Jewish Hospital

About: Jewish Hospital is a healthcare organization based out in Cincinnati, Ohio, United States. It is known for research contribution in the topics: Antigen & Population. The organization has 3881 authors who have published 3414 publications receiving 123044 citations.

Pioglitazone and metformin in obese women with polycystic ovary syndrome not optimally responsive to metformin

Abstract: BACKGROUND: In an observational study of 13 women with polycystic ovary syndrome (PCOS) not optimally responsive to metformin diet, we assessed the efficacy and safety of addition of pioglitazone. We also compared these 13 women to 26 women with PCOS, who were responsive to metformin diet, matched by age and by pretreatment menstrual history and not different by obesity categories. METHODS: Prospectively, as outpatients, with diet constant [1500‐2000 calorie (depending on entry body mass index), 26% protein, 44% carbohydrate, 30% fat], metformin (2.55 g/day) was given for 12 months to 39 women, 13 not optimally responsive, 26 responsive to metformin diet, followed by addition of pioglitazone (45 mg/day) for 10 months in the 13 non-responders. Outcome measures included changes in sex hormones, insulin, insulin resistance (IR), insulin secretion, high density lipoprotein cholesterol, weight, and menstrual status. RESULTS: In 13 non-responders, on metformin diet, median serum insulin fell (21 to 16 mIU/ml, P 0.07). Compared with 14% pretreatment, on metformin diet, expected menses occurred 46% of the time at 3 months (P = 0.05), 38% at 6 months (P = 0.07), 27% at 9 months, and 24% at 12 months. In 26 responders, on metformin diet, median weight fell (93 to 87 kg), testosterone fell (50 to 32 ng/dl), insulin fell (26 to 16 mIU/ml), IR fell (5.32 to 3.45) and insulin secretion fell (351 to 271) (P < 0.017 for all). The occurrence of expected menses in the 26 responders was 2.5-fold higher than in the 13 non-responders (P < 0.0001). In 11 non-responders, on pioglitazone + metformin diet over 10 months versus antecedent metformin diet, DHEAS fell (211 to 171 mg/dl, P = 0.02), insulin fell (16 to 10 mIU/ml, P = 0.001), IR fell (3.37 to 1.73, P = 0.002), insulin secretion fell (217 to 124, P = 0.004), sex hormone-binding globulin rose (31 to 43 nmol/l, P = 0.006), and HDL cholesterol rose (38 to 42 mg/dl, P = 0.003). On pioglitazone + metformin diet, the occurrence of expected menses was 2-fold higher than on metformin diet (P < 0.0001). CONCLUSIONS: In women with PCOS who failed to respond optimally to metformin, when pioglitazone was added, insulin, glucose, IR, insulin secretion, and DHEAS fell, HDL cholesterol and sex hormone-binding globulin rose, and menstrual regularity improved, without adverse side-effects.

Outcomes of the first 2 American hand transplants at 8 and 6 years posttransplant.

Abstract: Purpose The feasibility of hand allotransplantation has been demonstrated. The purpose of the article is to report the (1) functional return, (2) psychosocial outcomes, (3) clinical and histological assessment for rejection, (4) complications, and (5) graft survival in the 2 American hand transplant recipients. Methods We present 2 patients 106 and 81 months, respectively, after unilateral transplantation of an allogeneic hand and forearm. We analyzed clinical course, number of rejection episodes, adverse events, function of the allograft, and quality of life. Clinical laboratory results, biopsy histology, and patient clinical examinations were used to compare the clinical course. Standard hand function tests were used to evaluate function. Psychological interviews were used to assess acceptance and quality of life. Results Our patients have allograft survival with improvements in intrinsic muscle activity, total active motion and return of functional grip, pinch strength, and sensibility. Rejection episodes were restricted primarily to the first 6 months after transplantation, and all responded to treatment. The major posttransplantation complications were a cytomegalovirus infection in patient 1 and osteonecrosis of the hip requiring both hips to be replaced, 1 at year 4 and the other at year 6, as well as transient immunosuppression-related diabetes in patient 2. Recently we have weaned both patients off maintenance steroids. Current Carroll scores are fair for patient 1 (72/99) and fair for patient 2 (55/99), although patient 2 has not had good recovery of intrinsic function. Both patients are back at work and report an excellent quality of life at nearly 9 and 7 years, respectively, after transplantation. Conclusions Our intermediate long-term results of hand transplants have demonstrated functional return similar to that of replants. Graft survival and quality of life after hand transplantation has far exceeded initial expectations. We conclude that allogeneic hand transplant is feasible and holds promise as a treatment modality for catastrophic upper extremity loss. Type of study/level of evidence Therapeutic IV.

The influence of the anterior pituitary gland on protein metabolism

Abstract: IT is NOW well established that the anterior pituitary gland exerts a pro-found influence on protein metabolism (1). This may be exemplified by the fact that extracts of this gland when administered to normal animals (dog and rat), produce a diminution of nitrogen excretion (2-5), a decrease in the concentration of blood non-protein-nitrogen (3, 6) and a consistent decrease in the amino acids of liver, muscle and other tissues (7, 8). Such evidence can be interpreted as showing that under the influence of the pituitary gland there occurs either a retention of nitrogen and synthesis of protein, or a decreased catabolism of protein. In a recent report (9) we have demonstrated that insulin plays an im-portant role in protein anabolism in that a ‘nitrogen-sparing effect’ can be produced in normal, eviscerated and depancreatied animals.