A wise person plants a tree a day before the end of the world: coping with the emotional experience of climate change in Poland.

It is now widely accepted that we are in a climate emergency, and the number of people who are concerned about this problem is growing. Yet, qualitative, in-depth studies to investigate the emotional response to climate change were conducted either in high-income, western countries, or in low-income countries particularly vulnerable to climate change. To our knowledge, there are no qualitative studies conducted in countries that share great barriers to decarbonization while being significant contributors to carbon emissions. Since climate change affects people globally, it is crucial to study this topic in a variety of socio-political contexts. In this work, we discuss views and reflections voiced by highly concerned residents of Poland, a Central European country that is a major contributor to Europe's carbon emissions. We conducted 40 semi-structured interviews with Polish residents, who self-identified as concerned about climate change. A variety of emotions related to climate change were identified and placed in the context of four major themes: dangers posed by climate change, the inevitability of its consequences, attributions of responsibility, and commonality of concern. Our findings highlight a variety of often ambivalent and conflicting emotions that change along with the participant's thoughts, experiences and behaviours. Furthermore, we describe a wide repertoire of coping strategies, which promoted well-being and sustained long-term engagement in climate action. As such, our work contributes to research on a broad array of climate-related emotions. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03807-3.

Inflammatory Bowel Disease On-Line Web-Based Guide to Health Professionals and Patients in Developing and African Nations.

Introduction: 1.1.Inflammatory Bowel Disease (IBD) is recklessly evolving worldwide as incautious disaster, especially in developing nations as a regional duplicitous emergence disease. It has come to light that adaptive Western culture, rapid urbanization lifestyle in the developing nations has been seen to be associated with this increasing trend incidence. Apparent unclassified strategic challenge assessment of how key trends and uncertainties might lead the world over the next decades to help developing nations and plan for the long term. Healthcare professionals are faced with limited resource and unequipped laboratories for IBD diagnostics, prognostics and monitoring management. Limited knowledge on IBD among developing nation's physician's/healthcare providers is painstaking and indisputable challenge. With the emergence of advanced communications technology, the internet offers diverse, substantial, easily accessible, and educational resources that are more time- and cost-efficient than conventional modes of knowledge acquisition. An On-Line Web-Based Resources about IBD, as a guide would greatly assist health professionals and patients. Methods: 1.2.We performed a literature search according to PRISMA-P (preferred reporting items for review and meta-analysis and searches in PubMed (MEDLINE database) to identify and select peer-reviewed articles allied to web-based educational accoutrements for IBD. Results: 1.3.In developing nations, locally trained physicians have limited knowledge on IBD. Mostly, IBD is not included in their training Core Curriculum and research in this field/area is limited in these countries. The healthcare approaches, both at the primary care and referral levels, many times lack the essential regular clinical guidance and laboratory evaluation assessments needs for monitoring patients. Moreover, increasing treatment costs impose additional burden on the healthcare systems. Expensive pharmacological biosimilar and biologic agents/drugs, new treatment targets, and new quality indicators in patient health quality of life and care are significant challenge in addition to early manifestations of IBD are likely to be missed at most health institutions. Conclusion: 1.4.We herewith summarize an on-line web-based e-learning guide for IBD-related educational resources to assist physicians, healthcare personnel and patients worldwide, especially in the developing nations where the epidemiological monitoring studies are limited, due to a lack of medical surveillance systems and reliable and unified registries and databases.

Difference in signalling between various hormone therapies in endometrium, myometrium and upper part of the vagina.

BACKGROUND: Combined hormone treatments in post-menopausal women have different clinical responses on uterus and vagina; therefore, we investigated differences in steroid signalling between various hormone therapies in these tissues. METHODS: A total of 30 post-menopausal women scheduled for hysterectomy were distributed into four subgroups: control-group (n = 9), Tibolone-group (n = 8); estradiol (E(2))-group (n = 7); E(2) + medroxyprogesterone acetate (MPA)-group (n = 6). Medication was administered orally every day for 21 days prior to removal of uterus and upper part of the vagina. Tissue RNA was isolated, and gene expression profiles were generated using GeneChip technology and analysed by cluster analysis and significance analysis of microarrays. Apoptosis and cell proliferation assays, as well as immunohistochemistry for hormone receptors were performed. RESULTS: 21-days of treatment with E(2), E(2) + MPA or tibolone imposes clear differential gene expression profiles on endometrium and myometrium. Treatment with E(2) only results in the most pronounced effect on gene expression (up to 1493 genes differentially expressed), proliferation and apoptosis. Tibolone, potentially metabolized to both estrogenic and progestagenic metabolites, shows some resemblance to E(2) signalling in the endometrium and, in contrast, shows significant resemblance to E(2) + MPA signalling in the myometrium. In the vagina the situation is entirely different; all three hormonal treatments result in regulation of a small number (4-73) of genes, in comparison to signalling in endometrium and myometrium. CONCLUSION: Endometrium and myometrium differentially respond to the hormone therapies and use completely different sets of genes to regulate similar biological processes, while in this experiment the upper part of the vagina is hardly hormone responsive.

