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Determination of luteal phase length by quantitative basal temperature methods: validation against the midcycle LH peak.

Basal temperature data are known to provide unreliable assessments of luteal phase length when they are evaluated by qualitative, visual-pattern methods. This study of 24 cycles in 24 women compared the serum LH peak day with the luteal phase onset day determined by three quantitative basal temperature methods: a) a new computerized least mean square method developed by the authors; b) the mean temperature method reported by Vollman; and c) a computerized version of the World Health Organization cumulative sum method of Royston. The luteal phase onset day determined by the three quantitative basal temperature methods, (a, b, and c) correlated well with the midcycle LH peak (r = 0.879, 0.891, and 0.791, respectively, all p less than 0.001). The cumulative sum method, however, was only able to analyze 19/24 cycles. The mean delay between the LH peak day and the luteal phase onset day determined by thermal shift was 2.4 +/- 1.5, 2.7 +/- 1.4, and 4.1 +/- 2.0 d (mean +/- SD), respectively. The mean temperature method, but not the other two methods, showed an increasing delay between the LH peak day and the thermal shift day with longer follicular phase lengths. Rectal and oral temperature data from the same cycle give identical luteal onset days when analyzed by the least mean square and mean temperature methods, but discrepant days by the cumulative sum analysis. The least mean square technique is a reliable and precise method for population documentation of luteal phase lengths.

Adult↗

The effect of temperature on the basal metabolism of cardiac muscle.

Using independent methods, measurements were made of the rate of oxygen consumption of quiescent rat ventricular tissue slices and of K+-arrested rabbit hearts at different temperatures. Experiments were designed such that the effect of temperature could be separated from the effect of time. The rate of oxygen consumption of both cardiac muscle preparations declined with time following cardiectomy. Likewise the rate of resting oxygen consumption of both preparations was relatively insensitive to temperature: Q10 = 1.3. By contrast, the rate of oxygen consumption of rat liver slices showed a Q10 of 2.6. The low Q10 values of the cardiac preparations do not appear to be due to an inadequate supply of oxygen. The results are in close agreement with those of myothermic studies.

Animals↗

On the increase in rate of heat production caused by stretch in frog's skeletal muscle.

1. The increase in rate of heat production caused by stretch in the unstimulated frog's sartorius (stretch response) has been measured using a conventional thermopile technique.2. The rate of heat production was found constant between l(0) (the distance in vivo between the tendons when the legs were in a straight line) and 1.2 l(0), and rose rapidly above this length to reach 3-5 times the basal rate at 1.3 l(0). Stretching to greater lengths appeared to damage the muscles.3. The stretch response is increased by several substances which increase the duration of the active state.4. Unlike the rate of heat production at l(0), the stretch response is increased by procaine; while the presence of CO(2) greatly reduces it.5. Evidence is presented supporting the hypothesis that the stretch response is associated with the appearance of tension in the sarcolemma.

Animals↗

The role of ultrasound in ovulation induction: a critical appraisal.

Twenty-five cycles induced by human menopausal gonadotropin (hMG) were serially studied by ultrasound. The developing follicles were observed up to and beyond human chorionic gonadotropin (hCG) administration. Ovulation as determined by subsequent pregnancy or a sustained elevation of basal temperature was seen in 18 of these cycles. Among these patients the follicular size ranged between 24 and 13 millimeters. No pregnancies occurred where the follicular size was below 15 mm. A shortened luteal phase was noted in three cycles where the follicular size was either 13 or 14 mm. Multiple follicles greater than 10 mm were observed in 14 of the ovulating cycles, but in no case did a multiple pregnancy occur. Fifteen millimeters is therefore suggested as a minimum size for satisfactory ovulation, but it does not appear that an optimum size exists. We conclude that ultrasound can play an important role in the monitoring of ovulation induction but does not replace the present methods.

Anovulation↗

Metabolic aging and predicted longevity: results of a cross-sectional study in post-menopausal women.

