Metformin decreases bone turnover markers in polycystic ovary syndrome : a post hoc study

Objective: To study the effects of metformin treatment on bone turnover in women with polycystic ovary syndrome (PCOS), as measured by serum concentrations of bone turnover markers. Design: Post hoc study of a previously conducted prospective multicenter, placebo-controlled, randomized study. Setting: University clinic. Patient(s): The study cohort consisted of 74 non-obese women (body mass index = 27 kg/m(2)) diagnosed with PCOS, with a mean age of 27.6 +/- 4.0 (SD) years. Intervention(s): Randomization to receive metformin or placebo for 3 months. Main Outcome Measure(s): Serum levels of bone formation marker procollagen type I amino-terminal propeptide (PINP) and bone resorption marker carboxy-terminal cross-linking telopeptide of type I collagen (CTX) at baseline and after metformin/placebo treatment. Result(s): Serum levels of PINP and CTX were similar between the metformin and placebo groups at baseline in the whole study population. Obese women, when compared with non-obese, had lower baseline levels of PINP and CTX. Levels of PINP and CTX were significantly reduced in the whole study population, as well as in both non-obese and obese women after 3 months of metformin treatment, whereas no significant changes were observed in the placebo group. Conclusion(s): Metformin treatment, when compared with placebo, was associated with reduced bone turnover, as suggested by reductions in markers of bone formation and resorption, leading to slower bone remodeling in premenopausal women with PCOS. ((C) 2019 by American Society for Reproductive Medicine.)Peer reviewe

Histomorphological spectrum of gastrointestinal stromal tumors: an institutional experience

Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the abdominal area. They can involve any portion of the gastrointestinal (GI) tract, omentum, mesentery, retroperitoneum, and other sites. They form 1-2% of the histologic types of gastrointestinal tract tumors. Aims and objectives were to analyze and correlate morphological, clinical and histomorphology features of gastrointestinal tumors presenting at different sites.Methods: This was a retrospective observational study for six years. Medical records of the histopathologically diagnosed GIST cases were reviewed for patient demographics and clinical presentation, and tumor findings were noted.Results: Of the 28 patients, ages ranged from 28 to 80 years. Symptoms ranged from abdominal pain, epigastric discomfort, mass, upper/lower gastrointestinal bleeding, rectal bleeding, anemia, weight loss, and small bowel obstruction. Sites involved were the small bowel, stomach, mesentery, rectum, duodenum, greater omentum, and retroperitoneum. Of 28 cases of GIST, 25 cases showed both c-KIT and DOG-1 positivity, 1 case showed only c-KIT positivity, 1 case showed only DOG-1 positivity, and 1 case was both c-KIT and DOG-1 negative.Conclusions: GISTS are unpredictable mesenchymal tumors. Common sites are the stomach and small gut. Mesenteric and omental GIST are rare. Spindle cell morphology was more commonly present

Serum retinol-binding protein 4 levels in polycystic ovary syndrome

OBJECTIVE: Serum levels of retinol-binding protein 4 (RBP4), an adipokine thought to affect systemic insulin sensitivity, were compared between women with polycystic ovary syndrome (PCOS) and non-PCOS controls to evaluate the association of RBP4 with clinical, hormonal and metabolic parameters of PCOS. SUBJECTS AND METHODS: Serum RBP4 levels were analysed in 278 women with PCOS (age range 18-57 years) and 191 non-PCOS controls (age 20-53 years) by enzyme-linked immunosorbent assay. RESULTS: Serum levels of RBP4 were increased in women with PCOS compared with control women in the whole population (45.1 ± 24.0 (s.d.) vs 33.5 ± 18.3 mg/L, P <0.001). Age-stratified analysis showed that serum RBP4 levels were increased in women with PCOS aged ≤30 years compared with controls (47.7 ± 23.5 vs 27.1 ± 10.4 mg/L, P <0.001), whereas no significant differences were seen in the other age groups. No significant correlations of RBP4 were seen with either steroids or indices of insulin resistance. CONCLUSIONS: Although serum RBP4 levels were increased in younger women with PCOS compared with age-matched non-PCOS controls, RBP4 does not seem to be a good marker of insulin resistance or other metabolic derangements in women with PCOS.Peer reviewe

Increased Oral Care Needs and Third Molar Symptoms in Women with Gestational Diabetes Mellitus: A Finnish Gestational Diabetes Case–Control Study

(1) Hyperglycemia and oral pathology accelerate each other in diabetes. We evaluated whether gestational diabetes mellitus (GDM) is associated with self-reported increased oral health care needs and oral symptoms, including third molar symptoms, during pregnancy. (2) Pregnant women with (n = 1030) and without GDM (n = 935) were recruited in this multicenter Finnish Gestational Diabetes study in 2009–2012. Of the women with GDM, 196 (19.0%) receiving pharmacological treatment, 797 (77.0%) receiving diet treatment and 233 (23.0%) with recurrent GDM were analyzed separately. Oral health was assessed using structured questionnaires and analyzed by multivariable logistic regression adjusted for background risk factors. (3) Women with GDM were more likely to report a higher need for oral care than controls (31.1% vs. 24.5%; odds ratio (OR) 1.39; 95% confidence interval (CI) 1.14–1.69), particularly women with recurrent GDM (38.1% vs. 24.5%; OR 1.90; 95% CI 1.40–2.58). Women with pharmacologically treated GDM (46.9%) more often had third molar symptoms than controls (36.1%; OR 1.57; 95% CI 1.15–2.15) than women with diet-treated GDM (38.0%; OR 1.47; 95% CI 1.07–2.02). (4) GDM is associated with perceived oral care needs. Third molar symptoms were associated with pharmacologically treated GDM

