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Gatenby C, Simpson P. Menopause: Physiology, definitions, and symptoms. Best Pract Res Clin Endocrinol Metab 2024; 38:101855. [PMID: 38171939 DOI: 10.1016/j.beem.2023.101855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The menopause transition is usually a gradual process occurring over many years, caused by the cessation of ovarian reproductive function, resulting in the end of menstrual bleeding. In the peri-menopause, ovarian function and therefore the production of the hormones oestrogen, progesterone and testosterone can fluctuate greatly, leading to a wide variety of symptoms, affecting multiple organ systems. Menopause and the management of its associated symptoms can be very challenging for patients and clinicians alike and can negatively impact quality of life. The management options include lifestyle adjustment, talking therapies, dietary supplements as well as prescribed medications, including hormone replacement therapy. The UK's average life expectancy for women is approximately 81 years. Therefore, women will now live up to a third of their life being either peri- or postmenopausal. Thus, understanding and treating, where possible, the symptoms of menopause is essential to reduce the burden associated with this physiological state.
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Affiliation(s)
| | - Paul Simpson
- Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, United Kingdom.
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Huang MC, Huang TT, Feng HC, Chen IC, Chang CI, Wang TN, Kuo WH, Wang MY, Tsai LW, Li SY, Huang CS, Lu YS, Lin CH. Lifestyle Factors and Energy Intakes with Risks of Breast Cancer among Pre- and Post- Menopausal Women in Taiwan. Nutrients 2023; 15:3900. [PMID: 37764684 PMCID: PMC10534793 DOI: 10.3390/nu15183900] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/24/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023] Open
Abstract
Although the incidence of invasive breast cancer (BC) among women in Asian is generally lower than that in Western countries, the incidence of BC has been on the rise in the past three decades in Asian countries. This hospital-based case-control study aimed to explore the relationship between dietary and metabolic factors and BC risk in pre- and post-menopausal women. We enrolled 285 patients with newly diagnosed BC at the National Taiwan University Hospital and 297 controls from the local community and hospital staff. Before receiving anticancer therapy, all patients with BC and control participants completed a 57-question semi-quantitative Food Frequency Questionnaire. For pre-menopausal women, plant-based factor scores rich in seeds and nuts, soy, fruits, and seaweeds correlated significantly with reduced BC risks, whereas menarche occurring at <12 years of age, reduced physical activity, and high-density lipoprotein <40 mg/dL were associated with increased BC risks. For post-menopausal women, plant-based dietary factor scores were also associated with reduced risks, whereas increased body mass index and energy intake levels correlated with increased BC risks. Diets rich in plant-based dietary patterns are protective against BC risk, regardless of menopausal status. Habitual physical activity is protective against BC risk among pre-menopausal Taiwanese women. Maintaining optimal weight and caloric intake is beneficial for reducing post-menopausal BC risk.
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Affiliation(s)
- Meng-Chuan Huang
- Department of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (M.-C.H.); (T.-T.H.)
- Department of Public Health and Environmental Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Tz-Ting Huang
- Department of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (M.-C.H.); (T.-T.H.)
| | - Hsin-Chun Feng
- Department of Nutrition, National Taiwan University Hospital, Taipei 100, Taiwan;
| | - I-Chun Chen
- Graduate Institute of Oncology, National Taiwan University, Taipei 100, Taiwan; (I.-C.C.); (S.-Y.L.)
- Department of Medical Oncology, National Taiwan University Hospital, Cancer Center Branch, Taipei 100, Taiwan
- Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Chiao-I Chang
- Department of Public Health and Environmental Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Tsu-Nai Wang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Wen-Hung Kuo
- Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan; (W.-H.K.); (C.-S.H.)
| | - Ming-Yang Wang
- Department of Surgical Oncology, National Taiwan University Hospital, Cancer Center Branch, Taipei 100, Taiwan; (M.-Y.W.); (L.-W.T.)
| | - Li-Wei Tsai
- Department of Surgical Oncology, National Taiwan University Hospital, Cancer Center Branch, Taipei 100, Taiwan; (M.-Y.W.); (L.-W.T.)
| | - Szu-Yi Li
- Graduate Institute of Oncology, National Taiwan University, Taipei 100, Taiwan; (I.-C.C.); (S.-Y.L.)
- Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Chiun-Sheng Huang
- Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan; (W.-H.K.); (C.-S.H.)
| | - Yen-Shen Lu
- Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Ching-Hung Lin
- Department of Medical Oncology, National Taiwan University Hospital, Cancer Center Branch, Taipei 100, Taiwan
- Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
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Schroeder RJ, Staszkiewicz J, O'Quin C, Carroll B, Doan N, Patel S, Ahmadzadeh S, Kallurkar A, Viswanath O, Varrassi G, Shekoohi S, Kaye AD. Oral Therapeutics Post Menopausal Osteoporosis. Cureus 2023; 15:e42870. [PMID: 37664395 PMCID: PMC10474253 DOI: 10.7759/cureus.42870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
Osteoporosis affects a significant number of postmenopausal women in the United States. Screening is performed using clinical assessments and bone mineral density scans via dual x-ray absorptiometry. Oral therapy is indicated to prevent pathologic fractures in those deemed at increased risk following screening. Bisphosphonates including alendronate, ibandronate, and risedronate are currently first-line oral therapeutics in fracture prevention following the diagnosis of osteoporosis. Hormonal therapies include estrogen-containing therapies, selective estrogen receptor modulators, and other compounds that mimic the effects of estrogen such as tibolone. Lifestyle modifications such as supplementation and physical activity may also contribute to the prevention of osteoporosis and are used as adjuncts to therapy following diagnosis. These therapeutics are limited primarily by their adverse effects. Treatment regimens should be tailored based on significant risk factors demonstrated by patients, adverse effects, and clinical response to treatment. The most severe risk factors relevant to pharmacological selection involve hormone replacement therapies, where concern for venous thrombosis, coronary artery disease, breast, and uterine cancer exist. Bisphosphonates are most commonly associated with gastrointestinal discomfort which may be mitigated with proper administration. Although adverse effects exist, these medications have proven to be efficacious in the prevention of vertebral and non-vertebral fractures in post-menopausal women. Fracture risk should be weighed against the risk of adverse events associated with each of the regimens, with clinical judgment dictating the treatment approach centered around patient goals and experiences.
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Affiliation(s)
- Ryan J Schroeder
- Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, USA
| | - Julia Staszkiewicz
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Collyn O'Quin
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Brandon Carroll
- Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, USA
| | - Nicolette Doan
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Sagar Patel
- Anaesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Shahab Ahmadzadeh
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Anusha Kallurkar
- Anaesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Omar Viswanath
- Pain Management, Valley Pain Consultants - Envision Physician Services, Phoenix, USA
| | | | - Sahar Shekoohi
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Alan D Kaye
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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Martino G, Bellone F, Vicario CM, Gaudio A, Corica F, Squadrito G, Lund-Jacobsen T, Schwarz P, Lo Coco G, Morabito N, Catalano A. Interrelations between clinical-psychological features and bone mineral density changes in post-menopausal women undergoing anti-osteoporotic treatment: a two-year follow-up. Front Endocrinol (Lausanne) 2023; 14:1151199. [PMID: 37229451 PMCID: PMC10203700 DOI: 10.3389/fendo.2023.1151199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction Psychological features have been bidirectionally associated with osteoporosis, but it is still unclear whether patient's anxiety fluctuations during the anti-osteoporotic treatment can have an impact on bone mineral density (BMD) variation. The aim of this study was to investigate the interrelations between psychological distress features, such as anxiety, depression, health-related QoL (HRQoL) and bone health in women receiving anti-osteoporotic treatment. Methods 192 post-menopausal osteoporotic women were treated with alendronate or risedronate according to the standard procedure. The levels of anxiety, depression, and perceived HRQoL, along with BMD, were assessed at baseline and at a 2-year follow-up. Results At the end of the study, the patients showed a statistically significant increase of both psychic and somatic anxiety (p<0.0001) and exhibited a worsening of depressive symptoms (p<0.0001), whereas HRQoL showed no change. BMD improved and no incident fractures occurred. BMD variation (ΔBMD) at lumbar spine was significantly associated with anxiety levels (r=0.23, p=0.021). Multiple regression analysis showed that both patients' worsening anxiety levels (β = -0.1283, SE=0.06142, p=0.04) and their treatment adherence (β=0.09, SE=0.02, p=0.0006) were independently associated with ΔBMD. Discussion The findings of the current follow-up study suggest that BMD in post-menopausal women undergoing anti-osteoporotic treatment was predicted by treatment adherence and anxiety change over time.
