Background. Although chronic hyperandrogenism, a typical feature of polycystic ovary syndrome, is often associated with disturbed reproductive performance, androgens have been shown to promote ovarian follicle growth in shorter exposures. Here, we review the main effects of androgens on the regulation of early folliculogenesis and the potential of their application in improving follicular in vitro growth. Review. Androgens may affect folliculogenesis directly via androgen receptors (ARs) or indirectly through aromatization to estrogen. ARs are highly expressed in the granulosa and theca cells of early stage follicles and slightly expressed in mature follicles. Short-term androgen exposure augments FSH receptor expression in the granulosa cells of developing follicles and enhances the FSH-induced cAMP formation necessary for the transcription of genes involved in the control of follicular cell proliferation and differentiation. AR activation also increases insulin-like growth factor (IGF-1) and its receptor gene expression in the granulosa and theca cells of growing follicles and in the oocytes of primordial follicles, thus facilitating IGF-1 actions in both follicular recruitment and subsequent development. Conclusion. During the early and intermediate stages of follicular maturation, locally produced androgens facilitate the transition of follicles from the dormant to the growing pool as well as their further development.

background: There is evidence that intrauterine growth restriction, resulting in newborn girls that are small for gestational age (SGA), may be related to the onset of polycystic ovary syndrome (PCOS). Thus, we studied whether women born SGA have a higher prevalence of PCOS than women born appropriate for gestational age (AGA).methods: This was a prospective birth cohort study of 384 women born at term between June 1, 1978, and May 31, 1979, in Ribeirão Preto, Brazil. After exclusion, 165 women effectively participated in this study, of whom 43 were SGA and 122 were AGA. The prevalence of PCOS was analysed. At a mean age of 29 years, the women agreed to follow the study protocol, which included: anamnesis, physical examination, serum tests [follicle stimulating hormone, luteinizing hormone, total and free testosterone, dehydroepiandrostenedione sulphate, 17-OH-progesterone, fasting insulin, sex steroid-binding globulin (SHBG) and fasting glucose] and pelvic ultrasound. Data regarding gestational age, birthweight, age at menarche and maternal data were obtained from the files of the cohort. The adjusted relative risk (RR) values of the SGA, insulin resistance, body mass index, maternal smoking and parity variables were analysed using Poisson regression with robust adjustment of variance for the prediction of PCOS.results: The prevalence of PCOS was higher in the SGA group than in the AGA group [adjusted RR ¼ 2.44, 95% CI (1.39-4.28)].Hyperandrogenism was more prevalent in the SGA women than in the AGA women (P ¼ 0.011). Circulating SHBG was lower in the SGA women than in the AGA women (P ¼ 0.041), but fasting insulinemia was similar in both groups.conclusions: The prevalence of PCOS in SGA women was twice as high as in AGA women in our study population.