Increased Oral Care Needs and Third Molar Symptoms in Women with Gestational Diabetes Mellitus: A Finnish Gestational Diabetes Case-Control Study

(1) Hyperglycemia and oral pathology accelerate each other in diabetes. We evaluated whether gestational diabetes mellitus (GDM) is associated with self-reported increased oral health care needs and oral symptoms, including third molar symptoms, during pregnancy. (2) Pregnant women with (n = 1030) and without GDM (n = 935) were recruited in this multicenter Finnish Gestational Diabetes study in 2009-2012. Of the women with GDM, 196 (19.0%) receiving pharmacological treatment, 797 (77.0%) receiving diet treatment and 233 (23.0%) with recurrent GDM were analyzed separately. Oral health was assessed using structured questionnaires and analyzed by multivariable logistic regression adjusted for background risk factors. (3) Women with GDM were more likely to report a higher need for oral care than controls (31.1% vs. 24.5%; odds ratio (OR) 1.39; 95% confidence interval (CI) 1.14-1.69), particularly women with recurrent GDM (38.1% vs. 24.5%; OR 1.90; 95% CI 1.40-2.58). Women with pharmacologically treated GDM (46.9%) more often had third molar symptoms than controls (36.1%; OR 1.57; 95% CI 1.15-2.15) than women with diet-treated GDM (38.0%; OR 1.47; 95% CI 1.07-2.02). (4) GDM is associated with perceived oral care needs. Third molar symptoms were associated with pharmacologically treated GDM

Markers assessing bone and metabolic health in polycystic ovary syndrome

Abstract Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-aged women. The main features of the syndrome include menstrual irregularities, hyperandrogenism, polycystic ovaries, chronic inflammation, and insulin resistance, predisposing these women to reproductive, metabolic, and cardiovascular health implications across the life span. Adipose tissue dysfunction, via the secretion of adipocytokines and altered intestinal permeability have been thought to influence the pathogenesis of the syndrome. Moreover, women with PCOS display changes in several hormonal systems, which can affect bone metabolism and bone mass. The main objectives of the study were to evaluate the association between PCOS and bone metabolism, and to study the effect of metformin, a common drug used in the management of PCOS, on bone health in women with PCOS. Further, adipokines and intestinal permeability markers were studied to evaluate their association in women with PCOS. The study populations were a Nordic population including 298 women with PCOS and 194 controls, and a population derived from the Northern Finland Birth Cohort 1966 consisting of 104 women with PCOS and 203 controls. Decreased levels of bone formation markers and unchanged levels of bone resorption marker were observed in women with PCOS under the age of 30 compared with age-matched controls. Furthermore, metformin treatment in premenopausal women with PCOS for three months was associated with reduced bone turnover as assessed by decreases in bone formation and resorption markers. These findings suggest that bone formation is decreased in women with PCOS under the age of 30. However, treatment with metformin was associated with reduced bone turnover and slower bone remodeling, possibly preventing bone loss. Even though increased levels of retinol-binding protein 4 (RBP4), an adipokine influencing systemic insulin sensitivity, were seen in women with PCOS under the age of 30, the impact of RBP4 on the metabolic derangements in PCOS could not be determined. RBP4 does not seem to be a marker of insulin resistance or other metabolic derangements in women with PCOS. Serum levels of markers of intestinal permeability (IP) and dysbiosis did not differ between body mass index-matched women with PCOS and controls at late reproductive age, suggesting that IP and dysbiosis do not influence the metabolic derangements in women with PCOS.Tiivistelmä Monirakkulainen munasarjaoireyhtymä (PCOS) on yleisin hormonaalinen häiriö lisääntymisikäisillä naisilla. Oireyhtymän tyypillisiin oireisiin ja löydöksiin kuuluvat kuukautiskierron häiriöt, lisääntynyt miessukupuolihormonivaikutus, monirakkulaiset munasarjat, elimistön krooninen tulehdus ja heikentynyt sokerinsieto. Nämä tekijät heikentävät hedelmällisyyttä ja altistavat naiset aineenvaihdunta- ja sydän- ja verisuonitaudeille. Rasvakudoksen toimintahäiriöiden, jotka välittyvät, adiposytokiinien ja muuttuneen suoliston läpäisevyyden kautta, on uskottu liittyvän oireyhtymän patogeneesiin. Lisäksi PCOS-naisilla esiintyy häiriöitä useissa hormonaalisissa järjestelmissä, jotka voivat vaikuttaa luun aineenvaihduntaan ja luumassaan. Tutkimuksen päätavoitteena oli selvittää PCOS:n ja metformiinin, PCOS:n hoidossa yleisesti käytettävän lääkkeen, mahdollisia vaikutuksia luun terveyteen sekä adipokiinien ja suoliston läpäisevyyden roolia PCOS:n patogeneesissä. Tutkimukseen osallistui 298 pohjoismaalaista PCOS-naista ja 194 kontrollia sekä 104 PCOS-naista ja 203 kontrollia Pohjois-Suomen syntymäkohortista 1966. Alle 30-vuotiailla PCOS-naisilla havaittiin matalampia luun muodostumista kuvaavien merkkiaineiden pitoisuuksia kuin ikävakioiduilla kontrolleilla, mutta resorptiota kuuvaavissa merkkiaineissa ei todettu eroja. Nämä havainnot viittaavat siihen, että luun muodostuminen on vähentynyt nuoremmilla PCOS-naisilla, mikä saattaa estää luun huipputiheyden saavuttamista ja vaikuttaa kielteisesti naisten pitkäaikaiseen luuston terveyteen. Kolmen kuukauden metformiinihoito premenopausaalisilla naisilla laski sekä luun muodostumis-että resorptiomerkkinaineiden pitoisuuksia viitaten luun vaihtuvuuden (turnover) laskuun ja mahdolliseen luukadon estymiseen. Alle 30-vuotiailla PCOS-naisilla retinolia sitova proteiini 4 (RBP4) tasojen havaittiin olevan korkeammat kuin ikävakioiduilla kontrolleilla, mutta tämän ei todettu liittyvän insuliiniresistenssiin tai muihin aineenvaihdunnan häiriöihin. Suoliston läpäisevyyttä ja dysbioosia kuvaavat merkkiaineet eivät eronneet PCOS-naisten ja kontrollien välillä myöhäisessä lisääntymisiässä, mikä viittaa siihen, että suoliston läpäisevyydellä ei ole merkittävää osuutta PCOS:n patogeneesissä