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Affiliation(s)
- Gabriella Martino
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Federica Bellone
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Carmelo Mario Vicario
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, Messina, Italy
| | - Agostino Gaudio
- Department of Clinical and Experimental Medicine, University Hospital of Catania, Catania, Italy
| | - Francesco Corica
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Giovanni Squadrito
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Trine Lund-Jacobsen
- Department of Endocrinology, Centre for Cancer and Organ Diseases, The Copenhagen University Hospital, Rigshospitalet and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Schwarz
- Department of Endocrinology, Centre for Cancer and Organ Diseases, The Copenhagen University Hospital, Rigshospitalet and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gianluca Lo Coco
- Department of Psychology, Educational Science and Human Movement- University of Palermo, Palermo, Italy
| | - Nunziata Morabito
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Antonino Catalano
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
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Hooper SC, Espinoza SE, Marshall VB, Kilpela LS. The Clinical Phenotype of Binge Eating Disorder among Postmenopausal Women: A Pilot Study. Nutrients 2023; 15:2087. [PMID: 37432212 PMCID: PMC10180572 DOI: 10.3390/nu15092087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 07/12/2023] Open
Abstract
Binge eating disorder (BED), a form of overnutrition, may impact healthy aging for postmenopausal women. In community samples, 12-26% of older women (ages 60+) engage in binge eating. In younger adults, BED is comorbid with physical and psychological morbidities. However, little is known regarding the clinical phenotype, including medical and psychiatric comorbidities, of BED in postmenopausal women. This pilot study sought to identify psychosomatic, cardiometabolic, body composition, and physical function characteristics of postmenopausal, older adult (age ≥60 years) women with BED. Participants (N = 21, ages 60-75) completed a battery of physical assessments and surveys assessing psychosomatic health. Overall, 62% of women reported BE onset during peri- or post-menopause. Rates of comorbid depression, anxiety, sleep problems, and a history of severe menopausal symptoms were high. Cardiometabolic health was poor, and 42.9% met the criteria for metabolic syndrome. Additionally, 71.4% met the BMI criteria for obesity, and 40% of this sample met the criteria for sarcopenic obesity. Almost half of the sample presented with at least one mobility limitation; 85.7% had poor endurance. Evidence suggests that BED is highly comorbid with other chronic health conditions and may complicate treatment of these conditions, warranting further investigation and increased attention from healthcare providers serving postmenopausal women.
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Affiliation(s)
- Savannah C. Hooper
- ReACH Center, UT Health San Antonio, San Antonio, TX 78229, USA
- Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Sara E. Espinoza
- Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, TX 78229, USA
- Division of Geriatrics, Gerontology and Palliative Medicine, Department of Medicine, UT Health San Antonio, San Antonio, TX 78229, USA
- Geriatrics Research, Education, and Clinical Center, South Texas VA Healthcare System, San Antonio, TX 78229, USA
| | - Victoria B. Marshall
- ReACH Center, UT Health San Antonio, San Antonio, TX 78229, USA
- Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Lisa S. Kilpela
- ReACH Center, UT Health San Antonio, San Antonio, TX 78229, USA
- Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, TX 78229, USA
- Division of Geriatrics, Gerontology and Palliative Medicine, Department of Medicine, UT Health San Antonio, San Antonio, TX 78229, USA
- Geriatrics Research, Education, and Clinical Center, South Texas VA Healthcare System, San Antonio, TX 78229, USA
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Abstract
There is a fundamental gap in knowledge in how Parkinson's disease manifests and affects women throughout their hormonal life cycle, resulting in unmet needs and adversely impacting women's quality of life. A set of questionnaires was developed and deployed through Fox Insight (open access) to address these issues by gathering data. This is the data from the first survey. The data from the questions regarding self-image were striking. 61% of women report that their Parkinson's disease negatively impacts their self-image. Here we explore the negative impact of Parkinson's disease on women to begin to fill the gaps in knowledge.
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Affiliation(s)
- Soania Mathur
- PD Avengers (Global Alliance to End Parkinson's Disease), Canada
| | - Kristi LaMonica
- PD Avengers (Global Alliance to End Parkinson's Disease), Canada.,Russell Sage College, Troy, NY, USA
| | - Helen Matthews
- PD Avengers (Global Alliance to End Parkinson's Disease), Canada.,Cure Parkinson's, London, UK
| | - Kat Hill
- PD Avengers (Global Alliance to End Parkinson's Disease), Canada
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Donofry SD, Lesnovskaya A, Drake JA, Ripperger HS, Gilmore AD, Donahue PT, Crisafio ME, Grove G, Gentry AL, Sereika SM, Bender CM, Erickson KI. Obesity, Psychological Distress, and Resting State Connectivity of the Hippocampus and Amygdala Among Women With Early-Stage Breast Cancer. Front Hum Neurosci 2022; 16:848028. [PMID: 35431843 PMCID: PMC9011058 DOI: 10.3389/fnhum.2022.848028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/07/2022] [Indexed: 12/20/2022] Open
Abstract
Objective Overweight and obesity [body mass index (BMI) ≥ 25 kg/m2] are associated with poorer prognosis among women with breast cancer, and weight gain is common during treatment. Symptoms of depression and anxiety are also highly prevalent in women with breast cancer and may be exacerbated by post-diagnosis weight gain. Altered brain function may underlie psychological distress. Thus, this secondary analysis examined the relationship between BMI, psychological health, and resting state functional connectivity (rsFC) among women with breast cancer. Methods The sample included 34 post-menopausal women newly diagnosed with Stage 0-IIa breast cancer (Mage = 63.59 ± 5.73) who were enrolled in a 6-month randomized controlled trial of aerobic exercise vs. usual care. At baseline prior to randomization, whole-brain analyses were conducted to evaluate the relationship between BMI and seed-to-voxel rsFC of the hippocampus and amygdala. Connectivity values from significant clusters were then extracted and examined as predictors of self-reported depression and anxiety. Results Mean BMI was in the obese range (M = 31.83 ± 6.62). For both seeds examined, higher BMI was associated with lower rsFC with regions of prefrontal cortex (PFC), including ventrolateral PFC (vlPFC), dorsolateral PFC, and superior frontal gyrus (z range = 2.85-4.26). Hippocampal connectivity with the vlPFC was negatively correlated with self-reported anxiety (β = 0.47, p < 0.01). Conclusion Higher BMI was associated with lower hippocampal and amygdala connectivity to regions of PFC implicated in cognitive control and emotion regulation. BMI-related differences in hippocampal and amygdala connectivity following a recent breast cancer diagnosis may relate to future worsening of psychological functioning during treatment and remission. Additional longitudinal research exploring this hypothesis is warranted.
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Affiliation(s)
- Shannon D. Donofry
- Psychiatry and Behavioral Health Institute, Allegheny Health Network, Pittsburgh, PA, United States
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Alina Lesnovskaya
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
- Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, United States
| | - Jermon A. Drake
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
- Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, United States
| | - Hayley S. Ripperger
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
- Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, United States
| | - Alysha D. Gilmore
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Patrick T. Donahue
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Mary E. Crisafio
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
| | - George Grove
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Amanda L. Gentry
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Susan M. Sereika
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Catherine M. Bender
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kirk I. Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
- Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, United States
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Fung YL, Lee CK, Kwon SY, Soedarmono Y, Satake M, Alcantara R, Donkin R. The contribution and potential of older blood donors in Asia Pacific regions. Transfus Med 2021; 32:71-76. [PMID: 34954862 DOI: 10.1111/tme.12845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/23/2021] [Accepted: 12/01/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To investigate the blood supply contribution of older donors in five Asia Pacific regions. BACKGROUND Older people are often the largest blood user group. Thus, as the population ages blood supply needs increase. Minimum and maximum donation age criteria potentially constrain the size of the donor pool. MATERIALS AND METHODS Haemoglobin values and demographic frequency analytics (sex, age and blood type) were analysed on blood donors aged 60 years or more, from Hong Kong, Indonesia, Japan, Singapore and South Korea over 12 months. RESULTS Data on 434357 donations was analysed. ABO Rh(D) frequencies of older donors matched that of national frequencies. Older donors were a disproportionately smaller proportion of the total donor pool for each country. Indonesia was the only region with no maximum age limit. Median haemoglobin for older males ranged from 14.2 to 14.8 g/dl and for females 13.1 to 13.9 g/dl. The frequency of female donors was between 15% and 33% of older donors. Older donors had higher donation frequency and lower deferral rates. CONCLUSION Older donors are loyal and regular donors but under-represented in all regions studied. They could help meet future blood supply needs, especially post-menopausal female donors. Studies including ferritin levels are needed to determine if upper age limits can be safely modified.
