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1.
Medicine (Baltimore) ; 98(38): e17260, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568000

RESUMO

INTRODUCTION: This study is a prospective, assessor-blinded, parallel-group, randomized controlled pilot trial to explore the effectiveness of 12-week adjuvant moxibustion therapy for arthralgia in menopausal females at stage I to III breast cancer on aromatase inhibitor (AI) administration, compared with those receiving usual care. METHODS/DESIGN: Forty-six menopausal female patients with breast cancer who completed cancer therapy will be randomly allocated to either adjuvant moxibustion or usual care groups with a 1:1 allocation ratio. The intervention group will undergo 24 sessions of adjuvant moxibustion therapy with usual care for 12 weeks, whereas the control group will receive only usual care during the same period. The usual care consists of acetaminophen administration on demand and self-directed exercise education to manage AI-related joint pain. The primary outcome is the mean change of the worst pain level according to the Brief Pain Inventory-Short Form between the initial visit and the endpoint. The mean changes in depression, fatigue, and quality of life will also be compared between groups. Safety and pharmacoeconomic evaluations will also be included. DISCUSSION: Continuous variables will be compared by an independent t test or Wilcoxon rank-sum test between the adjuvant moxibustion and usual care groups. Adverse events will be analyzed using the chi-square or Fisher exact test. The statistical analysis will be performed by a 2-tailed test at a significance level of .05.


Assuntos
Inibidores da Aromatase/efeitos adversos , Artralgia/terapia , Neoplasias da Mama/tratamento farmacológico , Moxibustão , Idoso , Inibidores da Aromatase/uso terapêutico , Artralgia/induzido quimicamente , Artralgia/economia , Protocolos Clínicos , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Humanos , Pessoa de Meia-Idade , Moxibustão/efeitos adversos , Moxibustão/economia , Projetos Piloto , Pós-Menopausa , Resultado do Tratamento
2.
Ann Agric Environ Med ; 26(3): 425-428, 2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31559798

RESUMO

INTRODUCTION AND OBJECTIVE: Physical effort plays a positive role in reducing the risk of cardiovascular diseases. The aim of this study was to assess the cardiovascular status in postmenopausal women after several years of regular amateur training. MATERIAL AND METHODS: A total of 55 generally healthy females aged 50-70 years, of whom 38 were members of a senior exercise group and 17 comprised a control group, were enrolled in the study. Parameters of blood flow, vascular resistance, myocardial contractility and thoracic fluid content were measured in a 10-minute supine resting test by impedance cardiography. Thereafter, central blood pressure, augmentation index and pulse wave velocity were measured by applanation tonometry. RESULTS: Exercising women have a better outcome than the control group, when evaluated both with impedance cardiography and with applanation tonometry. They have a lower heart rate - HR (65.1 vs 71.5; p = 0.033), higher blood flow (stroke index - SI, 58.6 vs 50.3; p = 0.040), better myocardial contractility (acceleration index - ACI, 108.8 vs 88.1; p = 0.027), higher preload (thoracic fluid content index - TFCI, 20.5 vs 18.1; p = 0.002), lower afterload (systemic vascular resistance index - SVRI, 1972.9 vs 2110.5; p = 0.026), lower central systolic blood pressure - cBPsys (119.0 vs 129.5; p = 0.037), lower augmentation pressure - AP (10.3 vs 15.0; p = 0.044) and lower pulse wave velocity - PWV (7.4 vs 8.4; p = 0.001). CONCLUSIONS: Regular moderate continuous aerobic exercise training has a beneficial impact on the cardiovascular system in postmenopausal women.


Assuntos
Fenômenos Fisiológicos Cardiovasculares , Exercício , Pós-Menopausa/fisiologia , Idoso , Pressão Sanguínea , Cardiografia de Impedância , Feminino , Hemodinâmica , Humanos , Pessoa de Meia-Idade
3.
JAMA ; 322(11): 1054-1065, 2019 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-31529008

RESUMO

Importance: Vaginal hysterectomy with suture apical suspension is commonly performed for uterovaginal prolapse. Transvaginal mesh hysteropexy is an alternative option. Objective: To compare the efficacy and adverse events of vaginal hysterectomy with suture apical suspension and transvaginal mesh hysteropexy. Design, Setting, Participants: At 9 clinical sites in the US Pelvic Floor Disorders Network, 183 postmenopausal women with symptomatic uterovaginal prolapse were enrolled in a randomized superiority clinical trial between April 2013 and February 2015. The study was designed for primary analysis when the last randomized participant reached 3 years of follow-up in February 2018. Interventions: Ninety-three women were randomized to undergo vaginal mesh hysteropexy and 90 were randomized to undergo vaginal hysterectomy with uterosacral ligament suspension. Main Outcomes and Measures: The primary treatment failure composite outcome (re-treatment of prolapse, prolapse beyond the hymen, or prolapse symptoms) was evaluated with survival models. Secondary outcomes included operative outcomes and adverse events, and were evaluated with longitudinal models or contingency tables as appropriate. Results: A total of 183 participants (mean age, 66 years) were randomized, 175 were included in the trial, and 169 (97%) completed the 3-year follow-up. The primary outcome was not significantly different among women who underwent hysteropexy vs hysterectomy through 48 months (adjusted hazard ratio, 0.62 [95% CI, 0.38-1.02]; P = .06; 36-month adjusted failure incidence, 26% vs 38%). Mean (SD) operative time was lower in the hysteropexy group vs the hysterectomy group (111.5 [39.7] min vs 156.7 [43.9] min; difference, -45.2 [95% CI, -57.7 to -32.7]; P = <.001). Adverse events in the hysteropexy vs hysterectomy groups included mesh exposure (8% vs 0%), ureteral kinking managed intraoperatively (0% vs 7%), granulation tissue after 12 weeks (1% vs 11%), and suture exposure after 12 weeks (3% vs 21%). Conclusions and Relevance: Among women with symptomatic uterovaginal prolapse undergoing vaginal surgery, vaginal mesh hysteropexy compared with vaginal hysterectomy with uterosacral ligament suspension did not result in a significantly lower rate of the composite prolapse outcome after 3 years. However, imprecision in study results precludes a definitive conclusion, and further research is needed to assess whether vaginal mesh hysteropexy is more effective than vaginal hysterectomy with uterosacral ligament suspension. Trial Registration: ClinicalTrials.gov Identifier: NCT01802281.


