Association between consultations with complementary/alternative medicine practitioners and menopause-related symptoms: a cross-sectional study

OBJECTIVES

To examine the associations between consultations with complementary and alternative medicine (CAM) practitioners and menopause-related symptoms.

METHODS

A cross-sectional survey of a nationally representative sample of 10 011 women aged 59-64 years from the Australian Longitudinal Study on Women's Health, conducted in 2010. Women, including those with hysterectomy, oophorectomy and natural menopause, were asked about their consultations with a range of CAM practitioners and menopause-related symptoms experienced.

RESULTS

Acupuncturists were more likely to be consulted by women with hysterectomy experiencing night sweats (odds ratio, OR = 2.21), but were less likely to be consulted by those experiencing hot flushes (OR = 0.53). Acupuncturists were also more likely to be consulted by women with oophorectomy (OR = 3.11) and natural menopausal women (OR = 1.57) experiencing back pain. Massage therapists were more likely to be consulted by women with oophorectomy experiencing back pain (OR = 1.98), women with hysterectomy experiencing anxiety (OR = 1.52), and natural menopausal women experiencing back pain (OR = 1.54) and/or anxiety (OR = 1.29). Naturopaths/herbalists were more likely to be consulted by women with oophorectomy experiencing leaking urine (OR = 2.08). Chiropractors/osteopaths were more likely to be consulted by women across all menopausal status experiencing back pain (OR = 2.52, 2.31 and 2.25 for women with oophorectomy, hysterectomy and natural menopause, respectively).

CONCLUSIONS

There are substantial levels of CAM practitioners' consultations amongst menopausal women, with a range of menopause-related symptoms associated with the use of specific CAM practitioner modalities. It is important that health-care providers are mindful of CAM practitioner use in order to ensure safe, effective and coordinated treatment and support for menopausal women in their care.

Maternal plasma levels of cell-free β-HCG mRNA as a prenatal diagnostic indicator of placenta accrete

OBJECTIVE

Several biomarkers, including maternal serum creatinine kinase and α-fetoprotein, have been described as potential tools for the diagnosis of placental abnormalities. This study aimed to determine whether maternal plasma mRNA levels of the β subunit of human chorionic gonadotropin (β-HCG) could predict placenta accreta prenatally.

METHODS

Sixty-eight singleton pregnant women with prior cesarean deliveries (CDs) were classified into three groups: normal placentation (35 women, control group); placenta previa alone (21 women, placenta previa group); and both placenta previa and placenta accreta (12 women, placenta previa/accreta group). Maternal plasma concentrations of cell-free β-HCG mRNA were measured by real-time reverse-transcription polymerase chain reaction and were expressed as multiples of the median (MoM).

RESULTS

Cell-free β-HCG mRNA concentrations (MoM, range) were significantly higher in women with placenta accreta (3.65, 2.78-7.19) than in women with placenta previa (0.94, 0.00-2.97) or normal placentation (1.00, 0.00-2.69) (Steel-Dwass test, P < 0.01 and P < 0.01, respectively). In the placenta previa/accreta group, the concentration of cell-free β-HCG mRNA was significantly higher among women who underwent CDs with hysterectomy (4.41, 3.49-7.19) than among women whose CDs did not result in hysterectomy (3.20, 2.78-3.70) (Mann-Whitney U test, P = 0.012).

DISCUSSION

An increased level of cell-free β-HCG mRNA in the maternal plasma of women with placenta accreta may arise from direct uteroplacental transfer of cell-free placental mRNA molecules.

CONCLUSIONS

The concentration of cell-free β-HCG mRNA in maternal plasma may be applicable to the prenatal diagnosis of placenta accreta, especially to identify women with placenta accreta likely to require hysterectomy.

A critical review of traditional Chinese medicine use amongst women with menopausal symptoms

OBJECTIVES

To provide the first critical review of traditional Chinese medicine (TCM) use amongst symptomatic menopausal women, drawing upon work examining the perspectives of both TCM users and TCM practitioners.

METHODS

A search was conducted in three English-language databases (MEDLINE, CINAHL and AMED) and three Chinese-language databases (CNKI, VIP and CBM Disc) for 2002-2013 international peer-reviewed articles reporting empirical findings of TCM use in menopause.

