Ethnicity in polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is the commonest gynecological endocrinopathy. Little is known about the exact etiopathogenesis and cardiometabolic mortality and morbidity in women with PCOS. PCOS is beyond the cosmetic concerns of an adolescent and fertility concerns of an adult and can cause serious unhealthy consequences in perimenopausal and postmenopausal age. This area needs to be assessed and addressed since the majority of these patients are lost to follow-up after completion of their families. Good evidence suggests that there are significant racial and ethnic differences in prevalence, insulin resistance, metabolic syndrome, hyperandrogenemia and the related cardiometabolic risk in women with PCOS.

The futile case of the aging ovary: is it mission impossible? A focused review.

Despite immense and impressive progress in the field of reproductive medicine, little has been achieved in terms of replenishing aged ovaries and improving their reproductive outcome. Age causes irreversible damage to human eggs in terms of quantity as well as quality. Nature probably designed women to reproduce best in their twenties and thirties. However, due to social, personal, career, educational and financial pressures, women delay pregnancies until their late thirties, by which time the chance of becoming pregnant is compromised by low fecundity rates and an increased risk of miscarriage. Age, unfortunately, is the most detrimental prognostic factor for success of fertility treatment. We have seen an increasing population of older women seeking fertility treatment. The existing evidence does not offer any clear-cut guidelines for the clinical handling of older women seeking fertility treatment. Various strategies have been tried to improve the fertility outcome of such women, but none has met with significant success. This review focuses on what can and what cannot be done in terms of improving fertility rates in older women.

Polycystic ovary syndrome and metabolic syndrome: the worrisome twosome?

By virtue of insulin resistance being the common etiology for polycystic ovary syndrome (PCOS) and metabolic syndrome, the cardiometabolic risks of these two syndromes are shared. The usual concerns of a PCOS patient are cosmetic or reproductive. However, there are more serious concerns past the reproductive age. Early treatment of insulin resistance, hypertension and hyperlipidemia reduces the long-term risk. This review highlights the unhealthy association of metabolic syndrome with PCOS and emphasizes the importance of early diagnosis, patient education and long-term follow-up beyond the reproductive age into menopause to prevent the long-term serious co-morbidities.

Comparative Analysis of Stereotactic Radiation Therapy and Conventional Radiation Therapy in Cancer Pain Control: A Systematic Review and Meta-Analysis.

AIMS: Approximately 55% of patients diagnosed with primary or metastatic cancer endure pain directly attributable to the disease. Consequently, it becomes imperative to address pain management through a comparative analysis of stereotactic radiotherapy (SRT) and conventional radiation therapy (CRT), especially in light of the less efficacious improvement achieved solely through pharmacological interventions. MATERIALS AND METHODS: A systematic exploration was undertaken on PubMed, the Cochrane Library, and Elsevier's ScienceDirect databases to identify studies that compare Stereotactic Radiotherapy to Conventional radiation therapy for pain management in individuals with metastatic bone cancer. The analyses were executed utilizing the random-effects model. RESULTS: A cohort of 1152 participants with metastatic bone cancer was analyzed, demonstrating significantly higher complete pain relief in the Stereotactic Radiotherapy group during both early and late follow-up (RR: 1.61; 95% CI: 1.17, 2.23, p-value: 0.004; I2: 0%). Stereotactic Radiotherapy also showed a non-significant increase in the incidence of partial pain relief (RR: 1.07; 95% CI: 0.85, 1.34, p-value: 0.56; I2: 18%). Furthermore, Stereotactic Radiotherapy was associated with a significantly reduced risk of stationary pain throughout follow-up (RR: 0.61; 95%CI: 0.48, 0.76, p-value: <0.0001; I2: 0. The incidence of progressive pain was non-significantly reduced with Stereotactic Radiotherapy during both early and late follow-up (RR: 0.77; 95% CI: 0.50, 1.17, p-value: 0.22; I2: 0%). Secondary outcomes exhibited a non-significant trend favoring Stereotactic Radiotherapy for dysphagia, esophagitis, pain, and radiodermatitis, while a non-significant increase was observed for nausea, fatigue, and vertebral compression fracture. CONCLUSION: In summary, stereotactic radiation therapy (SRT) has improved in achieving complete pain relief while exhibiting a decreased probability of delivering stationary pain compared to conventional radiation therapy (CRT). Nevertheless, it is crucial in future research to address a noteworthy limitation, specifically, the risk of vertebral compression fracture.

