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Articles 17881 - 17910 of 19357
Full-Text Articles in Entire DC Network
To Compare The Total Cholesterol And Hdl-Cholesterol Before And After Ultra-Centrifugation In Lipemic Samples, Jawaid Jabbar, Imran Siddiqui, Syed Qaiser Raza, Ayaz Baig
To Compare The Total Cholesterol And Hdl-Cholesterol Before And After Ultra-Centrifugation In Lipemic Samples, Jawaid Jabbar, Imran Siddiqui, Syed Qaiser Raza, Ayaz Baig
Department of Pathology and Laboratory Medicine
Objective: It is an everyday routine in laboratories to encounter interference in the analysis of lipids. These likely interferences (hemolysis, icterus and lipemia) are countered by asking physicians and patients to send fresh and properly collected samples. At the Aga Khan University (AKU) Laboratory, we receive 2-3 lipemic/turbid samples per day. Previously it was our departmental policy to advise these patients to go for lipoprotein electrophoresis, which though accurate was time consuming and not cost effective. We therefore studied ultra centrifugation/airfuge as an alternate method to clear lipid interference and provide accurate, reliable and cost effective results.
Methods: Daily 2-3 …
Prognosis Of Stage Ii Colon Cancer By Non-Neoplastic Mucosa Gene Expresssion Profiling, Alain Barrier, Sandrine Dudoit, Et Al.
Prognosis Of Stage Ii Colon Cancer By Non-Neoplastic Mucosa Gene Expresssion Profiling, Alain Barrier, Sandrine Dudoit, Et Al.
U.C. Berkeley Division of Biostatistics Working Paper Series
Aims. This study assessed the possibility to build a prognosis predictor, based on non-neoplastic mucosa microarray gene expression measures, in stage II colon cancer patients. Materials and Methods. Non-neoplastic colonic mucosa mRNA samples from 24 patients (10 with a metachronous metastasis, 14 with no recurrence) were profiled using the Affymetrix HGU133A GeneChip. The k-nearest neighbor method was used for prognosis prediction using microarray gene expression measures. Leave-one-out cross-validation was used to select the number of neighbors and number of informative genes to include in the predictor. Based on this information, a prognosis predictor was proposed and its accuracy estimated by …
Colon Cancer Prognosis Prediction By Gene Expression Profiling, Alain Barrier, Sandrine Dudoit, Et Al.
Colon Cancer Prognosis Prediction By Gene Expression Profiling, Alain Barrier, Sandrine Dudoit, Et Al.
U.C. Berkeley Division of Biostatistics Working Paper Series
Aims. This study assessed the possibility to build a prognosis predictor, based on microarray gene expression measures, in stage II and III colon cancer patients. Materials and Methods. Tumour (T) and non-neoplastic mucosa (NM) mRNA samples from 18 patients (9 with a recurrence, 9 with no recurrence) were profiled using the Affymetrix HGU133A GeneChip. The k-nearest neighbour method was used for prognosis prediction using T and NM gene expression measures. Six-fold cross-validation was applied to select the number of neighbours and the number of informative genes to include in the predictors. Based on this information, one T-based and one NM-based …
Cart: An Hrs/Actinin-4/Berp/Myosin V Protein Complex Required For Efficient Receptor Recycling, Qing Yan, Wei Sun, Pekka Kujala, Yasmin Lotfi, Thomas A Vida, Andrew J Bean
Cart: An Hrs/Actinin-4/Berp/Myosin V Protein Complex Required For Efficient Receptor Recycling, Qing Yan, Wei Sun, Pekka Kujala, Yasmin Lotfi, Thomas A Vida, Andrew J Bean
Faculty, Staff and Student Publications
Altering the number of surface receptors can rapidly modulate cellular responses to extracellular signals. Some receptors, like the transferrin receptor (TfR), are constitutively internalized and recycled to the plasma membrane. Other receptors, like the epidermal growth factor receptor (EGFR), are internalized after ligand binding and then ultimately degraded in the lysosome. Routing internalized receptors to different destinations suggests that distinct molecular mechanisms may direct their movement. Here, we report that the endosome-associated protein hrs is a subunit of a protein complex containing actinin-4, BERP, and myosin V that is necessary for efficient TfR recycling but not for EGFR degradation. The …
Trefoil Factor 2 (Tff2) Deficiency In Murine Digestive Tract Influences The Immune System, M. Baus- Loncar, J. Schmid, El-Nasir Lalani, I. Rosewell, R. A. Goodlad, H. G.W. Stamp, N. Blin, T. Kayademir
Trefoil Factor 2 (Tff2) Deficiency In Murine Digestive Tract Influences The Immune System, M. Baus- Loncar, J. Schmid, El-Nasir Lalani, I. Rosewell, R. A. Goodlad, H. G.W. Stamp, N. Blin, T. Kayademir
Department of Pathology and Laboratory Medicine
Background & Aims:
The gastrointestinal trefoil factor family (TFF1, TFF2, TFF3) peptides are considered to play an important role in maintaining the integrity of the mucosa. The physiological role of TFF2 in the protection of the GI tract was investigated in TFF2 deficiency.
