Background: Sex is suggested to be an important determinant of ischemic stroke risk factors, etiology, and outcome. However, the basis for this remains unclear. The Y chromosome is unique in males. Genes expressed in males on the Y chromosome that are associated with stroke may be important genetic contributors to the unique features of males with ischemic stroke, which would be helpful for explaining sex differences observed between men and women.Objective: We compared Y chromosome gene expression in males with ischemic stroke and male controls.Methods: Blood samples were obtained from 40 male patients <= 3, 5, and 24 hours after ischemic stroke and from 41 male controls (July 2003 April 2007). RNA was isolated from blood and was processed using Affymetrix Human U133 Plus 2.0 expression arrays (Affymetrix Inc., Santa Clara, California). Y chromosome genes differentially expressed between male patients with stroke and male control subjects were identified using an ANCOVA adjusted for age and batch. A P < 0.05 and a fold change >1.2 were considered significant.Results: Seven genes on the Y chromosome were differentially expressed in males with ischemic stroke compared with controls. Five of these genes (VAMP7, CSF2RA, SPRY3, DHRSX, and PLCXD1) are located on pseudoautosomal regions of the human Y chromosome. The other 2 genes (EIF1AY and DDX3Y) are located on the nonrecombining region of the human Y chromosome. The identified genes were associated with immunology, RNA metabolism, vesicle fusion, and angiogenesis.Conclusions: Specific genes on the Y chromosome are differentially expressed in blood after ischemic stroke. These genes provide insight into potential molecular contributors to sex differences in ischemic stroke. (Gend Med. 2012;9:68-75) (C) 2012 Elsevier HS Journals, Inc. All rights reserved.
Background: Sleep-disordered breathing (SDB) and cardiometabolic risk factors are male prevalent.Objective: This study investigated whether gender differences remained prominent after matching for the apnea hypopnea index (AHI) and postmenopause.Methods: In a retrospective analysis of 350 eligible SDB patients, female patients were matched with male patients of the same age and body mass index (BMI) (age-BMI-matched [nAHImt]; n = 102 pairs) or were matched with male patients of the same age, BMI, and AHI (age-BMI-AHI-matched [AHImt]; n = 66 pairs). The nAHImt or AHImt patients were further separated into junior and senior subgroups.Results: In the nAHImt/junior group, women had shorter neck circumferences, better sleep architecture, and lower AHI, Epworth Sleepiness Scale (ESS) score, blood pressure (BP), total cholesterol (TC), triglyceride (TG), and uric acid (UA) than nAHImt/junior men. In the AHImt/junior group, women had shorter neck circumferences, lower waist/hip ratios, ESS, BP, TG, and UA than AHImt junior men. In the nAHImt/senior group, women had lower AHI, neck circumferences, waist/hip ratios, diastolic BP, and UA than men. In contrast, in the AHImt/senior group, most cardiometabolic parameters were similar between women and men. After further matching for the AHI, many elements of gender differences disappeared.Conclusions: Compared with AHImt men, women had lower UA, TG, BP, and daytime sleepiness before menopause, but gender differences became indistinguishable postmenopause. We suggested that matching sleep quality or adjusting AHI would be noteworthy and required for studying gender differences. (Gend Med. 2012;9:9-20) (C) 2012 Elsevier HS Journals, Inc. All rights reserved.
Diabetes complications account for significant worldwide morbidity and mortality. Improving glycemic control decreases microvascular complications, particularly among patients with the worst control. Current performance measures fail to prioritize such individuals. The categorization of glycemic control within a safety-net clinic population was compared using a common performance measure against one derived from a metric accounting for change in glycated hemoglobin (A1c) over time.Retrospective cohort analysis of all patients in a safety-net primary care clinic population quality registry with confirmed diabetes mellitus who had at least two A1c values between 2007 through 2011. Patients were stratified into five groups on the basis of maximum and earliest A1c level (< 7%, 7% to < 8%, 8% to < 9%, 9% to < 10%, and ≥ 10%). The change in A1c was assessed over time and compared with standard Healthcare Effectiveness Data and Information Set (HEDIS) performance measures.Some 1,122 patients were included in the analysis, with mean A1c of 7.9%. There was a modest annual decrease in the average A1c, and ≥ 19% of patients improved by 1% or more during each of the previous three years. For patients who had maximum A1c values ≥ 10%, there was a significantly greater reduction in A1c (p < .01), which was not reflected in the standard performance measure.It is feasible for safety-net clinics to analyze their patients with diabetes by level of disease control on the basis of change in A1c over time. Patients with the worst glycemic control tend to have the greatest improvement but are often overlooked by conventional performance measures. Improved performance measures should focus on longitudinal diabetes control and emphasize reducing risk of complications among patients at highest risk.