Estrogen and tibolone metabolite levels in blood and breast tissue of postmenopausal women recently diagnosed with early-stage breast cancer and treated with tibolone or placebo for 14 days.

Unlike estrogens plus progestagens, tibolone, a selective tissue estrogenic activity regulator, does not increase breast tenderness and mammographic density. To elucidate this, serum and breast levels of tibolone and estrogenic metabolites are measured. Postmenopausal women (n = 102) with early-stage, ER(+ve), primary breast cancer received tibolone or placebo for 14 days in an exploratory, double-blind, randomized trial (STEM carcinoma tissue). Baseline and presurgery sera were collected; tumor tissues were obtained at surgery. E(1) (estrone), E(2) (estradiol), E(1)S (estrone-sulfate), tibolone-its nonsulfated, monosulfated, and disulfated 3-hydroxymetabolites-and Delta(4)-tibolone were measured by validated gas chromatography and mass spectrometry and liquid chromatography with tandem mass spectrometry assays. More than 12 hours after the final dose, serum E(1), E(2), and E(1)S levels were unchanged with placebo, whereas tibolone significantly increased E(1)S and the E(1)S/(E(1) + E(2)) ratio. In tumors, E(1) and E(2) levels were higher than in serum, and E(1)S levels were lower, with placebo and tibolone administration. The percentage of E(1)S was about 90% in serum and 16% in tissue. Tibolone did not affect tissue levels of endogenous estrogens. Serum levels of estrogenic 3alpha- and 3beta-hydroxytibolone, progestagenic/androgenic Delta(4)-tibolone, and monosulfate metabolites were low. Serum 3alphaS,17betaS-tibolone and 3 betaS,17betaS-tibolone levels were 250 and 52 ng/mL, respectively. Tumor levels of 3alpha- and 3beta-hydroxytibolone and Delta(4)-tibolone were higher than in serum, but disulfate levels were lower. The percentage of sulfated tibolone metabolites was 99% in serum and 96% in tumor. Serum metabolite patterns of estradiol and tibolone are different from those in tissues and are compatible with neutral effects of tibolone on breast Ki67 expression.

Levels of tibolone and estradiol and their nonsulfated and sulfated metabolites in serum, myometrium, and vagina of postmenopausal women following treatment for 21 days with tibolone, estradiol, or estradiol plus medroxyprogestrone acetate.

Tibolone has estrogenic effects on the vagina but not on the uterus. To explain this, levels of tibolone and estradiol and their metabolites were determined in serum, myometrium, and vagina. Thirty-four postmenopausal women with uterine prolapse received either no treatment, tibolone, E(2) or E(2) + medroxyprogesterone acetate (MPA) for 21 days, or a single dose of tibolone. Twenty +/- 6 hours after administration, >98% of the 3-hydroxytibolone metabolites in serum and tissues were disulfated. Of the unconjugated metabolites, the estrogenic 3alpha-hydroxytibolone predominated in serum, whereas the progestagenic/ androgenic Delta(4)-tibolone predominated in myometrium and vagina. Levels of disulfated metabolites in serum and tissues were higher (3- to 5-fold) after multiple dosing than after a single dose. Tissue:serum ratios were <1, except for Delta(4)-tibolone. In all groups, E(2) tissue levels were higher than serum levels; the percentage of serum E(1)S was >90%. Tibolone did not affect endogenous E(1), E(2), or E(1)S levels in serum, but in myometrium and vagina, E(1) levels were significantly higher and E(1)S levels tended to be lower than in controls. Serum and tissue levels of endogenous and exogenous E(1), E(2), and E(1)S were markedly increased 20 hours after E(2) or E(2) + MPA; the percentage of E(1)S and tissue:serum ratios were not affected. MPA had no effect on the degree of sulfation of E(1). Compared with serum, tissue levels of E(2) were high in all groups; absolute E(2) levels in control and tibolone groups were much lower than in the E(2) groups. Tibolone metabolite patterns are different in serum, myometrium, and vagina.

