High output power, single mode, and TEM00 operation of a multiple gain chip VECSEL using a twisted-mode configuration.

A vertical external cavity surface emitting laser (VECSEL) has been developed for a sodium guide star application. Stable single frequency operation with 21 W of output power near 1178 nm with multiple gain elements while lasing in the TEM00 mode has been achieved. Higher output power results in multimode lasing. For the sodium guide star application, the 1178 nm can be frequency doubled to 589 nm. The power scaling approach used involves using multiple gain mirrors in a folded standing wave cavity. This is the first demonstration of a high power single frequency VECSEL using a twisted-mode configuration and multiple gain mirrors located at the cavity folds.

The effect of coenzyme Q10 on the exercise performance of cross-country skiers.

Coenzyme Q10 supplementation (Bio-Qinon Pharma Nord, 90 mg/day) was studied in a double-blind cross-over study of 25 Finnish top-level cross-country skiers. With CoQ10 supplementation, all measured indexes of physical performance (AET, ANT and VO2Max) improved significantly. During verum supplementation, 94% of the athletes felt that the preparation had been beneficial in improving their performance and recovery time vs. only 33% in the placebo periods.

A controlled, prospective, 1-year trial of citalopram in the treatment of panic disorder.

BACKGROUND: The objective of this study was to evaluate the efficacy and tolerability of citalopram in the long-term treatment of adult outpatients with panic disorder with or without agoraphobia. METHOD: Patients in this double-blind, parallel-group trial were assigned to 1 of 3 fixed dosage ranges of citalopram (10 or 15 mg/day, 20 or 30 mg/day, or 40 or 60 mg/day), 1 dosage range of clomipramine (60 or 90 mg/day), or placebo. After the completed 8-week acute treatment period, the eligible patients could continue the treatment for up to 1 year. Of the 475 patients who were randomly assigned for the short-term trial, 279 agreed to continue double-blind treatment at their assigned doses. The primary efficacy measure used was the Clinical Anxiety Scale panic attack item, and the response was defined as no panic attacks (score of 0 or 1). The other key measures used were the Physician's Global Improvement Scale, the Patient's Global Improvement Scale, and the Hamilton Rating Scale for Anxiety (HAM-A). RESULTS: In all drug-treated groups, except the group receiving the lowest citalopram dose, the treatment outcome was generally better than with placebo. As determined by a life table analysis of response, the probability of response during the 12 months was significantly greater with all treatment regimens than with placebo (p < .05), with citalopram 20 or 30 mg/day demonstrating the best response. Panic attacks tended to disappear in all patients remaining in the study until the end of follow-up. Analysis of the difference in the number of patients in different treatment groups remaining in the study (perhaps the best measure of long-term efficacy) also demonstrated that the patients treated with citalopram in dosage ranges of 20 or 30 mg/day and 40 or 60 mg/day had better response than placebo-treated patients (p < .0002 and p < .004, respectively). HAM-A and Global Improvement Scale scores also showed that patients treated with active drug showed greater improvement than placebo-treated patients. All treatment groups showed no new or exceptional adverse event clusters. CONCLUSION: Citalopram in the dosage range of 20 to 60 mg/day is effective, well tolerated, and safe in the long-term treatment of patients who have panic disorder.

Use of psychotropic drugs and risk of myocardial infarction: a case-control study in Finnish farmers.

BACKGROUND: In 1992 Thorogood et al. reported an increased risk of myocardial infarction in women using psychotropic drugs. The aim of our study is to find out whether there is a link between the use of psychotropic drugs and subsequent myocardial infarction in males. METHOD: A cohort of 3172 male farmers was followed from 1 February 1980 to 31 December 1992. Those subjects who had myocardial infarction without any previous symptoms during the follow-up were considered as cases. For every case three matched controls were selected. The matched variables were age, smoking habits, social status and county. The final sample includes 83 cases and 249 controls. RESULTS: Those who had used psychotropic drugs had increased risk for myocardial infarction, odds ratio (OR) = 2.5, 95% confidence interval (CI):1.2-5.2. Most pronounced risk for myocardial infarction was found among users of anti-depressants, OR = 5.4 (CI:1.8-16.1). CONCLUSION: The use of psychotropic drugs, especially antidepressants, is associated with increased risk of myocardial infarction. Further attempts are needed to determine whether the relationship between use of psychotropic drugs and risk of myocardial infarction is causal or not.

Six-microtransducer catheter connected to computer in evaluation of urethral closure function of women.

