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Clinical Obstetrics and Gynecology Jun 2024Timing of delivery such that maternal and perinatal outcomes are optimized is among the most important and commonplace decisions in obstetric care. Given the importance... (Review)
Review
Timing of delivery such that maternal and perinatal outcomes are optimized is among the most important and commonplace decisions in obstetric care. Given the importance of this determination, it is somewhat surprising that there has been, until relatively recently, little in the way of high-quality evidence to guide obstetric clinicians in this decision. This chapter describes the evolution of studies examining the effects of labor induction and the importance of the ARRIVE trial in that context.
Topics: Humans; Pregnancy; Female; Labor, Induced; Randomized Controlled Trials as Topic; Time Factors; Oxytocin
PubMed: 38032824
DOI: 10.1097/GRF.0000000000000844 -
Current Opinion in Obstetrics &... Dec 2023To review the evidence-informed options for cervical preparation prior to second-trimester dilation and evacuation (D&E). (Review)
Review
PURPOSE OF REVIEW
To review the evidence-informed options for cervical preparation prior to second-trimester dilation and evacuation (D&E).
RECENT FINDINGS
As abortion restrictions increase and the number of abortion clinics and providers decreases, pregnant people are facing more barriers to abortion access. Those in need are now often required to travel for second-trimester abortion care, only to be faced with additional restrictions, such as mandatory waiting periods. Cervical preparation is recommended prior to D&E and takes time for effect. Given the increasing time required to obtain an abortion, patients and providers may prefer same-day cervical preparation to decrease the total time required. Options for same-day cervical preparation include misoprostol alone with single or serial doses, and misoprostol combined with osmotic dilators or transcervical balloon (Foley catheter). Same-day preparation may require additional clinical space to accommodate people after initiation of cervical preparation to manage side-effects and timing of the abortion. Overnight options are also used and more frequently later in the second trimester. Overnight options include mifepristone, osmotic dilators, and transcervical balloon and are often combined with same-day misoprostol. Medication alone preparation is well tolerated and effective in the second trimester, with the addition of mechanical methods with advancing gestation. With many options and combinations being safe and effective, providers can be dynamic and alter approach with supply shortages, adjust to different clinical settings, consider patient medical and surgical factors, and accommodate provider and patient preferences.
SUMMARY
Multiple pharmacologic and mechanical options have been shown to be safe and effective for cervical preparation prior to D&E. Consideration for multiple factors should influence the method of cervical preparation and methods may vary by patient, provider and setting.
Topics: Pregnancy; Female; Humans; Misoprostol; Pregnancy Trimester, Second; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Mifepristone
PubMed: 37678155
DOI: 10.1097/GCO.0000000000000912 -
Psychoneuroendocrinology Dec 2023Oxytocin (OT) has been detected in various body fluids, including blood, urine, saliva, breastmilk, and spinal fluid. Consistent with models that regard skin as a social...
BACKGROUND
Oxytocin (OT) has been detected in various body fluids, including blood, urine, saliva, breastmilk, and spinal fluid. Consistent with models that regard skin as a social organ and in line with studies demonstrating that skin cells express both OT and its receptor, our study sought to examine the presence of OT in human sweat.
METHODS
Overall, 553 individuals participated in a pilot study and three experiments. Firstly, 50 participants provided sweat after engaging in various sports for different durations. Secondly, 26 participants provided sweat from forehead, upper-chest, forearm, and underarm, including 11 in natural setting and 15 following OT administration and a 30-minute exercise. Thirdly, of 435 volunteers, 97 provided sufficient axillary sweat for assaying. Of these, 84 participated in a naturalistic experiment that involved saliva and sweat collection in response to physical activity in either solitary or social settings. OT and testosterone (TS) were assayed in sweat and saliva.
