Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disease in which environmental and medication-related exposures may precipitate disease onset or flares in susceptible individuals, which can result in lupus nephritis (LN) and, in rare cases, posterior reversible encephalopathy syndrome (PRES). Immediate hypersensitivity reactions preceding the initial presentation of SLE have rarely been described. We report that a 21-year-old Hispanic woman developed airway-compromising angioedema, encephalopathy, and generalized tonic-clonic seizures, requiring intubation after her first depot medroxyprogesterone acetate (DMPA) injection. Brain magnetic resonance imaging (MRI) demonstrated PRES with extensive posterior vasogenic edema consistent with PRES with hemorrhagic transformation and bilateral posterior cerebral artery vasoconstriction. Laboratory evaluation revealed acute kidney injury with proteinuria, hypocomplementemia, positive antinuclear and antidouble-stranded DNA antibodies, and positive SSA antibodies. Kidney biopsy confirmed class IV diffuse LN. Treatment included pulse corticosteroids, seizure prophylaxis, immunosuppressants, and antihypertensive therapy, resulting in neurological and renal recovery. Although causality cannot be inferred, the temporal sequence raises the hypothesis that immune activation associated with DMPA exposure, or hypersensitivity to one of its excipients, may have contributed to the clinical unmasking of autoimmune disease.

In recent years, food safety concerns associated with veterinary drug residues have aroused significant public attention, highlighting the critical need for continuous monitoring in both animal-derived foods and the environment to safeguard public health. Medroxyprogesterone acetate (MPA), a major anabolic steroid widely used in animal husbandry, poses potential human health risks according to recent studies. Although conventional analytical techniques based on chromatography and immunological assays are effective, they often suffer from complex operations, the need for skilled personnel, high cost, and time consumption. To overcome these limitations, electrochemical immunosensors modified with advanced nanomaterials offer a promising alternative. Herein, a highly sensitive electrochemical immunosensor was developed for trace MPA detection utilizing core-shell SiO2-PEI@Ag nanoparticles as the sensing matrix. In this nanocomposite, the structural synergy between the SiO2 core and outer Ag NPs shell not only provides a high-density platform for specific antibody immobilization, but also drastically expands the electroactive surface area and accelerates electron transfer to maximize signal amplification. Benefiting from these synergistic advantages, the constructed immunosensor exhibited a limit of detection (LOD) of 0.014 ng/mL and a wide linear range of 0.03-100 ng/mL. Furthermore, the recovery rates in pork and milk samples were 91.32-97.29% and 95.14-102.54%, respectively. In addition, negligible cross-reaction was observed toward structurally related steroid hormones related to MPA and common antibiotics. The immunosensor shows good stability, reproducibility, and accuracy, demonstrating great potential as a promising candidate to complement conventional tools for future MPA residue screening.

The ovarian responses concerning types of vaginal devices in fat-tailed ewes carrying the Booroola fecundity gene (FecB) has not been studied in detail. Evaluation of the ovulatory responses and distributions following estrus synchronization with controlled internal drug release (CIDR) or a vaginal sponge in ewes carrying FecB compared to non-carriers and reproductive indices after laparoscopic insemination (LI) are the aims of the current study. Estrus was synchronized using CIDR ( n = 16 ) or medroxyprogesterone acetate (MPA) sponge ( n = 15 ) insertion (day - 14) and an eCG injection on device removal (day 0). Laparoscopic insemination was performed, and the ovarian structures were measured intensively using a transvaginal probe after - 14 and 0 d as well as after 36-38 and 48-51 h and continued every 4 h until 75 h after the eCG treatment. The progesterone amounts were measured in sera samples. The initiation and termination of ovulations happened earlier in CIDR-receiving ewes and FecB carriers compared to MPA-sponge-treated ewes and non-carriers, respectively ( P < 0.05 ). Progesterone concentrations were higher in the CIDR group compared to MPA sponge group on day 0. Device types did not affect the sizes of ovulatory follicles, corpora lutea diameters, and reproductive indices ( P > 0.05 ), while the twining rate, litter size, and reproductive rate were greater in FecB carriers compared to non-carriers ( P < 0.05 ). Ovulation synchronization with MPA sponge with an eCG delayed the ovulation but did not influence the conception rate compared to CIDR-treated ewes. In spite of the smaller sizes of the ovulatory follicles and subsequent corpora lutea, higher reproductive outcomes were acquired in the FecB carriers compared to non-carrier fat-tailed ewes following LA.