Methods:
TFF2-/- mice were generated and differential expression of various genes was assessed by using a mouse expression microarray, quantitative real time PCR, Northern blots or immunohistochemistry.
Results:
On an mRNA level we found 128 differentially expressed genes. We observed modulation of a number of crucial genes involved in innate and adaptive immunity in the TFF2-/- mice. …
Com Outlook Spring 2005, College Of Osteopathic Medicine
Com Outlook Spring 2005, College Of Osteopathic Medicine
COM Outlook
No abstract provided.
Bench-To-Bedside Review: Rhabdomyolysis -- An Overview For Clinicians., Ana L Huerta-Alardín, Joseph Varon, Paul E Marik
Bench-To-Bedside Review: Rhabdomyolysis -- An Overview For Clinicians., Ana L Huerta-Alardín, Joseph Varon, Paul E Marik
Jefferson Hospital Staff Papers and Presentations
Rhabdomyolysis ranges from an asymptomatic illness with elevation in the creatine kinase level to a life-threatening condition associated with extreme elevations in creatine kinase, electrolyte imbalances, acute renal failure and disseminated intravascular coagulation. Muscular trauma is the most common cause of rhabdomyolysis. Less common causes include muscle enzyme deficiencies, electrolyte abnormalities, infectious causes, drugs, toxins and endocrinopathies. Weakness, myalgia and tea-colored urine are the main clinical manifestations. The most sensitive laboratory finding of muscle injury is an elevated plasma creatine kinase level. The management of patients with rhabdomyolysis includes early vigorous hydration.
Mechanisms Of Cell Death Initiated In Herpes Simplex Virus Thymidine Kinase Expressing Colon Tumor Cells Treated With Ganciclovir And Ucn-01, Christina Elizabeth Ahn
Mechanisms Of Cell Death Initiated In Herpes Simplex Virus Thymidine Kinase Expressing Colon Tumor Cells Treated With Ganciclovir And Ucn-01, Christina Elizabeth Ahn
Theses and Dissertations in Biomedical Sciences
Metastatic colon carcinoma is the second leading cause of death from malignancy in the United States, and development of more effective treatments is essential. Heterologous expression of Herpes Simplex Virus Thymidine Kinase (HSVtk) in combination with the prodrug, ganciclovir (GCV), has shown great promise for the genetic therapy of many cancers, but most patients have had only a partial or minimal response to the therapy. After screening a panel of two drug combinations, our laboratory has shown that the combination of GCV and the protein kinase inhibitor UCN-01 (7-hydroxystaurosporine) enhances tumor cell death more effectively than either drug alone. However …
Attributional Styles Of Women Who Quit Or Reduce Smoking In The Antepartum, Patricia T. Alpert
Attributional Styles Of Women Who Quit Or Reduce Smoking In The Antepartum, Patricia T. Alpert
Loma Linda University Electronic Theses, Dissertations & Projects
Background: Researchers in the field of smoking have sought to identify variables that predict whether or not pregnant smokers stop or continue to smoke. Most variables examined are demographic in nature and little is known about psychological variables associated with those who quit or reduce smoking while pregnant.
Purpose: To analyze attributional style and locus of control to determine which factors alone, or in combination, are associated with quitting versus reduced smoking among pregnant smokers.