Assuntos
Histerectomia Vaginal/métodos , Telas Cirúrgicas , Prolapso Uterino/cirurgia , Útero/cirurgia , Idoso , Feminino , Seguimentos , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Histerectomia Vaginal/efeitos adversos , Estimativa de Kaplan-Meier , Ligamentos/cirurgia , Pessoa de Meia-Idade , Pós-Menopausa , Complicações Pós-Operatórias , Telas Cirúrgicas/efeitos adversos , Resultado do Tratamento , Vagina/cirurgia
4.
Klin Lab Diagn ; 64(7): 417-423, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31408594

RESUMO

Recently, they increasingly began to pay attention to the role of a nonspecific immune-inflammatory vascular response as a link in general pathogenetic mechanisms with a change in the elastic properties of arteries and phenomena of destructive bone changes, which at the subclinical level is of great importance for the prevention of the development of socially significant diseases. A total of 104 patients were examined (mean age 57.45 years), which were divided into three groups. The first group included 39 healthy women, the second group included 30 patients with hypertension and osteopenia, and the third group included 35 women with hypertension and osteoporosis. The analysis of markers of the immune inflammatory response, endothelial dysfunction, hormonal and mineral-vitamin status parameters was conducted against the background of the study of parameters of daily monitoring of arterial pressure, study of parameters of vascular wall stiffness and densitometry to clarify the predictors of cardiovascular and degenerative bone changes in postmenopausal women. A significant increase in the concentration of HF-CRP, the level of homocystemine, IL-8, parathyroid hormone, against the background of a significant decrease in the level of estrogen, progesterone, testosterone, with a persistent tendency to increase in total cholesterol, atherogenic lipid fractions, myeloperoxidase, endothelin-1 and decrease was recorded calcitonin, total and ionized calcium, with a significantly minimal value of vitamin D in the 3rd group of patients. The risks of development and progression of bone destructive changes were calculated using the logistic regression method for the group of AH with osteopenia and osteoporosis. Thus, for patients with hypertension and osteopenia, a significantly significant parameter associated with the risk of developing osteoporosis was an indicator of the velocity of the pulse wave, an increase in the level of which exceeds 12.05 m/s is associated with an increased risk of developing osteoporosis by 3.8 times. Increased levels of pro-inflammatory parameters, IL-6 and 8, TNF-α, HB-SRB, parathyroid hormone and reduced levels of progesterone and IL10, took the most active part in aggravating the degree of available bone tissue destruction. Timely specialized multidirectional study of biochemical and instrumental parameters (in particular, the study of the speed of the pulse wave and densitometry) can be the basis for the development of personalized prevention and treatment tactics for women in order to prevent socially dangerous cardiovascular and bone complications.


Assuntos
Hipertensão/patologia , Inflamação/patologia , Osteoporose/patologia , Densidade Óssea , Doenças Ósseas Metabólicas/imunologia , Doenças Ósseas Metabólicas/patologia , Osso e Ossos , Estudos de Casos e Controles , Citocinas/sangue , Feminino , Hormônios/sangue , Humanos , Hipertensão/imunologia , Pessoa de Meia-Idade , Osteoporose/imunologia , Pós-Menopausa
5.
DNA Cell Biol ; 38(10): 1088-1099, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31424267

RESUMO

The biological functions of lipocalin-1 (LCN1) are involved in innate immune responses and act as a physiological scavenger of potentially harmful lipophilic molecules. However, the relevance of LCN1 with cancer is rarely concerned currently. The aim of this study is to address the relevance of LCN1 with BRCA by bioinformatics. In this study, we found that the expressions of LCN1 increased significantly in various cancerous tissues, including BRCA, compared with their adjacent normal tissues through the TIMER database. Furthermore, UALCAN database analysis showed that the expression of LCN1 increased gradually from stage 1 to stage 4 and was upregulated in BRCA patients with different races and subtypes compared with that in the normal. In addition, those patients with perimenopause and postmenopause status displayed higher LCN1 expression. Importantly, LCN1 genetic alterations, including copy number amplification, deep deletion, and missense mutation, could be found, and the alteration frequency showed difference in various invasive BRCA through cBioPortal database. Moreover, a positive correlation between LCN1 somatic copy number alterations and immune cell enrichments was revealed in basal like BRCA by GISTIC 2.0. Finally, analysis on prognostic value of LCN1 by Kaplan-Meier plotter showed that low LCN1 expression correlated with poor prognosis for relapse-free survival in all types of BRCA, overall survival in luminal B BRCA, distant metastasis free survival in human epithelial growth factor receptor-2 (HER2) positive BRCA, and postprogression survival (PPS) in luminal A BRCA. But high LCN1 expression also displayed poor prognosis for PPS in HER2 positive BRCA. The results together verified the significance of LCN1 in BRCA, suggesting that it may be a potential biomarker for BRCA diagnosis.


