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Ebeling P, Stenman UH, Seppälä M, Koivisto VA. Acute hyperinsulinemia, androgen homeostasis and insulin sensitivity in healthy man. J Endocrinol 1995; 146:63-9. [PMID: 7561622 DOI: 10.1677/joe.0.1460063] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The acute effects of hyperinsulinemia on androgen homeostasis and a possible association of androgens to insulin sensitivity, serum lipids and lipoproteins and to lipid oxidation were examined in 19 healthy males (27 +/- 1 yrs, body mass index 24 +/- 1 kg/m2). In each subject, a 240 min euglycemic hyperinsulinemic clamp was performed and glucose and lipid oxidation were determined by indirect calorimetry. During hyperinsulinemia serum sex hormone-binding globulin (SHBG) concentration decreased by 5% (P < 0.01), insulin-like growth factor binding protein (IGFBP-1) by 88% (P < 0.001) and dehydroepiandrosterone sulphate (DHEAS) by 12% (P < 0.001), with no change in total or free testosterone concentrations. In the basal state, IGFBP-1 and C-peptide were inversely related (r = -0.54, P < 0.05). Fasting concentrations of serum free testosterone (r = 0.59, P < 0.01) and DHEAS (r = 0.47, P < 0.05) correlated positively with serum free fatty acid (FFA) concentrations during hyperinsulinemia, but not with fasting FFA level. Lipid oxidation rate in the basal state correlated positively to the decline in SHBG (r = 0.61, P < 0.01) and DHEAS concentrations (r = 0.62, P < 0.01) during hyperinsulinemia. While the fasting serum high density lipoprotein cholesterol level correlated positively with the insulin-induced decline in DHEAS level (r = 0.58, P < 0.01), no associations were found between serum androgens and total cholesterol, low density lipoprotein cholesterol or triglyceride concentrations. Insulin sensitivity was not related to SHBG, IGFBP-1, DHEAS or testosterone concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)
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Abstract
The abundant use of drugs in nursing homes demands special attention. Inappropriate indications and dosages, and lack of monitoring of drug-related effects and adverse reactions in patients are problems which can easily be solved. Knowledge of basic aspects of geriatric pharmacokinetics, and of basic rules and the main pitfalls involved in prescribing drugs for the elderly is essential, and demands both training of personnel and a change in prevailing attitudes.
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Tiitinen A, Husa LM, Tulppala M, Simberg N, Seppälä M. The effect of cryopreservation in prevention of ovarian hyperstimulation syndrome. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1995; 102:326-9. [PMID: 7612517 DOI: 10.1111/j.1471-0528.1995.tb09140.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate the effect of elective cryopreservation of all embryos in the prevention of severe ovarian hyperstimulation syndrome in women at increased risk, following superovulation for in vitro fertilisation. DESIGN Three hundred and ninety women undergoing superovulation for in vitro fertilisation between September 1991 and December 1992. SETTING University Infertility Clinic, Helsinki, Finland. INTERVENTIONS Twenty-three women were considered to have an increased risk of developing ovarian hyperstimulation syndrome. They were characterised by more than 20 retrieved oocytes and/or by serum oestradiol levels exceeding 10,000 pmol/l on the day of administration of human chorionic gonadotrophin. Instead of cancelling the cycle the oocytes were harvested and fertilised, and all good quality embryos were cryopreserved. The embryos were thawed and replaced during subsequent natural cycles. MAIN OUTCOME MEASURES Occurrence of ovarian hyperstimulation syndrome and pregnancy rate. RESULTS One out of the 23 patients at increased risk developed a moderate degree ovarian hyperstimulation syndrome, while the others had only mild symptoms. Two of the remaining 367 women with no risk developed ovarian hyperstimulation syndrome, both during early pregnancy. Among the 23 patients at increased risk there have been 15 clinical pregnancies after transfer of two to three frozen-thawed embryos in natural cycles, with a 32.6% pregnancy rate. CONCLUSIONS Withholding embryo replacement and elective cryopreservation of the embryos is effective in preventing severe ovarian hyperstimulation syndrome. After subsequent replacement in natural cycles the implantation rate per embryo is good (22.7%).
