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Further treatment of secondary effluents before their discharge into the receiving water bodies could alleviate water eutrophication. In this study, the Chlorella proteinosa was cultured in a membrane photobioreactor to further remove nitrogen from the secondary effluents. The effect of hydraulic retention time (HRT) on microalgae biomass yields and nutrient removal was studied. The results showed that soluble algal products concentration reduced in the suspension at low HRT, thereby alleviating microalgal growth inhibition. In addition, the lower HRT reduced the nitrogen limitation for Chlorella proteinosa's growth through the phase-out of nitrogen-related functional bacteria. As a result, the productivity for Chlorella proteinosa increased from 6.12 mg/L/day at an HRT of 24 hr to 20.18 mg/L/day at an HRT of 8 hr. The highest removal rates of 19.7 mg/L/day, 23.8 mg/L/day, and 105.4 mg/L/day were achieved at an HRT of 8 hr for total nitrogen (TN), ammonia, and chemical oxygen demand (COD), respectively. However, in terms of removal rate, TN and COD were the largest when HRT is 24 hr, which were 74.5% and 82.6% respectively. The maximum removal rate of ammonia nitrogen was 99.2% when HRT was 8 hr., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Purpose: To evaluate whether the type of frozen embryo transfer (FET) regimen - ovulation-induced regimens vs. hormone replacement therapy regimens (HRT) - is associated with live birth rates and the risk of hypertensive diseases of pregnancy (HDP) in women with polycystic ovary syndrome (PCOS)., Methods: All studies in PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched using a combination of MeSH terms and keywords. Inclusion criteria included studies on women with a diagnosis of PCOS, utilization of FET, and reporting of pregnancy and/or obstetric outcomes. Studies were excluded if they were case series or conference abstracts or used other FET regimens. A random effects meta-analysis was performed. Primary outcomes include relative risk (RR) of live birth and HDP., Results: Eleven studies were included in the meta-analysis for the final review. Ovulation-induced regimens were associated with a higher live birth rate (8 studies, RR 1.14 [95% CI 1.08, 1.21]) compared to HRT regimens. The risk of HDP (3 studies RR 0.78 [95% CI 0.53, 1.15]) was not significantly different. Ovulation-induced regimens were associated with a lower miscarriage rate (9 studies, RR 0.67 [95% CI 0.59-0.76]). Rates of clinical pregnancy (10 studies, RR 1.05 [95% CI 0.99, 1.11]) and ectopic pregnancy (7 studies, RR 1.40 [95% CI 0.84, 2.33]), were not significantly different., Conclusion: This SR/MA demonstrates that for women with PCOS, ovulation-induced FET regimens are associated with higher rates of live birth and lower rates of miscarriage compared to HRT regimens., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The anaerobic biological treatment of landfill leachate frequently encounters the souring problems because of the high concentration of organic in landfill leachate. Nonetheless, the performance of anaerobic membrane bioreactor (AnMBR) is commendable in terms of removal of organic compounds. Hence, this study explored the effect of organic concentration and hydraulic retention time(HRT) on the removal performance of actual landfill leachate, additionally, carbon conversion through carbon mass balance analysis was analyzed, in order to determine the optimal treatment potential of AnMBR in treating landfill leachate. For HRT values between 14.5 h and 34.6 h, and the influent COD (Chemical Oxygen Demand) range of 12,773.33-15706.67 mg/L, AnMBR could efficiently treat landfill leachate. As HRT was fixed at 14.5 h and influent COD was around 12,206.7-15,373.33 mg/L, AnMBR achieved a maximum organic removal rate of 18.22 ± 0.51 kg COD/(m 3 ∙d) with methane yield of 0.24 ± 0.01 m 3 CH 4 /kg COD and methane content of 88.26%. Based on carbon mass balance, increasing COD concentration in the influent (less than 16,000 mg/L) boosted the conversion of organic compounds (45.19 ± 4.24%) into CH 4 ; while decreasing HRT (more than 27.0 h) also promoted the conversion of organic compounds into CH 4 (38.36-60.93%) resulting in a decreased TOC (Total Organic Carbon) loss by 2.02-7.19% with outflow. AnMBR may efficiently produce methane while treating landfill leachate by assessing the random forest model (RF) and adjusting the balance between HRT and influent COD concentration., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Sulfur-driven autotrophic denitrification (S 0 dAD) was employed to remove residual nitrogen from the biological effluent of landfill leachate after partial nitrification and denitrification pretreatment. The performance of S 0 dAD were assessed with various NO x - -N (NO 2 - -N and NO 3 - -N) loadings over a 185-day operational period. The results demonstrated that a notable NO x - -N removal efficiency of 97.8 ± 2.0% was achieved under nitrogen removal rates of 0.12 ± 0.02 kg N/(m 3 · d), leading to total nitrogen concentrations of 8.6 ± 3.8 mg/L in the effluent. Batch experiments revealed competitive utilization of nitrogenous electron acceptors, with NO 2 - -N demonstrating 2-4 times higher denitrification rates than NO 3 - -N under coexistence conditions. Genus-level microbial community identified that Thiobacillus and Sulfurovum was highly enriched with as key denitrifying bacteria in the S 0 dAD system. These findings provide insights for advanced nitrogen removal coupling S 0 dAD with partial nitrification and denitrification process for landfill leachate treatment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To investigate the effects of combining gonadotropin-releasing hormone agonist (GnRHa) downregulation with hormone replacement therapy (HRT, GnRHa-HRT) on the clinical outcomes of patients undergoing frozen-thawed embryo transfer (FET)., Methods: In this retrospective study, we included patients who had FET between January 2018 and December 2022. They were categorized into HRT and GnRHa-HRT groups based on the endometrial preparation protocol. The study compared the clinical outcomes of patients in two groups. Possible factors affecting clinical outcomes were analyzed using univariate analysis. To analyze the impact of two endometrial preparation methods on clinical outcomes, multifactorial logistic regression was performed., Results: The rates of clinical pregnancy (47.31% vs. 59.60%), embryo implantation (37.58% vs. 49.65%), biochemical pregnancy (52.36% vs. 64.31%), and early abortion (7.07% vs. 10.77%) were statistically different between the two groups ( p  < 0.05). Analysis using multifactorial logistic regression showed that there was a 1.65-fold increase in clinical pregnancy rates (OR = 1.65, 95% CI: 1.29-2.12, p  < 0.001) and a 1.55-fold increase in embryo implantation rates (OR = 1.55, 95% CI: 1.27-1.90, p  < 0.001) in the GnRHa-HRT group when compared to the HRT group. For blastocyst transfer, the clinical pregnancy and implantation rates of the GnRHa-HRT group were significantly higher than those of the HRT group (OR = 1.75, 95% CI: 1.30-2.37, p  < 0.001; OR = 1.73, 95% CI: 1.35-2.21, p  < 0.001)., Conclusion: In FET cycles, leuprorelin (as a GnRHa) downregulation combined with HRT may improve the clinical outcome of patients compared to the HRT cycle, especially for the clinical pregnancy and embryo implantation rates of patients with blastocyst transfer., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Hao, Li, Zhang and Zhang.)