Assuntos
Biomarcadores Tumorais/genética , Neoplasias da Mama/genética , Regulação Neoplásica da Expressão Gênica , Lipocalina 1/genética , Recidiva Local de Neoplasia/genética , Receptor ErbB-2/genética , Biomarcadores Tumorais/imunologia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/imunologia , Neoplasias da Mama/mortalidade , Variações do Número de Cópias de DNA , Bases de Dados Genéticas , Feminino , Humanos , Lipocalina 1/imunologia , Pessoa de Meia-Idade , Mutação , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/imunologia , Recidiva Local de Neoplasia/mortalidade , Estadiamento de Neoplasias , Perimenopausa/genética , Pós-Menopausa/genética , Pós-Menopausa/imunologia , Receptor ErbB-2/imunologia , Análise de Sobrevida
6.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(4. Vyp. 2): 105-111, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317923

RESUMO

AIM: To study the characteristics of somnological status in women in the late reproductive, pre- and postmenopausal periods before and after partial light deprivation. MATERIAL AND METHODS: One hundred and eighty-four women of menopausal age were included. A polysomnographic study of night sleep was performed and the excretion of the morning fraction of 6-sulfatoxymelatonin in the urine was measured before and after partial light deprivation in the light-saturated months of the year (from April to October) using optical lenses with a mineral photochromic coating. RESULTS AND CONCLUSIONS: The following characteristics of sleep for women with a neuro-vegetative form of menopausal syndrome are identified: the deterioration in the overall effectiveness of sleep, consisting in the increase of 'apnea-hypopnea sleep' in women in premenopause and menopause compared to women in late reproductive period, the increase in the duration of superficial stages of slow-wave sleep, the decrease in the duration of paradoxical sleep, the prevalence of slow-wave sleep in all sleep cycles, the decrease in the duration of paradoxical sleep, the increase in wakefulness in sleep, motor activity and desaturation during sleep that is accompanied by the decrease in the level of 6-sulfate-oxymelatonin in the morning urine compared to women in the late reproductive period. After the use of partial light deprivation, the parameters of the subjective assessment of sleep quality improved in the majority of women and polysomnographic patterns, including the significant increase in melatonin production, reached the normal levels.


Assuntos
Perimenopausa , Transtornos do Sono-Vigília , Adulto , Feminino , Humanos , Menopausa , Pessoa de Meia-Idade , Pós-Menopausa , Pré-Menopausa , Sono
7.
Yonsei Med J ; 60(8): 742-750, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31347329

RESUMO

PURPOSE: Muscle mass, strength, and composition determine muscle quantity and quality. However, data on muscle properties in relation to bone mass or insulin resistance are limited in Asian populations. This study aimed to investigate the relative importance of muscle measurements in regards to their relationship with lower bone mass and insulin resistance. MATERIALS AND METHODS: In this study, 192 postmenopausal women (age, 72.39±6.07 years) were enrolled. We measured muscle cross-sectional area (CSA) and attenuation at the gluteus maximus and quadriceps muscles through quantitative computed tomography. Muscle strength and physical performance were evaluated with the hand grip test and Short Physical Performance Battery (SPPB). Pearson correlation analysis and linear regression were performed to evaluate the relationship between muscle properties and homeostatic model assessment-insulin resistance (HOMA-IR) or bone mineral density (BMD). RESULTS: Muscle CSA, hand grip strength, and SPPB score held positive correlations with spine and hip BMDs, but not with insulin resistance. In contrast, muscle attenuation of the gluteus maximus or quadriceps was inversely related to HOMA-IR (r=-0.194, p=0.018 and r=-0.292, p<0.001, respectively), but not BMD. Compared with the control group, muscle CSA was significantly decreased in patients with osteoporosis; however, decreased muscle attenuation, indicating high fat infiltration, was found only in patients with diabetes. CONCLUSION: Muscle mass, strength, and physical performance were associated with low bone mass, and accumulation of intramuscular fat, a histological hallmark of persistently damaged muscles, may play a major role in the development of insulin resistance in Korean postmenopausal women.


Assuntos
Osso e Ossos/anatomia & histologia , Resistência à Insulina , Força Muscular/fisiologia , Músculo Esquelético/anatomia & histologia , Músculo Esquelético/fisiologia , Pós-Menopausa/fisiologia , Idoso , Índice de Massa Corporal , Densidade Óssea/fisiologia , Estudos Transversais , Diabetes Mellitus/fisiopatologia , Feminino , Força da Mão/fisiologia , Humanos , Tamanho do Órgão , Osteoporose/fisiopatologia , República da Coreia
8.
Yonsei Med J ; 60(8): 791-795, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31347335

RESUMO

PURPOSE: To determine the relationship between uterine leiomyoma and female sexual dysfunction (FSD) among premenopausal and postmenopausal women. MATERIALS AND METHODS: The study population consisted of consecutive women who underwent gynecologic screening tests, including transvaginal ultrasound, and completed the questionnaires on FSD. A total of 841 women were included from January 2010 to December 2011. FSD was defined as Female Sexual Function Index (FSFI) ≤26.55. The relationship between uterine leiomyoma and FSD were compared according to menopausal status. RESULTS: In premenopausal group (n=564), there were no differences in the frequency of FSD (55.0% vs. 58.8%, p=0.387) and total FSFI score. However, in postmenopausal group (n=277), women with uterine leiomyoma had a lower frequency of FSD than those without uterine leiomyoma (71.3% vs. 86.4%, p=0.003). This relationship between uterine leiomyoma and lower frequency of FSD in postmenopausal women remained significant after adjusting for confounding variables. CONCLUSION: The relationship between uterine leiomyoma and FSD is different depending on the menopausal status.


