Is the endometrium or oocyte/embryo affected in endometriosis?

One of the most puzzling problems of endometriosis is determining which mechanisms link this spectrum of conditions to infertility. There is conflicting evidence about the effect of endometriosis on the endometrium and on oocyte/embryo quality. Clinical studies reveal that implantation rates seem to be lower in women with endometriosis, while spontaneous abortion rates show variable results which are difficult to interpret due to the design of the studies. Biochemical markers (integrins and other cell adhesion molecules), morphological markers (pinopodes), apoptosis and ultrasound studies confirm that not only does the endometrium from women with endometriosis behave differently from the endometrium of women without endometriosis, but ectopic endometrium also behaves differently from eutopic endometrium. Data from oocyte donation programmes suggest that oocyte quality may be hampered in women with endometriosis. Recent reports have focused on the molecular mechanisms that may be altered, such as ovarian steroid production, or inadequate luteal function. In this review, we analyse the most recent literature dealing with the different mechanisms which affect the endometrium and oocyte/embryo quality and which thereby might cause infertility.     

Is survivin expression prognostic or predictive in malignant pleural mesothelioma?

Malignant pleural mesothelioma is an incurable cancer strongly associated with asbestos exposure and characterised by poor response to treatment. The inhibitor-of-apoptosis protein family member survivin is involved in apoptosis and proliferation and is expressed in cancer cells only. The aims of the present study were to elucidate whether survivin expression is associated with tumour cell apoptosis and proliferation and to assess the prognostic and predictive value of survivin expression in malignant pleural mesothelioma. Archival pleural mesothelioma tissue samples from 101 patients were immunohistochemically analysed for nuclear expression of survivin, for proliferation with the use of Ki-67 as marker and for apoptosis using active caspase-3 as a marker. Staining results and clinical data were included in a survival analysis. Survivin was highly expressed in tumour cell nuclei in all samples and this correlated positively with both apoptosis and proliferation, but did not have a significant prognostic value. We found significantly higher survivin expression in patients who responded to chemotherapy compared to patients with progressive disease. Survivin expression might contribute to treatment response prediction, but survivin expression in malignant pleural mesothelioma did not have prognostic significance.     

Serotonin dilemma in postmenopausal women: Is it low or high?

OBJECTIVE: In this study, we have studied with premenopausal (PM), naturally menopausal (NM) and surgically induced menopausal (SM) women in order to investigate the differences in serum cortisol, dehydroepiandrosterone sulfate (DHEA-S), follicle stimulating hormone (FSH) and estradiol (E2) levels on serum serotonin levels. METHODS: Forty premenopausal (36.7+/-3.5 years), 40 naturally menopausal (54.2+/-8.4 years) and 38 surgically induced menopausal (55.4+/-11.2 years) women were included in the study. None of the subjects were using antidepressants or hormone replacement therapy. In NM and SM, years since menopause (YSM) were 3.16+/-1.58 and 3.36+/-1.89, respectively. Cortisol, DHEA-S, FSH and E2 levels were determined by immunochemiluminisence while serotonin levels were determined by HPLC. RESULTS: Serum serotonin levels in NM women were higher than the other two groups [144.23+/-45.29 microg/L vs 61.35+/-37.72 microg/L in SM women and 98.74+/-50.29 microg/L in PM women]. E2 and DHEA-S were positively correlated, while FSH and cortisol were negatively correlated with serotonin in NM and SM. There was no significant correlation between serotonin and age or YSM. In the PM group, there was no significant correlation between serotonin and the hormones. CONCLUSION: In conclusion, increased serotonin levels in naturally menopausal women may be a compensatory mechanism to decreased E2 levels as it is postulated that there is strong interaction between E2 and the serotoninergic system.     

Is Helicobacter pylori good or bad?

Helicobacter pylori remains a controversial organism with regards to humans, with its epidemiology still being unclear nearly two decades after its discovery. The association between H. pylori infection and subsequent development of chronic active gastritis, peptic ulcer disease, gastric cell carcinoma, and B cell mucosa-associated lymphoid tissue (MALT) lymphoma has been well established. Current studies, however, suggest that fewer than 20 % of all infected patients will develop any consequences from their infection. Hence, should the infection be considered a disease not at all or, on the contrary, is the microorganism harmful in only some circumstances? This article attempts to weigh the currently available evidence supporting that H. pylori may be good and not always bad.     

Boom or bubble? Is medical research thriving or about to crash?

A recent issue of JAMA (2005; vol. 294) presented a portrait of medical research as a booming enterprise. By contrast I have suggested that medical research is a speculative bubble due to burst. How can two such different predictions be compatible? From inside the expanding world of medical research everything seems fine and getting better. But to people outside the system, it seems like there is an awful lot of money going in, and not much coming out. Professional criteria of success (publications, impact factors, citations, grant income, large teams, etc.) are not the same as the outsider's view of success. Outsiders want the medical research system to generate therapeutic progress as efficiently as possible: the most progress for the least resources. Medical research is not the only good way of spending money and is in competition with other social systems. As funding increases, diminishing returns will set-in, opportunity costs will begin to bite, and there will be more and more social benefit to be gained from spending the extra research money on something else. Therefore, future cuts in medical research will happen because of pressure from outside the system - specifically pressure from other powerful social systems which will press their alternative claims for funding. In the short term, there will be a quantitative decline of research production. But in the longer term the medical research system will re-grow in a more efficient form. After a 'golden age of therapeutic progress in the mid-20th century, recent decades have seen a 'silver age' of scholasticism which is due to end soon. Perhaps a renaissance of medical research lies not too many years in the future.     

Is it a new syndrome or a clinical variability in cerebro-oculo-nasal syndrome?

We present a male infant 2.5-months old with asymmetric skull, anophthalmia, apparent hypertelorism, abnormal nares, unilateral cleft lip and palate, and structural abnormalities of the central nervous system. These findings are similar to cerebro-oculo-nasal syndrome except for the appearance of nose. This case is either a clinical variability in cerebro-oculo-nasal syndrome or a new entity.     

Is occupation relevant in suicide?

BACKGROUND: The seasonality of suicide rates and methods of suicide may be related to changes in weather and conditions of employment. Particularly the amount of occupational outdoor exposure could show differences in the distribution of suicides by season and the selection of suicide method, in addition to age at the time of death. METHODS: The data consisted of all death certificates (n=1359) of completed suicides in the province of Oulu, Finland, during the years 1988-1999. For male subjects included in this study, four occupational groups were identified according to decreasing occupational outdoor exposure. The mean ages, the distribution of suicide methods and the seasonal variation in suicides for each occupational group were analyzed. RESULTS: Farmers were significantly older at the time of suicide than construction or indoor workers, and farmers employed significantly more violent methods than the other occupational groups. In the spring, farmers had a significant peak in the rate of suicides. In the winter, forest workers had a significant trough in the rate of suicides. In the summer, indoor workers had a significant peak in the rate of suicides. LIMITATIONS: The analyses were restricted to males due to the low number of females in the study population. CONCLUSIONS: The novel finding in this study was that the seasonality of violent suicides was most strongly seen as a spring peak and a winter trough among outdoor workers. The recognition of typical risk factors of different occupations, such as outdoor exposure, and occupational-related susceptibility towards certain suicide methods could benefit in the prevention of suicides.