Objectives: This study assessed the uptake of hormone replacement therapy (HRT) in cervical cancer patients with iatrogenic menopause. Survival in relation to HRT use was assessed via a retrospective chart study, and the severity of menopausal symptoms, motivations and barriers to starting HRT were examined via questionnaires., Study Design: In total, 293 women under the age of 51 and treated with radiotherapy for cervical cancer between 2010 and 2020 were identified. Medical records were searched for information on HRT use. If still living, women were sent digital questionnaires addressing menopausal symptoms, quality of life (QoL) and potential barriers and motivations concerning HRT use. Univariable data were analysed using Mann-Whitney U, chi-square, and Fisher's exact test, while logistical regression was used to analyse relationships between certain variables and use of HRT and survival., Results: Overall HRT uptake was 78.1 %, which was related to age and Charlson Comorbidity Index, but independent of the duration of radiotherapy or FIGO stage. Overall survival was higher for HRT users (χ 2 (1) = 4.3, p = 0.038). Questionnaires were sent to 193 patients and 100 completed it (response rate 51.8 %). Main reasons for HRT use were relief of hot flushes and improvement in QoL. For women below age 51, QoL was indeed higher for current HRT users than for non-HRT users (EQ-index 0.8 vs. 0.7, p = 0.008)., Conclusions: HRT prescription rate was inversely correlated with age. Survival was not negatively affected by HRT use. It is important to stress the benefits of HRT and address women's fears regarding its use., Competing Interests: Declaration of competing interest The authors declare that they have no competing interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The Gidabo River and its tributaries are the main sources of water for more than 1,584,646 inhabitants. It is an important source of water for the surrounding rural communities for various uses such as domestic, irrigation, livestock watering, fishing, and recreation. The river is the main tributary of Lake Abaya. The present study was designed to investigate the water quality status of the Gidabo River and its tributaries for domestic and aquatic life. To assess the water quality status, water samples were collected in monthly intervals for a period of 3 months from September to November (coffee processing time), 2022. Arc GIS 9.3, 3 DEM, and spreadsheet were used to analyze the data collected from SRTM (Shuttle Radar Thematic Mapper, 90 m) and field observation. Of all the water quality parameters analyzed; turbidity, BOD 5 , DO, COD, pH, Ni, Fe, NO 3 - were higher than the recommended limits of national and international standards for aquatic life. Based on the Weighted Arithmetic Mean (WAM), Water Quality Index (WQI) calculations of the River, WQI value of the river ranges between 34.83 and 54.31 in different reaches of the watershed which is classified under bad category. The wet coffee processing industry which is the main sources of contamination in the watershed uses 63 L of processing water to produce 1 kg of green coffee beans. Traditional lagoons, with an average hydraulic retention time (HRT) of 1.99 days, are the most common methods of treating wastewater. The river is at higher risk from harmful anthropogenic activities in the watershed and requires urgent monitoring and mitigation to prevent further degradation.4 3- were higher than the recommended limits of national and international standards for aquatic life. Based on the Weighted Arithmetic Mean (WAM), Water Quality Index (WQI) calculations of the River, WQI value of the river ranges between 34.83 and 54.31 in different reaches of the watershed which is classified under bad category. The wet coffee processing industry which is the main sources of contamination in the watershed uses 63 L of processing water to produce 1 kg of green coffee beans. Traditional lagoons, with an average hydraulic retention time (HRT) of 1.99 days, are the most common methods of treating wastewater. The river is at higher risk from harmful anthropogenic activities in the watershed and requires urgent monitoring and mitigation to prevent further degradation., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Due to increasing life expectancy, women spend a significant part of their lives in menopause. Women with a history of endometriosis are more likely to become menopausal at an early age due to bilateral oophorectomy or repeated ovarian surgery. In addition, some medical therapies used for endometriosis, such as gonadotropin releasing hormone agonists or progestins reduce bone mineral density. Furthermore, women with endometriosis have a higher background risk of cardiovascular disorders and hypercholesterolemia. Hence, it is important to recommend the use of hormone replacement therapy (HRT) to these women when they become menopausal, at least until the age of natural menopause. Although based on limited data, there is a possibility of reactivation of symptoms of endometriosis or its lesions, and a theoretical possibility of malignant transformation, although this remains unproven. Therefore, women should be advised in the light of this information before starting HRT after the age of natural menopause and are asked to seek help if they experience symptoms that may indicate these changes. Estrogen only HRT should be avoided and combined HRT preparations should be recommended, even after a hysterectomy., Competing Interests: Conflict of Interest: No conflict of interest is declared by the authors., (Copyright© 2024 The Author. Published by Galenos Publishing House on behalf of Turkish-German Gynecological Association. This is an open access article under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 (CC BY-NC-ND) International License.)

Radiotherapy is an effective cancer treatment, particularly for pelvic tumours. The number of patients with pelvic cancer being diagnosed and successfully treated is growing. Radiotherapy to the pelvis causes lasting side-effects collectively referred to as pelvic radiation disease (PRD), including bowel, bladder, sexual dysfunction, vaginal and cervical stenoses, and menopause. There is growing interest in management of menopause in cancer survivors, with the primary focus on the oncologic risk of hormone replacement therapy (HRT). Research examining if the modality with which the cancer was treated causes menopause-specific side effects is rare; however, malabsorption syndromes and anatomical changes in the pelvis post-radiotherapy may complicate effective delivery and monitoring of HRT. Consideration of these changes may significantly benefit patients in this young and growing cohort; thus, there is an urgent need to raise awareness of PRD among all clinicians, including those providing menopause care., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Treatment guidelines for gender-affirming hormone therapy with estrogen (GAHT-E) recommend specific dosing regimens based on limited data. Well-controlled efficacy trials are essential to tailoring treatment to patient goals as the guidelines recommend. The goal of this study was to take a foundational step toward designing community-centered effectiveness trials for gender-diverse individuals seeking GAHT-E., Methods: Our team developed a cross-sectional survey based on broad clinical experience and consultation with our community advisory board. The survey included 60 items covering demographics, transition history, goals and priorities for treatment, indicators of treatment success, sexual function goals, and future research priorities. The survey was distributed during the summer of 2021, primarily through social networks designed for gender-expansive individuals seeking treatment with estrogen., Results: A total of 1270 individuals completed the survey. Overall treatment goals most frequently rated "extremely important" or "very important" were the following: (1) improved satisfaction with life (81%), (2) appearing more feminine (80%), (3) appearing less masculine (77%), (4) improved mental health (76%), and (5) being seen as your true gender by others (75%). The three body characteristics most frequently rated "highest priority" or "high priority" among changes were the following: (1) facial hair (85%), (2) breast shape or size (84%), and (3) body shape (80%). The highest-rated research priority was comparing feminization with different routes of estrogen administration., Conclusion: The goals and experiences of individuals seeking GAHT-E are diverse. Future clinical trials of GAHT-E should be grounded in the needs and priorities of community stakeholders., (© 2024. The Author(s).)

Gender Affirmation Surgery (GAS) is a super specialized subset within the field of plastic and reconstructive surgery (PRS) that is ever evolving and of increasing interest to the PRS community. It is a multifaceted process which, in addition to surgical therapy, involves mental health therapy and hormonal therapy. One rapidly emerging interest within GAS is the role that gender affirming hormone therapy (GAHT) plays in enhancing surgical outcomes. GAHT has been used adjunctively with GAS as a comprehensive therapy to ameliorate gender dysphoria. This literature review will examine the positive effects of GAHT on the surgical outcomes on GAS, as well as other important considerations prior to surgery. As such, the primary objective of this literature review is to evaluate and assess the current evidence concerning the efficacy and safety of GAHT, as it relates to Gender Affirmation Surgery procedures., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT), was looked upon as a fountain of youth that kept women young and reduced cardiovascular disease. This led to a large-scale study called the Women's Health Initiative (WHI) that was conducted to show the cardiovascular benefits of HRT. This study was suspended early because of adverse side effects. The USFDA responded by slapping a "black box" warning on all HRT products. USFDA-approved bioidentical HRT formulations are safe and effective. We propose that these formulations have the "black box" warning removed so that doctors feel more confident in prescribing these products for symptoms of menopause and chronic conditions such as cardiovascular health. We propose eliminating the sale of products containing medroxyprogesterone acetate (MPA) because of the increased risk of heart attacks and breast cancers associated with this medication., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Kissinger.)

