Purpose To implement an evidence‐based lifestyle modification intervention, guided by motivational interviewing, among a sample of infertile overweight and obese women with polycystic ovary syndrome to increase chances of conception while improving overall health. Data sources A prospective quantitative design was utilized (n = 12). Infertile overweight and obese women with polycystic ovary syndrome at an infertility practice completed questionnaires to assess diet and exercise practices at study onset and completion. Body mass index and weight measurements were obtained on participants at study onset and completion of intervention. Menstrual history was assessed by interview. Conclusions There was a mean weight loss (p = .005) of 7(±5) pounds although a 5% weight reduction did not occur. Mean daily calorie (p = .005), fat (p = .006), and carbohydrate intake (p = .014) were significantly reduced. Frequency in brisk walking exercise significantly increased (p = .024). Frequency in home or gym exercise increased (p = .050). Menstrual cyclicity improved by 50% among prior amenorrheic subjects. Implications for practice An evidence‐based lifestyle modification guideline could prove to be a cost effective intervention for infertile women with polycystic ovary syndrome (PCOS) who desire pregnancy. This intervention could be integrated into the primary care and reproductive medicine visits as sole therapy or in conjunction with infertility treatment.

Mitochondria are important organelles referred to as cellular powerhouses for their unique properties of cellular energy production. With many pathologic conditions and aging, mitochondrial function declines, and there is a reduction in the production of adenosine triphosphate. The energy carrying molecule generated by cellular respiration and by pentose phosphate pathway, an alternative pathway of glucose metabolism. D-ribose is a naturally occurring monosaccharide found in the cells and particularly in the mitochondria is essential in energy production. Without sufficient energy, cells cannot maintain integrity and function. Supplemental D-ribose has been shown to improve cellular processes when there is mitochondrial dysfunction. When individuals take supplemental D-ribose, it can bypass part of the pentose pathway to produce D-ribose-5-phosphate for the production of energy. In this article, we review how energy is produced by cellular respiration, the pentose pathway, and the use of supplemental D-ribose.

BackgroundHeart failure (HF), the leading cause of morbidity and mortality in the US, affects 6.6 million adults with an estimated additional 3 million people by 2030. More than 50% of HF patients have heart failure with preserved left ventricular ejection fraction (HFpEF). These patients have impaired cardiac muscle relaxation and diastolic filling, which investigators have associated with cellular energetic impairment. Patients with HFpEF experience symptoms of: (1) fatigue; (2) shortness of breath; and (3) swelling (edema) of the lower extremities. However, current HF guidelines offer no effective treatment to address these underlying pathophysiologic mechanisms. Thus, we propose a biobehavioral symptom science study using ubiquinol and D-ribose (therapeutic interventions) to target mitochondrial bioenergetics to reduce the complex symptoms experienced by patients with HFpEF.MethodsUsing a randomized, double-blind, placebo-controlled design, the overall objective is to determine if administering ubiquinol and/or D-ribose to HFpEF patients for 12 weeks would decrease the severity of their complex symptoms and improve their cardiac function. The measures used to assess patients’ perceptions of their health status and level of vigor (energy) will be the Kansas City Cardiomyopathy Questionnaire (KCCQ) and Vigor subscale of the Profile of Mood States. The 6-min walk test will be used to test exercise tolerance. Left ventricular diastolic function will be assessed using innovative advanced echocardiography software called speckle tracking. We will measure B-type natriuretic peptides (secreted from ventricles in HF) and lactate/ATP ratio (measure of cellular energetics).DiscussionsUbiquinol (active form of Coenzyme Q10) and D-ribose are two potential treatments that can positively affect cellular energetic impairment, the major underlying mechanism of HFpEF. Ubiquinol, the reduced form of CoQ10, is more effective in adults over the age of 50. In patients with HFpEF, mitochondrial deficiency of ubiquinol results in decreased adenosine triphosphate (ATP) synthesis and reduced scavenging of reactive oxygen species. D-ribose is a substrate required for ATP synthesis and when administered has been shown to improve impaired myocardial bioenergetics. Therefore, if the biological underpinning of deficient mitochondrial ATP in HFpEF is not addressed, patients will suffer major symptoms including lack of energy, fatigue, exertional dyspnea, and exercise intolerance.Trial registrationClinicalTrials.gov Identifier: NCT03133793; Data of Registration: April 28, 2017.

Purpose Patients with heart failure with preserved ejection fraction (HFpEF) experience fatigue due to impaired myocardial bioenergetics. Cardiomyocyte function depends on the delivery of adenosine triphosphate (ATP), yet there is no convenient bedside method to measure ATP. The purpose of this study was to develop a point-of-contact measurement of ATP that can be used in a clinical setting. Methods In a laboratory setting, digital finger punctures were conducted using 5 μl and 10 μl of capillary blood placed into various amounts of water (H2O). After mixing the solution for 10 s, a Hygiena AquaSnapTM Free ATP probe was placed into the solution for 10 s for the detection of ATP. The probe was then placed into the Hygiena luminometer for 15 s, and a value in relative light units (RLU) was obtained. Results Test samples using 10 μl of blood diluted from 50 to 500 mls of H2O produced ATP readings of 10,000-7569 RLUs. Using 5 μl of blood in 375–900 ml of H2O decreased the ATP values to 6459-4189 RLUs. Dilutional volume sparing experiments were conducted with ATP standards to determine the concentration of ATP per RLUs. Conclusion Patients with HFpEF have increased metabolic demand and impaired myocardial bioenergetics. Thus, identifying a method to measure ATP that is quick and accurate is imperative to accurately assess cellular energy production in this population. Point-of-contact measures, such as ATP, are needed for precision-guided treatment. Data from this study provides the first step toward developing evidence for health policies related to managing fatigue.

