Risk of hypertension after hysterectomy: a population-based study.

OBJECTIVE: Hysterectomy is the second most common surgery performed mainly for benign uterine pathologies in females. The association between hysterectomy and the subsequent risk of hypertension remains controversial. This study investigated the risk of developing hypertension in women who had a hysterectomy. DESIGN: Population-based retrospective cohort study. SETTING: We used the Taiwan National Health Insurance Research Database with claims data of 1 million randomly selected insured individuals. POPULATION: Women with and without hysterectomy and bilateral salpingo-oophorectomy, aged 30-49 years, were identified in 2000-2013 from the insurance data. METHODS: From the claims data, we identified 6674 women with hysterectomy without hypertension at the time of the surgery. The comparison cohort were 26 696 women randomly selected from women without hysterectomy and hypertension, matched by age and the year hysterectomy was performed. Adjusted hazard ratio (aHR) of hypertension was estimated after controlling for comorbidities. MAIN OUTCOME MEASURE: Prediction for hypertension following hysterectomy for benign disease. RESULTS: Both cohorts had a median age of 43.9 years. After a median follow up of 6.4 years, the incident hypertension was higher in the hysterectomy cohort than in the comparison cohort, with an adjusted hazard ratio (aHR) of 1.35 [95% confidence interval (CI) 1.27-1.44]. The incidence increased with age, with a higher aHR in hysterectomised women aged 40-49 years (aHR 1.37, 95% CI 1.06-1.83) than in those aged 30-39 years (aHR 1.22, 95% CI 1.02-1.46). CONCLUSION: Findings in this study suggest that women with hysterectomy are more likely to be diagnosed with hypertension in the follow-up period. TWEETABLE ABSTRACT: Women with hysterectomy before 50 years of age are at an increased risk of developing subsequent hypertension. PLAIN LANGUAGE SUMMARY: Hysterectomy is one of the most common surgeries for women with benign uterine disease. Hysterectomy may lead to a sudden decline in the production of sex hormone (estrogen and progesterone), which is responsible for vessel wall endothelial dysfunction leading to hardening of arteries and subsequent hypertension. However, the association between hysterectomy and risk of hypertension remains controversial. This study investigated whether premenopausal women have an elevated risk of hypertension after hysterectomy. This study employed the Taiwan National Health Insurance Research Database to identify 6674 women 30-49 years old who had a hysterectomy between 2000 and 2013, and a comparison group of 26 696 women who did not have a hysterectomy matched by age. Women in both the groups had no hypertension at baseline (recruiting date or within 1 year after recruiting date). By the end of 2013, we found that 1196 (17.9%) and 3613 (13.5%) women had developed hypertension in the hysterectomy and the comparison groups, respectively. The hypertension incidence was 1.4-fold greater in the hysterectomy group than in the control group (27.8 versus 20.2/1000 person-years).

Emergency peripartum hysterectomy in a teaching hospital in Eastern Taiwan.

This study aims to review the incidence, indications, risk factors and complications associated with emergency peripartum hysterectomy in a teaching hospital. We reviewed records of patients undertaking emergency peripartum hysterectomy performed at our institution from 1998 to 2004. Emergency peripartum hysterectomy was defined as one performed for haemorrhage unresponsive to other treatments <24 h after delivery. Eight cases of emergency peripartum hysterectomy were performed. The rate of peripartum hysterectomy was 0.25%. The main indications for hysterectomy were uterine atony and abnormal placentation. No maternal death occurred. Use of peripartum hysterectomy may become necessary in managing obstetrical haemorrhage refractory to other measures.

Hypoglycemia enhances the expression of prion protein and heat-shock protein 70 in a mouse neuroblastoma cell line.

Cellular prion protein (PrP(C)) expression can be regulated by heat-shock stress, and we designed the present study to determine whether hypoglycemia could affect PrP(C) expression. RT-PCR and Western blotting were used to measure the expression of PrP(C) and heat-shock protein (Hsp70) in mouse neuroblastoma (N18) cells cultured 3 hr to 3 days in media deprived of 97.5% (L) or 75% (M) of its glucose. Hypoglycemia caused a concomitant time-dependent and glucose dose-dependent increase in PrP(C) and Hsp70. In addition, hypoglycemia also increased phosphorylated c-Jun N-terminal kinase (JNK) protein levels in a time-dependent manner. The upregulation of PrP(C) and Hsp70 under hypoglycemic conditions was disrupted by the specific JNK inhibitor SP600125. It was also found from in vitro studies that hypoglycemic conditions induced higher levels of PrP(C) promoter activity in PrP(C) promoters containing a heat-shock element (HSE) than in PrP(C) promoters lacking HSE. We propose that hypoglycemia-increased PrP(C) expression might be due to JNK phosphorylation of a heat-shock transcriptional factor, which then interacts with HSE in the promoter of PrP(C).

Comparison of nitric oxide production and motion characteristics after 3-layer percoll and IxaPrep preparation methods of human sperm.