Background: This review aimed to comprehensively investigate the impact of Hormone Replacement Therapy (HRT) on implant osseointegration and bone loss. The study considered factors such as HRT type, osteoporosis, smoking, and diabetes mellitus, and analysed the available literature to provide insights into the association between HRT and implant outcomes., Methods: Multiple databases were utilized, and studies with diverse designs and methodologies were included that examined the relationship between HRT and implant osseointegration. The selected studies were analyzed and relevant data on implant success rates, bone loss, and other correlations was extracted., Results: The review findings indicate that HRT has a detrimental impact on implant osseointegration, as evidenced by lower implant success rates and increased bone loss in HRT-treated individuals. The odds ratio analysis further strengthens this association, with significant values of 0.59 (95% CI: 0.50-0.70) and 0.64 (95% CI: 0.54-0.76), indicating a higher likelihood of implant failure in HRT-treated patients., highlighting the need for caution when considering HRT as a treatment option in patients undergoing implant procedures. Smoking and diabetes mellitus were also found to significantly affect implant outcomes, emphasizing the importance of addressing these factors in patient management., Conclusion: The assessments demonstrate that HRT adversely affects implant osseointegration and increases bone loss. The results suggest the importance of considering the potential negative impact of HRT on implant outcomes and the need for thorough patient evaluation and management. Further research is warranted to explore the underlying mechanisms, assess the impact of specific HRT types and dosages, and evaluate preventive strategies to mitigate the detrimental effects of HRT on implant success., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 THE AUTHORS.)

Suitable operating parameters are one of the key factors to efficient and stable biological wastewater treatment of N, N-dimethylformamide (DMF) wastewater. In this study, an improved AnSBR-ASBR reactor (anaerobic sequencing batch reactor, AnSBR, and aerobic SBR, ASBR, run in series) was used to investigated the effects of operating conditions such as hydraulic residence time (HRT), AnSBR stirring speed and ASBR dissolved oxygen (DO) for DMF wastewater treatment. When HRT decreased from 24 h to 12 h, the average removal rates of COD by the AnSBR were 34.59% and 39.54%, respectively. Meanwhile, the removal rate of NH 4 -N by ASBR decreased from 88.38% to 62.81%. The DMF removal rate reached the best at 18 h and the expression of dehydrogenase was the highest in the AnSBR. The abundance of Megasphaera, the dominant sugar-degrading bacteria in the AnSBR, continued to decline due to the decrease of HRT. The relative abundance of Methanobacterium gradually increased to 80.2% with the decrease of HRT and that hydrotrophic methanogenesis dominated the methanogenic process. The HRT decrease promoted butyrate and pyruvate metabolism in anaerobic sludge, but the proportion of glycolysis and methane metabolism decreased. The AnSBR-ASBR reactor had the best operation performance when HRT was 18 h, AnSBR speed was 220 r/min, and ASBR DO content was 3-4 mg/L. This study provided an effective reference for the reasonable selection of operating parameters in the treatment of DMF-containing wastewater by the AnSBR-ASBR.+ -N by ASBR decreased from 88.38% to 62.81%. The DMF removal rate reached the best at 18 h and the expression of dehydrogenase was the highest in the AnSBR. The abundance of Megasphaera, the dominant sugar-degrading bacteria in the AnSBR, continued to decline due to the decrease of HRT. The relative abundance of Methanobacterium gradually increased to 80.2% with the decrease of HRT and that hydrotrophic methanogenesis dominated the methanogenic process. The HRT decrease promoted butyrate and pyruvate metabolism in anaerobic sludge, but the proportion of glycolysis and methane metabolism decreased. The AnSBR-ASBR reactor had the best operation performance when HRT was 18 h, AnSBR speed was 220 r/min, and ASBR DO content was 3-4 mg/L. This study provided an effective reference for the reasonable selection of operating parameters in the treatment of DMF-containing wastewater by the AnSBR-ASBR., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Hormone replacement therapy (HRT), menopausal hormone therapy (MHT), and estrogen-containing medications are frequently withheld before elective lower limb arthroplasty, based on a perceived risk of venous thromboembolism (VTE). However, evidence linking HRT, MHT, and an increased VTE risk is equivocal. This systematic review evaluated the concordance of international clinical practice guidelines (CPGs) on the withholding of HRT or MHT., Methods: The PubMed, Google Scholar, Cochrane, and Ovid databases were searched for CPGs for the preoperative, perioperative, and postoperative management of patients on HRT and MHT undergoing elective lower limb arthroplasty. This was supplemented by an internet search. There were 7 international CPGs in English, from Europe and North America, published between January 2000 and February 2023 reviewed against the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE-II) criteria, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist., Results: The guidelines reviewed revealed a mixed picture on HRT or MHT withdrawal and use in arthroplasty, with some featuring detailed advice on the preoperative and postoperative management of HRT or MHT (Scottish Intercollegiate Guidelines Network), while others featured no guidance (American College of Chest Physicians). The evidence referenced in these guidelines highlighted studies showing HRT or MHT to play a limited role in increasing VTE risk, with most studies from the 1990s and 2000s., Conclusions: Based on current evidence, non-estrogen-containing transdermal HRT or MHT should not be withheld in patients undergoing elective joint arthroplasty, though further evidence is required to justify withholding estrogen-containing forms., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Aim: Both morbidity and mortality rates of cervical cancer are increasing, especially in reproductive-aged women. Radical trachelectomy (RT) is an effective fertility-preserving surgery for early-stage cervical cancer. This study aimed to determine the influence of RT on endometrial thickness during in vitro fertilization-embryo transfer (IVF-ET)., Methods: Forty-four patients had undergone RT, and 23 women undergoing IVF-ET treatment (105 ET cycles) were included. Endometrial thickness during hormone replacement therapy (HRT) was retrospectively evaluated and compared between patients with and without RT., Results: Eleven patients (50 ET cycles) in the RT group and 12 (52 ET cycles) in the control group were investigated. Compared with the control group, higher ET cancellation rates were observed in patients in the RT group (1 of 52 cycles [control group] vs. 8 of 50 cycles [RT group], p < 0.01). Endometrial thinning was not affected by patient age at first IVF-ET treatment, history of artificial abortion, preservation of uterine arteries during RT, or postoperative chemotherapy (p = 0.27, 1, 1, and 1, respectively)., Conclusions: Our data revealed that RT influenced endometrial thickness in IVF-ET. This was not affected by the background of the patients or perioperative management in this study. We could not reveal the underlying mechanism, but it is postulated that the transient postoperative uterine blood flow status and postoperative infections may have some effect on the endometrium. To resolve these issues, accumulation of evidences are required. We recommend informing patients about the impact of RT on IVF-ET before starting assisted reproductive technology (ART)., (© 2023 Japan Society of Obstetrics and Gynecology.)

