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The presence of endocrine-disrupting chemicals (EDCs) in aquatic environments such as water, sediment, and sludge received more and more attention. However, the bioaccumulate properties of EDCs, particularly progestins and androgens, in various tissues of different wild freshwater fish species, as well as their effects on human health, have not been fully studied. The muscle, liver, and gills of three wild fish species obtained from the East Dongting Lake in southern China were examined for the presence of 19 EDCs (4 progestins, 5 androgens, 6 estrogens, and 4 phenols). Seventeen analytes were detected in all fish samples, and the concentrations of progestins, androgens, estrogens, and phenols ranged from ND–78.80 ng/g (wet weight, ww), ND–50.40 ng/g ww, ND–3573.82 ng/g ww, and ND–88.17 ng/g ww, respectively. The bioaccumulation of some EDCs in wild fish from East Dongting Lake was species-specific. Additionally, AND, EES, P4, and E2 were discovered in the liver at higher levels than in the muscle, suggesting that livers had a larger ability for enriching these EDCs than the muscle. Furthermore, the relationships between the fish sizes and the EDC concentrations indicated that total weight and length had a negligible impact on the bioaccumulation of EDCs in various fish species. Most importantly, the effects of EDCs on human health as a result of fish consumption were assessed. Although the estimated daily intakes (EDIs) of most EDCs were much lower compared with the corresponding acceptable daily intakes (ADIs) via consuming fish collected in this study, the EDI of EE2 in Silurus asotus was higher than the ADI of E2, indicating that Silurus asotus from East Dongting Lake should be eaten in moderation by local residents. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the application status and rationality of progestogens in outpatient and emergency patients in China based on big data analysis techniques, so as to provide support for promoting clinical rational drug use and ensuring drug safety for patients. METHODS: Data of progestogen prescriptions from 2016 to 2020 were extracted from 112 hospitals in 9 cities. The application status of progestogens in China was analyzed, the composition and selection of progestogen for typical diseases were analyzed, and the problem of off-label indications was discussed. RESULTS: Totally 540 184 prescriptions were enrolled, including 605 233 records of progestogens. Except for 2020, which may be affected by COVID-19, the overall use and frequency of progestogens were on the increase, and the defined daily cost of high-priced progestogens decreased significantly since 2017. Progestin and dydrogesterone were the most widely used, and the latter had an obvious trend of increasing in clinical selection. Drug combination of progestogens were common (10. 9%, 58 625 cases). The applications of progestogens in patients with typical diseases had their own characteristics, and the drug selection was basically rational. Off-label indications were also common, and the most common diagnoses were endometrial polyps, gynecological examination and vaginitis. CONCLUSIONS: Progestogens are widely used in China and show an increasing trend, and the clinical application is basically reasonable, yet the problem of off-label indication drug use and the lack of evidence for drug combination deserve attention. In the future, it is still necessary to carry out high-quality clinical studies with large samples to verify the safety, effectiveness and economy of the use of progestogens. [ABSTRACT FROM AUTHOR]

What is known and objective: Approximately half of the patients with threatened miscarriage suffer an abortion, and consistent medication therapy to prevent threatened miscarriage is lacking. Our goal was to investigate the real‐world pharmacological treatment patterns of patients with threatened miscarriage in China, with a focus on the trend and rationality of progestogen use over the last 7 years. Methods: We performed a cross‐sectional analysis of data from the Hospital Prescription Analysis Cooperation Project that is overseen by the Chinese Pharmaceutical Association. Information was extracted from prescriptions of outpatients with threatened miscarriage between January 2014 and December 2020. We quantified the types of medications using the first level anatomical therapeutic chemical (ATC) classification code and the frequency of use of medicines classified as category X by the United States Food and Drug Administration (FDA). We also calculated the prevalence of the most frequently used progestogens by assessing prescription rates, determined the sum of the defined daily doses (DDDs) and defined daily