Relationship between serum progesterone concentrations and cardiovascular disease,diabetes, and mortality in elderly Swedish men and women: An 8-Year prospective study

Background: The use of synthetic progesterone-like substances in hormone replacement therapy and birth control pills has been associated with increases in cardiovascular morbidity and the prevalence of diabetes.Objectives: The primary aims of this study were to investigate whether physiologic concentrations of progesterone might also be associated with cardiovascular disease and diabetes, and to explore potential gender differences in these associations in elderly Swedish men and women.Methods: This prospective, longitudinal study was performed in a Swedish population-based sample of opposite-sex twins aged between 71 and 80 years who were not receiving sex hormone therapy. Serum concentrations of progesterone, estradiol, C-reactive protein (CRP), and urea were measured at baseline (1996) and at 8-year follow-up (2004), and serum concentrations of cystatin and insulin were measured only at follow-up. The outcomes of interest were cardiovascular morbidity (myocardial infarction, angina pectoris, peripheral arterial disease, stroke, congestive heart failure [CHF], cardiac arrhythmia, hypertension, and thromboembolism), diabetes, and mortality throughout the observation period.Results: At baseline, the study sample included 230 men and 195 women (mean [SD] age, 74.6 [2.6] years). At follow-up, 132 men and 145 women (mean age, 82.4 [2.5] years) met the inclusion criteria, of whom 128 men and 112 women did so at both baseline and follow-up. Serum progesterone concentrations, which did not differ significantly from reported concentrations for the age group, were significantly associated with mortality across the observation period (P < 0.001). At follow-up, higher serum progesterone was significantly associated with the occurrence of CHF (P < 0.01); this association remained robust after adjustment for CRP, cystatin, and insulin levels.Conclusion: In these elderly Swedish men and women, increased physiologic concentrations of progesterone were found to be associated with an increased prevalence of CHF, independent of inflammatory factors, markers of renal function, and insulin metabolism.     

Gender-specific differences in bladder cancer: A retrospective analysis

Background: A higher incidence of bladder cancer has been reported in men compared with women. Clinical gender differences have been observed but are less well described.Objective: This retrospective analysis further examines clinical differences in the development and manifestation of bladder cancer between men and women.Methods: Consecutive male and female patients with bladder cancer treated between 1969 and 1997 at a single center (University Hospital of Innsbruck, Innsbruck, Austria) were included in the study. Patient characteristics regarding age, tumor classification, localization, and recurrence were compared between male and female patients. Statistical analysis was conducted using the t test, the χ² test, and the Kaplan-Meier method, with the log-rank test for subgroup analysis.Results: In the 1269 patients (876 men, 393 women) who were examined, 1744 tumors were found. The male-to-female bladder cancer incidence ratio was 2.2:1. Tumors were diagnosed at a significantly younger age in men than in women (mean age: 62 years vs 67 years, respectively; P < 0.001). No difference in the histology of tumors was observed between the sexes. Muscle-invasive tumors more frequently occurred in men than in women (39.8% vs 34.5%; P = NS). In men compared with women, primary tumors were more aggressive (grade 2, 36.6% vs 28.2%; P < 0.001) and tumor recurrences were more invasive (59.0% vs 57.8%; P = NS). Tumors were more often located in the urethra in men than in women (43 [3.4%] vs 9 [1.8%]; P = 0.034), the trigonum (246 [19.8%] vs 75 [14.9%]; P < 0.001), and the bladder dome or vault (128 [10.3%] vs 37 [7.4%]; P = 0.015). Generally, no difference in survival rate was observed between the sexes; only in the subgroup of muscle-invasive tumors (n = 455) did women have a worse overall survival rate than did men (P = 0.022).Conclusions: Clinical gender differences in bladder cancer appear to have a higher incidence in men than in women. In this analysis, women were older at the age of detection, but had less-invasive and less-aggressive tumors than did men. However, women with muscle-invasive disease had a worse overall survival rate than did men in the same subset.     

Gender differences in self-rated health,quality of life,quality of care,and metabolic control in patients with diabetes

Background: Because the projected increase in the number of diabetic patients is expected to strain the capabilities of health care providers worldwide, we are challenged to find ways of reducing the burden of diabetes. Maintaining and improving health-related quality of life (QoL) for diabetic patients may be viewed as public health goals.Objective: The aim of this cross-sectional study was to compare different aspects of health, QoL, and quality of care (QoC) between men and women with diabetes as a basis for planning and managing diabees care.Methods: All patients in 2 age groups (aged 20–30 years [younger age group] and aged 50–60 years [middle-aged group]) who were registered with the Department of Endocrinology, Metabolism, and Diabetes at Karolinska University Hospital, Stockholm, Sweden, in October 2004, were recruited for a survey. Questions were included about self-rated health (SRH), QoL, QoC, diabetes-related worries, occupational status, physical activity level, living arrangements, and educational background. Glycosylated hemoglobin (HbA_1c) values were obtained from medical records.Results: Of the 223 eligible patients (109 men, 114 women) in the younger age group, 49 men and 74 women responded to the questionnaire; of the 300 eligible patients (170 men, 130 women) in the middle-aged group, 120 men and 93 women responded. Middle-aged women rated their mental well-being and QoL as worse compared with men (P < 0.001 and P < 0.05, respectively). In both age groups, women reported more diabetes-related worries and less ability to cope (P < 0.05 for the younger age group and P < 0.001 for the middle-aged group for both variables), thus the differences were more marked for middleaged women. Although there were no gender differences in metabolic control, middle-aged women reported less satisfaction with diabetes care (P < 0.001). Higher HbA_1c was related to worse SRH in both men and women when analyzing the age groups together (P < 0.05). This association was most prominent in young women, in whom having more diabetes-related worries was also related to higher HbA_1c (P < 0.01).Conclusion: In this study, women with diabetes appeared to have worse QoL and mental well-being compared with men with diabetes. Therefore, identifying strategies to improve SRH and QoL among diabetic patients, especially among women, is of great importance.     

