Search Results (551)

Positioned at the intersection of sex medicine and endocrinology, metabolic dysfunction-associated steatotic liver disease (MASLD) is often managed by specialists who may not be fully familiar with the complex roles of sex hormones in its pathogenesis and clinical course. To address this gap, we review the molecular actions of testosterone, estradiol, and progesterone on liver functions, as well as the role of sex-hormone binding globulin (SHBG) in MASLD histogenesis, highlighting disparities by sex as well as reproductive status. We also discuss how sex hormones influence fatty acid metabolism, gut dysbiosis, mitochondrial activity, gluco-lipidic homeostasis, lipotoxicity, inflammation, and MASLD-related liver tumorigenesis. Furthermore, we examine observational studies on associations between endogenous and exogenous sex hormones and SHBG with MASLD, with attention to hypogonadism in either sex or polycystic ovary syndrome. We summarize the role of sex hormones in modulating MASLD risk across life stages such as menopause, breastfeeding, and lactation. Lastly, we review the hepatic effects of hormone replacement therapy (HRT) on MASLD in both sexes, prospects, and safety of HRT and contraceptives among individuals with chronic liver disease. In conclusion, sex hormones play significant roles in MASLD pathobiology, underscoring the importance of sex-specific approaches in clinical practice and research. Full article

Acid mine drainage (AMD) is an environmental concern that needs to be addressed by some mining industries because of its high concentrations of metals and acidity that destroy affected ecosystems. Its formation typically persists beyond the operating life of a mine site. Its management is even more challenging for sites that are abandoned without rehabilitation. In this study, a legacy copper–gold mine located in Sto. Niño, Tublay, Benguet, Philippines, generating a copper- and manganese-rich AMD (Cu, maximum 17.2 mg/L; Mn, maximum 2.90 mg/L) at pH 4.59 (minimum) was investigated. With its remote location inhabited by the indigenous people local community (IPLC), a novel limestone-based hybrid passive treatment system that combines a limestone leach bed (LLB) and a controlled modular packed bed reactor (CMPB) has been developed from the laboratory and successfully deployed in the field while investigating the effective hydraulic retention time (HRT), particle size, and redox conditions (oxic and anoxic) in removing Cu and Mn and increasing pH. Laboratory-scale and pilot-scale systems using simulated and actual AMD, respectively, revealed that a 15 h HRT and both oxic and anoxic conditions were effective in treating the AMD. Considering these results and unsteady conditions of the stream in the legacy mine, a hybrid multi-stage limestone leach bed and packed bed were deployed having variable particle size (5 mm to 100 mm) and HRT. Regular monitoring of the system showed the effective removal of Cu (88.5%) and Mn (66.83%) as well as the increase of pH (6.26), addressing the threat of AMD in the area. Improvement of the lifespan of the system needs to be addressed, as issues of Cu-armoring were observed, resulting in reduced performance over time. Nonetheless, the study presents a novel technique in implementing passive treatment systems beyond the typical treatment trains reported in the literature. Full article

Although adding iron salts can improve phosphorus removal in membrane bioreactor (MBR) processes, overdosing iron salts may result in excessive iron concentrations in the effluent and pose risks of surface water contamination. In this study, an optimized iron salt dosing method was proposed to comprehensively investigate its effects on the performance of MBRs and the control of iron leakage. The results showed that batch dosing of solid iron salts (Fe₂(SO₄)₃) into the influent or activated sludge maintained an effluent Fe³⁺ concentration below 1.0 mg/L and a total phosphorus (TP) concentration below 0.30 mg/L. Long-term operation of the MBR (under conditions of HRT = 4.3 h, SRT = 20 d, and MLSS = 12 g/L) showed that batch dosing of solid iron salts led to an increase in the effluent ammonia–nitrogen (NH₃-N) concentration, and the nitrification effect was restored after supplementing the alkalinity. Iron salts increased the TP removal rate by approximately 40% while inhibiting the biological phosphorus removal capacity. The average Fe³⁺ concentration in the membrane effluent (0.23 ± 0.11 mg/L) met China’s Environmental Quality Standard for Surface Water (GB3838-2002). This study demonstrates that batch dosing of solid iron salts effectively controls iron concentration in the MBR effluent while preventing secondary pollution. The mechanisms of the impact of iron salts on MBR performance provide crucial theoretical and technical support for MBR process optimization. Full article