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Affiliation(s)
- Yoke-Lin Fung
- University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | | | | | - Yuyun Soedarmono
- Directorate of Primary Health Care at Ministry of Health Indonesia, Indonesia
| | | | | | - Rebecca Donkin
- University of the Sunshine Coast, Maroochydore, Queensland, Australia
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Bates LC, Hanson ED, Levitt MM, Richie B, Erickson E, Bartlett DB, Phillips MD. Mucosal-Associated Invariant T Cell Response to Acute Exercise and Exercise Training in Older Obese Women. Sports (Basel) 2021; 9:133. [PMID: 34678914 DOI: 10.3390/sports9100133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/01/2022] Open
Abstract
(1) Background: Obesity is a major global public health concern as it is associated with many of the leading causes of preventable deaths. Exercise reduces obesity-induced inflammation; however, it is unknown how exercise training may impact mucosal associated invariant T (MAIT) cells in overweight/obese (OW) post-menopausal women. Therefore, the purpose of this study was to investigate (i) circulating MAIT-cells at rest in OW vs. Lean women, (ii) the response of MAIT-cells to a single bout of combined aerobic and resistance exercise, and (iii) the effects of 12 weeks of exercise training (EX) or educational program (ED) on the MAIT-cell response in OW. (2) Methods: OW completed an acute exercise session or sitting control, underwent 12 weeks of exercise training or received educational materials, and then repeated the exercise session/sitting control. Lean post-menopausal women provided a baseline comparison. (3) Results: OW had lower circulating MAIT-cells at rest than Lean prior to exercise training; however, after training EX displayed improved MAIT-cell frequency. Additionally, prior to training EX did not exhibit MAIT-cell mobilization/egress, however, both improved after training. (4) Conclusions: Reduced MAIT-cell frequency and ability to mobilize/egress were potentially partially rescued in EX after 12 weeks of exercise training; however, further research is needed to elucidate age or obesity-induced attenuations in MAIT-cells.
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Chalwe JM, Mukherjee U, Grobler C, Mbambara SH, Oldewage-Theron W. Association between hypertension, obesity and dietary intake in post-menopausal women from rural Zambian communities. Health SA 2021; 26:1496. [PMID: 34522391 PMCID: PMC8424718 DOI: 10.4102/hsag.v26i0.1496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 05/26/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Amongst the cardiovascular risk (CVR) factors, hypertension (HT) and obesity appear to be prominent in post-menopausal women. The underlying mechanisms of HT development in menopause are not fully understood. AIM To determine the association between HT, obesity and dietary intakes in post-menopausal women from rural Zambia. SETTING This study was conducted in Twatasha Compound of Kitwe and Ndeke Community of Ndola. METHODS Blood pressure (BP), weight, height and dietary intakes (24-h recall) were measured in 153 women (> 50 years) from households. The South African Hypertension Society (SAHS), the World Health Organization (WHO) and estimated average requirements (EARs) guidelines were followed for HT, obesity and dietary intake definitions, respectively. Statistical Package for the Social Sciences (SPSS) version 26 was used for descriptive and inferential statistical analyses. RESULTS Prevalence of HT was 70%, whilst 37.25% and 28.10% of the participants were overweight and obese, respectively. The median interquartile range (IQR) dietary intakes showed inadequate intakes for most nutrients, except for carbohydrates (170 g [133; 225]). The total fat intake represented 14% of total energy intake. All median fatty acid intakes and sodium intakes (409 mg [169; 662]) were below the recommended levels. Only body mass index (BMI) correlated with HT (r = 0.268; p = 0.001). CONCLUSIONS Despite low dietary intakes, an alarming prevalence of HT and obesity was found in our population. Hormonal changes, a high energy-dense diet and poor treatment adherence, may be possible underlying factors. We recommend measures to better manage HT as a CVR factor. CONTRIBUTION This article supplements evidence on the prevalence of obesity-related hypertension in post-menopausal women and the link to dietary intake.
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Affiliation(s)
- Joseph M Chalwe
- Department of Health Sciences, Faculty of Applied and Computer Sciences, Vaal University of Technology, Vanderbijlpark, South Africa
| | - Upasana Mukherjee
- Department of Nutritional Sciences, Faculty of Human Sciences, Texas Tech University, Lubbock, Texas, United States of America
| | - Christa Grobler
- Department of Health Sciences, Faculty of Applied and Computer Sciences, Vaal University of Technology, Vanderbijlpark, South Africa
| | - Saidon H Mbambara
- Department of Biomedical Sciences, Tropical Diseases Research Centre, Ndola, Zambia
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, Faculty of Health Sciences, Texas Tech University, Lubbock, Texas, United States of America
- Department of Nutrition and Dietetics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Pawlik J, Pawlik W, Branecka-Woźniak D, Kotrych K, Cymbaluk-Płoska A. Rhabdomyosarcoma of the Cervix in a Post-Menopausal Woman-An Unparalleled Phenomenon. Int J Environ Res Public Health 2021; 18:ijerph18157851. [PMID: 34360144 PMCID: PMC8345433 DOI: 10.3390/ijerph18157851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/15/2021] [Accepted: 07/23/2021] [Indexed: 11/20/2022]
Abstract
Rhabdomyosarcoma of the cervix is a soft tissue sarcoma that usually occurs in young women. It is very rare in adulthood. We discuss symptoms, the process of diagnosis of rhabdomyosarcoma embryonale of the cervix in a 61-year-old women and differences in treatment dependent on patient’s age. A 61-year-old woman with symptoms such as palpable mass in the external cervical opening and post-menopausal hemorrhaging was admitted to the oncology ward where excision of the polyp was performed. Embryonal rhabdomyosarcoma (ERMS) was diagnosed by histopathological examination of obtained tissues. The diagnosis was complemented by chest computed tomography and pelvis magnetic resonance imaging to exclude metastases. A Wertheim–Meigs operation and excision of the ovaries, the fallopian tubes and the surrounding tissue was performed in the course of treatment. In the patient’s follow-up of 25 months to date, there have been no signs of recurrence or symptoms connected to ERMS. Based on the therapeutic outcome, the decision to limit the treatment to a surgical resection was adequate for a post-menopausal patient. Because of the rarity of ERMS in the post-menopausal age, we think that the patient should be carefully followed up to further examine this issue and develop diagnostic and treatment guidelines.
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Affiliation(s)
- Jakub Pawlik
- Department of Gynecological Surgery and Oncology of Adults and Adolescents, Pomeranian Medical University, 70-111 Szczecin, Poland; (W.P.); (A.C.-P.)
- Correspondence:
| | - Weronika Pawlik
- Department of Gynecological Surgery and Oncology of Adults and Adolescents, Pomeranian Medical University, 70-111 Szczecin, Poland; (W.P.); (A.C.-P.)
| | - Dorota Branecka-Woźniak
- Department of Gynecology and Reproductive Health, Pomeranian Medical University, 71-210 Szczecin, Poland;
| | - Katarzyna Kotrych
- Department of General and Dental Radiology, Pomeranian Medical University, 70-111 Szczecin, Poland;
| | - Aneta Cymbaluk-Płoska
- Department of Gynecological Surgery and Oncology of Adults and Adolescents, Pomeranian Medical University, 70-111 Szczecin, Poland; (W.P.); (A.C.-P.)
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12
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Muirhead FC, Lee HL, Singh R. Ovarian endosalpingiosis mimicking hydrosalpinges. Unexpected intraoperative findings and a diagnostic rollercoaster. J Surg Case Rep 2021; 2021:rjab264. [PMID: 34211694 PMCID: PMC8241478 DOI: 10.1093/jscr/rjab264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/23/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022] Open
Abstract
Over 80 % of ovarian cancer diagnoses are in women aged over 50 years. Post-menopausal women are at significantly increased risk compared with other age groups. Tumour biomarkers and ultrasound assist with diagnostics. A post-menopausal woman was referred with a possible left adnexal cyst on ultrasound. A tertiary gynaecological ultrasound suggested bilateral hydrosalpinges without cysts. Tumour markers were negative. Unexpectedly, while undergoing a laparoscopy, the tubes were normal in appearance; however, multiple cystic deposits suspicious for malignancy were noted on the ovaries. A laparoscopic bilateral salpingo-oophorectomy was performed without spillage and pelvic washings obtained. On histopathology, the ovaries contained multiple, benign epithelial cysts and pelvic washings were negative. This case demonstrates an unanticipated peri-operative diagnostic dilemma. It highlights the surgical management decisions required to balance duty of care and consent compliance within the scope of general gynaecology. It emphasizes the importance of histopathological examination to confirm diagnoses.