Objective: In this study, we aimed to develop education to assist BRCA mutation carriers in making informed decisions about HRT in the context of risk-reducing surgery, while simultaneously clarifying their treatment-specific values and reducing decisional conflict., Methods: We enrolled premenopausal BRCA mutation carriers ages 19-49 without prior cancer or risk-reducing salpingo-oophorectomy to structured interviews in which they reviewed education about the risks and benefits of HRT. Materials included literature-derived data demonstrating associations between HRT and commonly considered health outcomes (breast cancer, vasomotor symptoms, sexual functioning, cardiovascular disease, osteoporosis, and blood clots). Participants completed the 16-item Decisional Conflict Scale (DCS) before and after education, communicated their preferences by rating and ranking the six outcomes, and provided feedback to inform iterative revisions of the educational content., Results: 25 participants completed interviews. DCS scores decreased significantly from 54.6 to 22.8 following education (p < 0.001); sub-scores for uncertainty (71.7 to 37.3), informed (71.7 to 15.3), values clarity (53.7 to 17.0), effective decision (44.2 to 25.5), and support (35.0 to 17.7) also decreased significantly. Participants ranked cardiovascular disease as the most important outcome to consider, followed by breast cancer, osteoporosis, blood clots, decline in sexual function, and hot flashes. Participants with prior mastectomy (N = 10) ranked breast cancer as the most important outcome 25% of the time, compared to 80% in participants without mastectomy (N = 15)., Conclusion: Following education, BRCA mutation carriers had significantly less decisional conflict regarding the choice to use HRT. This pilot study was successful in generating a prototype educational aid for further testing., Competing Interests: Declaration of Competing Interest There are no conflicts of interest or financial disclosures for any of the manuscript authors. This work was supported by the Gray Foundation., (Copyright © 2023. Published by Elsevier Inc.)

Background: Transgender individuals frequently undergo gender-affirming hormone therapy (GAHT) during their gender transition which plays a vital role in gender identity affirmation. Cholelithiasis, a common condition affecting 10-15% of the US population, has been linked to estrogen therapy in cisgender women. Despite the fact that hormonal profiles achieved after GAHT are not always identical to cisgender individuals, the effects of GAHT on gallbladder disease (GBD) risk have not been evaluated in transgender populations. This research aims to address this gap utilizing a large nationwide database., Methods: The study analyzed medical records data from the TrinetX database from 52,847 trans men and 38,114 trans women. Four cohorts were created: trans women and men either receiving either hormone therapy or no intervention. Descriptive statistics were calculated before matching to estimate disease burden. The groups were then propensity score matched on known risk factors (age, race, BMI, etc.) and rates of GBD were compared., Results: Before matching, trans women on hormone therapy (TWHT) had a significantly higher 10-year GBD probability than those naïve to therapy (TWNI) (4.69% vs 1.88%). For trans men, there was no significant difference in 10-year rates between those on therapy (TMHT) and those not (TMNI) (3.15% vs 3.87%). Cholecystectomy rates were significantly higher for TWHT than TWNI (1.10% vs. 0.57%), but similar between TMHT and TMNI (0.95% vs. 1.10%). After accounting for risk factors, TWHT had increased GBD risk (HR 1.832), while TMHT showed no significant change., Discussion: This study suggests a link between estrogen GAHT and increased GBD risk in transgender women. Notably, testosterone GAHT did not offer protection against GBD in transgender men, contrary to expectations. This study is, to our knowledge, the first to describe the burden of GBD in the transgender population and to investigate the effects of GAHT on GBD risk., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 Taylor & Francis Group, LLC.)

Growing evidence suggests that transgender individuals face a significant health disparity and are particularly vulnerable to sleep disorders. We present two patients who developed irregular sleep-wake rhythm disorder after gender reassignment and hormone replacement therapy. The growing interest in transgender health warrants further evaluation of the effects and frequency of all sleep disorders in this population. Efforts to address sleep disorders should consider assessing sleep disturbance in terms of sleep/wake patterns and schedules., Citation: Kokash A, Vendrame M. Images: irregular sleep-wake rhythm disorder in transgender individuals. J Clin Sleep Med . 2023;19(11):1981-1984., (© 2023 American Academy of Sleep Medicine.)

The modality of endometrial preparation for the transfer of frozen-thawed embryos may influence maternal and fetal adaptation to pregnancy and could thus impact the results of the first trimester combined screening test. We conducted a retrospective cross-sectional study on singleton pregnancies achieved by embryo transfer of a single frozen-thawed blastocyst, comparing two different endometrial preparation protocols: natural cycle ( n = 174) and hormone replacement therapy (HRT) ( n = 122). The primary outcome was the risk of preeclampsia at the first trimester combined screening test. Secondary endpoints included variable reflecting fetal cardiac function (nuchal translucency and fetal heart rate), maternal adaptation (median arterial blood pressure-MAP and uterine arteries pulsatility index-UtA-PI), and placentation (pregnancy associated plasma protein A and placental growth factor). The risk of early preeclampsia was comparable in the two groups (38% vs. a 28%, p = 0.12). However, women in the natural cycle group showed lower fetal heart rate (159 [155-164] vs. 164 [158-168], p = 0.002) and higher UtA-PI (0.96 [0.74-1.18] vs. 0.72 [0.58-0.90], p < 0.001). The frequency of a screening test at high risk for aneuploidies was similar. The modality of transfer of frozen-thawed embryos is associated with changes in the variables reflecting maternal and fetal cardiovascular function.

The musty odorant (2-methylisoborneol, MIB) is prevalent in source water reservoirs and has become one of the major challenges for drinking water quality. This study proposes an approach to control the growth of MIB-producing cyanobacteria in a small reservoir based on hydraulic regulation, according to the results of long-term field investigations, laboratory culture experiments, model construction, and field application. Field investigations found that longer hydraulic retention time (HRT) is a factor that triggers MIB episodes. The culture study revealed that the maximum cell density, growth rate of MIB-producing Planktothricoides raciborskii, and MIB concentration are determined by the HRT (R 2 = 0.94, p-value < 0.001) and can be minimized by decreasing the HRT to less than 10 d. On this basis, an HRT regulation model was constructed and validated by field investigation, and critical HRT values were evaluated for 14 cyanobacteria genera. By decreasing the HRT to 5.4 ± 0.8 d, which is lower than the critical value of 7.5 ∼ 15.0 d, an MIB episode was successfully terminated in ZXD Reservoir in 2021. The results suggest that the proposed principle can provide a scientific basis for HRT regulation, which has been proved to be effective and feasible. This approach avoids negative impacts on water quality, does not require extra investment in engineering infrastructure, and in some cases may be applied readily by changing existing operational procedures. Therefore, HRT-based regulation is a promising strategy targeting MIB control and possibly for other cyanobacterial-derived water quality problems in small reservoirs., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Premature Ovarian Insufficiency (POI) is a multi-factorial disorder that affects women of reproductive age. The condition is characterized by the loss of ovarian function before the age of 40 years and several factors have been identified to be implicated in its pathogenesis. Remarkably though, at least 50% of women have remaining follicles in their ovaries after the development of ovarian insufficiency. Population data show that approximately up to 3.7% of women worldwide suffer from POI and subsequent infertility. Currently, the treatment of POI-related infertility involves oocyte donation. However, many women with POI desire to conceive with their own ova. Therefore, experimental biological therapies, such as Platelet-Rich Plasma (PRP), Exosomes (exos) therapy, In vitro Activation (IVA), Stem Cell therapy, MicroRNAs and Mitochondrial Targeting Therapies are experimental treatment strategies that focus on activating oogenesis and folliculogenesis, by upregulating natural biochemical pathways (neo-folliculogenesis) and improving ovarian microenvironment. This mini-review aims at identifying the main advantages of these approaches and exploring whether they can underpin existing assisted reproductive technologies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Moustaki, Kontogeorgi, Tsangkalova, Tzoupis, Makrigiannakis, Vryonidou and Kalantaridou.)

