Expanding applications for metformin in polycystic ovarian syndrome.
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Child Development↗
Biomedical subjects
James H Liu
Publications and source records attributed to James H Liu.
Successful use of vaginal sildenafil citrate in two infertility patients with Asherman's syndrome.
Vaginal sildenafil citrate (Viagra, Pfizer, Inc., New York, NY) has been shown to be useful in increasing endometrial thickness and achieving pregnancy in women with varied uterine disorders. However, it failed to demonstrate favorable results in the setting of Asherman's syndrome, a condition characterized by the presence of uterine synechiae. We have successfully applied this treatment in two women noted to have inadequate endometrium after surgical resection of uterine synechiae. Both patients had a history of a postpartum uterine curettage with subsequent secondary infertility. Asherman's syndrome was surgically demonstrated and treated in both patients. Postoperatively, both patients were noted to have a thin endometrium and failed to conceive despite fertility treatment. Subsequently, these women achieved pregnancy in the first treatment cycle with vaginal sildenafil citrate. Using transvaginal ultrasound, endometrial thickness was noted to improve when sildenafil citrate was administered. It is suspected that this medication causes selective vasodilatation, resulting in improved endometrial development.
Administration, Intravaginal↗
Evolving approaches in the treatment of menopausal symptoms.
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Adult↗
Therapeutic effects of progestins, androgens, and tibolone for menopausal symptoms.
Therapeutic strategies using progestins, androgens, and synthetic steroids such as tibolone are based on the understanding that estrogen, progesterone, and androgen receptors are localized to reproductive target tissues, brain, and bone. Unfortunately, these sex steroid receptors are widely distributed and localized to other tissues, often resulting in unintended effects. Progestins at high doses have been shown to be effective at reducing hot flashes by approximately 80% to 90%. Side effects include weight gain, mastalgia, fluid retention, vaginal discharge, and dry mouth. Dehydroepiandrosterone (DHEA), an adrenal-derived androgen, can be considered a prohormone that is peripherally converted to more potent androgens and estrogens. In studies with small numbers of subjects, DHEA has been reported to reduce vasomotor symptoms, increase sexual arousal, and improve cognitive performance. With regard to use of other androgens, there are no current testosterone preparations approved by the US Food and Drug Administration (FDA) for use in menopausal women. In phase 3 trials, a testosterone transdermal matrix patch has been shown to be effective in treatment of hypoactive sexual desire disorder in menopausal women on estrogen therapy. Tibolone, a synthetic steroid with estrogenic, androgenic, and progestational properties has been shown to be effective in the treatment of vasomotor symptoms and in preserving bone density, and it may provide positive effects on sexual function. The beneficial effects of these compounds in the menopausal woman for treatment of vasomotor symptoms, general well-being, cognitive deficits, bone loss, mood disorders, and sexual function are discussed. The overall clinical trial evidence for benefits and side effects also is presented.
Androgens↗
The effects of progestins on bone density and bone metabolism in postmenopausal women: a randomized controlled trial.
OBJECTIVE: The purpose of this study was to evaluate the action of progestins on bone metabolism in early menopausal women. STUDY DESIGN: One hundred thirty-two menopausal women were randomized into a 2-year double-blinded, placebo-controlled clinical trial. There were 6 treatment groups: micronized progesterone (P 4 ) 300 mg/day; medroxyprogesterone acetate (MPA) 10 mg/day; norethindrone (NET) 1 mg/day; micronized estradiol (E 2 ) 1 mg/day; E 2 1 mg/day + MPA 10 mg/day; and placebo. All subjects received 1000 mg of calcium and 400 IU of vitamin D/day. Primary outcome variables were bone mineral density (BMD) changes at the spine and hip. Secondary variables were bone turnover markers. RESULTS: With E 2 or E 2 +MPA treatment, BMD at L2-L4 increased by 2% to 4% over 2 years. Bone mineral density (BMD) at the spine followed a decreasing trend with MPA, P 4 , and placebo treatments. With NET treatment, BMD did not change from baseline. At the femoral neck site, BMD did not change significantly for any treatment group. Bone resorption and bone formation markers decreased with E 2 or E 2 +MPA treatment, and did not change appreciably with all 3 progestin-alone treatments. There were no vertebral or hip fractures observed during the trial. CONCLUSION: Estrogen remains the primary bone active agent in hormone therapy, while progestins have significantly less activity. The selection of the appropriate progestin in hormone therapy should be based on criteria other than bone activity.