Assuntos
Leiomioma/complicações , Leiomioma/fisiopatologia , Pós-Menopausa/fisiologia , Disfunções Sexuais Fisiológicas/complicações , Neoplasias Uterinas/complicações , Neoplasias Uterinas/fisiopatologia , Adulto , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Inquéritos e Questionários
9.
Gastroenterology ; 157(2): 586, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31260666
10.
Gan To Kagaku Ryoho ; 46(7): 1187-1189, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31296828

RESUMO

Ethinyl estradiol(EE2)therapy has been reported to be an effective endocrine therapy for postmenopausal hormone receptor-positive advanced breast cancer, especially in the supposed acquired resistance state. The current study retrospectively investigated the efficacy and safety of EE2 therapy in postmenopausal women with hormone receptor-positive advanced breast cancer who had previously undergone multiple endocrine therapies. Twelve patients were enrolled; median lines of endocrine therapies were seven before EE2. Median PFS was 4.8 months and median overall survival was 10.0 months. Grade 3 adverse event comprised of anorexia in only one patient. EE2 therapy may be considered effective and safe in hormone receptor-positive advanced breast cancer even in late-stage endocrine therapy.


Assuntos
Neoplasias da Mama , Etinilestradiol/uso terapêutico , Mama , Neoplasias da Mama/tratamento farmacológico , Feminino , Humanos , Pós-Menopausa , Estudos Retrospectivos
11.
Nan Fang Yi Ke Da Xue Xue Bao ; 39(7): 861-866, 2019 Jul 30.
Artigo em Chinês | MEDLINE | ID: mdl-31340922

RESUMO

OBJECTIVE: To explore the relationship between metabolic syndrome (MS) and the risk for chronic kidney disease (CKD) in premenopausal and postmenopausal women. METHODS: We conducted a cross-sectional study among 1346 community-based women from June to October 2012 and collected the data of personal history, lifestyle, physical measures and laboratory indicators. The diagnosis of CKD was established for an eGFR of less than 60 mL/min per 1.73 m2 or albuminuria. The diagnosis of metabolic syndrome was based on the International Diabetes Federation Guide. According to an epidemiological survey in Guangdong province, women older than 48.9 years were classified as having a postmenopausal status. The prevalence of MS and CKD was determined in both the premenopausal and postmenopausal women, and the association between MS and CKD was analyzed using logistic regression models. RESULTS: MS was significantly correlated with CKD in premenopausal women in both unadjusted analyses (OR=3.10, 95% CI: 1.32-7.28, P=0.009) and in analysis after adjustment for potential confounders (OR=4.09, 95% CI: 1.63- 10.32, P=0.003). When adjusted for diabetes, hypertension, and hyperuricemia, no correlation was found between MS and CKD in premenopausal women (OR=1.56, 95% CI: 0.31-7.63, P= 0.592); in the unadjusted analyses, MS was significantly correlated with CKD in postmenopausal women (P < 0.001). After further adjustment for age, education status, current smoking, physical inactivity, and current drinking, MS was still significantly correlated with CKD (OR=2.60, 95% CI: 1.69-3.99, P < 0.001). When adjusted for diabetes, hypertension, and hyperuricemia, the correlation between MS and CKD was still significant (OR=1.61, 95% CI: 1.09-2.37, P=0.018). In the unadjusted model, a high blood pressure (OR=2.77, 95%CI: 1.57-4.89, P < 0.001), an elevated serum triglyceride level (OR=1.84, 95%CI: 1.16-2.90, P=0.009) and a high fast glucose level (OR=2.07, 95%CI: 1.30-3.28, P=0.002) were all significantly correlated with CKD in postmenopausal women. After adjusting for age, current smoking, current alcohol use, education status and physical inactivity, a high blood pressure (OR=2.28, 95%CI: 1.22-4.26, P=0.01), a high serum triglyceride level (OR=1.71, 95%CI: 1.03-2.86, P=0.039) and a high fast glucose (OR=2.25, 95%CI: 1.36-3.73, P=0.002) were still significantly correlated with CKD in postmenopausal women. Blood pressure, serum triglyceride level, fast glucose, serum HDL cholesterol level and central obesity were not correlated with CKD in either the unadjusted model or adjusted model in premenopausal women (P > 0.05). CONCLUSIONS: MS is correlated with CKD in both premenopausal and postmenopausal women, and the association is dependent on diabetes, hypertension, and hyperuricemia in premenopausal women but not in postmenopausal women.


