Abstract
This Position Statement has been endorsed by the International Menopause Society, The Endocrine Society, The European Menopause and Andropause Society, The International Society for Sexual ...Medicine, The International Society for the Study of Women's Sexual Health, The North American Menopause Society, The Federacion Latinoamericana de Sociedades de Climaterio y Menopausia, The Royal College of Obstetricians and Gynecologists, The International Society of Endocrinology, The Endocrine Society of Australia, and The Royal Australian and New Zealand College of Obstetricians and Gynecologists.*
The only evidence-based indication for testosterone for women is for HSDD. There are insufficient data for using testosterone for any other symptom/condition or for disease prevention.
AbstractObjectiveTo derive a US-based value set for the EQ-5D-5L questionnaire using an international, standardized protocol developed by the EuroQol Group. MethodsRespondents from the US adult ...population were quota-sampled on the basis of age, sex, ethnicity, and race. Trained interviewers guided participants in completing composite time trade-off (cTTO) and discrete choice experiment (DCE) tasks using the EuroQol Valuation Technology software and routine quality control measures. Data were modeled using a Tobit model for cTTO data, a mixed logit model for DCE data, and a hybrid model that combined cTTO and DCE data. Model performance was compared on the basis of logical ordering of coefficients, statistical significance, parsimony, and theoretical considerations. ResultsOf 1134 respondents, 1062, 1099, and 1102 respondents provided useable cTTO, DCE, and cTTO or DCE responses, respectively, on the basis of quality control criteria and interviewer judgment. Respondent demographic characteristics and health status were similar to the 2015 US Census. The Tobit model was selected as the preferred model to generate the value set. Values ranged from −0.573 (55 555) to 1 (11 111), with 20% of all predicted health states scores less than 0 (ie, worse than dead). ConclusionsA societal value set for the EQ-5D-5L was developed that can be used for economic evaluations and decision making in US health systems. The internationally established, standardized protocol used to develop this US-based value set was recommended by the EuroQol Group and can facilitate cross-country comparisons.
Mutations in the Golgi SNARE (SNAP soluble NSF attachment protein receptor) protein Membrin (encoded by the GOSR2 gene) cause progressive myoclonus epilepsy (PME). Membrin is a ubiquitous and ...essential protein mediating ER-to-Golgi membrane fusion. Thus, it is unclear how mutations in Membrin result in a disorder restricted to the nervous system. Here, we use a multi-layered strategy to elucidate the consequences of Membrin mutations from protein to neuron. We show that the pathogenic mutations cause partial reductions in SNARE-mediated membrane fusion. Importantly, these alterations were sufficient to profoundly impair dendritic growth in Drosophila models of GOSR2-PME. Furthermore, we show that Membrin mutations cause fragmentation of the presynaptic cytoskeleton coupled with transsynaptic instability and hyperactive neurotransmission. Our study highlights how dendritic growth is vulnerable even to subtle secretory pathway deficits, uncovers a role for Membrin in synaptic function, and provides a comprehensive explanatory basis for genotype-phenotype relationships in GOSR2-PME.
Display omitted
•Epilepsy/ataxia-linked mutations in Membrin confer partial Golgi SNARE defects•Partial reductions in membrane trafficking strongly impair dendritic growth•Synaptic morphology and function tightly depend upon efficient secretory trafficking
In this study, Praschberger et al. utilize in vitro assays, patient-derived cells, and Drosophila models to unravel how mutations in the essential Golgi SNARE protein Membrin cause progressive myoclonus epilepsy and to demonstrate a selective vulnerability of developing neurons to partial impairment of ER-to-Golgi trafficking.
Tropical forest degradation emits carbon at a rate of ∼0.5 Pg·y⁻¹, reduces biodiversity, and facilitates forest clearance. Understanding degradation drivers and patterns is therefore crucial to ...managing forests to mitigate climate change and reduce biodiversity loss. Putative patterns of degradation affecting forest stocks, carbon, and biodiversity have variously been described previously, but these have not been quantitatively assessed together or tested systematically. Economic theory predicts a systematic allocation of land to its highest use value in response to distance from centers of demand. We tested this theory to see if forest exploitation would expand through time and space as concentric waves, with each wave targeting lower value products. We used forest data along a transect from 10 to 220 km from Dar es Salaam (DES), Tanzania, collected at two points in time (1991 and 2005). Our predictions were confirmed: high-value logging expanded 9 km·y⁻¹, and an inner wave of lower value charcoal production 2 km·y⁻¹. This resource utilization is shown to reduce the public goods of carbon storage and species richness, which significantly increased with each kilometer from DES carbon, 0.2 Mg·ha⁻¹; 0.1 species per sample area (0.4 ha). Our study suggests that tropical forest degradation can be modeled and predicted, with its attendant loss of some public goods. In sub-Saharan Africa, an area experiencing the highest rate of urban migration worldwide, coupled with a high dependence on forest-based resources, predicting the spatiotemporal patterns of degradation can inform policies designed to extract resources without unsustainably reducing carbon storage and biodiversity.