A new instrument consisting of a six-transducer catheter, one transducer for the bladder and five transducers for urethral pressure recordings, and a computer with specific software was developed for urodynamic investigation of women. Twenty-six patients with stress urinary incontinence (SUI) and 10 continent female patients were evaluated during the single cough, the first and the fourth ones of the forced coughings in supine and standing positions. The results were compared with those obtained with the conventional two-transducer method. Negative urethral closure pressure (UCP) at stress, indicative of SUI, was present in 88 percent of the cases with the six-transducer method, and in 77 percent with the two-transducer method. The fourth cough in the standing position with the six-transducer method was most diagnostic. In SUI, the six-transducer method indicated exactly, e.g., the minimum bladder pressure needed for negative UCP and the duration of negative UCP. Patients with SUI had significantly lower UCP at rest, UCP at stress, and pressure transmission ratio (PTR) than continent women. Findings, that UCP at stress decreased and duration of negative UCP at stress increased but PTR did not change when the fourth cough was compared with the first one in SUI, suggest that factors which are responsible for the altered urodynamics during prolonged stress are anatomic rather than functional.

Comparison of three serum assays for bone collagen formation during postmenopausal estrogen-progestin therapy.

Postmenopausal hormone replacement therapy (HRT) lowers the turnover rate of the mineralized bone matrix, the predominant organic component of which is type I collagen. The effect of estrogen on bone metabolism has been monitored by measuring the circulating concentration of the carboxy-terminal propeptide of type I procollagen (PICP), which decreases during HRT. We have recently developed assays for the intact amino-terminal propeptide (PINP) of type I procollagen, a protein set free from the other end of the same gene product. PICP and PINP, both derived from the synthesis of type I collagen, but differing in their further metabolism, were assessed in 47 postmenopausal women, aged 45-66 years, undergoing postmenopausal HRT. Estradiol-gel applied daily was combined to a continuous progestin administered by three different routes. Serum samples obtained before the treatment and 6 and 12 months after its commencement were analyzed for PICP, PINP, PINP Col 1 (assay variant measuring also the degradation product of PINP) and PIIINP (amino-terminal propeptide of type III procollagen). During HRT the circulating concentration of PICP decreased by 20%, that of PINP by 42% and that of PINP Col 1 by 32% in 12 months. The correlation between the two propeptides, which was 0.676 before the treatment, increased to 0.851 in 6 months and to 0.815 in 12 months. The correlations between PINP and PINP Col 1 were 0.872 before the treatment and increased to 0.925 and 0.941 after 6 and 12 months of treatment, respectively. The serum concentration of PIIINP, which reflects the turnover of the soft tissue collagens, did not change remarkably. Our findings indicate that the intact PINP is a more dynamic marker of bone metabolism than PICP and can therefore be recommended as a marker reflecting the effect of estrogen on bone collagen formation during HRT.

Percutaneous estradiol gel with an intrauterine levonorgestrel releasing device or natural progesterone in hormone replacement therapy.

OBJECTIVE: To evaluate the bleeding patterns and clinical compliance associated with postmenopausal amenorrhea-inducing forms of hormone replacement therapy using either percutaneous estradiol-gel and a levonorgestrel-releasing intrauterine device or an oral/vaginal natural progesterone. METHODS: Sixty postmenopausal women with an intact uterus were followed over 12 months in this open, non-randomised, parallel group study. All patients continuously received a gel containing 1.5 mg of estradiol daily. The women were divided into three groups on the basis of progestin administration. Twenty women (group I) had a levonorgestrel-releasing device (LNG-IUD) inserted at the beginning of the study. Twenty-one women (group II) received oral natural micronised progesterone (oral P) 100 mg daily during 25 calendar days each month, and 19 women (group III) used vaginal natural micronised progesterone (vaginal P) 100-200 mg daily during 25 calendar days each month (higher dose if spotting occurred). Clinic visits were at 0, 3, 6 and 12 months. Bleeding patterns were recorded by the patient in a diary and clinical compliance was evaluated at control visits during the treatment. Symptoms were recorded using a modified Kuppermann index. The serum estradiol concentration was determined at the 0, 6 and 12 month control visits. RESULTS: 80% (n = 16) of the patients in the LNG-IUD group, 67% (n = 14) in the oral P group II and 53% (n = 10) in the vaginal P group were without bleeding at 12 months. Spotting was common during the first 3 months. Symptom relief was good in each group. The LNG-IUD did not cause any serious side-effects. Compliance was good for LNG-IUD and oral progesterone but not for vaginal progesterone. CONCLUSIONS: Percutaneous estradiol-gel associated with LNG-IUD is an appropriate method of hormone replacement therapy. The combination of oral natural progesterone with estradiol-gel is also useful, although bleeding episodes complicated the treatment in one third of the patients. The vaginal administration of natural progesterone was impractical due to bleeding disorders.