Gender- and age-related outcomes of cardiac resynchronization therapy: A pilot observational study

Background: Cardiac re synchronization therapy (CRT) has been reported to improve clinical status and survival, and shorten hospitalization rates, in patients with heart failure (HF). However, questions remain regarding the success of CRT in different subgroups of patients with HEObjective: We assessed whether CRT response was related to gender or age in patients with HE.Methods: In a longitudinal observational study, patients with severe HF (New York Heart Association [NYHA] class III or IV, left ventricular ejection fraction [LVEF] ≤35%, and QRS duration >120 ms with left bundle branch block configuration) were enrolled. Clinical electrophysiologic and echocardiographic evaluations were performed before, and 3 and 6 months after, CRT implantation.Results: A total of 65 Iranian patients (50 men, 15 women; mean [SD] age, 60.3 [10.3] years; baseline NYHA class, 3.1 [0.36]; QRS duration, 144 [14] ms; LVEF, 21% [7.3%]; left ventricular end-diastolic diameter (LVEDD), 6.8 [0.56] mm) were evaluated. NYHA class, QRS duration, LVEF, and LVEDD were significantly improved at 3- and 6-month follow-ups both in patients aged ≤60 years and in those aged >60 years (P < 0.001, except for aged ≤60 years after 3-month follow-up [P = 0.002]). All these parameters were significantly improved in men at 3- and 6-month follow-ups (P < 0.001). NYHA class (P = 0.002), QRS duration (P = 0.001), LVEF (P = 0.013 at 3 months and <0.001 at 6 months), and LVEDD (P = 0.007 at 3 months and <0.001 at 6 months) also were significantly improved in women. At 3- and 6-month follow-ups, there were no significant differences in improvement of these factors between the 2 age groups of patients.Conclusion: CRT response in these patients with HF did not appear to be gender or age related at 3- and 6-month follow-ups in this small observational study. Confirmation of these findings by larger studies is needed.     

Short-Term Decline in Prolactin Concentrations Can Predict Future Prolactin Normalization,Tumor Shrinkage,and Time to Remission in Men with Macroprolactinomas

Objective: To identify early follow-up measures that will predict the dynamics of prolactin (PRL) decrease and adenoma shrinkage in men harboring macroprolactinomas.Methods: A single-center historical prospective study including a consecutive group of 71 men with pituitary macroadenomas (≥10 mm) and hyperprolactinemia (PRL >7 times the upper limit of normal &lsqb;ULN]) treated medically with cabergoline. Comparisons of PRL normalization rates were performed according to PRL levels achieved at 6 months, maximal adenoma shrinkage during follow-up, and other patient characteristics. Correlations were analyzed to identify characteristics of PRL suppression dynamics.Results: PRL levels after 6 months of treatment correlated positively with current PRL levels (r = 0.74; P<.001), with time to PRL normalization (r = 0.75; P<.001), and with adenoma diameter following treatment (r = 0.38; P = .01). Adenoma shrinkage depicted by first magnetic resonance imaging on treatment correlated with maximal adenoma shrinkage during follow-up (r = 0.56; P = .006). Five patients had nadir PRL levels ≥3 times the ULN (51 ng/mL) and showed slower response to cabergoline treatment, with consistently higher PRL levels compared with responding patients throughout follow-up (mean 6-month PRL levels, 519 ± 403 ng/mL versus 59 ± 118 ng/mL; P<.001).Conclusion: Six-month PRL level might serve as a surrogate marker for PRL normalization and adenoma shrinkage dynamics among men harboring macroprolactinomas.Abbreviations: CAB = cabergoline MRI = magnetic resonance imaging PRL = prolactin RMC = Rabin Medical Centre ULN = upper limit of normal     

Gestational Weight Gain as an Independent Risk Factor for Macrosomia in Women with Intermediate State Gestational Blood Glucose