7alpha-Methyl-ethinyl estradiol is not a metabolite of tibolone but a chemical stress artifact.

OBJECTIVE: This study was conducted to establish whether 7alpha-methyl-ethinyl estradiol (7alpha-MEE) in plasma from postmenopausal women treated with tibolone is a metabolite or an artifact. DESIGN: Clinical samples with known levels of tibolone metabolites, plus plasma samples spiked with tibolone and metabolites, were analyzed for levels of 7alpha-MEE using liquid chromatography-mass spectometry (LC-MS/MS) with and without derivatization. RESULTS: Approximately 20 to 40 pg/mL 7alpha-MEE was detected using LC-MS/MS with derivatization in plasma samples from postmenopausal women treated with tibolone. In plasma samples spiked with 200 ng/mL tibolone or Delta-tibolone, LC-MS/MS with derivatization revealed the generation of around 200 and 36 pg/mL 7alpha-MEE, respectively, whereas LC-MS/MS without derivatization showed no detectable chemical conversion of tibolone to 7alpha-MEE. Generation of 7alpha-MEE is increased by the "stress conditions" used in the derivatization procedure; simply drying the sample also shows this artifactual conversion. The major active and sulfated 3-hydroxy metabolites of tibolone are not converted to 7alpha-MEE. Without derivatization, and avoiding stress conditions, no detectable levels (<20 pg/mL) of 7alpha-MEE were found in plasma samples from postmenopausal women treated with single (eight participants at 13 time points) or multiple (seven participants at 18 time points) doses of tibolone. CONCLUSIONS: 7alpha-MEE is not a metabolite of tibolone but is a chemical artifact generated during analytical procedures with derivatization. Using LC-MS/MS without derivatization, 7alpha-MEE cannot be demonstrated in plasma from postmenopausal women after single or multiple doses of tibolone.

Blond hair removal using ELOS systems.

OBJECTIVE: The aim of this study was to test blond hair removal using the ELOS system, which is optical energy and radio-frequency combined. METHODS: Seventeen patients with blond hair were randomly selected from the Department of Lasertherapy, Medical Centre Maastricht, The Netherlands. The mean age of the patients was 57.4 years. The mean energy used per patient was 23.2 J/cm2 and the mean radio-frequency was 18.6 J/cm2. RESULTS: A mean hair reduction of 57.4% was obtained with a mean of 8.5 treatments. There was a trend found between hair removal and the number of treatments. No correlation was found between the percentage of hair removal and age. Furthermore, there was no correlation between hair removal and the device's technical data. No major side effects were observed postoperatively. CONCLUSIONS: This study showed that ELOS can effectively be used for blond hair reduction.

Effective treatment of rosacea using intense pulsed light systems.

BACKGROUND: To date, a variety of lasers have been used for treating vascular skin lesions. Intense pulsed light (IPL) is a proven technology for vascular lesion management, such as rosacea. OBJECTIVES: The aim of this study was to test the effectiveness of IPL in treating vascular facial lesions in rosacea patients. METHODS: Sixty patients presenting with telangiectasia owing to facial rosacea were selected randomly from the patient population in the Department of Laser Therapy at the Medical Centre Maastricht, the Netherlands. Patients of various skin types (Fitzpatrick I-IV) were selected with an average age of 44.2 years. Five hundred eight sites were treated, with a mean of 4.1 treatments per site and an IPL spectrum ranging from 515 to 1,200 nm with different pulse durations between 4.3 and 6.5 milliseconds. The energy density varied from 25 to 35 J/cm2. RESULTS: Patients were assessed clinically and photographically. A mean clearance of 77.8% was achieved and was maintained for a follow-up period averaging 51.6 months (range 12-99 months). No correlation was found between the clearance of rosacea and patient-related or technical data. For approximately 3 years post-treatment, lesion recurrence was noted in 4 of the 508 treated facial sites. DISCUSSION: This study demonstrated that IPL treatment of facial rosacea is effective in obtaining clearance of 77.8%, with minimal side effects, and that treatment effects are maintained. CONCLUSION: The IPL system, with its broad range of technical variables, is an effective tool in achieving meaningful and lasting rosacea clearance.

