Anti-TNFα therapy and its implication in gynecology and obstetrics

Anti-TNFα treatments have modified the medical care, the course and the quality of life of the patients with autoimmune rheumatic, cutaneous or bowel inflammatory diseases. On the other hand, these treatments may have potential severe side effects during pregnancy (congenital malformations, fetal infections). Actually, many pregnancies have been reported during anti-TNFα exposures, with good maternal and neonatal outcomes. The introduction or the discontinuation of these treatments will always have to be discussed with the specialist of the chronic disease and, ideally, during a preconceptional counselling. In gynecology, anti-TNFα drugs may offer a new safe and effective approach to treating patients with recurrent miscarriages or unexplained or failed in vitro fertilization cycles. On the other hand, these treatments significantly increase the risk for serious infections or viral reactivations and may promote gynaecological malignancies. An adapted gynaecological survey is necessary.     

Hercules and Barbie? Reflections on the influence of pornography and its spread in the media and society in groups of adolescents in Sweden

ABSTRACT

Objectives To describe and get a deeper understanding of how groups of young women and men reflect on and discuss pornography and its spread in the media and society, and its possible influence on sexual behaviour and relationships.

Methods Six focus group interviews were conducted with teenagers, three with women (n = 17) and three with men (n = 18). Open questions about pornography and its spread in the media and society were discussed. The interviews were tape-recorded and transcribed verbatim. Data were analysed according to Grounded Theory.

Results The core category ‘A discriminatory sexuality’ illustrates how participants felt regarding the messages conveyed by pornography portraying a man's role as dominant and a woman's role as subordinate. Pornographic messages were described as ‘Fiction’ depicting a distorted reality. Feelings of ambivalence towards pornography were expressed: anxiety and fear, but also inspiration. Participants said pornography occurred everywhere in the media and society, and felt pressured by messages relating to looks and sexual techniques.

Conclusions Pornography and its spread in the media and society were considered as presenting a discriminatory image of body ideals, sexuality and relationships. Despite this awareness, both men and women considered pornography as sources of knowledge and inspiration: an apparent paradox.     

Lipopolysaccharide induces alterations in ovaries and serum level of progesterone and 17β-estradiol in the mouse

Our objective was to investigate the effect of gram-negative bacterial infection on the ovaries and serum level of P(4) and 17β-E(2) during the preimplantation days of pregnancy in the mouse. We found that lipopolysaccharide alters the serum level of P(4) and E(2) during the preimplantation days of pregnancy and elevates the E(2)/P(4) ratio, which may keep the uterus nonreceptive during the preimplantation days of pregnancy and also not prepare the developing blastocysts for implantation in the mouse. A large infiltration of macrophages in the corpora lutea and appearance of graafian follicles from day 3.5 of pregnancy because of lipopolysaccharide treatment, which reflect a gram-negative bacterial infection, may be responsible for ovarian dysfunction and altered P(4) and E(2) level in serum.     

Is there a seasonal variation in gonorrhea and chlamydia in adolescents?

STUDY OBJECTIVE: To determine if a seasonal variation exists in gonorrhea and chlamydia in female adolescents. DESIGN, SETTING, PARTICIPASNTS: We conducted a retrospective chart review of 604 sexually active adolescent females 21 years of age and younger in a teen pregnancy prevention clinic in a small Midwestern city. Positive gonorrhea and chlamydia tests were evaluated for seasonal variation. Chi-square, odds ratios, and 95% confidence intervals were calculated. RESULTS: A greater percentage of tests were positive in the fall than in other seasons (P = 0.028), and there was a trend towards more cases in the summer than winter and spring. CONCLUSIONS: Increased emphasis should be placed on prevention and screening during summer and fall.     

IGF-I, 17β-estradiol and progesterone in SHR and in rats treated with L-NAME: fetal-placental development

Methods The relationship between progesterone (P4), 17-estradiol, insulin-like growth factor (IGF-I) and embryonic and fetal development, were examined. Female Sprague Dawley rats were divided into two groups: control untreated (n=60) and treated (n=63) with L-NAME (N-nitro-L-arginine methyl ester), 15 mg/day in drinking water from the first day after mating to day 18 of gestation. A further group was formed (n=63) of spontaneously hypertensive rats (SHR). Mean systolic blood pressure was recorded daily. On days 6, 11 and 18 of pregnancy, the number of sites of implantation, litter and placenta weight was examined. In addition, serum levels of P4, 17-estradiol and IGF-I were determined.Results Systolic blood pressure (SBP) (mmHg) increased significantly in L-NAME and SHR rats over the course of the experiment. On day 6 of pregnancy, in the L-NAME group the number of implantation sites, levels of IGF-I and 17-estradiol were significantly lower than in the control group. In SHR, only the concentration of IGF-I was low (p<0.05). In contrast, on day 11 of pregnancy no variation was found in the parameters under study. On day 18 of gestation, a significant decrease in litter and placenta weight, concentration of P4 and IGF-I was observed in the experimental groups.Conclusion The data further suggest that nitric oxide might regulate IGF-I production, indicating that growth factors may play an important role in fetal-placental development.     

Localization and ceoncentration of β- and β-lipotrophin in human placenta

Immunohistochemical staining of placental tissue for β-endorphin immunoreactivity was positive in the syncytiotrophoblast in both early and term pregnancy. Cation-exchange liquid chromatography and radioimmunoassay revealed peaks of β-endorphin and β-lipotrophin and a third immunoreactive peak of unknown nature. The concentration of β-endorphin was higher in the placental tissue than it was in the maternal or cord plasma. β-Lipotrophin was not detected in all placentae studied. We did not find any effect of gestational age on tissue concentrations of endorphins in the placenta, nor was there any significant difference in the placental endorphin content between placentae collected at elective caesarean section before labour and after spontaneous vaginal delivery.     