Objective: Macrosomia is closely associated with gestational diabetes mellitus (GDM) but its relationship with maternal intermediate state gestational blood glucose (ISGBG; normal fasting blood glucose and 7.8 mmol/L <1 hour blood glucose &lsqb;BG] <10 mmol/L or 6.7 mmol/L <2 hour BG <8.5 mmol/L) is unclear. Here, we analyzed the clinical characteristics and pregnancy outcomes and explored risk factors for macrosomia in women with ISGBG.Methods: A total of 847 women with normal glucose tolerance gestation, 330 with ISGBG, and 99 with GDM were included. Maternal and fetal clinical data were collected and 3-point BG following oral glucose tolerance test, fasting insulin, glycated hemoglobin, and blood lipids profile were measured.Results: The incidence rate of macrosomia among the neonates of women with ISGBG was as high as 10.9%. In the ISGBG group, prepregnancy body mass index (BMI), gestational weight gain (GWG) and the proportion of women with excessive GWG (eGWG) were significantly higher in women with macrosomia compared with those who delivered a normal weight neonate. In women with ISGBG, neonate weight was positively correlated with maternal prepregnancy weight (r = 0.183, P<.01), prepregnancy BMI (r = 0.135, P<.01), and GWG (r = 0.255, P<.01), and negatively correlated with high-density lipoprotein cholesterol (r = -0.172, P<.01). Nonetheless, only eGWG was an independent risk factor (odds ratio = 3.18, 95% confidence interval = 1.26 to 7.88, P<.05) for macrosomia. The risk of macrosomia in pregnant women with prepregnancy BMI <25 kg/m² or BMI ≥25 kg/m² and eGWG was 3.39 and 3.27 times, respectively.Conclusion: The incidence rate of macrosomia is increased in women with ISGBG and eGWG is the strongest independent risk factor. In order to reduce the risk for macrosomia, timely lifestyle intervention to promote appropriate weight gain during pregnancy deserves evaluation.Abbreviations: AUC = area under the curve; BG = blood glucose; 1 hour BG = 1 hour blood glucose after OGTT; 2 hour BG = 2 hour blood glucose after OGTT; BMI = body mass index; CI = confidence interval; eGWG = excessive gestational weight gain; FBG = fasting blood glucose; FINS = fasting insulin; GDM = gestational diabetes mellitus; HbA1c = glycated hemoglobin; HDL-C = high-density lipoprotein cholesterol; HOMA-IR = homeostasis model assessment of insulin resistance index; ISGBG = intermediate state gestation blood glucose; LDL-C = low-density lipoprotein cholesterol; Ln = natural logarithm; MLBW = mature low birth weight; NGTG = normal glucose tolerance gestation; OGTT = oral glucose tolerance test; OR = odds ratio; SD = standard deviation     

Pituitary Imaging By Mri and its Correlation with Biochemical Parameters in the Evaluation of Men with Hypogonadotropic Hypogonadism

Objective: A significant ambiguity still remains about which patient deserves a magnetic resonance imaging (MRI) scan of the pituitary during evaluation of hypogonadotropic hypogonadism (HH) in men.Methods: Retrospective case series of 175 men with HH referred over 6 years.Results: A total of 49.7% of men had total testosterone (TT) levels lower than the Endocrine Society threshold of 5.2 nmol/L. One-hundred forty-two patients (81.2%) had normal appearance of pituitary MRI, whereas others had different spectrum of abnormalities (empty sella &lsqb;n = 16], macroadenoma &lsqb;n = 8], microadenoma &lsqb;n = 8], and pituitary cyst &lsqb;n = 1]). In men with TT in the lowest quartile, MRI pituitary findings were not significantly different from men in the remaining quartiles (P = .50). Patients with raised prolactin had higher number of abnormal MRI findings (38.9% vs. 13.7%; P = .0014) and adenomatous lesions (macro and micro) (27.8% vs. 4.3%; P = .01) in comparison to men with normal prolactin. The prolactin levels (median &lsqb;interquartile range]) were highest in men with macroadenomas in both groups (9,950 &lsqb;915]; P = .007 and 300 &lsqb;68.0] mU/L; P = .02, respectively), with concomitant lower levels of other pituitary hormones. Multivariate logistic regression showed an association of abnormal pituitary MRI with insulin-like growth factor 1 (IGF-1) standard deviation score (SDS) (odds ratio &lsqb;OR], 1.78 &lsqb;95% confidence interval (CI), 1.15 to 2.77]; P = .009) and prolactin (OR, 1.00 &lsqb;95% CI, 1.00 to 1.03]; P = .01).Conclusion: MRI of the pituitary is not warranted in all patients with HH, as the yield of identifiable abnormalities is quite low. Anatomic lesions are likely to be present only when low levels of TT (<5.2 nmol/L) are found concomitantly with high levels of prolactin and/or low IGF-1 SDS.Abbreviations: CI = confidence interval; FT4 = free thyroxine; GH = growth hormone; HH = hypogonadotropic hypogonadism; IGF-1 = insulin-like growth factor; LH = luteinizing hormone; MRI = magnetic resonance imaging; OR = odds ratio; SDS = standard deviation score; TSH = thyroid-stimulating hormone; TT = total testosterone     

Hyperthyroidism and Hyperprolactinemia: Is There any Association?