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Tulppala M, Julkunen M, Tiitinen A, Stenman UH, Seppälä M. Habitual abortion is accompanied by low serum levels of placental protein 14 in the luteal phase of the fertile cycle. Fertil Steril 1995; 63:792-5. [PMID: 7890064 DOI: 10.1016/s0015-0282(16)57483-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To study serum levels of placental protein 14 (PP14) in relation to endometrial function in women with a history of habitual abortion. DESIGN Prospective study. SETTING Departments I and II of Obstetrics and Gynecology, University Central Hospital of Helsinki, Helsinki, Finland. PATIENTS Fifty patients (26 primary and 24 secondary habitual aborters) and 38 controls without a history of abortion studied during a regular cycle. RESULTS Habitual aborters as a whole or when subgrouped into those with normal cycles (n = 40) or with a luteal phase defect (LPD; n = 10) and control women demonstrated a distinct increase in PP14 levels from late follicular to late luteal phases. In the luteal phase, serum PP14 levels were lower in the patients than in the controls (27.2 +/- 3.1 versus 48.5 +/- 10.1 micrograms/L), but the differences in PP14 levels between habitual aborters with or without LPD was not significant (16.3 +/- 4.3 versus 29.9 +/- 3.7 micrograms/L). CONCLUSIONS Habitual aborters exhibit lower serum PP14 levels in the late luteal phase compared with normal fertile women.
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Jahanfar S, Eden JA, Warren P, Seppälä M, Nguyen TV. A twin study of polycystic ovary syndrome. Fertil Steril 1995; 63:478-86. [PMID: 7531655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To examine the role of genetic and environmental factors in polycystic ovary syndrome (PCOS) by using the classic twin model. SETTING Outpatient clinic of the Royal Hospital for Women, Paddington, Sydney, New South Wales, Australia. PATIENTS A group of 19 monozygotic (MZ) and 15 dizygotic (DZ) twin pairs identified from the national twin register. INTERVENTIONS Ultrasound, clinical, and biochemical parameters were used to define PCOS. RESULTS Eleven pairs of twins (5 MZ, 6 DZ pairs) were scan-discordant (i.e., one twin had scan-PCOS and the co-twin did not). Model-fitting analysis suggested that fasting insulin level, androstanediol glucuronide, and body mass index (BMI) were significantly influenced by genetic factors. CONCLUSION This study suggests that PCOS is not the result of a single autosomal genetic defect, but rather environmental factors, perhaps both intrauterine and extrauterine, are involved in the pathogenesis of this disorder or that PCOS may be an X-linked disorder or the result of polygenic factors. However, fasting insulin level, androstanediol glucuronide, and BMI did appear to be under significant genetic influence.
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Miettinen T, Tiitinen A, Koistinen R, Julkunen M, Seppälä M. Serum placental protein 14 concentrations are similar in the first trimester pregnancies of women after pituitary down-regulation with a gonadotrophin-releasing hormone agonist and normal cycles with frozen embryo transfers. Hum Reprod 1994; 9:2429-31. [PMID: 7714170 DOI: 10.1093/oxfordjournals.humrep.a138464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Previous studies suggest that, in pregnancies after in-vitro fertilization (IVF) and embryo transfer following pituitary down-regulation with a gonadotrophin-releasing hormone analogue (buserelin) and ovulation induction with human gonadotrophins, the serum placental protein 14 (PP14) concentration is lower than in normally conceived pregnancies. We studied serum PP14 concentrations in two groups of women: (i) in 17 infertile women whose pregnancy followed IVF and embryo transfer using buserelin (long protocol) and human menopausal gonadotrophin for ovulation induction; (ii) in 15 women whose pregnancy followed transfer of frozen-thawed embryos. Similar PP14 concentrations were found in both groups on days 9-10, 14-15 and 70-77 after human chorionic gonadotrophin administration (buserelin, IVF/embryo transfer) or spontaneous luteinizing hormone surge (frozen-thawed embryo transfer). Our results show that PP14 secretion is not compromised by pituitary down-regulation with buserelin in infertile women with functional ovaries.
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Anttila R, Koistinen R, Seppälä M, Koistinen H, Siimes MA. Insulin-like growth factor I and insulin-like growth factor binding protein 3 as determinants of blood hemoglobin concentration in healthy subjects. Pediatr Res 1994; 36:745-8. [PMID: 7534901 DOI: 10.1203/00006450-199412000-00011] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We studied the serum concentrations of IGF-I, IGF-binding protein 3 (IGFBP-3), and testosterone in relation to blood Hb in 60 healthy prepubertal or early pubertal boys twice, with a 9-mo interval. Serum IGF-I and testosterone levels were measured by RIA, and serum IGFBP-3 was measured by monoclonal immunofluorometric assay. Positive correlations were observed between the concentrations of blood Hb and serum IGF-I at the first examination (r = 0.36, p = 0.008) and Hb and IGFBP-3 at both examinations (r = 0.53, p < 0.001, and r = 0.39, p = 0.003). No association between Hb and testosterone concentrations was found. Our results show that blood Hb is positively correlated to serum IGF-I and IGFBP-3 levels, indicating indirectly the involvement of growth hormone in the regulation of physiologic Hb concentration. Because no association was found between Hb and testosterone concentrations, this may indicate that the role of androgens in erythropoiesis may be different at different stages of puberty. It is concluded that the IGF system may be involved in the rise of Hb level during early puberty.
