Effect of a low glycemic diet in patients with polycystic ovary syndrome and anovulation - a randomized controlled trial.

OBJECTIVE: To determine whether a low glycemic index diet is better than a normal glycemic index diet in producing ovulatory cycles in women with polycystic ovary syndrome (PCOS) and anovulation. MATERIALS AND METHODS: A randomized controlled clinical trial involving 37 women with PCOS and anovulation. The authors randomly assigned low glycemic index diets (n = 19) and normal glycemic index (n = 18) diets, and analyzed the number of ovulatory cycles for three months. RESULTS: In patients who consumed a low glycemic index diet, 24.6% (14/57) of the cycles were ovulatory. In those who consumed a normal glycemic index diet, only 7.4% (4/54) of the cycles were ovulatory (p = 0.014). CONCLUSIONS: The difference observed in the number of ovulatory cycles could be related to a decrease in the serum levels of circulating androgens, secondary to an improvement in insulin resistance.

Association of the C677T polymorphism in the methylenetetrahydrofolate reductase gene with breast cancer in a Mexican population.

The methylenetetrahydrofolate reductase (MTHFR) gene plays an important role in the steps involved in the processing of amino acids. The analysis of polymorphisms in the MTHFR gene has revealed associations with cancer; in particular the C677T polymorphism, which has been suggested to affect folate metabolism, DNA methylation, synthesis, and repair, and to contribute to tumor promotion in the mammary gland. We examined the role of the C677T polymorphism in the MTHFR gene by comparing the C677T genotypes of 339 healthy Mexican women with those of 497 Mexican women with breast cancer (BC). The genotype frequencies observed in the controls and patients with BC were 10 and 21% for 677TT; 41 and 36% for 677CT; and 49 and 43% for 677CC, respectively. The odds ratio (OR) for the 677TT genotype was 2.5, with a 95% confidence interval (95%CI) of 1.6-3.8; P = 0.0001. The positive association was also evident when the distributions of the 677TT genotype in control and patients affected within the following two categories were compared to alcohol consumption (OR = 0.41; 95%CI = 0.19-0.86; P = 0.018); and high level glutamate-oxaloacetate transaminase (SGOT) (OR = 0.36; 95%CI = 0.15-0.83, P = 0.017). These results suggest that the 677TT genotype of the C677T polymorphism in the MTHFR gene is associated with BC susceptibility in the Mexican population.

Association of the GSTM1 null polymorphism with breast cancer in a Mexican population.

The glutathione S transferase (GST) family plays an important role in the processing of carcinogens. Data on the null GSTM1 genotype has revealed associations with cancer, and has been suggested to affect carcinogen metabolism and to contribute to tumor promotion in the mammary gland. We examined the role of the null GSTM1 genotype by comparing the genotypes of 276 healthy Mexican women with those of 558 Mexican women with breast cancer (BC). The genotype frequencies observed in the controls and patients with BC were 38 and 45% for the null GSTM1 genotype, respectively. The obtained odds ratio (OR) was 1.36, with a 95% confidence interval (95%CI) of 1.02-1.8, P = 0.04. The protective association was also evident upon analysis of the distributions of the null GSTM1 genotype in patients with positive chemotherapy response who had high plasma levels of glucose (OR 0.56, 95%CI = 0.33-0.94, P = 0.03). This study suggested that the null GSTM1 genotype is associated with BC susceptibility in the Mexican population analyzed.

Association of the tumor necrosis factor-alpha -308G>A polymorphism with breast cancer in Mexican women.

The tumor necrosis factor-alpha (TNF-α) gene plays an important role in cell proliferation, differentiation, apoptosis, lipid metabolism, coagulation, insulin resistance, and endothelial function. Polymorphisms of TNF-α have been associated with cancer. We examined the role of the -308G>A polymorphism in this gene by comparing the genotypes of 294 healthy Mexican women with those of 465 Mexican women with breast cancer. The observed genotype frequencies for controls and breast cancer patients were 1 and 14% for AA, 13 and 21% for GA, and 86 and 65% for GG, respectively. We found that the odds ratio (OR) for AA genotype was 2.4, with a 95% confidence interval (95%CI) of 5.9-101.1 (P = 0.0001). The association was also evident when comparing the distribution of the AA-GA genotype in patients in the following categories: 1) premenopause and obesity I (OR = 3.5, 95%CI = 1.3-9.3, P = 0.008), 2) Her-2 neu and tumor stage I-II (OR = 2.5, 95%CI = 1.31-4.8, P = 0.004), 3) premenopause and tumor stage III-IV (OR = 1.7, 95%CI = 1.0-2.9, P = 0.034), 4) chemotherapy non-response and abnormal hematocrit (OR = 2.4, 95%CI = 1.2-4.8, P = 0.015), 5) body mass index and Her-2 neu and III-IV tumor stage (OR = 2.8, 95%CI = 1.2- 6.6, P = 0.016), and 6) nodule metastasis and K-I67 (OR = 4.0, 95%CI = 1.01-15.7, P = 0.038). We concluded that the genotypes AA-GA of the -308G>A polymorphism in TNF-α significantly contribute to breast cancer susceptibility in the analyzed sample from the Mexican population.

