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Adropin is a hormone which increases insulin sensitivity. It enhances the oxygenation of glucose in the muscles. The 91 obese pregnant women (BMI >30 kg/m2) with gestational diabetes mellitus (GDM) diagnosed in the first half of pregnancy has been recruited to the study group. The control group consisted of 10 age matched and homogeneous pregnant women with BMI <25 kg/m2. Blood samples were collected on visit V1 - between the 28th and 32nd week and on visit V2 - between the 37th and 39th week of gestation. The ELISA test was used to measure the adropin level. The results in the study group and the control group were compared. Blood samples were collected at the same visits. The median concentration of adropin was 442.2 pg/ml on V1 and 453.1 pg/ml on V2. The increase was significant (p<0.05). Results were significantly lower in the control group's patients, i.e. 57.0 pg/ml (p<0.001) on V1 and 107.9 pg/ml on V2 (p<0.001). The higher adropin level on the V1 and V2 visits were related to patients' lower BMI and better metabolic control. The increase in the adropin level in the third trimester may have been involved in the weight gain reduction, whereas better dietary adherence might have had a compensatory effect on increasing insulin resistance. However, the small control group is a limitation of this study. [ABSTRACT FROM AUTHOR]

Background: The molecular aetiology of disturbed embryogenesis and other unfavourable outcomes in offspring of diabetic mothers is not fully understood. Experimental studies have suggested an involvement of radical oxygen species (ROS) in the teratological process. The aim of our study: To investigate if maternal diabetes in humans is capable of inducing alterations in vascular oxidative stress parameter's and whether such changes are associated with disturbances in foetal development. Methods: Seventy patients with pre-gestational diabetes (PGDM) were chosen for the study: 29 (41.4%) belonged to class B according to White, 15 (21.4%) to class C, 8 (11.4%) to class D, 3 (4.3%) to class F, 3 to class R and 12 (17.1%) to class F/R. In 20 (28.6%) patients from this group an unfavourable outcome was noted. All patients were subjected to intensive insulin therapy. Glycaemia was estimated by daily self-monitoring, and diurnal glucose profiles and glycated haemoglobin (HbA1C) concentrations were measured monthly. Oxidative stress was evaluated as changed superoxide dismutase, catalase and glutathione peroxidase activities as well as of malondialdehyde (MDA) and peroxides concentrations in maternal erythrocytes and blood serum. Results: Prior to conception, the mean glycaemia in the group that had a planned pregnancy was 6.6 mmol/l and HBA1C was 9.35%. Throughout the course of pregnancy, these parameters were maintained at a level of 6.7 mmol/l and 7.85%, respectively. The activity of all antioxidative enzymes was lower before than during pregnancy, and so was the concentration of MDA. The MDA concentrations were higher in patients with elevated glycaemia and with an unfavourable outcome. The investigated ROS, the glycaemia level, as well as the concentration of HBA1C did not show any significant differences between pregnancies with and without vascular complications. Patients with a favourable perinatal outcome presented a higher activity of antioxidant enzymes, than those with unfavourable outcome, throughout the whole course of pregnancy. The appearance of unfavourable perinatal outcomes in relation to parameters of oxidative stress was assessed by logistic regression. Both SOD and GPX activities, as well as peroxides' concentration, showed significant correlations (p < 0.005) with foetal complications. However, after mean glucose levels in the studied group were included into these analyses; this relationship was only evident with SOD and GPX activity (P < 0.0016). Conclusion: Oxidative stress is one of several important factors contributing to unfavourable outcome of human diabetic pregnancy. [ABSTRACT FROM AUTHOR]

p-tert -Butylthiacalix[4]arene ( 1 ) reacts with phosphorus pentachloride under participation of the sulfur atoms to a hexacoordinated phosphorus derivative ( 2 ) of the thiacalixarene. Hydrolysis of 2 leads to the twofold 1,2-bridged thiacalixarene bis(chlorophosphate) 3 . [ABSTRACT FROM AUTHOR]