RESULTS

A total of 25 journal articles reporting 22 studies were identified as meeting the review inclusion criteria. Chinese herbal medicine appears to be the most common therapy amongst symptomatic menopausal women, and vasomotor symptoms and emotional changes are the most frequent symptoms for which TCM is sought. However, evidence regarding the prevalence of TCM use and users' profile in menopause is limited. Existing studies are of varied methodological quality, often reporting low response rate, extensive recall bias and a lack of syndrome differentiation.

CONCLUSIONS

This review provides insights for practitioners and health policy-makers regarding TCM care to symptomatic menopausal women. More nationally representative studies are required to rigorously examine TCM use for the management of menopausal symptoms. Syndrome differentiation of menopausal women is an area which also warrants further attention.

Androgen dynamics and serum PSA in patients treated with abiraterone acetate

Background:

We analyzed the potential of abiraterone acetate (henceforth abiraterone) to reduce androgen levels below lower limits of quantification (LLOQ) and explored the association with changes in PSA decline in metastatic castration-resistant prostate cancer (mCRPC) patients.

Methods:

COU-AA-301 is a 2:1 randomized, double-blind, placebo-controlled study comparing abiraterone (1000 mg q.d.) plus low-dose prednisone (5 mg b.i.d.) with placebo plus prednisone in mCRPC patients post docetaxel. Serum testosterone, androstenedione and dehydroepiandrosterone sulfate from baseline to week 12 were measured by novel ultrasensitive two-dimensional liquid chromatography coupled to tandem mass spectrometry assays in a subset of subjects in each arm (abiraterone plus prednisone, n=80; prednisone, n=38). The association between PSA response (⩽50% baseline) and undetectable androgens (week 12 androgen level below LLOQ) was analyzed using logistic regression.

Results:

A significantly greater reduction in serum androgens was observed with abiraterone plus prednisone versus prednisone (all P⩽0.0003), reaching undetectable levels for testosterone (47.2% versus 0%, respectively). A positive association was observed between achieving undetectable serum androgens and PSA decline (testosterone: odds ratio=1.54; 95% confidence interval: 0.546–4.347). Reduction of androgens to undetectable levels did not occur in all patients achieving a PSA response, and a PSA response did not occur in all patients achieving undetectable androgen levels.

Conclusions:

Abiraterone plus prednisone significantly reduced serum androgens, as measured by ultrasensitive assays and was generally associated with PSA response. However, androgen decline did not uniformly predict PSA decline suggesting ligand-independent or other mechanisms for mCRPC progression.

MRI appearances of stage IE/IIE extranodal NK/T-cell lymphoma, nasal type, in the upper aerodigestive tract

BACKGROUND

The clinical symptoms of NK/T-cell lymphoma at presentation are nonspecific and may mimic those of other benign nasal diseases such as rhinitis and nasal polypus. However, radiologic studies regarding this aggressive clinical course entity are limited.

AIM

To review 123 newly diagnosed MRI appearances in patients with extra-nodal NK/T-cell lymphoma, nasal type, in a large cohort and determine the characteristic imaging findings.

SUBJECTS AND METHODS

We investigated the magnetic resonance imaging (MRI) findings of patients with newly diagnosed stage IE/IIE extranodal NK/T-cell lymphoma, nasal type, in the upper aerodigestive tract.

RESULTS

Most nasal cavity patients (63.4%) showed extra nasal cavity involvements. The polypoid pattern was most frequently seen (55.3%), followed by the infiltrative (27.6%) and combined (17.1%) patterns. The polypoid pattern tended to develop in the nasal cavity group, while the infiltration pattern was more common in the non-nasal cavity group (63.4% vs. 60.0%, p < 0.001). Homogeneous iso-intensity was seen in 97.6%, 88.6% and 56.1% of cases on T1-, T2-weighted images and post-contrast images, respectively. Bone destruction and necrosis were observed in 44.7% and 56.3% of patients. Both tumour necrosis and bone destruction were related to tumour size (p = 0.008, 0.001). Only 12.2% of patients had cervical lymphadenopathy Multi-region involvement, irregular growth pattern, predisposition to necrosis and bone destruction, and little lymphadenopathy are valuable for diagnosis and can be used to differentiate these tumours from other malignant tumours.