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Sarvas K, Angervo M, Koistinen R, Tiitinen A, Seppälä M. Prostaglandin F2 alpha stimulates release of insulin-like growth factor binding protein-3 from cultured human granulosa-luteal cells. Hum Reprod 1994; 9:1643-6. [PMID: 7530723 DOI: 10.1093/oxfordjournals.humrep.a138766] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Human ovarian follicular fluid contains a number of insulin-like growth factor binding proteins (IGFBP) of which IGFBP-3 is the most abundant. IGFBP-3 synthesis is growth hormone-regulated. We studied the effect of prostaglandin F2 alpha (PGF2 alpha) on IGFBP-3 secretion by cultured human granulosa-luteal cells from follicular aspirates of women participating in an in-vitro fertilization programme. The IGFBP-3 concentration was measured using a specific monoclonal immunofluorimetric assay. Contrary to a previous report on unstimulated follicles, this study demonstrated a positive correlation between follicular fluid IGFBP-3 concentration and follicular size. PGF2 alpha was found to stimulate in a dose-dependent fashion the secretion of IGFBP-3. Significant (P < 0.05) effects were found at PGF2 alpha concentrations of 10(-8), 10(-7) and 10(-6) M. Because IGFBP-3 inhibits progesterone production stimulated by insulin-like growth factor (IGF)-I, the PGF2 alpha-induced stimulation of IGFBP-3 production may be one of the mechanisms whereby PGF2 alpha exerts its luteolytic effect via the IGF system.
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84
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Kämäräinen M, Riittinen L, Seppälä M, Palotie A, Andersson LC. Progesterone-associated endometrial protein--a constitutive marker of human erythroid precursors. Blood 1994; 84:467-73. [PMID: 8025274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Progesterone-associated endometrial protein (PAEP/PP14) is a 28-kD glycoprotein with sequence homology to beta-lactoglobulins containing a retinol-binding motif. PAEP/PP14 is present at nanomolar concentrations in human serum. It is produced by secretory and decidualized endometrium in women and by seminal vesicle epithelium in men. We report here that PAEP mRNA is constitutively expressed in normal hematopoietic tissue. Western immunoblotting of bone marrow cells with rabbit antibodies to PAEP gave a band at 28 kD, and immunocytochemical staining with monoclonal antibodies localized PAEP into the cytoplasm of erythroid precursors representing different stages of the normoblast series. PAEP was not detected in mature red blood cells, platelets, or in cells of the myeloid lineage. Untreated K562 leukemia cells did not contain PAEP, whereas treatment of the cells with tetradecanoylphorbol acetate (TPA) induced strong expression of PAEP mRNA and synthesis of the intact protein that was found both in the cytoplasm of the differentiating cells and in the supernatant of TPA-treated cultures. These findings add a new member to the growing family of genes that are constitutively expressed both in the reproductive tract and in the hematopoietic system.
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85
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Seppälä M, Koistinen R, Rutanen EM. Uterine endocrinology and paracrinology: insulin-like growth factor binding protein-1 and placental protein 14 revisited. Hum Reprod 1994; 9:917-25. [PMID: 7523437 DOI: 10.1093/oxfordjournals.humrep.a138617] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
A large number of proteins and peptides have been identified in the endometrium where they are likely to exert local biological effects. These substances may be enzymes, their inhibitors, proteinases, proteinase inhibitors, hormones, or bioactive peptides with diverse functions. Endometrial function and embryo-endometrial interactions require synchronized actions between endocrine and local factors. As examples of local factors recent studies on the insulin-like growth factor (IGF) system and placental protein 14 (PP14) are reviewed. IGF binding protein-1 (IGFBP-1) and PP14 are products of the secretory phase endometrium: IGFBP-1 is produced by decidualized stromal cells and PP14 by glandular epithelial cells. IGFBP-1 may inhibit the action of IGFs at the endometrial-trophoblastic interphase, and it may also have a role in stromal-epithelial interaction. PP14 has immunosuppressive properties, and recent findings indicate that it may play a part in the fertilization process by inhibiting binding of spermatozoa to the zona.