Methodology: Pregnant smokers who quit (n = 66) or reduced their smoking (n = 43) were identified by the nursing staff at a women’s county …
Screening For Diseases In Family Practice, Ali Khan Khuwaja, Nadya Khan Khuwaja
Screening For Diseases In Family Practice, Ali Khan Khuwaja, Nadya Khan Khuwaja
Department of Family Medicine
The active check-over for disease among apparently healthy people is a fundamental aspect of prevention. This is perceivable by screening, which is a search of unrecognized disease or condition by means of rapidly applied test, examination or other procedures in apparently healthy individuals. This is carried out in the hope that earlier diagnosis and subsequent management favorably alters the natural history of the disease in a significant proportion of those who are identified as 'test-positive'. Family Practitioners have privilege to provide comprehensive and holistic health care services including preventive, curative and rehabilitative on continuous and long-term basis to all members …
Systemic Lupus Erythematosus Presenting As Hemolytic Uremic Syndrome: A Case Report, Malik Anas Rabbani, Bushra Ahmad, Sabeen Fatima Mekan, Suhail Muzaffar, Syed Sohail Ali
Systemic Lupus Erythematosus Presenting As Hemolytic Uremic Syndrome: A Case Report, Malik Anas Rabbani, Bushra Ahmad, Sabeen Fatima Mekan, Suhail Muzaffar, Syed Sohail Ali
Section of Pulmonary & Critical Care
Associating systemic lupus erythematosus (SLE), with an initial presentation of hemolytic uremic syndrome (HUS) is rare. We report a case of 21-year old Afghani female admitted to our hospital with an initial complaint of high grade fever and diffuse maculopapular rash and swelling of lower limbs. Diagnosis of atypical HUS was established according to the clinical triad of HUS without a veriotoxin-producing organism in her stool and the pathological finding compatible to thrombotic microangiopathy. In addition, her symptoms fulfilled the 1982 revised criteria for the classification of SLE. After pulse methylprednisolone, cyclophosphamide and plasmapheresis therapies, her laboratory findings and general …
Multiple Parameters In The Diagnosis Of Ectopic Pregnancy, Iram Naseem, Vaqar Bari, Naila Nadeem
Multiple Parameters In The Diagnosis Of Ectopic Pregnancy, Iram Naseem, Vaqar Bari, Naila Nadeem
Department of Radiology
Objective: To determine the role of emergency ultrasound examination in the diagnosis and management of ectopic pregnancy.Methods: A descriptive study done at the Radiology Department, Aga Khan University Hospital, Karachi from January 1999 to December 2000 using observational facts by non-probability convenient sampling method. Seventy one patients who presented with acute symptoms in early pregnancy, were subjected to emergency pelvic ultrasound. Both transabdominal and transvaginal ultrasound were done in 52 patients while in 19 patients only transabdominal ultrasound was performed. Serum Beta hCG levels, of all patients were greater than 1500 iu/ml.Results: Ultrasound correctly identified ectopic pregnancy in 71 patients. …
Multiple Metabolic Hits Converge On Cd36 As Novel Mediator Of Tubular Epithelial Apoptosis In Diabetic Nephropathy., Katalin Susztak, Emilio Ciccone, Peter Mccue, Kumar Sharma, Erwin P Böttinger
Multiple Metabolic Hits Converge On Cd36 As Novel Mediator Of Tubular Epithelial Apoptosis In Diabetic Nephropathy., Katalin Susztak, Emilio Ciccone, Peter Mccue, Kumar Sharma, Erwin P Böttinger
Department of Medicine Faculty Papers
BACKGROUND: Diabetic nephropathy (DNP) is a common complication of type 1 and type 2 diabetes mellitus and the most common cause of kidney failure. While DNP manifests with albuminuria and diabetic glomerulopathy, its progression correlates best with tubular epithelial degeneration (TED) and interstitial fibrosis. However, mechanisms leading to TED in DNP remain poorly understood.