CONCLUSIONS

Our large cohort study of MRI of NK/T cell lymphoma, nasal type, revealed the features of this lymphoma on MRI including some radiologic signs never reported earlier; these findings are invaluable for early diagnosis and may aid future studies aiming to predict the prognosis and response to therapy.

The features of breast lymphoma on MRI

OBJECTIVE

To investigate the morphological features of breast lymphoma (BL) on MRI.

METHODS

MRI features of 20 patients with BL (12 primary and 8 secondary) were reviewed according to Breast Imaging-Reporting and Data System categories.

RESULTS

19 cases were unilateral and 1 was bilateral. According to the enhanced images, of the 20 cases, BL presented as a mass in 11 (55%), as an enhancement with no mass effect in 7 (35%) and as a mass and mixed enhancement with no mass effect in 2 (10%). There were 38 masses and 44 lesions with no mass effect in our study. All lesions showed mild heterogeneous internal enhancement. For lesions with mass effect, the margins were smooth in 32% (12/38) and irregular in 68% (26/38); and the shape was oval in 87% (32/38). Kinetic curve assessment (13 cases, 38 lesions) revealed that the average initial rise rate was 104%. The type II enhancement curve appeared in 55% (21/38) of lesions. No significant differences between the primary and secondary BL were observed for any of the MRI features.

CONCLUSION

BL mostly appeared oval with irregular margins showing mild heterogeneous internal enhancement and/or as enhanced lesions with no mass effect with mild heterogeneous internal enhancement.

ADVANCES IN KNOWLEDGE

Some special features on MRI are useful for the diagnosis of BL.

Structural insights into the unusually strong ATPase activity of the AAA domain of the Caenorhabditis elegans fidgetin-like 1 (FIGL-1) protein

The FIGL-1 (fidgetin like-1) protein is a homolog of fidgetin, a protein whose mutation leads to multiple developmental defects. The FIGL-1 protein contains an AAA (ATPase associated with various activities) domain and belongs to the AAA superfamily. However, the biological functions and developmental implications of this protein remain unknown. Here, we show that the AAA domain of the Caenorhabditis elegans FIGL-1 protein (CeFIGL-1-AAA), in clear contrast to homologous AAA domains, has an unusually high ATPase activity and forms a hexamer in solution. By determining the crystal structure of CeFIGL-1-AAA, we found that the loop linking helices α9 and α10 folds into the short helix α9a, which has an acidic surface and interacts with a positively charged surface of the neighboring subunit. Disruption of this charge interaction by mutagenesis diminishes both the ATPase activity and oligomerization capacity of the protein. Interestingly, the acidic residues in helix α9a of CeFIGL-1-AAA are not conserved in other homologous AAA domains that have relatively low ATPase activities. These results demonstrate that the sequence of CeFIGL-1-AAA has adapted to establish an intersubunit charge interaction, which contributes to its strong oligomerization and ATPase activity. These unique properties of CeFIGL-1-AAA distinguish it from other homologous proteins, suggesting that CeFIGL-1 may have a distinct biological function.

MicroRNA-199a-3p is downregulated in gastric carcinomas and modulates cell proliferation

MicroRNAs (miRNAs) are small non-coding RNAs that regulate the translation of targeted mRNAs. An increasing amount of evidence indicates that miRNAs play important role in cancer pathogenesis, apoptosis, proliferation, and differentiation as oncogenes or tumor suppressors. Recently, miRNA-199a has been shown to be involved in many human cancers, although the role of miRNA-199a-3p in gastric cancer has not yet been evaluated. In the present study, the expression of miRNA-199a-3p was found to be significantly downregulated in human gastric cancer tissues and cells. miRNA-199a-3p induced anti-proliferation effects on human gastric cancer cells. Furthermore, using quantitative RT-PCR (real-time polymerase chain reaction) and luciferase reporter assays, mTOR was identified as a direct target gene of miRNA-199a-3p that is downregulated by it. In conclusion, our findings suggest that miRNA-199a-3p is associated with human gastric cancer through its ability to decrease cancer cell proliferation and target the mTOR signaling pathway, and, therefore, may provide a novel therapeutic target for the treatment of human gastric cancer.