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Räihä I, Seppälä M, Impivaara O, Hyyppä MT, Knuts LR, Sourander L. Chronic illness and subjective quality of sleep in the elderly. AGING (MILAN, ITALY) 1994; 6:91-6. [PMID: 7918736 DOI: 10.1007/bf03324222] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The effect of chronic illness on the subjective quality of sleep, and the use of hypnotics was studied in a stratified random sample of elderly people. Six hundred subjects aged 65 years or over were included in the study. A structured interview on the quality of sleep and medical history was carried out. In addition, the majority of diagnoses were confirmed from the national health insurance documents of the subjects. Logistic regression analysis disclosed that only perceived poor health and peptic ulcer or esophagitis were associated with perceived poor sleep. Age did not contribute to the quality of sleep. Age over 80 years and the presence of peptic ulcer or esophagitis, heart failure, cholelithiasis, and, in particular, depression were associated with the habitual use of hypnotics. The results stress the importance of perceived poor general health status, and acid-related gastrointestinal diseases as the determinants of subjective poor sleep, rather than age or many specific somatic diseases as such. On the other hand, depression is a major determinant for the habitual use of hypnotics.
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87
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Koistinen H, Seppälä M, Koistinen R. Different forms of insulin-like growth factor-binding protein-3 detected in serum and seminal plasma by immunofluorometric assay with monoclonal antibodies. Clin Chem 1994. [DOI: 10.1093/clinchem/40.4.531] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Monoclonal antibodies against recombinant insulin-like growth factor-binding protein-3 (IGFBP-3) were produced to study the various forms of IGFBP-3 and to develop a specific immunofluorometric assay. We tested seven antibodies that showed no cross-reactions with the other five human IGFBPs. By immunoblotting, the main bands in normal serum were seen at > 90, 45, 41, 29, and 25 kDa. In pregnancy serum, the 29-kDa was stronger, and the double band at 41-45 kDa was weaker or totally absent. We characterized two immunofluorometric assays. IGF-I had no effect on either assay. Added IGF-II lowered the amount of recombinant IGFBP-3 measured by the 5C11/7F8 assay, but not by the 1B6/5C11 assay. In normal serum and follicular fluid, IGFBP-3 measurements were lower by the 5C11/7F8 assay, but in most pregnancy sera and amniotic fluids the assays gave similar results. The 5C11/7F8 assay also detected IGFBP-3 in seminal plasma, whereas the 1B6/5C11 assay did not. We conclude that the results of IGFBP-3 measurement depend on the antibodies used, and that different antibodies are suitable for the IGFBP-3 measurement in different body fluids.
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Koistinen H, Seppälä M, Koistinen R. Different forms of insulin-like growth factor-binding protein-3 detected in serum and seminal plasma by immunofluorometric assay with monoclonal antibodies. Clin Chem 1994; 40:531-6. [PMID: 7511996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Monoclonal antibodies against recombinant insulin-like growth factor-binding protein-3 (IGFBP-3) were produced to study the various forms of IGFBP-3 and to develop a specific immunofluorometric assay. We tested seven antibodies that showed no cross-reactions with the other five human IGFBPs. By immunoblotting, the main bands in normal serum were seen at > 90, 45, 41, 29, and 25 kDa. In pregnancy serum, the 29-kDa was stronger, and the double band at 41-45 kDa was weaker or totally absent. We characterized two immunofluorometric assays. IGF-I had no effect on either assay. Added IGF-II lowered the amount of recombinant IGFBP-3 measured by the 5C11/7F8 assay, but not by the 1B6/5C11 assay. In normal serum and follicular fluid, IGFBP-3 measurements were lower by the 5C11/7F8 assay, but in most pregnancy sera and amniotic fluids the assays gave similar results. The 5C11/7F8 assay also detected IGFBP-3 in seminal plasma, whereas the 1B6/5C11 assay did not. We conclude that the results of IGFBP-3 measurement depend on the antibodies used, and that different antibodies are suitable for the IGFBP-3 measurement in different body fluids.
