Menstrual function among women exposed to polybrominated biphenyls: A follow-up prevalence study

BACKGROUND: Alteration in menstrual cycle function is suggested among rhesus monkeys and humans exposed to polybrominated biphenyls (PBBs) and structurally similar polychlorinated biphenyls (PCBs). The feedback system for menstrual cycle function potentially allows multiple pathways for disruption directly through the hypothalamic-pituitary-ovarian axis and indirectly through alternative neuroendocrine axes. METHODS: The Michigan Female Health Study was conducted during 1997–1998 among women in a cohort exposed to PBBs in 1973. This study included 337 women with self-reported menstrual cycles of 20–35 days (age range: 24–56 years). Current PBB levels were estimated by exponential decay modeling of serum PBB levels collected from 1976–1987 during enrollment in the Michigan PBB cohort. Linear regression models for menstrual cycle length and the logarithm of bleed length used estimated current PBB exposure or enrollment PBB exposure categorized in tertiles, and for the upper decile. All models were adjusted for serum PCB levels, age, body mass index, history of at least 10% weight loss in the past year, physical activity, smoking, education, and household income. RESULTS: Higher levels of physical activity were associated with shorter bleed length, and increasing age was associated with shorter cycle length. Although no overall association was found between PBB exposure and menstrual cycle characteristics, a significant interaction between PBB exposures with past year weight loss was found. Longer bleed length and shorter cycle length were associated with higher PBB exposure among women with past year weight loss. CONCLUSION: This study suggests that PBB exposure may impact ovarian function as indicated by menstrual cycle length and bleed length. However, these associations were found among the small number of women with recent weight loss suggesting either a chance finding or that mobilization of PBBs from lipid stores may be important. These results should be replicated with larger numbers of women exposed to similar lipophilic compounds

Concordance of Sleep and Pain Outcomes of Diverse Interventions: An Umbrella Review

<div><h3>Background/Objective</h3><p>Pain influences sleep and vice versa. We performed an umbrella review of meta-analyses on treatments for diverse conditions in order to examine whether diverse medical treatments for different conditions have similar or divergent effects on pain and sleep.</p> <h3>Methods</h3><p>We searched published systematic reviews with meta-analyses in the Cochrane Database of Systematic Reviews until October 20, 2011. We identified randomized trials (or meta-analyses thereof, when >1 trial was available) where both pain and sleep outcomes were examined. Pain outcomes were categorized as headache, musculoskeletal, abdominal, pelvic, generic or other pain. Sleep outcomes included insomnia, sleep disruption, and sleep disturbance. We estimated odds ratios for all outcomes and evaluated the concordance in the direction of effects between sleep and various types of pain and the correlation of treatment effects between sleep and pain outcomes.</p> <h3>Results</h3><p>151 comparisons with 385 different trials met our eligibility criteria. 96 comparisons had concordant direction of effects between each pain outcome and sleep, while in 55 the effect estimates were in opposite directions (P<0.0001). In the 20 comparisons with largest amount of evidence, the experimental drug always had worse sleep outcomes and tended to have worse pain outcomes in 17/20 cases. For headache and musculoskeletal pain, 69 comparisons showed concordant direction of effects with sleep outcomes and 36 showed discordant direction (P<0.0001). For the other 4 pain types there were overall 27 vs. 19 pairs with concordant vs. discordant direction of effects (P = 0.095). There was a weak correlation of the treatment effect sizes for sleep vs. headache/musculoskeletal pain (r = 0.17, P = 0.092).</p> <h3>Conclusions</h3><p>Medical interventions tend to have effects in the same direction for pain and sleep outcomes, but exceptions occur. Concordance is primarily seen for sleep and headache or musculoskeletal pain where many drugs may both disturb sleep and cause pain.</p> </div

Analyses for primary vs. non-primary outcome.

<p>NA, not applicable.</p

Treatment effects for sleep and pain outcomes for the 20 comparisons with largest amount of evidence^a.

a<p>Amount of evidence is defined by the weight (sum of the inverse variances of the pain and sleep outcome effect sizes), OR>1.00 signifies worse outcome with the experimental versus control treatment.</p><p>SSRIs, selective serotonin reuptake inhibitors; OR, odds ratio; CI, confidence interval:, TCA, tricyclic antidepressants.</p

Correlation between treatment effect size (odds ratio) for sleep vs. headache or musculoskeletal pain.

<p>Not shown are 6 (3 on each type of pain) comparisons that have effects outside the range.</p

First experimental study of carbon dioxide digital subtraction lymphangiography

Fourteen pigs with an average weight of 17 kg were used in this study. Under general anesthesia and magnification 1-3 ccm/kg of carbon dioxide were administered in the lymph vessels of the front and rear legs. Imaging of the peripheral lymph vessels, lymph nodes and the thoracic duct was achieved with digital subtraction angiography. The quality of lymphangiography was satisfactory and comparable with that of the standard non-ionic contrast agent. It is anticipated that further technical evolution will permit the application of CO2/DSA lymphangiography to man. Carbon dioxide is non-nephrotoxic and is non-allergic; it is inexpensive, can be administered in unlimited quantity and is quickly eliminated via the pulmonary system

Correlations of the effect sizes for sleep versus pain outcomes.

<p>NP, not pertinent, because only two comparisons were available.</p

Correlation between treatment effect size (odds ratio) for sleep vs. any other type of pain outcome.

<p>Not shown are 2 comparisons that have effects outside the range (1 for abdominal pain and 1 for pelvic pain).</p