Objective: To compare the serum prolactin level in hyperthyroid and normal control females. Hyperthyroidism is a common disease. Although a direct association has been demonstrated between hypothyroidism and increased prolactin levels, this association has not been established for hyperthyroidism.Methods: Cross-sectional study in cases and control groups. Control subjects were chosen from those participating in the Kerman Coronary Artery Disease Risk Factors study. To select the cases, all women referred to the laboratories of Kerman with a thyroid-stimulating hormone (TSH) level ≤0.5 mIU/L who met the inclusion criteria were entered in the study. A total of 231 women aged 15 to 50 years were enrolled. The case group included 71 hyperthyroid women, and the control group included 160 women with normal thyroid function matched by age.Results: The mean (SD) serum level of prolactin was 16.56 (0.97) ng/mL (95% confidence interval [CI], 15.41 ng/mL to 15.71 ng/mL) in the controls and 23.07 (1.49) ng/mL (95% CI, 22.7 ng/mL to 23.4 ng/mL) in the case subjects. Hyperprolactinemia was more common in the hyperthyroid group (16.5 [0.97] ng/mL versus 23.07 [1.49] ng/mL; P<.001). The prolactin level decreased with age. Hyperthyroidism and estradiol increased the prolactin level. After adjusting for age and estradiol, hyperthyroidism increased the serum prolactin level (P<.001).Conclusion: The results of this study revealed that hyperprolactinemia is more frequent in hyperthyroid females. Serum prolactin level can be increased in hyperthyroidism.Abbreviations:PRL = prolactinT4 = thyroxineTRH = thyrotropin-releasing hormoneTSH = thyroid-stimulating hormone     

Blood oxidative stress biomarkers: influence of sex,exercise training status,and dietary intake

Background: Sex and lifestyle factors are known to influence the oxidation of protein, lipids, and DNA. Biomarkers such as protein carbonyls (PC), malondialdehyde (MDA), and 8-hydroxydeoxyguanosine (8-OHdG) have been commonly used in an attempt to characterize the oxidative status of human subjects.Objective: This study compared resting blood oxidative stress biomarkers, in relation to exercise training status and dietary intake, between men and women.Methods: Exercise-trained and sedentary men and women (with normal menstrual cycles; reporting during the early follicular phase) were recruited from the University of Memphis, Tennessee, campus and surrounding community via recruitment flyers and word of mouth. Participants were categorized by sex and current exercise training status (ie, trained or untrained). Each completed a detailed 5-day food record of all food and drink consumed. Diets were analyzed for kilocalories and macro- and micronutrient (vitamins C, E, A) intake. Venous blood samples were obtained at rest and analyzed for PC, MDA, and 8-OHdG.Results: In the 131 participants (89 men, of whom 74 were exercise trained and 15 untrained, and 42 women, of whom 22 were exercise trained and 20 untrained; mean [SD] age, 24 [4] years), PC did not differ significantly between trained men and women or between untrained men and women. However, trained participants had significantly lower plasma PC (measured in nmol · mg protein^-1) (mean [SEM] 0.0966 [0.0055]) than did untrained participants (0.1036 [0.0098]) (P < 0.05). MDA levels (measured in μmol · L^-1) were significantly lower in trained women (0.4264 [0.0559]) compared with trained men (0.6959 [0.0593]); in trained men and women combined (0.5621 [0.0566]) compared with untrained men and women combined (0.7397 [0.0718]); and in women combined (0.5665 [0.0611]) compared with men combined (0.7338 [0.0789]) (P < 0.05 for all comparisons). No significant differences were noted between any groups for 8-OHdG. Neither PC nor 8-OHdG were correlated to any dietary variable, with the exception of PC and percent of protein in untrained men (r = 0.552; P = 0.033). MDA was positively correlated to protein intake and negatively correlated to percent of carbohydrate and vitamin C intake, primarily in trained men (P ≤ 0.03).Conclusions: In this sample of young healthy adults, oxidative stress was lower in women than in men and in trained compared with untrained individuals, particularly regarding MDA. With the exception of MDA primarily in trained men, dietary intake did not appear to be correlated to biomarkers of oxidative stress.     

Women tolerate drug therapy for coronary artery disease as well as men do,but are treated less frequently with aspirin, β-blockers,or statins