This manuscript presents the methodology used to assess the impact of a clinical simulation module used for training providers specializing in women's health. The methodology presented here will be used for a quantitative study in the future.
Background: In white populations, age seems to modify the effect of sex on stroke risk, and compared with men, women are protected from stroke until approximately age 75 to 85 years, after which the protection is lost or reversed. Compared with non-Hispanic whites (NHWs), Mexican Americans (MAs) are at higher risk of stroke; however, age- and sex-specific stroke incidence data are currently not available for this population.Objective: This study was performed to compare the age-specific sex differences in stroke risk in MAs and NHWs.Methods: Data were derived from the BASIC (Brain Attack Surveillance in Corpus Christi) Project, a population-based stroke surveillance study conducted in Nueces County Texas. Incident strokes (n = 2421, including ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage) that occurred between January 1, 2000 and May 25, 2007 in individuals aged 45 years or older were included in the analysis. Poisson regression using the generalized additive models framework was used to analyze the relationship between sex, age (5-year intervals), and race/ethnicity (NHW or MA) and incident stroke risk.Results: Among both NHWs and MAs aged 45 to 79 years, men were at higher risk of stroke than women were. The magnitude of increased stroke risk in men compared with women diminished with age, and after age 79 years, no sex difference in stroke risk was observed.Conclusions: Reasons for the loss of protection from stroke in aging women of all races/ethnicities are not fully understood, and further study is warranted. (Gend Med. 2012;9:121-128) (C) 2012 Elsevier HS Journals, Inc. All rights reserved.
Background: Low levels of cardiorespiratory fitness (CRF) and physical activity (PA) are associated with a risk of the development of metabolic syndrome. Contradictory findings are reported in the literature regarding the influence of sex and CRF and PA on metabolic changes.Objective: The aim of this study was to analyze the effects of CRF and PA on lipid and carbohydrate metabolism biomarkers in boys and girls.Methods: A total of 82 prepubertal boys and 55 girls (7-12 years of age) were classified according to sex, low or high CRF, and performance or nonperformance of PA. Anthropometric and blood pressure (BP) measurements, plasma lipid profile values, glucose and insulin levels, and homeostasis model assessment for insulin resistance were analyzed.Results: The percentage of boys with high CRF and performance of PA was higher than that of girls (P < 0.05). When children of the same sex were compared, higher values for body mass index and waist circumference z-scores were found for boys with low CRF compared with boys with high CRF (P < 0.001) without differences between girls, and in all groups classified by PA. Systolic and diastolic BPs were higher in boys than in girls, in both CRF and PA groups (P < 0.05). In the low CRF and no PA groups, girls had higher plasma glucose, total cholesterol, and low-density lipoprotein cholesterol levels than boys, with higher high-density lipoprotein cholesterol and apolipoprotein A levels (P < 0.05).Conclusions: Sex in relation to CRF and PA could affect the plasma lipid profile. These changes in girls are associated with low CRF and low levels of PA. Considering these results, we suggest the need to improve CRF and promote PA, especially in girls, to reduce metabolic risk. (Gend Med. 2012;9:436-444) (c) 2012 Elsevier HS Journals, Inc.Elsevier HS Journals, Inc. All rights reserved.
Background: Outcome of patients with urothelial carcinoma of the bladder (UCB) varies between sexes. Although overall incidence is higher in men, cancer-specific survival (CSS) has been suggested to be lower in women. Although the former effect is attributed to greater exposure to carcinogens in men, the latter has not been elucidated.Objectives: The aim of the study was to identify sex-specific outcomes based on one of the largest databases of patients with UCB who underwent radical cystectomy (RC).Methods: This retrospective multicenter series comprised 2483 patients in Stage M0 who underwent RC for UCB from 1989 to 2008; 20.4% of patients were women. The impact of sex on CSS in the entire study group and in specific subgroups was analyzed. The median follow-up time was 42 months (interquartile range, 21-79).Results: Histopathologic criteria of pathologic tumor (pT), pathologic nodal (pN), grade, lymphovascular invasion (LVI), and associated carcinoma in situ (CIS) of the study did not differ between sexes. The percentage of female patients increased over time. Five-year CSS in female patients was significantly lower than in male patients (60% vs 66%; P = 0.005). In multivariate analysis adjusted to other covariates, tumor stage >= pT3 (hazard ratio [HR] = 2.44; P < 0.001), positive pN status (HR = 1.91; P < 0.001), LVI (HR = 1.48; P < 0.001), lower count of lymph nodes removed (HR = 0.98; P = 0.002), older age (HR = 1.01; P < 0.001), female gender (HR = 1.26; P = 0.011) had an independent impact on CSS. Deterioration of CSS in female patients was pronounced when LVI was present (HR = 1.57; P < 0.001) and when RC was performed in the earlier time period (HR = 2.44; P < 0.001). However, women showed significantly lower perioperative mortality (within 90 days after RC) compared with men.Conclusions: After RC for UCB, cancer-specific mortality was higher in female patients; this disadvantage was more pronounced in earlier time periods. In addition, worse outcome of women with verified LVI was shown to be comparable with men. These findings were suggestive of different tumor biology and potentially unequal access to timely RC in earlier time periods because of reduced awareness of UCB in women. Further studies are required to improve UCB outcome in both sexes, notably in female patients. (Gend Med. 2012;9:481-489) (c) 2012 Elsevier HS Journals, Inc. All rights reserved.