ECG dispersion mapping predicts clinical deterioration, measured by increase in the Simple Clinical Score.

OBJECTIVE: ECG dispersion mapping (ECG-DM) is a novel technique that reports abnormal ECG microalternations. We report the ability of ECG-DM to predict clinical deterioration of acutely ill medical patients, as measured by an increase in the Simple Clinical Score (SCS) the day after admission to hospital. METHODS: 453 acutely ill medical patients (mean age 69.7 +/- 14.0 years) had the SCS recorded and ECGDM performed immediately after admission to hospital. RESULTS: 46 patients had an SCS increase 20.8 +/- 7.6 hours after admission. Abnormal micro-alternations during left ventricular re-polarization had the highest association with SCS increase (p=0.0005). Logistic regression showed that only nursing home residence and abnormal micro-alternations during re-polarization of the left ventricle were independent predictors of SCS increase with an odds ratio of 2.84 and 3.01, respectively. CONCLUSION: ECG-DM changes during left ventricular re-polarization are independent predictors of clinical deterioration the day after hospital admission.

Hepcidin-to-ferritin ratio: A potential novel index to predict iron overload-liver fibrosis in ß-thalassemia major.

OBJECTIVES: We aimed to determine a threshold cutoff for hepcidin, ferritin, and the hepcidin-to-ferritin ratio in the diagnosis of liver fibrosis caused by iron overload in chronic hepatitis C virus (HCV)-free ß-thalassemia major patients . METHODS: This 1:1-matched case-control study included 102 individuals (3-30 yr.); 51 ß-thalassemia major patients with iron overload , and 51 apparently healthy individuals. RESULTS: The highest areas under the receiver operating characteristic curves (AUC-ROCs) for the diagnosis of patients vs. controls had overlapping 95% confidence intervals (CIs): serum hepcidin (0.758; 0.64-0.87; P Ë‚ 0.001), serum ferritin (1.000; 1.00-1.00; P˂0.001), and the hepcidin/ferritin ratio (1.000; 1.00-1.00; P˂0.001). For differentiation of patients with liver fibrosis stages of F0-F1 vs. F2-F4 and F0-F1 vs. F3-F4, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) with P-values˂0.001 were the only statistically significant parameters, while the AUC-ROCs of the hepcidin/ferritin ratio (0.631, P=0.188 and 0.684, P=0.098) exhibited 90% and 89.5% sensitivity, respectively, in staging liver fibrosis. CONCLUSION: Our results showed that the hepcidin/ferritin ratio is as effective as the APRI and maybe a better predictor for the diagnosis of liver fibrosis and discriminating its stages, with excellent sensitivity and specificity compared to its components.

Evolution of the Earth's Atmosphere.

We living things are a late outgrowth of the metabolism of our Galaxy. The carbon that enters so importantly into our composition was cooked in the remote past in a dying star. From it at lower temperatures nitrogen and oxygen were formed. These, our indispensable elements, were spewed out into space in the exhalations of red giants and such stellar catastrophes as supernovae, there to be mixed with hydrogen, to form eventually the substance of the sun and planets, and ourselves. The waters of ancient seas set the pattern of ions in our blood. The ancient atmospheres molded our metabolism.

Atmospheric carbon dioxide and aerosols: effects of large increases on global climate.

Effects on the global temperature of large increases in carbon dioxide and aerosol densities in the atmosphere of Earth have been computed. It is found that, although the addition of carbon dioxide in the atmosphere does increase the surface temperature, the rate of temperature increase diminishes with increasing carbon dioxide in the atmosphere. For aerosols, however, the net effect of increase in density is to reduce the surface temperature of Earth. Because of the exponential dependence of the backscattering, the rate of temperature decrease is augmented with increasing aerosol content. An increase by only a factor of 4 in global aerosol background concentration may be sufficient to reduce the surface temperature by as much as 3.5 degrees K. If sustained over a period of several years, such a temperature decrease over the whole globe is believed to be sufficient to trigger an ice age.