BACKGROUND AND AIMS: The extent to which general characteristics of metabolic aging contribute to differences in life span among individuals remains uncertain. The objective of this study was to examine the association of age-related physiological and metabolic variables with predicted longevity in postmenopausal women. METHODS: Subjects were 33 healthy women aged 55-65 years. Total and resting energy expenditure, body temperature, immune function as assessed by a delayed-type hypersensitivity skin test (DTH), lipid profile, and reported dietary intake were measured. RESULTS: There were no significant associations between longevity, energy expenditure, body temperature, lipid profile, or dietary intake. However, there was a significant association of predicted longevity with DTH (partial r=0.44, p=0.023). CONCLUSIONS: These results suggest that immune function may predict familial differences in longevity, while energy expenditure, body temperature, lipid profile, and dietary intake are unrelated. Although the small sample size may have limited the ability to detect metabolic effects on longevity in this study, the general approach may be broadly applicable to examinations of metabolic aging in humans.

Aged↗

Disturbances in melatonin, cortisol and core body temperature rhythms after major surgery.

BACKGROUND: It has been suggested that circadian rhythm disturbances are present after major surgery and that this may play a role in the development of postoperative sleep disturbances, fatigue, cognitive dysfunction and cardiovascular morbidity. The objective of this study was to examine the profile of melatonin, cortisol and core body temperature rhythms before and after major surgery. METHODS: Blood samples (melatonin and cortisol) and core body temperature readings were collected every hour in the 24-h period prior to surgery and the 48 h after surgery from 11 patients undergoing major abdominal surgery. All patients had private rooms. Light exposure was controlled and monitored. Phase markers [50% dim light melatonin onset (DLMO 50%) and offset (DLMOff 50%), cortisol and core body temperature acrophase] for the three circadian rhythm profiles were calculated before and after surgery. The correlation between the melatonin rhythm and time of surgery, duration of surgery and opioid use was examined. RESULTS: A median delay in the onset of melatonin was seen on the first postoperative day [median DLMO 50% 22:46 hours (range: 21:15-01:08 hours) on the preoperative day compared with 23:54 hours (range: 19:09-02:46 hours) on the first postoperative day; P </= 0.05] . A significant positive correlation existed between the duration of surgery and the time of melatonin onset (r = 0.67, P </= 0.05) . There was a significantly reduced basal secretion of melatonin immediately after surgery, with a subsequent significant increase in maximum melatonin values on the second postoperative night. A median delay of up to 4 h was seen in the timing of the peak of the temperature rhythm on the second postoperative day. Both cortisol secretion and core body temperature were increased after surgery and did not return to preoperative values in the 48 h of the postoperative study period. No significant correlation between opioid dose and the basal or maximum melatonin levels or the time of melatonin onset was found. CONCLUSION: We found disturbances in three circadian markers after major surgery. The clinical consequences of postoperative circadian disturbances should be investigated further in the future.

Abdomen↗

Embryonic heart rates: development in early first trimester and clinical evaluation.

One hundred and forty-three women in the early first trimester of gestation were examined 364 times using transvaginal sonography, and the development of embryonic heart rate was studied. In each case gestational age was revised retrospectively by either recorded basal body temperature or ultrasound crown-rump length dating between 9 and 10 weeks. Embryonic cardiac activity could be detected as early as 37 days of gestation. In 133 continuing pregnancies, embryonic heart rate rose from an average of 97.7 beats per min at 36-38 days to 174.7 beats per min at 60-62 days. A significant correlation was seen between gestational age and embryonic heart rate (p less than 0.001). The regression equation for heart rate was as follows: heart rate = 3.850 x gestational age (days) -54.64 (r = 0.908, n = 347), in short, embryonic heart rate continued to rise about 4 beats per min every day until 8 weeks of gestation. In this series, 10 pregnancies resulted in spontaneous abortion in the first trimester, and all of them showed relative bradycardia. Embryonic heart rate measurements in 8 of them were below the 95% prediction intervals for normal heart rate plotted against gestational age. This study suggests that embryonic heart rate measurement by ultrasound may be a new method for dating early first trimester, and that first trimester bradycardia may be associated with a poor prognosis for the pregnancy.

Abortion, Spontaneous↗

Veralipride: alternative antidopaminergic treatment for menopausal symptoms.

The vasomotor hot flushes and increased perspiration symptomatic of the menopausal period reflect the adaptation of the body to the lowering of its preset basal temperature resulting from the interference of various central neurotransmitters of suprahypothalamohypophyseal origin. The present double-blind study was conducted to test the efficacy of veralipride, a synthetic antidopaminergic molecule, in eliminating the symptoms of menopause in 50 patients. Results indicated a total elimination of both hot flushes and excessive perspiration in 63% to 80% of the patients treated. The beneficial effects persisted up to 3 months of follow-up. Veralipride significantly increased dehydroepiandrosterone sulfate and estradiol levels. High values of prolactin were found, and some patients showed slight breast discharge; these changes disappeared 48 hours after the drug was stopped.