Ductal carcinoma in situ (DCIS) is widely accepted as a precursor of invasive ductal carcinoma (IDC). Lobular carcinoma in situ (LCIS) is considered a risk factor for invasive lobular carcinoma (ILC), and it is unclear whether LCIS is also a precursor. Therefore, it would be expected that similar risk factors predispose to both DCIS and IDC, but not necessarily LCIS and ILC. This study examined associations with risk factors using data from 3075 DCIS cases, 338 LCIS cases, and 1584 controls aged 35-60, recruited from the UK-based GLACIER and ICICLE case-control studies between 2007 and 2012. Analysis showed that breastfeeding in parous women was protective against DCIS and LCIS, which is consistent with research on invasive breast cancer (IBC). Additionally, long-term use of HRT in post-menopausal women increased the risk of DCIS and LCIS, with a stronger association in LCIS, similar to the association with ILC. Contrary to findings with IBC, parity and the number of births were not protective against DCIS or LCIS, while oral contraceptives showed an unexpected protective effect. These findings suggest both similarities and differences in risk factors for DCIS and LCIS compared to IBC and that there may be justification for increased breast surveillance in post-menopausal women taking long-term HRT.

Introduction: Turner Syndrome (TS) is the commonest chromosomal abnormality in females. Establishing and maintaining long-term follow-up after transition to adult endocrine services, to allow for essential lifelong surveillance of hypertension and cardiovascular disease, and optimal hormone replacement, remains a challenge. A TS transition clinic was established with the aim of supporting successful transfer and establishing long-term follow-up in adult endocrine services. Our objectives are to evaluate the success of our TS transition service primarily in achieving and maintaining follow-up after transfer to adult services and to assess the adequacy of health surveillance post-transition with a specific focus on cardiac monitoring and hormone replacement., Methods: A departmental database was used to identify young people whose care had transferred to adult endocrine services. An electronic case record was utilised to obtain clinic attendance and relevant clinical information on cardiovascular monitoring and hormone replacement therapy (HRT)., Results: Forty-six (n=46) young people transferred to adult endocrine services during the observed 20-year period, 1998-2017. Thirty-six (n=36) had transferred prior to 2015, of whom sixteen (n=16, 44%) are lost to long-term follow-up at 5 years. Overall, 41 (89%) patients have had cardiac imaging surveillance since transferring, However, only 30 (73%) of these were carried out at the recommended frequencies. All 20 women in established follow-up have had cardiac imaging. Five out of the 46 (11%) patients do not have any documented cardiovascular monitoring. Forty (86.9%) women have had a documented BP measurement. Nineteen of the 20 women who are in 5- year established follow-up have a documented blood pressure. Five (11%) women are not on HRT, while two (4%) remain on oestrogen-only HRT. Thirty-seven (80.4%) women are on combined HRT, only eight (21.6%) are on the recommended form of oestradiol. Two (4%) are not on HRT due to normal ovarian function., Conclusion: A significant proportion of girls with TS are currently lost to adult endocrine services. Strategies to improve long-term endocrine follow-up are needed to ensure lifelong health needs and adequate hormone replacement are met. Whilst similar parameters are monitored in adult endocrine services a group of patients may be at risk of receiving inadequate HRT and developing cardiovascular complications., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zahra, Sastry, Freel, Donaldson and Mason.)

The number of patients presenting to primary care requiring support with menopause symptoms is increasing and the number of available appointments in general practice is reducing. In attempt to improve access new ways of engaging with these patients may be beneficial. Group consultations could be a solution. Here I describe my experience of setting up group consultations in a GP practice.

An anaerobic baffled reactor (ABR) is one of the useful wastewater treatment technologies, but the knowledge about its treatment performance for actual wastewater with load fluctuation is limited. The organic removal performance of an ABR for treating supermarket wastewater was evaluated. The ABR, which consisted of eight columns, was examined under four hydraulic retention time (HRT) conditions of 19.4, 12.9, 8.0, and 4.4 h. As a result, the unfiltered chemical oxygen demand (COD) removal efficiency was 80 (±8) % at an HRT of 19.4 h. When the HRT was shortened to 12.9 h, the average unfiltered COD removal efficiency decreased to 58 (±15) %. However, it showed buffering effect against high load inflow in the first column, indicating that it is useful as a pretreatment system under this condition. At an HRT of 4.4 h, the unfiltered COD removal efficiency decreased to 9%, indicating the system failed. The results of the microbial community structure analysis showed that the detection frequency of acidogenic bacteria decreased in proportion to the extension of residence time in the reactor. These results indicate that the ABR is useful for the treatment of supermarket wastewater with load fluctuations as a main treatment system at a HRT of 19.4 h and as a pretreatment system at a HRT of 12.9 h.

This review explores the challenges in the diagnosis of hypogonadotropic hypogonadism, the transition of care from paediatric to adult care and the considerable health implications of this condition. The role gynaecologists and general practitioners have in managing hormone replacement therapy and reproductive potential is also highlighted. The fertility treatment options, which include ovulation induction with gonadotrophins and in-vitro fertilisation, are discussed in detail along with highlighting the fact that anovulation and markers of low ovarian reserve prior to priming treatment may not be reflective of poor reproductive potential. The holistic management of women with hypogonadotropic hypogonadism is still not standardised and evidence for subfertility management is scarce. This review aims to highlight this concern and provide guidance by evaluating current evidence.

The liver performs a multitude of bodily functions, whilst retaining the ability to regenerate damaged tissue. In this review, we discuss sex steroid biology, regulation of mammalian liver physiology and the development of new model systems to improve our understanding of liver biology in health and disease. A major risk factor for the development of liver disease is hepatic fibrosis. Key drivers of this process are metabolic dysfunction and pathologic activation of the immune system. Although non-alcoholic fatty liver disease (NAFLD) is largely regarded as benign, it does progress to non-alcoholic steatohepatitis in a subset of patients, increasing their risk of developing cirrhosis and hepatocellular carcinoma. NAFLD susceptibility varies across the population, with obesity and insulin resistance playing a strong role in the disease development. Additionally, sex and age have been identified as important risk factors. In addition to the regulation of liver biochemistry, sex hormones also regulate the immune system, with sexual dimorphism described for both innate and adaptive immune responses. Therefore, sex differences in liver metabolism, immunity and their interplay are important factors to consider when designing, studying and developing therapeutic strategies to treat human liver disease. The purpose of this review is to provide the reader with a general overview of sex steroid biology and their regulation of mammalian liver physiology.

European clinical guidelines recommend the use of Exposure and Response Prevention (ERP) and Comprehensive Behavioral Intervention for Tics (CBIT) as first-line treatments for tic disorders. Although ongoing efforts in research are being made to understand the mechanisms underlying these behavioral approaches, as of yet, the neurophysiological mechanisms behind behavioral interventions are poorly understood. However, this is essential to tailor interventions to individual patients in order to increase compliance and efficacy. The Theory of Event Coding (TEC) and its derivative BRAC (Binding and Retrieval in Action Control) provide a theoretical framework to investigate cognitive and neural processes in the context of tic disorders. In this context, tics are conceptualized as a phenomenon of enhanced perception-action binding, with premonitory urges constituting the perceptual and the motor or vocal expression constituting the action part of an event file. Based on this, CBIT is assumed to strongly affect stimulus-response binding in the context of response selection, whereas the effects of ERP presumably unfold during stimulus-response binding in the response inhibition context. Further studies are needed to clarify the neurophysiological processes underlying behavioral interventions to enable the individualization and further development of therapeutic approaches for tic disorders.