cost (DDC) and evaluated the rationality of progestogens according to drug labels and guidelines. Results and discussion: Of the 91,464 patients included in this study, 69.4% were from the eastern region, 92.5% were from tertiary hospitals, and 72.9% were between 25 and 34 years old. The average number of medications per patient was 1.4. The following types of medicines were the most prevalent: "genitourinary system and sex hormones" (90.7%), "alimentary tract and metabolism" (10.8%) and "blood and blood‐forming organs" (9.9%). Progestogens were prescribed for 81,080 patients (88.6%), among which oral progesterone (39.7%) was the most commonly used, followed by oral dydrogesterone (34.4%), progesterone injection (26.0%), oral allylestrenol (0.7%) and progesterone gel (0.4%). In other words, 10,991 (12.0%) patients used more than one progestogen, and the top three combinations were oral dydrogesterone plus progesterone injection (5.6%), oral progesterone plus progesterone injection (4.7%) and oral dydrogesterone plus oral progesterone (1.1%). The prescription rate of dydrogesterone increased gradually, whereas that of progesterone, especially progesterone injection, obviously decreased. Among 34,760 prescriptions of progestogens with complete usage information, the primary errors of progestogen use were "low frequency" (18.4%), "high single dose" (15.9%) and "low single dose" (11.3%). In addition, 137 prescriptions were identified with drug‐progestogen interactions, and 61 were identified with contraindications for progestogens. A total of 4.5% of prescriptions included FDA category X medicines. What is new and conclusion: Our findings are the first to provide information on medication use in patients with threatened miscarriage over the last seven years in China. Medicines targeting the "genitourinary system and sex hormones," especially progestogens, were the most commonly prescribed medications, among which dydrogesterone was the most prevalent. However, it is remarkable that the use of progestogens for the treatment of threatened abortion is still controversial; thus, high‐quality large sample studies are still required, especially among Chinese patients. Since usage errors in progestogen records and exposure to category X medicines were common, more efforts are needed to guarantee the safety and rationality of medicines used in pregnant women. [ABSTRACT FROM AUTHOR]

• Nineteen progestogens were measured in seventeen WWTPs during four seasons. • Ten progestogens concentrations in influent were significantly varied across seasons. • Progestogens concentrations in influent were significantly spatial varied in spring and summer. • AAO process was the most effective for progestogens removal and biodegradation of aerobic units was the primary removal pathway. This study investigated the overall occurrence and spatiotemporal variation of 19 progestogens in 608 samples collected from 17 wastewater treatment plants (WWTPs) distributed across China during four seasons. The aqueous removal efficiencies of progestogens were calculated and the efficacies of process segments, secondary and advanced processes, and process units in the removal of progestogens were explored. The results indicated that progestogens were widely detected in investigating WWTPs, with the progesterone, dydrogesterone, dienogest, ethisterone, and norethindrone were always dominant in the influent, secondary effluent, final effluent, and excess sludge. Seasonally, the influent exhibited more variability than the other matrices, that 10 progestogens concentrations varied significantly during the four seasons. Spatially, the influent concentrations of progestogens were generally higher in northern WWTPs than that in southern WWTPs during spring and summer. Eight progestogens were stably removed by the WWTPs across seasons, and most progestogens varied considerably in removal in different WWTPs. The conventional process segment was the dominant contributor to progestogen removal. The anaerobic-anoxic-oxic process and a combined process consisting of densadeg and cloth media filter and ultraviolet disinfection showed the highest removal of progestogens among various secondary and advanced treatment processes, respectively. Mass balance analysis showed that most progestogens were effectively eliminated in the aerobic unit, with biodegradation being the primary removal pathway. This study presents the first picture of the spatiotemporal dynamics of the distribution of progestogens in WWTPs of China and provides valuable information for better understanding of the occurrence and removal of progestogens in WWTPs. