Inhibin is a gonadal glycoprotein hormone that regulates the production of follicle-stimulating hormone (FSH) by the anterior pituitary gland and exhibits intragonadal actions as well. The present study shows that inhibin-like immunoreactivity (inhibin-LI) is present in cells of the cytotrophoblast layer of human placenta at term and in primary cultures of human trophoblasts. Human chorionic gonadotropin (hCG) stimulated secretion of inhibin-LI from these cultured placental cells. This effect was mimicked by 8-bromo-cyclic adenosine monophosphate (8-bromo-cAMP), forskolin, and cholera toxin, suggesting that the mechanism of hCG induction of placental inhibin-LI secretion is cAMP-dependent. Incubation with an antiserum that binds the alpha-subunit of human inhibin increased the secretion of hCG and gonadotropin-releasing hormone-like immunoreactivity (GnRH-LI) from trophoblast cells in culture, suggesting a local tonic inhibitory action of endogenous inhibin on hCG and GnRH-LI release. The action of inhibin on hCG secretion may partially require the presence of placental GnRH, as suggested by evidence that a synthetic GnRH antagonist partially reverses the hCG increase induced by inhibin immunoneutralization. Results suggest paracrine roles for both inhibin and GnRH in the regulation of placental hCG production.
BackgroundUncontrolled asthma during pregnancy is associated with the maternal hazards of disease exacerbation, and perinatal hazards including intrauterine growth restriction and preterm birth. Interventions directed at achieving better asthma control during pregnancy should be considered a high priority in order to optimise both maternal and perinatal outcomes. Poor compliance with prescribed asthma medications during pregnancy and suboptimal prescribing patterns to pregnant women have both been shown to be contributing factors that jeopardise asthma control. The aim is to design and evaluate an intervention involving multidisciplinary care for women experiencing asthma in pregnancy.Methods/designA pilot single-blinded parallel-group randomized controlled trial testing a Multidisciplinary Approach to Management of Maternal Asthma (MAMMA©) which involves education and regular monitoring. Pregnant women with asthma will be recruited from antenatal clinics in Victoria, Australia. Recruited participants, stratified by disease severity, will be allocated to the intervention or the usual care group in a 1:1 ratio. Both groups will be followed prospectively throughout pregnancy and outcomes will be compared between groups at three and six months after recruitment to evaluate the effectiveness of this intervention. Outcome measures include Asthma Control Questionnaire (ACQ) scores, oral corticosteroid use, asthma exacerbations and asthma related hospital admissions, and days off work, preventer to reliever ratio, along with pregnancy and neonatal adverse events at delivery. The use of FEV1/FEV6 will be also investigated during this trial as a marker for asthma control.DiscussionIf successful, this model of care could be widely implemented in clinical practice and justify more funding for support services and resources for these women. This intervention will also promote awareness of the risks of poorly controlled asthma and the need for a collaborative, multidisciplinary approach to asthma management during pregnancy. This is also the first study to investigate the use of FEV1/FEV6 as a marker for asthma control during pregnancy.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12612000681853)
Pregnant women are not well supported in managing asthma during pregnancy, despite being concerned about outcomes. Interventions, education, and more support are warranted and wanted by pregnant women with asthma to optimize pregnancy and neonatal outcomes.
A B S T R A C T Immunoreactive ACTH (ir-ACTH
Context Patients with glucocorticoid dependent Duchenne Muscular Dystrophy (DMD) have increased fracture risk and reduced bone mineral density (BMD), often precipitating mobility loss. Objective To investigate use of Zoledronic acid (ZA) in DMD in improving BMD. Design Two arm, parallel, randomised controlled trial Setting Paediatric hospitals across Australia and New Zealand Patients Sixty-two (31 per arm) boys with glucocorticoid dependent DMD between 6-16 years Intervention(s) Five ZA infusions (0.025mg/kg at months 0,3, 0.05mg/kg at months 6, 12 and 18), plus calcium and vitamin D, compared with calcium and vitamin D alone Main outcome measures Change in lumbar spine (LS) BMD raw and Z-score by dual energy absorptiometry x-ray (DXA) at 12 and 24 months, secondary outcomes assessing mobility, fracture incidence, bone turnover, pQCT and pain scores Results At 12 and 24 months, mean difference in changes of LSBMD Z-score from baseline was 1.2 SD (95% CI: 0.9-1.5), higher by 19.3% (14.6-24.0) and 1.4 SD (0.9-1.9), higher by 26.0% (17.4-34.5) in ZA compared to control arms respectively (both p < 0.001). Five controls developed Genant 3 vertebral fractures, 0 in the ZA arm. Mobility, pain and bone turnover markers were similar between arms at 12 and 24 months Trabecular BMC and vBMD pQCT at radius and tibia were greater at 12 months in the ZA cohort compared to control; difference remaining at 24 months for radius. Conclusion ZA improved BMD in glucocorticoid dependent DMD boys. Whilst the small cohort precluded demonstrable fracture benefit, improved BMD might reduce incident vertebral fracture.
Objective. Objective Structured Clinical Examination (OSCE) practice sessions are logistically challenging and resource demanding. Our objective was to examine pharmacy students' OSCE performance and perceptions about an interactive online learning module (Monash OSCE Virtual Experience (MOVE). Methods. MOVE online module consists of twenty pharmacy case scenarios with virtual patients. It was piloted with our final year pharmacy students at Monash University campuses in Australia (Parkville) and Malaysia (Sunway). A mixed methods approach consisting of: (1) reviewing user attempts and grade comparison, (2) self-administered questionnaires, and (3) focus groups was used to examine students' perception and performance. Results. More than 99% of all students attempted at least one online case scenario in preparation for their final OSCE. 81% attempted all twenty scenarios two or more times. 90% of Sunway students and 70% of Parkville students reported MOVE to be a helpful study tool for their OSCE preparation. However, raw comparison of user attempts and OSCE marks showed no direct correlation between online module attempts and assessment grades. Self-administered questionnaire and focus group results indicated that MOVE prepared students for targeted and time-bound history taking and problem-solving skills. Overall, students perceived MOVE to be a useful learning tool and less overwhelming learning experience than face to face sessions. Nevertheless, students still preferred face-to-face OSCE practice with simulated patients than online practice with virtual patients. Conclusion. MOVE was perceived by our students as a flexible and useful online learning aid for their final year OSCE preparation.
Some negative outcomes of preventive asthma medications have been reported, although their direct link with medication use is inconclusive. Selection of preventive medications for asthma management during pregnancy should be based on an assessment of the risks and benefits of medication use versus the risks of poorly controlled asthma.
Although the ovarian production of sex steroids is of obvious physiological importance, recent studies suggest that peptides such as oxytocin, relaxin and inhibin are also synthesized in the ovary. We report here the presence of immunoreactive (ir) beta-endorphin, ir-adrenocorticotropic hormone (ACTH) and presumptive high molecular weight forms of both in extracts of sheep ovary, consistent with ovarian production from a common precursor. Our findings suggest that beta-endorphin and ACTH are produced and secreted by the follicular cells, and that their production may be related to the oestrous cycle.
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