武汉市青山地区1380例月经失调女性性激素检测结果分析

目的调查武汉市青山地区1 380例月经失调女性的血清性激素水平。方法应用电化学发光免疫分析检测血清中孕酮(PROG)、睾酮(TEST)、泌乳素(PRL)、雌二醇(E2)、促黄体生成素(LH)、卵泡刺激素(FSH)浓度。结果 PROG异常199例,占14.42%;TEST异常128例,占9.28%;PRL异常323例,占23.41%;E2异常334例,占24.20%;LH异常568例,占41.16%;FSH异常553例,占40.07%。结论武汉市青山地区月经失调女性中,LH与FSH异常所占比例最高,卵巢功能失调可能是女性月经失调的主要原因。     

The effects of oral contraceptives on detection and pain thresholds as well as headache intensity during menstrual cycle in migraine

(Headache 2011;51:92‐104) Background.— Clinically, oral contraceptives (OC) can influence pain in both migraine headache and temporomandibular pain disorders. Estrogen as an ingredient of OC might be a responsible factor for these observations. We conducted the present study to test whether OC are able to alter the severity of headache attacks as well as the detection or pain thresholds over the course of the menstrual cycle in patients with migraine. Methods.— Thirteen healthy and regularly menstruating women and 26 migraineurs (13 using OC and 13 not using OC) were studied on the days 1, 4, 14, and 22 of their menstrual cycle. In all participants, saliva was collected first for determination of estrogen on each study day. Then, detection thresholds (warmth, cold, electrical current) and pain thresholds (cold, heat, pressure, electrical current) were assessed. Migraineurs were asked for headache attacks occurring in a period of 24 hours before testing and to estimate pain intensity on a verbal rating scale. Results.— On day 4 of the menstrual cycle, migraineurs using OC suffered significantly more from severe migraine attacks than migraineurs not taking OC. With respect to detection and pain thresholds, no effects of OC could be observed as concerning the differences between migraineurs with or without OC medication. On day 22, the severity of migraine headache was significantly related with the pain thresholds for pressure and electrical current, suggesting paradoxically more severe headache attacks in patients presenting with higher pain thresholds. Healthy volunteers disclosed higher salivary estrogen levels than migraineurs and migraineurs not using OC higher concentrations than migraineurs using OC throughout the menstrual cycle. Conclusions.— In this study, the use of OC intensified migraine (however only at the end of menstruation) however had no influence on detection and pain thresholds in migraineurs. Possible reasons for this dissociation will be discussed.     

Combined Oral Contraceptive Use and Breast Cancer Risk: Select Considerations for Clinicians

Combined oral contraceptives (COCs) are commonly used by individuals for contraceptive and noncontraceptive purposes, such as the management of dysmenorrhea or to reduce risk for ovarian and endometrial cancer. However, a common consideration that continues to arise is whether COC use increases breast cancer risk. Many researchers have investigated this, but study results are varied and may be affected by variables such as hormone type, an individual’s age, and the duration of COC use. In this article, we summarize select breast cancer risk considerations regarding COC use to assist clinicians when counseling individuals considering using oral contraceptives.     

Treatment with combined oral contraceptives induces a rise in serum C-reactive protein in the absence of a general inflammatory response

BACKGROUND: The role of inflammation in the pathogenesis of cardiovascular disease is well established. C-reactive protein (CRP) is the strongest independent predictor of myocardial infarction and stroke in women. Recent studies have indicated that CRP levels are raised during use of combined oral contraceptives (COCs). OBJECTIVES: The aim of the study was to investigate the effect of COCs on serum CRP levels and to indicate the underlying mechanisms of an expected increase. METHOD: In a prospective randomized cross over-study 35 women used two different preparations of COC, one second and one third generation. Serum levels of CRP, serum amyloid A (SAA), interleukin-6 (IL-6), tumor necrosis factor alpha (TNFalpha), antibodies against oxidized LDL, insulin and insulin-like growth factor-I (IGF-I) along with insulin-like growth factor binding protein-1 (IGFBP-1) and IGFBP-3 were analyzed before and during the two treatments. E-selectin, von Willebrand factor and factor VIII concentrations in plasma were also measured. RESULTS: A rise in serum CRP was observed during both treatments; the median level increased from 0.45 mg L(-1) at baseline to 1.48 mg L(-1) with second generation and to 2.02 mg L(-1) with third generation COC. The serum levels of SAA increased slightly during treatment with the third generation COC. IL-6 and TNFalpha were unaffected by treatment. Both preparations lowered IGF-I and raised IGFBP-1 and IGFBP-3 concentrations. CONCLUSION: The raised serum CRP concentration during treatment with COCs appears to be related to a direct effect on hepatocyte CRP synthesis and does not reflect IL-6 mediated inflammation, endothelial activation or induction of insulin resistance.     