Women with a BRCA mutation have an increased risk of developing breast and ovarian cancer. Bilateral salpingo-oophorectomy is the only effective strategy to reduce this risk. Risk-reducing bilateral salpingo-oophorectomy (RRSO) is recommended between the ages of 35 and 40 for women carriers of BRCA1 and between the ages of 40 and 45 for women carriers of BRCA1 and BRCA2 mutations. Most women undergo this procedure prior to their natural menopause subsequently developing an anticipated lack of hormones. This condition affects the quality of life and longevity, while it is more pronounced in women carrying a BRCA1 mutation compared to BRCA2 because they are likely to have surgery earlier. Hormone replacement therapy (HRT) is the only strategy able to significantly compensate for the loss of ovarian hormone production and counteract menopausal symptoms. There is strong evidence that short-term HRT use does not increase the risk of breast cancer among women with a BRCA1 mutation. Few data are available on BRCA2 mutation carriers. Therefore, BRCA mutation carriers require careful counseling about the outcomes of their RRSO, including menopausal symptoms and/or the fear associated with HRT use., (© 2022. The Author(s), under exclusive licence to Hellenic Endocrine Society.)

This paper presents the first study to quantify and demonstrate the interactions between SBR operating conditions (hydraulic retention time (HRT) and temperature) and soluble microbial product (SMP) generation, as well as the impact of SBR operating conditions and filtration temperature on fouling of membranes used in tertiary treatment. Reducing SBR operating HRT from 20 to 10 h resulted in an increase in SMP concentrations, however, the extent of the increase in high and low molecular weight (MW) organics was different for the effluents from SBRs operated at 8 and 20 °C. Results of SMP modelling demonstrated that a reduction in SBR operating HRT induced decreased utilization associated product (UAP) yields and the influence was greater at the SBR operating temperature of 8 °C. In contrast, biomass associated product (BAP) yields were relatively stable with SBR operating HRT but greater at lower SBR operating temperature. The effects of SBR operating HRT and temperature on fouling indices were also interactive. Reducing SBR operating HRT led to a lower increase in hydraulically reversible resistances and a greater increase in hydraulically irreversible resistances for the effluent from the SBR operated at 8 °C. Reducing the filtration temperature resulted in additional increase in membrane resistances, and the increase was greater at lower SBR operating HRT. The contribution of filtration temperature was observed to have the greatest impact on membrane resistances, followed in importance by SBR operating HRT and temperature. The comprehensive analysis undertaken in the present study provides insights into the interaction between secondary and tertiary operations on fouling development. The results can be employed to understand the limits of fouling control for tertiary treatment under challenging conditions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

This cohort study investigated whether letrozole versus hormone replacement therapy (HRT) results in higher live birth rate among anovulatory and oligoovulatory women in frozen-thawed embryo transfer (FET) cycles. It was conducted from 1st February 2018 to 31st January 2019 and included 261 anovulatory and oligoovulatory women. Since letrozole has become an effective alternative to HRT cycles, 121 patients received letrozole in 121 cycles from 1st February 2018 to 31st January 2019 and were compared to 140 HRT FET cycles among 140 women from 1st February 2017 to 31st January 2018. The primary outcome was live birth rate. Secondary outcomes were clinical pregnancy, multiple pregnancy and miscarriage rates. Clinical pregnancy and live birth rates of transferred cleavage embryos were higher in the letrozole compared to the HRT group (36/65 (55.3%) vs. 20/110 (18.1%), p  < 0.001) and (25/65 (38.4%) vs. 17/110 (15.4%), p  < 0.001) respectively, whilst these rates were similar for transferred blastocyst embryos. Miscarriage and multiple pregnancy rates were similar between groups. The letrozole group was older than the HRT group (31.8 ± 5.1 vs. 29.9 ± 5.1 years, p  = 0.002) and more smoked cigarettes ( p  = 0.035). Groups were similar regarding BMI, male versus non-male indication for fertility treatment, peak oestradiol levels, and numbers of oocytes retrieved, blastocysts, frozen and transferred embryos. Letrozole compared to HRT might improve live birth and clinical pregnancy rates among anovulatory and oligoovulatory women undergoing FET cycles.

All cancers develop as a result of mutations in genes. DNA damage induces genomic instability and subsequently increases susceptibility to tumorigenesis. Women who carry mutations of BRCA 1 and BRCA2 genes have an augmented risk of breast and ovarian cancer and a markedly augmented probability of dying because of cancer compared to the general population. As a result, international guidelines recommend that all BRCA1\2 mutation carriers be offered risk-reducing bilateral salpingo-oophorectomy at an early age to reduce the risk of cancer and decrease the mortality rate of this high-risk population. NCCN guidelines recommend risk-reducing bilateral salpingo-oophorectomy in pre-menopausal women, between 35-40 years in BRCA1 mutation carriers and between 40-45 years in BRCA2 mutation carriers. Unfortunately, the well-documented reduction of cancer risk is counterbalanced by early sterility and premature ovarian failure with an early onset of secondary menopausal syndromes such as neuromotor, cardiovascular, cognitive and urogenital deficiency. Hormonal replacement therapy significantly compensates for hormonal deprivation and counteracts menopausal syndrome morbidity and mortality; however, some data suggest a possible correlation between hormonal medications and cancer risk, especially in BRCA1\2 carriers who undergo long-term regimens. Conversely, short-term treatment before the age of natural menopause does not appear to increase the cancer risk in BRCA1 mutation carriers without a personal history of breast cancer after prophylactic surgery. Few data are available on BRCA2 mutation carriers and more well-designed studies are needed. In conclusion, clinicians should propose short-term hormone replacement therapy to BRCA 1 carriers to counteract hormonal deprivation; personalized counselling should be offered to BRCA2 mutation carriers for a balance between the risks and benefits of the treatment.

Cytochrome P450 oxidoreductase deficiency (PORD) is a rare recessive disease with multiple clinical manifestations, which is usually diagnosed in neonates and children because of ambiguous genitalia or skeletal malformations. Moreover, the paucity of studies does not allow us to establish whether adult-onset PORD is associated with infertility. Here, we report clinical and laboratory findings in two phenotypically normal women diagnosed with PORD who underwent in vitro fertilization (IVF) and frozen embryo transfer (FET). We modified the gonadotropin stimulation protocol during controlled ovarian hyperstimulation (COH) and suggest the use of the vaginal 17β-estradiol route for endometrium preparation in hormone replacement therapy (HRT) cycles. We presume that PORD may be associated with infertility in several aspects, including disordered steroidogenesis, endometrium impairment, attenuation of drug metabolism, and the high risk of miscarriage. Our observations will help the early diagnosis and make a tailored approach to infertility management in adult-onset PORD., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Li, Zhang and Zhang.)

Background: Recent studies on the prescribing of hormone replacement therapy (HRT) medicines to treat symptoms of menopause are lacking., Aim: To describe the prescribing of HRT in a cohort of UK menopausal women., Design & Setting: Population-based drug utilisation study using IQVIA Medical Research Database (IMRD-UK)., Method: Primary care data of women with recorded menopause and/or aged ≥50 years between January 2010 and November 2021 were extracted from the database. The incidence rate of women who received their first prescription for HRT was calculated annually using person-years-at-risk (PYAR) as the denominator. Incidence rates of HRT were estimated by type and route of administration. Relative changes in annual incidence rates were expressed as percentages and the average percentage change was assessed using linear regression. Annual prescribing prevalence per 100 women was calculated using mid-year menopausal population estimates., Results: The incidence rate of prescribing of HRT increased from 5.01 in 2010 to 18.16 per 1000 PYAR in 2021, a relative increase of 13.64% (95% confidence interval [CI] = 6.97 to 20.30) per year. The incidence rate of fixed combinations of HRT increased from 3.33 to 12.23 per 1000 PYAR in 2010 and 2021, respectively. Transdermal formulations of HRT increased from 1.48 to 14.55 per 1000 PYAR in 2010 and 2021, respectively. The overall proportion of women in receipt of a prescription for HRT changed from 7.89% in 2010 to 6.86% in 2020., Conclusion: This study shows a steady increase in the number of women receiving their first prescription for HRT during the study period, which suggests regained acceptance of HRT medicines., (Copyright © 2022, The Authors.)