Insulin-like growth factor-binding protein-1: a biochemical marker of endometrial response to progestin during hormone replacement therapy.

OBJECTIVES: To compare immunohistochemical localization of insulin-like growth factor binding protein-1 (IGFBP-1) in endometrial stromal cells with endometrial morphology during three regimens of continuous combined hormone replacement therapy. METHODS: Endometrial samples for morphological examination and immunohistochemical staining with monoclonal antibody against IGFBP-1 were obtained from 30 menopausal women before treatment and after 12 and 24 months of continuous combined hormone replacement therapy. All women received percutaneous estradiolgel releasing 1.5 mg estradiol daily. Regarding progestins, patients were divided into three groups: one group (n = 15) had a 20 micrograms/24 h levonorgestrel-releasing intrauterine device (LNG-IUD); the women in the other two groups received micronised natural progesterone either 100 mg orally (n = 7) or 100-200 mg vaginally (n = 8) daily, 25 days per calendar month. RESULTS: Before treatment the endometrium of all women was atrophic or subatrophic and no IGFBP-1 could be detected in any of the samples which contained enough stromal cells for evaluation. After 12 and 24 months of treatment, epithelial atrophy with decidual transformation in stroma was detected in all specimens in the LNG-IUD group, and IGFBP-1 was localized in decidualized stromal cells in all samples. In the other two groups, no signs of progestin effect were detected by microscopic examination in any of the endometrial samples and IGFBP-1 staining was completely negative in all of them. CONCLUSION: A striking difference occurred in both morphological and biochemical response in the endometrium of women treated with LNG-IUD compared with those receiving oral or vaginal micronised progesterone during continuous combined HRT. Micronised progesterone at doses used in this study turned out to be ineffective to prevent the proliferative effect of estrogen. Immunohistochemical localization of IGFBP-1 in endometrial stromal cells strongly correlated with decidual reaction in all endometrial specimens exposed to LNG-IUD, suggesting that the immunostaining of IGFBP-1 can be used as a means of assessing the strength of progestin effect in the endometrium during HRT.

Risk of myocardial infarction among subjects visiting a doctor because of back disorder. A case--control study in Finnish farmers.

STUDY DESIGN: A nested case-control study was made to analyze the correlation between back trouble and myocardial infarction. OBJECTIVES: The purpose of the present study was to determine whether individuals visiting a doctor because of back trouble have an increased risk for myocardial infarction. SUMMARY OF BACKGROUND DATA: According to previous results, back pain precedes myocardial infarction in young and middle-aged male farmers. There are no previous results concerning the risk of myocardial infarction among patients visiting a doctor because of back pain. METHODS: The basic cohort includes 3172 Finnish farmers. Those having myocardial infarction from February 1, 1980 through December 31, 1992 were considered case studies. Three matched control subjects were selected for every case subject. The final group had 83 case subjects and 249 matched control subjects. Case subjects and control subjects were compared according to doctor visits because of back complaint during the follow-up period, which began February 1, 1980 and ended on the date of myocardial infarction of each case subject. RESULTS: Fewer case subjects than control subjects visited a doctor because of back disorders during the follow-up period. This was especially true for nonspecific back pain (odds ratio = 0.51; confidence interval = 0.25-1.05). CONCLUSION: Atherosclerosis is not a probable cause of any kind of back pain among individuals visiting a general practitioner because of back complaint.

Urethral pressure variations diagnosed by multiple urethral pressure transducers. A common phenomenon in women suffering from urinary incontinence.

The prevalence of urethral pressure variations (variation of urethral pressure greater than 15 cm H2O) was investigated, with the use of a data-based multitransducer catheter, in female patients suffering from urinary incontinence. Urethral pressure variations were diagnosed in 45 (63%) of 71 patients. This prevalence was greater than in previous studies, possibly for methodological reasons; the urethral pressure was simultaneously measured by five urethral microtransducers, thereby registering all variations in maximal urethral pressure. The present method also showed that urethral pressure variations were simultaneously present in different urethral sites, but that the amplitude of variation differed between the different points of registration. In most cases, urethral pressure variations were already apparent at the start of urethrocystometry. Voluntary holding, in an effort to inhibit the desire to void, can cause these variations in urethral pressure. Hence urethral pressure variations may be a normal physiological phenomenon.

High plasma interleukin-2: a potential cause of insulin resistance.