Mars: upper atmosphere.

The thermal structure of the upper atmosphere of Mars has been theoretically investigated. The exospheric temperature, for a pure CO(2) model atmosphere, lies between 400 degrees and 700 degrees K. The origin of the Martian atmosphere is discussed in the light of these results.

Mariners 6 and 7: radio occultation measurements of the atmosphere of Mars.

Radio occultation measurements with Mariners 6 and 7 provided refractivity data in the atmosphiere of Mars at four points above its surface. For an atmosphere consisting predominantly of carbon dioxide, surface pressures between 6 and 7 millibars are obtained at three of the points of measurement, and 3.8 at the fourth, indicating an elevation of 5 to 6 kilometers. The temperature profile measured by Mariner 6 near the equator in the daytime indicates temperatures in the stratosphere about 100 degrees K warmer than those predicted by theory. The measurements of Mariner 6 taken at 79 degrees N at the beginning of polar night indicate that conditions are favorable for the condensation of carbon dioxide at almost all altitudes. Mariner 7 measurements taken at 58 degrees S in daytime and 38 degrees N at night also show that carbon dioxide condensation is possible at altitudes above about 25 kilometers. Measurements of the electron density in the ionosphere show that the upper atmosphere is substantially warmer than it was in 1965, possibly because of increased solar activity and closer proximity to the sun.

Atmosphere and ionosphere of venus from the mariner v s-band radio occultation measurement.

Measurements of the frequency, phase, and amplitude of the S-band radio signal of Mariner V as it passed behind Venus were used to obtain the effects of refraction in its atmosphere and ionosphere. Profiles of refractivity, temperature, pressure, and density in the neutral atmosphere, as well as electron density in the daytime ionosphere, are presented. A constant scale height was observed above the tropopause, and the temperature increased with an approximately linear lapse rate below the tropopause to the level at which signal was lost, presumably because heavy defocusing attenuation occurred as critical refraction was approached. An ionosphere having at least two maxima was observed at only 85 kilometers above the tropopause.

Preliminary results on the atmospheres of io and jupiter from the pioneer 10 s-band occultation experiment.

The preliminary analysis of data from the Pioneer 10 S-band radio occultation experinment has revealed the presence of an ionosphere on the Jovian satellite Io (JI) having an electron density peak of about 6 x 10(4) electrons per cubic centimeter at an altitude of approximately 60 to 140 kilometers. This suggests the presence of an atmosphere having a surface number density of about 10(10) to 10(12) per cubic centimeter, corresponding to an atmospheric surface pressure of between 10(-8) and 10(-10) bar, at or below the detection threshold of the Beta Scorpii stellar occultation. A measurement of the atmosphere of Jupiter was obtained down to the level of about 80 millibars, indicating a large temperature increase at about the 20 millibar level, which cannot be explained by the absorption of solar radiation by methane alone and can possibly be due to absorption by particulate matter.

Mariner 9 s-band martian occultation experiment: initial results on the atmosphere and topography of Mars.

A preliminary analysis of 15 radio occultation measurements taken on the day side of Mars between 40 degrees S and 33 degrees S has revealed that the temperature in the lower 15 to 20 kilometers of the atmosphere of Mars is essentially isothermal and warmer than expected. This result, which is also confirmed by the increased altitude of the ionization peak of the ionosphere, can possibly be caused by the absorption of solar radiation by fine particles of dust suspended in the lower atmosphere. The measurements also revealed elevation differences of 13 kilometers and a range of surface pressures between 2.9 and 8.3 millibars. The floor of the classical bright area of Hellas was found to be about 6 kilometers below its western rim and 4 kilometers below the mean radius of Mars at that latitude. The region between Mare Sirenum and Solis Lacus was found to be relatively high, lying 5 to 8 kilometers above the mean radius. The maximum electron density in the ionosphere (about 1.5 x 10(5) electrons per cubic centimeter), which was found to be remarkably constant, was somewhat lower than that observed in 1969 but higher than that observed in 1965.