Adult↗

Influence of ambient temperature on sleep characteristics and autonomic nervous control in healthy infants.

OBJECTIVE: To evaluate the influence of ambient temperature on infant's sleep and cardiorespiratory parameters during sleep. PATIENTS AND METHOD: 20 healthy infants with a median age of 11.5 weeks (range 7 to 18 weeks) were recorded polygraphically for one night. They were exposed to 3 different ambient temperatures (20 degrees C-25 degrees C-30 degrees C). Ambient and core temperatures were measured throughout the procedure. RESULTS: Influence of ambient temperature was seen in: RESPIRATORY PARAMETERS: The frequency of central apneas increased significantly with increasing temperatures in REM sleep, but not in NREM sleep. HEART RATE (HR) PARAMETERS AND HR SPECTRAL ANALYSIS: Elevation of temperature was characterized by significantly higher basal HR, shorter RR intervals, and lower parasympathetic activity in REM and NREM sleep. SATURATION IN OXYGEN: During total sleep time, rise in temperature induced a decrease in basal oxygen saturation. During REM sleep, a greater frequency of oxygen saturation drops was associated with central apneas. CORE TEMPERATURE: With increasing ambient temperature, the rise of rectal temperature was mild. Despite this lack of significant increase, similar results were found when sleep and cardiorespiratory parameters were evaluated according to rectal temperatures. CONCLUSION: Changes in ambient temperatures associated with mild increases in body temperature significantly modified cardiorespiratory parameters and autonomic controls in healthy infants. The changes associated with increases in temperature were mainly seen during REM sleep.

Apnea↗

[The nature of the hypermetabolism and tachycardia in cold adaptation and experimental hyperthyroidism].

The cross circulation method has been used to study contribution of humoral and nonhumoral components to the origin of hypermetabolism (increased level of basal metabolism) and tachycardia under adaptation to cold and experimental hyperthyroidism. Consumption of oxygen, heart rate and rectal temperature have been studied in periods prior to and during the cross circulation. It is shown that under experimental hyperthyroidism contribution of humoral and nonhumoral factors to the origin of hypermetabolism equals 22 and 78%, while that to genesis of tachycardia--44 and 56%, respectively. Under cold adaptation an increase of the basal metabolism level depends on humoral agents by 77% and on changes of the stationary character only by 23%. The nature of adaptation tachycardia is mainly, of the humoral origin (65%).

Adaptation, Physiological↗

Passerines versus nonpasserines: so far, no statistical differences in the scaling of avian energetics.

We analyzed and compared the scaling of both basal and maximal thermogenic metabolic rates in passerine and nonpasserine birds using conventional and phylogenetic methods. In spite of the presumed adaptive importance of both metabolic traits, few studies concerning both their relationships and their ecological and evolutionary constraints have been conducted. We found no statistical differences in the scaling of maximal metabolic rate between passerines and nonpasserines; hence, we suggest the use of a single allometric regression for this trait in birds. In addition, basal and maximal metabolic rates were indeed correlated after removing the effects of body mass and phylogeny. The apparent generality of this correlation within both birds and mammals reinforces the need for general ecological and physiological explanations for the evolution of endothermy.

Animals↗

Breast-feeding and natural family planning.

The record of 50 postpartum women who intended to breast-feed for longer than 6 month were analyzed. Fifty percent of the women breast-feed longer than 12 month, and 50% resumed menses by 40 weeks after childbirth. Fifty-two women record of mucus and basal body temperature (BBT) fort at least 4 week before resumption of menses. Ovulation before menses while fully breast-feeding was probable in only one woman. Fifty percent of the first postpartum cycles had a short luteal phase Thirty-five women chose NFP to avoid pregnancy during the study period. Mucus and BBT proved to be a good marker of ovulation during postpartum cycles. Confidence in NFP during lactational amenorrhoea and first postpartum cycles in analyzed. Finally, research aimed at improving the teaching and use of NP for postpartum breast-feeding women is described.

Adult↗

Effects of dexfenfluramine treatment on body weight and postprandial thermogenesis in obese subjects. A double-blind placebo-controlled study.