Objectives: The present study aimed to investigate medication adherence awareness among women undergoing infertility treatment. Materials and Methods: Several databases were searched including PubMed, Embase, CINAHL, PsycINFO, as well as ProQuest dissertations in order to collect the required data. In addition, based on the purpose of the study, English-language prospective, retrospective, observational, cross-sectional, quasi-experimental, and randomized controlled trial studies were selected which focused on medication adherence as a primary or secondary outcome in women with a diagnosis of infertility. Finally, critical appraisal for the quality of the study was assessed using Downs and Black Quality Checklist (1998) and STROBE guidelines. Results: Three studies conducted during 1993-2011 were analyzed. Further, sample sizes varied from 30 to 626 subjects with average rates of oral medication adherence ranging from 26% to 81% when used as the first-line therapy. More frequent daily dosing was associated with lower adherence rates. Based on the results, adherence was significantly lower when women were concerned about the side effects of medication adherence or reported 3 or more side effects rather than one or 2 cases. Furthermore, women with a body mass index of <23 kg/m² or those who viewed medical treatment as convenient had higher adherence rates. It is noteworthy that none of the studies evaluated medication adherence during controlled ovarian hyperstimulation (COH) cycles, along with intrauterine insemination (IUI) or in vitro fertilization (IVF). Conclusions: In general, rates of oral medication adherence are found suboptimal when used alone as first-line therapy. Accordingly, further studies regarding medication-taking behaviors are warranted in future research trials involving injection medications and COH cycles associated with IUI and IVF cycles in order to strengthen the clinical practice.

As nurses engage in behavior change interventions, supporting patients and families in problem-solving will optimize health outcomes and transform clinical practice.

The objective of this review was to examine the comprehensive role of microbiota in epithelial ovarian carcinogenesis. Methods: A scoping review method was used, and relevant databases were searched using combinations of key terms. Human and animal studies were selected that met inclusion criteria and critical appraisal tools were used to assess study quality. Results: A total of 10 international studies (human n = 8; animal n = 2) were included with total samples sizes varying from 16 to 580. Mean/median ages of women with epithelial ovarian cancer (EOC) were 50.5 to 66 years, and controls were 47.3 to 56 years. Compared to the ovaries and fallopian tubes of women without disease, tissue collected from women with EOC were characterized by differing proportions of bacterial phyla including Actinobacteria, Bacteroidetes, Chlamydiae, Firmicutes, and Proteobacteria. Intestinal depletions and reduced diversity of genera Lactobacillus accelerated ovarian tumor growth in animal models. Cytomegalovirus and human papillomavirus types 6, 16, 18, and 45 had a significantly higher prevalence in women with disease and represented up to 70% of cases with high-grade serous ovarian carcinoma. Colonized bacteria were detected in fallopian tubes, peritoneal fluid, and ovarian tissue similar to that of commensal GI tract and vaginal bacteria. Conclusion: The EOC microenvironment harbors diverse microbes. Due to the heterogeneity of microbiota identified between studies, additional research is needed to reconcile findings and ascertain clinical applicability. Future investigations should also examine potential associations between EOC tumor, gut, and vaginal microbiota, patient symptoms throughout disease, chemotherapy response, recurrence, and survival.

GI microbiota has been implicated in producing the inflammatory tumor microenvironment of several cancers. Women with ovarian cancer often report GI-related symptoms at diagnosis although minimal is known about the possible GI bacteria that may trigger pro-tumorigenic immune responses in early EOC. The purpose of this study was to investigate the influences of GI microbiota dysbiosis on serum inflammatory markers during EOC utilizing a rodent model. This experimental design consisted of C57BL/6 mice randomly assigned to either the microbiota dysbiosis group (n = 6) or control group (n = 5). The CD7BL/6 mice assigned to the microbiota dysbiosis group were administered a mixture of broad-spectrum antibiotics (bacitracin and neomycin) for 2 weeks. Both groups were injected intraperitoneally with mouse ovarian epithelial cells that induce ovarian tumorigenesis. Levels of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) were assessed in the serum, and the composition of the GI microbiota in fecal samples was measured using 16S rRNA gene sequencing. Overall CRP serum levels were significantly lower and TNFα levels were significantly higher in the microbiota dysbiosis group compared to the control group. The abundances of microbiota that correlated with CRP serum levels in the combined groups were genus Parabacteroides, Roseburia, and Emergencia and species Ruminococcus faecis, Parabacteroides distasonis, Roseburia Faecis, and Emergencia timonensis. This study provides evidence to support for further investigation of the GI microbial profiles in patients at risk of EOC.