Overdosing an external carbon source can lead to its incomplete utilization. With this in mind, this study aimed to investigate the effect of carbon dosing on nutrient removal in a rotating electro-biological disc contactor (REBDC) treating hydroponic tomato wastewater and to evaluate its impact on effluent COD under a constant electric current (2.5 A/m²). In REBDC, discs served as the cathode, and an aluminum sheet placed in the tank served as the anode. Sodium acetate was added to provide carbon to nitrogen (C/N) ratios of 0.5, 1.0, 2.0, and 3.0. The HRT was 24 h. The phosphorus removal efficiency in the REBDC exceeded 90% at C/N ratios of 0.5, 1.0, and 2.0. A several-fold increase was observed in nitrogen removal efficiency at C/N = 2.0 and C/N = 3.0 compared to C/N = 0.5 (9 and 11 times higher, respectively). At C/N ratios of 2.0 and 3.0, the efficiency was 56.0% and 65%, respectively. Considerable amounts of unutilized organic carbon were found in the REBDC-treated wastewater. The rational solution would be to extend the HRT, which would enable greater substrate consumption and nitrogen removal. Full article

Endometrial hyperplasia, presenting without atypia (EH) or as atypical hyperplasia (AH), is considered a precursor of endometrial cancer and affects women of reproductive or perimenopausal age, posing a major public health concern. The aim of this study was to review and compare the most recently published influential guidelines providing recommendations on the management of endometrial hyperplasia. Thus, a comparative review of guidelines from the Royal College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, and the American College of Obstetricians and Gynecologists was conducted. There is a consensus regarding the optimal management strategies for EH, with observation and medical treatment being the first-line options and surgical treatment with total hysterectomy offering a second line in specific cases. Moreover, there is agreement regarding patients with AH, with surgical treatment being the recommended approach, while medical therapy is preferred for women who seek fertility preservation. Notably, close surveillance with endometrial biopsies every 3 or 6 months is suggested unanimously, as well as long-term follow-up in high-risk patients. Controversy exists regarding the initial diagnostic approach, with RCOG and SOGC suggesting outpatient endometrial biopsy, while ACOG recommends diagnostic hysteroscopy, as well as the therapeutic regimens for the oral treatment of EH. Surgical techniques such as endometrial ablation, intraoperative frozen section analysis, intraoperative visual inspection of the uterus, and morcellation constitute areas of controversy among the reviewed guidelines, and the surveillance protocols for women with EH are addressed differently between RCOG and SOGC. Notably, RCOG is the only medical society offering recommendations regarding women under HRT and those on therapy for breast cancer. The development of consistent international practice protocols for timely management strategies and surveillance protocols is of paramount importance to safely guide clinical practice and subsequently improve women’s health. Full article

Given the demand for sustainable and cost-effective manure management in livestock systems, this study evaluated the economic feasibility of cattle manure treatment via composting and anaerobic digestion (AD) under different configurations. Five scenarios were compared: composting without solid–liquid separation, AD without separation at 20- and 30-day hydraulic retention times (HRTs), and combined systems with separation, composting the solid fraction and digesting the liquid. The analysis was based on a 200-cow herd and experimental data, with 15-year projected cash flows. Economic indicators included net present value (NPV), internal rate of return (IRR), discounted payback period (DPP), benefit–cost ratio (B/C), modified internal rate of return (MIRR), uniform annual equivalent (UAE), and profitability index (PI), supported by sensitivity analysis and Monte Carlo simulation. All scenarios were viable and posed low risk. Energy and fertilizer value were key drivers. The scenario 30-day HRT without separation had the best financial performance (NPV = 53,407.15 USD; IRR = 15.54%; DPP = 7.33 years; B/C = 1.57; MIRR = 9.28%; UAE = 5654.48 USD; PI = 1.66) and is recommended for capitalized farms seeking higher returns. Composting had lower returns (NPV = 9832.06 USD) but required the lowest investment, remaining a cost-effective alternative for smallholders. Full article