METHODS AND FINDINGS: We found that expression of scavenger receptor CD36 coincided with proximal tubular epithelial cell (PTEC) apoptosis and TED specifically in human DNP. High glucose stimulated cell surface expression of CD36 in PTECs. CD36 expression was necessary and sufficient to mediate PTEC apoptosis induced …
Clinics In Diagnostic Imaging (102), M Azeemuddin, T Ul-Haq, H Ahsan, W A. Memon
Clinics In Diagnostic Imaging (102), M Azeemuddin, T Ul-Haq, H Ahsan, W A. Memon
Department of Radiology
A 19-year-old man presented with cough and haemoptysis of ten days duration. He also had mild right hypochondrial pain. Chest radiograph and computed tomography (CT) showed a rounded soft tissue density opacity with an air crescent sign. CT showed multiple cystic lesions in the liver with a daughter cyst in its lateral wall. Diagnosis of hydatid disease of lung and liver was made. The contents of the liver cyst were aspirated, hypertonic saline instilled, re-aspirated, and absolute alcohol injected. Hydatid disease is endemic in certain parts of the world. Although the lungs and liver are most frequently affected, the disease …
2004 Cancer Care Annual Report, Children's Mercy Hospital
2004 Cancer Care Annual Report, Children's Mercy Hospital
Cancer Center Annual Reports
Annual report of cancer care and oncology services at the Children's Mercy Hospital, Kansas City MO, a pediatric medical center, with a focus on the Ewing's sarcoma family of tumors.
Weight Loss Practices In Amateur Wrestlers And Its Relationship To Disordered Eating, Lyndsey M. Manderfield
Weight Loss Practices In Amateur Wrestlers And Its Relationship To Disordered Eating, Lyndsey M. Manderfield
Graduate Research Papers
The premise behind many athletic programs is to encourage wellness, a state of well being in both physical and emotional aspects. This research paper reviews how wrestling and other athletic programs where weight plays a significant role, may affect eating and other weight-related habits. It addresses whether weight loss practices in wrestling play a role in disordered eating patterns of its participants.
Thyroid Hormone-Regulated Skeletal Muscle Glut4 Glucose Transporter Trafficking During Fasting In Diet-Induced Obesity And Insulin Resistance, Lucy Soo Yon Jun
Thyroid Hormone-Regulated Skeletal Muscle Glut4 Glucose Transporter Trafficking During Fasting In Diet-Induced Obesity And Insulin Resistance, Lucy Soo Yon Jun
Theses Digitization Project
This thesis project will investigate the effects of fasting on the serum levels of two key regulatory hormones, insulin and thyroid hormone (T3) and the effects of these hormones on the trafficking of Glut4 on soleus muscle.
Early Oral-Motor Interventions For Pediatric Feeding Problems: What, When And How, C. J. Manno, C. Fox, P. S. Eicher, Mary Louise Kerwin
Early Oral-Motor Interventions For Pediatric Feeding Problems: What, When And How, C. J. Manno, C. Fox, P. S. Eicher, Mary Louise Kerwin
College of Science & Mathematics Departmental Research
Children with developmental delays often have feeding difficulties resulting from oral-motor problems. Based on both clinical experience and a review of published studies, oral-motor interventions have been shown to be effective in improving the oral function of preterm infants and children with neuromotor disorders, such as cerebral palsy. However, oral-motor problems may be under identified in other populations of children with developmental difficulties. The purpose of this paper is to provide a conceptual framework for understanding oral-motor skill development and problems that can occur in any infant and young child and to review oral-motor treatment techniques and their empirical support.
Chronic Outpatient Sildenafil Therapy For Pulmonary Hypertension In A Child After Cardiac Surgery, Chad A. Knoderer, E. S. Ebenroth, J. W. Brown
Chronic Outpatient Sildenafil Therapy For Pulmonary Hypertension In A Child After Cardiac Surgery, Chad A. Knoderer, E. S. Ebenroth, J. W. Brown
Scholarship and Professional Work – COPHS
We report the case of a 14-month-old male with d-transposition of the great arteries, ventricular septal defect, and pulmonary hypertension successfully treated with long-term sildenafil following cardiac surgery. To our knowledge, this is the first published report of long-term sildenafil treatment in a child after corrective cardiac surgery.
Children's Mercy Annual Report 2004, Children's Mercy Hospital
Children's Mercy Annual Report 2004, Children's Mercy Hospital
Children's Mercy Annual Reports
Annual report for The Children's Mercy Hospital in Kansas City MO, a pediatric medical center.
Old Legacies And New Paradigms: Confusing "Research" And "Treatment" And Its Consequences In Responding To Emergent Health Threats, Gail H. Javitt
Old Legacies And New Paradigms: Confusing "Research" And "Treatment" And Its Consequences In Responding To Emergent Health Threats, Gail H. Javitt
Journal of Health Care Law and Policy
No abstract provided.
