Risk of pleural mm and residual asbestos burden in the lung: a retrospective case-control study

Introduction Results of Malignant Pleural Mesothelioma (MPM) occurrence (mortality and incidence) by cumulative exposure dose clearly showed a proportional relation of MPM risk with dose, confirmed among studies by fibre burden. We evaluated the association between residual fibre content and MPM risk by circumstance of asbestos exposure. Methods and materials Lung samples obtained from pleuropneumonectomies or autopsies (349 MPMs, and 41 controls) among subjects investigated for probability and circumstance of asbestos exposure were examined through Scanning Electron Microscopy; 291 cases had an occupational asbestos exposure, 38 MPMs a non-occupational exposure (familiar or environmental), whereas among 20 MPM an asbestos exposure was not identified. The MPM risk was evaluated by means of Odds Ratio (OR). Results The residual asbestos fibre burden was higher among MPMs occupationally exposed (Geometric Mean:2.10 Million fibres/gram of dried tissue; 95% CI:1.5–2.58) in comparison with non-occupational (GM:0.66 Mff/gdt; 95% CI:0.47–0.95) or with unknown exposures (GM:0.59 Mff/gdt; 95% CI:0.34– 1.03) and controls (GM:0.26 Mff/gdt; 95% CI:0.20–0.34). Among occupationally exposed, the MPM risk increased according to the asbestos fibre burden reaching an OR of 36.8 (95%CI:11.9–113.5) for concentrations higher than 1 Mff/g dt, compared to the reference level (<0.25 Mff/gdt). Higher ORs were observed at any concentration of amphibole fibres in comparison those for chrysotile fibres. Conclusions The MPM risk was strongly associated to the residual asbestos fibre lung burden. The MPM risk due to non-occupational exposure shows a magnitude comparable with that with unknown asbestos exposures. The residual lung burden of chrysotile is strongly influenced by clearance and time since exposures ceased

Residual fibre lung burden among patients with pleural mesothelioma who have been occupationally exposed to asbestos

Objectives To evaluate the lungs asbestos fibres concentration in participants with malignant pleural mesothelioma (MPM) who have been occupationally exposed. Methods The lung samples were obtained from pleuropneumonectomies or autopsies of 271 male MPMs. The lung samples were examined through scanning electron microscopy. Retrospective assessment was used to assess for asbestos exposure. This study includes 248 MPMs with an occupational exposure defined as either ‘definite’ or ‘probable’ or ‘possible’. Results The participants had finished working in asbestos exposure conditions more than 20 years ago (on average 26.1±11.0 years). The fibre burden resulted with a geometric mean equal to 2.0 (95% CI 1.6 to 2.4) million fibres per gram of dry lung tissue. The burden was higher among participants employed in asbestos textiles industry and in shipyards with insulation material, if compared with construction workers or non-asbestos textile workers or participants working in chemicals or as auto mechanics. 91.3% of MPMs had a detectable amount of amphibole fibres. A strong lung clearance capability was evident among workers exposed to chrysotile fibres. Owing to that, the 1997 Helsinki Criteria for occupational exposure were reached in <35% of cases among participant working in construction, in metallurgical industry, in chemical or textile industry and among those performing brake repair activities. Conclusions The MPM cases are now occurring in Italy in participants who ceased occupational asbestos exposure decades before the analysis. A large majority still shows a residual content of amphibole fibres, but given the lung clearance capability, attribution to occupational exposure cannot rely only on fibres detection

0203 The lung burden of Asbestos Fibres (AF) and Asbestos Bodies (AB) and the risk of mesothelioma (MM) for exposures ceased 30 years ago

Objectives To estimate the risk of MM according to AF and AB in the lungs. Method Freeze dried lung samples from 309 MM and 41 controls have been analysed for AF (Scanning Electronic Microscopy) and AB (Optical Microscopy) from subjects investigated and classified for probability and circumstances of asbestos exposure. Odds Ratios (OR) were obtained using logistic regression. Results 254 (82%) MMs have been classified as occupationally and 25 (8%) as non-occupationally exposed: Geometric Mean (GM) for AF burden was 1 950 000 and 608 000 ff/g dlt, respectively; and 39 300 and 3300 for AB. 75% and 58% of the AF respectively were amphibole. Controls reported a GM of 269 000 AF and 28 of AB g/dlt. For any increase of 100.000 ff/g dlt, we computed an OR of 1.7 (1.3–2.3) for amphibole, 1.1 (1.0–1.3) for chrysotile, among occupational MMs; an OR of 1.3 (1.0–1.7) and 1.1 (1.0–1.1) among non-occupational MMs. The 1997 Helsinki criteria for attribution to occupational exposure would have excluded more than 30% of MMs under study: here occupational exposures ceased on average 26 years before the disease, and therefore clearance and time since last exposure must be taken into account because are relevant determinants of the retained amount of fibres. Conclusions The risk of MM increases with the amount of retained amphibole, and to a lesser extent, of chrysotile fibres. Because occupational and non-occupation asbestos exposures have been to mixture of fibres, the lungs of MM patients are still loaded with amphibole AF