Influence of nitric oxide signaling mechanisms in cancer.

Nitric oxide (NO) is a molecule with multiple biological functions that is involved in various pathophysiological processes such as neurotransmission and blood vessel relaxation as well as the endocrine system, immune system, growth factors, and cancer. However, in the carcinogenesis process, it has a dual behavior; at low doses, NO regulates homeostatic functions, while at high concentrations, it promotes tissue damage or acts as an agent for immune defense against microorganisms. Thus, its participation in the carcinogenic process is controversial. Cancer is a multifactorial disease that presents complex behavior. A better understanding of the molecular mechanisms associated with the initiation, promotion, and progression of neoplastic processes is required. Some hypotheses have been proposed regarding the influence of NO in activating oncogenic pathways that trigger carcinogenic processes, because NO might regulate some signaling pathways thought to promote cancer development and more aggressive tumor growth. Additionally, NO inhibits apoptosis of tumor cells, together with the deregulation of proteins that are involved in tissue homeostasis, promoting spreading to other organs and initiating metastatic processes. This paper describes the signaling pathways that are associated with cancer, and how the concentration of NO can serve a beneficial or pathological function in the initiation and promotion of neoplastic events.

WITHDRAWN: Profiles in Comparative Endocrinology: Carl B. Schreck Howard Bern Lecturer, Annual Meeting of Society of Integrative and Comparative Endocrinology, Seattle, January 5, 2010.

This article has been withdrawn at the request of the editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Supraclavicular approach for subclavian vein catheterization in pediatric anesthesia: The reborn of an ancient technique with the ultrasound's assistance. / Acceso central subclavio por vía supraclavicular en anestesia pediátrica: el renacer de una técnica antigua con la ayuda del ultrasonido.

The insertion of a central venous catheter is a procedure frequently performed in paediatric anaesthesia. The most frequent approach for this procedure is the internal jugular vein. However, some specific factors in children, such as the short neck and the easy collapse of this vein, which is accentuated in situations such as hypovolaemia and changes in the respiratory pattern, can lead to greater difficulty. The supraclavicular approach of the subclavian vein was described more than 50 years ago. However, it is not often considered nowadays, even after the introduction of ultrasound, and despite the obvious advantages with respect to the internal jugular approach due to the lower incidence of thrombosis and infection. This document reviews the considerations of the supraclavicular approach according to the available evidence in paediatric anaesthesia, discusses the feasibility and safety of the procedure, and finally describes the technique of ultrasound--guided puncture.

The role of growth hormone in the pathogenesis of postmenopausal osteoporosis.

The secretory response of somatotropic hormone (STH) to arginine hydrochloride stimulation (0.5 g/kg) was studied in 13 postmenopausal women. Eight showed evidence of osteoporosis, based on clinical and morphoradiological data and on metacarpal cortical thickness measurement, and five had normal bone mass. In addition, the response to levodopa (500 mg) was determined in four of the osteoporotic patients. Baseline STH concentrations in the osteoporotic subjects did not differ from those in the nonosteoporotic group, but the latter showed a significant increase over the former at 45, 60, 90, and 120 minutes after stimulation. Similar findings were obtained with levodopa stimulation. Without necessarily implying a cause-effect relationship, our data appear to support the hypothesis that the poor secretory response of STH may be to some degree responsible for the osteopenia observed during the climateric.

Plasma C3d levels and ischemic heart disease in type II diabetes.

