Stężenie fibrogenu i D-dimerów u chorych z nadczynnością tarczycy przed i po leczeniu 131I

Background: Various abnormalities of haemostasis have been described in patients with hyperthyroidism. The results of different studies point to the underlying thyroid disease, especially severity of hyperthyroidism and autoimmune processes, as important factors contributing to coagulation-fibrinolytic balance. The objective of this study was to investigate the association between hyperthyroidism (concerning severity of thyroid dysfunction and anti-thyroid perioxidase antibodies level) and plasma fibrinogen and D-dimers levels before and after radioiodine therapy. Material and methods: The study included 35 non-smoking, postmenopausal women, aged 51–69, with subclinical or overt hyperthyroidism treated with radioiodine. Analysis comprised serum TSH (thyroid stimulating hormone), fT4 (free thyroxine), fT3 (free triiodothyronine), TPO antibodies (anti-thyroid perioxidase) levels, and plasma D-dimers and fibrinogen levels before and 12-16 weeks and 24–28 weeks after radioiodine therapy. Results: Elevated fibrinogen (3.82 g/L ± 0.75, reference range 2–4.5 g/L) and D-dimers (674.26 ng/mL ± 652.71, reference range 70–490 ng/mL) levels were observed in subjects with hyperthyroidism. They decreased after radioiodine therapy. A negative correlation between plasma fibrinogen and D-dimers levels and anti-thyroid perioxidase antibodies level was found. TSH, fT4 and fT3 correlated with D-dimers level in overt hyperthyroidism. Conclusions: Hyperthyroidism is associated with a tendency toward hypercoagulation and hyperfibrinolysis. The changes observed in plasma fibrinogen and D-dimers levels are reversible. Fibrinogen level decreases within reference range and D-dimers level decreases almost to the upper reference range. They depend on severity and autoimmunity of the underlying thyroid disease and may be modified by restoring euthyroidism. (Pol J Endocrinol 2011; 62 (5): 409–415)Wstęp: U pacjentów z nadczynnością tarczycy opisano różne zaburzenia hemostazy. Wyniki publikowanych dotychczas prac sugerują, że najważniejszymi czynnikami, od których zależy równowaga procesów koagulacji i fibrynolizy, są stopień nasilenia choroby tarczycy oraz procesy autoimmunologiczne. Celem prezentowanej pracy jest ocena stężeń fibrynogenu i D-dimerów w nadczynności tarczycy przed leczeniem i po podaniu 131I w zależności od nasilenia choroby i braku lub obecności przeciwciał przeciw tyreoperoksydazie. Materiał i metody: Do badania włączono 35 niepalących kobiet po menopauzie, w wieku 51–69 lat, z subkliniczną lub jawną klinicznie nadczynnością tarczycy, leczonych 131I. Badano stężenia tyreotropiny (TSH), wolnej tyroksyny (fT4), wolnej trójjodotyroniny (fT3), przeciwciał przeciw tyreoperoksydazie (anty-TPO) oraz fibrynogenu i D-dimerów przed leczeniem oraz 12–16 tygodni i 24–28 tygodni po podaniu 131I. Wyniki: U kobiet z nadczynnością tarczycy obserwowano podwyższone stężenie fibrynogenu (3,82 g/L ± 0,75, norma 2–4,5 g/L) i D-dimerów (674,26 ng/mL ± 652,71, norma 70–490 ng/mL), które obniżały się po leczeniu 131I. Stwierdzono ujemną korelację pomiędzy stężeniem fibrynogenu i D-dimerów a stężeniem przeciwciał anty-TPO. U pacjentek z jawną klinicznie nadczynnością tarczycy uzyskano dodatnią korelację pomiędzy stężeniem TSH, fT4, fT3 a stężeniem D-dimerów. Wnioski: Nadczynność tarczycy wiąże się z większą skłonnością do koagulacji i fibrynolizy. Stężenie fibrynogenu zmniejsza się w zakresie wartości referencyjnych, natomiast D-dimerów zmniejszając się, osiąga górny zakres wartości referencyjnych. Zmiany obserwowane w stężeniu fibrynogenu i D-dimerów są odwracalne. Zależą od stopnia nasilenia nadczynności tarczycy oraz procesów autoimmunologicznych, a także podlegają modyfikacji po przywróceniu prawidłowej funkcji tarczycy. (Endokrynol Pol 2011; 62 (5): 409–415

The difficulties in differential diagnosis of primary aldosteronism subtypes in women with strokes at a young age