Maternal age and risk of low birth weight and premature birth in children conceived through medically assisted reproduction : Evidence from Finnish population registers

STUDY QUESTION Does the risk of low birth weight and premature birth increase with age among mothers who conceive through medically assisted reproduction (MAR)? SUMMARY ANSWER Among MAR mothers, the risk of poorer birth outcomes does not increase with maternal age at birth except at very advanced maternal ages (40+). WHAT IS KNOWN ALREADY The use of MAR treatments has been increasing over the last few decades and is especially diffused among women who conceive at older ages. Although advanced maternal age is a well-known risk factor for adverse birth outcomes in natural pregnancies, only a few studies have directly analysed the maternal age gradient in birth outcomes for MAR mothers. STUDY DESIGN, SIZE, DURATION The base dataset was a 20% random sample of households with at least one child aged 0-14 at the end of 2000, drawn from the Finnish population register and other administrative registers. This study included children who were born in 1995-2000, because the information on whether a child was conceived through MAR or naturally was available only from 1995 onwards. PARTICIPANTS/MATERIALS, SETTING, METHODS The outcome measures were whether the child had low birth weight (LBW, MAIN RESULTS AND THE ROLE OF CHANCE A total of 56026 children, 2624 of whom were conceived through MAR treatments, were included in the study. Among the mothers who used MAR to conceive, maternal age was not associated with an increased risk of LBW (the overall prevalence was 12.6%) at ages 25-39. For example, compared to the risk of LBW at ages 30-34, the risk was 0.22 percentage points lower (95% CI: -3.2, 2.8) at ages 25-29 and was 1.34 percentage points lower (95% CI: -4.5, 1.0) at ages 35-39. The risk of LBW was increased only at maternal ages >= 40 (six percentage points, 95% CI: 0.2, 12). Adjustment for maternal characteristics only marginally attenuated these associations. In contrast, among the mothers who conceived naturally, the results showed a clear age gradient. For example, compared to the risk of LBW (the overall prevalence was 3.3%) at maternal ages 30-34, the risk was 1.1 percentage points higher (95% CI: 0.6, 1.6) at ages 35-39 and was 1.5 percentage points higher (95% CI: 0.5, 2.6) at ages >= 40. The results were similar for preterm births. LIMITATIONS, REASON FOR CAUTION A limited number of confounders were included in the study because of the administrative nature of the data used. Our ability to reliably distinguish mothers based on MAR treatment type was also limited. WIDER IMPLICATIONS OF THE FINDINGS This is the first study to analyse the maternal age gradient in the risk of adverse birth outcomes among children conceived through MAR using data from a nationally representative sample and controlling for important maternal health and socio-economic characteristics. This topic is of considerable importance in light of the widespread and increasing use of MAR treatments.Peer reviewe

Opportunities and Limits of Conventional IVF versus ICSI: It Is Time to Come off the Fence

Conventional IVF (c-IVF) is one of the most practiced assisted reproductive technology (ART) approaches used worldwide. However, in the last years, the number of c-IVF procedures has dropped dramatically in favor of intracytoplasmic sperm injection (ICSI) in cases of non-male-related infertility. In this review, we have outlined advantages and disadvantages associated with c-IVF, highlighting the essential steps governing its success, its limitations, the methodology differences among laboratories and the technical progress. In addition, we have debated recent insights into fundamental questions, including indications regarding maternal age, decreased ovarian reserve, endometriosis, autoimmunity, single oocyte retrieval-cases as well as preimplantation genetic testing cycles. The “overuse” of ICSI procedures in several clinical situations of ART has been critically discussed. These insights will provide a framework for a better understanding of opportunities associated with human c-IVF and for best practice guidelines applicability in the reproductive medicine field

Is Shifting to a Progestin Worthwhile When Estrogen-Progestins Are Inefficacious for Endometriosis-Associated Pain?

