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61.
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63.
Maternal serum androgens in human pregnancy: early increases within the cycle of conception 总被引:1,自引:0,他引:1
Castracane VD; Stewart DR; Gimpel T; Overstreet JW; Lasley BL 《Human reproduction (Oxford, England)》1998,13(2):460-464
Previous studies have demonstrated elevations in testosterone and
androstenedione initiated within the cycle of conception in pregnant
non-human primates, and minimal data in the human support the same picture.
In the present study we have investigated a group of patients scheduled for
artificial insemination with regular menstrual cycles. For this study all
patients provided blood samples at 5 days after the luteinizing hormone
(LH) surges and daily through the luteal phase and into early pregnancy (n
= 12). Patients who did not become pregnant served as normal controls (n =
9). We have measured 17- hydroxyprogesterone (17-OHP) as a marker of luteal
activity not obscured by progesterone within the cycle of conception and
testosterone and androstenedione as the major androgens. There were no
significant changes in testosterone and androstenedione in the non-
pregnant controls, but both testosterone and androstenedione were
significantly elevated in the pregnant luteal phase, with the first
increases occurring at 15 and 14 days respectively after the LH surge.
Three of 12 pregnant patients did not demonstrate a dramatic increase in
either testosterone or androstenedione and when examined more carefully a
corresponding lack of increase in 17-OHP in those same subjects indicated
less than optimal luteal activity, suggesting that these androgens were
products of the corpus luteum. In three subjects in which consecutive
non-pregnant and pregnant cycles were followed there was a dramatic
increase from the non-pregnant luteal phase to the pregnant luteal phase
indicating that the more important observation may be the concentrations of
androgens in the conceptive luteal phase compared to some baseline, either
previous luteal phase or even follicular phase. We have also studied
changes in dehydroepiandrosterone sulphate and found that there was no
significant contribution to this increase in androgens in early conception.
These studies demonstrate a significant increase in both testosterone and
androstenedione presumably of ovarian, specifically luteal, origin and that
adrenal androgen production is not a factor in these changes.
相似文献
64.
65.
Background
Studies have shown that type 2 diabetic patients have higher all-cause mortality than people without diabetes, but it is less clear how diabetes affects mortality in elderly patients and to what degree mortality differs between diabetic men and women. The aim of the present study is to investigate the age- and sex-specific all-cause mortality pattern in patients with type 2 diabetes in comparison with the Danish background population. 相似文献66.
Nielsen AB Gannik D Siersma V Olivarius Nde F 《Scandinavian journal of primary health care》2011,29(3):157-164
Objective
Improving glycaemic control is generally supposed to reduce symptoms experienced by type 2 diabetic patients, but the relationships between glycated haemoglobin (HbA1c), diabetes-related symptoms, and self-rated health (SRH) are unclarified. This study explored the relationships between these aspects of diabetes control.Design
A cross-sectional study one year after diagnosis of type 2 diabetes.Subjects
A population-based sample of 606 type 2 diabetic patients, median age 65.6 years at diagnosis, regularly reviewed in primary care.Main outcome measures
The relationships between HbA1c, diabetes-related symptoms, and SRH.Results
The patients’ median HbA1c was 7.8 (reference interval: 5.4–7.4 % at the time of the study). 270 (45.2%) reported diabetes-related symptoms within the past 14 days. SRH was associated with symptom score (γ = 0.30, p < 0.001) and HbA1c (γ = 0.17, p = 0.038) after correction for covariates. The relation between HbA1c and symptom score was explained by SRH together with other confounders, e.g. hypertension (γ = 0.02, p = 0.40). The relation between the symptom fatigue and SRH was not explained by symptom score and significantly modified the direct association between symptom score and SRH.Conclusions
Symptom relief may not occur even when HbA1c level is at its lowest average level in the natural history of diabetes, and symptoms and SRH are closely linked. Monitoring symptoms in the clinical encounter to extend information on disease severity, as measured e.g. by HbA1c, may help general practitioners and patients to understand the possible impact of treatments and of disease manifestations in order to obtain optimum disease control.Key Words: Family practice, glycosylated haemoglobin A, health status, signs and symptoms, type 2 diabetes mellitusTo reduce complications, lowering of HbA1c is a primary objective in diabetes care.- Many patients experience diabetes-related symptoms in spite of acceptable glycaemic control.
- These symptoms are closely related to poor SRH while the association with HbA1c is weak.
67.