Absorptiometry, Photon↗
Reliability and validity of the revised experiences in close relationships (ECR-R) self-report measure of adult romantic attachment.
Three studies examine the psychometric properties (i.e., the test-retest reliability, convergent, and discriminant validity) of Fraley, Waller, and Brennan's Revised Experiences in Close Relationships (ECR-R) self-report measure of romantic attachment anxiety (model of self) and avoidance (model of others). Longitudinal analyses suggest that the ECR-R provided highly stable indicators of latent attachment during a 3-week period (85% shared variance). Hierarchical linear modeling analyses further validated the ECR-R, suggesting that it explained between 30% to 40% of the between-person variation in social interaction diary ratings of attachment-related emotions experienced during interactions with a romantic partner and only 5% to 15% of that in interactions with family and friends. Guidelines are offered regarding the conditions where highly reliable and precise measures of romantic attachment, such as the ECR-R, are deemed necessary and where shorter, albeit slightly less reliable measures, such as Bartholomew and Horowitz's Relationship Questionnaire, may also be viable.
Adult↗
How the past weighs on the present: social representations of history and their role in identity politics.
Socially shared representations of history have been important in creating, maintaining and changing a people's identity. Their management and negotiation are central to interethnic and international relations. We present a narrative framework to represent how collectively significant events become (selectively) incorporated in social representations that enable positioning of ethnic, national and supranational identities. This perspective creates diachronic (temporal) links between the functional (e.g. realistic conflict theory), social identity, and cognitive perspectives on intergroup relations. The charters embedded in these representations condition nations with similar interests to adopt different political stances in dealing with current events, and can influence the perceived stability and legitimacy of social orders. They are also instrumental in determining social identity strategies for reacting to negative social comparisons, and can influence the relationships between national and ethnic identities.
Culture↗
Successful surrogate pregnancy after ovarian transposition, pelvic irradiation and hysterectomy.
BACKGROUND: Treatment of cervical cancer is often effective but at the cost of the woman's fertility. Ovarian transposition with subsequent oocyte retrieval and surrogate pregnancy can enable these patients to become genetic parents. We present the third reported such case. CASE: A 22-year-old woman was diagnosed with bulky, stage IB cervical cancer. Following transposition of both ovaries to the upper abdomen, she underwent pelvic irradiation followed by total abdominal hysterectomy. Eleven years later she presented for assisted reproduction. Two oocytes were retrieved following ovarian stimulation and transcutaneous, abdominal oocyte retrieval. One embryo was transferred to the gestational surrogate, resulting in a single intrauterine pregnancy and successful delivery at term. CONCLUSION: These procedures can preservefertility while successfully treating cervical cancer.
Embryo Transfer↗
Menopausal hormone therapy: a paradigm shift?
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Breast Neoplasms↗
The Women's Health Initiative postmenopausal hormone trials: overview and baseline characteristics of participants.
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Aged↗
Cultural stereotypes and social representations of elders from Chinese and European perspectives.
Hierarchical cluster analyses of a trait sorting task were used to investigate social representations (and cultural stereotypes) of elderly New Zealanders (NZers) of Chinese and European origin, held by young (mean age = 17) and middle-aged (mean age = 46) NZers from both ethnic groups. Consistent with cultural theories of aging in Chinese societies, organizational features for NZ Chinese were: evaluative simplicity, role-governed representations (e.g., division between socio-emotional and task-oriented elders), little differentiation as a consequence of the ethnicity of elders or age group of subject, and an overall structure dominated by good/bad. NZ Europeans' social representations were more evaluatively complex, had fewer subtypes and more differences as a consequence of target person ethnicity. The Curmudgeon and the Nurturant were the most consensual stereotypes across the 8 cluster analyses (2 subject ethnicity x 2 target ethnicity x 2 subject age group), with the most power to organize stereotypical perceptions of elders across cultural groups. Only the majority group, NZ Europeans, displayed out-group homogeneity effects by creating more categories of elderly Europeans than Chinese. Both ethnic groups held representations of elderly Europeans as higher status in society, and both had more contact with European than Chinese elders outside the family.