In patients with primary aldosteronism (PA), it is fundamental to distinguish between subtypes that benefit from different treatment. The authors describe difficulties in differential diagnosis in a case of 46 year old women with PA and two strokes in the past. Based on high plasma and urine aldosterone concentration, low plasma renin activity (PRA), very high aldosterone/PRA ratio and unilateral macroadenoma detected in computed tomography, aldosterone producing adenoma was diagnosed and the patient was performed unilateral adrenalectomy. Despite the surgical treatment the patient still presented with clinical and biochemical PA symptoms. Moreover, histological examination suggested adrenal hyperplasia, and laboratory tests were typical for glucocorticoid-remediable aldosteronism. Unfortunately, we didn’t find a chimeric CYP 11β1/CYP 11β2 gene. Finally, bilateral adrenal hyperplasia was diagnosed and medical treatment with aldosterone antagonist was initiated.U chorych z pierwotnym aldosteronizmem (PA, primary aldosteronism) rozpoznanie podtypu aldosteronizmu ma zasadnicze znaczenie dla wyboru odpowiedniego leczenia. Poniżej autorzy prezentują przypadek zespołu pierwotnego aldosteronizmu u 46-letniej kobiety po dwóch udarach mózgowych, który nastręczył wiele trudności w określeniu przyczyny PA. Ze względu na znacznie podwyższone stężenia aldosteronu w surowicy krwi i moczu, obniżenie aktywności reninowej osocza (PRA, plasma renin activity), wysoki wskaźnik aldosteron/PRA i obraz makrogruczolaka nadnercza w tomografi komputerowej, rozpoznano aldosteronoma i chorą poddano jednostronnej adrenalektomii. Leczenie to nie było skuteczne, wynik badania histopatologicznego wskazywał na przerost nadnerczy, a badania biochemiczne - na aldosteronizm hamowany glikokortykosteroidami. W badaniu genetycznym nie wykazano jednak genu chimerycznego CYP 11β1/CYP 11β2. Ostatecznie rozpoznano obustronny przerost nadnerczy i zastosowano leczenie zachowawcze z uwzględnieniem antagonisty aldosteronu

Niealkoholowe stłuszczenie wątroby u kobiet z zespołem wielotorbielowatych jajników — aspekty kliniczne i metaboliczne oraz polimorfizm genu lipazy lipoproteinowej

Introduction: The aim was to assess associations among PCOS and NAFLD, the lipoprotein lipase polymorphism gene, and metabolic disorders in PCOS.Material and methods: In 184 women with PCOS and 125 healthy, premenopausal volunteers, sex steroids, lipids, glucose, insulin, aminotransferases, free androgen index (FAI), HOMA-IR and E2/T were calculated. Hepatic steatosis was determined by ultrasound. Whole genomic DNA was isolated from blood leucocytes. Lipoprotein lipase polymorphisms rs268 and rs328 were analysed by polymerase chain reaction (PCR) and minisequencing.Results: 57.6% of PCOS women had NAFLD, while women without PCOS had NAFLD in 49.6%. PCOS-NAFLD women had higher BMI, WHR and waist circumference compared to women with PCOS without NAFLD and women without PCOS. PCOS-NAFLD women had lower SHBG, E2/T ratio, and higher FAI compared to other groups. ALT levels were higher in PCOS women with NAFLD compared to other groups. PCOS women with and without NAFLD had higher fasting glucose and insulin and HOMA compared to women without PCOS. Women with PCOS had higher triglycerides and lower HDL-C compared to women without PCOS. There was no evidence that evaluated polymorphisms influenced hepatic steatosis in women with and without PCOS.Conclusions: PCOS is not an independent factor influencing NAFLD in women. The influences on NAFLD incidence in women are BMI > 25 kg/m², glucose level > 80 mg/dL, E2/T < 80 and ALT > 19 IU/L as independent factors. Hyperandrogenism in PCOS may increase the risk of NAFLD indirectly by obesity, insulin resistance, and directly by the hepatotoxic effect. Polymorphisms rs328 and rs268 of the lipoprotein lipase gene do not affect the occurrence of NAFLD in women with PCOS or without PCOS. (Endokrynol Pol 2014; 65 (6): 416–421) Wstęp: Celem pracy było zbadanie zależności między zespołem wielotorbielowatych jajników (PCOS) a niealkokoholowym stłuszczniem wątroby (NAFLD), polimorfizmem genu lipazy lipoproteinowej oraz zaburzeniami metabolicznymi obserwowanymi w PCOS.Materiał i metody: W grupie 184 kobiet z PCOS i wśród 125 zdrowych kobiet premenopauzalnych badano w surowicy stężenia hormonów płciowych, frakcji lipidowych, glukozy insuliny i transaminaz oraz obliczano wskaźniki wolnych androgenów (FAI), insulinooporności HOMA i E2/T. Stłuszczenie wątroby oceniano ultrasonograficznie. Genomowe DNA izolowano z leukocytów krwi obwodowej metodami standardowymi. Do oznaczanie polimorfizmów rs268 i rs 328 lipazy lipoproteinowej użyto metody PCR i minisekwencjonowania.Wyniki: częstość występowania NAFLD u kobiet z PCOS nie różniła się istotnie w porównaniu do kobiet bez PCOS. Kobiety z PCOS i NAFLD miały istotnie wyższy BMI , WHR i obwód talii w porównaniu z kobietami z PCOS bez NAFLD oraz kobiet bez PCOS. Ponadto stwierdzono u nich istotnie niższe SHBG, E2/T i wyższy FAI w porównaniu z kobietami z pozostałych grup. Stężenia transaminazy alaninowej (ALT) w grupie PCOS z NAFLD były istotnie wyższe niż w pozostałych grupach. U kobiet z PCOS z i bez NAFLD obserwowano istotnie wyższe stężenia glukozy, insuliny i wskaźnika HOMA w porównaniu z kobietami bez PCOS. Nie stwierdzono istotnych różnic w występowaniu określonych polimorfizmów genu lipazy lipoproteinowej w badanych grupach.Wnioski: Zespół wielotorbielowatych jajników nie jest niezależnym czynnikiem wpływającym na NAFLD u kobiet. Niezależnymi czynnikami mającymi wpływ na wystąpienie NAFLD są: BMI > 25 kg/m², stężenie glukozy > 80 mg/dl, E2/T < 80 oraz ALT > 19 IU/l. Hiperandrogenizm w PCOS może pośrednio zwiększać ryzyko NAFLD przez insulinooporność i otyłość oraz bezpośrednio przez efekt hepatotoksyczny. Polimorfizmy rs320 i rs268 genu lipazy lipoproteinowej nie mają wpływu na częstość występowania NAFLD u kobiet z PCOS. (Endokrynol Pol 2014; 65 (6): 416–421