The purpose of this study was to determine the effects of dexfenfluramine on body weight and post-prandial thermogenesis in obese subjects. Thirty obese subjects, men and women, with an excess weight between 20 and 80% of the ideal weight and aged from 20 to 60 years, participated in this double-blind, placebo-controlled study. During the treatment period, the subjects were not submitted to caloric restriction. Basal metabolic rate and postprandial thermogenesis (following a 400 kcal test meal) measurements were made by indirect calorimetry. Metabolic parameters such as glucose, insulin, thyroid hormones, free fatty acids, beta-hydroxybutyrate, total cholesterol and triglycerides were also measured before the test meal. These measurements were done at baseline, after one week and after three months of treatment. Following the three month treatment period, the mean weight loss of the dexfenfluramine group was 4.6 +/- 1.6 kg (s.e.) (P < 0.01) whereas the placebo group maintained the initial weight. The mean weight loss in the dexfenfluramine group represented 15% of the initial overweight. There was no significant change in either group in basal metabolic rate and postprandial thermogenesis following one week and three months of treatment (P > 0.05). The caloric intake after the treatment period was significantly reduced in the dexfenfluramine group (from 1631 +/- 103 kcal (s.e.) to 1353 +/- 109 kcal (s.e.); P < 0.05); in the placebo group, the changes were not significant (P > 0.05). The plasma concentrations of tri-iodothyronine, total cholesterol and triglycerides were significantly reduced in the dexfenfluramine group (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Temporal relation of ovulation to salivary and vaginal electrical resistance patterns: implications for natural family planning.

An independent assessment of the CUE Monitor (Zetek, Aurora, Colorado) as an ovulation predictor was made with emphasis on its potential role in "natural family planning". The device provides a digital measurement of the electrical resistance of saliva and vaginal secretions. Twenty-nine menstrual cycles from 11 regularly cycling women were monitored with basal temperatures, urinary LH, pelvic ultrasound and the CUE monitor. Patterns of peak salivary electrical resistance were able to predict ovulation on average 5.3 (+/- 1.9 SD) days in advance. Despite variations in total length of the follicular phase from cycle to cycle, the within-subject variation of this predictive interval was quite small. Nadirs in the electrical resistance of vaginal secretions occurred within 2 days of ovulation in all but one patient. Variation in this interval from cycle-to-cycle was small as well. We propose an algorithm for the use of these intervals in "natural family planning" that could safely reduce the monthly abstinence period of present methods. The simplicity, objectivity and consistency of this device could result in their greater general acceptance.

Body Temperature↗

Control of skin blood flow in pre- and full-term infants.

The response of skin blood flow to local ischemia, heating and cooling was investigated at different intervals after birth in 10 healthy full-term babies and 10 preterm postincubator infants using 2 noninvasive and locally neutral methods of microcirculatory measurement: laser Doppler flowmetry and cutaneous oxygen partial pressure (cPO2) estimation with a probe temperature of 37 degrees C. Both groups of infants were capable of myogenic and neural control of skin blood flow. Higher cPO2 values under basal conditions and during reactive hyperemia suggest a raised nutritive capillary blood flow in the preterm group. The increase in cutaneous blood flow during local warming and reactive hyperemia shows that even in neonates on the first day of life no maximal skin vasodilatation is present. An increase in the periodic flow waves attributed to arteriolar vasomotion in 19- to 22-day-old infants, compared to the preterm group and younger babies, indicates that myogenic activity in skin arterioles increases with advancing age.

Blood Flow Velocity↗

Chronic paroxysmal hemicrania. XIII. The pupillometric pattern.

Pupillometric studies were carried out in eight patients with chronic paroxysmal hemicrania (CPH) and in age- and sex-matched controls in the basal condition and after instillation of 2% tyramine (CPH, n = 5; controls, n = 17), 1% OH-amphetamine (CPH, n = 6; controls, n = 12), and 1% phenylephrine (CPH, n = 6; controls, n = 17). The pupil on the symptomatic and non-symptomatic sides in CPH patients was significantly smaller in the basal condition than in controls, particularly on the symptomatic side. The mydriatic responses to pharmacologic stimulation were essentially similar on the symptomatic and non-symptomatic sides. An evaporimetric study of the forehead sweat glands, using the body heating and pilocarpine tests, was also carried out in these patients and in age- and sex-matched controls. "Early", "intermediate", and "late" measurements demonstrated symmetry of forehead sweating. The findings for both methods of examination thus contrast with those in cluster headache patients. Pupillometric and forehead sweating patterns therefore suggest differences in the pathogenesis of the two headache entities. These tests may be used to distinguish CPH and cluster headache clinically.