RESULTS
Intense activity for at least 25 min was required to produce sufficient sweat for OT analysis. Highest OT levels were found in axillary sweat compared to sweat from the forehead, upper-chest, and forearm. Salivary OT and TS increased after both solitary and social physical activity; however, higher sweat OT was found after solitary sports. Post-hoc preliminary findings indicate that highly extroverted individuals exercising in solitary environments showed the highest sweat OT levels.
CONCLUSIONS
Findings demonstrate, for the first time, the presence of OT in human sweat and show the feasibility of its measurement. Much further research is required to illuminate how sweat OT is impacted by personality and social context and to uncover the role of the skin in OT production.
Topics: Humans; Oxytocin; Sweat; Pilot Projects; Saliva; Social Behavior; Testosterone
PubMed: 37797406
DOI: 10.1016/j.psyneuen.2023.106407 -
NEJM Evidence May 2024Accumulating preclinical and preliminary translational evidence shows that the hypothalamic peptide oxytocin reduces food intake, increases energy expenditure, and... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Accumulating preclinical and preliminary translational evidence shows that the hypothalamic peptide oxytocin reduces food intake, increases energy expenditure, and promotes weight loss. It is currently unknown whether oxytocin administration is effective in treating human obesity.
METHODS
In this randomized, double-blind, placebo-controlled trial, we randomly assigned adults with obesity 1:1 (stratified by sex and obesity class) to receive intranasal oxytocin (24 IU) or placebo four times daily for 8 weeks. The primary end point was change in body weight (kg) from baseline to week 8. Key secondary end points included change in body composition (total fat mass [g], abdominal visceral adipose tissue [cm], and liver fat fraction [proportion; range, 0 to 1; higher values indicate a higher proportion of fat]), and resting energy expenditure (kcal/day; adjusted for lean mass) from baseline to week 8 and caloric intake (kcal) at an experimental test meal from baseline to week 6.
RESULTS
Sixty-one participants (54% women; mean age ± standard deviation, 33.6 ± 6.2 years; body-mass index [the weight in kilograms divided by the square of the height in meters], 36.9 ± 4.9) were randomly assigned. There was no difference in body weight change from baseline to week 8 between oxytocin and placebo groups (0.20 vs. 0.26 kg; P=0.934). Oxytocin (vs. placebo) was not associated with beneficial effects on body composition or resting energy expenditure from baseline to week 8 (total fat: difference [95% confidence interval], 196.0 g [-1036 to 1428]; visceral fat: 3.1 cm [-11.0 to 17.2]; liver fat: -0.01 [-0.03 to 0.01]; resting energy expenditure: -64.0 kcal/day [-129.3 to 1.4]). Oxytocin compared with placebo was associated with reduced caloric intake at the test meal (-31.4 vs. 120.6 kcal; difference [95% confidence interval], -152.0 kcal [-302.3 to -1.7]). There were no serious adverse events. Incidence and severity of adverse events did not differ between groups.
CONCLUSIONS
In this randomized, placebo-controlled trial in adults with obesity, intranasal oxytocin administered four times daily for 8 weeks did not reduce body weight. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; ClinicalTrials.gov number, NCT03043053.).
Topics: Humans; Oxytocin; Female; Male; Administration, Intranasal; Adult; Obesity; Double-Blind Method; Energy Metabolism; Body Composition; Energy Intake; Weight Loss
PubMed: 38815173
DOI: 10.1056/EVIDoa2300349 -
Reproductive Sciences (Thousand Oaks,... Aug 2023Dysmenorrhea is a prevalent gynecological disease among women at reproductive age. It is classified as the primary dysmenorrhea and the secondary dysmenorrhea according... (Review)
Review
Dysmenorrhea is a prevalent gynecological disease among women at reproductive age. It is classified as the primary dysmenorrhea and the secondary dysmenorrhea according to the etiology. The primary dysmenorrhea is caused by uterine hypercontraction without any identifiable pelvic lesions, while the secondary dysmenorrhea is incurred by gynecological disorder with pelvic organic lesions. However, the underlying mechanism of dysmenorrhea is not completely clear. Animal models of dysmenorrhea, especially mouse and rat model, are helpful to explore the pathophysiological mechanism of dysmenorrhea, clarify the therapeutic effect of compounds, and guide clinical treatment. The murine model of primary dysmenorrhea is commonly induced by oxytocin or prostaglandin F, while the secondary dysmenorrhea murine model was further created by injecting oxytocin on the basis of the established primary disease model. This review summarizes the current progress of dysmenorrhea models in rodent, including experimental methods, corresponding evaluation indexes, and the advantages and disadvantages of various murine dysmenorrhea models, in order to provide a reference for the selection of murine dysmenorrhea models and the further study of the pathophysiological mechanism of dysmenorrhea.