Background: Limited recent observational data have suggested that there may be a protective effect of oestrogen on the severity of COVID-19 disease. Our aim was to investigate the association between hormone replacement therapy (HRT) or combined oral contraceptive pill (COCP) use and the likelihood of death in women with COVID-19., Methods: We undertook a retrospective cohort study using routinely collected computerized medical records from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care database. We identified a cohort of 1,863,478 women over 18 years of age from 465 general practices in England. Mixed-effects logistic regression models were used to quantify the association between HRT or COCP use and all-cause mortality among women diagnosed with confirmed or suspected COVID-19 in unadjusted and adjusted models., Results: There were 5,451 COVID-19 cases within the cohort. HRT was associated with a reduction in all-cause mortality in COVID-19 (adjusted OR 0.22, 95% CI 0.05 to 0.94). There were no reported events for all-cause mortality in women prescribed COCPs. This prevented further examination of the impact of COCP., Conclusions: We found that HRT prescription within 6 months of a recorded diagnosis of COVID-19 infection was associated with a reduction in all-cause mortality. Further work is needed in larger cohorts to examine the association of COCP in COVID-19, and to further investigate the hypothesis that oestrogens may contribute a protective effect against COVID-19 severity., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Menopause is an important hormonal transition of women's lifespan which can strike as early as 30-35 years of age. Menopause-specific quality of life (MENQoL) mainly depends upon awareness, frequency, and intensity of menopausal symptoms; sociocultural, lifestyle, and dietary factors; and availability of health services specifically focusing on these issues. As life expectancy increases, women have to spend more years after menopause. So menopause specific quality of life will be a major issue of concern in the near future. The aim of this study was to assess the post-menopausal symptoms and quality of life (QoL) amongst post-menopausal women and their association with various sociodemographic factors., Materials and Methods: A community-based, descriptive, cross-sectional study was undertaken at Sakuri village among 100 postmenopausal women. Information was collected using MENQoL questionnaire. Unpaired t -test and Chi-squared test were used., Results: The mean age of participants and menopause was 51.8 ± 4.54 years and 46.42 ± 4.13 years, respectively. The major symptoms reported were hot flushes (70%), under accomplishment (100%), bloating (100%), decrease in physical strength (95%), and change in sexual desire (78%). Statistically significant association was found between age and psychosocial domain. QoL was associated with age and educational level., Conclusion: More than half of the participants had poor QoL for all four domains. Awareness about post-menopausal changes and available treatment modalities can improve QoL. Accessible and affordable gynaecological and psychiatric health services through channel of primary health care are necessary to alleviate these complaints., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)

Topic: This systematic review summarizes evidence for associations between female reproductive factors (age at menarche, parity, oral contraceptive [OC] use, age at menopause, and postmenopausal hormone [PMH] use) and intraocular pressure (IOP) or open-angle glaucoma (OAG)., Clinical Relevance: Understanding the associations between female reproductive factors and glaucoma may shed light on the disease pathogenesis and aid clinical prediction and personalized treatment strategies. Importantly, some factors are modifiable, which may lead to new therapies., Methods: Two reviewers independently extracted articles in MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials databases to identify relevant studies. Eligibility criteria included studies with human subjects aged > 18 years; a measured outcome of either IOP or OAG; a cohort, case-control, cross-sectional, or randomized controlled trial design; a reported measure of association, such as the hazard ratio, relative risk, odds ratio, or mean difference, with an associated confidence interval; and a measured exposure of at least 1 of the following variables: age at menarche, parity, OC use, age at menopause, or PMH use., Results: We included a total of 27 studies. Substantial differences in study designs, exposure and treatment levels, treatment durations, and variable reporting precluded a meaningful quantitative synthesis of the identified studies. Overall, relatively consistent associations between PMH use and a lower IOP were identified. Estrogen-only PMH use may be associated with lower OAG risk, which may be modified by race. No significant associations were found with combined estrogen-and-progesterone PMH use. No strong associations between parity or age at menarche and glaucoma were found, but a younger age at menopause was associated with an increased glaucoma risk, and adverse associations were identified with a longer duration of OC use, though no overall association with OC use was found., Conclusions: The association between PMH use and lower IOP or OAG risk is a potentially clinically relevant and modifiable risk factor and should be investigated further, although this needs to be interpreted in the context of a high risk of bias across included studies. Future research should examine associations with IOP specifically and how the relationship between genetic factors and OAG risks may be influenced by female reproductive factors., (Copyright © 2022 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

This paper explores the performance of pilot-scale constructed wetland osmotic microbial fuel cell (CW-OMFC) in different gravel conditions. The performance was measured in terms of power generation, water flux, chemical oxygen demand (COD) removal, and coulombic efficiency. The CW-OMFC was divided into four sections based on the porosity of the materials. The surface area of materials at Side A, Side B, Side C, and Side D were 2.717 m 2 .g -1 , 0.228 m 2 .g -1 , 0.095 m 2 .g -1 , and 0.072 m 2 .g -1 , respectively. The CW-OMFC achieved maximum water flux, minimum reverse salt flux, high power density, and COD removal efficiency of 6.66 ± 0.5 L.m -2 .h -1 , 3.33 ± 1.2 g.m -2 .h -1 , 59.53 ± 10 mW.m -2 and 84.69%, respectively, by using high porous materials. The nutrients (nitrogen, phosphorus, and potassium) uptake by plants from wastewater were 12.17%, 12.01%, and 21.73%, respectively., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: The purpose of the study was to assess and compare the optic nerve head (ONH) and retinal nerve fibre layer (RNFL) parameters and image quality parameters obtained by Cirrus HD-OCT, GDxECC and HRT3 in a population-based screening study., Methods: This analysis examined 2566 subjects taking part in the Northern Finland Birth Cohort Eye study. Images with spectral domain OCT (Cirrus HD-OCT 4000), scanning laser ophthalmoscopy (HRT3) and scanning laser polarimetry (GDxECC) were obtained from each subject. The correlation of average and regional parameters of RNFL and ONH between devices was evaluated., Results: The RNFL thickness was 90.9 µm when measured with OCT, 24.6 µm with HRT and 48.1 µm with GDx. There was a high correlation between the disc and cup measurements with the HRT and OCT and the RNFL thickness of the OCT and GDx (r > 0.5). A statistically significant correlation was found between RNFL measurements of the HRT and OCT in the superior, temporal and inferior quadrants. Optical coherence tomography (OCT) signal strength correlated with the image quality parameters of the HRT and GDx. The percentage of good quality images was the lowest with the GDx., Conclusion: The RNFL thickness in Northern Finland birth cohort was at a lower level compared to other studies. The study confirms the difference in measuring ONH parameters between the imaging devices. However, significant correlations between devices were found in the cup volume and cup disc area ratio parameters of the OCT and HRT. The correlations between image quality parameters and glaucoma detection parameters were relatively low., (© 2021 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Several myths and misconceptions exist about hormones in women with familial predisposition to cancer, and there are few real-life data on their prescription and uptake. To better understand how they are prescribed and accepted in healthy carriers of a BRCA1/2 pathogenetic variant, an online survey was uploaded on Google Forms and shared through social media closed groups of patients' associations, aBRCAcadabra and ACTO Campania. A total of 241 questionnaires were collected. Sexual quality of life was considered of the utmost importance by most of the respondents (mean score of 7 ± 2.8/10), but they felt the counseling they received by healthcare professionals on the topic was insufficient (4.9 ± 3.2/10). Only 57 women out of 233 (24.5%) had used hormonal contraception after being diagnosed as carriers of a BRCA pathogenetic variant, and 42 out of 148 (28.4%) underwent menopause hormonal therapy. The majority of women (53.6% for contraception and 61.5% for menopause) reported being dissatisfied with the counseling received, and 58.2% were not aware of the protective effect of hormonal contraception on the risk of ovarian cancer. An educational effort is desirable to guarantee healthy BRCA carriers reliable contraception and evidence-based menopause counseling.