Background: The human menstrual cycle (MC) has historically been the focus of myth and misinformation, leading to ideas that constrain women's activities.Objectives: We wished to examine one pervasive idea, that the MC is a cause of negative mood, by studying the scientific literature as a whole. We briefly reviewed the history of the idea of premenstrual syndrome and undertook a systematic review of quality studies.Methods: We searched PubMed, PsycINFO, and article bibliographies for published studies using non-help-seeking samples with daily mood data collected prospectively for a minimum of 1 complete MC. We critiqued their methodologies and tabulated the key findings.Results: Of 47 English language studies identified, 18 (38.3%) found no association of mood with any MC phase; 18 found an association of negative mood in the premenstrual phase combined with another MC phase; and only 7 (14.9%) found an association of negative mood and the premenstrual phase. Finally, the remaining 4 studies (8.5%) showed an association between negative mood and a non-premenstrual phase. Considering the only 41 adequately powered studies, the same phase links were reported by 36.6%, 41.5%, and 13.5% of studies, respectively. Their diversity of methods (sampling, instruments, and cycle phase definitions) precluded a meta-analysis.Conclusions: Taken together, these studies failed to provide clear evidence in support of the existence of a specific premenstrual negative mood syndrome in the general population. This puzzlingly widespread belief needs challenging, as it perpetuates negative concepts linking female reproduction with negative emotionality. (Gend Med. 2012;9:361-384) 2012 Elsevier HS Journals, Inc. All rights reserved.
BACKGROUND:Many reports suggest gender disparity in cardiac care as a contributor to the increased mortality among women with heart disease. OBJECTIVE:We sought to identify gender differences in the management of Myocardial Infarction (MI) Alert-activated ST-segment elevation myocardial infarction (STEMI) patients that may have resulted from prehospital initiation. METHODS:A retrospective database was created for MI Alert STEMI patients who presented to the emergency department (ED) of an academic community hospital with 74,000 annual visits from April 2000 through December 2008. Included were patients meeting criteria for an MI Alert (an institutional clinical practice guideline designed to expedite cardiac catheterization for STEMI patients). Data points (before and after initiation of a prehospital alert protocol) were compared and used as markers of therapy: time to ECG, receiving β-blockers, and time to the catheterization laboratory (cath lab). Differences in categorical variables by patient sex were assessed using the χ(2) test. Medians were estimated as the measure of central tendency. Quantile regression models were used to assess differences in median times between subgroups. RESULTS:A total of 1231 MI Alert charts were identified and analyzed. The majority of the study population were male (70%), arrived at the ED via ambulance (60.1%), and were taking a β-blocker (67.8%) or aspirin (91.6%) at the time of the ED admission. Female patients were more likely than male patients to arrive at the ED via ambulance (65.9% vs 57.6%, respectively; P = 0.014). The median age of female patients was 68 years, whereas male patients were significantly younger (median age, 59 years; P < 0.001). The proportion of patients currently taking a β-blocker or low-dose aspirin did not vary by gender. Overall, 78.2% of the MI Alert patients arriving at the ED were MI2 (alert initiated by ED physician), and this did not vary by gender (P = 0.33). A total of 1064 MI Alert patients went to the cath lab: 766 male patients (88.9%) and 298 female patients (80.8%). Overall, the median time to cath lab arrival was 79 minutes for men and 81 minutes for women (P = 0.38). Overall, the median time to cath lab arrival significantly decreased from MI1 to MI3, (P(trend) < 0.001). For prehospital-initiated alerts (MI3), the median time to cath lab arrival was the same for men and women (64 minutes; P = 1.0). For hospital-initiated alerts, time to cath lab arrival was 82 minutes for male patients and 84 minutes for female patients (P = 0.38). Prehospital activation of the process decreased the time to the cath lab by 19 minutes (P < 0.001; 95% CI, 13.2-24.8). CONCLUSION:No significant gender differences were apparent in the STEMI patients analyzed, whether the MI Alert was initiated in the ED or prehospital initiated. Initiating prehospital-based alerts significantly decreased the time to the cath lab.