Assuntos
Síndrome Metabólica , Insuficiência Renal Crônica , Estudos Transversais , Feminino , Humanos , Pós-Menopausa , Pré-Menopausa , Fatores de Risco
12.
Urologiia ; (3): 66-71, 2019 Jul.
Artigo em Russo | MEDLINE | ID: mdl-31356015

RESUMO

INTRODUCTION: Lower urinary tract infections (LUTI) are one of the most common diseases among women. The risk of LUTI increases with the onset of peri- and postmenopause. Vulvovaginal atrophy occurs in 30% of women aged 55 years and 75% of women aged 70 years. Currently, local hormone therapy is the main method of its treatment. However, different variants of complex therapy are also used. MATERIALS AND METHODS: The study included 60 women aged with the diagnosis: "Postmenopausal atrophic vaginitis. Chronic recurrent bacterial cystitis in the acute stage". The patients were divided into 2 groups of 30 people. In group 1 was carried out etiotropic antibiotic therapy in combination with local use of single-agent preparation or estriol for 3 months. In group 2, the patients received antibiotics in combination with Triozhinal for 3 months. The effectiveness was monitored on the 1st and 7th day of therapy, as well as 3 months after the start of treatment. RESULTS: At admission in both groups there were signs of vulvovaginal atrophy and exacerbation of chronic cystitis. Complex therapy with Triozhinal, containing lyophilized culture of lactobacilli L. casei rhamnosus Doderleini, contributed to the normalization of PH, restoration of vaginal biocinosis, and, consequently, reduce the severity of complaints of dryness and burning in the vagina, dyspareunia. Thus, despite the reduction of symptoms in the majority of women, the proportion of such patients in group 2 was higher and amounted to 96.7% against 83.3% in group 1. Supportive reception of the drug for 3 months. it allowed to preserve the normocinosis of the vagina until the restoration of its trophic, as well as to reduce the frequency of bacteriuria and leukocyturia by 20% compared with the results of group 1, and to significantly reduce the number of relapses of infection (p<0.05). CONCLUSION: Triozhinal improves the results of treatment of recurrent urinary infection in women with vulvovaginal atrophy in peri- and postmenopausal and can be recommended for use in combination therapy.


Assuntos
Cistite , Probióticos , Infecções Urinárias , Idoso , Atrofia , Cistite/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Pós-Menopausa , Probióticos/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Vagina
13.
Zhonghua Fu Chan Ke Za Zhi ; 54(6): 393-398, 2019 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-31262123

RESUMO

Objective: To analyze the performance of colposcopy and investigate the diagnosis and treatment characteristics of high-grade squamous intraepithelial lesion (HSIL) diagnosed by cervical tissue sampling in post-menopausal women. Methods: A retrospective study was performed on 1 449 patients with HSIL diagnosed by cervical tissue sampling under colposcopy and treated by loop electrosurgical excision procedure (LEEP) or extrafascial hysterectomy as the primary therapy at the First Affiliated Hospital of Nanjing Medical University, from November 2015 to October 2017. In order to investigate the diagnosis and treatment of HSIL in post-menopausal women, a case-control study was conducted to compare the difference in performance of colposcopy and treatment modality between 213 post-menopausal patients (14.7%, 213/1 449) and 1 236 pre-menopausal patients (85.3%, 1 236/1 449). Results: (1)The proportion of cases pathologically upgraded to cervical cancer was significantly greater in post-menopausal patients (9.4%, 20/213) compared with pre-menopausal patients (3.8%, 47/1 236; P<0.05). (2) The proportion of ≥HSIL diagnosed by colposcopy showed no significant difference between post-menopausal patients (76.1%, 162/213) and pre-menopausal patients (78.2%, 967/1 236; P=0.479). The proportion of type Ⅲ transformation zone (TZ) was significantly greater in post-menopausal patients (91.1%, 194/213) compared with pre-menopausal patients (59.1%, 731/1 236; P<0.05). The rate of missed diagnosis of cervical cancer was significantly higher in type Ⅲ TZ (6.4%, 59/925) compared with type Ⅰ and(or) Ⅱ TZ (1.5%, 8/524; P<0.05). The proportion of HSIL detected by endocervical curettage alone was greater in post-menopausal patients (9.9%, 21/213) compared with pre-menopausal patients (2.6%, 32/1 236; P<0.05). (3)Initial treatment with LEEP: the positive rate of endocervical margin was significantly greater in post-menopausal patients (20.5%, 36/176) compared with pre-menopausal patients (10.5%, 130/1 236;P<0.05); in patients who were diagnosed as HSIL after LEEP, the positive rate of endocervical margin and the residual rate were both greater in post-menopausal patients compared with pre-menopausal patients [15.4% (25/162) versus 8.8% (105/1 189), P=0.008; 52.0% (13/25) versus 26.7% (28/105), P=0.014]. (4)Thirty-seven post-menopausal patients were treated by extrafascial hysterectomy as the primary therapy, 5 cases (13.5%, 5/37) were diagnosed as cervical cancer (stage Ⅰa1) after the surgery. Conclusions: (1) The lesions of HSIL in post-menopausal patients still have definite features under colposcopy as same as pre-menopausal patients. Endocervical curettage could help detect more HSIL in post-menopausal patients. Compared with pre-menopausal patients, post-menopausal HSIL patients have an increased risk of cervical cancer and are more likely missed by cervical tissue sampling. (2) LEEP has the dual effects of diagnosis and treatment, and is still the recommended treatment for post-menopausal HSIL patients. However, the increase in positive rate of endocervical margin and residual rate requires further active intervention. (3) Considering those post-menopausal HSIL patients who cannot accept conization as the initial treatment, the selection of hysterectomy type requires more thorough study.