Biomass energy transforms waste into biofuels and supports water purification. This study examines enhanced hydrogen production via dark fermentation, tracking volatile fatty acids (VFAs), chemical oxygen demand (COD), carbohydrates, and hydraulic retention time (HRT) to optimize biogas yield and quality. Investigations into acidogenesis and acetogenesis explore methods for breaking down long-chain VFAs into short-chain VFAs, which are critical for efficient hydrogen generation. Testing and analysis of VFAs, carbonates, COD, and HRT provide insights into bacterial activity that drives hydrogen production. The main VFAs produced were acetic, propionic, and butyric acids. DF1 and DF2 primarily generated acetic acid, consistent with cheese whey (CW)-based fermentations. DF1.1, using 5× diluted CW and a 30:70 inoculum-to-substrate ratio (I2SR), exhibited elevated butyric acid levels, similar to those observed with food waste. The first dark fermentation process (DF1) initially showed effective carbohydrate metabolism but later experienced spikes in succinic and lactic acids, which reduced hydrogen production. In contrast, the second dark fermentation process (DF2) maintained low lactic acid levels and increased acetate concentrations, indicating improved system performance. DF1.1 also demonstrated stable VFA production and lactic acid reduction. Greater CW dilution, higher initial pH, and increased HRT were key factors in minimizing acidification and enhancing hydrogen-producing pathways. Full article

Aquaculture wastewater is characterized by large discharge volumes and variable nitrogen concentrations, posing challenges for stable and efficient treatment. This study investigated biochar-amended bioretention systems (BBSs) under varying temperatures (8.0–26.0 °C), influent TN levels, and operation modes (intermittent and continuous flow). In intermittent runs, the 20% biochar system (BBS20) achieved 72.4% TN removal at low influent TN (9.55 mg/L) and 80.4% at high TN (29.96 mg/L), significantly outperforming the control (CBS). In continuous runs, BBS20 reduced effluent TN to 1.75 mg/L within 72 h, yielding higher average HRT, HLR, and ELR than CBS. Mechanistic analyses showed that biochar addition enhanced extracellular polymeric substance (EPS) secretion, stimulated electron transport system activity (ETSA), and increased the relative abundance of denitrifying genera and functional genes (e.g., nirS, narG). These synergistic effects optimized nitrification–denitrification coupling, particularly under low-temperature conditions. The findings demonstrate that biochar amendment is a practical and effective strategy for improving nitrogen removal from aquaculture wastewater. Full article

Background: Hormonal fluctuations significantly influence skin physiology, affecting collagen production, sebum regulation, pigmentation, and tissue repair. Hormonal therapies are increasingly used in cosmetic dermatology to address age-related and hormone-dependent skin changes. Methods: This narrative review synthesizes the current literature on the mechanisms, clinical applications, and future directions of hormonal therapies in dermatologic aesthetics. Studies were selected through a comprehensive search on PubMed, Scopus, and Web of Science. Results: Estrogens, androgens, progesterone, and other hormones act on skin through specific receptors, modulating fibroblast, sebocyte, and melanocyte activity. Clinical applications include hormone-based strategies for anti-aging, acne, melasma, alopecia, and postmenopausal atrophy. Both systemic (e.g., HRT) and topical (e.g., clascoterone, phytoestrogens) approaches are discussed. Safety concerns, including systemic absorption and off-label use, require careful evaluation. Emerging technologies such as SERMs, nanocarriers, and regenerative combinations suggest promising future avenues. Conclusions: Hormonal therapies offer a biologically rational and increasingly evidence-based tool in cosmetic dermatology. Responsible integration into clinical practice depends on personalized approaches, ethical prescribing, and further research on long-term safety and efficacy. Full article

This study evaluated chemical and physical parameters, volatile fatty acids (VFAs), pathogens indicators, ammonia, and greenhouse gas (GHG: CO₂, CH₄, N₂O) emissions from fresh and digested dairy manure under controlled laboratory conditions, simulating storage at 18 °C and 28 °C. Manure and digestate samples were collected during summer 2023 from three dairy farms in Northern Italy, all operating similar mono-substrate, mesophilic anaerobic digesters at 42 °C with short hydraulic retention times (HRT) of ~30 days, instead of the longer HRTs commonly used (up to 90 days). Gas emissions were measured using a static chamber method over 40 min sessions, and cumulative GHG losses were converted to CO₂ equivalents. Anaerobic digestion significantly increased ammonia emissions (p < 0.001), in comparison with fresh manure samples. Anaerobic digestion affected pH variations, while reducing CH₄ and N₂O emissions by up to 67% and 50%, respectively. Storage at 28 °C increased total GHG fluxes by 74% for fresh manure and 66% for digestate. Residual methane emissions suggest incomplete digestion, likely due to short HRT and low digestion temperatures. Among pathogens, only clostridia showed significant reduction post-digestion. Overall, anaerobic digestion effectively lowers the global warming potential (GWP) of dairy manure, but higher environmental temperatures exacerbate ammonia and GHG emissions during storage, highlighting the need for optimized post-digestion handling in warm climates. Full article