Adolescent↗
Guides to an efficient search for the best evidence.
As a clinician, the selection of the best treatment options for a patient given her clinical diagnosis can be challenging. Textbooks and the knowledge base acquired during residency and fellowship training may be out of date. The following article outlines how to perform a literature search to survey the available treatment options and ultimately how to look for evidence-based guidelines for management of the clinical problem.
Adult↗
Reduced vaginal bleeding in postmenopausal women who receive combined norethindrone acetate and low-dose ethinyl estradiol therapy versus combined conjugated equine estrogens and medroxyprogesterone acetate therapy.
OBJECTIVE: The purpose of this study was to compare the effects on vaginal bleeding patterns of continuous combined hormone replacement therapy with norethindrone acetate and ethinyl estradiol versus conjugated equine estrogens and medroxyprogesterone acetate. STUDY DESIGN: Three hundred fifty-seven postmenopausal women were selected randomly (in a blinded manner) to 12 months of treatment with 1 mg norethindrone acetate/5 microg ethinyl estradiol, placebo, or open-label 0.625 mg conjugated equine estrogens/2.5 mg medroxyprogesterone acetate (conjugated equine estrogens/medroxyprogesterone acetate [CEE/MPA]; Prempro). The incidence and duration of vaginal bleeding were assessed throughout the study. Statistical analyses used Cochran-Mantel-Haenszel methodology and analysis of variance. RESULTS: At 3 months, 1 mg norethindrone acetate/5 microg ethinyl estradiol therapy reduced the incidence of bleeding (12% vs 23%; P <.029) and bleeding and/or spotting (22% vs 44%; P <.001), compared with conjugated equine estrogens/medroxyprogesterone acetate therapy. The mean duration of bleeding and bleeding and/or spotting were also reduced with 1 mg norethindrone acetate/5 microg ethinyl estradiol therapy versus conjugated equine estrogens/medroxyprogesterone acetate (P =.004 and P <.001, respectively). The incidence of cumulative amenorrhea at every monthly interval was significantly better with 1 mg norethindrone acetate/5 microg ethinyl estradiol therapy versus conjugated equine estrogens/medroxyprogesterone acetate therapy (P <.05). Associated adverse event (ie, headache, breast pain) incidence rates were similar in the 2 active treatment groups. CONCLUSION: The 1 mg norethindrone acetate/5 microg ethinyl estradiol therapy provides significantly better control of vaginal bleeding than conjugated equine estrogens/medroxyprogesterone acetate therapy at all time points investigated in this 12-month study.
Adult↗
Social dominance orientation and gender: the moderating role of gender identity.
The aim of this research was to investigate the claim that gender differences in levels of social dominance orientation (SDO; Pratto, Sidanius, Stallworth, & Malle, 1994), a personality variable measuring a general predisposition towards anti-egalitarianism, are essentially invariant (Sidanius & Pratto, 1999). Previous findings have indicated that (regardless of covariate) males display higher levels of SDO than females. Two studies were conducted to test the expectation (derived from social identity theory) that the gender-SDO relationship would be moderated by strength of gender group identification. Both samples (150 non-students and 163 students) completed the full SDO(6) measure, and measures of gender group identification. Consistent with predictions, strength of gender identification was found to moderate the gender-SDO relationship, such that increasing group identification was associated with increasing SDO scores for males, and decreasing SDO for females. This result raises questions concerning the theoretical basis of social dominance theory, and whether gender group membership should be accorded a different status from other 'arbitrary-set' group memberships.
Adult↗
Pregnancy hormone metabolite patterns, pregnancy symptoms, and coffee consumption.