BACKGROUND:The lack of reliable human proxies for minor (ie, non-HLA) histocompatibility loci hampers the ability to leverage these factors toward improving transplant outcomes. Despite conflicting reports of the effect of donor-recipient sex mismatch on renal allografts, the association between acute rejection of renal allografts and the development of human alloantibodies to the male H-Y antigen suggested to us that donor-recipient sex mismatch deserved re-evaluation. OBJECTIVE:To evaluate whether the relationships between donor sex and allograft failure differed by recipient sex. METHODS:We studied recipients of deceased-donor (n = 125,369) and living-donor (n = 63,139) transplants in the United States Renal Data System. Using Cox proportional hazards models stratified by donor type, we estimated the association between donor-recipient sex mismatch and death-censored allograft failure with adjustment for known risk factors, with and without the use of multiple imputation methods to account for potential bias and/or loss of efficiency due to missing data. RESULTS:The advantage afforded by male donor kidneys was more pronounced among male than among female recipients (8% vs 2% relative risk reduction; interaction P < 0.01). This difference is of the order of magnitude of several other risk factors affecting donor selection decisions. CONCLUSIONS:Donor-recipient sex mismatch affects renal allograft survival in a direction consistent with immune responses to sexually determined minor histocompatibility antigens. Our study provides a paradigm for clinical detection of markers for minor histocompatibility loci.
Comparative assays of in vitro cytotoxicity using nonoxynol-9 (N-9) and the candidate microbicides C31G and sodium dodecyl sulfate (SDS) demonstrated that these agents, which are, respectively, characterized as nonionic, amphoteric, and anionic surfactants, differed in their concentration-dependent effects on cell viability, especially after prolonged exposure. We hypothesized that differences in cellular sensitivity may have been due, in part, to cellular changes induced by long-term exposure to each agent. To examine this possibility, HeLa cells were exposed to N-9, C31G, or SDS for extended periods of time and subsequently reassessed for sensitivity to each of these agents. Following 10 continuous days of C31G exposure, HeLa cells were less sensitive to a subsequent C31G exposure compared to cells that had not undergone long-term C31G treatment. Interestingly, long-term C31G exposure also changed subsequent sensitivity to N-9 but not SDS. In contrast, prolonged exposure to either N-9 or SDS did not reduce sensitivity to re-exposure. The effect of long-term C31G exposure was both concentration-dependent and transient, as treated cells reverted to pre-exposure sensitivity in a time-dependent manner following the cessation of C31G exposure. Lipid analyses of cells exposed to C31G for extended durations revealed altered phospholipid profiles relative to C31G-naïve cells. Experiments examining the individual components of C31G demonstrated the involvement of the amine oxide moiety in reductions in cellular sensitivity. These studies, which provide new information concerning the cytotoxicity of surfactant microbicides, suggest that cervicovaginal epithelial cells may have greater in vivo tolerance for products containing C31G through unique interactions between C31G and components of the cellular membranes.
To observe clinical effect of acupuncture and moxibustion on inducing ovulation.Forty cases of anovulatory infertility were treated with electroacupuncture and moxibustion at Zigōng ( EX-CA 1), Guānyuán ( CV 4) and Zhōngjí ( CV 3) as well as Linggui Bafa therapy, 30 min each time, once a day for 15 days. One menstrual cycle made a session, and totally 3 sessions were required. The level of follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2), the growth and development situation of follicle and endometrium before and after treatment, spontaneous pregnancy rate during follow-up visit were observed and compared.After the treatment, the level of FSH, LH and E2 were signifiacntly increased (allP<0.05), the thickness of endometrium and diameter of follicle were obviously increased (bothP<0.05). As for the spontaneous pregnancy rate during follow-up visit, 9 cases were cured, 25 cases were effective, 6 cases were failed and the total effective rate was 85.0%.The acupuncture and moxibustion has better clinical efficacy for anovulatory infertility.