Wpływ polimorfizmu genu receptora endokanabinoidowego 1 na parametry antropometryczne i metaboliczne u kobiet z zespołem wielotorbielowatych jajników

Introduction: Polycystic ovary syndrome (PCOS) is associated with an increasing number of metabolic comorbidities. About 50% of PCOS patients are obese, and insulin resistance affects up to 70% of these women. The endocannabinoid system contributes to human energy homeostasis. CNR1 is a biological candidate for human obesity and related metabolic disorders. The aim of this study was to determine the relationships between CNR1 polymorphisms and anthropometric and metabolic parameters in PCOS women.Material and methods: 130 women diagnosed with PCOS according to the Rotterdam criteria were recruited. The control group consisted of 70 healthy women. Medical history was taken, and physical examination as well as assessment of anthropometric (body mass, height, waist and hip circumference, BMI, waist-to-hip ratio [WHR]) and metabolic parameters (glucose and insulin, the insulin resistance index HOMA, lipid profile) was carried out. Genetic studies to detect six CNR1 gene polymorphisms were performed.Results: The total cholesterol and low-density lipoprotein (LDL) cholesterol levels in PCOS women carrying T/T genotype of rs2023239CNR1 polymorphism were higher than in those with C/T and C/C. There were no statistical differences in other metabolic parameters or in the value of BMI and WHR between the variants of rs2023239 CNR1 polymorphism. The other studied polymorphisms of the CNR1 gene were not associated with anthropometric or metabolic parameters in PCOS women. There were no differences in anthropometric or metabolic parameters between the variants of studied polymorphisms of the CNR1 gene in control women.Conclusions: On the basis of our study, it seems that CNR1 polymorphisms are not associated with obesity and metabolic disorders, including insulin resistance, in PCOS women.Wstęp: Zespół wielotorbielowatych jajników wiąże się z licznymi zaburzeniami metabolicznymi. Około 50% kobiet z PCOS jest otyłych, a insulinooporność wykazuje do 70% kobiet z tym zespołem. Układ endokanabinoidowy odgrywa rolę w regulacji równowagi energetycznej organizmu. Gen CNR1 jest genem kandydatem związanym z otyłością i zaburzeniami metabolicznymi. Celem badania była ocena wzajemnych powiązań między polimorfizmami genu CNR1 a parametrami antropometrycznymi i metabolicznymi u pacjentek z PCOS.Materiał i metody: Do badania włączono 130 kobiet, u których w oparciu o kryteria rotterdamskie postawiono rozpoznanie PCOS. Grupę kontrolną stanowiło 70 zdrowych kobiet. U wszystkich badanych przeprowadzono wywiad lekarski, badanie fizykalne z oceną parametrów antropometrycznych (masa i wysokość ciała, obwód talii i bioder, indeks masy ciała, wskaźnik talia–biodra), wykonano badania biochemiczne (ocena stężeń glukozy i insuliny, wskaźnika insulinooporności HOMA, lipidogramu). Przeprowadzono również badania genetyczne oceniające sześć polimorfizmów genu CNR1.Wyniki: Stężenie cholesterolu całkowitego i cholesterolu frakcji LDL było wyższe u kobiet z PCOS i genotypem T/T polimorfizmu rs2023239 genu CNR1 w porównaniu z pacjentkami z genotypami C/T i C/C. Nie było istotnych statystycznie różnic dotyczących innych parametrówmetabolicznych (stężenia glukozy, insuliny, wskaźnik HOMA) ani wskaźników masy ciała i talia–biodra między poszczególnymi genotypami polimorfizmu rs2023239. Nie wykazano zależności pomiędzy innymi badanymi polimorfizmami genu CNR1 a parametrami antropometrycznymi i metabolicznymi u pacjentek z PCOS. Nie stwierdzono również takich zależności u kobiet z grupy kontrolnej.Wnioski: Na podstawie przedstawionego badania wydaje się, że polimorfizmy genu CNR1 nie są związane z otyłością ani zaburzeniami metabolicznymi, w tym insulinoopornością, u kobiet z PCOS