Endometriosis is a chronic, estrogen-dependent condition that causes dysmenorrhea and pelvic pain. Elagolix, an oral, nonpeptide, gonadotropin-releasing hormone (GnRH) antagonist, produced partial to ...nearly full estrogen suppression in previous studies.
We performed two similar, double-blind, randomized, 6-month phase 3 trials (Elaris Endometriosis I and II EM-I and EM-II) to evaluate the effects of two doses of elagolix - 150 mg once daily (lower-dose group) and 200 mg twice daily (higher-dose group) - as compared with placebo in women with surgically diagnosed endometriosis and moderate or severe endometriosis-associated pain. The two primary efficacy end points were the proportion of women who had a clinical response with respect to dysmenorrhea and the proportion who had a clinical response with respect to nonmenstrual pelvic pain at 3 months. Each of these end points was measured as a clinically meaningful reduction in the pain score and a decreased or stable use of rescue analgesic agents, as recorded in a daily electronic diary.
A total of 872 women underwent randomization in Elaris EM-I and 817 in Elaris EM-II; of these women, 653 (74.9%) and 632 (77.4%), respectively, completed the intervention. At 3 months, a significantly greater proportion of women who received each elagolix dose met the clinical response criteria for the two primary end points than did those who received placebo. In Elaris EM-I, the percentage of women who had a clinical response with respect to dysmenorrhea was 46.4% in the lower-dose elagolix group and 75.8% in the higher-dose elagolix group, as compared with 19.6% in the placebo group; in Elaris EM-II, the corresponding percentages were 43.4% and 72.4%, as compared with 22.7% (P<0.001 for all comparisons). In Elaris EM-I, the percentage of women who had a clinical response with respect to nonmenstrual pelvic pain was 50.4% in the lower-dose elagolix group and 54.5% in the higher-dose elagolix group, as compared with 36.5% in the placebo group (P<0.001 for all comparisons); in Elaris EM-II, the corresponding percentages were 49.8% and 57.8%, as compared with 36.5% (P=0.003 and P<0.001, respectively). The responses with respect to dysmenorrhea and nonmenstrual pelvic pain were sustained at 6 months. Women who received elagolix had higher rates of hot flushes (mostly mild or moderate), higher levels of serum lipids, and greater decreases from baseline in bone mineral density than did those who received placebo; there were no adverse endometrial findings.
Both higher and lower doses of elagolix were effective in improving dysmenorrhea and nonmenstrual pelvic pain during a 6-month period in women with endometriosis-associated pain. The two doses of elagolix were associated with hypoestrogenic adverse effects. (Funded by AbbVie; Elaris EM-I and EM-II ClinicalTrials.gov numbers, NCT01620528 and NCT01931670 .).
Plant‐soil feedback (PSF) theory provides a powerful framework for understanding plant dynamics by integrating growth assays into predictions of whether soil communities stabilise plant–plant ...interactions. However, we lack a comprehensive view of the likelihood of feedback‐driven coexistence, partly because of a failure to analyse pairwise PSF, the metric directly linked to plant species coexistence. Here, we determine the relative importance of plant evolutionary history, traits, and environmental factors for coexistence through PSF using a meta‐analysis of 1038 pairwise PSF measures. Consistent with eco‐evolutionary predictions, feedback is more likely to mediate coexistence for pairs of plant species (1) associating with similar guilds of mycorrhizal fungi, (2) of increasing phylogenetic distance, and (3) interacting with native microbes. We also found evidence for a primary role of pathogens in feedback‐mediated coexistence. By combining results over several independent studies, our results confirm that PSF may play a key role in plant species coexistence, species invasion, and the phylogenetic diversification of plant communities.