Photodynamic therapy: new treatment for therapy-resistant plantar warts.

BACKGROUND: Plantar wart treatment remains a challenging one. Various treatment modalities have been previously used and are still in current use. The problem remains in the degree of response to these treatments and the side effects associated with them. OBJECTIVE: The aim of this study was to test a new treatment modality for therapy-resistant plantar warts. METHODS: Thirty-one patients with 48 plantar warts were randomly selected from the Department of Laser Therapy, Medical Centre Maastricht, The Netherlands. The mean age of the patients was 29 years (range 6-74 years). The mean incubation time was 6.8 hours, and the mean treatment time was 18.7 minutes per wart. Each wart was treated an average of 2.3 times, with a median fluence of 100 cm2. RESULTS: Forty-two of 48 (88%) warts showed a complete response. A trend was found between total clearance and size of the warts, age of the patient, and the mean treatment time. No significant side effects were seen postoperatively. CONCLUSION: This study showed that recalcitrant plantar warts were successfully treated with no significant side effects; however, the user needs sufficient experience for this new effective treatment application.

Pharmacokinetic evaluation of three different intramuscular doses of nandrolone decanoate: analysis of serum and urine samples in healthy men.

The pharmacokinetics of nandrolone in serum and urine were investigated in healthy young men after a single im injection of 50 mg (n = 20), 100 mg (n = 17), or 150 mg (n = 17) nandrolone decanoate. Blood samples were collected before treatment and for up to 32 d after dosing. In addition, in the 50- and 150-mg groups, 24-h urine samples were collected before treatment and on d 1, 7, and 33 after treatment; in the 150-mg group, additional samples were collected after 3 and 6 months. Serum concentrations and the area under the curve of nandrolone increased proportionally with the dose administered. The peak serum concentration ranged from 2.14 ng/ml in the 50-mg group to 4.26 ng/ml in the 100-mg group and 5.16 ng/ml in the 150-mg group. The peak serum concentration was reached after 30 h (50 and 100 mg) and 72 h (150 mg), whereas the terminal half-life was 7-12 d. In urine, pretreatment concentrations of 19-norandrosterone (19-NA) and/or 19-noretiocholanolone (19-NE) were detected in five of 37 subjects (14%). In the 50-mg group, 19-NA and/or 19-NE could be detected at least until 33 d after injection in 16 of 17 subjects (94%). In the 150-mg group, who were presumed to have not previously used nandrolone, nandrolone metabolites could be detected for up to 6 months in eight of 12 subjects (67%) for 19-NE and in 10 of 12 subjects (83%) for 19-NA.

Hair reduction using intense pulsed light source.

BACKGROUND: Long-term hair removal in hirsute women remains a challenging issue. Various laser and laser-like devices are currently in use for hair removal, but little is known about the permanence of their results. This study deals with the permanence of hair removal using the intense pulsed light source (IPLS). OBJECTIVE: To test the effectiveness in long-term hair reduction. METHODS: Seventy female hirsute patients were selected in the Department of Laser Therapy at the Medical Center, Maastricht, the Netherlands. The average age of the mostly dark-haired patients of various skin types (Fitzpatrick I to V) was 41 years. They were subjected to a mean of 8 treatments (range of 2 to 23) followed for a mean period of 27.3 months. RESULTS: Using the IPLS, 87% hair removal was achieved, whereby the number of treatments correlated with the amount of hair lost. No correlation was found between hair removal and patient-related or technical data. Minimal side effects occurred in 10% of the patients. CONCLUSION: The IPLS system with its broad range of technical variables is effective in achieving long-term hair removal.

Tibolone is not converted by human aromatase to 7alpha-methyl-17alpha-ethynylestradiol (7alpha-MEE): analyses with sensitive bioassays for estrogens and androgens and with LC-MSMS.

