OBJECTIVE: The aim of this study was to explore the possible (joint) contrib ut ing role of interleukin-6 (IL-6) and antiphospholipid antibodies to the occurr ence of the venous thromboembolism in women using oral con...OBJECTIVE: The aim of this study was to explore the possible (joint) contrib ut ing role of interleukin-6 (IL-6) and antiphospholipid antibodies to the occurr ence of the venous thromboembolism in women using oral contraceptives. METHODS: Interleukin-6 and antiphospholipid antibodies (anti-β2-glycoprotein I antibo dy-immunoglobulin M [IgM], G [IgG], and A [IgA]; anticardiolipin-IgM and IgG; antiphospha-tidylserine-IgM and IgG) were measured in 30 women (median age 41, range 28-49 years) in the stable period (on average 3.5 years) after first ven ous thromboembolism. Sixteen patients used oral contraceptives during the episod e of venous thromboembolism (oral contraceptives group), whereas 14 patients did not (non-oral contraceptives group). Thirty-seven age-matched, healthy women served as controls RESULTS: Compared with controls, the oral contraceptives gro up had elevated IL-6 (median interquartile range 2.3 [1.1-4.3] versus 1.4 [0- 2.0] pg/mL, P < .05). The oral contracepti ves group had elevated anti-β2-glycoprotein I antibody-IgM in comparison wit h both the non-oral contraceptives group (median interquartile range 47.5 [2.0 -77.0] versus 29.50 [11.00-45.50] OD450,P < .06) and controls (47.5 [2.0-77.0 ] versus 17.5 [3.5-30.0] OD450,P < .001). Interleukin-6 level in the non-oral contraceptives group was related to obesity, whereas such a relation was not fo und in the oral contraceptives group, suggesting the presence of another factor (oral contraceptive use), which stimulates IL-6 production. Of particular inter est is our finding that elevated IL-6 levels correlated significantly positivel y with elevated anti-β2-glycoprotein I antibody-IgG in patients who were use rs of oral contraceptives (but not overweight, n = 10) (r = 0.56, P < .05). CONC LUSION: The results suggest a new hypothesis that, in susceptible women, use of oral contraceptives induces production of IL-6, which stimulates production of anti-β2-glycoprotein I. Thus, the prothrombotic profile is aggravated and cou ld facilitate occurrence of venous thromboembolism. This remains to be elucidate d in further studies.展开更多
OBJECTIVE: We sought to assess the accuracy of endometrial thickness measure me nt in the diagnosis of endometrial cancer in patients with obesity, diabetes, an d hypertension and to evaluate whether patient character...OBJECTIVE: We sought to assess the accuracy of endometrial thickness measure me nt in the diagnosis of endometrial cancer in patients with obesity, diabetes, an d hypertension and to evaluate whether patient characteristics influence endomet rial thickness irrespective of the final diagnosis. METHODS: This was a prospect ive study of women not using hormone replacement therapy who presented with post -menopausal bleeding at 8 hospitals in The Netherlands. All women underwent tra nsvaginal ultrasonography and, in the event that the endometrial thickness (doub le layer) was more than 4 mm, subsequent endometrial sampling. The performance o f endometrial thickness measurement in the diagnosis of atypical hyperplasia and endometrial cancer was evaluated in subgroups of patients with diabetes, hypert ension, and obesity by using receiver operating characteristic analysis. RESULTS : Overall, we included 594 consecutive women, of whom 62 (10%) had endometrial carcinoma and 6 (1%) had atypical hyperplasia. In these women, transvaginal ult rasonography had an area under the receiver operating characteristic curve of 0. 87 (standard error [SE] 0.03). In the absence of (pre) malignancy, women with di abetes or obesity were found to have thicker endometria than women without these risk factors, whereas in women with a (pre) malignancy, this difference was not present. The area under the receiver operating characteristic curve decreased t o 0.74 (SE 0.05) and 0.75 (SE 0.07) in diabetic women and obese women, respectiv ely. The presence or absence of hypertension had no impact on the accuracy of transvaginal ultrasonography. CONCLUSION: In view of the decreased diagnostic accuracy in diabetic women and obese women, the clinical value of transvaginal e ndometrial thickness measurement in these women is questionable.展开更多