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Affiliation(s)
- Fleur C Muirhead
- Obstetrics and Gynaecology, Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - Hong L Lee
- Obstetrics and Gynaecology, Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - Rajeev Singh
- Obstetrics and Gynaecology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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13
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Hoier B, Olsen LN, Leinum M, Jørgensen TS, Carter HH, Hellsten Y, Bangsbo J. Aerobic High-Intensity Exercise Training Improves Cardiovascular Health in Older Post-menopausal Women. Front Aging 2021; 2:667519. [PMID: 35822005 PMCID: PMC9261406 DOI: 10.3389/fragi.2021.667519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/22/2021] [Indexed: 11/13/2022]
Abstract
The aim of this study was to determine the effect of a period of aerobic high intensity training on central- and peripheral cardiovascular parameters in older post-menopausal women. Eleven healthy post-menopausal (>10 years after menopause) women (mean age: 64 years; BMI: 25.3 kg m−2) completed an 8-week period of supervised, high intensity cycle training, with sessions conducted three times per week. Before and after the training period maximal oxygen uptake, body composition, popliteal artery flow mediated dilation, exercise hyperemia, arterial blood pressure, and plasma lipids were assessed. In addition, levels of estrogen related receptor α (ERRα) and vasodilator enzymes were determined in muscle biopsy samples. Training induced an 18% increase (P < 0.001) in maximal oxygen uptake. Plasma High-density lipoprotein (HDL) was higher (P < 0.05) after than before the training period. Fat mass was reduced (4.9%; P < 0.01), whereas lean body mass was unaltered. Mean arterial blood pressure was unchanged (91 vs. 88 mmHg; P = 0.058) with training. Training did not induce a change in popliteal flow mediated dilation. Exercise hyperemia at submaximal exercise was lower (P < 0.01; 11 and 4.6% at 10 and 16 W, respectively) after compared to before training. Muscle ERRα (~1.7-fold; P < 0.01) and eNOS (~1.4-fold; P < 0.05) were higher after the training intervention. The current study demonstrates that, in older post-menopausal women, a period of aerobic high intensity training effectively increases maximal oxygen uptake and improves the cardiovascular health profile, without a parallel improvement in conduit artery function.
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Affiliation(s)
- Birgitte Hoier
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Line Nørregaard Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Maria Leinum
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Tue Smith Jørgensen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.,Herlev Hospital, Copenhagen, Denmark
| | - Howard Henry Carter
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Ylva Hellsten
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jens Bangsbo
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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14
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Decleer W, Debeuckelaere A, Comhaire F. The exceptional case of a large extra-uterine, so-called parasitic leiomyoma in a post-menopausal woman with Hashimoto's thyroiditis. Facts Views Vis Obgyn 2020; 12:319-323. [PMID: 33575682 PMCID: PMC7863694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A large tumour mass was detected in a 65-year-old patient during a routine gynaecological examination. This patient had been treated for over 10 years with levothyroxine for Hashimoto's thyroiditis and was also given transdermal oestrogen replacement therapy. Before the operation, detailed imaging by CT scan and MRI was performed. A tumour weighing 1.056 grams and measuring 23x12x7 cm was successfully removed through laparotomy. Histopathology revealed the diagnosis of an extra-uterine, so-called parasitic leiomyoma. Post-surgery recovery was uneventful, but Tibolone treatment was indicated due to disturbing menopausal complaints.
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Affiliation(s)
- W Decleer
- Fertility Centre, AZ Jan Palfijn Ghent, Watersportlaan 5, 9000 Ghent, Belgium,Fertility Clinic, Weststraat 16/18, 9880 Aalter, Belgium
| | - A Debeuckelaere
- Master student Medical Science, KU Leuven, 3000 Leuven, Belgium
| | - F Comhaire
- Fertility Clinic, Weststraat 16/18, 9880 Aalter, Belgium
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15
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Yang Q, Wan YH, Hu SD, Cao YH. Associations between the levels of thyroid hormones and abdominal obesity in euthyroid post-menopausal women. Endokrynol Pol 2020; 71:299-305. [PMID: 32901910 DOI: 10.5603/ep.a2020.0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/12/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The aim of this study was to explore the association between thyroid hormones and abdominal fat quantities in euthyroid post-menopausal women. MATERIAL AND METHODS Serum levels of thyroid stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4) as well as body mass index (BMI) and waist circumference (WC) were collected from 540 euthyroid post menopausal women aged 45-65 years. Magnetic resonance imaging (MRI) was performed to measure visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) area. Multivariate linear regression analysis was used to determine whether abdominal fat was associated with thyroid hormones. RESULTS Weight, BMI, WC, fasting plasma glucose (FPG), fasting insulin (Fins), homeostasis model assessment of insulin resistance (HOMA-IR), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), TSH, and fT4 were higher in the obese group than in the nonobese group (p < 0.05). The study participants were divided into four groups according to quartiles in the light of TSH reference range (0.1-4.2 mU/L). Subcutaneous adipose tissue and VAT increased with the TSH levels. Adjusted for age, years since menopause (YSM), BMI, and HOMA-IR, VAT was negatively correlated with fT4 and positively correlated with fT3 and fT3-to-fT4 ratio (fT3/fT4) (p < 0.05), while no association was found between SAT and thyroid hormones. Similarly, we found no relation between body fat distribution and TSH. Furthermore, the association of common indicators of obesity and thyroid hormones showed no significance. CONCLUSIONS In euthyroid post-menopausal women, VAT rather than SAT was negatively correlated with fT4, and positively correlated with fT3 and fT3/fT4.
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Affiliation(s)
- Qiu Yang
- Division of Endocrinology and Metabolism, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China.
| | - Yan Hai Wan
- Division of Endocrinology and Metabolism, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Sheng De Hu
- Nuclear Medicine Department, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Yi Hong Cao
- Division of Endocrinology and Metabolism, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
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16
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Maslov PZ, Kim JK, Argulian E, Ahmadi A, Narula N, Singh M, Bax J, Narula J. Is Cardiac Diastolic Dysfunction a Part of Post-Menopausal Syndrome? JACC Heart Fail 2019; 7:192-203. [PMID: 30819374 DOI: 10.1016/j.jchf.2018.12.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/14/2018] [Accepted: 12/27/2018] [Indexed: 11/22/2022]
Abstract
Post-menopausal women exhibit an exponential increase in the incidence of heart failure with preserved ejection fraction compared with men of the same age, which indicates a potential role of hormonal changes in subclinical and clinical diastolic dysfunction. This paper reviews the preclinical evidence that demonstrates the involvement of estrogen in many regulatory molecular pathways of cardiac diastolic function and the clinical data that investigates the effect of estrogen on diastolic function in post-menopausal women. Published reports show that estrogen deficiency influences both early diastolic relaxation via calcium homeostasis and the late diastolic compliance associated with cardiac hypertrophy and fibrosis. Because of the high risk of diastolic dysfunction and heart failure with preserved ejection fraction in post-menopausal women and the positive effects of estrogen on preserving cardiac function, further clinical studies are needed to clarify the role of endogenous estrogen or hormone replacement in mitigating the onset and progression of heart failure with preserved ejection fraction in women.
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17
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Ebot J, Bohnen AM, Abode-Iyamah K. Bilateral Acute Osteoporotic Lumbar Pedicle Fracture Presenting with Associated Neurological Deficit: A Case Report and Review of Literature. Cureus 2020; 12:e7273. [PMID: 32292683 PMCID: PMC7153811 DOI: 10.7759/cureus.7273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Osteoporosis is a common cause of vertebral compression fractures. Often times affecting post-menopausal women, these fractures may occur spontaneously or following minor trauma and are typically managed non-surgically. Here we present a case of a 67-year-old patient who presented with acute compression fracture of the lumbar 5 vertebra and bilateral pedicle fractures of the fourth and fifth lumbar vertebrae following an episode of coughing secondary to tracheitis. She underwent a lumbar 3 to sacral 1/ilium instrumentation/arthrodesis, with screw augmentation via hydroxyapatite, followed by lumbar 4/5 laminectomy and foraminotomy.
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Affiliation(s)
- James Ebot
- Neurosurgery, Mayo Clinic, Jacksonville, USA
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18
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Wright HH, Kruger MC, Schutte WD, Wentzel-Viljoen E, Kruger IM, Kruger HS. Magnesium Intake Predicts Bone Turnover in Postmenopausal Black South African Women. Nutrients 2019; 11:nu11102519. [PMID: 31635369 PMCID: PMC6836205 DOI: 10.3390/nu11102519] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 12/28/2022] Open
Abstract
This prospective study investigated the association between nutrient intake, dietary patterns, and changes in bone turnover and bone mineral density (BMD) in postmenopausal urban black South African women over two years. These women (n = 144) underwent BMD measurements at the distal radius, lumbar spine, femoral neck (FN), as well as a biochemical analysis which included the parathyroid hormone (PTH), 25-hydroxyvitamin D, C-Telopeptide of type I collagen (CTX-1) in 2010 and 2012. Their dietary intake was assessed in 2010 using a food frequency questionnaire, and sociodemographic and health information was collected. Four dietary patterns explained 54.4% of the variance of dietary intake, namely staple foods and processed meats, home cooking, snacking, and high sugar. Dietary magnesium negatively correlated with CTx-1 in 2012 (r = −0.21, p = 0.02), calcium correlated with distal radius BMD in 2010 (r = 0.22, p = 0.01) and 2012 (r = 0.24, p = 0.005), and the snacking dietary pattern score correlated with FN BMD in 2010 (r = 0.18, p = 0.03) and 2012 (r = 0.21, p = 0.02). The baseline CTx-1 and dietary magnesium intake predicted 22% of the variance in percentage change of CTx-1 over two years (p < 0.001).The magnesium intake predicted short-term bone resorption over two years.