Topics: Humans; Female; Mice; Rats; Animals; Dysmenorrhea; Oxytocin; Disease Models, Animal; Uterus; Dinoprost
PubMed: 37010703
DOI: 10.1007/s43032-023-01220-0 -
Endocrine Regulations Jan 2024Oxytocin plays an important role in brain development and is associated with various neurotransmitter systems in the brain. Abnormalities in the production, secretion,... (Review)
Review
Oxytocin plays an important role in brain development and is associated with various neurotransmitter systems in the brain. Abnormalities in the production, secretion, and distribution of oxytocin in the brain, at least during some stages of the development, are critical for the pathogenesis of neuropsychiatric diseases, particularly in the autism spectrum disorder. The etiology of autism includes changes in local sensory and dopaminergic areas of the brain, which are also supplied by the hypothalamic sources of oxytocin. It is very important to understand their mutual relationship. In this review, the relationship of oxytocin with several components of the dopaminergic system, gamma-aminobutyric acid (GABA) inhibitory neurotransmission and their alterations in the autism spectrum disorder is discussed. Special attention has been paid to the results describing a reduced expression of inhibitory GABAergic markers in the brain in the context of dopaminergic areas in various models of autism. It is presumed that the altered GABAergic neurotransmission, due to the absence or dysfunction of oxytocin at certain developmental stages, disinhibits the dopaminergic signaling and contributes to the autism symptoms.
Topics: Oxytocin; Humans; Dopamine; gamma-Aminobutyric Acid; Autistic Disorder; Brain; Animals; Synaptic Transmission; Autism Spectrum Disorder
PubMed: 38656256
DOI: 10.2478/enr-2024-0012 -
Advanced Science (Weinheim,... Dec 2023Microgravity is the primary factor that affects human physiology in spaceflight, particularly bone loss and disturbances of the central nervous system. However, little...
Microgravity is the primary factor that affects human physiology in spaceflight, particularly bone loss and disturbances of the central nervous system. However, little is known about the cellular and molecular mechanisms of these effects. Here, it is reported that in mice hindlimb unloading stimulates expression of neuropeptide Y (NPY) and tyrosine hydroxylase (TH) in the hypothalamus, resulting in bone loss and altered fat metabolism. Enhanced expression of TH and NPY in the hypothalamus occurs downstream of a reduced prostaglandin E2 (PGE2)-mediated ascending interoceptive signaling of the skeletal interoception. Sympathetic antagonist propranolol or deletion of Adrb2 in osteocytes rescue bone loss in the unloading model. Moreover, depletion of TH sympathetic nerves or inhibition of norepinephrine release ameliorated bone resorption. Stereotactic inhibition of NPY expression in the hypothalamic neurons reduces the food intake with altered energy expenditure with a limited effect on bone, indicating hypothalamic neuroendocrine factor NPY in the facilitation of bone formation by sympathetic TH activity. These findings suggest that reduced PGE2-mediated interoceptive signaling in response to microgravity or unloading has impacts on the skeletal and central nervous systems that are reciprocally regulated.