OBJECTIVE: To estimate the effect of outpatient administration of a single d os e of vaginal misoprostol at term on the interval to delivery in women with unfav orable cervices. METHODS: Randomized, double blind, plac...OBJECTIVE: To estimate the effect of outpatient administration of a single d os e of vaginal misoprostol at term on the interval to delivery in women with unfav orable cervices. METHODS: Randomized, double blind, placebo-controlled trial co mparing a single 25-μg outpatient intravaginal dose of misoprostol to placebo in pregnant women with Bishop scores less than 9 at 40 weeks or greater. After p lacement of the study medication, subjects were permitted to go into spontaneous labor unless an indication for induction developed. Analysis was by intent to t reat. The interval to delivery, defined as the time from medication placement to delivery, was compared by Student t test and by survival analysis with the log -rank test. RESULTS: Thirty-three women were randomly assigned to receive miso prostol, and 35 were assigned to receive placebo. The mean interval to delivery was significantly less in the misoprostol group, 4.2 ±.4.1 compared with 6.1 ± .3.6 days, P = .04. The interval to delivery for only the nulliparous patients w as significantly less in the misoprostol group, 4.2 ±.4.0 compared with 7.2 ±. 3.7 days, P = .02. The survival curves for the interval to delivery were signifi cantly different (P = .04 by log-rank test) with 4.1 days median interval to de livery for misoprostol compared with 9.2 days for placebo. There were no adverse outcomes in either group. CONCLUSION: A single 25-μg outpatient intravaginal dose of misoprostol is effective in decreasing the interval to delivery in women with unfavorable cervices at term.展开更多
OBJECTIVE: Existing studies relating asthma and preeclampsia provide conflic ti ng results, perhaps due to differences in study populations, varying definitions of asthma, and inadequate control for confounding, parti...OBJECTIVE: Existing studies relating asthma and preeclampsia provide conflic ti ng results, perhaps due to differences in study populations, varying definitions of asthma, and inadequate control for confounding, particularly asthma medicati on use. This prospective study examines associations between aspects of asthma ( diagnosis, severity, symptoms, and medication use) and risk of preeclampsia. MET HODS: A total of 1,708 pregnant women, of whom 656 had asthma diagnosis and 1,05 2 had no asthma diagnosis, were included in this analysis. Asthma symptoms, trea tment, and severity were classified according to Global Initiative for Asthma gu idelines. Hospital records were abstracted, and strict criteria were applied to classify women as preeclamptic based on National Heart, Lung, and Blood Institut e guidelines. RESULTS: There were 568 of 656 women with diagnosed asthma and 353 of 1,052 women without asthma diagnosis who had symptoms or took asthma medicat ion during pregnancy. Separate adjusted logistic regression models were run for different measures of asthma status: 1) asthma diagnosis; 2) overall Global Init iative for Asthma severity; 3) Global Initiative for Asthma symptom and treatmen t steps; and 4) Global Initiative for Asthma symptom step and medication type. W omen at increased risk of preeclampsia were those classified as Global Initiativ e for Asthma symptom step 3/4 compared with no symptoms (odds ratio 3.36, 95%co nfidence interval 1.24-9.14) and theophylline users (odds ratio 1.16 for every dose/month increase in use, 95%confidence interval 1.02-1.33). In contrast, ne ither a history of physician-diagnosed asthma nor Global Initiative for Asthma treatment step was associated with preeclampsia status. CONCLUSION: Our findings suggest that women with moderate to severe asthma symptoms, regardless of asthm a diagnosis or treatment, are at increased risk of preeclampsia compared with wo men with no symptoms.展开更多