Six-minute walk distance as a measure of functional exercise capacity in multiple sclerosis

Purpose.?We hypothesised that six-minute walk (6MWT) distance of patients with ambulatory multiple sclerosis (MS) would differ from age-matched healthy control subjects. We also investigated the contribution of demographic, physical and physiological factors to impaired functional capacity in MS.

Method.?Thirty MS patients and 30 healthy subjects participated in this study. Respiratory muscle strength was measured. Pulmonary function test and 6MWT were performed. The Barthel Index (BI) was used to assess activities of daily living, and the Modified Ashworth Scale was used to determine spasticity. Symptomatic fatigue was measured using the Fatigue Severity Scale (FSS).

Results.?Pulmonary function and respiratory muscle strength of ambulatory MS patients were significantly lower, and baseline heart rate and fatigue perception were significantly higher than were healthy controls (p < 0.05). MS patients reached a significantly higher exercise heart rate, and walked significantly shorter distance than did healthy subjects (p < 0.05). The BI score, baseline heart rate and FSS score together accounted for 81 percent variance in 6MWT distance of MS patients (p < 0.05).

Conclusion.?The shorter distance covered during a 6MWT is determined by the limitations in activities of daily living, resting heart rate and subjective symptomatic fatigue in ambulatory patients with MS. Respiratory muscle weakness, lung function and level of neurological impairment do not contribute to impaired functional exercise capacity in these patients.     

The information score as a measure of oral discourse comprehension in the early school years

Abstract

Purpose: Oral discourse comprehension is a fundamental skill that is predictive of future reading comprehension. The ability to identify important semantic propositions, in a narrative text, and their attachment to a mental model is an essential component of discourse comprehension. This study aimed to pilot a measure of free-recall in a narrative retell across three age groups to explore development. A secondary aim compared measures of free-recall and cued-recall.

Method: One hundred and thirty-two (132) typically developing children aged 4–7 years provided a retell of the Squirrel Story narrative and completed the Narrative Comprehension Assessment (NCA). The Squirrel Story Information Score (SSIS) was used as a novel measure of free-recall calculated from the narrative retells. The NCA, which involves literal and inferential comprehension questions, was used as a measure of cued-recall. Scoring reliability was calculated to ensure test–retest validity.

Result: Correlation analysis found excellent reliability of the SSIS measure. The difference between 4 and 5 year olds, and 5 and 6 year olds, was significant, with a large effect size. The difference between the 5 and 6 year olds was not significant. A large positive correlation was found between the measures of SSIS and NCA.

Conclusion: The measure of SSIS proved sensitive to developmental progression, with a positive relationship found between the measures of free-recall and cued-recall. Variability between the measures highlights the need to consider both measures to ensure an accurate representation of discourse comprehension skills.     

生长激素对脑瘫患儿选择性脊神经切断术后血浆蛋白质代谢的影响

目的 观察脑瘫患儿选择性脊神经切断(SPR)手术后血浆蛋白的变化，探讨重组人生长激素(rhGH)对手术以后营养的治疗效果。方法 选择63例行SPR手术的脑瘫患儿作为研究对象，将这组患者随机分为对照组33例及rhGH组30例，两组术后治疗和支持方案相同，术后48h开始加用rhGHO．1u(ke-／d)^-1皮下注射，连续4～5d。观察两组患儿术后8～9d血浆白蛋白、前白蛋白浓度、血红蛋白水平。结果两组患者手术后血浆白蛋白水平均有明显降低，治疗干预后rhGH组血浆前白蛋白水平显著上升。结论术后早进食及短期thGH治疗有利于改善脑瘫患儿SPR手术后的营养状况。     