Gilles de la Tourette syndrome (GTS) is a neurodevelopmental disorder characterized by motor and phonic tics, often including attention deficit, hyperactivity, and obsessive–compulsive behaviours. The pathophysiology involves the dysfunction of cortico-striato-thalamo-cortical circuits, primarily implicating dopaminergic hyperactivity, but also involving multiple different neurotransmitter systems. Treatment of GTS is complex, highly individualized, and influenced by considerable variability in symptom presentation. Behavioural approaches, such as Habit Reversal Therapy (HRT), play a key role, especially in milder cases. Pharmacological therapy is largely empirical and varies across countries, influenced by drug availability and the perceived risks of certain classes of drugs, particularly dopamine receptor blocking agents. Drug options for managing tics include dopamine receptor antagonists, monoamine depleting agents, and alpha-2 agonists, all of which require close monitoring for metabolic, cardiovascular, and neurological side effects. Botulinum toxin injections represent an effective solution for focal tics that are resistant to systemic treatments. Cannabinoids and antiepileptics have limited efficacy, yet they may still offer relevant therapeutic potential in selected cases. Serotonergic drugs are useful for treating obsessive–compulsive symptoms. For patients with refractory tics, deep brain stimulation (DBS) represents an intervention of last-resort; however, DBS remains off-label and consensus on optimal targets is lacking. This narrative review draws on both the relevant literature and extensive personal clinical experience to explore the complexities of managing GTS, with a focus on evidence-based treatments for tics and associated neuropsychiatric symptoms. A therapeutic algorithm is proposed, emphasizing a “start low, go slow” approach, combining pharmacological interventions with cognitive behavioural and surgical therapies, when needed. We underscore the importance of tailoring treatments to individual patient profiles and symptom variability over time, highlighting the need for further research in GTS management. Full article

Background: Missed miscarriage (MM) is a common first-trimester complication. Misoprostol alone achieves moderate success, while combination therapy with mifepristone improves outcomes in spontaneous pregnancies. Evidence in assisted reproductive technology (ART) pregnancies is scarce. We evaluated whether combined mifepristone–misoprostol improves outcomes in ART pregnancies compared with misoprostol alone and compared results with spontaneously conceived (SC) pregnancies. Methods: This retrospective matched cohort study was conducted at a single center (2017–2024). ART pregnancies were matched 1:2 with SC pregnancies by maternal age. Patients received misoprostol alone or 200 mg mifepristone followed 48 h later by misoprostol. The primary outcome was treatment success, defined as complete uterine evacuation without repeat misoprostol or surgery. Secondary outcomes included emergency visits, surgical procedures, and ART-related predictors. Subgroup analyses were performed by ART protocol. Results: Among 307 patients (94 ART, 213 SC), combined therapy yielded higher success than misoprostol alone in SC (84% vs. 71%, p = 0.023) and ART pregnancies (95% vs. 80%, p = 0.035). In hormonally supported frozen embryo transfer (HRT-FET) cycles, success was 100% with combined therapy versus 80% with misoprostol alone. Conclusions: Combined mifepristone–misoprostol is more effective than misoprostol alone, with particularly high success in HRT-FET cycles. Full article