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Affiliation(s)
- Hattie H Wright
- School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore 4556, Australia.
- Centre of Excellence for Nutrition, North-West University, Potchefstroom 2520, South Africa.
| | - Marlena C Kruger
- School of Health Sciences, Massey University, Palmerston North 4410, New Zealand.
| | - Willem D Schutte
- Centre for Business Mathematics and Informatics, North-West University, Potchefstroom 2520, South Africa.
| | | | - Iolanthe M Kruger
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom 2520, South Africa.
| | - Herculina S Kruger
- Centre of Excellence for Nutrition, North-West University, Potchefstroom 2520, South Africa.
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19
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Kato CN, Tavares NP, Barra SG, Amaral TM, Brasileiro CB, Abreu LG, Mesquita RA. Digital panoramic radiography and cone-beam CT as ancillary tools to detect low bone mineral density in post-menopausal women. Dentomaxillofac Radiol 2018; 48:20180254. [PMID: 30306800 DOI: 10.1259/dmfr.20180254] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the usefulness of the mandibular cortical index (MCI) obtained by digital panoramic radiography (DPR) and by panoramic reconstruction (PR) of cone-beam CT (CBCT) with three different slice thicknesses for the screening of low bone mineral density (BMD) in post-menopausal women. METHODS Two trained oral and maxillofacial radiologists assessed the MCI based on the morphology of the mandibular bone cortex (classified as C1, C2 or C3). The DPR and PR of CBCT with slice thicknesses of 5, 15 or 25 mm were compared to the BMD obtained by dual-energy X-ray absorptiometry (DXA) in post-menopausal women. Measures related to accuracy were calculated with MedCalc software. The confidence interval was set at 95%. RESULTS 54 women (mean age 58.70 ± 7.35 years) participated in the study. The sensitivity and specificity values obtained for DPR were 52.6% and 56.2%, respectively, and values for PR of CBCT with 5, 15, and 25 mm slice thicknesses were 63.1% and 43.7%, 50.0% and 50.0%, and 52.6% and 62.5%, respectively. For the tools evaluated, the positive likelihood ratio ranged from 1.00 to 1.40 and negative likelihood ratio from 0.76 to 1.00. The positive predictive value (PPV) ranged from 70.4 to 76.9% and the negative predictive value (NPV) from 29.6 to 35.7%. Among the examinations, the highest value for area under the curve (AUC) was obtained for CBCT with 25 mm slice thickness (57.6%). CONCLUSIONS The MCI calculated by DPR and CBCT differed with regard to accuracy. Within the limitations of this study, the PR of CBCT with 25 mm slice thicknesses seems to be the most accurate among the examinations evaluated. Should the dentist be attentive, DPR and CBCT may be useful tools for the screening of low BMD in post-menopausal women, facilitating their timely referral for further assessment.
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Affiliation(s)
- Camila Nao Kato
- 1 Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Núbia Pk Tavares
- 1 Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Sâmila G Barra
- 1 Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Tânia Mp Amaral
- 1 Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Cláudia B Brasileiro
- 1 Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Lucas G Abreu
- 2 Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Ricardo A Mesquita
- 1 Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais , Belo Horizonte , Brazil
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20
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Clement Z, Kollias J, Bingham J, Whitfield R, Bochner M. Extended duration of adjuvant aromatase inhibitor in breast cancer: a meta-analysis of randomized controlled trials. Gland Surg 2018; 7:449-457. [PMID: 30505766 DOI: 10.21037/gs.2018.08.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background The risk of hormone positive breast cancer extends beyond 5 years. Extended duration of tamoxifen to 10 years has been shown to improve overall survival (OS) and disease-free survival (DFS). In post-menopausal women aromatase inhibitor (AI) is the gold standard for adjuvant endocrine therapy. Several randomized controlled trials (RCTs) showed benefit with extending the duration of AIs in post-menopausal women. However, the duration and the overall benefit is still controversial. Methods Eligible 8 RCTs comprising of 17,190 participants were included in this meta-analysis. Results Extending the duration of AI did not show any statistically significant advantage in OS with OR of 1.033 (95% CI: 0.925-1.154, P=0.56), DFS OR of 1.049 (95% CI: 0.930-1.185, P=0.435), recurrence-free survival (RFS) OR of 1.063 (95% CI: 0.952-1.187, P=0.276), and contralateral breast cancer (CBC) OR of 1.094 (95% CI: 0.920-1.301, P=0.311). Higher rates of side-effects of arthralgia, myalgia, hot flushes and bone toxicity was seen among the extended AI group. Conclusions Based on this meta-analysis and current literature review, extended use of AI after 5 years of endocrine therapy should be used in selected women with high risk tumour factors. Molecular markers and genomic profiling may assist in identifying the high-risk patients. It is important to consider quality of life and patient satisfaction when considering extending the duration of AI.
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Affiliation(s)
- Zackariah Clement
- Breast and Endocrine Surgery Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - James Kollias
- Breast and Endocrine Surgery Unit, Royal Adelaide Hospital, Adelaide, Australia.,Senior Clinical Lecturer, Department of Surgery, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Janne Bingham
- Breast and Endocrine Surgery Unit, Royal Adelaide Hospital, Adelaide, Australia.,Senior Clinical Lecturer, Department of Surgery, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Robert Whitfield
- Breast and Endocrine Surgery Unit, Royal Adelaide Hospital, Adelaide, Australia.,Senior Clinical Lecturer, Department of Surgery, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Melissa Bochner
- Breast and Endocrine Surgery Unit, Royal Adelaide Hospital, Adelaide, Australia.,Senior Clinical Lecturer, Department of Surgery, Adelaide Medical School, University of Adelaide, Adelaide, Australia
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Nguyen HPT, Xiao L, Deane JA, Tan KS, Cousins FL, Masuda H, Sprung CN, Rosamilia A, Gargett CE. N-cadherin identifies human endometrial epithelial progenitor cells by in vitro stem cell assays. Hum Reprod 2018; 32:2254-2268. [PMID: 29040564 DOI: 10.1093/humrep/dex289] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 08/25/2017] [Indexed: 12/28/2022] Open
Abstract
STUDY QUESTION Is there a specific surface marker that identifies human endometrial epithelial progenitor cells with adult stem cell activity using in vitro assays? SUMMARY ANSWER N-cadherin isolates clonogenic, self-renewing human endometrial epithelial progenitor cells with high proliferative potential that differentiate into cytokeratin+ gland-like structures in vitro and identifies their location in some cells of gland profiles predominantly in basalis endometrium adjacent to the myometrium. WHAT IS KNOWN ALREADY Human endometrium contains a small population of clonogenic, self-renewing epithelial cells with high proliferative potential that differentiate into large gland-like structures, but their identity and location is unknown. Stage-specific embryonic antigen-1 (SSEA-1) distinguishes the epithelium of basalis from functionalis and is a marker of human post-menopausal (Post-M) endometrial epithelium. STUDY DESIGN, SIZE, DURATION Prospective observational study of endometrial epithelial cells obtained from hysterectomy samples taken from 50 pre-menopausal (Pre-M) and 24 Post-M women, of which 4 were from women who had taken daily estradiol valerate 2 mg/day for 8 weeks prior. PARTICIPANTS/MATERIALS, SETTING, METHODS Gene profiling was used to identify differentially expressed surface markers between fresh EpCAM (Epithelial Cell Adhesion Molecule)-magnetic bead-selected basalis-like epithelial cells from Post-M endometrium compared with predominantly functionalis epithelial cells from Pre-M endometrium and validated by qRT-PCR. In vitro clonogenicity and self-renewal assays were used to assess the stem/progenitor cell properties of magnetic bead-sorted N-cadherin+ and N-cadherin- epithelial cells. The cellular identity, location and phenotype of N-cadherin+ cells was assessed by dual colour immunofluorescence and confocal microscopy for cytokeratin, proliferative status (Ki-67), ERα, SSEA-1, SOX9 and epithelial mesenchymal transition (EMT) markers on full thickness human endometrium. MAIN RESULTS AND THE ROLE OF CHANCE CDH2 (N-cadherin gene) was one of 11 surface molecules highly expressed in Post-M compared to Pre-M endometrial epithelial cells. N-cadherin+ cells comprise a median 16.7% (n = 8) and 20.2% (n = 5) of Pre-M endometrial epithelial cells by flow cytometry and magnetic bead sorting, respectively. N-cadherin+ epithelial cells from Pre-M endometrium were more clonogenic than N-cadherin- cells (n = 12, P = 0.003), underwent more population doublings (n = 7), showed greater capacity for serial cloning (n = 7) and differentiated into cytokeratin+ gland-like organoids. N-cadherin immunolocalised to the lateral and apical membrane of epithelial cells in the bases of glands in the basalis of Pre-M endometrium and Post-M gland profiles, co-expressing cytokeratin, ERα but not SSEA-1 or SOX9, which localized on gland profiles proximal to N-cadherin+ cells. N-cadherin+ cells were quiescent (Ki-67-) in the basalis and in Post-M endometrial glands and co-localized with EMT markers vimentin and E-cadherin. LARGE SCALE DATA The raw and processed data files from the gene microarray have been deposited in the National Center for Biotechnology Information Gene Expression Omnibus data set with accession number GSE35221. LIMITATIONS, REASONS FOR CAUTION This is a descriptive study in human endometrium only using in vitro stem cell assays. The differential ability of N-cadherin+ and N-cadherin-cells to generate endometrial glands in vivo was not determined. A small number of uterine tissues analysed contained adenomyosis for which N-cadherin has been implicated in epithelial-EMT. WIDER IMPLICATIONS OF THE FINDINGS A new marker enriching for human endometrial epithelial progenitor cells identifies a different and potentially more primitive cell population than SSEA-1, suggesting a potential hierarchy of epithelial differentiation in the basalis. Using N-cadherin as a marker, the molecular and cellular characteristics of epithelial progenitor cells and their role in endometrial proliferative disorders including endometriosis, adenomyosis and thin dysfunctional endometrium can be investigated. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by Cancer Council Victoria grant 491079 (C.E.G.) and Australian National Health and Medical Research Council grants 1021127 (C.E.G.), 1085435 (C.E.G., J.A.D.), 145780 and 288713 (C.N.S.), RD Wright Career Development Award 465121 (C.E.G.), Senior Research Fellowship 1042298 (C.E.G.), the Victorian Government's Operational Infrastructure Support and an Australian Postgraduate Award (HPTN), and China Council Scholarship (L.X.). The authors have nothing to declare.
