Fractional CO<Subscript>2</Subscript> laser for genitourinary syndrome of menopause in breast cancer survivors: clinical,immunological, and microbiological aspects

The composition of vaginal microbiome in menopause and cancer survivor women changes dramatically leading to genitourinary syndrome of menopause (GSM) in up to 70% of patients. Recent reports suggest that laser therapy may be valuable as a not hormonal therapeutic modality. The aim of the present study was to evaluate the effects of fractional CO₂ laser treatment on the vaginal secretory pathway of a large panel of immune mediators, usually implicated in tissue remodeling and inflammation, and on microbiome composition in postmenopausal breast cancer survivors. The Ion Torrent PGM platform and the Luminex Bio-Plex platform were used for microbiome and immune factor analysis. The significant reduction of clinical symptoms and the non-significant changes in vaginal microbiome support the efficacy and safety of laser treatment. Moreover, the high remodeling status in vaginal epithelium is demonstrated by the significant changes in inflammatory and modulatory cytokine patterns. Laser therapy can be used for the treatment of GSM symptoms and does not show any adverse effects. However, further studies will be needed to clarify its long-term efficacy and other effects.     

Outcomes of a program to evaluate mother and baby 6 months after umbilical cord blood donation

BACKGROUND: A routine program of evaluating mothers and infants 6 months after umbilical cord blood donation was started at the Milano Cord Blood Bank (MCBB) in 1996. This study evaluated the main outcomes of this program. STUDY DESIGN AND METHODS: All mothers donating cord blood at this bank from February 1996 through May 1999 were invited to visit the bank or the collection suite 6 months after delivery to report on the health condition of their babies and to provide a fresh blood sample for repeat basal serologic tests (HBsAg, anti-HCV, anti-HIV-1/2, and syphilis). A bank volunteer contacted the mothers by telephone to schedule their visits just before the expiration of the 6-month period. Before collection of the new sample, a trained operator interviewed the mothers to review the mother's medical history information collected at donation and to obtain the baby's postnatal medical history. RESULTS: Of the 2450 mothers enrolled in the study, 2315 (94.5%) attended the bank in agreement with the program, 4 promised to attend, 95 could not be traced, 26 declined the invitation, and 10 were unable to attend. Of the 135 mothers who could not be traced, 29 (21.4%) belonged to non-European ethnic groups. The average time spent with each mother was approximately 20 minutes. In serologic testing, one indeterminate anti-HCV seroconversion (c22) was detected. Collection of the baby's postnatal history reported one case of congenital urinary malformation not known at delivery, one of protein C deficiency, one of phenylketonuria, one of mucoviscidosis, and one of 10q- chromosomal abnormality. The cord blood components from all these births were discarded. CONCLUSION: These data support the feasibility of a routine 6-month program of evaluating mothers and babies giving cord blood at a cord blood bank. Such programs may increase the quality of components stored for transplantation.     

Semen analysis in chronic bacterial prostatitis： diagnostic and therapeutic implications

The significance and diagnostic value of semen analysis in chronic bacterial prostatitis has been extensively debated and remains controversial. To investigate the diagnostic relevance of semen culture in the bacteriological workup of prostatitis patients, we retrospectively analyzed a clinical database of 696 symptomatic patients. All patients were routinely subjected to a four-glass test, followed by semen culture and analysis. This allowed to dissect from the database three different diagnostic scenarios, and to compare the ＇two-glass＇ pre-/post- massage test and the standard ＇four-glass＇ test with a ＇five-glass＇ test （four-glass plus post-VB3 semen culture）. The ＇five-glass＇ test showed 3.6- or 6.5-fold increases in relative sensitivity and lesser reductions （-13.2% or -14.7%） in relative specificity for traditional uropathogens （TUs） compared with the four-glass or two-glass test, respectively. The area under the ROC curve and Jouden＇s index were increased, whereas positive and negative likelihood ratios were lower than comparators, indicating that the ＇five-glass＇ assay may be superior in confirming the negative outcome of both standard tests. The five-, four-, and two-glass tests detected TUs （Enterobacteriaceae, Enterococci, etc.） in 120, 33, and 20 patients and unusual pathogens （Streptococci, other Gram-positive species, Mycoplasmata, and others） in 130, 56, and 45 patients, respectively. When patients were subjected to pharmacological treatment, including a combination of a fluoroquinolone and a macrolide, no differences in eradication rates were observed between groups diagnosed with different tests, irrespective of pathogen category. Eradication was associated with long-term sign/symptom remission; no significant intergroup differences in sign/symptom scores were observed throughout a 24-month off-therapy follow-up period. In conclusion, our data support the usefulness of semen analysis in the diagnostic workup ofprostatitis patients when this test is used to complement the four-glass Meares and Stamey test. Improvement of microbiological assays conveys important diagnostic and therapeutic implications.     

An attempt to understand the paradox of anorexia nervosa without drive for thinness

The "atypical" subgroup of women with anorexia nervosa not characterized by drive for thinness (DT) was studied. The study group comprised 151 anorectic patients (restrictor anorectics [AN-R], n=74; binge-purging anorectics [AN-BP], n=77). Subjects completed the following self-administered questionnaires: Eating Disorder Inventory-2 (EDI-2), Temperament and Character Inventory (TCI), State-Trait Anger Expression Inventory (STAXI), and Beck Depression Inventory (BDI). Patients were subdivided into three groups on the basis of body mass index (BMI) and DT score: AN-I with a BMI<15 and DT<7 (n=24); AN-II with a BMI>15 and DT<7 (n=34); and AN-III with a BMI<17.5 and DT>7 (n=93). Patients belonging to the AN-III group had a more severe disorder and form of psychopathology based on their scores on several scales. No association emerged between personality disorders and any single subgroup. Three hypotheses emerge: (1) some patients (about 38%) deny DT and provide negative answers on the questionnaires; (2) patients without DT (even when malnourished) seem to show less severe psychopathologic and personality traits; and (3) patients without DT answer questions honestly, but they have developed a character structure that enables them to feel negative and ego-dystonic emotions regarding their condition. Implications for treatment are discussed.     