Maintenance of photosynthesis and the antioxidant defence systems have key roles for survival of Halopeplis perfoliata (Amaranthaceae) in a saline environment.

Coastal salt marsh plants employ various combinations of morphological and physiological adaptations to survive under saline conditions. Little information is available on salinity tolerance mechanisms of Halopeplis perfoliata, a C3 stem succulent halophyte. We investigated the growth, photosynthesis and antioxidant defence mechanisms of H. perfoliata under saline conditions (0, 150, 300 and 600 mM NaCl) in an open greenhouse. Optimal shoot succulence, projected shoot area and relative growth rate were obtained in the low (150 mm NaCl) salinity treatment, while growth was inhibited at the highest salinity (600 mm NaCl). The CO2 compensation point and carbon isotope composition of biomass confirmed C3 photosynthesis. Increases in salinity did not affect the photosynthetic pigment content or maximum quantum efficiency of PSII of H. perfoliata. Assimilation of CO2 (A) also remained unaffected by salinity. A modest effect on some gas exchange and photochemistry parameters was observed at 600 mm NaCl. With increasing salinity, there was a continual increase in respiration, suggesting utilisation of energy to cope with saline conditions. Under 300 and 600 mm NaCl, there was an increase in H2 O2 and MDA with a concomitant rise in AsA, GR content and CAT activity. Hence, H. perfoliata appears to be an obligate halophyte that can grow up to seawater salinities by modulating photosynthetic gas exchange, photochemistry and the antioxidant defence systems.

An evaluation of molecular markers for improved detection of breast cancer metastases in sentinel nodes.

BACKGROUND AND OBJECTIVES: In patients with breast cancer (BC), the sentinel node (SN) is the first node in the axillary basin that receives the primary lymphatic flow and can be used to accurately assess the axillary nodal status without removal of the axillary contents. Currently, histology and/or immunohistochemistry are the routine methods of SN analysis. The primary objective of this study was to develop a reproducible reverse transcription (RT) PCR assay, with emphasis on achieving high specificity for accurate detection of BC micrometastases in the SN. To correct for the heterogeneity of BC cells, a multimarker approach was followed, with the further aim of improving the detection rate of the assay. METHODS: In total, 73 markers were evaluated, of which 7 were breast epithelial markers and 66 were either cancer testis or tumour associated antigens. Twelve BC cell lines and 30 SNs (from 30 patients) were analysed using RT-PCR to determine the in vitro and in vivo detection rates for each of the markers. In addition, 20 axillary nodes obtained from a patient with brain death were used as controls to optimise the PCR cycle numbers for all the markers. RESULTS: Of the 30 SNs, 37% (11/30) were positive on haematoxylin and eosin analysis. Extensive immunohistochemical (IHC) analyses of the haematoxylin and eosin negative nodes confirmed the presence of very small numbers of BC cells in an additional 40% (12/30) of SNs. Molecular analysis with the hMAM-A alone identified metastases in 70% (21/30) of SNs. Using MAGE-A3 in combination with hMAM-A identified metastases in 90% (27/30) of patients. Seven SNs (23%) were negative for micrometastases (with haematoxylin and eosin and IHC) but RT-PCR positive for either hMAM-A or MAGE-A3. CONCLUSIONS: As IHC analysis resulted in a 77% detection rate compared with 37% for haematoxylin and eosin analysis, we consider that IHC is essential in order not to miss SN micrometastases. Molecular analysis with hMAM-A and MAGE-A3 allows detection of BC micrometastases with a 90% detection rate. However, the clinical value of histologically negative but RT-PCR positive SNs can only be determined with long term follow up.

Detection of Mycobacterium avium subsp. paratuberculosis in bovine faecal samples by Quantitative Real-Time Polymerase Chain Reaction (qRT-PCR) TaqMan Assay.