Aims: Our study aimed to examine the pregnancy outcomes (maternal and fetal) concerning different models of antenatal care across a period of over 25 years (1993-2018) in 459 women with type 1 diabetes. Data from patients with a history of the condition lasting at least 15 years were considered eligible for analysis., Methods: The study group was divided into three cohorts based on the different models of treatment used in Poznan University Hospital, Poland: 1993-2000 (cohort I, n = 91), 2001-2005 (cohort II, n = 83), 2006-2018 (cohort III, n = 284). To identify predictors for the selected dichotomous outcomes, we calculated the risks for fetal or maternal complications as dependent variables for cohorts II and III against cohort I, using multivariate logistic regression analysis., Results: The mean gestational age was 36.8 ± 2.4 weeks in the total cohort. The percentages of deliveries before the 33rd and the 37th weeks was high. We observed a decreasing percentage during the following periods, from 41.5% in the first period to 30.4% in the third group. There was a tendency for newborn weight to show a gradual increase across three time periods (2850, 3189, 3321 g, p < 0.0001). In the last period, we noticed significantly more newborns delivered after 36 weeks with a weight above 4000 g and below 2500 g. Caesarean section was performed in 88% of patients from the whole group, but in the subsequent periods this number visibly decreased (from 97.6%, 86.7%, to 71%, p = 0.001). The number of emergency caesarean sections was lowest in the third period (27.5%, 16.7%, 11.2%, p = 0.006). We observed a decreasing number of "small for gestational age" newborns (SGA) in consecutive periods of treatment (from 24.4% to 8.7%, p = 0.002), but also a higher percentage of "large for gestational age" (LGA) newborns (from 6.1% to 21.6%, p = 0.001). Modification of treatment might be associated with the gradual reduction of SGA rates (cohort I 3.6%, cohort III 2.3% p < 0,0005)., Conclusions: Strict glycemic and blood pressure control from the very beginning of pregnancy, as well as modern fetal surveillance techniques, may contribute to the improvement of perinatal outcomes in women with long-duration type 1 diabetes.

A 25-year-old primigravida with Marfan syndrome (MFS) was admitted at 36 weeks of gestation (WOG).

Objective: In recent years, the co-existence in Germany of two parallel comprehensive insurance systems-statutory health insurance (SHI) and private health insurance (PHI)-has been posited as a possible cause of a persistent unequal regional distribution of physicians. The present study investigates the effect of the proportion of privately insured patients on the density of SHI-licensed physicians, while controlling for regional variations in the average income from SHI patients., Methods: The proportion of residents in a district with private health insurance is estimated using complete administrative data from the SHI system and the German population census. Missing values are estimated using multiple imputation techniques. All models control for the estimated average income ambulatory physicians generate from treating SHI insured patients and a well-defined set of covariates on the level of districts in Germany in 2010., Results: Our results show that every percentage change in the proportion of residents with private health insurance is associated with increases of 2.1 and 1.3 % in the density of specialists and GPs respectively. Higher SHI income in rural areas does not compensate for this effect., Conclusion: From a financial perspective, it is rational for a physician to locate a new practice in a district with a high proportion of privately insured patients. From the perspective of patients in the SHI system, the incentive effects of PHI presumably contribute to a concentration of health care services in wealthy and urban areas. To date, the needs-based planning mechanism has been unable to address this imbalance.

The present study analyzes the effect of supply-side determinants on regional inequities in outpatient care. Inequities are measured by the degree of disparity between need for and actual utilization of outpatient health services in the 412 German districts. Outpatient care needs of each district are determined by applying the regression model of the German risk structure compensation scheme. We find that supply-side factors account for half of the model's coverage of regional inequities. The remaining regional variance explained by the model may be attributed to socioeconomic and (socio-)geographic determinants as well as price effects. Our findings call for strengthening the role of GPs as coordinators in the health care system, countering the geographic maldistribution of physicians and introducing adequate programs to improve the level of care in socially deprived districts. The study also highlights the importance of differentiating between need, demand and utilization of health services in order to understand the root causes of inequities., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To explore the effectiveness of four different policy mechanisms in achieving a more equitable geographical distribution of general practitioners (GPs) in European countries. The following mechanisms were analysed: (1) interventions during medical training; (2) financial incentives; (3) quotas to allocate GPs to regions and (4) capitation-based remuneration., Methods: A macro-comparative method, namely, fuzzy set qualitative comparative analysis, was employed to explore the distributional effectiveness of the four mechanisms. A literature review yielded information on the use of these mechanisms in the 21 European countries included, while country-specific equity in the geographic GP distribution served as the outcome variable., Results: Quotas determining the number of GPs per region proved to be highly effective in producing an equitable GP distribution if calculated based on health care needs. Remunerating GPs largely through capitation payments also proved to be an effective policy mechanism. Financial bonuses to GPs practising in under-served areas and interventions during medical training had little or no impact., Conclusion: Several high income countries have a maldistribution of primary care physicians to the detriment of rural or socially deprived areas. Policy makers have instituted a variety of policies to counter this. This study helps to identify mechanisms which are likely to be more and less effective.