Meningiomas are the most common central nervous system tumour and are associated with significant morbidity. Mounting evidence implicates the role of exogenous hormones in meningioma development and growth. This has led to increasing pressure on healthcare professionals to understand the risk profile of different hormonal compounds with regards to meningioma incidence and growth. This is particularly relevant when managing patients with pre-existing meningioma tumours or with one or more risk factors for meningioma formation. The aim of this review was to summarise existing evidence from clinical studies (cohort and case-control) concerning the risk of meningioma associated with different types of exogenous hormones and the associated meningioma characteristics. The literature review identified over 30 cohort and case-control studies published between 2003 and 2026. Studies demonstrated a mixed risk profile of broadly defined hormonal replacement therapy and hormonal contraceptives; however, many of these studies did not capture specific information about duration, dose or medication type. Risk associated with synthetic progestin-containing compounds such as depot medroxyprogesterone and desogestrel contraceptives was higher and related to duration of use. Highly potent synthetic progestins including cyproterone acetate (CPA) carried the strongest risk profile and showed a strong association with multiple meningiomas and anterior/middle skull base location. In conclusion, there is strong evidence for a link between meningioma incidence and highly potent synthetic progestins such as CPA, but further evidence is needed regarding menopausal hormone therapy and broadly defined oral contraceptives, as well as the doses and durations that are associated with clinically relevant risk. There is a space for translational research in this area to better understand the molecular basis underlying the relationship between hormones and meningioma growth.

There are a growing number of reproductive age solid organ transplant (SOT) recipients, yet comparative data on contraception use across organ types are limited. We performed a retrospective cohort study of women who underwent first-time liver, kidney, heart, or lung transplantation between the ages of 18 and 45 from 2015 and 2025 using TriNetX (n=10,155). Contraception uptake within two years was assessed by organ, including patterns of initial contraceptive choice and subsequent changes in contraception choice, and clinical outcomes, including osteoporosis, thromboembolism, and graft rejection, were compared by contraception type. Among 10,155 eligible SOTR, 19.9% had documented contraception within two years of SOT (heart 27.3%, lung 22.5%, kidney 19.7%, liver 16.8%, p<0.001). Combined oral contraception was the most common initial contraception method, followed by depot medroxyprogesterone acetate (DMPA). However, those who started on DMPA were more likely to switch medications. Compared with no contraception, DMPA was associated with increased osteoporosis, hypertension, thrombosis, and graft rejection, whereas estradiol-containing agents were not. Overall, contraception use after SOT was extremely uncommon with exceedingly low rates of highly effective options, particularly after liver and kidney transplant. Higher switching and adverse associations with DMPA support early, organ-tailored contraceptive counseling and careful method selection post-SOT.

Fertility-sparing treatment is a viable treatment option for selected patients with endometrial or ovarian cancer. However, its use in synchronous endometrial and ovarian cancer (SEOC) remains rare, and standardized treatment strategies have yet to be established. We report the case of a 26-year-old woman diagnosed with SEOC, characterized as grade 1, stage IA endometrioid carcinoma of both the endometrium and ovary. Genetic analysis ruled out hereditary cancer syndromes, including Lynch syndrome. The patient was treated with medroxyprogesterone acetate for 26 weeks, after which histological evaluation confirmed complete remission. She subsequently achieved two spontaneous pregnancies, both resulting in uncomplicated vaginal deliveries. To our knowledge, this is the fifth reported case of childbirth following fertility-sparing treatment for SEOC and the first involving two successful deliveries.