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89
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Klentzeris LD, Bulmer JN, Seppälä M, Li TC, Warren MA, Cooke ID. Placental protein 14 in cycles with normal and retarded endometrial differentiation. Hum Reprod 1994; 9:394-8. [PMID: 8006124 DOI: 10.1093/oxfordjournals.humrep.a138515] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The purpose of this study was to investigate whether endometrium with retarded development differs, functionally, from endometrium with normal 'in-phase' development. Precisely timed endometrial biopsies were obtained from 24 women suffering from unexplained infertility at 4, 7, 10 and 13 days following the luteinizing hormone (LH) surge. Frozen sections were labelled with an anti-placental protein (PP) 14 monoclonal antibody using an avidin-biotin peroxidase technique and semi-quantification of endometrial PP14 was performed using a Quantimet 970 image analyser. Serum PP14 and saliva progesterone were measured for each patient. Data were analysed using one- and two-way analysis of variance. Normal and retarded endometrium were identified in 16 (group I) and eight (group II) women respectively. Both groups demonstrated a significant increase of the area of precipitate measured for PP14 from day LH + 4 to LH + 13. However, two-way analysis of variance showed that endometrial PP14 was significantly (P < 0.05) lower in the retarded endometrium group at LH + 10 and LH + 13. Serum PP14 was also significantly lower (P < 0.01) in women with retarded endometrial development at LH + 13. Women with normal endometrial development had a significantly higher (P < 0.05) concentration of cumulative saliva progesterone from LH + 3 to LH + 5. This study indicates that there are functional differences between normal and retarded endometrium. These differences may adversely affect uterine receptivity during implantation and the early placentation stage.
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Räihä I, Impivaara O, Seppälä M, Knuts LR, Sourander L. Determinants of symptoms suggestive of gastroesophageal reflux disease in the elderly. Scand J Gastroenterol 1993; 28:1011-4. [PMID: 8284623 DOI: 10.3109/00365529309098301] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The study material consisted of 487 subjects from a stratified random sample of the non-institutionalized population of Turku aged 65 years or more (n = 24,937). The study was based on a population study on health status and sleeping habits of the elderly. Information on health status and medications was obtained by means of interviews and from the national health insurance records of the subjects. A postal questionnaire inquired about symptoms suggestive of gastroesophageal reflux disease (GERD). In univariate analyses, perceived poor health, insomnia, disability, depression, previous peptic ulcer, cholelithiasis, and bronchial asthma were associated with daily symptoms suggestive of GERD. Moreover, the symptoms were associated with the use of beta-blocking agents, benzodiazepines, and neuroleptic agents. In multivariate analyses, previous peptic ulcer, perceived poor health, insomnia, and use of benzodiazepines were independently associated with symptoms suggestive of GERD. In conclusion, the determinants of symptoms suggestive of GERD in the elderly differ from those reported in young and middle-aged subjects.
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91
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Hamilton-Fairley D, Kiddy D, Anyaoku V, Koistinen R, Seppälä M, Franks S. Response of sex hormone binding globulin and insulin-like growth factor binding protein-1 to an oral glucose tolerance test in obese women with polycystic ovary syndrome before and after calorie restriction. Clin Endocrinol (Oxf) 1993; 39:363-7. [PMID: 7693380 DOI: 10.1111/j.1365-2265.1993.tb02378.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE We determined the relationship of short-term changes in circulating insulin concentrations, resulting from an oral glucose load, to those in both sex hormone binding globulin (SHBG) and insulin-like growth factor binding protein 1 (IGFBP-1) and assessed the effect of a short-term low calorie diet on the levels of SHBG and IGFBP-1 during an oral glucose tolerance test. DESIGN A within-group comparison of biochemical indices during an oral glucose tolerance test before and after calorie restriction. PATIENTS AND METHODS Six obese women with polycystic ovary syndrome with mean (SD) BMI 34.2 (3.4) kg/m2 were studied before and after one month on a very low calorie diet (350 kcal/day; Cambridge diet). Each subject was given a 75-g oral glucose load after an overnight fast and blood samples were taken every 30 minutes for 3 hours. These were analysed for glucose, insulin, SHBG, and IGFBP-1. RESULTS All the women lost weight (range 1.7-9.5 kg). The SHBG concentrations did not change significantly during the oral glucose tolerance test but there was a highly significant decline in IGFBP-1 levels both before (0 min, mean (SD) 27.3 (10.6); 180 min, 8.9 (4.2) micrograms/l) and after (0 min, 28.4 (12.1); 180 min, 6.2 (2.1) micrograms/l, P < 0.001) dieting. The sum of the SHBG concentrations during the test, however, was significantly lower prior (129.9 (40.5) nmol/l) to calorie restriction than after (164.3 (70.6) nmol/l), whereas there was no significant effect of dieting on the IGFBP-1 response to glucose. CONCLUSIONS The changes in insulin and SHBG concentrations found after dieting have been confirmed. SHBG levels, in contrast to IGFBP-1, do not change in response to a short-term increase in insulin or glucose concentrations. The difference in the response of the two binding proteins may be explained by differences in their half-lives in the circulation or the regulation of mRNA for the peptides by insulin. This study confirms that insulin regulates both SHBG and IGFBP-1 but that there is a difference in the time course of the response of the two proteins to insulin.