Observations of active dike intrusions provide present day snapshots of the magmatic contribution to continental rifting. However, unravelling the contributions of upper crustal dikes over the ...timescale of continental rift evolution is a significant challenge. To address this issue, we analyzed the morphologies and alignments of >1500 volcanic cones to infer the distribution and trends of upper crustal dikes in various rift basins across the East African Rift (EAR). Cone lineament data reveal along‐axis variations in the distribution and geometries of dike intrusions as a result of changing tectonomagmatic conditions. In younger (<10 Ma) basins of the North Tanzanian Divergence, dikes are largely restricted to zones of rift‐oblique faulting between major rift segments, referred to here as transfer zones. Cone lineament trends are highly variable, resulting from the interplay between (1) the regional stress field, (2) local magma‐induced stress fields, and (3) stress rotations related to mechanical interactions between rift segments. We find similar cone lineament trends in transfer zones in the western branch of the EAR, such as the Virunga Province, Democratic Republic of the Congo. The distributions and orientations of upper crustal dikes in the eastern branch of the EAR vary during continental rift evolution. In early‐stage rifts (<10 Ma), upper crustal dikes play a limited role in accommodating extension, as they are confined to areas in and around transfer zones. In evolved rift basins (>10 Ma) in Ethiopia and the Kenya Rift, rift‐parallel dikes accommodate upper crustal extension along the full length of the basin.
Key Points:
Volcanic cone lineaments reveal variations in upper crustal diking in the East African Rift
We provide a model for the time‐evolving magmatic architecture of rift basins
Transfer zones play a key role in magma‐driven rifting at some rift settings
Interest in stratospheric aerosol and its role in climate have increased over the last decade due to the observed increase in stratospheric aerosol since 2000 and the potential for changes in the ...sulfur cycle induced by climate change. This review provides an overview about the advances in stratospheric aerosol research since the last comprehensive assessment of stratospheric aerosol was published in 2006. A crucial development since 2006 is the substantial improvement in the agreement between in situ and space-based inferences of stratospheric aerosol properties during volcanically quiescent periods. Furthermore, new measurement systems and techniques, both in situ and space based, have been developed for measuring physical aerosol properties with greater accuracy and for characterizing aerosol composition. However, these changes induce challenges to constructing a long-term stratospheric aerosol climatology. Currently, changes in stratospheric aerosol levels less than 20% cannot be confidently quantified. The volcanic signals tend to mask any nonvolcanically driven change, making them difficult to understand. While the role of carbonyl sulfide as a substantial and relatively constant source of stratospheric sulfur has been confirmed by new observations and model simulations, large uncertainties remain with respect to the contribution from anthropogenic sulfur dioxide emissions. New evidence has been provided that stratospheric aerosol can also contain small amounts of nonsulfatematter such as black carbon and organics. Chemistry-climate models have substantially increased in quantity and sophistication. In many models the implementation of stratospheric aerosol processes is coupled to radiation and/or stratospheric chemistry modules to account for relevant feedback processes.
New findings
•
What is the central question of this study?
Heart failure is associated with persistent sterile inflammation that worsens disease severity; however, the molecular mechanisms behind ...cytokine recruitment and their relevance in the diseased myocardium remain unknown.
•
What is the main finding and its importance?
We show that interleukin‐1β is activated downstream of the Nlrp3 inflammasome in calcineurin‐transgene‐induced structural heart disease. Genetic deletion of Nlrp3 abrogated inflammasome signalling and interleukin‐1β release, improving function. The role of Nlrp3 in non‐ischaemic cardiomyopathy and the utility of inflammasome antagonism have not yet been explored, revealing potential for translational application.
Heart failure is associated with a low‐grade and chronic cardiac inflammation that impairs function; however, the mechanisms by which this sterile inflammation occurs in structural heart disease remain poorly defined. Cardiac‐specific heterozygous overexpression of the calcineurin transgene (CNTg) in mice results in cardiac hypertrophy, inflammation, apoptosis and ventricular dilatation. We hypothesized that activation of the Nlrp3 inflammasome, an intracellular danger‐sensing pathway required for processing the pro‐inflammatory cytokine interleukin‐1β (IL‐1β), may contribute to myocardial dysfunction and disease progression. Here we report that Nlrp3 mRNA was increased in CNTg mice compared with wild‐type. Consistent with inflammasome activation, CNTg animals had increased conversion of pro‐caspase‐1 to cleaved and activated forms, as well as markedly increased serum IL‐1β. Blockade of IL‐1β signalling via chronic IL‐1 receptor antagonist therapy reduced cardiac inflammation and myocyte pathology in CNTg mice, resulting in improved systolic performance. Furthermore, genetic ablation of Nlrp3 in CNTg mice reduced pro‐inflammatory cytokine maturation and cardiac inflammation, as well as improving systolic performance. These findings indicate that activation of the Nlrp3 inflammasome in CNTg mice promotes myocardial inflammation and systolic dysfunction through the production of pro‐inflammatory IL‐1β. Blockade of IL‐1β signalling with the IL‐1 receptor antagonist reverses these phenotypes and offers a possible therapeutic approach in the management of heart failure.
PDF