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Affiliation(s)
- Hong P T Nguyen
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia
| | - L Xiao
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Gynecology and Obstetrics, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - James A Deane
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia
| | - Ker-Sin Tan
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Fiona L Cousins
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia
| | - Hirotaka Masuda
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia.,Department of Obstetrics and Gynaecology, Keio University, Tokyo 160-8582, Japan
| | - Carl N Sprung
- Centre for Innate Immunity and Infectious Disease, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, Victoria 3168, Australia
| | - Anna Rosamilia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia
| | - Caroline E Gargett
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia
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Abstract
Introduction Aromatase enzyme activity is predominant in adipose tissue. This has led to speculation that aromatase activity is elevated in obese women and subsequently decreased the clinical activity of adjuvant aromatase inhibitors (AIs) in women with estrogen receptor positive (ER+) breast cancer (BC). We investigated the effect of obesity on the outcome of this population. Patients and methods Records of 320 consecutive post-menopausal (PM) women with ER+ BC starting single agent adjuvant letrozole between years 2005 and 2014 were retrospectively reviewed. Tumour and patients characteristic including body mass index (BMI) on the day of starting letrozole were extracted. Endpoints of main interest were: (1) Frequency of obesity; (2) relapse-free survival (RFS) in nonobese (G1; BMI < 30) and obese (G2; BMI ≥ 30) patients. Results Obesity (BMI: 30–34.99) and morbid obesity (BMI ≥ 35) were present in 105/320 (32.8%) and 115/320 (35.9%) women, respectively. Median follow-up of patients was 49 months; RFS at 5 years (G1: 69% versus G2: 78%) and at 8 years (G1: 69% versus G2: 71%). Median RFS is not reached in both groups (Log rank; P = 0.097). There was no correlation between BMI and RFS (correlation coefficient r = 0.075; P = 0.174). Conclusion In this cohort, more than two-thirds of PM women starting adjuvant AIs are obese. Obesity did not adversely affect the outcome of women on adjuvant letrozole.
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Affiliation(s)
- Jamal Zekri
- College of Medicine, Al-Faisal University, Riyadh 11533, Saudi Arabia.,King Faisal Specialist Hospital & Research Centre, Jeddah 21499, Saudi Arabia
| | - Kamel Farag
- King Faisal Specialist Hospital & Research Centre, Jeddah 21499, Saudi Arabia.,Mansoura University, Mansoura, Egypt
| | - Ahmed Allithy
- King Faisal Specialist Hospital & Research Centre, Jeddah 21499, Saudi Arabia
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Sillanpää E, Niskala P, Laakkonen EK, Ponsot E, Alén M, Kaprio J, Kadi F, Kovanen V, Sipilä S. Leukocyte and Skeletal Muscle Telomere Length and Body Composition in Monozygotic Twin Pairs Discordant for Long-term Hormone Replacement Therapy. Twin Res Hum Genet 2017; 20:119-31. [PMID: 28193312 DOI: 10.1017/thg.2017.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Estrogen-based hormone replacement therapy (HRT) may be associated with deceleration of cellular aging. We investigated whether long-term HRT has effects on leukocyte (LTL) or mean and minimum skeletal muscle telomere length (SMTL) in a design that controls for genotype and childhood environment. Associations between telomeres, body composition, and physical performance were also examined. Eleven monozygotic twin pairs (age 57.6 ± 1.8 years) discordant for HRT were studied. Mean duration of HRT use was 7.3 ± 3.7 years in the user sister, while their co-twins had never used HRT. LTL was measured by qPCR and SMTLs by southern blot. Body and muscle composition were estimated by bioimpedance and computed tomography, respectively. Physical performance was measured by jumping height and grip strength. HRT users and non-users did not differ in LTL or mean or minimum SMTL. Within-pair correlations were high in LTL (r = 0.69, p = .020) and in mean (r = 0.74, p = .014) and minimum SMTL (r = 0.88, p = .001). Body composition and performance were better in users than non-users. In analyses of individuals, LTL was associated with BMI (r 2 = 0.30, p = .030), percentage total body (r 2 = 0.43, p = .014), and thigh (r 2 = 0.55, p = .004) fat, while minimum SMTL was associated with fat-free mass (r 2 = 0.27, p = .020) and thigh muscle area (r 2 = 0.42, p = .016). We found no associations between HRT use and telomere length. Longer LTLs were associated with lower total and regional fat, while longer minimum SMTLs were associated with higher fat-free mass and greater thigh muscle area. This suggests that telomeres measured from different tissues may have different associations with measures of body composition.
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Prince RM, Amir E. Update in treatment of early breast cancer in post-menopausal women. Expert Rev Endocrinol Metab 2016; 11:243-252. [PMID: 30058935 DOI: 10.1080/17446651.2016.1175937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In the last few years there have been significant advances in knowledge related to the treatment of post-menopausal women with early stage breast cancer. These include new information about the survival benefits with hormonal therapies and bone targeted treatments as well as identification of patient populations who may be able to avoid toxic treatments. In this paper we discuss these advances and provide suggested management algorithms.
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Affiliation(s)
- Rebecca M Prince
- a Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre and the Department of Medicine , University of Toronto , Toronto , Canada
| | - Eitan Amir
- a Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre and the Department of Medicine , University of Toronto , Toronto , Canada
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25
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Guérin A, Hao Y, Tang D, Peeples M, Fang A, Kageleiry A, Koo V, Li N, Wu EQ. Treatment patterns and factors associated with the use of everolimus among post-menopausal women with HR+/HER2- metastatic breast cancer: a retrospective US claims study. Expert Opin Pharmacother 2016; 17:1189-96. [PMID: 27052735 DOI: 10.1080/14656566.2016.1176148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To assess the real-world use of everolimus in the treatment of hormone-receptor-positive/human-epidermal-growth-factor-receptor-2-negative (HR+/HER2-) metastatic-breast-cancer (mBC). METHODS Postmenopausal women with HR+/HER2- mBC who initiated a new therapy for mBC between 20 July 2012 and 31 March 2014 after a non-steroidal-aromatase-inhibitor were identified from two commercial claims databases. Multivariate logistic regressions were used to identify factors associated with everolimus use versus endocrine-monotherapy or chemotherapy. Dosing patterns and adherence to everolimus were summarized. RESULTS A total of 940 everolimus, 6,134 endocrine-monotherapy, and 3,410 chemotherapy regimens were included across patients' first four lines of therapy. Patients with bone and visceral metastases were more likely to use everolimus versus endocrine-monotherapy. Patients with more comorbidities, visceral or central-nervous-system metastases, and prior chemotherapy use for mBC were less likely to use everolimus versus chemotherapy. Approximately 80% of patients initiated everolimus at label-recommended-dose of 10 mg daily; 60-70% of patients had a medical possession ratio >0.8 to everolimus, and consistently high adherence was observed across lines of therapy. CONCLUSIONS For HR+/HER2- mBC, patients treated with everolimus had more severe disease than patients treated with endocrine-monotherapy but less severe disease than patients treated with chemotherapy. Most patients used everolimus according to label-recommended dose and adherence was high across lines of therapy.