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Seppälä M, Julkunen M, Rutanen EM. Endometrial protein secretion during the peri-implantation phase and early pregnancy. ACTA EUROPAEA FERTILITATIS 1993; 24:225-8. [PMID: 7985468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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93
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Tiitinen A, Tenhunen A, Seppälä M. Ovarian electrocauterization causes LH-regulated but not insulin-regulated endocrine changes. Clin Endocrinol (Oxf) 1993; 39:181-4. [PMID: 7690311 DOI: 10.1111/j.1365-2265.1993.tb01771.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE We studied the effects of ovarian electrocauterization on the serum levels of luteinizing hormone (LH), testosterone, insulin, sex hormone-binding globulin (SHBG) and insulin-like growth factor binding globulin-1 (IGFBP-1) in women with polycystic ovarian disease (PCOD). DESIGN Prospective. PATIENTS Ten women with PCOD admitted to a University Infertility Clinic. MEASUREMENTS Fasting blood samples for determination of hormone levels were taken during the follicular phase before and one month after laparoscopic ovarian electrocauterization. RESULTS One month after electrocauterization the serum mean +/- SE LH levels had decreased from 14.4 +/- 1.9 to 10.9 +/- 1.1 U/l (P < 0.05), while the serum insulin levels showed no significant change (10.3 +/- 2.0 and 8.1 +/- 1.3 mU/l). The levels of IGFBP-1 (33.9 +/- 8.2 and 38.4 +/- 13.7 micrograms/l) and SHBG (48 +/- 10.4 and 43 +/- 5.7 nmol/l) showed no significant changes. Testosterone decreased from 3.9 +/- 2.6 to 2.9 +/- 0.3 nmol/l (P < 0.001) and androstenedione from 15.0 +/- 1.2 to 12.0 +/- 1.5 nmol/l (P = 0.05). After electrocautery seven out of ten PCOD patients ovulated either spontaneously (n = 3) or with clomiphene citrate (n = 4), and two of them conceived. CONCLUSIONS Ovarian electrocautery leads to resumption of ovulatory cycles in some but not all PCOD patients. This effect seems to be mediated by reduction of serum LH and androgen levels, while the insulin-driven pathway via SHBG and IGFBP-1 remains unaffected.
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Koistinen R, Angervo M, Leinonen P, Hakala T, Seppälä M. Phosphorylation of insulin-like growth factor-binding protein-1 increases in human amniotic fluid and decidua from early to late pregnancy. Clin Chim Acta 1993; 215:189-99. [PMID: 7691447 DOI: 10.1016/0009-8981(93)90125-n] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Different fractions of insulin-like growth factor-binding protein-1 (IGFBP-1) from anion exchange chromatography represent differently phosphorylated forms as demonstrated by protein kinase and alkaline phosphatase treatments. The major fraction is non-phosphorylated. Three minor fractions are more phosphorylated and, in native polyacrylamide gel electrophoresis (PAGE), they migrate faster than the major fractions. We studied the changes in phosphorylation of decidual and amniotic fluid IGFBP-1 during pregnancy. Both in decidua and in amniotic fluid the degree of phosphorylation increased from early to late pregnancy, as indicated by faster mobility of IGFBP-1 in native PAGE and increased relative amount of the phosphorylated forms in anion exchange chromatography. The more phosphorylated forms had higher IGF-binding affinity than the less phosphorylated forms. As the degree of phosphorylation of IGFBP-1 is highest in full term decidua it is likely that the inhibitory role of IGFBP-1 is accentuated in the end of pregnancy.
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Seppälä M, Rajala T, Sourander L. Subjective evaluation of sleep and the use of hypnotics in nursing homes. AGING (MILAN, ITALY) 1993; 5:199-205. [PMID: 8399465 DOI: 10.1007/bf03324155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The purpose of the study was to evaluate the sleep habits and the use of hypnotics in the elderly living in nursing homes. The study population consisted of 60 subjects aged 61-99 years who were interviewed by a geriatrician. The use of hypnotics was frequent (53%), but not associated with gender, memory impairment, moving disability, depression, quality of sleep or sleep behaviour. Users of hypnotics had shorter total sleep time (TST) and got up earlier from bed in the morning than the non-users. Most of the subjects perceived their sleep as interrupted but satisfactory. The elderly with impaired memory slept longer, stayed in bed longer, and took their hypnotics significantly earlier than those with normal memory. As we found no explaining factors for the use of hypnotics, we suggest regular evaluation of their administration in nursing homes. The subjective need for hypnotics, not the nursing home practices, should decide the necessity of these drugs and the medication times in nursing home residents.