A simple, rapid immunometric assay for determination of functional and growth hormone-occupied growth hormone-binding protein in human serum

We present a sensitive time-resolved fluorometric immunofunctional assay (TR-FIA) for direct quantitation of functional growth hormone-binding protein (GHBP), using an immunoassay kit for growth hormone (GH-DELFIA). In addition to the immobilized GH antibody, one monoclonal antibody against GHBP was used. This anti-GHBP was labelled with the chelate of europium. The assay was performed in one step. The detection limit for GHBP was 0.044 nmol L^–1 (NBS + 3 SD). The calibration curve was linear in the interval 0.11–8.03 nmol L^?1. Average intra-assay coefficient of variation (CV) was 3.44%. Average interassay CV at GHBP concentrations 0.563 nmol L^?1 and 1.40 nmol L^?1 were 12% and 6.3% respectively. Analytical recovery in serum ranged from 76% to 127% with a mean of 101 ± 3.6%. Serum GHBP in 102 normal subjects ranged from 0.513 to 3.772 nmol L ¹ and was positively related to body mass index (P < 0.001). In growth hormone-deficient sera GHBP was higher than in control subjects (1.751 ± 0.179 nmol L^?1 and 1.257 ± 0.140 nmol L^?1 respectively, P < 0.001). Acromegalic patients had lower levels of GHBP than controls (0.946 ± 0.251 and 1.234 ± 0.144 nmol L^?1 respectively, P = 0.005). This assay also allowed detection of GH-complexed GHBP in serum. These results were in agreement with theoretical values calculated from the measured GH and the functional GHBP concentrations. Results were compared with data obtained by a recently reported, validated ligand immunofunctional assay (LIFA), which is fundamentally different. There was a significant linear relationship between the results from the two assays (r = 0.89, P = 0.001). The slope of the regression line was 0.65. In conclusion, this new convenient GHBP TR-FIA provides a sensitive and precise method for detecting total GHBP as well as complexed GHBP in human serum, and allows easy processing of large numbers of samples.     

Sex difference in risk of recurrent venous thrombosis and the risk profile for a second event

Summary Background: The risk of recurrent venous thrombosis is higher in men than in women, and this is so far unexplained. We set out to determine the influence of age, time between first and second event, type of first event, oral contraception, pregnancy and surgery. Methods: We performed a prospective follow‐up study of 474 patients with a first objective diagnosis of deep vein thrombosis, aged 18–70 years (Leiden Thrombophilia Study cohort). Results: During 3477 person‐years of follow‐up, 90 recurrences occurred. The overall incidence rates of recurrence (IRs) were 40.9 per 1000 person‐years in men and 15.8 per 1000 person‐years in women. Men with an unprovoked first event had the highest risk of recurrence, with almost one‐third experiencing a second unprovoked event within 8 years (IR 41.2 per 1000 person‐years). This risk was three‐fold lower in women [IR 14.2 per 1000 person‐years; hazard ratio 2.8 (95% confidence interval 1.4–5.7)]. Age at diagnosis had little effect on recurrence rate, and nor had time elapsed since the first event. In women, almost half of the recurrences were provoked and were mainly related to oral contraceptive use or pregnancy. Conclusions: The higher recurrence rate in men than in women is not the result of differences in the environmental or transient risk factors that we studied. The risk profile for a second thrombotic event is clearly different from that of a first.     

Evaluation of pregnancy-associated plasma protein A as a prognostic indicator in acute coronary syndrome patients

BACKGROUND: Higher circulating concentrations of pregnancy-associated plasma protein A (PAPP-A), a potential proatherosclerotic metalloproteinase, have been associated with increased risk for acute coronary syndrome (ACS). Our goal was to determine the ability of circulating concentrations of PAPP-A to predict adverse events in patients presenting to the Emergency Department (ED) with symptoms of ACS. METHODS: A total of 346 patients with symptoms of ACS were included in the study. Serum samples obtained immediately after enrollment were analyzed for PAPP-A and cardiac troponin T (cTnT). The occurrence of adverse events during a 30-day follow-up period was recorded, and receiver-operating characteristic (ROC) curve analysis was performed to evaluate the prognostic characteristics of PAPP-A and cTnT. RESULTS: A total of 33 (9.5 %) patients developed adverse events during the follow up period. At a cut-off concentration of 0.22 mIU/l, PAPP-A was a predictor of adverse events with a sensitivity and specificity (95% C.I.) of 66.7% (48.2-82.0) and 51.1% (45.4-56.8), respectively. The sensitivity and specificity of cTnT were 51.5% (33.6-69.2) and 82.1% (77.4-86.2), respectively, using a 0.01-ng/ml cut-off value, which was obtained using ROC analysis. CONCLUSIONS: PAPP-A appears to be a modest predictor of adverse events in patients presenting to the ED with ACS symptoms, being inferior to cTnT in predicting adverse events in an ED setting. PAPP-A appears to be as sensitive as cTnT, but it is less specific.     