RESUMO-As experiências inovadoras, direcionadas para as especificidades da atenção integral, da formação e da capacitação profissional na área das urgências, no Brasil, são recentes e vêm sofrendo influências dos modelos franco-germânico e anglo-americano. A incorporação do Sistema de Atendimento Móvel de Urgência (SAMU) e da Regulação Médica(RM) à rede assistencial, no País, iniciou-se a partir da cooperação franco-brasileira, em 1995. Em nosso meio, o SAMU foi implantado em 1996 e a RM de toda a demanda de urgência para os hospitais, no ano de 2000. A atenção inicial às urgências, no Brasil, tal como no modelo franco-germânico é multidisciplinar, mas a sistematização do conhecimento e a das práticas assistenciais das equipes de saúde para o suporte avançado à vida têm sido influenciadas pelos programas anglo-americanos, tais como o Advanced Cardiac Life Support, o Advanced Trauma Life Support, o Pediatric Advanced Life Support e o Basic Life Support, dentre outros. Essas estratégias, adaptadas à realidade brasileira, têm contribuído para a transformação do velho modelo de organização da atenção às urgências, bem como proporcionado revisões dos conteúdos curriculares e da organização acadêmica. Os problemas da atenção às urgências, nos grandes centros urbanos, e algumas experiências com êxito, no âmbito do Sistema Único de Saúde(SUS), subsidiaram a formulação da Politicas Nacional de Atenção às Urgências (PNAU) e de Humanização (PNH) do Ministério da Saúde. Ao Ministério da Educação, aos Centros Formadores, aos Conselhos de Classe e às Agências de Fomento à Pesquisa cabem, em sintonia com o SUS, a formulação dos padrões para a formação, o exercício profissional e a investigação na atenção às urgências. A Unidade de Emergência do HCFMRP-USP (UE-HC), nos últimos anos, aplicando conceitos contemplados pela PNAU e pela PNH, participou da configuração de uma rede assistencial regional, hierarquizada de atenção às urgências, regulada e humanizada por meio da implantação da RM e do SAMU. Os serviços clínicos da UE-HC, vinculados aos Departamentos de Aplicação da FMRP-USP e apoiados pelo Centro de Estudos de Emergências ajudaram a redefinir a missão assistencial e educacional da unidade. A superlotação foi equacionada com a redução significativa do número de consultas e da taxa de ocupação, e, como era esperado, houve aumento da média de permanência, da complexidade dos casos atendidos e do custo médio das internações.Assim, a UE-HC tem se transformado num centro de referência para a assistência de elevada complexidade, assim como para a formação e capacitação de profissionais que lidam com as urgências. Neste cenário, estão surgindo as possibilidades para a reflexão crítica das práticas já instituídas, a sistematização das práticas e do conhecimento, a preparação para a produção de novos saberes e as bases para a criação de um departamento acadêmico e da especialidade de Urgências Médicas UNITERMOS-Emergência. Urgência. SAMU. Regulação Médica. Educação Médica. SUS (BR).

Introduction There is a need for specific measures to address overall care in women with polycystic ovary syndrome (PCOS). Physical resistance training (PRT) has been shown to improve certain body parameters. However, the effect of PRT on the sexual function of PCOS women has not been evaluated. Aim The study aimed to assess sexual function and emotional status of PCOS women after 16 weeks of PRT. Methods This case-control study involved 43 women with PCOS and 51 control ovulatory women, aged 18–37 years. All women were subjected to a supervised PRT protocol for 16 weeks and evaluated at the end of the program. Sexual function was assessed at baseline and after PRT protocol. Main Outcome Measures The main outcome measure used was the Female Sexual Function Index (FSFI). Results Of the 43 women with PCOS, 30 (69.70%) had a basal total FSFI score ≤ 26.55 and 24 of them (58.54%) had a score ≤ 26.55 after PRT (P = 0.08). Of the 51 control women, 32 (62.7%) and 27 (52.9%) had FSFI scores < 26.55 at baseline and after PRT, respectively (P = 0.06). Control women experienced a significant improvement in pain domain score after PRT (P < 0.03). PCOS women experienced significant increases in total score and in the desire, excitement and lubrication domains after PRT (P < 0.01 each). After PRT, there was a significant difference between the PCOS and control groups in the sexual desire domain (4.09 ± 1.29 vs. 3.75 ± 1.42, P = 0.04). Significantly fewer women in the PCOS group were at risk of depression (P < 0.01) and anxiety (P < 0.02) after than before PRT, whereas the differences in the control group were not significant. Mean depression and anxiety scores were reduced significantly in both the PCOS (P < 0.01 each) and control (P < 0.01) groups. Conclusions PRT significantly enhanced total score and the desire, excitement, and lubrication domains of the FSFI in PCOS women. PRT reduced pain, and total depression and anxiety scores in both groups.

Young women with PCOS exhibit changes in vascular elasticity even in the absence of classical risk factors for CVD, such as hypertension and obesity.