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Angervo M, Toivonen J, Leinonen P, Välimäki M, Seppälä M. Thyroxine withdrawal is accompanied by decreased circulating levels of insulin-like growth factor-binding protein-1 in thyroidectomized patients. J Clin Endocrinol Metab 1993; 76:1199-201. [PMID: 7684392 DOI: 10.1210/jcem.76.5.7684392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We carried out a study on the effect of T4 withdrawal on serum insulin-like growth factor-binding protein-1 (IGFBP-1) levels in 10 thyroidectomized patients with papillary thyroid cancer receiving T4 replacement therapy. As controls we also measured serum sex hormone-binding globulin (SHBG) levels, known to be regulated by T4. Each patient acted as his/her own control, studied both before and 30 days after T4 withdrawal. On the average, the IGFBP-1 level decreased by 36% from 66 +/- 9 to 44 +/- 8 micrograms/L (mean +/- SE; P = 0.0007) during T4 withdrawal. The SHBG level decreased by 47% from 78 +/- 17 to 46 +/- 13 nmol/L (P = 0.0001). The fasting insulin levels were unaffected by T4 withdrawal. There also was an 18% decline in the serum IGF-I concentration after T4 withdrawal (P = 0.011). It is concluded that in athyreotic patients receiving T4, withdrawal of the drug decreases serum IGFBP-1 and SHBG concentrations and IGF-I levels. In view of the possible role of IGFBP-1 in glucose counterregulation, these results indicate a novel mechanism by which T4 may exert its metabolic action on liver carbohydrate metabolism.
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Angervo M, Tiihonen M, Leinonen P, Välimäki M, Seppälä M. Thyroxine treatment increases circulating levels of insulin-like growth factor binding protein-1: a placebo-controlled study. Clin Endocrinol (Oxf) 1993; 38:547-51. [PMID: 7687206 DOI: 10.1111/j.1365-2265.1993.tb00352.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Thyroid hormones affect carbohydrate metabolism in the liver, and hepatic insulin-like growth factor binding protein-1 (IGFBP-1) participates in glucose counter-regulation, so we studied the effects of oral thyroxine on serum IGFBP-1. DESIGN The study was performed on a placebo-controlled cross-over basis covering 3 months' thyroxine and 3 months' placebo administration. PATIENTS Eight patients taking anticonvulsant medication and four patients with hypothalamic hypothyroidism were given thyroxine, 150-200 micrograms daily for 3 months, or placebo. MEASUREMENTS Serum IGFBP-1, sex hormone binding globulin, free T3 and free T4, TSH and IGF-I levels were measured after an overnight fast before treatment, and at the end of each 3-month period. RESULTS Anticonvulsant medication had no significant effect on serum IGFBP-1. After 3 months' thyroxine treatment the serum IGFBP-1 levels (69; 58-167 micrograms/l; median and interquartile range, respectively) were significantly higher than those after placebo treatment (44; 23-58 micrograms/l; P = 0.002), or the pretreatment levels (54; 19-81 micrograms/l, P = 0.005). The IGFBP-1 levels rose in all 12 patients after thyroxine treatment, the median rise being 2.1-fold compared to placebo levels. No change was found in serum IGF-I concentrations. CONCLUSIONS Oral thyroxine produces a rise in serum IGFBP-1 levels without a change in serum IGF-I concentration.