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Affiliation(s)
| | - Yanni Hao
- b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - Derek Tang
- b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | | | - Anna Fang
- c Analysis Group, Inc ., Boston , MA , USA
| | | | | | - Nanxin Li
- c Analysis Group, Inc ., Boston , MA , USA
| | - Eric Q Wu
- c Analysis Group, Inc ., Boston , MA , USA
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Abstract
Objective To explore the efficacy of local oxytocin for the treatment of post-menopausal vaginal atrophy. Design Double-blinded randomised controlled trial. Setting Healthy post-menopausal women in Stockholm, Sweden. Participants Sixty four post-menopausal women between February and June 2012 at the Karolinska University Hospital Huddinge/Sweden. Main outcome measures The efficacy of oxytocin for treatment of vaginal atrophy after seven weeks and cytological evaluation. Results The percentage of superficial cells in the vaginal smears and the maturation values were significantly increased after seven weeks of treatment with vagitocin 400 IU (p = 0.0288 and p = 0.0002, respectively). The vaginal pH decreased significantly after seven weeks of treatment with vagitocin 100 IU (p = 0.02). The scores of vaginal atrophy, according to the histological evaluation, were significantly reduced after administration of vagitocin 100 IU (p = 0.03). The thickness of the endometrium did not differ between the treatment and placebo groups after seven weeks of treatment. The symptom experienced as the most bothersome was significantly reduced after seven weeks of treatment in the women receiving vagitocin 400 IU compared to women in the placebo group (p = 0.0089). Conclusions Treatment with intravaginally applied oxytocin could be an alternative to local estrogen treatment in women with post-menopausal vaginal atrophy.
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Affiliation(s)
- Shahla H Al-Saqi
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Uvnäs-Moberg
- Department of Animal Environment and Health, Swedish University of Agricultural Sciences, Skara, Sweden School of Life Science, University of Skövde, Skövde, Sweden
| | - Aino F Jonasson
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Browall M, Kenne Sarenmalm E, Persson LO, Wengström Y, Gaston-Johansson F. Patient-reported stressful events and coping strategies in post-menopausal women with breast cancer. Eur J Cancer Care (Engl) 2015; 25:324-33. [PMID: 25690645 DOI: 10.1111/ecc.12294] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2014] [Indexed: 01/11/2023]
Abstract
The objective of this paper was to explore what stressful events post-menopausal women with primary or recurrent breast cancer experience, how bothersome these events were and which coping strategies these women used. Data were collected from 131 patients diagnosed with primary or recurrent breast cancer. The Daily Coping Assessment was used. Thematic analysis was applied to form themes of stressful events. Six types of stressful events were extracted. The most frequently experienced events for women with primary cancer and those with recurrent cancer were 'distressing bodily symptoms'. The most bothersome event among primary cancer was 'everyday concerns' and in the recurrent group, 'distressing psychological reactions'. The most commonly used strategies were 'acceptance', 'distraction' and 'relaxation'. This study shows that women in different parts of the cancer trajectory differ in what they perceive to be stressful events when reporting them in their own words in a diary. The differences have an impact on the subsequent coping strategies they used.
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Affiliation(s)
- M Browall
- School of Health and Education, University of Skövde, Skövde, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
| | | | - L-O Persson
- Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Y Wengström
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
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Abstract
BACKGROUND The objective of this study was to estimate the cost-effectiveness of denosumab for fracture prevention compared with no treatment, generic bisphosphonates, and strontium ranelate in a cohort of osteoporotic postmenopausal women in Spain. METHODS A Markov model represented the possible health state transitions of Spanish postmenopausal women from initiation of fracture prevention treatment until age 100 years or death. The perspective was that of the Spanish National Health System. Fracture efficacy data for denosumab were taken from a randomized controlled trial. Fracture efficacy data for alendronate, ibandronate, risedronate, and strontium ranelate were taken from an independent meta-analysis. Data on the incidence of fractures in Spain were either taken from the published literature or derived from Swedish data after applying a correction factor based on the reported incidence from each country. Resource use in each health state was obtained from the literature, or where no data had been published, conservative assumptions were made. Utility values for the various fracture health states were taken from published sources. The primary endpoints of the model were life-years gained, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios for denosumab against the comparators. RESULTS Denosumab reduced the risk of fractures compared with either no treatment or the other active interventions, and produced the greatest gains in life-years and QALYs. With an annual acquisition cost of €417.34 for denosumab, the incremental cost-effectiveness ratios for denosumab versus no treatment, alendronate, risedronate, and ibandronate were estimated at €6,823, €16,294, €4,895, and €2,205 per QALY gained, respectively. Denosumab dominated strontium ranelate. Sensitivity analyses confirmed the robustness of these findings. CONCLUSION Our analyses show that denosumab is a cost-effective intervention for fracture prevention in osteoporotic postmenopausal women in Spain compared with alendronate and risedronate, and is a dominant treatment option compared with strontium ranelate.
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Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
| | - Lisette Kaskens
- BCN Health Economics and Outcomes Research SL, Barcelona, Spain
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Yu S, Yang H, Guo X, Zheng L, Sun Y. Hyperuricemia is independently associated with left ventricular hypertrophy in post-menopausal women but not in pre-menopausal women in rural Northeast China. Gynecol Endocrinol 2015; 31:736-41. [PMID: 26376959 DOI: 10.3109/09513590.2015.1056730] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The aim of this article is to estimate the relationship between hyperuricemia and left ventricular hypertrophy (LVH) and to investigate whether menopause was associated with the relationship between hyperuricemia and LVH. This survey was conducted from July 2012 to August 2013. A total of 6029 women (3508, 58.2% were post-menopause) from the rural Northeast China were randomly selected and examined. LVH was defined using the 2007 Guidelines for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Age, body mass index, glucose, estimated glomerular filtration rate and lipid level were significantly correlated with serum uric acid level. LVH showed a gradual increase in accordance with the serum uric acid level in entire study population (<4.0 mg/dL, 11.4%; 4 to <5 mg/dL, 14.9%; 5 to <6 mg/dL, 18.9%; ≥6 mg/dL, 27.4%; p < 0.001). Multivariate analysis revealed that hyperuricemia was a significantly independent risk factor for LVH in post-menopausal women [OR (95% CI): 1.367 (1.026, 1.821)], but not in pre-menopausal women [OR (95% CI): 1.290 (0.669, 2.486)]. These findings suggested that hyperuricemia can be used as a risk marker of LVH in a female population and, in particular, as an independent risk factor in post-menopausal women but not in pre-menopausal women.
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Affiliation(s)
- Shasha Yu
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , Liaoning , China and
| | - Hongmei Yang
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , Liaoning , China and
| | - Xiaofan Guo
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , Liaoning , China and
| | - Liqiang Zheng
- b Department of Clinical Epidemiology , Shenjing Hospital of China Medical University , Shenyang , Liaoning , China
| | - Yingxian Sun
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , Liaoning , China and
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Benagiano G, Brosens I, Habiba M. Adenomyosis: a life-cycle approach. Reprod Biomed Online 2014; 30:220-32. [PMID: 25599903 DOI: 10.1016/j.rbmo.2014.11.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/12/2014] [Accepted: 11/12/2014] [Indexed: 11/30/2022]
Abstract
The life-cycle approach to endometriosis highlighted unexpected features of the condition; the same approach was therefore applied to gain insight into the clinical features of adenomyosis and to draw a comparison with endometriosis. This is possible today thanks to new imaging techniques enabling non-invasive diagnosis of adenomyosis. The specificity and sensitivity of magnetic resonance imaging and transvaginal ultrasound remain uncertain. Unlike endometriosis, little information is available on the presence of classic adenomyosis in adolescents, except for rare cystic forms that may not represent the true disease. Adenomyosis is most likely to affect adult women, although most reported incidences are still based on post-hysterectomy studies, and are affected by diligence in histopathologic diagnosis and the adopted cut-off point. The traditionally accepted associations of adult adenomyosis, such as multiparity, a link to infertility and its effect on pregnancy are uncertain. Active adenomyosis has been found in pre- and peri-menopausal women and in postmenopausal women receiving tamoxifen. In conclusion, major diagnostic limitations and the systematic bias of hysterectomy make it difficult to draw firm conclusions from existing evidence. In addition, no information is available on the natural history of adenomyosis and no study has systematically evaluated its existence in adolescents.