The pattern and magnitude of “in vivo thrombin generation” differ in women with preeclampsia and in those with SGA fetuses without preeclampsia

Objective: We aimed to determine the differences in the pattern and magnitude of thrombin generation between patients with preeclampsia (PE) and those with a small-for-gestational-age (SGA) fetus.

Methods: This cross-sectional study included women in the following groups: (1) normal pregnancy (NP) (n?=?49); (2) PE (n?=?56); and (3) SGA (n?=?28). Maternal plasma thrombin generation (TGA) was measured, calculating: (a) lag time (LT); (b) velocity index (VI); (c) peak thrombin concentration (PTC); (d) time-to-peak thrombin concentration (TPTC); and (e) endogenous thrombin potential (ETP).

Results: (1) The median TPTC, VI, and ETP differed among the groups (p?=?.001, p?=?.006, p?p?p?=?.02) groups; 3) patients with SGA had a shorter median TPTC and a higher median VI than the NP (p?=?.002, p?=?.012) and PE (p?p?=?.006) groups.

Conclusions: (1) Patients with PE had higher in vivo thrombin generation than women with NP and those with an SGA fetus; (2) the difference in TGA patterns between PE and SGA suggests that the latter group had faster TGA, while patients with PE had a longer reaction, generating more thrombin. This observation is important for the identification of a subset of patients who might benefit from low molecular-weight heparin.     

Behçet's disease in obstetrics and gynecology

Beh?et's disease is a multisystemic disease of unknown origin characterized by a recurrent bipolar aphtosis (oral and genital) associated with vascular, digestive or articular symptoms. Gynecologists can be faced to this disease at any time of the life of their patients, including during the pregnancy. Given that the first demonstrations of the disease can be genital, they are in the front line to evoke this diagnosis. They thus have to know the main characteristics of the disease to make the diagnosis and to organize a multidisciplinary management. During pregnancy, the treatment of the disease is to be adapted to avoid teratogenic drugs, and adapt the doses of the treatment.     

The involvement of osteopontin and β3 integrin in implantation and endometrial receptivity in an early mouse pregnancy model

Objective

To explore the roles of osteopontin and β3 integrin in successful implantation.

Study design

In this study, an early pregnant mouse model was established by peritoneal injection of pregnant mare serum gonadotropin and human chorionic gonadotropin (PMSG + hCG). The expression of osteopontin (OPN) and β3 integrin on the endometrium was measured by immunohistochemistry, RT-PCR, and western blot. The function of OPN and β3 integrin in implantation was investigated by intrauterine injection of OPN and β3 integrin antibody.

Results

We found that PMSG + hCG injection significantly increased the number of blastocysts during implantation as well as the concentration of estradiol and progesterone in serum and endometrium tissues. OPN and β3 integrin were co-expressed in luminal epithelium and their levels dynamically changed from day 4 to day 8 of pregnancy with peak expression on day 5. The percentages of OPN and β3 integrin positive cells in the luminal epithelium were significantly higher in PMSG + hCG-stimulated mice on day 5 than in control mice. Functional blockade of OPN and β3 integrin significantly inhibited implantation.

Conclusions

This study suggests that co-expression of OPN and β3 integrin is a biological marker for good endometrial receptivity and that both proteins play a crucial role in blastocyst implantation.     

Law and ethics in conflict over confidentiality?

Ethical principles that require the preservation of patients’ confidential information are reinforced by principles found in several areas of law, such as law on contracts, negligence, defamation and fiduciary duty. However, laws sometimes compel disclosures of medical confidences, and more often may justify or excuse disclosures. Legally contentious issues concern patients’ confidences regarding possible unlawful conduct, such as pregnancy termination, and the risk of spread of HIV and other infections. This article reviews the various legal bases of the duty of confidentiality, and legal challenges to the ethical obligation of non-disclosure. It addresses the justifications and limits of exchange of patients’ health information among healthcare professionals and trainees, and considers legally recognized limits of confidential duties, and the scope of legitimate disclosure. An underlying theme is how to determine whether physicians are ethically justified in employing the discretion the law sometimes affords them to breach patients’ expectations of confidentiality.     

Evaluation of maternal and umbilical serum TNFα levels in preeclamptic pregnancies in the intrauterine normal and growth-restricted fetus

Objective.?The aim of this study was to carry out a comparative analysis of the maternal and umbilical cord TNFα serum levels in pregnancies complicated by severe preeclampsia with normal intrauterine fetal growth, in preeclamptic pregnancies with intrauterine growth restriction (IUGR), and in normotensive pregnant patients.

Patients and methods.?The study was carried out on eight patients with severe preeclampsia complicated by IUGR and 18 preeclamptic patients with normal intrauterine fetal growth. The control group consisted of 18 healthy normotensive patients with singleton uncomplicated pregnancies. Maternal and umbilical serum TNFα concentrations were estimated using a sandwich ELISA assay.

Results and conclusions.?Pregnant women with severe preeclampsia had significantly higher maternal and umbilical serum TNFα levels than those in the normotensive controls. Our findings and other reports indicate that TNFα may participate in the pathogenesis and sequelae of preeclampsia with and without IUGR. The results of excessive umbilical serum activity of tumor necrosis factor α (TNFα) in preeclamptic pregnancy complicated by intrauterine growth restriction (IUGR) may suggest additional changes and dysfunction of the placental–fetal unit and deterioration of placental function, leading to fetal hypotrophia in the course of preeclampsia.