Malignant colorectal obstruction is a serious complication of advanced cancers. The obstruction can be caused by colorectal cancer, adjacent organ cancer or distant metastases. Rectal metastases from gastric cancer are rare. Foreign body ingestion is not a rare event and the majority of them causes no symptoms or complications. Nevertheless, they are likely to stop at any narrowing or angulation of the intestinal lumen. The authors describe a rare clinical presentation of an impacted foreign body in a pathological narrowing secondary to rectal metastasis of a gastric neoplasia that caused an acute malignant colonic obstruction. After endoscopic removal of the foreign body, there was complete resolution of symptoms avoiding surgery or palliative stenting. This case report highlights the need of careful inspection of colonic malignant strictures before stenting to exclude other causes of colonic obstructions, as an impacted foreign body.A obstrução colorretal maligna é uma complicação de neoplasias em estadio avançado. A obstrução pode resultar de neoplasias colorretais, neoplasias de órgãos adjacentes ao cólon ou metastização. A metastização cólica de neoplasias gástricas é rara. A ingestão de corpos estranhos não constitui um evento raro e a maioria dos casos cursa sem sintomas ou complicações. Contudo, estes podem ficar retidos em áreas de estreitamento ou angulação do lúmen intestinal. Os autores descrevem uma rara forma de apresentação clínica de impactação de corpo estranho numa estenose retal maligna secundária a metástases de neoplasia gástrica, que condicionou obstrução cólica maligna. Após remoção endoscópica do corpo estranho, verificou-se resolução da sintomatologia sem necessidade de tratamento cirúrgico ou colocação de prótese. Este caso ilustra a importância da inspeção minuciosa das estenoses malignas previamente à colocação de prótese para exclusão de outras causas de obstrução cólica, como corpo estranho impactado.
During analytical method development and validation, a strong charge interaction between metformin and croscarmellose sodium was observed when the aqueous solution containing metformin was spiked with croscarmellose sodium. The charge interaction resulted in the retention of metformin in croscarmellose sodium and caused a serious drug recovery problem. The percent recovery of metformin in the solution was much lower than its theoretical values, especially in the low metformin concentration range. To overcome the metformin–croscarmellose interaction, arginine was selected as a competitor for the binding sites on croscarmellose sodium. Because of the competition and stronger interaction between arginine and croscarmellose sodium than metformin and croscarmellose sodium, a complete recovery of metformin in presence of arginine in both low and high concentration ranges was achieved. The effect of arginine on the recovery of metformin and the competition mechanism are discussed in this paper.
Les hémoglobinopathies regroupent les thalassémies liées à un défaut de synthèse d'une des chaînes de globine et les pathologies dues à la synthèse d'un variant à solubilité, stabilité ou affinité pour l'oxygène altérée. Le variant le plus significatif est l'hémoglobine S qui à l'état homozygote ou sous forme de diverses hétérozygoties composites (S/C, S/E, S/D-Punjab, S/Lepore, S/β-thalassémie) est responsable des syndromes drépanocytaires majeurs (SDM) ou thalassémiques. En France, outre un dépistage néonatal ciblé des SDM regroupé dans 6 centres, un dépistage chez les femmes enceintes est couramment pratiqué et permet d'identifier les couples à risque. Devant une anémie hémolytique ou une microcytose hypochrome sans carence martiale, une recherche d'hémoglobinopathie est souvent effectuée. La chromatographie liquide haute performance d'échange d'ions ou l'électrophorèse capillaire permettent un dosage fiable des hémoglobines, en particulier A2 et F. Leur utilisation conjointe permet de détecter et d'identifier les principaux variants pathologiques. Le diagnostic étayé par une conclusion utilise les résultats de ces deux techniques et des paramètres érythrocytaires. Le recours à un laboratoire spécialisé pour le typage moléculaire est nécessaire pour le diagnostic de certaines thalassémies et pour l'identification du défaut moléculaire et des facteurs de pronostic des SDM.Hemoglobin disorders included thalassemias due to a reduced production of globin chains and diseases due to a hemoglobin variant with abnormal solubility, stability or oxygen delivery. Hemoglobin S is the most frequent clinically severe variant, involved at homozygous or various compound heterozygous states (S/C, S/E, S/D-Punjab, S/Lepore, S/β-thalassemia) in sickle cell disease (SCD) and thalassemias. In France, targeted newborn screening to identify SCD is performed by 6 laboratories and screening in pregnant women is common to identify couples at risk. Face to hemolytic or anemia or microcytosis and hypochromia without iron deficiency, laboratory diagnosis of hemoglobinopathies is requested. Cation-exchange high performance chromatography or capillary electrophoresis are indicated for quantification of hemoglobins, especially A2 and F. Identification of common clinically significant hemoglobin variants is possible by combination of these two methods. Result interpretation is done with red cell indices and a conclusion is reported with laboratory data. Molecular testing in reference laboratory is mandatory for diagnosis of complex thalassemias and characterization of sickling disorders.