OBJECTIVE--To test the hypothesis that the complement system may be activated in patients with type II diabetes and CAD. RESEARCH DESIGN AND METHODS--The plasma C3d concentration was measured in 106 type II diabetic patients and 25 nondiabetic control subjects. The patient group was subdivided according to AER, and the groups were adjusted for age, sex, and known duration of diabetes. For the assignment to a given subgroup, normoalbuminuria was defined as AER < 15 microns/min, microalbuminuria as AER 16-250 micrograms/min, and macroalbuminuria as AER > 250 micrograms/min. The presence or absence of coronary disease was assessed through clinical examination, ECG, and coronary angiography. An RIA system was used for measurement of urinary albumin levels, and the plasma C3d concentrations were measured by ELISA. RESULTS--Within each of the AER-defined subgroups, the plasma C3d levels were significantly higher in patients with IHD than in those without. Thus, in the normoalbuminuric group, plasma C3d levels were 16.3 AU/ml (95% CI 13.9-19) in patients with IHD vs. 11.6 AU/ml (95% CI 10.5-12.7) in those without (P < 0.001). The corresponding data for the microalbuminuric and macroalbuminuric groups were 21.8 (95% CI 18.1-26.3) vs. 13.6 (95% CI 12.3-15.1) and 31.6 (95% CI 24.9-40) vs. 17.5 (13.6-22.6) AU/ml (P < 0.01), respectively. Patients with IHD also had significantly higher plasma C3d levels than normal control subjects, regardless of AER subgroup. A multiple logistic regression analysis demonstrated an association between the plasma C3d concentration and IHD and AER. CONCLUSIONS--Activation of the complement system may play a role in the development of macrovascular disease in type II diabetes.

Intercellular channels in teleosts: functional characterization of two connexins from Atlantic croaker.

Gap junction channels, composed of protein subunits termed connexins, are believed to play a critical role in the process of oocyte differentiation and maturation. We have used the paired Xenopus oocyte assay to characterize functionally two connexin genes, connexin-32.2 and connexin-32.7, recently cloned from the ovary of the Atlantic croaker (Micropogonia undulatus), a species that has emerged as a useful model to study the process of maturation of the ovarian follicle. We have found that, while both connexin proteins were expressed at comparable levels in Xenopus oocytes, only one, connexin-32.2, was functionally competent to induce the formation of intercellular channels. Connexin-32.2 channels exhibited voltage-dependent closure that was similar to, but distinct from that of previously characterized mammalian connexins. In addition, the silent connexin-32.7 was unable to functionally interact with connexin-32.2, either in heterotypic channels or as dominant negative inhibitor. Because connexin-32.2 expression is strikingly regulated during oocyte maturation, these data provide further evidence for a role of intercellular channels in the control of oocyte-follicular cell interactions.

Circulating monocytes in patients with diabetes mellitus, arterial disease, and increased CD14 expression.

Low serum concentrations of high-density lipoprotein (HDL) cholesterol and elevated levels of acute-phase reactans are frequently found in patients with non-insulin-dependent diabetes mellitus (NIDDM) and cardiovascular disease. Changes in the phenotype of circulating monocytes have been reported with both of these circumstances in nondiabetic subjects. In the present study, we explored the possibility that similar changes may occur in circulating monocytes of patients with NIDDM and arterial disease. Two groups of subjects with NIDDM were studied: patients with cardiovascular disease (n = 25) were compared with a group without cardiovascular disease (n = 26); both groups were age- and sex-matched, had the same length of diabetes duration, and degree of glycemic control. Healthy nondiabetic volunteers of comparable age and sex (n = 35) formed the control group. There was no significant difference in the numbers of the CD14+/CD16+ monocyte subpopulations between the 3 groups. However, a significant graded increase of the mCD14 intensity expression values was observed among the groups, with the highest levels in patients with NIDDM patients and the lowest in nondiabetic subjects. The serum C-reactive protein concentrations were significantly higher in the group with arterial disease compared with those without arterial disease or healthy controls. In the group of patients as a whole, relative mCD14 intensity expression was significantly correlated with HDL cholesterol levels (inversely) and with serum concentrations of C-reactive protein. Serum HDL cholesterol levels and the C-reactive protein concentrations were also significantly correlated. We concluded that the increased mCD14 intensity expression on circulating monocytes may be an important contributor to the increased inflammatory response observed in patients with NIDDM and arterial disease, and eventually, to atherogenesis.

A randomized, blinded, comparative trial of one pepsin-digested and two whole IgG antivenoms for Bothrops snake bites in Uraba, Colombia. The Regional Group on Antivenom Therapy Research (REGATHER).

