Levonorgestrel Intrauterine Device Use for Medical Indications in Nulliparous Adolescents and Young Adults.

PURPOSE: Intrauterine devices (IUDs) are highly effective at preventing pregnancy. Levonorgestrel (LNG) IUDs also have beneficial effects on menstrual bleeding and abdominal and pelvic pain. Although there are increasing data on use of IUDs for contraception in adolescents and for medical indications in adults, there are extremely limited data on LNG IUD use for medical indications in adolescents. Our objective is to describe the characteristics and experiences of LNG IUD use in nulliparous adolescents and young women using IUDs for medical indications. METHODS: We conducted a retrospective chart review of all nulliparous patients aged 22 years and younger who underwent LNG IUD insertion at a tertiary care children\u27s hospital between July 1, 2004 and June 30, 2014 primarily for noncontraceptive indications. Descriptive statistical analysis was performed. RESULTS: We identified 231 LNG IUDs placed in 219 nulliparous women for medical indications during this time period. Mean patient age was 16.8 years (±2.2). Only 41% reported ever being sexually active. IUD continuation rate at 1 year was 86%. The amenorrhea rate at 1 year was 51%. Approximately 80% of women reported improvements in menstrual bleeding and abdominal and pelvic pain. Side effects and complications were low. CONCLUSIONS: This study provides evidence that LNG IUDs are effective, well-tolerated, and safe menstrual management options in young nulliparous women, including younger adolescents and those who have never been sexually active. This method is an excellent first-line therapy option for adolescents and young women for both contraceptive and noncontraceptive indications, regardless of age, parity, or sexual activity

Optimization of DNA Extraction Methods for Sequencing of the NADH Dehydrogenase Subunit 2 (ND2) Gene in Rainbow Trout (\u3cem\u3eOncorhynchus mykiss\u3c/em\u3e)

Morphological, behavioral, and genetic variation due to broad geographic ranges is common in salmonid fishes. This variation can be attributed to the isolation of populations from natural phenomenon or human alteration to habitats, which affect gene flow and genetic drift. These changes may play a role in intraspecific genetic variation, potentially isolating them into separate subspecies or locally adapted populations. Rainbow Trout (Oncorhynchus mykiss) are one of the most widely distributed fish species in western North America but no study has identified the main evolutionary lineages from across its range. Identifying and comparing distinct evolutionary lineages can be achieved by comparing sequence data from mitochondrial genes but requires extraction of archived tissue samples of rainbow trout and amplification of selected genes. In this study, we compare different DNA extraction methods for rainbow trout tissue samples, some of which are more than 25 years old. DNA was extracted from tissue samples following a 5 or 15% Chelex method, or by following Zymo Research extraction kit instructions. Following extractions, polymerase chain reaction (PCR) for the highly conserved NADH dehydrogenase subunit 2 mtDNA gene (ND2) was completed using a BIO RAD thermal cycler and a gel electrophoresis is done to determine whether the ND2 gene was successfully amplified. Photographs of the agarose gels were taken using a ChemiDoc imaging system, and samples showing a band at 1050 base pairs are sent to the Molecular Research Core Facility at Idaho State University for sequencing. The genetic sequences are then compared and used to create a phylogeny and distribution for Rainbow trout subspecies. Sequencing of individual specimen and comparison across the species range will aid in the development of management and conservation strategies for rainbow trout across the species range

Breech presentation at term and associated obstetric risks factors-a nationwide population based cohort study

Purpose The aim of this study was to estimate whether breech presentation at term was associated with known individual obstetric risk factors for adverse fetal outcome. Methods This was a retrospective, nationwide Finnish population-based cohort study. Obstetric risks in all breech and vertex singleton deliveries at term were compared between the years 2005 and 2014. A multivariable logistic regression model was used to determine significant risk factors. Results The breech presentation rate at term for singleton pregnancies was 2.4%. The stillbirth rate in term breech presentation was significantly higher compared to cephalic presentation (0.2 vs 0.1%). The odds ratios (95% CIs) for fetal growth restriction, oligohydramnios, gestational diabetes, a history of cesarean section and congenital fetal abnormalities were 1.19 CI (1.07-1.32), 1.42 CI (1.27-1.57), 1.06 CI (1.00-1.13), 2.13 (1.98-2.29) and 2.01 CI (1.92-2.11). Conclusions The study showed that breech presentation at term on its own was significantly associated with antenatal stillbirth and a number of individual obstetric risk factors for adverse perinatal outcomes. The risk factors included oligohydramnios, fetal growth restriction, gestational diabetes, history of caesarean section and congenital anomalies.Peer reviewe