Low-density lipoproteins, infections and smoking are closely associated with insulin resistance. According to the hypothesis proposed in this paper, all of these factors could cause insulin resistance by the same mechanism. The first step in the cascade of events leading to insulin resistance is increased production of interleukin-2. This is followed by secretion of other cytokines, activation of macrophages and increased production of nitric oxide from L-arginine. The reduced amount of plasma L-arginine leads to decreased secretion of growth hormone and insulin-like growth factor-1 during exercise. The decreased secretion of insulin-like growth factor-1 is the basic reason for insulin resistance. Tumour necrotizing factor may also be involved in the pathogenesis of insulin resistance directly by binding in beta-adrenergic receptors. High plasma interleukin-2 also causes decreased bioavailability of insulin-like growth factor-1 by reducing the production of androgenic hormones.

Analysis of the imputed female urinary incontinence data for the evaluation of expert system parameters.

We evaluated parameters for an expert system which will be designed to aid the differential diagnosis of female urinary incontinence by using knowledge discovered from data. To allow the statistical analysis, we applied means, regression and Expectation-Maximization (EM) imputation methods to fill in missing values. In addition, complete-case analysis was performed. Logistic regression results from the imputed data were reasonable. The significant parameters were mostly those that are important in the diagnostic work-up. Moreover, directions of relations between the parameters and the stress, mixed and sensory urge diagnoses were as expected. Analysis with the complete reduced data set gave clearly insufficient results. Imputed values had a moderate agreement, but odds ratios and classification accuracies of logistic regression equations were similar. Results suggest that with these data, simpler methods may be used to allow multivariate analysis and knowledge discovery, when better methods, such as EM imputation, are unavailable. Cluster analysis detected clusters corresponding to the small normal class, but was unable to clearly separate the larger incontinence classes.

Parameter evaluation of the differential diagnosis of female urinary incontinence for the construction of an expert system.

Female urinary incontinence is a difficult problem for a patient but also for a physician. In the differential diagnosis of female urinary incontinence the physician has to determine a diagnostic class for the patient. This task is complex because of the unreliable patient history and the overlapping class boundaries. In order to develop an expert system to help the physician, a retrospective investigation on the incontinent women was performed to detect the potential expert system parameters. Also a diagnosis table was constructed from the expected values of parameters and the diagnostic classes. The results from K-means cluster analysis indicate that it is possible to develop the expert system on basis of the defined parameters and classes.

Diagnosis and treatment of menorrhagia.

One-third of all women experience heavy menstrual bleeding at some point in their life. In western countries, about 5% of women of reproductive age will seek help for menorrhagia annually. Half of all women who consult for hypermenorrhea have some uterine abnormality, most often fibroids (among patients under 40 years of age) and endometrial polyps (above 40 years of age). Appropriate treatment considerably improves the quality of life of these patients, and it is important to make a rigorous assessment of the patient to provide the best treatment options. This guideline provides instructions on how to examine and treat women of fertile age who have menorrhagia. The subject's own assessment of the amount of menstrual blood loss does not generally reflect the true amount. All patients should undergo a pelvic examination and, if the menstrual pattern has changed substantially or if anaemia is present, a vaginal sonography should be carried out as the most important supplemental examination. Vaginal sonography combined with an endometrial biopsy is a reliable method for diagnosing endometrial hyperplasia or carcinoma, but it is insufficient for diagnosing endometrial polyps and fibroids; these can be diagnosed more reliably by sonohysterography or hysteroscopy. Non-steroidal anti-inflammatory drugs and tranexamic acid reduce menstrual blood loss by 20-60%, and the effectiveness of a hormonal intrauterine system (IUS) is comparable with that of endometrial ablation or hysterectomy. Cyclic progestogens do not significantly reduce menstrual bleeding of women who ovulate. Treatment should be started with one of the drug therapies, i.e. the IUS, tranexamic acid, anti-inflammatory drugs, or oral contraceptive. Drug treatment should be used and evaluated before surgical interventions are considered. With an effective training and feedback system, it is possible to organise the diagnostics, medical treatment and follow-up of heavy menstrual bleeding in the primary health care setting or in outpatient clinics, which reduces the burden on specialist health care.

Hypothesis: low serum cholesterol, suicide, and interleukin-2.

An excess mortality for violence (suicides and injuries) has been observed following the use of cholesterol-lowering drugs. It has been suggested that low cholesterol is associated with depression by modifying the serotonin metabolism. In this paper, a new hypothesis concerning the association among serum lipids, depression, and atherosclerosis is proposed. The hypothesis is based on epidemiologic evidence concerning serum lipids, depression, violent deaths, and atherosclerosis. It is also based on previous results concerning a cytokine, interleukin-2. Recent observations indicate that interleukin-2 has an important role in lipid metabolism, depression, and atherosclerosis.