Single serum activin a testing to predict ectopic pregnancy

CONTEXT: Ectopic pregnancy (EP) is an important cause of maternal deaths in early pregnancy because most fatal cases result from delayed diagnosis and inappropriate investigation. OBJECTIVE: We evaluated whether the measurement of activin A may be useful in the diagnosis of EP in women with unknown pregnancy location. DESIGN: The study was designed as an open observational study. SETTING: The study was set in a tertiary referral center for obstetric care. PATIENTS: Patients were women with unknown pregnancy location (n = 536) who had complaints of bleeding, pain, or cramping. INTERVENTIONS: Interventions included clinical examination; transvaginal ultrasound scan; human chorionic gonadotropin (hCG), progesterone, and activin A measurements; laparoscopy; uterine curettage; and histological examination. MAIN OUTCOME MEASURES: Main outcome measures were pregnancy outcomes and evaluation of sensitivity, specificity, and predictive values of hCG, progesterone, and activin A as diagnostic tests for the detection of EP. RESULTS: Pregnancy outcomes included 155 (28.9%) viable intrauterine pregnancies (IUP), 305 (56.9%) first-trimester spontaneous abortion (SAB), and 76 (14.2%) EP. SAB had the lowest (P < 0.0001) hCG and progesterone concentrations, significantly lower than EP (P < 0.001) and IUP (P < 0.001). In EP, levels were significantly (P < 0.001) lower than in IUP. On the contrary, activin A levels were lowest (P < 0.0001) in EP, significantly lower than in SAB (P < 0.001) and IUP (P < 0.001). IUP had significantly (P < 0.001) lower activin A levels than SAB. When evaluated by the receiver operating curve analysis, activin A at the cutoff of 0.37 ng/ml combined a sensitivity and a specificity of 100 and 99.6%, respectively, for prediction of EP. When activin A concentrations were below the cutoff, the positive predictive value for EP was 97.43%, and 0% for concentrations higher than 0.37 ng/ml. CONCLUSIONS: Activin A measurement may identify patients at risk of EP with a high sensibility and specificity.     

The dynamic relationship of parental personality traits with the personality and psychopathology traits of anorectic and bulimic daughters

Objective

Parenting and family dynamics influence the emergence, development, and maintenance of eating disorders (EDs). Although family interventions are relevant for therapeutic programs, knowledge of the relationship between parental personality traits and the eating psychopathology of daughters is scarce. This study explored the personality and psychopathology of women with EDs and correlated them with parental personality traits.

Method

The personality and eating psychopathology traits of 38 restricter anorectics, 30 bingeing/purging anorectics, 37 bulimics, and their parents' personality traits (87 fathers and 97 mothers) were measured with the Temperament and Character Inventory, the Clinical Global Impression Scale, the Eating Disorders Inventory-2, and the Beck Depression Inventory. The results were compared with matched controls (54 women, 50 fathers, 54 mothers). Personality and psychopathology were correlated with multiple regression.

Results

Women with ED displayed high harm avoidance and low self-directedness, whereas restricter anorectic women had high persistence. Low persistence was common in fathers of daughters across all EDs. Fathers of restricter anorectics were highly harm avoidant. Fathers of both anorectic subtypes and mothers of bulimic women displayed low self-directedness. Parental personality traits were linearly correlated with their daughter's personality and psychopathology, but the correlation differed among EDs.

Conclusion

Parents of eating-disordered participants displayed personality characteristics that differed from controls and, among ED subgroups, these differences were related to their daughter's personality and psychopathology. The linear correlation did not fully explain the relationship of the parental personality traits to the presence of their daughter's ED, suggesting that a more complex personality-based family dynamic is involved. A Temperament and Character Inventory profile of the entire family may be used in the planning of family treatment.     

Role of COMT, 5-HT(1A) , and SERT genetic polymorphisms on antidepressant response to Transcranial Magnetic Stimulation

Background: Transcranial Magnetic Stimulation (TMS) is an effective technique in the treatment of depression, specifically in drug‐resistant patients. However, there is little data available on the influence of genetic variables on TMS response. Methods: We analyzed the role of three genetic polymorphisms that affected the antidepressant response: serotonin transporter promoter region (SERTPR) polymorphism, 5‐HT_1A serotonergic receptor promoter region polymorphism (rs6295), and the coding region of COMT gene polymorphism (rs4680). Ninety patients with a major depressive drug‐resistant episode due to a Major Depressive Disorder or to a Bipolar Disorder were included in our study. Patients underwent high frequency TMS, focused on the left prefrontal cortex, for 2 weeks. At study completion, the response rate was 45.5%. Effects of gene polymorphisms on clinical improvement were analyzed with an analysis of variance with each gene (SERTPR, 5‐HT_1A, and COMT) as factors and the Hamilton Rating Scale for Depression variation from baseline to the end of the treatment as a dependent variable. Results: We found a significant model in which three factors were not significant (diagnosis, COMT, and SERTPR), whereas factor 5‐HT_1A showed a significant influence on the outcome, with patients with C/C genotype showing a greater improvement than G/G and C/G and no difference between G/G and C/G. Conclusion: According to our data, 5‐HT_1A polymorphism may play a role in influencing TMS response. The effect of COMT and SERTPR did not reach statistical significance. The analysis of these and other candidate genes in larger samples could help explain genetic influence on TMS response. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.