Adult↗

Left ventricular energetics: heat production by the human heart.

OBJECTIVE: The aim was to examine the effect of coronary artery disease on human left ventricular energetics by a comparison of left ventricular oxygen consumption and heat production. The usefulness of measurement of left ventricular heat production for the detection of the expected change in left ventricular energetics produced by atrial pacing to a faster heart rate was also assessed. METHODS: Forty six patients (mean age 57 years; 31 men) undergoing cardiac catheterisation and coronary arteriography for the investigation of chest pain were studied. Normal left ventricular function and normal coronary arteries were present in eight and 38 had atheromatous coronary artery disease. Left ventricular heat production was calculated from coronary blood flow, the coronary arteriovenous (aorta-coronary sinus) temperature difference, and the areas under thermodilution curves recorded in the aorta and coronary sinus after injection of cold saline into the pulmonary artery. Mean external left ventricular power was calculated from mean arterial blood pressure and cardiac output. Left ventricular mechanical efficiency was derived from heat production and the energy value of myocardial oxygen use, assuming aerobic metabolism. In 27 patients studies were repeated during atrial pacing from the coronary sinus. RESULTS: At rest under basal conditions left ventricular heat production was 2.4(SD 1.0) W in patients with normal hearts and 3.1(1.4) W in patients with coronary disease (NS). Mechanical efficiency was 44.2(9.7)% in the normal patients and 30.7(10.9)% in those with coronary disease (p = 0.003). During atrial pacing to a faster heart rate left ventricular energy supply increased from 4.6(2.7) W to 5.9(3.3) W (p < 0.0005), and heat production increased from 3.0(1.6) W to 4.6(2.4) W (p < 0.0005), but mean external power was not altered. As the extra energy used during pacing was "wasted" as heat, there was a significant fall in left ventricular mechanical efficiency with pacing from 33.9(13.5)% to 18.9(15.2)% (p < 0.0005). CONCLUSIONS: These results show the effect of coronary artery disease on the energetics of left ventricular function. They also show that the method and equipment can detect the expected alteration in left ventricular energetics produced by atrial pacing. The measurement of left ventricular heat production and oxygen consumption allows assessment of the total left ventricular energy flux, and may be useful for the evaluation of drug treatment with such as inotropes and vasodilators, and for the investigation of the functional consequences of left ventricular disease.

Adult↗

Attitudes to and management of fertility among primary health care physicians in Turkey: an epidemiological study.

BACKGROUND: The subject of infertility has taken its place in the health sector at the top level. Since primary health care services are insufficient, most people, especially women, keep on suffering from it all over the world, namely in underdeveloped or developing countries. The aim of this study was to determine primary care physicians' opinions about the approach to infertility cases and their place within primary health care services (PHCSs). METHODS: The study was conducted between October 2003 and April 2004. The study group comprised 748 physicians working in PHCSs. They were asked to fill in a questionnaire with questions pertaining to infertility support, laboratory and treatment algorithms, as well as the demographic characteristics. The data was evaluated using the chi square test, percentage rates and a logistic regression model. RESULTS: The multivariate analyses showed that having a previous interest in infertility and having worked for a postgraduate period of between 5-9 years and > or = 10 years were the variables that most positively influenced them in their approach to cases of infertility (p < 0.05, each one). Just 28.7% of the physicians indicated that they believed cases of infertility could be evaluated at the primary care level. The most frequently proposed reason for indicating 'difficulty in practice' (n = 533) was inadequate provision of equipment in PHCSs (55.7%). The physicians reported that they were able to perform most of the supportive treatments and proposals (between 64.6%-87.7%). The most requested laboratory investigations were the instruction of patients in taking basal body temperatures and semen analysis (89.7% and 88.7%, respectively). The most preferential course of treatment was that of sexually transmitted diseases (95.5%). CONCLUSION: It is clear that not enough importance is attached to the provision of care to infertile couples within PHCSs. This leads us to conclude that an integration of infertility services in primary care would be appropriate after strengthening the PHCSs.

Adult↗