OBJECTIVE: To compare two different spermatozoa preparation mediums, the three-layer Percoll (Sigma, St. Louis, MO; salica-based) and the IxaPrep (Medicult, Copenhagen, Denmark; non-salica based, polysucrose medium) method, with respect to recovery of pregressive motile sperm and various sperm motion characteristics. Analysis was determined by computer-aided sperm analysis and nitric oxide (NO) production of the supernatant after centrifugation. METHOD: Thirty-nine semen specimens were obtained from men who presented for semen analysis and each of them was divided into two aliquots for preparation with the two mediums mentioned above. The motile sperm recovery, motility percentage and motion parameters were measured for each semen specimen (n=39) before and after preparation using one of the two above methods. The NO was measured using the chemiluminscence method after centrifugation. RESULTS: Recovery rate was higher in the IxaPrep group (Ixaprep: 45.4+/-28.7% versus Percoll: 32.3+/-22.7%; p<0.05). The other motion characteristics such as average path velocity (VAP) and straight line velocity (VSL) were better than those of fresh semen samples [VAP: 72+/-17.2 micro m/s (Percoll), 62.8+/-18.2 micro m/s (Ixaprep) vs 52.2+/-9.5 micro m/s (fresh); p<0.05; VSL: 51.8+/-13.4 micro m/s (Percoll), 44.8+/-12.9 micro m/s (Ixaprep) vs 38.6+/-7.9 micro m/s (fresh); p<0.05]. The motility between fresh and post-preparation semen samples had no significant difference. Hyperactivation of the sperm was improved in the IxaPrep group compared with fresh sperm (Percoll: 24.7+/-16.9% and IxaPrep: 20.5+/-10.5% versus fresh: 9.2+/-9.2%; p<0.05). NO produced in the IxaPrep method was significantly lower than that in the Percoll method (Ixaprep: 0.24+/-0.3 micro M versus Percoll: 0.54+/-0.91 micro M; p<0.05). CONCLUSION: Our data suggests that the IxaPrep method provides a better recovery rate, but that other motion characteristics did not demonstrate any significant difference. The lower level of NO produced in the IxaPrep preparation method may suggest that better sperm quality achieved is due to the decreased NO production.

Differences in the laminar origin of projections from the medial prefrontal cortex to the nucleus accumbens shell and core regions in the rat.

The medial prefrontal cortex (mPFC) projects to the nucleus accumbens shell, core and rostral pole. In this retrograde tract-tracing study of rat mPFC to nucleus accumbens projection neurons, the advantages of Neurobiotin are utilised in order to reveal the detailed morphology of labelled projection cells, and to permit an examination of the laminar projections to shell and core compartments The retrogradely transported Neurobiotin was found in somata, proximal and distal dendrites of neurons that project from the mPFC to the nucleus accumbens. The morphology of these projection neurons was revealed in great detail and confirmed that the projection arises wholly from pyramidal cells. Interestingly, it was also found that retrogradely labelled neurons were exclusively located in prelimbic and infralimbic regions in layers V and VI, after shell injections, but also in layer II following core sites. This observation may reflect possibly different roles for cortical laminae on the nucleus accumbens.

Effects of four methods of sperm preparation on motion characteristics and nitric oxide concentration in laboratory-prepared oligospermia.

BACKGROUND: To compare four different spermatozoa preparation methods in semen samples with respect to recovery rate, percent motility, path and progressive velocity, and nitric oxide (NO) production before and after centrifugation. METHODS: Each of 36 semen specimens was diluted to 1 x 10(6)/ml and divided into four 1-ml aliquots for sperm processing using four methods: swim-up, two (Percoll II) and three (Percoll III) layer Percoll (Pharmacia Biotech AB, Uppsala, Sweden) gradients and albumin columns. The motile sperm recovery rate, percent motility and motion parameters were measured for each semen specimen (n = 36) before and after processing using the four methods. NO was measured with the use of a chemiluminescence method before and after centrifugation (n = 17). RESULTS: The sperm recovery rate was higher using both Percoll gradients than with the other two methods (Percoll II, 68 +/- 20.5%, Percoll III, 75.3 +/- 22.2% vs swim-up, 25.8 +/- 9.9% and albumin, 33.1 +/- 20.7%). The results were similar for total motile cells (Percoll II, 3.55 +/- 1.72 x 10(6)/ml, Percoll III, 4.25 +/- 1.29 x 10(6)/ml vs swim-up, 1.19 +/- 0.71 x 10(6)/ml and albumin, 1.89 +/- 1.36 x 10(6)/ml). Both Percoll methods and the albumin method produced a statistically significant improvement over the swim-up method in motility. The albumin column method resulted in the least path and progressive velocities (51.3 +/- 15.4 microns/s and 46.2 +/- 16.5 microns/s, respectively). NO produced during sperm processing did not differ significantly among the four processing methods (swim-up, 4,531 +/- 1,626 nM, Percoll II, 5,119 +/- 3,969 nM, Percoll III, 6,060 +/- 5,512 nM, albumin 4,838 +/- 2,462 nM). CONCLUSIONS: Our data suggest that Percoll methods are superior to swim-up and albumin columns for sperm preparation, yielding good sperm recovery, motility and motion characteristics. The trend toward lower NO levels among samples prepared using albumin columns did not reach statistical significance.

[Clinical multivariate statistical analysis of nephrotoxicity induced by cisplatin].

Nephrotoxicity was studied in 47 patients who received combined chemotherapy with cisplatin (DDP, 50-100 mg/m2) as the chief agent. The treatment was given every 3-4 weeks with vigorous hydration and forced diuresis. The renal tubular toxicity was evaluated by urinary beta 2 microglobulin (beta 2-MG). It was found that the nephrotoxicity secondary to DDP was dose-dependent. Hypertonic saline was able to decrease the renal damage without any significant difference among the first, second and third course. The nephrotoxicity of DDP administered in one day was more severe than that given in two days. beta 2-MG was a good parameter of DDP nephrotoxicity. By multivariate statistical analysis, metoclopramid and chlorpromazine were found to alleviate DDP nephrotoxicity. Classification, examination and management of DDP nephrotoxicity is proposed.