, a variety of postural, bone, and joint problems have become recognized as common aspects of the illness and deserve attention.
METHODS
A Medline literature search for the period from 1970 to 2016 was performed to identify articles relevant to this topic. Keywords for the search included posture, spine, bone disorders, fractures, joint disorders, kyphosis, scoliosis, stooping, camptocormia, Pisa syndrome, frozen shoulder, anterocollis, dropped head syndrome, and pain in combination with PD. The articles were then reviewed to summarize clinical features, frequency, impact, pathophysiology, and treatment options for these conditions.
RESULTS
Postural disorders (kyphoscoliosis, camptocormia, Pisa syndrome, dropped head syndrome), bone mineralization disorders (osteoporosis, bone fractures), and joint disorders (frozen shoulder, dystonia involving joints, joint pain) are often seen in association with PD. Treatment options for these conditions are varied and may include medications, physical therapy, or surgical interventions.
CONCLUSIONS
Posture, bone, and joint disorders are common in patients with PD; they often produce added disability, and they may be treatable.
PubMed: 30363567
DOI: 10.1002/mdc3.12386 -
Frontiers in Bioengineering and... 2021Lower back pain and musculoskeletal injuries are serious concerns for workers subjected to physical workload and manual material handling tasks. Spine assistive... (Review)
Review
Lower back pain and musculoskeletal injuries are serious concerns for workers subjected to physical workload and manual material handling tasks. Spine assistive exoskeletons are being developed to support the spine and distribute the spine load. This article presents a detailed up-to-date review on the back support exoskeletons by discussing their type (Active/Passive), structure (Rigid/Soft), power transmission methods, weight, maximum assistive force, battery technologies, tasks (lifting, bending, stooping work), kinematic compatibility and other important features. This article also assesses the back support exoskeletons in terms of their ability to reduce the physical load on the spine. By reviewing functional and structural characteristics, the goal is to increase communication and realization among ergonomics practitioners, developers, customers, and factory workers. The search resulted in reviewing 34 exoskeletons of which 16 were passive and 18 were active. In conclusion, back support exoskeletons have immense potential to significantly reduce the factors regarding work-related musculoskeletal injuries. However, various technical challenges and a lack of established safety standards limit the wide adaptation of exoskeletons in industry.
PubMed: 34805118
DOI: 10.3389/fbioe.2021.765257 -
JACC. Heart Failure Apr 2023Exercise training improves peak oxygen uptake (V.Opeak) in heart failure with preserved ejection fraction (HFpEF). Multiple adaptations have been addressed, but the role... (Clinical Trial)
Clinical Trial
BACKGROUND
Exercise training improves peak oxygen uptake (V.Opeak) in heart failure with preserved ejection fraction (HFpEF). Multiple adaptations have been addressed, but the role of circulating endothelium-repairing cells and vascular function have not been well defined.
OBJECTIVES
The authors investigated effects of moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) on vascular function and repair in HFpEF.
METHODS
This study is a subanalysis of the OptimEx-Clin (Optimizing Exercise Training in Prevention and Treatment of Diastolic Heart Failure) study randomizing patients with HFpEF (n = 180) to HIIT, MICT, or guideline control. At baseline, 3, and 12 months, the authors measured peripheral arterial tonometry (valid baseline measurement in n = 109), flow-mediated dilation (n = 59), augmentation index (n = 94), and flow cytometry (n = 136) for endothelial progenitor cells and angiogenic T cells. Abnormal values were defined as outside 90% of published sex-specific reference values.
RESULTS
At baseline, abnormal values (%) were observed for augmentation index in 66%, peripheral arterial tonometry in 17%, flow-mediated dilation in 25%, endothelial progenitor cells in 42%, and angiogenic T cells in 18%. These parameters did not change significantly after 3 or 12 months of HIIT or MICT. Results remained unchanged when confining analysis to patients with high adherence to training.
CONCLUSIONS
In patients with HFpEF, high augmentation index was common, but endothelial function and levels of endothelium-repairing cells were normal in most patients. Aerobic exercise training did not change vascular function or cellular endothelial repair. Improved vascular function did not significantly contribute to the V.Opeak improvement after different training intensities in HFpEF, contrary to previous studies in heart failure with reduced ejection fraction and coronary artery disease. (Optimizing Exercise Training in Prevention and Treatment of Diastolic Heart Failure [OptimEx-Clin]; NCT02078947).
Topics: Female; Humans; Male; Exercise; Exercise Therapy; Heart Failure; Heart Failure, Diastolic; Stroke Volume
PubMed: 36892488
DOI: 10.1016/j.jchf.2022.12.011 -
Annals of Surgery Oct 2023Examine the potential benefit of total pancreatectomy (TP) as an alternative to pancreatoduodenectomy (PD) in patients at high risk for postoperative pancreatic fistula... (Meta-Analysis)
Meta-Analysis
Systematic Review and Meta-analysis of the Role of Total Pancreatectomy as an Alternative to Pancreatoduodenectomy in Patients at High Risk for Postoperative Pancreatic Fistula: Is it a Justifiable Indication?
OBJECTIVE
Examine the potential benefit of total pancreatectomy (TP) as an alternative to pancreatoduodenectomy (PD) in patients at high risk for postoperative pancreatic fistula (POPF).
SUMMARY BACKGROUND DATA
TP is mentioned as an alternative to PD in patients at high risk for POPF, but a systematic review is lacking.
METHODS
Systematic review and meta-analyses using Pubmed, Embase (Ovid), and Cochrane Library to identify studies published up to October 2022, comparing elective single-stage TP for any indication versus PD in patients at high risk for POPF. The primary endpoint was short-term mortality. Secondary endpoints were major morbidity (i.e., Clavien-Dindo grade ≥IIIa) on the short-term and quality of life.
RESULTS
After screening 1212 unique records, five studies with 707 patients (334 TP and 373 high-risk PD) met the eligibility criteria, comprising one randomized controlled trial and four observational studies. The 90-day mortality after TP and PD did not differ (6.3% vs. 6.2%; RR=1.04 [95%CI 0.56-1.93]). Major morbidity rate was lower after TP compared to PD (26.7% vs. 38.3%; RR=0.65 [95%CI 0.48-0.89]), but no significance was seen in matched/randomized studies (29.0% vs. 36.9%; RR = 0.73 [95%CI 0.48-1.10]). Two studies investigated quality of life (EORTC QLQ-C30) at a median of 30-52 months, demonstrating comparable global health status after TP and PD (77% [±15] vs. 76% [±20]; P =0.857).
CONCLUSIONS
This systematic review and meta-analysis found no reduction in short-term mortality and major morbidity after TP as compared to PD in patients at high risk for POPF. However, if TP is used as a bail-out procedure, the comparable long-term quality of life is reassuring.
Topics: Humans; Pancreatectomy; Pancreaticoduodenectomy; Pancreatic Fistula; Quality of Life; Pancreas; Postoperative Complications
PubMed: 37161977
DOI: 10.1097/SLA.0000000000005895