Measurement of plasma 5-hydroxyindoleacetic acid as a possible clinical surrogate marker for the action of antivascular agents.

BACKGROUND: Serotonin (5HT), a naturally occurring vasoactive substance, is released from platelets into plasma under various pathological conditions. Recently, anticancer drugs that act by selectively disrupting tumour blood flow have been found to increase plasma 5HT concentrations in mice. Two such antivascular agents, flavone acetic acid (FAA) and 5,6-dimethylxanthenone-4-acetic acid (DMXAA), have completed Phase I clinical trial and raise the important question of whether suitable surrogate markers for antivascular effects can be identified. METHODS: 5HT is unstable to storage, precluding routine clinical assay, but the 5HT metabolite, 5-hydroxyindoleacetic acid (5HIAA) accumulates in plasma following 5HT release and is a more suitable marker because of its greater stability. We have developed an automated procedure for the assay of the low concentrations of 5HIAA found in humans by combining solid-phase extraction with high-performance liquid chromatography (HPLC). RESULTS: Efficient separation of 5HIAA from possible interfering substances in human plasma, including a variety of pharmaceutical agents, was achieved on C18 columns using cetyltrimethylammonium bromide (CETAB) as an organic modifier. Adequate precision, accuracy and sensitivity were achieved by electrochemical detection (ECD) at +400 mV. Analysis of plasma from two patients treated with DMXAA in a Phase I trial demonstrated DMXAA-induced elevation of plasma 5HIAA with a time course similar to that previously described in mice. CONCLUSIONS: Measurement of changes in plasma 5HIAA provides a new approach to the monitoring of therapies with an antivascular effect. The assay is sensitive to dietary sources of 5HT, which should be minimised.     

Indocyanine green plasma clearance as a measure of changes in hepatic blood flow

Summary. The results from simultaneous measurements of indocyanine green (ICG) plasma clearance and hepatic blood flow (HBF) in subjects without hepatic dysfunction duringchanges in HBF induced pharmacologically or by food stimulation, are reported. A linear relation is established between the relative changes in HBF and that of ICG clearance (r= 0·94), but the changes are not identical, and therefore the changes in HBF cannot be accurately predicted from that of ICG plasma clearance. The reason behind the lack of identity of the changes lies in the complicated kinetics of dye removal by the liver. The hepatic venous catheterization technique is the only method when physiologically correct values for hepatic blood flow or changes therein are wanted.     

窒息高危新生儿早期干预后血液学指标评估

目的：探讨早期干预对出生窒息的高危新生儿体液免疫、生长激素（GH）和胰岛素样生长因子1（IGF-1）的影响及临床评估价值。方法：对本院病房出生的105例窒息高危新生儿进行分组研究,按监护人是否接受后期干预治疗的意愿,将70例足月窒息新生儿分为干预组A1（40例）和对照组A2（30例）,35例早产窒息儿分为干预组B1（20例）和对照组B1（15例）,于出生后1d、3个月、6个月,检测IgG、IgA、IgM、GH和IGF-1含量。结果：窒息高危新生儿出生后体液免疫物质、GH和IGF-1水平两组间差异无统计学意义（P〉0.05）。干预治疗3个月、6个月后,干预组体液免疫物质、GH和IGF-1均高于非干预组,差异均有统计学意义（P〈0.05）。结论：对出生窒息高危新生儿进行早期干预可以提升其体液免疫、GH和IGF-1的水平,有利于提高窒息高危儿的生存质量。     

Evaluation of a 12-week home-based walking intervention for breast cancer survivors