Heldgaard PE Henriksen JE Sidelmann JJ Olivarius Nde F Siersma VD Gram JB 《Scandinavian journal of primary health care》2011,29(2):85-91
OBJECTIVE. To compare the cardiovascular disease (CVD) risk factor profile in subjects with screen-detected type 2 diabetes (SDM) and subjects with known type 2 diabetes (KDM). DESIGN. Population-based, cross-sectional survey. SETTING AND SUBJECTS. In a single, semi-rural general practice 2082 subjects were between 20 and 69 years. Of those, 1970 subjects were invited, and a total of 1374 (69.7%) subjects were examined by blood tests, anthropometric measures, and self-administered questionnaires. RESULTS. Before the survey 19 persons were known to have type 2 diabetes. The screening revealed another 31 individuals with type 2 diabetes, diagnosed according to the 1999 World Health Organization criteria. Age, levels of blood pressure, BMI, and dyslipidaemia, and markers of haemostasis and inflammation were comparable in the two groups. Median age in the KDM group was 58 vs. 57 years in the SDM group, p = 0.82, 79% were male vs. 61%, p = 0.23. In both groups 74% had blood pressure ≥ 130/85 mmHg, p = 1.00. In both groups 90% had BMI ≥ 25, p = 1.00, and about half in both groups had BMI ≥ 30, p = 0.56. In the KDM group 63% had dyslipidaemia (low HDL cholesterol or elevated triglycerides) vs. 80% in the SDM group, p = 0.32. Median levels of plasminogen-activator-inhibitor (PAI-1), tissue plasminogen activator (t-PA), as well as fibrinogen and C-reactive protein (CRP) were without statistically significant differences in the two groups, p > 0.1. In contrast, in markers of glycaemic regulation statistically significant differences were found between groups. Median HbA1 was 8.0 vs. 6.5, p < 0.001. Median fasting whole blood glucose level was 8.8 mmol/L vs. 6.3 mmol/L, p < 0.001, and glucose at two hours during OGTT was 16.9 mmol/L vs. 11.2 mmol/L, p < 0.001. Median fasting serum insulin level was 52 pmol/L vs. 80 pmol/L, p = 0.039 and at two hours 127 pmol/L vs. 479 pmol/L, p < 0.001. CONCLUSIONS. The CVD risk-factor profile of SDM patients was similar to the expected adverse profile of patients with KDM. This indicates an already increased risk of cardiovascular disease in diabetic patients before the diabetes becomes clinically manifest, supporting the need for early diagnosis. 相似文献
68.
Background
Skeletal metastases in oncology patients are identified by Bone scan and/Positron Emission Tomography (PET) scan. But developing countries in the world still lack adequate numbers of these imaging facilities.Aims
Since Magnetic Resonance Imaging (MRI) is widely available as compared to bone scan or PET scan; a double blind study was undertaken to see if whole body imaging with MRI can give an idea of skeletal metastases.Method
Diffusion weighted whole body Magnetic Resonance Imaging with background body signal suppression (DWIBS) was performed using 1.5 Tesla (T) MRI on histopathologically proven cases of carcinoma of breast within two months of mastectomy and followed up after a year of surgery. Similarly bone scan was also performed in these patients.Results
DWIBS MRI demonstrated the presence and extent of bone metastases in 10 out of a total 18 patients included in study while bone scan could demonstrate them in only three cases. A highly significant difference between proportions of the skeletal metastases detected by whole body DWIBS-MRI than that by bone scan at one year follow-up. (i.e. p<0.01, z=2.66) was seen.Conclusion
DWIBS MRI scores high in demonstrating skeletal metastases. Further comparative studies are necessary to evaluate if DWIBS can replace bone scan or PET scan. 相似文献69.
Background
We examined clinical outcomes, patient characteristics and trends over time of non‐medically supervised treatment interruptions (TIs) from a free‐of‐charge antiretroviral therapy (ART) programme in British Columbia (BC), Canada.Methods
Data from ART‐naïve individuals ≥18 years old who initiated triple combination highly active antiretroviral therapy (HAART) between January 2000 and June 2006 were analysed. Participants having ≥3 month gap in HAART coverage were defined as having a TI. Cox proportional hazards modelling was used to examine factors associated with TIs and to examine factors associated with resumption of treatment.Results
A total of 1707 participants were study eligible and 643 (37.7%) experienced TIs. TIs within 1 year of ART initiation decreased from 29% of individuals in 2000 to 19% in 2006 (P<0.001). TIs were independently associated with a history of injection drug use (IDU) (P=0.02), higher baseline CD4 cell counts (P<0.001), hepatitis C co‐infection (P<0.001) and the use of nelfinavir (NFV) (P=0.04) or zidovudine (ZDV)/lamivudine (3TC) (P=0.009) in the primary HAART regimen. Male gender (P<0.001), older age (P<0.001), AIDS at baseline (P=0.008) and having a physician who had prescribed HAART to fewer patients (P=0.03) were protective against TIs. Four hundred and eighty‐eight (71.9%) participants eventually restarted ART with male patients and those who developed an AIDS‐defining illness prior to their TI more likely to restart therapy. Higher CD4 cell counts at the time of TI and unknown hepatitis C status were associated with a reduced likelihood of restarting ART.Conclusion
Treatment interruptions were associated with younger, less ill, female and IDU participants. Most participants with interruptions eventually restarted therapy. Interruptions occurred less frequently in recent years.70.