Mycobacterium avium subsp. paratuberculosis, the causative agent of Johne's disease is a degenerative chronic granulomatous disease of bovines. In the present study, quantitative real time polymerase chain reaction (qRT-PCR) using TaqMan chemistry targeting the IS900 sequence of Mycobacterium avium subsp. paratuberculosis (MAP) was employed for the molecular diagnosis of the disease in bovine faecal samples. Out of 200 bovine faecal samples processed, 7 samples were tested as positive by IS900 qRT-PCR. The sensitivity limit of detection of MAP DNA in faecal samples by qRT-PCR TaqMan assay was found to be 0.05pg. No amplification was observed in other Mycobacterial spp. viz. M. phlei, M. smegmatis, M. intracellulare and M. kansasii.

Source identification of Indian opium based on chromatographic fingerprinting of amino acids.

Total and free pool of amino acids was determined in Indian opium samples using liquid chromatography (LC) with post-column opthalaldehyde derivatization followed by its fluorimetric detection. The limit of detection (LOD) was found to be in the range of 2-10 pmol with a signal to noise ratio of 3:1 and limit of quantitation (LOQ) was found to be in the range of 7-31 pmol with a signal to noise ratio of 10:1. The recovery of amino acids was found to be in the range of 86-103%. A total of 124 Indian opium samples were collected from the states of Madhya Pradesh (MP), Uttar Pradesh (UP) and Rajasthan (Raj), covering 14 licit opium growing divisions of India were chromatographically fingerprinted for the presence of various amino acids. The amino acids identified in sample hydrosylate included D, T, S, S, G, A, V, I, L, Y, F, H, K and R, while the analysis of free pool of amino acids (80% aqueous ethanol extract) indicated the presence of D, T, S, E, A, V, I, L, Y, H, K respectively. Multiple discriminant analysis was applied to the quantitative total amino acid data to determine an optimal classifier in order to evaluate the source of Indian opium. The foremost amino acid variables that accounted for the true discrimination were identified as D, E, G, A, F and K in evaluating the geographical origin of Indian opium and the predictive value based on the discriminant analysis was found to be 90% in relation to the source of opium samples. Chemometrics performed with amino acid analytical data was used successfully in discriminating the licit opium growing divisions of India into three major groups, viz. groups I, II and III. The methodology developed may find wide application in forensic analysis.

Oral candidal species among smokers and non-smokers.

OBJECTIVE: To determine the various oral Candidal species among healthy Malaysian adults. DESIGN: Case-control study. PLACE AND DURATION OF STUDY: This study was collaborated between the Department of Medical Microbiology, Faculty of Medicine and Department of Oral Pathology, Oral Medicine and Periodontology, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia, between September 2002 till January 2004. PATIENTS AND METHODS: One hundred adults (50 smokers and 50 non-smokers), aged between 40 and 70 years were studied. Swabs and carbohydrate assimilation (Saboraud Dextrose Agar, Corn Meal Agar, API 20C AUX System) were performed. Specimens were collected from dorsum of the tongue, buccal mucosa and commissures (right and left each). Colony forms were established by positive colony forming units, on SDA medium (24-48 hours). Germ tube test for (true/pseudohyphae) growth was done on Corn Meal Agar Medium. Candida biotypes were evaluated by API 20C AUX system, which had a numerical 7 digit profile, added to evaluate a definite Candida species. RESULTS: Thirty-five percent of Malaysian adults harbored Candida intraorally. Candidal species identified among 100 subjects had C. albicans (27) 77%, C. glabrata (3) 8%, C. famata, C. tropicalis, C. krusei, C. lusitaniae and C. guilliermondii (1) 3% each. Thirty-three positive cases comprised of 35 species i.e. two cases had two species each. Fifty seven percent of these were smokers and 43% non-smokers. These included 40% Chinese, 36% Malays and 24% Indians. Species were, however, not specified according to intra-oral sites i.e. buccal, commissural mucosa and dorsum of tongue. CONCLUSION: On this series C. albicans is the most common species found in the oral cavity of Malaysian adults. It is equally frequent in smokers and non-smokers, but showed a predilection for the ethnic Chinese group.