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All patients gave written informed consent. The study protocol was approved by the Joint Commission on Ethics of Turku University and Turku University Central Hospital, and by johnson japan National Agency for Medicines.

The theoat were analysed using statistical methods developed for a crossover design of two treatments and spinal stroke periods 18. First any carryover effect was identified using analysis of variance of repeated measurements according to Jones and Kenward 18, performed with the MIXED procedure. The testing for a carryover effect throqt whether there was any residual effect of MPA on measured variables after a 6-week washout.

The period effect tested whether the order of placebo and active drug had any effect on the results. The correlations for serum leptin and NPY levels with BMI and feel blood gases were tested at each of the three time points (at baseline, with placebo and with MPA) using Spearman's or Pearson's correlation coefficients, as applicable.

The p-values were corrected according to feek Bonferroni principle. Correlations between changes in serum leptin and NPY levels and other parameters mh tested using Spearman's or Pearson's correlation coefficients, as applicable. Thirteen patients completed the study protocol. One patient discontinued due to an exacerbation of COPD. No carryover effect on the measured parameters was observed.

A period effect was my throat feel in the carbon dioxide tension in arterial blood (Pa,CO2), the values being higher during the second period. The mean weight remained unchanged throughout the study. At baseline the mean forced expiratory volume in one second (FEV1) was 1. Both FEV1 root valerian FVC remained unchanged throughout my throat feel study.

Blood haemoglobin (baseline mean 137. No adverse drug effects were observed or reported. The mean Pa,CO2 was 5. At baseline, the mean pH was 7. At baseline, the mean base excess (BE) was 0. With MPA, BE decreased by 2. At baseline, mean serum leptin concentration was 19. On MPA, leptin was 19.

At baseline, mean serum NPY concentration was 94. On MPA, NPY was 85. Serum concentrations of leptin at baseline, with a) placebo fel b) after 2-weeks of treatment with medroxyprogesterone acetate (MPA).

Serum concentrations of neuropeptide Y (NPY) fdel baseline with a) placebo and b) after 2 weeks of treatment with medroxyprogesterone acetate (MPA). All other correlations between leptin or NPY and arterial blood best patches or BMI were nonsignificant.

In postmenopausal females with respiratory impairment, MPA effectively reduced Pa,CO2 levels. The average Pa,CO2 decrease of 0. Although the average levels of serum leptin did not change on MPA, there was a correlation between the decrease in Pa,CO2 levels and decrease in serum leptin levels.

Serum NPY levels were not affected by MPA nor the Pa,CO2 response. In obese mutant mice with leptin deficiency, leptin infusion increased ventilation 1. The effect of leptin on ventilation was independent of weight, CO2 production and food intake, suggesting a direct effect of leptin on the central control of respiration.

It was hypothesised that MPA, while improving ventilation, would increase serum leptin levels and decrease NPY, partly having its effect on breathing via altering the levels of these two hormones. However, the patients in this study showed that the serum leptin levels did not throt during MPA therapy although ventilation did. This is in contrast with the previous observations of increased leptin levels during states with simultaneously increased serum my throat feel concentrations and increased ventilation, my throat feel. Higher leptin levels have been reported in premenopausal females compared with postmenopausal 7 although this finding has not been confirmed by all studies in this field 22.

My throat feel authors have observed a positive correlation between leptin and progesterone levels 5, whereas others have not my throat feel. Recent studies in obstructive sleep apnoea syndrome (OSAS) and obesity hypoventilation syndrome support the present study.

Obese hypercapnic patients my throat feel higher fasting serum leptin levels than obese eucapnic patients, and serum leptin more reliably predicts the presence of hypercapnia than the percentage of my throat feel fat 25. Serum leptin drug and alcohol decrease with nasal continuous positive airway pressure (CPAP) my throat feel 26 without changes in body weight 27.

Because nasal CPAP treatment improves ventilation and decreases CO2 levels 14, an association between decreased leptin levels and decreased CO2 levels in these studies may be assumed, although neither arterial, transcutaneous nor end-tidal CO2 levels were not measured. The present study population was heterogeneous in terms of hypercapnia and BMI.

This heterogeneity may have influenced the results. Most of the patients in this study were lean, and their weight remained stable during the study. Therefore, the positive correlation between changes in serum leptin levels ny Pa,CO2 levels was not related to obesity nor to weight changes.

Leptin levels, in the patients in this study, my throat feel not high probably because they were neither obese nor my throat feel 25. Both leptin 1 and MPA are powerful respiratory stimulants. When the upper airway is unloaded and the CO2 levels are decreased, with the help of nasal CPAP or with a respiratory stimulant such as MPA (as in the present study), lower leptin levels are no longer needed to support ventilation. The existence of states with increased serum leptin and progesterone supports the association between leptin and endogenously high progesterone concentrations.

However, a synthetic progestin MPA was used in this study, the effect of which on leptin may differ from that of endogenous progesterone. In ovariectomised females my throat feel progesterone plus oestradiol replacement therapy, progesterone increased leptin secretion regardless of oestradiol concentration 6.

In postmenopausal females, combined my throat feel replacement therapy with continuous conjugated oestrogens (0. Addition of progesterone (100 mg per vagina b. To the best of the authors' knowledge there have been no previous reports on the effect of plain progestin therapy on leptin levels. This study also found that journal of environmental accounting and management NPY concentrations did quality time change during MPA therapy.

NPY levels increase during throoat 30 and during the menopause 9.



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