Printing ink wastewater from printing facilities is difficult to treat because of its heavy pollutant load (chemical oxygen demand - COD, color and total suspended solids - TSS). In this study undiluted printing ink wastewater with high COD (i.e., 20,000 mgL -1 ) was treated using a highly efficient, continuous flow electrocoagulation reactor with aluminum electrodes. The parameters investigated were: initial COD concentration (4000, 10,000 and 20,000 mgL -1 ), current density (21, 42 and 83 mAcm -2 ), and inlet flow rate (6, 8 and 10 mLmin -1 ). All parameters showed great efficiency in terms of pollutant removal for diluted printing ink wastewater. For undiluted printing ink wastewater treatment, COD, color, and TSS removal were maximized at 6 mLmin -1 flow rate reaching 82%, 98%, and 85% COD, color, and TSS removal, respectively, by applying the lower tested current density 21 mAcm -2 . COD, color and TSS removal increased with increasing current density. For undiluted printing ink wastewater and a flow rate of 8 mLmin -1 , COD removal was between 42 and 88%, color reduction between 85 and 99%, and TSS reduction between 83 and 98% when the applied current was increased (from 21 to 83 mAcm -2 ). Lower pollutant removal was observed at the highest flow rate of 10 mLmin -1 for all current densities tested. Process cost calculations in terms of electrical energy, electrode material consumption and sludge disposal, showed that the use of continuous flow electrocoagulation reactor (with flow rate 6 mLmin -1 , and at 21 mAcm -2 ) is an affordable and effective treatment method for printing ink wastewater streams with very high COD. Sludge characterization showed Al-silicate-rich sludge. Particle sizes increased after treatment and Cu and Ti were detected in the sludge. A post-treatment stage is necessary before discharging effluent into water bodies., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

This paper study the performance of a lab-scale hybrid up-flow anaerobic sludge blanket (UASB) reactor treating low-strength synthetic wastewater using different biofilm supporting materials. Two identical reactors are constructed and operated at constant up-flow velocity of 0.1 m/hr., inflow rate of 9.76 L/d, and hydraulic retention time (HRT) of 8.26 hours. The Start-up phase, using seed sludge for existing wastewater treatment plant, lasted until the efficiency of chemical oxygen demand (COD) removal of both reactors reached 80%. Polyethylene (PE) media are added to one of the reactors and luffa sponge is used in the second reactor. Results show increased COD removal efficiency up to about 90% at 20 °C and biogas production rates from 3.8*10 -3 till 7.5*10 -3  m 3 CH 4 /kg COD r using PE media. The COD removal efficiency reaches about 95% at 20 °C using luffa sponge and biogas production rates up to 6.5*10 -3  m 3 CH 4 /kg COD r are achieved before clogging problem is observed. Effect of HRT reduction, from 8.26 to 4.13 hours, on removing clogging is investigated. Reduction in COD removal efficiencies is observed at low ambient temperatures during seasonal variations of 15-25 °C. AFM and SEM analysis are used to examine sludge granulation and biofilm formation., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2022.)

Research Question: Does endometrial compaction, determined by both transvaginal (TVUS) and abdominal ultrasonography (AUS), improve reproductive outcomes in vitrified-warmed embryo transfer (FET) cycles, and is there a correlation between compaction and serum progesterone concentrations on day of embryo transfer?, Design: Prospective observational cohort study at a single tertiary care IVF centre including 204 patients undergoing high-quality vitrified-warmed blastocyst transfer in a hormone replacement therapy (HRT) cycle. The change in endometrial thickness (EMT) between end of oestrogen-only phase and day of embryo transfer, as measured by sequential TVUS, was used to categorize endometrium as undergoing compaction (≥5% decrease), no change, or expansion (≥5% increase). EMT was also examined using AUS at the time of embryo transfer. Primary outcome measure was ongoing pregnancy rates., Results: Thirty-one cycles (15.2%) demonstrated compaction, whereas 123 (60.3%) expanded and 50 (24.5%) remained unchanged as measured by sequential TVUS. Ongoing pregnancy rates did not differ among cycles with compaction (58.1%), those with expansion (56.9%), and those with no change (60.0%; P=0.932). Furthermore, oestrogen, progesterone and oestrogen/progesterone concentrations on day of embryo transfer were comparable among all groups. Using AUS, endometrial compaction was seen in 46 cycles (22.5%), and there was a positive correlation between body mass index and AUS-measured EMT change (ρ = 0.161, P = 0.021). In the group with AUS-determined endometrial compaction, AUS measurements showed a significantly thinner EMT on day of embryo transfer (8.3 mm; interquartile range [IQR] [7.5; 9.2] versus 9.3 mm; IQR [8.4; 11.4], P < 0.001) and higher for EMT change (1.3 mm; IQR [0.8; 1.7] versus 0.1 mm; IQR [-1.1; 1.0], P < 0.001) compared with TVUS measurements., Conclusions: Endometrial compaction during HRT-FET does not predict ongoing pregnancy., (Copyright © 2022. Published by Elsevier Ltd.)

One of the most important and potentially long-lasting detrimental consequences of Functional Hypothalamic Amenorrhoea (FHA) is on skeletal homeostasis. Beyond oestrogen deficiency, FHA is associated with a cascade of additional neuro-endocrine and metabolic alterations, some adaptive, but which combine to disrupt skeletal homeostasis. Ultimately, this leads to a two-fold increased risk of fractures in women with FHA compared to healthy eumenorrhoeic women. Although the cornerstone of management of FHA-related bone loss remains recovery of menses via restoration of metabolic/psychological balance, there is rapidly developing evidence for hormonal manipulations (with a particular emphasis on route of administration) and other pharmacological treatments that can protect or improve skeletal homeostasis in FHA. In this mini-review, we provide an update on the pathophysiology, clinical management and future avenues in the field from a bone perspective., Competing Interests: AC has received non-promotional educational lecture honoraria and conference support from Amgen. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Behary and Comninos.)

Up to 20% of the UK population may have dietary restrictions due to ethical, lifestyle or religious views. It is important for clinicians to be aware of the constituents of what is prescribed, so that the patient can make an informed choice about their medication. This will improve both compliance and the therapeutic relationship. This article looks at the constituents of common HRT preparations currently available in the United Kingdom.

The natural lifespan of the ovary is occasionally interrupted by pathological processes; some are known, but many are unknown. Premature ovarian insufficiency (POI) can be a devastating diagnosis for an adolescent or for someone who has yet to start a family. Common causes of POI include genetic and chromosomal defects, autoimmune damage, and cancer treatments. Knowledge of the pathogenesis of this condition and an awareness of contemporary hormone replacement and fertility options are required to design a multidisciplinary therapeutic approach comprising reproductive medicine, endocrinology, clinical psychology, and assisted fertility expertise., Competing Interests: Declaration of competing interest The authors have no conflict of interest., (Copyright © 2021. Published by Elsevier Ltd.)