Intra-abdominal fibromatosis: differentiation from gastrointestinal stromal tumour based on biphasic contrast-enhanced CT findings

AIM

To identify the computed tomography (CT) criteria that differentiate intra-abdominal fibromatosis (IAF) from gastrointestinal stromal tumour (GIST).

MATERIALS AND METHODS

CT images of 34 pathologically proven cases of IAF (n = 15) and GIST (n = 19) were retrospectively reviewed. Location, contour, border, enhancement pattern, presence of necrosis, vessels, and air within the lesion were analysed. Long diameter (LD), short diameter (SD), LD/SD ratio, degree of enhancement, and lesion/aorta (L/A) CT attenuation ratio were measured and calculated. Significant CT criteria were identified using Fisher's exact test, grouped t-test, and receiver operating characteristic (ROC) curve. Sensitivity and specificity values were calculated when single or multiple CT criteria were used.

RESULTS

Extra-gastrointestinal location, ovoid or irregular contour, homogeneous enhancement, absence of intra-lesional necrosis, lower degree of enhancement, and L/A CT attenuation ratio differentiated IAF from GIST (p < 0.05). When any three of these eight criteria were combined, the sensitivity and specificity for diagnosing IAF were 100% (15 of 15) and 89.5% (17 of 19), respectively.

CONCLUSION

The following eight CT criteria are helpful to differentiate IAF from GIST: extra-gastrointestinal location, ovoid or irregular contour, homogeneous enhancement, absence of intra-lesional necrosis, a degree of enhancement of less than 40.5 HU in the arterial phase versus 46.5 HU in the portal venous phase, and an L/A CT attenuation ratio <0.315 in the arterial phase versus 0.525 in the portal phase.

Single-nucleotide polymorphism of the pri-miR-34b/c gene is not associated with susceptibility to congenital heart disease in the Han Chinese population

Recent evidence has shown that the microRNA polymorphism may play an important role in the susceptibility to congenital heart disease (CHD). A potentially functional SNP rs4938723 (T>C) in the promoter region of pri-miR-34b/c might affect transcription factor GATA binding and therefore pri-miR-34b/c expression. We genotyped the pri-miR-34b/c polymorphism in a case-control study of 590 patients and 672 controls in a Han Chinese population and assessed the effects of the pri-miR-34b/c polymorphism on CHD susceptibility by TaqMan SNP genotyping assay. There was no association between the pri-miR-34b/c polymorphism and the risk of CHD in both genotype and allelic frequency. In a subsequent analysis of the association between this polymorphism and CHD classification, there was still no significant difference in both genotype and allelic frequency. Our results suggest that the pri-miR-34b/c polymorphism rs4938723 is not associated with susceptibility to sporadic CHD in the Han Chinese population.

Radiological and clinical features of adult non-puerperal mastitis

OBJECTIVE

To describe the radiological and clinical features of adult non-puerperal mastitis and to determine the most accurate method of preventing unnecessary surgical procedures.

METHODS

Clinical and imaging findings were retrospectively reviewed in 51 females with non-puerperal mastitis, which was confirmed by biopsy/surgical pathology. All 51 patients had pre-operative MRI; 45 patients also had sonograms and 25 also had mammograms, pre-operatively.

RESULTS

Of the 51 cases with non-puerperal mastitis, 94.1% (48/51) were confirmed as having acute or chronic inflammation, and the other 3 had plasma cell mastitis; areola papillaris inflammation was found in 39.2% (20/51) of the cases. Overall, 6 of the 25 cases that were examined with mammography and 2 of the 45 cases that were examined with sonography appeared normal, but all 51 lesions were positively identified on MRI. Asymmetrical density (12/25) on mammograms and solitary or separated/contiguous, clustered, hypoechoic mass-like lesions (31/45) on ultrasound were the most common signs of non-puerperal mastitis. On enhanced MRI, 90.2% (46/51) of patients showed non-mass-like enhanced lesions. Multiple regional enhancements in the pattern of distribution (32/46) and separated or contiguous, clustered, rim-like enhancements in the pattern of internal enhancement (29/46) were the most common manifestations in non-mass-like enhanced lesions. Of the 51 patients, mastitis Type 1 and Type 2 in the time-signal intensity curve were detected in 47.1% and 51.0% of the patients, respectively. The breast imaging reporting and data system categories with the highest number of patients were Category 0 (9/25) on mammography, Category 4a on sonography (18/45) and Category 4a on MRI (29/51).