Assuntos
Colo do Útero/patologia , Conização/métodos , Eletrocirurgia/métodos , Pós-Menopausa , Lesões Intraepiteliais Escamosas Cervicais/diagnóstico , Lesões Intraepiteliais Escamosas Cervicais/terapia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/terapia , Idoso , Estudos de Casos e Controles , Colposcopia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos
14.
Medicine (Baltimore) ; 98(26): e16080, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261519

RESUMO

Osteoporosis is a common problem, especially among postmenopausal women. Postmenopausal women with osteoporosis have major risk factors for osteoporotic fractures. The abuse of epidural steroid injections (ESIs) or the misunderstanding of their proper use could cause osteoporotic fractures. Therefore, we aimed to investigate whether ESIs are associated with osteoporotic fractures in postmenopausal women with low back pain and osteoporosis. Furthermore, we aimed to provide evidence on whether ESIs could be used in postmenopausal women with osteoporosis who are at high risk for osteoporotic fractures.We reviewed the medical records of postmenopausal women with osteoporosis but no fractures. A total of 172 postmenopausal women were divided into 2 groups. Group 1 comprised patients receiving medications and Group 2 comprised patients receiving ESIs. All participants received medications for treating osteoporosis. Each patient's age, bone mineral density, body mass index, medical history, and status with respect to smoking, drinking, physical activity, and exercise were obtained using a questionnaire and medical records.The mean total number of ESIs was 6.2, and the mean cumulative administered dose of glucocorticoids (dexamethasone) was 31 mg. The incidences of fractures in the medication and ESI groups were 22% and 24%, respectively, in the thoracolumbar spine, and 2% and 5%, respectively, in the hip joint.There was no significant difference in the incidences of osteoporotic fractures at the thoraco-lumbar spine and hip joint in postmenopausal women with osteoporosis between those who received ESIs (a mean of 6.2 ESIs, a cumulative dexamethasone dose of 31 mg) and those who did not, with both groups taking anti-osteoporotic medications for low back pain. Our data suggest that ESI treatment using a mean of 6.2 ESIs to deliver a maximum cumulative dexamethasone dose of 31 mg could be safely used in postmenopausal women with osteoporosis, without any significant impact on the their risk for osteoporotic fractures.


Assuntos
Glucocorticoides/administração & dosagem , Osteoporose Pós-Menopausa/epidemiologia , Fraturas por Osteoporose/epidemiologia , Esteroides/administração & dosagem , Idoso , Dexametasona/administração & dosagem , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Incidência , Injeções Epidurais , Dor Lombar/tratamento farmacológico , Dor Lombar/epidemiologia , Pós-Menopausa , Prevalência , Estudos Retrospectivos , Fraturas da Coluna Vertebral/epidemiologia
15.
Eur J Radiol ; 116: 205-211, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31153566

RESUMO

PURPOSE: To assess the association of fatty acid levels in mammary adipose tissue of postmenopausal women with the presence of breast cancer using the Gradient-echo Spectroscopic Imaging (GSI). MATERIALS AND METHODS: Unilateral GSI was performed at 3 T in 61 postmenopausal women undergoing breast MRI exams. The study included 19 women with breast cancer, 23 women with benign/high risk lesions, and 19 women with a history of cancer. Voxel-wise spectral analysis of fatty acids was conducted to measure relative portions of monounsaturated (MUFA), polyunsaturated (PUFA), and saturated fatty acids (SFA) in each voxel. The voxels within mammary adipose tissue were automatically selected and their median fatty acid fractions were used for quantitative analysis. Statistical analyses were performed using χ2 test, one-way analysis of variance (ANOVA) with Tukey-Kramer multiple comparison tests, and linear regression. RESULTS: Postmenopausal women with malignancies had significantly higher SFA (0.336 ± 0.038) in mammary adipose tissue compared to those with benign disease (0.283 ± 0.046, p = 0.0008) and to those with a history of breast cancer (0.287 ± 0.050, p = 0.0038). Postmenopausal women with malignant lesions had significantly lower MUFA (0.352 ± 0.041) compared to those with benign disease (0.401 ± 0.043, p = 0.0032) and with history of breast cancer (0.388 ± 0.055, p = 0.0484). The history of cancer group had a significant correlation (r = 0.60, p = 0.006) between SFA and BMI, and the cancer group had a significant correlation (r = 0.57, p = 0.010) between PUFA and BMI. CONCLUSIONS: Fatty acid composition of mammary adipose tissue, particularly higher SFA and lower MUFA, may be associated with breast cancer. The GSI method utilizes an automated voxel-based analysis to measure fatty acid composition, and may be used to assess the role of mammary adipose tissue in cancer development and progress.