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Exposure to per-/polyfluoroalkyl substances (PFASs) can disrupt endocrine hormones in humans. Prior studies have focused on the harmful effects of the two traditional per-/polyfluoroalkyl substances (PFASs), perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA). Other PFASs, used as the replacements of PFOS and PFOA, are widely and increasingly detected in humans. Whether these replacements influence glucocorticoids and progestogens in newborns remains unknown., Objective: To investigate the associations between exposures of PFOS, PFOA and their replacements and glucocorticoids and progestogens in newborns., Methods: We measured the concentrations of 13 PFASs, 3 glucocorticoids (11-deoxycortisol, cortisol and cortisone) and 2 progestogens [progesterone, 17-hydroxyprogesterone (17OHP)] in the cord sera of 374 neonates in a birth cohort from Wuhan, China, between 2013 and 2014. We evaluated the associations of each PFAS with glucocorticoids and progestogens using multiple linear regression models, and multiple comparisons were additionally corrected via false discovery rates (FDR)., Results: Out of the 13 PFASs, 9 were detected in over 95% of cord sera. The Chinese specific PFOS replacement - 6:2 chlorinated polyfluorinated ether sulfonate (6:2 Cl-PFESA, trade name F-53B) was positively associated with 13.13% change in cortisol in girls (95% CI = 4.47%, 22.52%, for each IQR increase in 6:2 Cl-PFESA). Seven PFASs had positive associations with the precursor of cortisol, namely 11-deoxycortisol (percent change ranged from 6.41% to 11.24%, for each IQR increase in PFASs). Perfluorobutane sulfonate (PFBS) in cord sera was positively associated with progesterone in the linear model, whereas PFOS and perfluorohexane sulfonate (PFHxS) levels were associated with progesterone in the quartile models. No PFASs were related to 17OHP or cortisone., Conclusions: In this study, PFOS, PFOA and/or their replacements were positively associated with progesterone, cortisol and 11-deoxycortisol in newborns. These results suggested that not only PFOS and PFOA, but also other PFASs have potential impacts on glucocorticoids and progestogens in newborns., 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 © 2020. Published by Elsevier Ltd.)

Object: Is it possible to use different progestins cotreatment with human menopausal gonadotrophin (hMG) in women with advanced endometriosis but normal ovulation during controlled ovarian hyperstimulation (COH) in vitro fertilization (IVF)? Whether different progestins treatments can be an alternative choice for women with severe endometriosis in considering IVF/ICSI treatment remains unknown? Design: Non-inferiority randomized clinical trial. Setting: Tertiary-care academic medical center. Population: Four hundred and fifty infertile patients with severe endometriosis undergoing IVF/ICSI between May 2016 and March 2017. Methods: Four hundred and fifty infertile patients with severe endometriosis undergoing IVF/ICSI were randomized to: medroxyprogesterone acetate +hMG; dydrogesterone +hMG; and progesterone +hMG. Ovulation was induced with a gonadotropin-releasing hormone agonist (GnRH-a) and chorionic gonadotropin (hCG). Viable embryos were cryopreserved for later transfer. Main Outcome Measures: The primary endpoint outcome was the number of oocytes retrieved. Secondary indicators included the incidence of a premature surge in luteinizing hormone (LH), the number of viable embryos, and clinical pregnancy outcomes. Results: The number of oocytes retrieved was higher in the medroxyprogesterone acetate +hMG group than the two other groups (9.3 ± 5.7 vs. 8.0 ± 4.5 vs. 7.8 ± 5.2, P = 0.021). LH levels were suppressed after a 6-day progestin treatment in the medroxyprogesterone acetate +hMG and dydrogesterone +hMG groups, but there was a rebound of LH values in the progesterone +hMG group. No premature LH surge and ovarian hyperstimulation syndrome (OHSS) occurred. No significant differences among the three groups were observed in fertilization and pregnancy outcomes. Conclusion: It is mandatory to point out that our conclusions are valid for patients with ovarian advanced endometriosis but normal ovarian functions. These results suggest three different progestins protocols are equivalent in terms of pregnancy outcomes for women with advanced endometriosis. PPOS protocol can be an alternative choice for women with severe endometriosis and normal ovarian reserve in IVF/ICSI treatment. These methods could be tested with other populations of women with endometriosis. Clinical Trial Registration: www.ClinicalTrials.gov, identifier:ChiCTR-OIN-16008529. Trial registration date: 2014-05-25. Date of first patient enrollment: May 2016., (Copyright © 2020 Guo, Li, Shen, Cong, Wang, Wu, Li, Gao, Ma, Zhang, Mao, Fu, Lyu, Chai and Kuang.)