To exclude that aromatization plays a role in the estrogenic activity of tibolone, we studied the effect tibolone and metabolites on the aromatization of androstenedione and the aromatization of tibolone and its metabolites to 7alpha-methyl-17alpha-ethynylestradiol (7alpha-MEE) by human recombinant aromatase. Testosterone (T), 17alpha-methyltestosterone (MT), 19-nortestosterone (Nan), 7alpha-methyl-19-nortestosterone (MENT) and norethisterone (NET) were used as reference compounds. Sensitive in vitro bioassays with steroid receptors were used to monitor the generation of product and the reduction of substrate. LC-MSMS without derivatization was used for structural confirmation. A 10 times excess of tibolone and its metabolites did not inhibit the conversion of androstenedione to estrone by human recombinant aromatase as determined by estradiol receptor assay whereas T, MT, Nan, and MENT inhibited the conversion for 75, 53, 85 and 67%, respectively. Tibolone, 3alpha- and 3beta-hydroxytibolone were not converted by human aromatase whereas the estrogenic activity formed with the Delta4-isomer suggests a conversion rate of 0.2% after 120 min incubation. In contrast T, MT, Nan, and MENT were completely converted to their A-ring aromates within 15 min while NET could not be aromatized. Aromatization of T, MT, Nan and MENT was confirmed with LC-MSMS. Structure/function analysis indicated that the 17alpha-ethynyl-group prevents aromatization of (19-nor)steroids while 7alpha-methyl substitution had no effect. Our results with the sensitive estradiol receptor assays show that in contrast to reference compounds tibolone and its metabolites are not aromatized.

Receptor profiling and endocrine interactions of tibolone.

The receptor profiles and in vivo activity of tibolone, and its primary metabolites, Delta(4)-isomer, and 3alpha- and 3beta-hydroxytibolone, were studied and compared to those of structurally related compounds. The Delta(4)-isomer was the strongest binder and activator of the progesterone receptor (PR); tibolone was 10 times weaker in binding and half as potent in transactivation of PR; 3alpha- and 3beta-hydroxytibolone did not bind or activate PR. In rabbits oral tibolone produced a minor progestagenic effect in the endometrium, whereas co-administration of tibolone and the anti-estrogen ICI 164,384 unmasked tibolone's progestagenic effect. 3-Hydroxytibolones were the strongest binders and activators of the estrogen receptors (ERs), with greater affinity for ERalpha than for ERbeta. Tibolone showed weaker binding and activation of both ERs and the Delta(4)-isomer has a binding and activation activity of less than 0.1% of E2 for ERalpha or ERbeta. Tamoxifen and 4-hydroxytamoxifen showed partial ERalpha agonistic effects with a maximal response of 12% and raloxifene of 3-5%. Oral administration of 1mg tibolone to ovariectomized rats induced an estrogenic effect on vaginal epithelium. The Delta(4)-isomer was a stronger binder and activator of the androgen receptor (AR) than tibolone; both 3-hydroxytibolones did not bind or activate AR. Introducing a 7alpha-methyl group decreased progestagenic and increased androgenic activity. We conclude that the progestagenic and androgenic activities of tibolone are mediated by the Delta(4)-isomer, and the estrogenic activity, by the 3-hydroxytibolones. The estrogenic activity of the 3-hydroxytibolones masked the progestagenic activity of tibolone in rabbit endometrium. Full estrogenic response was observed in rat vaginal tissue after oral administration of tibolone.

Bedside estimation of Down syndrome risk during first-trimester ultrasound screening.

OBJECTIVE: To construct tables for 'bedside' estimation of Down syndrome risk based on maternal age and nuchal translucency measurements. METHODS: Likelihood ratios were calculated using the log multiple of median Gaussian model. The parameters for the model (mean and standard deviation) were derived from 5560 normal and 51 Down syndrome-affected pregnancies scanned during the first trimester in three different centers. Equations for calculating maternal background risk and median values were obtained from previous reports. The results were compared to two modalities using the log Gaussian model and software that uses the delta-value model. RESULTS: The distribution fitted the data well, and the parameters obtained in the study group for the log multiple of median model were a mean of 0 and a standard deviation of 0.12356 among normal pregnancies and a mean of 0.305312 and a standard deviation of 0.240337 among Down syndrome-affected ones. The likelihood ratios obtained for the various combinations of fetal crown-rump lengths and nuchal translucency measurements were comparable to other modalities reported earlier. CONCLUSIONS: The results of the current study provide useful tables for simple and accurate 'bedside' estimation of Down syndrome risk without the need for computerized software or complicated calculations.