Altered leptin,adiponectin, resistin and ghrelin secretion may represent an intrinsic polycystic ovary syndrome abnormality

Abstract

The aim of the study was to investigate whether altered adipose tissue secretion of various adipokines is secondary to obesity, hyperandrogenism, and hyperinsulinemia or intrinsic to polycystic ovary syndrome (PCOS). This cross-sectional study included 151 women diagnosed with PCOS by the Rotterdam criteria and 95 healthy women matched by age, body mass index (BMI), and waist-to-hip ratio (WHR). Clinical, biochemical, and hormonal characteristics were assessed. Serum concentrations of ghrelin and adiponectin were found to be significantly lower and concentrations of leptin and resistin significantly higher in women with PCOS than in healthy women matched by age, BMI, and WHR. A PCOS diagnosis made the largest contribution to predicting serum levels of leptin, adiponectin, resistin, and ghrelin in all stepwise multiple regression models, which included PCOS diagnosis, BMI, WHR, luteinizing hormone, total testosterone, free testosterone and homeostatic model assessment of insulin resistance as independent predictors. Leptin, adiponectin, ghrelin and resistin levels may serve as independent biomarkers for the diagnosis of PCOS.     

Evaluation of VP 2 epitopes of infectious bursal disease virus using in vitro expression and radioimmunoprecipitation

Summary A clone (pV 17-7) spanning a portion of the VP2 gene of infectious bursal disease virus (IBDV) was selected from a cDNA library produced using the variant A virus strain. This clone was expressed in vitro and the protein products were immunoprecipitated with various virus-neutralizing antisera made against 6 different strains of IBDV. The antisera made against 4 variant strains immunoprecipitated the translation products from the pV 17-7 clone, but the antisera to the classic STC virus and the serotype 2 OH virus did not immunoprecipitate the pV 17-7 translation products.     

Pain and the relationship with mood and anxiety disorders and psychological symptoms

ObjectiveThe objective of this study was to investigate the association between pain and mood and anxiety disorders, as well as psychological symptoms, in a population-based sample of women.MethodsThis study examined the data collected from 1067 women aged 20–93 years (median 51 years) participating in the Geelong Osteoporosis Study. Mood and anxiety disorders were diagnosed using a clinical interview (SCID-I/NP) and psychological symptomatology was assessed using the General Health Questionnaire. Pain was determined using a Visual Analogue Scale (0–100 mm) and deemed present if score ≥ 40 mm.ResultsCurrent mood disorders were associated with an increased likelihood of overall (OR = 3.2, 95% CI 2.0–5.1), headache (OR = 2.8, 95% CI 1.6–4.8), back (OR = 4.0, 95% CI 2.5–6.5) and shoulder pain (OR = 2.2, 95% CI 1.2–4.2). In those with current mood disorders, the pain interfered with daily activities (OR = 3.2, 95% CI 1.9–5.5) and was present most of their time awake (OR = 2.5, 95% CI 1.5–4.1). This pattern was similarly observed for those with past mood disorders. Current anxiety disorders were associated with an increased likelihood for overall (OR = 2.2, 95% CI 1.4–3.6), headache (OR = 2.2, 95% CI 1.3–4.0), back (OR = 1.8, 95% CI 1.1–3.0) and shoulder pain (OR = 1.9, 95% CI 1.0–3.5, p = .05). In those with current anxiety disorders, the pain interfered with daily activities (OR = 2.4, 95% CI 1.4–4.1) and was present most of their time awake (OR = 1.9, 95% CI 1.2–3.2). There was no association between pain and past anxiety. Psychological symptomatology was associated with pain at each site (all p < .001).ConclusionsThis study is consistent with studies utilising clinical samples in reporting that mood and anxiety disorders, as well as psychological symptoms, are associated with higher levels of perceived pain.     

Detection of possible factors favouring the evolution of migraine without aura into chronic migraine

In a minority of cases, the natural history of migraine without aura (MO) is characterised over time by its evolution into a form of chronic migraine (CM). In order to detect the possible factors predicting this negative evolution of MO, we searched in our Headache Centre files for all clinical records that met the following criteria: (a) first visit between 1976 and 1998; (b) diagnosis of MO or of common migraine at the first observation, with or without association with other primary headache types; (c) <15 days per month of migraine at the first observation; and (d) at least one follow-up visit at least 10 years after the first visit. The patients thus identified were then divided into two groups based on a favourable/steady evolution (Group A: n = 243, 195 women and 48 men) or an unfavourable evolution (Group B: n = 72, 62 women and 10 men) of their migraine over time. In the two groups, we compared various clinical parameters that were present at the first observation or emerged at the subsequent follow-up visits. The parameters that were statistically significantly more frequent in Group B--and can therefore be considered possible negative prognostic factors--were: (a) ≥ 10 days per month of migraine at the first observation; (b) presence of depression at the first visit in males; and (c) onset of depression or arterial hypertension after the first observation but before transformation to CM in females. Based on these findings, in MO patients the high frequency of migraine attacks, comorbidity with depression, and the tendency to develop arterial hypertension should require particular attention and careful management to prevent evolution into CM.     