Background: Women have worse morbidity, mortality, and health-related quality-of-life outcomes associated with coronary artery disease (CAD) compared with men. This may be related to underutilization of drug therapies, such as aspirin, β-blockers, angiotensin-converting enzyme (ACE) inhibitors, or statins. No studies have sought to describe the relationship of gender with adverse reactions to drug therapy (ADRs) for CAD in clinical practice.Objective: The aim of this study was to determine the prevalence of ADRs associated with common CAD drug therapies in women and men in clinical practice.Methods: In a cohort of consecutive outpatients with CAD, detailed chart abstraction was performed to determine the use of aspirin, β-blocker, ACE inhibitor, and statin therapy, as well as the ADRs reported for these treatments. Baseline clinical characteristics were also determined to identify the independent association of gender with use of standard drug treatments for CAD.Results: Consecutive patients with CAD (153 men, 151 women) were included in the study. Women and men were observed to have a similar prevalence of cardiac risk factors and comorbidities, except that men had significantly higher prevalence of atrial fibrillation (30 [19.6%] men vs 15 [9.9%] women; P = 0.03) and significantly lower mean (SD) high-density lipoprotein cholesterol concentrations (45 [16] mg/dL for men vs 55 [19] mg/dL for women; P < 0.001). No significant differences were observed between the sexes in the prevalence of ADRs; however, significantly fewer women than men were treated with statins (118 [78.1%] vs 139 [90.8%], respectively; P = 0.003). After adjusting for clinical characteristics, women were also found to be less likely than men to receive aspirin (odds ratio [OR] = 0.164; 95% CI, 0.083–0.322; P = 0.001) and β-blockers (OR = 0.184; 95% CI, 0.096-0.351; P = 0.001).Conclusions: Women and men experienced a similar prevalence of ADRs in the treatment of CAD; however, women were significantly less likely to be treated with aspirin, β-blockers, and statins than were their male counterparts. To optimize care for women with CAD, further study is needed to identify the cause of this gender disparity in therapeutic drug use.     

Monitoring blood plasma leptin and lactogenic hormones in pregnant sows

The mechanism of action of leptin in pregnant breeding sows, in which hyperphagia is managed through dietary strategies, is yet to be clarified. The aim of this study was to monitor leptin concentrations and their interactions with lactogenic hormones in Large White×Landrace breeding multiparous sows (n=15). All sows showed a normal body condition (mean body condition score: 2.96). Blood samples were collected the day after weaning the litters, at insemination, every 15 days up to day 45 of pregnancy and every 7 days from day 46 to farrowing. At delivery, the placenta was collected for the analysis of leptin and leptin receptor expressions. Plasma leptin levels increased from the end of mid gestation (day 72) and remained high until farrowing (P<0.05). As expected, plasma prolactin (PRL), low during most of pregnancy, increased during the 2 weeks before farrowing (P<0.05), whereas progesterone levels reached plateau at 30 days of gestation and decreased at farrowing (P<0.05). Cortisol levels peaked close to farrowing (P<0.05). Leptin was expressed in the placenta, where the receptor expression analysis showed the presence of the short form but not of the long form. A positive correlation was found between leptin and PRL concentrations during mid (r=0.430; P<0.001) and late (r=0.687; P<0.001) pregnancy, and with progesterone in early pregnancy (r=0.462; P<0.05). During late gestation, a positive correlation was observed between leptin and cortisol (r=0.585; P<0.001). Our results suggested that, in restrictively fed pregnant sows, the leptin levels increased from the end of mid pregnancy to delivery, confirming the presence of leptin resistance. We showed a correlation between leptin and lactogenic hormones during different stages of pregnancy in sows. Lactogenic hormones show pregnancy-specific changes in their secretion and all may become involved in modulating leptin signal.     

Health-related quality of life in Swedish men and women with early rheumatoid arthritis

Background: Rheumatoid arthritis (RA) is a chronic inflammatory joint disorder that may adversely affect health-related quality of life (HRQoL) both in established and early disease.Objectives: In patients with recent onset (<12 months) of RA, this extension of a previous study assessed HRQoL and the effect of disease activity over time.Methods: Consecutive patients with recent onset of RA between March 1996 and November 1998 were followed for 6 years at the Department of Rheumatology of the University Hospital of Umeå in Sweden. Patients were requested to complete the 36-item Short Form (SF-36) Health Survey at 0, 24, 48, and 72 months. Gender differences were examined, and correlations between the SF-36 scales (with higher scores indicating better HRQoL) and data reflecting disease activity were analyzed.Results: Fifty-one patients, 34 women and 17 men (mean age, 50.6 years; range, 20–78 years), participated in the study; in all, 41 patients completed the SF-36 at both 0 and 72 months. At inclusion (0 months), women reported significantly higher scores for physical role functioning, bodily pain, and social functioning compared with men (all, P < 0.05). At 72 months compared with 0 months, women reported significantly better mental health (P < 0.05), whereas men reported significantly better physical role functioning (P < 0.05), bodily pain (P < 0.01), mental health (P < 0.01), and vitality (P < 0.01). Additionally, at 72 months, the entire patient group rated physical role functioning and social functioning (both, P < 0.05), bodily pain and vitality (both, P < 0.01), and mental health (P < 0.001) as significantly better compared with the inclusion assessment. Overall improvement with time was significantly better for men than for women (P < 0.05). There were limited correlations between SF-36 point disease activity parameters and the SF-36 scores at 0 months (erythrocyte sedimentation rate vs physical functioning, mental health [both, P < 0.05], and bodily pain [P < 0.01]; 28-joint Disease Activity Score vs bodily pain [P < 0.05] and emotional role functioning [P < 0.01]) and at 72 months (C-reactive protein vs physical role functioning [P < 0.05]). Most of the physical subscales at inclusion correlated with the physical component summary (PCS) of the SF-36 questionnaire at 6 years.Conclusions: At disease onset, women with early RA reported better HRQoL than did their male counterparts. After 6 years, women and especially men both experienced better HRQoL, and no significant gender differences remained in any of the SF-36 scales or values for disease activity parameters. The PCS score at disease onset was the best predictor of the PCS score after 6 years.     