Background/Objectives: Estrogen deficiency-related menopause is associated with various physical and psychological symptoms. Although hormone replacement therapy (HRT) effectively alleviates these symptoms, its long-term use is associated with several side effects such as an increased risk of breast cancer and cardiovascular disease. Consequently, there is a growing interest in some plant-derived phytoestrogens that are considered safer alternatives to estrogen. Recent studies on Scrophularia buergeriana confirmed their anti-inflammatory and antioxidant properties; however, their effects on menopausal health remain unclear. Therefore, the aim of this study was to investigate the estrogen-like effects of S. buergeriana root (SB-R) extract, a potential phytoestrogen. Methods: Briefly, the MCF-7 cell line, a widely used in vitro model for assessing estrogen-like activity, was treated with SB-R extract and 17β-estradiol (E2; positive control) in the presence or absence of ICI 182,780 (Fulvestrant), an estrogen receptor antagonist. An E-screen assay and flow cytometry were performed to assess the effects of the treatments on cell proliferation and the cell cycle, respectively. Additionally, Western blotting and immunofluorescence assays were performed to elucidate the potential mechanisms underlying the estrogen-like effects of SB-R. Result: Treatment with SB-R extract promoted MCF-7 cell proliferation in a manner similar to E2. However, ICI 182,780 co-treatment inhibited the SB-R extract-induced increase in MCF-7 cell proliferation. Additionally, SB-R extract promoted cell cycle progression by increasing the proportion of cells in the S and G2/M phases. Moreover, Western blotting and immunofluorescence assays showed that SB-R extract increased the expression of estrogen receptor alpha (ERα). Furthermore, SB-R treatment activated downstream signaling pathways by enhancing AKT and ERK phosphorylation and upregulated the expression of cell cycle regulators, including cyclin D1, cyclin dependent kinase 4 (CDK4), cyclin E1, and cyclin dependent kinase 2 (CDK2). Conclusions: SB-R exhibits estrogen-like activity by activating ERα-mediated AKT and ERK pathways and thereby increasing the expression of proteins involved in cell cycle regulation. This makes it a promising phytoestrogen candidate and a safer alternative to conventional hormonal therapy for alleviating menopausal symptoms. Full article

Sugarcane vinasse, a byproduct of ethanol production, presents environmental challenges due to its high organic content and occasional contamination with antibiotics, such as monensin. This study successfully evaluated thermophilic two-phase anaerobic digestion for simultaneous monensin degradation and biogas production. The system, consisting of an acidogenic anaerobic structured-bed bioreactor (ASTBR) operating at with a hydraulic retention time (HRT) of 7.5 h followed by a methanogenic reactor at HRT = 24 h, with two options of the methanogenic phase, an upflow anaerobic sludge blanket (UASB), and an ASTBR, operated continuously for 254 days with incremental monensin concentrations (0–2000 ng·mL⁻¹). The acidogenic reactor consistently removed over 70% of monensin across all phases, demonstrating its effectiveness as a pretreatment step. At realistic residual concentrations (20–100 ng·mL⁻¹), monensin not only failed to inhibit biogas production but enhanced methane yield by up to 100% through selective pressure on the microbial community. This study demonstrated that anaerobic digestion can effectively degrade monensin while increasing the value of vinasse, providing a scalable solution for mitigating antibiotic contamination and enhancing bioenergy recovery in the sugarcane–ethanol industry. Full article

In developing countries, indoor air pollution in rural areas is often attributed to the use of solid biomass fuels for cooking. Such fuels generate particulate matter (PM), carbon monoxide (CO), carbon dioxide (CO₂), polyaromatic hydrocarbons (PAHs), and volatile organic compounds (VOCs). PM created from biomass combustion is a pollutant particularly damaging to health. This rigorous study employed a personal sampling device and multi-stage cascade impactor to collect airborne PM (including PM_2.5) and deposited ash from 20 real-world kitchen microenvironments. A robust analysis of the PM was undertaken using a range of morphological, physical, and chemical techniques, the results of which were then compared to a controlled burn experiment. Results revealed that airborne PM was predominantly carbon (~85%), with the OC/EC ratio varying between 1.17 and 11.5. Particles were primarily spherical nanoparticles (50–100 nm) capable of deep penetration into the human respiratory tract (HRT). This is the first systematic characterisation of biomass cooking emissions in authentic rural kitchen settings, linking particle morphology, chemistry and toxicology at health-relevant scales. Toxic heavy metals like Cr, Pb, Cd, Zn, and Hg were detected in PM, while ash was dominated by crustal elements such as Ca, Mg and P. VOCs comprised benzene derivatives, esters, ethers, ketones, tetramethysilanes (TMS), and nitrogen-, phosphorus- and sulphur-containing compounds. This research showcases a unique collection technique that gathered particles indicative of their potential for penetration and deposition in the HRT. Impact stems from the close link between the physico-chemical properties of particle emissions and their environmental and epidemiological effects. By providing a critical evidence base for exposure modelling, risk assessment and clean cooking interventions, this study delivers internationally significant insights. Our methodological innovation, capturing respirable nanoparticles under real-world conditions, offers a transferable framework for indoor air quality research across low- and middle-income countries. The findings therefore advance both fundamental understanding of combustion-derived nanoparticle behaviour and practical knowledge to inform public health, environmental policy, and the UN Sustainable Development Goals. Full article