目的分析和估价目前我国艾滋病流行态势所处的阶段,探索预防艾滋病蔓延的关键所在。方法采用描述流行病学的方法,从艾滋病传播的三条途径入手,探索阻断艾滋病传播的有效办法和关键环节。结果目前我国艾滋病流行态势已接近大面积爆发阶段...目的分析和估价目前我国艾滋病流行态势所处的阶段,探索预防艾滋病蔓延的关键所在。方法采用描述流行病学的方法,从艾滋病传播的三条途径入手,探索阻断艾滋病传播的有效办法和关键环节。结果目前我国艾滋病流行态势已接近大面积爆发阶段,必须引起全社会的关注;找出了一系列预防的有效办法和关键环节,主要包括有关艾滋病的科学知识教育、性道德教育;使用安全套;对暗娼的科学管理;实行无偿献血;认真筛查;使用 NAT(核酸扩增检测)技术;劝阻感染HIV 或患艾滋病的妇女怀孕;对分娩可疑患儿跟踪检查:禁止感染 HIV 或患艾滋病的妇女哺乳。结论我们必须首先清醒认识到艾滋病在我国流行现状的严重性和危险性,只要我们能把握住关键环节,科学管理、有效防治、坚持不懈;只要我们在阻断艾滋病的三条传播途径上狠下工夫,认真做好每个环节的预防工作,就能够有效地遏制艾滋病在我国的流行并最终战胜艾滋病。展开更多
文摘OBJECTIVE: The aim of this study was to explore the possible (joint) contrib ut ing role of interleukin-6 (IL-6) and antiphospholipid antibodies to the occurr ence of the venous thromboembolism in women using oral contraceptives. METHODS: Interleukin-6 and antiphospholipid antibodies (anti-β2-glycoprotein I antibo dy-immunoglobulin M [IgM], G [IgG], and A [IgA]; anticardiolipin-IgM and IgG; antiphospha-tidylserine-IgM and IgG) were measured in 30 women (median age 41, range 28-49 years) in the stable period (on average 3.5 years) after first ven ous thromboembolism. Sixteen patients used oral contraceptives during the episod e of venous thromboembolism (oral contraceptives group), whereas 14 patients did not (non-oral contraceptives group). Thirty-seven age-matched, healthy women served as controls RESULTS: Compared with controls, the oral contraceptives gro up had elevated IL-6 (median interquartile range 2.3 [1.1-4.3] versus 1.4 [0- 2.0] pg/mL, P < .05). The oral contracepti ves group had elevated anti-β2-glycoprotein I antibody-IgM in comparison wit h both the non-oral contraceptives group (median interquartile range 47.5 [2.0 -77.0] versus 29.50 [11.00-45.50] OD450,P < .06) and controls (47.5 [2.0-77.0 ] versus 17.5 [3.5-30.0] OD450,P < .001). Interleukin-6 level in the non-oral contraceptives group was related to obesity, whereas such a relation was not fo und in the oral contraceptives group, suggesting the presence of another factor (oral contraceptive use), which stimulates IL-6 production. Of particular inter est is our finding that elevated IL-6 levels correlated significantly positivel y with elevated anti-β2-glycoprotein I antibody-IgG in patients who were use rs of oral contraceptives (but not overweight, n = 10) (r = 0.56, P < .05). CONC LUSION: The results suggest a new hypothesis that, in susceptible women, use of oral contraceptives induces production of IL-6, which stimulates production of anti-β2-glycoprotein I. Thus, the prothrombotic profile is aggravated and cou ld facilitate occurrence of venous thromboembolism. This remains to be elucidate d in further studies.
文摘OBJECTIVE: We sought to assess the accuracy of endometrial thickness measure me nt in the diagnosis of endometrial cancer in patients with obesity, diabetes, an d hypertension and to evaluate whether patient characteristics influence endomet rial thickness irrespective of the final diagnosis. METHODS: This was a prospect ive study of women not using hormone replacement therapy who presented with post -menopausal bleeding at 8 hospitals in The Netherlands. All women underwent tra nsvaginal ultrasonography and, in the event that the endometrial thickness (doub le layer) was more than 4 mm, subsequent endometrial sampling. The performance o f endometrial thickness measurement in the diagnosis of atypical hyperplasia and endometrial cancer was evaluated in subgroups of patients with diabetes, hypert ension, and obesity by using receiver operating characteristic analysis. RESULTS : Overall, we included 594 consecutive women, of whom 62 (10%) had endometrial carcinoma and 6 (1%) had atypical hyperplasia. In these women, transvaginal ult rasonography had an area under the receiver operating characteristic curve of 0. 87 (standard error [SE] 0.03). In the absence of (pre) malignancy, women with di abetes or obesity were found to have thicker endometria than women without these risk factors, whereas in women with a (pre) malignancy, this difference was not present. The area under the receiver operating characteristic curve decreased t o 0.74 (SE 0.05) and 0.75 (SE 0.07) in diabetic women and obese women, respectiv ely. The presence or absence of hypertension had no impact on the accuracy of transvaginal ultrasonography. CONCLUSION: In view of the decreased diagnostic accuracy in diabetic women and obese women, the clinical value of transvaginal e ndometrial thickness measurement in these women is questionable.