Management of nonpalpable ultrasound-indeterminate breast lesions

BACKGROUND: A series of such lesions was studied to determine the validity of applying criteria routinely used to manage palpable breast cysts to the management of mammographically detected, nonpalpable breast lesions characterized as indeterminate on ultrasound (US). METHODS: The clinicopathologic data from a series of 134 patients who underwent US-guided fine needle aspiration biopsy for nonpalpable, mammographically detected breast lesions, categorized as indeterminate on US, were reviewed. RESULTS: Of 139 indeterminate lesions, 78 were consistent with complex cysts, whereas in 61, the cystic-versus-solid nature was indistinguishable. All 71 complex cyst lesions that contained nonbloody fluid and resolved completely were benign. Two of 7 complex cyst lesions that had incomplete resolution, bloody aspirate, or both were malignant. Of 61 cystic-versus-solid lesions, 29 and 32 were primarily solid and cystic, respectively. Three of the 29 solid lesions were malignant. Of the 32 cystic lesions, all 26 that contained nonbloody fluid and resolved completely were benign, whereas 1 of 6 lesions that had incomplete resolution, bloody aspirate, or both was malignant. CONCLUSION: Criteria such as complete resolution and nonbloody aspirate are an effective adjunct to the management of nonpalpable, mammographically detected breast lesions categorized as indeterminate by US.     

A prospective evaluation of a quantitative D-dimer assay in the evaluation of acute pulmonary embolism

PURPOSE: A prospective study was designed to determine if a screening quantitative serum D-dimer measurement of 1.0 microg/mL or less precludes pulmonary computed tomographic (CT) angiography in patients with possible acute pulmonary embolism (PE). MATERIALS AND METHODS: Over a period of 16 months, every patient seen in the emergency department in whom there was clinical suspicion of PE sufficient to warrant pulmonary CT angiography was also requested to have a quantitative serum D-dimer level measurement taken. All pulmonary CT angiography procedures were performed on a four-slice scanner and every examination was overread by a radiologist who was blinded to the D-dimer assay results. Three-month medical record and telephone follow-up was carried out for all participants who had a serum D-dimer level of 1.0 microg/mL or less to verify no new diagnosis or death from PE. RESULTS: In this prospective study, 361 consecutive patients who received pulmonary CT angiography had a D-dimer level of 1.0 microg/mL or less. There were 310 patients who had negative pulmonary CT angiography results and 50 patients who had indeterminate CT angiography results. Only one patient had positive pulmonary CT angiography findings. Minimum 3-month follow-up information was available for 349 patients, none of whom reported subsequent PE, including those with indeterminate pulmonary CT angiography results. CONCLUSION: The use of a screening D-dimer measurement of 1.0 microg/mL or less precludes pulmonary CT angiography in patients with possible acute PE. The use of this quantitative D-dimer assay would decrease radiation exposure, contrast medium toxicity, cost, and time for patients seen in the emergency medicine department.     

What Demographic and Clinical Characteristics Correlate With Expectations With Trapeziometacarpal Arthritis?

Background

Pretreatment variables have been shown to be associated with the fulfillment of patient expectations, yet in treating thumb trapeziometacarpal osteoarthritis (OA) it remains unclear how patient expectations correlate with the effectiveness of treatment. An increased understanding of the variables that affect patient expectations enables tailored patient education and patient-provider communication.

Questions/purposes

(1) Is there a correlation between patient demographics and clinical characteristics, and the expectations the patients have when seeking treatment for trapeziometacarpal OA? (2) What factors are independently associated with the total expectations score and frequency of expecting “back to normal” among patients treated for trapeziometacarpal OA?

Methods

Between March 2011 and October 2013, 89 patients of all 96 eligible patients seeking treatment for trapeziometacarpal OA were approached and agreed to participate in this study. Participants completed a validated expectations survey measuring the number of expectations and the degree of improvement expected. Comparative analysis of demographic and clinical characteristics and multivariate regression analysis against patients’ expectations were performed to assess and identify factors that correlate with the number and degree of expectations. Sample size was determined with an a priori power analysis (with 80% power and statistical significance set at p < 0.05), which showed that 88 patients were needed to detect the minimal clinical difference of 12 points in the Michigan Hand Questionnaire; we then increased this by 10% to allow for potential dropouts.

Results

After controlling for potential confounding variables such as age, hand dominance, and work status, the following factors were associated with a higher expectations score: choice of surgery (β = 11.5; 95% CI, 0.7–23.8; p = 0.044), female gender (β = 19.0; 95% CI, 5.3–32.7; p = 0.007), and dominant side affected (β = ?41.6; 95% CI, ?63.7 to ?19.5; p < 0.001). For the frequency of “back to normal” responses, surgical treatment (β = 7.4; 95% CI, 2.3–12.4; p = 0.005) and history of previous injury (β = 8.2; 95% CI, 0.1–16.3; p = 0.047) were independently associated factors after controlling for confounding variables. There were no independent associations with age, marital status, work status, depression or anxiety, or prior contralateral surgery.

Conclusions

Patients whose dominant side was affected, were female, and chose surgical treatment, had higher total expectations. Patients who reported an antecedent injury and chose surgical treatment more frequently expected a return to normal. With identification of these factors, orthopaedic surgeons can recognize patients who are prone to higher expectations, and, thus, have the opportunity to implement efficient pretreatment education. In addition, identification of specific factors enables a focused measure of the effect of these factors on the fulfillment of expectations.

Level of Evidence

Level II, prognostic study.