Long-acting injectable (LAI) suspensions have emerged as a promising class of drug delivery systems offering sustained drug release, improved patient adherence, and reduced dosing frequency. However, their in vivo performance remains poorly understood due to the complex interplay of physicochemical and physiological factors governing depot formation at the intramuscular (IM) injection site. The present study provides a mechanistic understanding of intramuscular depot formation and drug release of Depo-Provera® (medroxyprogesterone acetate) injectable suspension and its qualitatively and quantitatively (Q1/Q2) equivalent formulations from a physicochemical perspective. Characterization of polyethylene glycol (PEG3350) polymers from two different suppliers revealed notable differences in molecular weight and polydispersity. These molecular-scale variations appeared to influence the strength of particle-polymer agglomerates, with the extent of this effect likely depending on both the polymer characteristics and the surface chemistry of the drug substance. These differing interactions subsequently contribute to variations in both in vitro and in vivo drug release behavior. In vivo studies in female New Zealand White rabbits demonstrated formulation-dependent differences in depot morphology and excipient retention. Depots formed by Depo Provera® and its Q1/Q2 equivalents with formulation differences retained more than 60% of PEG3350 after 14 days and were gel-like in appearance. Whereas, Depo Provera® Q1/Q2 equivalents with manufacturing differences showed reduced PEG retention and formed granular depots. Scanning electron microscopy (SEM) analyses further revealed distinct patterns of particle evolution: compact depots primarily underwent surface dissolution and largely preserved the particle morphology, while loosely packed granular depots dissolved from both the surface and the core, resulting in reduced particle size and altered morphology. Differential scanning calorimetry showed that medroxyprogesterone acetate in the formulations with manufacturing differences maintained crystallinity, whereas those with formulation differences demonstrated reduced melting points consistent with plasticization and hydration effects. Histopathological and immunohistochemical analyses showed that depot morphology directly influenced the local tissue response. Compact depots primarily induced macrophage accumulation at the periphery. In contrast, sparse, loosely structured, granular depots allowed deeper macrophage infiltration and elicited a more pronounced inflammatory response. Co-administration of dexamethasone microspheres markedly attenuated inflammation and reduced CD68-positive cell density across the formulations. However, no clear correlation was observed between particle size and in vivo drug release under the study conditions, potentially due to confounding factors affecting systemic clearance. Instead, a potential association was identified between depot structure, local immune response, and drug release kinetics, highlighting depot morphology and tissue interactions as key determinants of the in vivo performance.

Extended-release buprenorphine (Bup-XR) is commonly used to manage postoperative pain in rodents while minimizing stress related to handling. An FDA-indexed Bup-XR formulation is commercially available (Ethiqa XR; Fidelis Animal Health, New Brunswick, NJ) and is indicated for the control of postprocedural pain in multiple species, including rats. Despite its widespread use in multiple rat strains, the safety and efficacy of Bup-XR in the August Copenhagen Irish (ACI) rat strain has not been reported, particularly when it is combined with nonsteroidal anti-inflammatory drugs (NSAIDs) and local anesthetics. In this study, 20 male ACI rats aged 6-13 months underwent a minor surgical procedure involving continuous-release hormone pellet implantation ('pellets'), performed either as a primary implantation or a replacement procedure. All rats were administered Bup-XR (0.65 mg/kg, SC) before the procedure. They were also administered carprofen (5 mg/kg, SC) immediately before surgery, as well as bupivacaine (1.8 mg/kg) as a line block anesthetic along the incision line after surgery. Adverse reactions were observed in all animals within 24 hours of surgery, with marked lethargy being most noticeable. Additional symptoms during the first postoperative week included pica behavior, labored breathing, gastrointestinal distress, self-injurious behavior, and dehydration. Within 9 days of the procedure, 13 of 20 males (65%) either died or were humanely euthanized due to significant welfare concerns. Statistical testing confirmed that neither age, weight, nor replacement pellet surgery was significantly associated with mortality. These findings suggest that the adverse effects observed in this strain of rat postsurgery are associated with the use of Bup-XR, possibly in combination with the other agents.