文摘OBJECTIVE: To estimate the effect of outpatient administration of a single d os e of vaginal misoprostol at term on the interval to delivery in women with unfav orable cervices. METHODS: Randomized, double blind, placebo-controlled trial co mparing a single 25-μg outpatient intravaginal dose of misoprostol to placebo in pregnant women with Bishop scores less than 9 at 40 weeks or greater. After p lacement of the study medication, subjects were permitted to go into spontaneous labor unless an indication for induction developed. Analysis was by intent to t reat. The interval to delivery, defined as the time from medication placement to delivery, was compared by Student t test and by survival analysis with the log -rank test. RESULTS: Thirty-three women were randomly assigned to receive miso prostol, and 35 were assigned to receive placebo. The mean interval to delivery was significantly less in the misoprostol group, 4.2 ±.4.1 compared with 6.1 ± .3.6 days, P = .04. The interval to delivery for only the nulliparous patients w as significantly less in the misoprostol group, 4.2 ±.4.0 compared with 7.2 ±. 3.7 days, P = .02. The survival curves for the interval to delivery were signifi cantly different (P = .04 by log-rank test) with 4.1 days median interval to de livery for misoprostol compared with 9.2 days for placebo. There were no adverse outcomes in either group. CONCLUSION: A single 25-μg outpatient intravaginal dose of misoprostol is effective in decreasing the interval to delivery in women with unfavorable cervices at term.
文摘OBJECTIVE: Existing studies relating asthma and preeclampsia provide conflic ti ng results, perhaps due to differences in study populations, varying definitions of asthma, and inadequate control for confounding, particularly asthma medicati on use. This prospective study examines associations between aspects of asthma ( diagnosis, severity, symptoms, and medication use) and risk of preeclampsia. MET HODS: A total of 1,708 pregnant women, of whom 656 had asthma diagnosis and 1,05 2 had no asthma diagnosis, were included in this analysis. Asthma symptoms, trea tment, and severity were classified according to Global Initiative for Asthma gu idelines. Hospital records were abstracted, and strict criteria were applied to classify women as preeclamptic based on National Heart, Lung, and Blood Institut e guidelines. RESULTS: There were 568 of 656 women with diagnosed asthma and 353 of 1,052 women without asthma diagnosis who had symptoms or took asthma medicat ion during pregnancy. Separate adjusted logistic regression models were run for different measures of asthma status: 1) asthma diagnosis; 2) overall Global Init iative for Asthma severity; 3) Global Initiative for Asthma symptom and treatmen t steps; and 4) Global Initiative for Asthma symptom step and medication type. W omen at increased risk of preeclampsia were those classified as Global Initiativ e for Asthma symptom step 3/4 compared with no symptoms (odds ratio 3.36, 95%co nfidence interval 1.24-9.14) and theophylline users (odds ratio 1.16 for every dose/month increase in use, 95%confidence interval 1.02-1.33). In contrast, ne ither a history of physician-diagnosed asthma nor Global Initiative for Asthma treatment step was associated with preeclampsia status. CONCLUSION: Our findings suggest that women with moderate to severe asthma symptoms, regardless of asthm a diagnosis or treatment, are at increased risk of preeclampsia compared with wo men with no symptoms.
文摘目的分析和估价目前我国艾滋病流行态势所处的阶段,探索预防艾滋病蔓延的关键所在。方法采用描述流行病学的方法,从艾滋病传播的三条途径入手,探索阻断艾滋病传播的有效办法和关键环节。结果目前我国艾滋病流行态势已接近大面积爆发阶段,必须引起全社会的关注;找出了一系列预防的有效办法和关键环节,主要包括有关艾滋病的科学知识教育、性道德教育;使用安全套;对暗娼的科学管理;实行无偿献血;认真筛查;使用 NAT(核酸扩增检测)技术;劝阻感染HIV 或患艾滋病的妇女怀孕;对分娩可疑患儿跟踪检查:禁止感染 HIV 或患艾滋病的妇女哺乳。结论我们必须首先清醒认识到艾滋病在我国流行现状的严重性和危险性,只要我们能把握住关键环节,科学管理、有效防治、坚持不懈;只要我们在阻断艾滋病的三条传播途径上狠下工夫,认真做好每个环节的预防工作,就能够有效地遏制艾滋病在我国的流行并最终战胜艾滋病。