On The Utility Of Stochastic Models Of Chronic Obstructive Pulmonary Disease, Rebecca Boehm
On The Utility Of Stochastic Models Of Chronic Obstructive Pulmonary Disease, Rebecca Boehm
MUSC Theses and Dissertations
Chronic obstructive pulmonary disease (COPD) is a progressive and irreversible lung disease characterized by reduced lung function, abnormal inflammatory response, dyspnea, increased sputum production, and costly and debilitating exacerbations. Common treatments for COPD include smoking cessation therapy, short- and long-acting bronchodilators, inhaled corticosteroids, pulmonary rehabilitation, and home oxygen therapy. However, a recent meta-analysis demonstrated that inhaled corticosteroids fail to slow the decline in FEV1, the primary clinical marker of COPD progression. In addition, some evidence exists to suggest that long-term inhaled corticosteroid use may increase bone density loss, leading to osteoporosis. Given that the bone health effects of inhaled corticosteroid …
Disaster Drill At A University Hospital, Rifat Rehmani
Disaster Drill At A University Hospital, Rifat Rehmani
Department of Emergency Medicine
The course of a disaster drill held on 23 October 2001 at Aga Khan University, Karachi is reported. The Hospital Emergency Plan was put to trial on that day. Volunteers were invited to become simulated casualties in the drill. Briefing seminars had been conducted with the key players of the hospital. The scenario was a man-made type disaster. A 747 jumbo jet with 200 passengers had crashed at the end of the runway at Quaid-e-Azam International Airport while taking off in a thunderstorm. Fifty casualties were sent to Emergency Room by ambulance. The Plan was activated and relevant units were …
A Preliminary Study Of 24-Hour Post-Cesarean Patient Controlled Analgesia: Postoperative Pain Reports And Morphine Requests/Utilization Are Greater In Abstaining Smokers Than Non-Smokers, Alan P. Marco, Mark K. Greenwald, Michael S. Higgins
A Preliminary Study Of 24-Hour Post-Cesarean Patient Controlled Analgesia: Postoperative Pain Reports And Morphine Requests/Utilization Are Greater In Abstaining Smokers Than Non-Smokers, Alan P. Marco, Mark K. Greenwald, Michael S. Higgins
Anesthesiology Faculty Publications
Previous clinical studies have not examined the relationship between nicotine abstinence and opioid use for postoperative analgesia. This may be important because tobacco smokers are routinely required to abstain from smoking just before and during acute post-surgical recovery. This study investigated IV morphine self-administration [patient controlled analgesia (PCA)], subjective pain/drug effects and other measures during post-operative (elective Cesarean section) recovery.
These preliminary data suggest that a history of nicotine use and/or short-term nicotine abstinence can modulate morphine use and analgesia during post-operative recovery. These procedures provide a model for studying patterns and determinants of analgesic self-administration in medical settings.
Efficacy And Safety Of Artemether-Lumefantrine (Coartem®) Tablets (Six-Dose Regimen) In African Infants And Children With Acute, Uncomplicated Falciparum Malaria, C. Falade, M. Makanga, Zul Premji, C.E. Ortmann, M. Stockmeyer, P. Ibarra De Palacios
Efficacy And Safety Of Artemether-Lumefantrine (Coartem®) Tablets (Six-Dose Regimen) In African Infants And Children With Acute, Uncomplicated Falciparum Malaria, C. Falade, M. Makanga, Zul Premji, C.E. Ortmann, M. Stockmeyer, P. Ibarra De Palacios
Pathology, East Africa
Approximately one million children die from malaria each year. A recently approved artemisinin-based tablet, Coartem (co-artemether), comprising artemether 120 mg plus lumefantrine 20 mg, given in four doses, provides effective antimalarial treatment for children in many sub-Saharan countries. However, this regimen is considered insufficient for non-immune infants and in areas where multidrug-resistant Plasmodium falciparum predominates. This open-label study assessed the efficacy and safety of co-artemether administered to 310 African children weighing 5-25 kg, with acute, uncomplicated falciparum malaria. Six doses of co-artemether were given over 3 days, with follow-up at 7, 14 and 28 days. Treatment rapidly cleared parasitemia and …
Deference, Denial, And Exclusion: Men Talk About Contraception And Unintended Pregnancy, Scott D. Johnson, Lindy B. Williams