Germany's ruling coalition has recently introduced a new bill to Parliament, the Care Structures Act (CSA), which aims to improve outpatient care supply structures, decentralize decision-making, facilitate cross-sectoral treatment, and strengthen innovation in the nation's health care sector. These objectives are to be achieved through a variety of measures, including changes in financial incentives for physicians, the transfer of decision-making to the regional level, and the creation of a new sector for highly specialized care. The opposition parties in Parliament and most health care stakeholders agree on the objectives of the reform package, but their evaluation of the bill is mixed. Physicians' representative organizations generally deem the law to be headed in the right direction, while the opposition parties, sickness funds, patients' rights groups and a majority of German federal states (Bundesländer) feel it does not adequately address the issues of supply inequity and sectoral division. This skepticism seems well founded. The reforms aimed at attracting physicians to high-need regions have significant shortcomings, and the measures to overcome sectoral barriers between the outpatient care and hospital sectors remain weak. Furthermore, the new procedure for including innovative treatment methods in the SHI benefits catalogue falls short of internationally recognized standards., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

We present a case of pregnancy in 28-years old nulliparous woman with an over 20-years long history of diabetes, hypothyroidism, diabetic nephropathy with nephrotic syndrome, retinopathy and coronary artery disease treated with PCA prior the pregnancy (class H diabetes, according to White classification).

Background: Sleep-related breathing disorders (SRBD) are the additional factor related to poor prognosis in patients with cardiovascular disorders. The apnoea/hypopnoea index (AHI), describing the number of apnoea and hypopnoea episodes per one hour of sleep, has been used as a marker of severity of the disorder. The disease is present in 4% of men and 2% of women above 40 years of age. However, SRBD are diagnosed in less than 3% of patients with this syndrome due to lack of awareness of the disease among health care practitioners and patients. Polysomnography (PSG) has been used as a golden standard for detecting SRBD, however this test is available only in selected centres. Therefore, a simple, fast and inexpensive test for screening for SRBD is necessary. Respiratory activity influences the amplitude of ECG signal whereas heart rate variability (HRV) depicts the activity of the autonomic nervous system. These associations have been used to develop a new method for detection of SRBD involving analysis of HRV and morphology of ECG signal in ECG monitoring., Aim: Assessment of accuracy of SRBD detection using estimated AHI (Est.AHI), calculated from Holter ECG recordings., Methods: In a study group consisting of 74 patients tested for SRBD, simultaneous PSG and 24-hour ECG monitoring were performed. Following PSG, AHI for each patient was calculated. According to the AHI values patients were classified as SRBD patients (AHI >15), non-SRBD patients (AHI <5), whereas 12 individuals had borderline SRBD (5< or = AHI < or =15). Age, prevalence of concomitant disorders and treatment were similar in all groups. In all individuals the Est.AHI value was calculated based on ECG recording. Considering the AHI value as a reference parameter discriminating SDB and non-SRBD patients, the number of false positive and false negative results for detecting SDB with the Est.AHI was calculated. Moreover, the SRBD detection accuracy using the Est.AHI calculation was evaluated by the receiver-operator characteristic (ROC) curves which were used to calculate area under curve (AUC), sensitivity, specificity, as well as positive (PPV) and negative (NPV) predictive values for optimal cut-off value., Results: According to Est.AHI, 50 (68%) patients were correctly diagnosed. The ROC analysis showed high accuracy of SRBD detection using Est.AHI: AUC - 0.91 with sensitivity - 91.2%, specificity - 87.5%, PPV - 88.6%, and NPV - 88.9%. The cut-off value of Est.AHI set at 17 was optimal for the differentiation between patients with or without SRBD., Conclusions: The Est.AHI calculated with the Lifescreen Apnea software from Holter ECG is an accurate, specific and sensitive method for the detection and classification of obstructive and mixed SRBD.

2-deoxy-D-glucose (2-DG), the unmetabolizable analogue of glucose induces a series of metabolic, hormonal and behavioral responses, causing cellular glucoprivation. According to in vitro studies, 2-DG inhibits phosphofructokinase in cultured human cells. The present investigations deal with changes in the cytosolic glucose-6-phosphate dehydrogenase activity following in vivo 2-DG administration. A single dose of 2-DG (600 mg/kg) has no influence on the activity of glucose-6-phosphate dehydrogenase in the cytosol of liver, heart and skeletal muscle of the rat. The concomitant increase in serum glucose, lactate and FFA concentrations observed in the study indicates indirectly a stimulation of adrenergic system. After three days of successive administration of 2-DG to rats, dehydrogenase activity decreased in the liver by approx 57% and in the skeletal muscle by approx 82% in comparison with control animals. Moreover the in vivo effect of 2-DG was found to be fully reversible, probably when the total amount of the inhibitor was excreted.