Ophthalmic wearable devices for color blindness management

Color vision deficiency (CVD) or color blindness is an ocular disorder that hinders the patients from distinguishing shades of certain colors. Color blind patients are often not considered for critical occupations (e.g., military, police) and cannot differentiate colors in public places or media (i.e., watching TV). The most common form of color blindness is red-green, which is a result of either a missing or defective red or green photoreceptor cone. Since no cure for this disorder exists, sufferers opt for methods to enhance their color perception. The products and methods that have been developed to aid CVD patients are discussed. These technologies include contemporary work on gene therapy, tinted glasses, lenses, optoelectronic glasses, and advanced features developed on smartphones and computers. Among these wearables, tinted glasses, developed by companies such as Enchroma, are the most widely used by CVD patients

A View from the Past Into our Collective Future: The Oncofertility Consortium Vision Statement

Today, male and female adult and pediatric cancer patients, individuals transitioning between gender identities, and other individuals facing health extending but fertility limiting treatments can look forward to a fertile future. This is, in part, due to the work of members associated with the Oncofertility Consortium. The Oncofertility Consortium is an international, interdisciplinary initiative originally designed to explore the urgent unmet need associated with the reproductive future of cancer survivors. As the strategies for fertility management were invented, developed or applied, the individuals for who the program offered hope, similarly expanded. As a community of practice, Consortium participants share information in an open and rapid manner to addresses the complex health care and quality-of-life issues of cancer, transgender and other patients. To ensure that the organization remains contemporary to the needs of the community, the field designed a fully inclusive mechanism for strategic planning and here present the findings of this process. This interprofessional network of medical specialists, scientists, and scholars in the law, medical ethics, religious studies and other disciplines associated with human interventions, explore the relationships between health, disease, survivorship, treatment, gender and reproductive longevity. The goals are to continually integrate the best science in the service of the needs of patients and build a community of care that is ready for the challenges of the field in the future

Safety, efficacy, actions, and patient acceptability of drospirenone/ethinyl estradiol contraceptive pills in the treatment of premenstrual dysphoric disorder

Lesley L Breech, Paula K BravermanDivision of Adolescent Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USAAbstract: Premenstrual dysphoric disorder (PMDD) is estimated to affect 3%–8% of reproductive age women. Multiple therapeutic modalities have been evaluated with varying efficacy for the associated somatic and mood symptoms. The majority of older studies had shown that oral contraceptive pills (OCs) were most effective for the physical symptoms. However, newer OCs containing a novel progestin, drospirenone, have shown promise in alleviating both the somatic and affective/behavioral symptoms. This progestin, which is a derivative of spironolactone, has both antimineralocorticoid and antiandrogenic activity. A 24/4 formulation containing 20 µg of ethinyl estradiol has been found effective in randomized double-blind placebo-controlled trials utilizing established scales documenting symptoms associated with PMDD. Multiple studies have shown that drospirenone-containing OCs are safe without evidence of clinically adverse effects on carbohydrate metabolism, lipids, blood pressure, weight, serum potassium or increased thrombotic events compared to other low dose OCs. In addition, significant improvements have been demonstrated in acne, hirsutism, and fluid retention symptoms. Several open label studies demonstrated good patient compliance and reported satisfaction with the method. Because of the significant placebo effect demonstrated in the blinded placebo-controlled trials, additional large randomized placebo-controlled trials are needed to confirm the efficacy of the drospirenone OCs in the treatment of PMDD. However, this OC formulation appears to be a promising therapeutic modality.Keywords: drospirenone, premenstrual dysphoric disorder, premenstrual syndrome, oral contraceptive pil

MHD Modeling of the Solar Wind with Turbulence Transport and Heating

We have developed a magnetohydrodynamic model that describes the global axisymmetric steady-state structure of the solar wind near solar minimum with account for transport of small-scale turbulence associated heating. The Reynolds-averaged mass, momentum, induction, and energy equations for the large-scale solar wind flow are solved simultaneously with the turbulence transport equations in the region from 0.3 to 100 AU. The large-scale equations include subgrid-scale terms due to turbulence and the turbulence (small-scale) equations describe the effects of transport and (phenomenologically) dissipation of the MHD turbulence based on a few statistical parameters (turbulence energy, normalized cross-helicity, and correlation scale). The coupled set of equations is integrated numerically for a source dipole field on the Sun by a time-relaxation method in the corotating frame of reference. We present results on the plasma, magnetic field, and turbulence distributions throughout the heliosphere and on the role of the turbulence in the large-scale structure and temperature distribution in the solar wind