Differences in associations between markers of antioxidative defense and asthma are sex specific

Background: Lungs are exposed to high levels of oxygen, air pollutants, and smoke, all of which stimulate the production of reactive oxygen species (ROS). In addition, inflammatory cells produce ROS, and thus there may be increased demand for antioxidants, including antioxidant enzymes, in inflammatory lung diseases such as asthma. Sex-specific differences have been noted for asthma, which in postpubertal subjects is predominantly found in females. These sex-specific differences may be associated with differences on the molecular level as well.Objective: The aim of this cross-sectional study was to examine associations between markers of antioxidative defense and asthma, and to investigate whether these associations were different between women and men.Methods: Based on the European Community Respiratory Health Survey protocol, subjects were enrolled in a study of asthma risk factors. The multicenter study was conducted in 5 west Danish counties between 2003 and 2006, and the subjects were recruited as a case-enriched random sample of 10,000 Danish inhabitants aged 20 to 44 years selected by their civil registration number. Participants were identified by positive answers to asthma questions on a screening questionnaire, random sampling, or both. Serum selenium concentrations and antioxidant enzyme activities (superoxide dismutase, glutathione peroxidase [GPX], glutathione reductase [GR], and glucose-6-phosphate dehydrogenase [G6PD]) in erythrocytes were measured. Asthma was defined as either current asthma symptoms with bronchial hyperresponsiveness (BHR) or a continuous asthma score based on 8 questions.Results: A total of 1191 mostly white women and men (mean [SD] age, 34.0 [7.1] and 35.1 [7.1] years, respectively) were enrolled in the study. Current asthma symptoms were present in 29.9% (200/670) of women and 22.5% (117/521) of men, with women reporting more positive answers (51.1% vs 40.9%, respectively; P < 0.01) to asthma questions. Serum selenium concentrations were measured in 1151 subjects (640 women, 511 men), and antioxidant enzyme activities were measured in 295 subjects (161 women, 134 men). Women had higher enzyme activities of most antioxidant enzymes (GPX, P = 0.006; GR, P < 0.001; and G6PD, P = 0.009) than did men. Although the serum selenium concentration was inversely associated with asthma in both sexes, there was a female preponderance, with 3.5% lower serum selenium in subjects with current asthma symptoms with BHR (n = 77) compared with controls (n = 287). GR activity was associated with asthma in men, with 5.7% higher enzyme activity in subjects with current asthma symptoms with BHR (n = 14) compared with controls (n = 77). However, a significant interaction with gender was observed for analyses of GR (P = 0.02), but not for analyses of selenium.Conclusions: In this study of asthma risk factors, women had higher levels of enzyme activities than did men in a randomly selected Danish population, and sex-specific differences were found in the associations between markers of antioxidative defense and asthma.     

The repeatability of feed intake and feed efficiency in beef cattle offered high-concentrate,grass silage and pasture-based diets

Breeding values for feed intake and feed efficiency in beef cattle are generally derived indoors on high-concentrate (HC) diets. Within temperate regions of north-western Europe, however, the majority of a growing beef animal’s lifetime dietary intake comes from grazed grass and grass silage. Using 97 growing beef cattle, the objective of the current study was to assess the repeatability of both feed intake and feed efficiency across 3 successive dietary test periods comprising grass silage plus concentrates (S+C), grazed grass (GRZ) and a HC diet. Individual DM intake (DMI), DMI/kg BW and feed efficiency-related parameters, residual feed intake (RFI) and gain to feed ratio (G : F) were assessed. There was a significant correlation for DMI between the S+C and GRZ periods (r = 0.32; P < 0.01) as well as between the S+C and HC periods (r = 0.41; P < 0.001), whereas there was no association for DMI between the GRZ and HC periods. There was a significant correlation for DMI/kg BW between the S+C and GRZ periods (r = 0.33; P < 0.01) and between the S+C and HC periods (r = 0.40; P < 0.001), but there was no association for the trait between the GRZ and HC periods. There was a significant correlation for RFI between the S+C and GRZ periods (r = 0.25; P < 0.05) as well as between S+C and HC periods (r = 0.25; P < 0.05), whereas there was no association for RFI between the GRZ and HC periods. Gain to feed ratio was not correlated between any of the test periods. A secondary aspect of the study demonstrated that traits recorded in the GRZ period relating to grazing bite rate, the number of daily grazing bouts and ruminating bouts were associated with DMI (r = 0.28 to 0.42; P < 0.05 - 0.001), DMI/kg BW (r = 0.36 to 0.45; P < 0.01 - 0.001) and RFI (r = 0.31 to 0.42; P < 0.05 - 0.001). Additionally, the number of ruminating boli produced per day and per ruminating bout were associated with G : F (r = 0.28 and 0.26, respectively; P < 0.05). Results from this study demonstrate that evaluating animals for both feed intake and feed efficiency indoors on HC diets may not reflect their phenotypic performance when consuming conserved forage-based diets indoors or when grazing pasture.     