Assuntos
Tecido Adiposo/química , Neoplasias da Mama/metabolismo , Mama/química , Ácidos Graxos/metabolismo , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética/métodos , Pessoa de Meia-Idade , Pós-Menopausa/fisiologia , Estudos Retrospectivos
16.
High Blood Press Cardiovasc Prev ; 26(3): 217-225, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31236901

RESUMO

INTRODUCTION: A possible role of the oral microbiome, specifically oral nitrate reducing flora, in blood pressure (BP) homeostasis, if proven etiologic in nature, could lead to novel mechanism-based therapy to improve hypertension prevention and control. AIM: This cross-sectional study characterized and compared the oral microbiome between four study groups based on BP status among 446 postmenopausal women aged 53-82 years. METHODS: Three study groups were not taking hypertension medication and were separated based on BP, as follows: normal BP (systolic < 120 and diastolic < 80; N = 179), elevated BP/Stage I hypertension (systolic 120-139 or diastolic 80-90; N = 106), Stage II hypertension (systolic > 140 or diastolic > 90; N = 42). The forth group consisted of anyone taking hypertension medications, regardless of BP (N = 119). Subgingival microbiome composition was determined using 16S rRNA sequencing with the Illumina MiSeq platform. Kruskal-Wallis tests were used to compare species-level relative abundance of bacterial operational taxonomic units across the four groups. RESULTS: Sixty-five bacterial species demonstrated significant differences in relative abundance in women with elevated BP or using hypertension medication as compared to those with normal BP. After correction for multiple testing, two species, Prevotella oral (species 317) and Streptococcus oralis, remained significant and were lower in abundance among women taking antihypertension medications compared to those with normal BP (corrected P < 0.05). CONCLUSIONS: These data provide novel description of oral subgingival bacteria grouped according to BP status. Additional larger studies including functional analysis and prospective designs will help further assess the potential role of the oral microbiome in BP regulation and hypertension.


Assuntos
Bactérias/isolamento & purificação , Pressão Sanguínea , Hipertensão/microbiologia , Hipertensão/fisiopatologia , Microbiota , Boca/microbiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Bactérias/classificação , Bactérias/genética , Pressão Sanguínea/efeitos dos fármacos , Estudos Transversais , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Pessoa de Meia-Idade , Pós-Menopausa , Ribotipagem/métodos , Fatores de Risco , Fatores Sexuais
17.
J Forensic Leg Med ; 66: 58-64, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31226500

RESUMO

The presence of vaginal fluid as a bio-stain in the crime scene of sexual assaults provides pivotal evidence. The vaginal secretions are known to be rich in Lactobacillus; hence the current work aims to identify vaginal secretions via detection and quantification of Lactobacillus DNA in pre and postmenopausal females and to test its stability over storage time using Critical Threshold method applied by Polymerase chain reaction approach. Comparative study is done by Critical Threshold and Relative Expression methods aiming to evaluate the two methods. Results showed that (ΔCT) <9 powerfully indicates the presence of vaginal fluids. Values of ΔCT in all vaginal samples are stable and not affected by storage. Two novel cutoff values are obtained in order to differentiate between premenopausal and postmenopausal vaginal fluid samples which are (8.42) using the Critical Threshold method and (0.24) using the Relative Expression method. One novel cutoff value is obtained to differentiate between fresh and stored vaginal samples by the Relative Expression method which is (0.39). It is concluded that Lactobacillus DNA quantification via PCR is a good positive identifier for vaginal secretions which is remarkably stable over storage time.


Assuntos
Muco do Colo Uterino/microbiologia , DNA Bacteriano/análise , Lactobacillus/genética , Vagina/microbiologia , Feminino , Medicina Legal , Humanos , Lactobacillus/isolamento & purificação , Pós-Menopausa , Pré-Menopausa , Estudos Prospectivos , Reação em Cadeia da Polimerase em Tempo Real , Manejo de Espécimes
18.
Anticancer Res ; 39(6): 2883-2889, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177126

RESUMO

BACKGROUND/AIM: High-grade serous carcinoma (HGSC) is the most common histological subtype of ovarian carcinoma. Somatic mutation of tumor protein 53 (TP53) is a hallmark of tubo-ovarian HGSC and is observed in almost all such cases. Highly sensitive targeted genomic sequencing can be used to identify novel mutations that may become potential druggable targets and aid in therapeutic decisions. The aim of this study was to describe the clinicopathological and molecular characteristics of HGSCs with novel somatic TP53 mutations identified by next-generation sequencing (NGS). MATERIALS AND METHODS: A commercial NGS panel comprising 170 genes, including TP53, was used to analyze the genetic profiles of 132 ovarian carcinoma cases. The clinicopathological characteristics and p53 immunostaining results of two HGSCs exhibiting novel TP53 mutations were investigated. RESULTS: Eighty-eight (66.7%) out of 132 ovarian carcinoma cases were diagnosed as HGSC. Novel TP53 in-frame deletion mutations c.719_727delGTTCCTGCA (p53 p.Ser240_Cys242del) and c.634_642delTTTCGACAT (p53 p.F212_H214del) were detected in a single case of HGSC each. Both patients were postmenopausal women. Imaging and laboratory studies revealed peritoneal carcinomatosis and elevated levels of serum tumor markers. The patients underwent primary debulking surgery and were diagnosed as having stage IIIC HGSC. In both cases, p53 immunostaining revealed uniform nuclear immunoreactivity in 90% or more of tumor cells at a very strong intensity. CONCLUSION: Targeted genomic sequencing revealed novel in-frame deletion mutations of TP53 leading to p53 overexpression in tubo-ovarian HGSC. This discovery of previously unreported somatic TP53 mutations provides insight into the translation of NGS technology into personalized medicine and identifies new potential targets for therapeutic applications.