The purpose of this study was to assess the proportion of patients satisfied with their treatment after a change from a low-dose oral contraceptive (OC) to norethisterone acetate (NETA) because of inefficacy of OC on pain symptoms. To this end, prospective, self-controlled study was conducted on 153 women using OC as a treatment for endometriosis and with persistence of one or more moderate or severe pain symptoms. At baseline and during 12 months after a shift from OC to oral NETA, 2.5 mg/d, pelvic pain was measured by means of a 0- to 10-point numerical rating scale and a multidimensional categorical rating scale. Variations in health-related quality of life, psychological status, and sexual function were also evaluated with validated scales. At the end of the study period, participants indicated the degree of satisfaction with their treatment according to a 5-degree scale from very satisfied to very dissatisfied. A total of 28 women dropped out of the study, the main reason was intolerable side effects (n = 15). At 12-month assessment, 70% of participants were very satisfied or satisfied with NETA treatment (intention-to-treat analysis). Statistically significant improvements were observed in health-related quality of life, psychological status, and sexual function. At per-protocol analysis, almost half of the patients (58/125) reported suboptimal drug tolerability. However, complaints were not severe enough to cause dissatisfaction, drug discontinuation, or request for surgery. These encouraging results could be used to counsel women with symptomatic endometriosis not responding to OC and to inform their decisions on modifications of disease management

Contraception after pregnancy

Whatever the outcome, pregnancy provides the opportunity to offer effective contraception to couples motivated to avoid another pregnancy. This narrative review summarizes the evidence for health providers, drawing attention to current guidelines on which contraceptive methods can be used, and when they should be started after pregnancy, whatever its outcome. Fertility returns within 1 month of the end of pregnancy unless breastfeeding occurs. Breastfeeding, which itself suppresses fertility after childbirth, influences both when contraception should start and what methods can be used. Without breastfeeding, effective contraception should be started as soon as possible if another pregnancy is to be avoided. Interpregnancy intervals of at least 6 months after miscarriage and 1‐2 years after childbirth have long been recommended by the World Health Organization in order to reduce the chance of adverse pregnancy outcome. Recent research suggests that this may not be necessary, at least for healthy women <35 years old. Most contraceptive methods can be used after pregnancy regardless of the outcome. Because of an increased risk of venous thromboembolism associated with estrogen‐containing contraceptives, initiation of these methods should be delayed until 6 weeks after childbirth. More research is required to settle the questions over the use of combined hormonal contraception during breastfeeding, the use of injectable progestin‐only contraceptives before 6 weeks after childbirth, and the use of both hormonal and intrauterine contraception after gestational trophoblastic disease. The potential impact on the risk of ectopic pregnancy of certain contraceptive methods often confuses healthcare providers. The challenges involved in providing effective, seamless service provision of contraception after pregnancy are numerous, even in industrialized countries. Nevertheless, the clear benefits demonstrate that it is worth the effort

Residual fibre lung burden among patients with pleural mesothelioma who have been occupationally exposed to asbestos

OBJECTIVES: to assess the association among malignant pleural mesothelioma (MPM) and lung cancer (LC) among workers who have been exposed to asbestos and have or not have required an anticipated leave from work, a possibility offered by the 1992 law banning asbestos in Italy, in the framework of the health surveillance programmes on going in the Veneto Region (Northern Italy). SETTING AND PARTICIPANTS: a cohort of asbestos workers derived from the rosters of selected factories and alive in 1992, followed from 1992 to 2012.MPM cases have been identified through the Regional Mesothelioma Registry, while LC cases through a link with the Regional Cancer Registry, hospital discharges, and death certificates. Risks related to asbestos exposure were calculated by mixed effects Poisson regression model. RESULTS: the risk of MPM and LC increases at any additional duration of work, up to very high values for long term durations of work for MPM, and up to a three fold increase for LC. Early retirements have been requested by a fraction only in the position of submitting it. CONCLUSION: subjects who have been exposed to asbestos should be the target of a post-occupational surveillance, and further work is suggested to identify subjects at high risk of LC because of smoking habits and more heavy exposure to asbestos, in order to develop programmes for primary and secondary cancer prevention