Markers of gastrointestinal permeability and dysbiosis in premenopausal women with PCOS : a case-control study

Objectives Altered intestinal permeability and gut barrier dysfunction have been suggested to play a role in the pathogenetic mechanism of polycystic ovary syndrome (PCOS), the most common endocrine and metabolic condition in reproductive-aged women. However, data on intestinal permeability and dysbiosis of the gut microbiota in PCOS is still limited, with conflicting results. To this end, the concentrations of gastrointestinal permeability and gut dysbiosis markers were analysed in women with PCOS. Design Case-control study. Setting General community. Participants 104 women with PCOS and 203 body mass index (BMI) matched control women at age 46. Primary and secondary outcome measures Serum levels of zonulin, fatty acid-binding protein 2 (FABP2), urinary levels of indican, and hormonal and metabolic parameters. Results Serum levels of zonulin (128.0 +/- 17.0 vs 130.9 +/- 14.0 ng/mL, p=0.13) and FABP2 (1.5 +/- 0.9 vs 1.5 +/- 0.7 ng/mL, p=0.63) and urinary levels of indican (9.5 +/- 5.5 vs 8.4 +/- 4.2 mg/dL, p=0.07) were comparable in women with PCOS and controls in the whole study population. Likewise, when the study population was divided into different BMI groups as normal weight, overweight and obese, the levels of the above markers were comparable between the study groups. After BMI adjustment, zonulin levels correlated with the levels of high-sensitivity C reactive protein and homoeostasis model assessment of insulin resistance (pPeer reviewe

Increased Oral Care Needs and Third Molar Symptoms in Women with Gestational Diabetes Mellitus : A Finnish Gestational Diabetes Case-Control Study

(1) Hyperglycemia and oral pathology accelerate each other in diabetes. We evaluated whether gestational diabetes mellitus (GDM) is associated with self-reported increased oral health care needs and oral symptoms, including third molar symptoms, during pregnancy. (2) Pregnant women with (n = 1030) and without GDM (n = 935) were recruited in this multicenter Finnish Gestational Diabetes study in 2009-2012. Of the women with GDM, 196 (19.0%) receiving pharmacological treatment, 797 (77.0%) receiving diet treatment and 233 (23.0%) with recurrent GDM were analyzed separately. Oral health was assessed using structured questionnaires and analyzed by multivariable logistic regression adjusted for background risk factors. (3) Women with GDM were more likely to report a higher need for oral care than controls (31.1% vs. 24.5%; odds ratio (OR) 1.39; 95% confidence interval (CI) 1.14-1.69), particularly women with recurrent GDM (38.1% vs. 24.5%; OR 1.90; 95% CI 1.40-2.58). Women with pharmacologically treated GDM (46.9%) more often had third molar symptoms than controls (36.1%; OR 1.57; 95% CI 1.15-2.15) than women with diet-treated GDM (38.0%; OR 1.47; 95% CI 1.07-2.02). (4) GDM is associated with perceived oral care needs. Third molar symptoms were associated with pharmacologically treated GDM.Peer reviewe