Goals of work To evaluate a 12-week home-based walking intervention among breast cancer survivors and to quantify changes in physical activity (PA) behaviors, body weight, and body composition in response to the intervention. Patients and methods Breast cancer survivors that were in the posttreatment period were randomized to intervention (n=23) or wait-list usual care (n=13). PA was assessed by self-report, and in a study subsample (n=23), by an accelerometer. Intention to treat principles were employed to estimate the intervention effect on PA behaviors, body weight, and body composition. Intervention adherence was calculated as the proportion of exercise sessions completed relative to the number of exercise sessions recommended, as reported each week on walking logs. Main results Thirty-four of 36 women randomized (94%) completed the study. Average intervention adherence over 12 weeks was 94%. Intervention participants reported a significantly greater increase in walking for exercise [+11.9 metabolic equivalent (MET)-h/week] over time than did usual care participants (+1.7 MET-h/week, p=0.01). Objective measures of activity also indicated that intervention participants increased their activity levels over time as compared to usual care participants [i.e., counts/min/day and steps/day (p≤0.04)]. No significant changes in body weight or composition were observed. Conclusion We found that a 12-week home-based walking intervention was safe and effective for increasing short-term PA levels in breast cancer survivors. Future studies are needed to assess the ability of brief interventions to facilitate the maintenance of increased activity levels and to produce favorable quality of life and risk factor outcomes.     

Role of the needling per se in acupuncture as prophylaxis for menstrually related migraine: a randomized placebo-controlled study

The objectives were to introduce a new method for controlled trials of acupuncture in the field of headache research and to examine the role of needling per se. Women with menstrually related migraine were randomized to three months of treatment with verum or placebo needles. Three standard size casts were moulded to secure the placebo needles in the head. No significant differences were found between the verum group (n=15) and the placebo group (n=13) during treatment or follow up three and six months later, either in the attack frequency or in the number of days per month with migraine, headache intensity or drug-use. The casts held the needles exactly in place despite movements of the head, and are validated as practical, hygienic and extremely durable. This method is satisfactory for controlled studies of acupuncture in headache. It is possible that the positive results in earlier clinical trials on acupuncture in migraine are attributable to other mechanisms than needling of subcutaneous tissue.     

Heritability of plasma concentrations of clotting factors and measures of a prethrombotic state in a protein C-deficient family

Summary.  Background : Earlier studies found strong support for a genetic basis for regulation of coagulation factor levels and measures of a prethrombotic state ( d -dimer, prothrombin fragment 1.2). Objectives : Estimation of how much of the variation in the levels of coagulation factors and measures of a prethrombotic state, including measures of protein C activation and inactivation, could be attributed to heritability and household effect. Patients and methods : Blood samples were collected from 330 members of a large kindred of French-Canadian origin with type I protein C deficiency. Heritability and common household effect were estimated for plasma concentrations of prothrombin, factor (F)V, factor VIII, factor (F)IX, fibrinogen, von Willebrand factor (VWF), antithrombin, protein C, protein S, protein Z, protein Z-dependent protease inhibitor (ZPI), fibrinopeptide A (FPA), protein C activation peptide (PCP), activated protein C–protein C inhibitor complex (APC–PCI), activated protein C–α₁-antitrypsin complex (APC–α1AT), prothrombin fragment 1.2 (F1.2) and d -dimer, using the variance component method in sequential oligo-genic linkage analysis routines (SOLAR). Results : The highest heritability was found for measures of thrombin activity (PCP and FPA). High estimates were also found for prothrombin, FV, FIX, protein C, protein Z, ZPI, APC–PCI and APC–α1AT. An important influence of shared household effect on phenotypic variation was found for VWF, antithrombin, protein S and F1.2. Conclusions : We found strong evidence for the heritability of single coagulation factors and measures of a prethrombotic state. Hemostatic markers with statistically significant heritability constitute potential targets for the identification of novel genes involved in the control of quantitative trait loci.     

Commentary on a Cochrane Review of Hormone Therapy for Preventing Cardiovascular Disease in Postmenopausal Women

Findings of a Cochrane Review provide strong evidence that use of hormone therapy has little if any benefit in preventing cardiovascular disease in postmenopausal women and could increase risk for stroke and venous thromboembolic events.