Because of contradictory reports of pregnancy outcomes and coffee intake, this study was designed to determine how hormone metabolite levels, symptoms, and coffee consumption patterns are related. Eligible subjects were recruited in Cincinnati, Ohio, from 1996 to 1998, aged 18-40 years, and nonsmokers; drank at least 18 ounces (1 ounce = 29.6 ml) of coffee per week (including decaffeinated) at the last menstrual period; and were enrolled by 9 weeks from the last menstrual period. Beverage consumption and pregnancy symptoms were recorded daily. Weekly, first-morning urine samples were collected to assess human chorionic gonadotropin, estrone-3-glucuronide, and pregnanediol-3-glucuronide. A time-dependent, repeated measures analysis was performed to test several associations. Data from 92 subjects were analyzed with the following results. 1) Coffee consumption was significantly, inversely associated with weekly levels of estrone-3-glucuronide and human chorionic gonadotropin. 2) Weekly hours of nausea were significantly, directly associated with human chorionic gonadotropin and inversely with estrone-3-glucuronide and pregnanediol-3-glucuronide. 3) Weekly coffee consumption was significantly associated with vomiting but not with nausea or appetite loss. 4) Weekly levels of pregnanediol-3-glucuronide were 32.2% lower in subjects who drank at least 8 ounces of coffee/day at the last menstrual period, though above what was necessary to maintain those pregnancies. This study shows the significance of these important variables to be considered in future research.
Adult↗
Subglottic stenosis complicated by allergic esophagitis: case report.
Allergic esophagitis is a known entity that had been described in patients with dysphagia. It has not been previously described in association with subglottic stenosis. We report the case of a 2-year-old girl with symptoms suggestive of allergic esophagitis who suffered from subglottic stenosis that recurred despite surgical measures. Her esophageal pH monitoring results were normal, and she did not respond to antireflux medications. She did respond dramatically to corticosteroid therapy with improvement of both her esophageal and laryngeal symptoms. Allergic esophagitis as a clinical entity is discussed.
Child, Preschool↗
Urinary beta-FSH subunit concentrations in perimenopausal and postmenopausal women: a biomarker for ovarian reserve.
OBJECTIVE: The purpose of this study was to develop an integrative assessment of pituitary follicle-stimulating hormone (FSH) secretion and to validate these measurements in a population of perimenopausal (PERI) and postmenopausal (POST) women. DESIGN: In this cross-sectional study, 170 POST and 20 PERI women collected first-void morning urine samples and had a single blood sample drawn on the same day. For comparison, 11 midreproductive-aged women had urine samples collected for one menstrual cycle. In addition, one 48.5-year-old woman collected daily urine samples for 4 consecutive years during her menopausal transition. Urine samples were assayed for estrone glucuronide (E1G) and pregnanediol-3-glucuronide (PdG) and were normalized to creatinine. An ELISA assay was developed for measurement of the free beta-FSH subunit in urine. RESULTS: Mean age (+/- SD) of the PERI and POST women were 48.1 +/- 3.0 and 52.8 +/- 4.1 years, respectively. Mean serum FSH levels were 9.5 +/- 5.8 and 79.3 +/- 32 IU/L (P < 0.001) in the PERI and POST women. Mean urinary beta-FSH/Cr for the PERI were 1.8 +/- 1.2 ng/mg; for the POST, 9.3 +/- 4.5 ng/mg (P < 0.001). Mean estradiol, E1G/Cr, and PdG/Cr levels were also significantly different between the two groups. There was a high correlation between serum FSH and urinary beta-FSH/Cr for the PERI (r = 0.584, P = 0.007) and POST (r = 0.54, P < 0.001), with minimal overlap in the urinary beta-FSH/Cr levels between the PERI and POST groups. A significant correlation between PdG/Cr and urinary beta-FSH/Cr was observed for POST (r = 0.581, P = 0.002). No correlation was seen between urinary beta-FSH/Cr and E1G/Cr or estradiol levels. In the perimenopausal participant, who collected 4 years of daily urine samples, urinary beta-FSH/Cr levels progressively increased during the follicular phase and, by the fourth year, there were persistent, almost tonically high elevations of beta-FSH/Cr in the urine. CONCLUSIONS: Urinary beta-FSH subunit measurements are a useful marker for monitoring ovarian function during the menopausal transition. Urinary free beta-FSH subunit concentrations reflect pituitary FSH secretion and serve as a biomarker for ovarian reserve.
Climacteric↗