Deference, Denial, And Exclusion: Men Talk About Contraception And Unintended Pregnancy, Scott D. Johnson, Lindy B. Williams
Rhetoric and Communication Studies Faculty Publications
Individual in-depth interviews were conducted with 20 men, ages 21-48, who have fathered at least one unintended pregnancy. The goal of the interviews was to explore the experiences of these men with unintended pregnancy, their communication with partners and others, contraceptive beliefs and practices, their relationships with their partners, and the outcomes and consequences of the unintended pregnancies. This essay describes results derived from their comments regarding their contraceptive practices and the pregnancy-outcome decisions, with thematic analysis used to identify prominent themes from participant comments. Two strong themes, "deference" and "denial," and one lesser theme, "exclusion," emerged from participant responses. …
Oncolog, Volume 50, Number 01, January 2005, Rachel Williams, Dawn Chalaire, Caren E. Blinka, Angelina Esparza, Allen W. Burton Md
Oncolog, Volume 50, Number 01, January 2005, Rachel Williams, Dawn Chalaire, Caren E. Blinka, Angelina Esparza, Allen W. Burton Md
OncoLog MD Anderson's Report to Physicians (All issues) Archives
- New Perspectives on Brain Metastasis
- Out of the Darkroom
- Equity and Health
- House Call: Blood and Platelet Donors Give Life
- DiaLog: Cancer Pain Control in the New Millennium, by Allen W. Burton, MD, Section Chief, Cancer Pain Management Department of Anesthesiology and Pain Medicine
Familial Homocystinuria, F Bilwan, Na Syed, M Usman, Mohammad Khurshid
Familial Homocystinuria, F Bilwan, Na Syed, M Usman, Mohammad Khurshid
Department of Pathology and Laboratory Medicine
Two cases of siblings diagnosed as cases of familial homocystinuria are reported. Both the cases have classical presentation of familial homocystinuria including history of dislocation of lens of the right eye. Brother had history of psychomotor retardation while sister had a significant history of deep vein thrombosis. Levels of plasma homocysteine were elevated and urinary homocysteine was positive in both the cases.
Heart Rate Variability In Non-Apneic Snorers And Controls Before And After Continuous Positive Airway Pressure, Gregory J. Gates, Susan E. Mateika, Jason H. Mateika
Heart Rate Variability In Non-Apneic Snorers And Controls Before And After Continuous Positive Airway Pressure, Gregory J. Gates, Susan E. Mateika, Jason H. Mateika
Wayne State University Associated BioMed Central Scholarship
Abstract
Background
We hypothesized that sympathetic nervous system activity (SNSA) is increased and parasympathetic nervous system activity (PNSA) is decreased during non-rapid eye movement (NREM) sleep in non-apneic, otherwise healthy, snoring individuals compared to control. Moreover, we hypothesized that these alterations in snoring individuals would be more evident during non-snoring than snoring when compared to control.
Methods
To test these hypotheses, heart rate variability was used to measure PNSA and SNSA in 11 normotensive non-apneic snorers and 12 control subjects before and 7-days after adapting to nasal continuous positive airway pressure (nCPAP).
Results
Our results showed that SNSA was increased …
The Role Of Aromatase Inhibitors In Ameliorating Deleterious Effects Of Ovarian Stimulation On Outcome Of Infertility Treatment, Mohamed Fm Mitwally, Robert F. Casper, Michael P. Diamond
The Role Of Aromatase Inhibitors In Ameliorating Deleterious Effects Of Ovarian Stimulation On Outcome Of Infertility Treatment, Mohamed Fm Mitwally, Robert F. Casper, Michael P. Diamond
Wayne State University Associated BioMed Central Scholarship
Abstract
Clinical utilization of ovulation stimulation to facilitate the ability of a couple to conceive has not only provided a valuable therapeutic approach, but has also yielded extensive information on the physiology of ovarian follicular recruitment, endometrial receptivity and early embryo competency. One of the consequences of the use of fertility enhancing agents for ovarian stimulation has been the creation of a hyperestrogenic state, which may influence each of these parameters. Use of aromatase inhibitors reduces hyperestrogenism inevitably attained during ovarian stimulation. In addition, the adjunct use of aromatase inhibitors during ovarian stimulation reduces amount of gonadotropins required for optimum …