The therapeutic efficacy and the incidence of early antivenom reactions (EARs) were compared in a clinical trial performed in 79 patients bitten by Bothrops sp. in Urabá, Colombia. Patients were randomized into three groups according to the antivenom administered: A (n = 30, Butantan polyspecific, pepsin-digested Bothrops antivenom); B (n = 27, Butantan polyspecific, whole IgG Bothrops antivenom); and C (n = 22, Colombian commercial, monovalent, whole IgG Bothrops antivenom). The groups were comparable in all clinical and epidemiologic aspects; 33 patients had mild, 22 moderate, and 24 severe envenoming. At the doses used (two, four, and six vials [10 ml/vial] for mild, moderate, and severe envenomings, respectively) there were no differences between the antivenoms in restoring normal hemostatic parameters within 24 hr. The evolution of local envenoming was comparable in the three groups. Serum venom/antivenom kinetics determined by ELISA showed a complete clearance of venom levels 1 hr after treatment in mild/moderate envenomings. In severe cases, venom levels remained detectable up to 24 hr and recurrence of antigenemia was observed in some cases. Antivenom concentrations remained at high levels up to 24 hr of treatment. The incidence of EARs was significantly different in the groups: A (36.7%), B (11.1.%), and C (81.8%). There were no life-threatening anaphylactic reactions. We conclude that the efficacy of the three antivenoms was similar in neutralizing human Bothrops envenomings and that the production of whole IgG antivenoms by caprylic acid fractionation is a good alternative for reducing the incidence of EARs.

Gonadotropic control of ovarian follicle maturation: the two-stage concept and its mechanisms.

Most research on the control of oocyte maturation by luteinizing hormone (LH) in teleosts and amphibians has focused on the production and action of maturation-inducing hormone (MIH), the follicular hormone that directly triggers the resumption of oocyte meiosis. However, current information indicates that LH regulates maturation in two stages, and that 'oocyte maturation' can be appropriately described within the broader context of 'ovarian follicle maturation'. During the first stage of maturation the follicle (somatic) cells acquire the ability to produce MIH and the oocyte to respond to MIH (i.e. oocyte maturational competence, OMC), whereas in the second stage the follicle cells produce MIH and, consequently, the oocyte is released from meiotic arrest. A number of factors such as insulin-like growth factor-I, serotonin, and others may mediate or modulate the OMC-inducing action of LH. Like the acquisition of MIH-producing ability, the acquisition of OMC requires activation of the protein kinase A pathway. Two major cellular events associated with OMC acquisition are increases in homologous and heterologous gap junction contacts and in oocyte MIH receptor activity. The increased oocyte MIH receptor activity is presumably associated with OMC acquisition, but the significance of changes in gap junction contacts is at present uncertain. To eliminate inconsistency and ambiguity associated with current terminology we propose that the term, ovarian follicle (or oocyte) maturation be used for teleosts without qualifiers such as 'final' to define the first and second stages of follicular maturation.

Expression of connexin 43 mRNA and protein in developing follicles of prepubertal porcine ovaries.

A major form of cell-cell communication is mediated by gap junctions, aggregations of intercellular channels composed of connexins (Cxs), which are responsible for exchange of low molecular weight (<1200 Da) cytosolic materials. These channels are a growing family of related proteins. This study was designed to determine the ontogeny of connexin 43 (Cx43) during early stages of follicular development in prepubertal porcine ovaries. A partial-length (412 base) cDNA clone was obtained from mature porcine ovaries and determined to have 98% identity with published porcine Cx43. Northern blot analysis demonstrated a 4.3-kb mRNA in total RNA isolated from prepubertal and adult porcine ovaries. In-situ hybridization revealed that Cx43 mRNA was detectable in granulosa cells of primary follicles but undetectable in dormant primordial follicles. The intensity of the signal increased with follicular growth and was greatest in the large antral follicles. Immunohistochemical evaluation indicated that Cx43 protein expression correlated with the presence of Cx43 mRNA. These results indicate that substantial amounts of Cx43 are first expressed in granulosa cells following activation of follicular development and that this expression increases throughout follicular growth and maturation. These findings suggest an association between the enhancement of intercellular gap-junctional communication and onset of follicular growth.

Treatment of tumors of the third ventricle: a new and simple technique.

A new surgical technique is described for the treatment of benign cystic tumors of the third ventricle. It basically consist of: 1) introduction of a catheter to the third ventricle, therefore to the cyst; 2) suction of all the material of the cyst; 3) connection of the catheter to a ventriculoatrial shunt. A report of five patients with a possible colloid cyst in the third ventricle treated with this technique and the satisfactory results obtained in all the cases, with lack of morbidity and mortality, is presented. A comparison between the traditional surgical procedure and ours, as far as the technique itself and the results are concerned, is made. The simplicity of the technique is emphasized and it is proposed as another solution for the treatment of cystic tumors of the third ventricle.

Assessing reproductive and endocrine parameters in male largescale suckers (Catostomus macrocheilus) along a contaminant gradient in the lower Columbia River, USA.

