G.M. Bareh

Genetic determinants of pelvic organ prolapse among African American and Hispanic women in the Women's Health Initiative

Current evidence suggests a multifactorial etiology to pelvic organ prolapse (POP), including genetic predisposition. We conducted a genome-wide association study of POP in African American (AA) and Hispanic (HP) women from the Women’s Health Initiative Hormone Therapy study. Cases were defined as any POP (grades 1–3) or moderate/severe POP (grades 2–3), while controls had grade 0 POP. We performed race-specific multiple logistic regression analyses between SNPs imputed to 1000 genomes in relation to POP (grade 0 vs 1–3; grade 0 vs 2–3) adjusting for age at diagnosis, body mass index, parity, and genetic ancestry. There were 1274 controls and 1427 cases of any POP and 317 cases of moderate/severe POP. Although none of the analyses reached genome-wide significance (p<5x10-8), we noted variants in several loci that met p<10−6. In race-specific analysis of grade 0 vs 2–3, intronic SNPs in the CPE gene (rs28573326, OR:2.14; 95% CI 1.62–2.83; p = 1.0x10-7) were associated with POP in AAs, and SNPs in the gene AL132709.5 (rs1950626, OR:2.96; 95% CI 1.96–4.48, p = 2.6x10-7) were associated with POP in HPs. Inverse variance fixed-effect meta-analysis of the race-specific results showed suggestive signals for SNPs in the DPP6 gene (rs11243354, OR:1.36; p = 4.2x10-7) in the grade 0 vs 1–3 analyses and for SNPs around PGBD5 (rs740494, OR:2.17; p = 8.6x10-7) and SHC3 (rs2209875, OR:0.60; p = 9.3x10-7) in the grade 0 vs 2–3 analyses. While we did not identify genome-wide significant findings, we document several SNPs reaching suggestive statistical significance. Further interrogation of POP in larger minority samples is warranted.

Food intake diet and sperm characteristics in a blue zone: a Loma Linda Study

OBJECTIVES The study examined the effect the life-long vegetarian diet on male fertility and focused on vegetarians living in the Loma Linda blue zone, a demographic area known for life longevity. The objective was to compare sperm characteristics of vegetarian with non-vegetarian males. STUDY DESIGN The cross-sectional observational study was based on semen analyses of 474 males from 2009 to 2013. Patients categorized themselves as either life-long lacto-ovo vegetarians (N=26; vegetable diet with dairy and egg products), vegans (N=5; strictly vegetables with no animal products) or non-vegetarians (N=443; no diet restrictions). Sperm quality was assessed using a computer-aided sperm analyzer and strict morphology and chromatin integrity were manually evaluated. RESULTS Lacto-ovo vegetarians had lower sperm concentration (50.7±7.4M/mL versus non-vegetarians 69.6±3.2M/mL, mean±S.E.M.). Total motility was lower in the lacto-ovo and vegan groups (33.2±3.8% and 51.8±13.4% respectively) versus non-vegetarians (58.2±1.0%). Vegans had lowest hyperactive motility (0.8±0.7% versus lacto-ovo 5.2±1.2 and non-vegetarians 4.8±0.3%). Sperm strict morphologies were similar for the 3 groups. There were no differences in rapid progression and chromatin integrity. CONCLUSIONS The study showed that the vegetables-based food intake decreased sperm quality. In particular, a reduction in sperm quality in male factor patients would be clinically significant and would require review. Furthermore, inadequate sperm hyperactivation in vegans suggested compromised membrane calcium selective channels. However, the study results are cautiously interpreted and more corroborative studies are needed.

Relationship Between Marital Transitions, Health Behaviors, and Health Indicators of Postmenopausal Women: Results from the Women's Health Initiative

BACKGROUND Historically, marital status has been associated with lower mortality and transitions into marriage were generally accompanied by improved health status. Conversely, divorce has been associated with increased mortality, possibly mediated by changes in health behaviors. METHODS This study uses data from a prospective cohort of 79,094 postmenopausal women participating in the Womens Health Initiative Observational Study (WHI-OS) to examine the relationship between marital transition and health indicators (blood pressure, waist circumference, body mass index [BMI]) as well as health behaviors (diet pattern, alcohol use, physical activity, and smoking) in a sample of relatively healthy and employed women. Linear and logistic regression modeling were used to test associations, controlling for confounding factors. RESULTS Womens transitions into marriage/marriage-like relationship after menopause were associated with greater increase in BMI (β = 0.22; confidence interval (95% CI), 0.11-0.33) and alcohol intake (β = 0.08; 95% CI, 0.04-0.11) relative to remaining unmarried. Divorce/separation was associated with a reduction in BMI and waist circumference, changes that were accompanied by improvements in diet quality (β = 0.78, 95% CI, 0.10-1.47) and physical activity (β = 0.98, 95% CI, 0.12-1.85), relative to women who remained married. CONCLUSION Contrary to earlier literature, these findings among well-educated, predominantly non-Hispanic white women suggest that marital transitions after menopause are accompanied by modifiable health outcomes/behaviors that are more favorable for women experiencing divorce/separation than those entering a new marriage.

Endometriosis and Lipid Concentration: Do We Have to Screen Patients for Hyperlipidemia? [349]

OBJECTIVE: Endometriosis affects 5–10% of reproductive-aged women. The exact etiology is poorly understood. Oxidative stress and intrinsic inflammatory status are associated with the development and progression of endometriosis. Atherosclerotic disease is a chronic and degenerative process that starts slowly during infancy. The inflammatory process and the oxidative phenomena contribute to the development of atherosclerosis. The question is whether women with endometriosis have unfavorable lipid profiles triggered by the inflammatory process and oxidative stress noted in both conditions. Our objective was to determine whether endometriosis promotes changes in plasma lipid profiles in reproductive-aged women. METHODS: Prospective cohort study at a tertiary care center. Institutional review board approval was obtained. Twenty-five reproductive-aged women were enrolled. Fifteen participants were diagnosed with endometriosis at the time of laparoscopy. Ten participants composed the control group with no endometriosis. Exclusion criteria included pregnancy, obesity, smoking, alcohol or drug intake, use of hormones, and history of familial dyslipidemia. Serum levels of total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol were measured in both groups. RESULTS: The total cholesterol, triglycerides, and LDL cholesterol levels were statistically higher in the endometriosis group compared with the control group. High-density lipoprotein was higher in the control group compared with the endometriosis group (P<.001). CONCLUSION: The lipid profile of the endometriosis patients is unfavorable with higher LDL, triglycerides, and total cholesterol levels and a lower HDL compared with control women. Patients with endometriosis may benefit from earlier screening for dyslipidemia as a preventive measure.

Unilateral Labial Hypertrophy in Adolescents: when should we Interfere? Two Case Reports

Increasing availability and awareness of reductive labioplasty has led to a corresponding increase in case reports. A literature review revealed primarily cases of bilateral hypertrophyin adults (Pubmed search from 1987–2014 of: labial hypertrophy, unilateral labial hypertrophy, adolescent labial hypertrophy, labial reconstruction) [2]. Three case series involved adolescent patients presenting for unilateral labial reduction, but none discuss this condition in pre-menarchal girls [2-4]. We present the management of unilateral labial hypertrophy in two adolescent patients pre and post menarchal.