Risk factors for posttraumatic stress disorder following an industrial disaster in a residential area: A note on the origin of observed gender differences

Background: Studies indicate that differences in trait anxiety and trauma-related distress may mediate the gender differences observed in posttraumatic stress disorder (PTSD).Objective: We examined the contributions of gender, trait anxiety, and trauma-related distress to the development of PTSD after an industrial disaster.Methods: Three months after a massive explosion in a fireworks factory in Kolding, Denmark, in November 2004, residents in the surrounding area were asked to complete the Harvard Trauma Questionnaire, the General Health Questionnaire, and a questionaire designed for the present study. Using multivariable logistic regression with PTSD as the dependent variable, we examined 4 explanatory models: (1) gender; (2) gender and trait anxiety; (3) gender, trait anxiety, and perceived danger; and (4) gender, trait anxiety, perceived danger, perceived hostility, feeling isolated, depersonalization, and behavioral self-blame.Results: Fifty-one percent (N = 516; 265 women and 251 men) of the area residents participated in the study. The female-to-male ratio of PTSD was 2.4:1. Women experienced significantly more trait anxiety (P < 0.001), feelings of isolation (P < 0.005), and behavioral self-blame (P = 0.018), and less perceived danger (P = 0.034) than did men. In multivariable logistic regression analysis, gender alone predicted 3.7% of the variance in PTSD status (odds ratio [OR] = 2.40; 95% CI, 1.35-4.27; P < 0.005); however, in all other models, gender was not significant. The final model comprised trait anxiety (OR = 1.20; 95% CI, 1.11-1.30; P < 0.001), perceived danger (OR = 4.62; 95% Cl, 2.24-9.50; P < 0.001), perceived hostility (OR = 5.21; 95% CI, 1.93-14.09; P < 0.001), feeling isolated (OR = 3.34; 95% CI, 1.55-7.16; P < 0.002), depersonalization (OR = 2.49; 95% CI, 1.42-4.37; P < 0.001), and behavioral self-blame (OR = 0.46; 95% CI, 0.24-0.86; P = 0.015), explaining 48.9% of the variance in PTSD severity.Conclusion: This cross-sectional study found that gender was no longer associated with PTSD status when trait anxiety, perceived danger and hostility, feeling isolated, depersonalization, and behavioral selfblame were taken into account.     

Sex differences in prefrontal hemodynamic response to mental arithmetic as assessed by near-infrared spectroscopy

Background: Sex differences in cognitive tasks have been widely investigated. With brain-imaging techniques, the functions of the brain during the performance of tasks can be examined.Objective: Mental arithmetic and near-infrared spectroscopy (NIRS) were used to assess sex differences in prefrontal area activation in a functional brain study.Methods: Healthy college students were recruited to perform 2 mental arithmetic tasks. In the first (easy) task, students had to subtract a 1-digit number from a 3-digit number. In the second (difficult) task, they had to subtract a 2-digit number from a 3-digit number. Changes in the concentration of oxygenated hemoglobin (oxy-Hgb) in the prefrontal area during the tasks were measured with NIRS.Results: Thirty students (15 men, 15 women; mean [SD] age: 24.9 [2.2] and 24.3 [2.6] years, respectively) were recruited from Southeast University, Nanjing, China, to participate in the study. The concentration of oxy-Hgb increased during both mental arithmetic tasks (difficult task vs easy task, mean [SD] % arbitrary units: 4.36 [4.38] vs 2.26 [2.82]; F_1,28 = 222.80; P < 0.01). Significant interactions of task x sex (F_1,28 = 82.95), time × sex (F_1,28 = 34.48), task × time (F_1,28 = 222.57), and task × time × sex (F_1,28 = 83.09) were obtained (all, P < 0.01). However, for the 2 tasks, no significant differences between men and women were observed in the mean (SD) response time (men vs women, sec: 3.60 [0.74] vs 3.56 [0.49] for the easy task, 6.55 [0.77] vs 6.44 [0.75] for the difficult task; F_1,28 = 0.67; P = NS) or accuracy rate (men vs women, %: 95.33 [7.40] vs 92.77 [8.80] for the easy task, 62.67 [28.56] vs 54.67 [18.75] for the difficult task; F_1,28 = 0.54; P = NS). Male students showed neural efficiency (less prefrontal activation in subjects with better performance) during the difficult task.Conclusions: In these subjects, sex differences in prefrontal response when performing mental arithmetic were associated with the intensity of the task. Compared with men, women had greater efficiency in task performance (ie, less activation or oxygen consumption for equal performance).     