Persistent organochlorine pollutants such as polychlorinated biphenyls (PCBs), dichlorodiphenyldichloroethylene (p,p'-DDE), and polybrominated diphenyl ethers (PBDEs) are stable, bioaccumulative, and widely found in the environment, wildlife, and the human population. To explore the hypothesis that reproduction in male fish is associated with environmental exposures in the lower Columbia River (LCR), reproductive and endocrine parameters were studied in male resident, non-anadromous largescale sucker (Catostomus macrocheilus) (LSS) in the same habitats as anadromous salmonids having conservation status. Testes, thyroid tissue and plasma collected in 2010 from Longview (LV), Columbia City (CC), and Skamania (SK; reference) were studied. Sperm morphologies and thyrocyte heights were measured by light microscopy, sperm motilities by computer-assisted sperm motion analysis, sperm adenosine triphosphate (ATP) with luciferase, and plasma vitellogenin (VTG), thyroxine (T4), and triiodothyronine (T3) by immunoassay. Sperm apoptosis, viability, mitochondrial membrane potential, nuclear DNA fragmentation, and reproductive stage were measured by flow cytometry. Sperm quality parameters (except counts) and VTG were significantly different among sites, with correlations between VTG and 7 sperm parameters. Thyrocyte heights, T4, T3, gonadosomatic index and Fulton's condition factor differed among sites, but not significantly. Sperm quality was significantly lower and VTG higher where liver contaminants and water estrogen equivalents were highest (LV site). Total PCBs (specifically PCB-138, -146, -151, -170, -174, -177, -180, -183, -187, -194, and -206) and total PBDEs (specifically BDE-47, -100, -153, and -154) were negatively correlated with sperm motility. PCB-206 and BDE-154 were positively correlated with DNA fragmentation, and pentachloroanisole and VTG were positively correlated with sperm apoptosis and negatively correlated with ATP. BDE-99 was positively correlated with sperm counts and motility; T4 was negatively correlated with counts and positively correlated with motility, thus indicating possible androgenic mechanisms and thyroid endocrine disruption. Male LSS proved to be an informative model for studying reproductive and endocrine biomarkers in the LCR.

An extended model of phosphorus metabolism in growing ruminants.

A major objective of this study was to extend the Vitti-Dias model used to describe P metabolism in ruminants, by adding 2 new pools to the original model to represent the rumen and saliva. An experiment was carried out using 24 male sheep, initial BW of 34.5 kg, aged 8 mo, fed a basal diet supplied with increasing amounts of dicalcium phosphate to provide 0.14, 0.32, 0.49, and 0.65% P in the diet. Sheep were individually housed indoors in metabolic cages and injected with a single dose of 7.4 MBq of (32)P into a jugular vein. Feed intake and total fecal and urinary outputs were recorded and sampled daily for 1 wk, and blood samples were obtained at 5 min, and 1, 2, 4, 6, 24, 48, 72, 96, 120, 144, and 168 h after (32)P injection. Saliva and rumen fluid samples were taken on d 6, 7, and 8. Then, animals were slaughtered and samples from liver, kidney, testicle, muscle, and heart (soft tissue) and bone were collected. Specific radioactivity and inorganic P were then determined in bone, soft tissue, plasma, rumen, saliva, and feces, and used to calculate flows between pools. Increased P intake positively affected total P (r = 0.97, P < 0.01) and endogenous P excretion in feces (r = 0.85, P < 0.01), P flow from plasma to saliva (r = 0.73, P < 0.01), from saliva to rumen (r = 0.73, P < 0.01), and from lower gastrointestinal tract to plasma (r = 0.72, P < 0.01). Urinary P excretion was similar for all treatments (P = 0.35). It was, however, related to plasma P (r = 0.63, P < 0.01) and to net P flow to bone (accretion - resorption; r = -0.64, P < 0.01). Phosphorus intake affected net P flow to soft tissue (P = 0.04) but not net P flow to bone (P = 0.46). Phosphorus mobilized from bone was directed toward soft tissue, as suggested by the correlations between P flow from bone to plasma and net P flow to soft tissue (r = 0.89, P < 0.01), and P flow from plasma to soft tissue and net P flow to bone (r = -0.76, P < 0.01). The lack of effect of dietary P on net P accretion in bone suggests that P demand for bone formation was low and surplus P was partially used by soft tissue. In conclusion, the model resulted in appropriate biological description of P metabolism in sheep and added knowledge of the effects of surplus dietary P on P metabolism. Additionally, the model can be used as a tool to assess feeding strategies aiming to mitigate P excretion into the environment.