CONCLUSION

The findings from mammography and ultrasound are non-specific; therefore, using MR can be helpful in the diagnosis, especially in the presence of non-mass-like enhancements that are multiple, regional, separated, or contiguous, clustered and rim-like.

ADVANCES IN KNOWLEDGE

Mastitis is often neglected because of the lack of typical clinical signs and symptoms. This study has assessed and described the clinical features and imaging findings of adult non-puerperal mastitis on mammograms, sonograms and MRI and found that MRI is more specific in the diagnosis of disease.

Next-generation small RNA sequencing for microRNAs profiling in Apis mellifera: comparison between nurses and foragers

MicroRNAs (miRNAs) are endogenous small non-coding RNAs regulating gene expression in animals and plants. To find some differentially expressed miRNAs that may be associated with age-dependent behavioural changes in honey bees (Apis mellifera), we applied next-generation high-throughput sequencing technology to detect small RNAs in nurses and foragers. Our results showed that both nurses and foragers had a complicated small RNA population, and the length of small RNAs varied, 22 nucleotides being the predominant length. Combining deep sequencing and bioinformatic analysis, we discovered that nine known miRNAs were significantly different between nurses and foragers (P < 0.01; absolute value of fold-change ≥ 1). Some of their target genes were related to neural function. Moreover, 67 novel miRNAs were identified in nurses and foragers. Ame-miR-31a and ame-miR-13b were further validated using quantitative reverse-transcription PCR assays. The present study provides new information on the miRNA abundance of honey bees, and enhances our understanding of miRNA function in the regulation of honey bee development.

Increased autophagic activity in senescent human dental pulp cells

AIM

To establish whether autophagy is involved in dental pulp cell (DPC) senescence, so as to better understand the mechanism of the ageing process within the dental pulp.

METHODOLOGY

Human DPCs obtained from intact molars and premolars were cultured and serially passaged. Senescence-β-galactosidase (SA-β-gal) staining was performed to assess DPC senescence, which is considered to be the senescence of cells in culture after a series of passages. Autophagic activity was analysed by Western blot for major autophagic proteins and transmission electron microscopy (TEM) for autophagic vacuoles in both young and senescent cells. Statistical analyses were performed using the Student's t-test.

RESULTS

Senescence-β-galactosidase staining was higher in senescent DPC than in young cells (P = 0.011). Western blot revealed senescent DPCs had greater expression of autophagic proteins (microtubule-associated protein light chain 3 and Beclin 1) than young cells (P = 0.04, P = 0.001). Transmission electron microscopy revealed more autophagic vacuoles in senescent DPCs compared to young cells (P = 0.029).

CONCLUSIONS

Expression of autophagic proteins (microtubule-associated protein light chain 3 and Beclin 1) increased in senescent DPCs compare to young cells. More autophagic vacuoles were observed in senescent DPCs by TEM. Collectively, these data imply that autophagic activity increased in senescent DPCs.

Development and characterization of 70 novel microsatellite markers for the sea cucumber (Apostichopus japonicus)

The sea cucumber (Apostichopus japonicus) is an important item in Asian cuisine. It is currently produced through aquaculture, especially in China, after being overexploited in the wild in the 1990s. We isolated 70 novel polymorphic microsatellite loci using an enrichment-colony hybridization protocol. All loci were characterized in 48 individuals from a natural population in Rongcheng (Shandong, China) using genomic DNA isolated from muscle tissue. The number of alleles ranged from 2 to 17 (mean 7.0), and the observed and expected heterozygosities varied from 0.0010 to 1.0000 and from 0.2125 to 0.9477, respectively. Thirty-one of the 70 loci exhibited departure from Hardy-Weinberg equilibrium. These microsatellite markers should be useful resources for population genetic studies and for molecular marker-assisted breeding of A. japonicus.