Predictors of depressive symptoms post-acute coronary syndrome

Objective: We examined the influence of gender on the prevalence of acute coronary syndrome (ACS) and the severity of depressive symptoms post-ACS.Methods: Patients received a Zung self-assessment questionnaire at hospital discharge for unstable angina (UA) or acute myocardial infarction (AMI) and returned it by mail. Major depressive symptoms were diagnosed based on a summed depressive symptoms (SDS) score of >50. Depressive symptomatology was modeled by stepwise multivariable logistic regression with the following predictors: gender, age, hypertension, diabetes mellitus, history of smoking, hypercholesterolemia, peripheral vascular disease, prior stroke, prior myocardial infarction (MI), and prior percutaneous coronary intervention or coronary artery bypass graft surgery. We also modeled severity of depressive symptoms via stepwise multiple linear regression with the same predictor variables.Results: A total of 944 patients were surveyed: 716 men and 228 women, mean (SD) age, 67 (13) years and 71 (12) years, respectively. Of these patients, 250 (35%) men and 103 (45%) women had depressive symptoms (P = 0.005). No significant difference was observed between men and women in rates of cardiac catheterization; severity of coronary artery disease; treatment with antiplatelet agents, β-blockers, angiotensin-converting enzyme inhibitors, or statins; or percutaneous or surgical revascularization rates during or post-ACS. Significant predictors of the presence of depressive symptoms were female gender (odds ratio [OR] = 1.64; 95% CI, 1.19-1.28), diabetes mellitus (OR = 1.42; 95% CI, 1.03-1.97), prior MI (OR = 1.56; 95% CI, 1.15-2.20), and smoking (OR = 1.41; 95% CI, 1.01-1.97). Variables significantly associated with a higher severity of depressive symptoms were female gender, prior MI, smoking, and stroke. Men with prior MI had significantly higher mean (SD) SDS scores than did men without prior MI in all age groups (48.4 [11] vs 44.6 [11], respectively; P < 0.001). In addition, significantly more men with prior MI had depressive symptoms compared with those without prior MI (45% vs 32%; P = 0.001). However, prior MI did not appear to affect SDS scores in women (49.1 [12] for prior MI vs 48.5 [12] for no prior MI; P = NS), and there was no significant difference in the percentage of women who had depressive symptoms with or without a history of prior MI. Depressive symptoms were much more severe in women with UA (SDS = 49.0 [12]) compared with women with AMI (SDS = 45.0 [12]; P = NS), or men with AMI (45.0 [12]; P = 0.004) or UA (46.0 [11]; P = 0.007) (analysis of variance, P = 0.003).Conclusions: Female gender is a significant independent predictor of depressive symptoms and their severity post-UA and post-AMI. History of prior MI is associated with a higher frequency and severity of depressive symptoms in men. These findings call for routine screening for depressive symptoms in men with prior MI and in women who present with ACS.     

Conditioning Factors for High Cardiovascular Risk in Patients with Cushing Syndrome

Objective: To characterize the alterations in carbohydrate and lipoprotein metabolism, to evaluate markers of lipoprotein functionality, and to identify the presence of novel atherogenic risk factors in patients with Cushing syndrome (CS) in comparison with sex- and age-matched controls.Methods: In an open, cross-sectional study, 32 nontreated patients with active CS were consecutively recruited from the Endocrinology Service at “José de San Martín” Clinical Hospital, University of Buenos Aires, Argentina, between April 11, 2010 and December 11, 2012. The patients were compared with sex- and age-matched controls.Results: Versus controls, patients with CS presented with excess weight, central obesity, and hypercortisolism. They also exhibited an insulin-resistant state, with high resistin levels (median [interquartile range], 16 [10 to 22] ng/mL versus 6 [5 to 9] ng/mL; P<.0001), a more atherogenic lipoprotein profile, high oxidized low-density lipoprotein levels (oxLDL; mean ± SD, 100 ± 31 U/L versus 75 ± 32 U/L; P<.05) and high sensitive C-reactive protein levels (median [interquartile range], 1.2 [0.6 to 3.1] mg/L versus 0.6 [0.3 to 1.1] mg/L; P<.05), and increased leukocyte count (mean ± SD, 9.5 ± 2.6 × 10³ cells/μL versus 6.5 ± 1.4 × 10³ cells/μL; P<.0001). Multivariate analyses showed that the increase in waist circumference was associated with both the diagnosis of CS and the degree of insulin resistance. Resistin concentration was related to a greater extent to the diagnosis of CS than to homeostasis model assessment–insulin resistance. Triglyceride and oxLDL levels were only significantly associated with the diagnosis of CS.Conclusion: Hypercortisolism is related to the increase observed in triglycerides and oxLDL levels, and, in combination with insulin resistance, acts to increase waist circumference and amplify the inflammatory process, key factors for the development of cardiovascular disease.Abbreviations: apo = apolipoprotein ARE = arylesterase CETP = cholesteryl ester transfer protein CRP = C-reactive protein CS = Cushing syndrome CV = coefficient of variation HDL = high-density lipoprotein HDL-C = high-density-lipoprotein cholesterol HOMA = homeostasis model assessment LDL = low-density lipoprotein LDL-C = low-density-lipoprotein cholesterol Lp-PLA₂ = lipoprotein-associated phospholipase A₂ oxLDL = oxidized LDL PON = paraoxonase TG = triglyceride