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Seppälä M, Alihanka J, Himberg JJ, Kanto J, Rajala T, Sourander L. Midazolam and flunitrazepam: pharmacokinetics and effects on night time respiration and body movements in the elderly. INTERNATIONAL JOURNAL OF CLINICAL PHARMACOLOGY, THERAPY, AND TOXICOLOGY 1993; 31:170-6. [PMID: 8500918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In a double-blind crossover study, the pharmacokinetics and effects on night-time respiration and body movements of midazolam 7.5 mg, flunitrazepam 1 mg, and placebo were studied in 5 elderly insomniac patients with the static charge sensitive bed-method (SCSB). In a supine position, the gastrointestinal absorption rate of flunitrazepam (tmax 0.6 h) was faster than that of midazolam (tmax 0.95 h). The elimination phase half-life of midazolam was about twice as long as reported earlier in healthy adult volunteers, but ageing did not affect the elimination of flunitrazepam. The shape of the serum concentration-time curve of both benzodiazepine derivatives was quite similar. The sleep of these five insomniacs became more peaceful and the respiration more regular during midazolam and flunitrazepam, compared with placebo. Both benzodiazepines significantly decreased body movements and the cumulative movement time remained shorter throughout the night, compared with placebo. Total variability (VI) was clearly decreased with flurazepam, and a similar but not statistically significant tendency was seen with midazolam, compared with placebo. Accordingly, the proportion of quiet sleep (QS) increased (p = 0.014) and the proportion of active sleep (AS) decreased (p = 0.019) with both benzodiazepines, compared with placebo. This reflects the changed control of respiration by higher brain structures. No signs of increased respiratory resistance (i.e. ballistocardiographic respiratory amplitude variation BRV < 60%) were seen with either of the drugs or placebo. There were no differences in the subjects' own estimation of their sleep during medication with these drugs. Only the sleep onset latency was shorter with flunitrazepam compared with midazolam and placebo.(ABSTRACT TRUNCATED AT 250 WORDS)
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Insler V, Shoham Z, Barash A, Koistinen R, Seppälä M, Hen M, Lunenfeld B, Zadik Z. Polycystic ovaries in non-obese and obese patients: possible pathophysiological mechanism based on new interpretation of facts and findings. Hum Reprod 1993; 8:379-84. [PMID: 7682564 DOI: 10.1093/oxfordjournals.humrep.a138055] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
This study was designed to investigate the basic concentrations of different hormones in obese and non-obese patients with polycystic ovarian disease (PCOD). Eight women with PCOD, of whom four were obese with body mass index (BMI, kg/m2) of > 25 and four were non-obese with BMI < 25, volunteered to participate in this study. Serum samples were taken every 20 min over an 8 h period, starting at 2300 h, on day 5 of a spontaneous or gestagen-induced cycle. Basic insulin concentration was found to be significantly higher in the obese women compared with their non-obese counterparts (P < 0.0001). Serum concentrations of insulin-like growth factor binding protein (IGFBP-I) and sex hormone binding globulin (SHBG) were found to be significantly lower (P < 0.001 for both hormones) in the obese compared with the non-obese women. Serum concentrations of insulin-like growth factor I (IGF-I) did not differ between the two groups. The non-obese women had significantly higher serum concentrations of luteinizing hormone (LH) (P < 0.001) and of growth hormone (GH) (P < 0.002) than their obese counterparts. Based on these results, two models of the development of PCOD were suggested. In obese women, hyperinsulinaemia causes an excessive production of androgens through the enhancement of IGF-I receptors which, in synergism with LH, causes increased activity of cytochrome P-450c 17a. In non-obese patients, relative increase of GH concentration stimulates excessive ovarian IGF-I production. At this point synergism with LH results in excessive production of androgens by the same mechanism as in obese patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Seppälä B, Seppälä M, Ainamo J. A longitudinal study on insulin-dependent diabetes mellitus and periodontal disease. J Clin Periodontol 1993; 20:161-5. [PMID: 8450080 DOI: 10.1111/j.1600-051x.1993.tb00338.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In the present two-year longitudinal investigation, the progression of periodontal disease was assessed after 1 year from the baseline examination in 38 dentate subjects and after 2 years in 22 dentate subjects with a mean duration of 18 years of insulin-dependent diabetes mellitus. The diabetics, aged 35 to 56 years at baseline, were under medical treatment at the outpatient clinic of the III Department of Medicine, University Central Hospital of Helsinki and at 2 diabetic clinics of the Helsinki Health Centre. Based upon their long-term medical records, 26 subjects were at baseline identified as having poorly controlled insulin-dependent diabetes (PIDD) with a mean blood glucose level of 12.5 mmol/l and a mean glycosylated hemoglobin (HBA1) level of 10.1%. 12 subjects were classified as having controlled insulin-dependent diabetes (CIDD) with a mean blood glucose level of 6.7 mmol/l and a mean HBA1 level of 9.2% at baseline. For each individual, recordings were made at baseline and after 1 and 2 years from the baseline for the plaque index, gingival index, pocket depth, loss of attachment, bleeding after probing, gingival recession, and radiographic loss of alveolar bone. At baseline and 2 years after the baseline examination, the PIDD subjects had similar plaque conditions as the CIDD subjects. At baseline and after 1 and 2 years from baseline the PIDD subjects had more gingivitis and bleeding after probing (P < 0.05, chi 2-test) than the CIDD subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
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