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Search for stop and higgsino production using diphoton Higgs boson decays

Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top-quark (stop) and the Higgs boson (higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7 inverse femtobarns of proton-proton collision data at sqrt(s) = 8 TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the stop mass below 360 to 410 GeV, depending on the higgsino mass

Impacts of the Tropical Pacific/Indian Oceans on the Seasonal Cycle of the West African Monsoon

The current consensus is that drought has developed in the Sahel during the second half of the twentieth century as a result of remote effects of oceanic anomalies amplified by local land–atmosphere interactions. This paper focuses on the impacts of oceanic anomalies upon West African climate and specifically aims to identify those from SST anomalies in the Pacific/Indian Oceans during spring and summer seasons, when they were significant. Idealized sensitivity experiments are performed with four atmospheric general circulation models (AGCMs). The prescribed SST patterns used in the AGCMs are based on the leading mode of covariability between SST anomalies over the Pacific/Indian Oceans and summer rainfall over West Africa. The results show that such oceanic anomalies in the Pacific/Indian Ocean lead to a northward shift of an anomalous dry belt from the Gulf of Guinea to the Sahel as the season advances. In the Sahel, the magnitude of rainfall anomalies is comparable to that obtained by other authors using SST anomalies confined to the proximity of the Atlantic Ocean. The mechanism connecting the Pacific/Indian SST anomalies with West African rainfall has a strong seasonal cycle. In spring (May and June), anomalous subsidence develops over both the Maritime Continent and the equatorial Atlantic in response to the enhanced equatorial heating. Precipitation increases over continental West Africa in association with stronger zonal convergence of moisture. In addition, precipitation decreases over the Gulf of Guinea. During the monsoon peak (July and August), the SST anomalies move westward over the equatorial Pacific and the two regions where subsidence occurred earlier in the seasons merge over West Africa. The monsoon weakens and rainfall decreases over the Sahel, especially in August.Peer reviewe

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Severe early onset preeclampsia: short and long term clinical, psychosocial and biochemical aspects

Preeclampsia is a pregnancy specific disorder commonly defined as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5% of pregnancies and it is still a major cause of both foetal and maternal morbidity and mortality worldwide1. As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. The only rational treatment is delivery, which benefits the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It is, however often associated with maternal morbidity as the risk of progression to severe maternal disease is inversely related with gestational age at onset2. Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia3. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by expectant, non-interventional management. This temporising treatment option to lengthen pregnancy includes the use of antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity4. With optimal maternal haemodynamic status and reassuring foetal condition this results on average in an extension of 2 weeks. Prolongation of these pregnancies is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefits on the other. Clinical controversies regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands5 - a debate which is even more pronounced in very preterm pregnancies with questionable foetal viability6-9. Do maternal risks of prolongation of these very early pregnancies outweigh the chances of neonatal survival? Counselling of women with very early onset preeclampsia not only comprises of knowledge of the outcome of those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance. This thesis opens with a review of the literature on identifiable risk factors of preeclampsia