Topics: Humans; Mice; Animals; Dinoprostone; Interoception; Neuropeptide Y; Hypothalamus; Neurons
PubMed: 37880864
DOI: 10.1002/advs.202305042 -
Nature Reviews. Neuroscience Dec 2023Many social behaviours are evolutionarily conserved and are essential for the healthy development of an individual. The neuropeptide oxytocin (OXT) is crucial for the... (Review)
Review
Many social behaviours are evolutionarily conserved and are essential for the healthy development of an individual. The neuropeptide oxytocin (OXT) is crucial for the fine-tuned regulation of social interactions in mammals. The advent and application of state-of-the-art methodological approaches that allow the activity of neuronal circuits involving OXT to be monitored and functionally manipulated in laboratory mammals have deepened our understanding of the roles of OXT in these behaviours. In this Review, we discuss how OXT promotes the sensory detection and evaluation of social cues, the subsequent approach and display of social behaviour, and the rewarding consequences of social interactions in selected reproductive and non-reproductive social behaviours. Social stressors - such as social isolation, exposure to social defeat or social trauma, and partner loss - are often paralleled by maladaptations of the OXT system, and restoring OXT system functioning can reinstate socio-emotional allostasis. Thus, the OXT system acts as a dynamic mediator of appropriate behavioural adaptations to environmental challenges by enhancing and reinforcing social salience and buffering social stress.
Topics: Animals; Humans; Oxytocin; Cues; Reinforcement, Psychology; Social Behavior; Mammals; Receptors, Oxytocin
PubMed: 37891399
DOI: 10.1038/s41583-023-00759-w -
Cells Oct 2023Alzheimer's disease (AD)-the most common cause of dementia in the elderly-is characterized by progressive memory loss and β-amyloid protein (Aβ) accumulation in the... (Review)
Review
Alzheimer's disease (AD)-the most common cause of dementia in the elderly-is characterized by progressive memory loss and β-amyloid protein (Aβ) accumulation in the brain. Recently, loneliness was found to be a high risk factor for AD, and social isolation has become a major cause of AD. AD. Oxytocin (OXT), the main hormone involved in social bonding, has been implicated in social interactions, notably in building trust and relationships. Moreover, social isolation or social enrichment modulates the activation of neurons related to OXT. Recently, we reported that OXT reverses learning and memory impairment in AD animal models. Based on the limited number of studies currently available, OXT might be a therapeutic target for AD. Further studies are necessary in order to better understand the role of oxytocin in AD. In this review, we described the relationships between OXT, AD, and social interaction.
Topics: Animals; Humans; Aged; Alzheimer Disease; Oxytocin; Social Interaction; Amyloid beta-Peptides; Brain
PubMed: 37887270
DOI: 10.3390/cells12202426 -
Expert Review of Endocrinology &... 2023Known for its effect on labor and lactation and on emotional and social functions, oxytocin has recently emerged as a key modulator of feeding behavior and indeed... (Review)
Review
INTRODUCTION
Known for its effect on labor and lactation and on emotional and social functions, oxytocin has recently emerged as a key modulator of feeding behavior and indeed suggested as a potential treatment for obesity. The potential positive effect of oxytocin on both metabolic and psychological-behavioral complications of hypothalamic lesions makes it a promising tool in the management of these conditions.
AREAS COVERED
The aim of the present review article is to provide an overview of the mechanism of action and clinical experience of the use of oxytocin in different forms of obesity.
EXPERT OPINION
Current evidence suggests a potential role of oxytocin in the treatment of obesity with different causes. Several challenges remain: an improved understanding of the physiological regulation, mechanisms of action of oxytocin, and interplay with other endocrine axes is fundamental to clarify its role. Further clinical trials are needed to determine the safety and efficacy of oxytocin for the treatment of different forms of obesity. Understanding the mechanism(s) of action of oxytocin on body weight regulation might also improve our understanding of obesity and reveal possible new therapeutic targets - as well as promoting advances in other fields in which oxytocin might be used.
Topics: Female; Humans; Oxytocin; Obesity; Hypothalamus
PubMed: 37232186
DOI: 10.1080/17446651.2023.2216794