Assuntos
Cistadenocarcinoma Seroso/cirurgia , Neoplasias das Tubas Uterinas/cirurgia , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Neoplasias Ovarianas/cirurgia , Neoplasias Peritoneais/cirurgia , Deleção de Sequência , Proteína Supressora de Tumor p53/genética , Regulação para Cima , Núcleo Celular/metabolismo , Cistadenocarcinoma Seroso/genética , Cistadenocarcinoma Seroso/metabolismo , Cistadenocarcinoma Seroso/patologia , Procedimentos Cirúrgicos de Citorredução , Neoplasias das Tubas Uterinas/genética , Neoplasias das Tubas Uterinas/metabolismo , Neoplasias das Tubas Uterinas/patologia , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Pessoa de Meia-Idade , Mutação , Gradação de Tumores , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/metabolismo , Neoplasias Ovarianas/patologia , Neoplasias Peritoneais/genética , Neoplasias Peritoneais/metabolismo , Neoplasias Peritoneais/patologia , Pós-Menopausa , Medicina de Precisão , Análise de Sequência de DNA , Proteína Supressora de Tumor p53/metabolismo
19.
Pan Afr Med J ; 32: 1, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31182986

RESUMO

Introduction: In Africa, sex life after menopause remains an under-explored topic due to the fact that it is a taboo. This study aims to evaluate the quality of couple's sex life during menopause. Methods: We conducted a cross-sectional survey of a representative sample of 320 postmenopausal women. The inclusion criteria were natural menopause. Patients who had experienced early or iatrogenic menopause were excluded. Investigation form was divided into 4 sections: social and cultural characteristics, clinical data, psycho-sexual data and therapeutic data. Comparison of proportions and chi-squared test with a significance threshold of less than 0.05 were used. Results: The average age of women was 60 years; the average age of onset of menopause was 48 years and the age of the menopause was 11.3 years. All woman suffered from climacteric syndrome. Hot flushes occured in 85.9% of women, vaginal dryness in 62.8% and urinary disorders in 52.5%. Only married women reported having sex with their partner (62.1%). Women had sex occasionally in 68.9% of cases, while 18.1% of women reported no sexual activity. Decreased sexual activity was due to partner's erectile dysfunction (62% of couples) and the lack of sexual desire (83.5% of women). Lack of sexual appetite and orgasm were also reported in 92% and 100% of cases. However, 93.5% of married women thought their life was bearable. Conclusion: Marital status, dyspareunia, vaginal dryness and partner's erectile dysfunction have a significant impact on sexuality of menopausal women in Senegal.


Assuntos
Pós-Menopausa , Comportamento Sexual/estatística & dados numéricos , Disfunções Sexuais Fisiológicas/epidemiologia , Sexualidade/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Dispareunia/epidemiologia , Disfunção Erétil/epidemiologia , Feminino , Humanos , Masculino , Menopausa/fisiologia , Pessoa de Meia-Idade , Senegal , Parceiros Sexuais , Inquéritos e Questionários , Doenças Vaginais/epidemiologia
20.
Gynecol Oncol ; 154(3): 531-538, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31227223

RESUMO

OBJECTIVE: Treatment options are limited for patients with recurrent/metastatic low-grade ovarian cancers (LGOCs) and serous borderline ovarian tumors (SBOTs) as response rates to chemotherapy are low. A subset of patients appears to derive clinical benefit from antiestrogens, but most studies have been retrospective and clinical benefit rates (CBR) remain uncertain. The primary aim of PARAGON was to prospectively investigate the CBR of anastrozole, an aromatase inhibitor, in patients with estrogen receptor (ER) and/or progesterone receptor (PR) positive LGOC and SBOT. METHODS: Post-menopausal women with ER-positive and/or PR-positive recurrent/metastatic LGOCs and SBOTs and evaluable disease by RECIST v1.1 or GCIG CA125 criteria were treated with anastrozole 1 mg daily until progression or unacceptable toxicity. RESULTS: Thirty-six patients were enrolled. Clinical benefit at 3 months (primary endpoint) was observed in 23 patients (64%, 95% CI 48%-78%) and was similar at 6 months (61%, 95% CI 43%-75%). The median duration of clinical benefit was 9.5 months (95% CI 8.3-25.8). Best study response was partial response by RECIST in 5 patients (14%), stable disease in 18 patients (50%) with progressive disease in 13 patients (36%). Median PFS was 11.1 months (95% CI 3.2-11.9). Anastrozole was well-tolerated. Patients with evidence of clinical benefit at 3 months reported less pain, fatigue, and improved physical and role functioning as early as 1 month of commencing treatment. CONCLUSIONS: Anastrozole was associated with a CBR of 61% of patients with recurrent ER-positive and/or PR-positive LGOC or SBOT for at least 6 months with acceptable toxicity.


Assuntos
Anastrozol/uso terapêutico , Carcinoma Epitelial do Ovário/tratamento farmacológico , Cistadenocarcinoma Seroso/tratamento farmacológico , Neoplasias Ovarianas/tratamento farmacológico , Receptores Estrogênicos/metabolismo , Adulto , Idoso , Anastrozol/efeitos adversos , Antineoplásicos Hormonais/efeitos adversos , Antineoplásicos Hormonais/uso terapêutico , Carcinoma Epitelial do Ovário/metabolismo , Carcinoma Epitelial do Ovário/patologia , Cistadenocarcinoma Seroso/metabolismo , Cistadenocarcinoma Seroso/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/metabolismo , Recidiva Local de Neoplasia/patologia , Neoplasias Ovarianas/metabolismo , Neoplasias Ovarianas/patologia , Pós-Menopausa , Intervalo Livre de Progressão , Estudos Prospectivos , Qualidade de Vida , Receptores de Progesterona/metabolismo , Adulto Jovem
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