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Affiliation(s)
- Giuseppe Benagiano
- Department of Gynaecology, Obstetrics and Urology, Sapienza University, 00161 Rome, Italy
| | - Ivo Brosens
- Leuven and Leuven Institute for Fertility and Embryology, Catholic University, 3000 Leuven, Belgium.
| | - Marwan Habiba
- Reproductive Sciences Section, University of Leicester, University Hospitals of Leicester, Leicester LE2 7LX, UK
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31
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Rodriguez-Garcia M, Barr FD, Crist SG, Fahey JV, Wira CR. Phenotype and susceptibility to HIV infection of CD4+ Th17 cells in the human female reproductive tract. Mucosal Immunol 2014; 7:1375-85. [PMID: 24759207 DOI: 10.1038/mi.2014.26] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 03/13/2014] [Indexed: 02/04/2023]
Abstract
Prevention of sexual acquisition of HIV in women requires a substantial increase in our knowledge about HIV-target cell availability and regulation in the female reproductive tract (FRT). In this study, we analyzed the phenotype and susceptibility to HIV infection of CD4(+) T cell in the endometrium (EM), endocervix (END), and ectocervix (ECT) of the FRT. We found that T helper type 17 (Th17) cells represent a major subset in FRT tissues analyzed and that Th17 cells were the main CD4(+) T-cell population expressing C-C motif chemokine receptor 5 (CCR5) and CD90. In premenopausal women, CD4(+) T cells and Th17 cells, in particular, were significantly lower in EM relative to END and ECT. Th17 cells were elevated in EM from postmenopausal women relative to premenopausal tissues but not changed in END and ECT. Susceptibility of CD4(+) T cells to HIV infection measured as intracellular p24 was lowest in the EM and highest in the ECT. Additionally, we found that Th17 cells co-expressing CCR5 and CD90 were the most susceptible to HIV infection. Our results provide valuable information for designing preventive strategies directed at targeting highly susceptible target cells in the FRT.
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Singh B, Pallagatti S, Narang RS, Kaur K, Sheikh S, Manchanda A, Arora G. Evaluation of serum calcium and serum parathyroid levels in post-menopausal women with and without oral dryness. Gerodontology 2014; 33:240-6. [PMID: 25220404 DOI: 10.1111/ger.12148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The primary objective of this study was to estimate and secondary objective was to compare the serum calcium levels and serum parathyroid hormone (PTH) levels in post-menopausal women with and without oral dryness (OD). MATERIALS AND METHODS A case-control study was carried out on 80 selected post-menopausal women. Salivary flow was assessed by flow rate; serum calcium concentrations were assessed through Semi Autoanalyzer by Arsenazo III reaction. The serum PTH concentration was measured by the enzyme-linked immunosorbent assay. Severity of OD was assessed by a questionnaire through which the xerostomia inventory (XI) score could be measured. Statistical analysis of Student's t-test, Mann-Whitney test and Pearson's correlation was used. RESULTS There was a significant difference in mean values of both serum PTH concentration and XI score in post-menopausal women with/without OD (p < 0.001). No statistically significant difference (p = 0.354) was found in salivary flow rate and serum calcium levels in post-menopausal women in both groups. A positive correlation was found between the serum PTH and XI score in both case and control groups (p < 0.05). CONCLUSION Severity of oral dryness in post-menopausal women is associated with the high levels of serum PTH. However, the correlation of severity of OD with serum calcium could not be established.
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Affiliation(s)
- Balwinder Singh
- Department of Oral Medicine and Radiology, SGRD Institute of Dental Sciences & Research, Amritsar, India
| | - Shambulingappa Pallagatti
- Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, India
| | - Ramandeep Singh Narang
- Department of Oral & Maxillofacial Pathology, SGRD Institute of Dental Sciences and Research, Amritsar, India
| | - Kirandeep Kaur
- Department of Oral & Maxillofacial Surgery, SGRD Institute of Dental Sciences & Research, Amritsar, India
| | - Soheyl Sheikh
- Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, India
| | - Adesh Manchanda
- Department of Oral & Maxillofacial Pathology, SGRD Institute of Dental Sciences and Research, Amritsar, India
| | - Gagandeep Arora
- Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, India
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Abstract
STUDY QUESTION Does post-menopausal endometrium contain mesenchymal stem/stromal cells (MSC) that have adult stem cell properties and can be prospectively isolated from a biopsy? SUMMARY ANSWER Perivascular W5C5(+) cells isolated from post-menopausal endometrial biopsies displayed characteristic MSC properties of clonogenicity, multipotency and surface phenotype irrespective of whether the women were or were not pre-treated with estrogen to regenerate the endometrium. WHAT IS KNOWN ALREADY Recently MSCs have been identified in human premenopausal endometrium, and can be prospectively isolated using a single marker, W5C5/SUSD2. STUDY DESIGN, SIZE, DURATION Endometrial tissue of both the functional and basal layers, from 17 premenopausal (pre-MP) women, 19 post-menopausal (post-MP) women without hormonal treatment and 15 post-menopausal women on estrogen replacement therapy (post-MP+ E2), was collected through a prospective phase IV clinical trial over 2 years. PARTICIPANTS/MATERIALS, SETTING, METHODS Post-menopausal women <65 years of age were treated with or without E2 for 6-8 weeks prior to tissue collection. Serum E2 levels were determined by estradiol immunoenzymatic assay. Endometrial tissue was obtained from women by biopsy (curettage) just prior to the hysterectomy. The effect of E2 on endometrial thickness and glandular and luminal epithelial height was determined using image analysis. Endometrial tissue was dissociated into single cell suspensions and MSC properties were examined in freshly isolated and short-term cultured, magnetic bead-purified W5C5(+) cells. MSC properties were assessed using clonogenicity, serial cloning, mesodermal differentiation in adipogenic, chondrogenic, osteogenic and myogenic induction culture media, and surface phenotype analysis by flow cytometry. Estrogen receptor α expression in W5C5(+) cells was examined using dual colour immunofluorescence. Vascularity was analysed using CD34 and alpha smooth muscle actin immunostaining and subsequent image analysis. MAIN RESULTS AND THE ROLE OF CHANCE A small population of stromal cells with MSC properties was purified with the W5C5 antibody from post-menopausal endometrium, whether atrophic from low circulating estrogen or regenerated from systemic estrogen treatment, similar to premenopausal endometrium. The MSC derived from post-menopausal endometrium treated with or without E2 fulfilled the minimum MSC criteria: clonogenicity, surface phenotype (CD29(+), CD44(+), CD73(+), CD105(+), CD140b(+), CD146(+)) and multipotency. The post-menopausal endometrial MSCs also showed comparable properties to premenopausal eMSC with respect to self-renewal in vitro and W5C5 expression. The W5C5(+) cells were located perivascularly as expected and did not express estrogen receptor α. LIMITATIONS, REASONS FOR CAUTION The properties of the MSC derived from post-menopausal endometrium were evaluated in vitro and their in vivo tissue reconstitution capacity has not been established as it has for premenopausal endometrial MSC. WIDER IMPLICATIONS OF THE FINDINGS The endometrium is an accessible source of MSC obtainable with minimum morbidity that could be used for future clinical applications as a cell-based therapy. This study shows that menopausal women can access their endometrial MSC by a simple biopsy for use in autologous therapies, particularly if their endometrium has been regenerated by short-term E2 treatment, provided they have an intact uterus and are not contraindicated for short-term E2 treatment. Endometrial MSC in post-menopausal women possess key MSC properties and are a promising source of MSC independent of a woman's age. STUDY FUNDING/COMPETING INTERESTS This study was supported by the National Health and Medical Research Council (NHMRC) of Australia grant (1021126) (C.E.G., A.R.) and Senior Research Fellowship (1042298) (C.E.G.), Australian Gynaecological Endoscopic Society grant (A.R.) , Monash International Postgraduate Research Scholarship (DU), Australian Stem Cell Centre, South East Melbourne Alliance for Regenerative Therapies and Australian Stem Cell Centre top up scholarships (DU) and Victorian Government's Operational Infrastructure Support Program. Competing interests: AR receives Preceptorship fees from AMS, advisory board fees and sponsored study from Astellas, and conducts investigator led studies sponsored by AMS and Boston Scientific for other projects. TRIAL REGISTRATION NUMBER CTNRN12610000563066.
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Affiliation(s)
- D Ulrich
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, 27-31 Wright Street, Clayton, VIC 3168, Australia Monash University Department of Obstetrics and Gynaecology, Monash Medical Centre, 246 Clayton Road, Clayton, VIC 3168, Australia Present address: Department of Obstetrics and Gynaecology, Medical University Graz, 8045 Graz, Austria
| | - K S Tan
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, 27-31 Wright Street, Clayton, VIC 3168, Australia
| | - J Deane
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, 27-31 Wright Street, Clayton, VIC 3168, Australia
| | - K Schwab
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, 27-31 Wright Street, Clayton, VIC 3168, Australia
| | - A Cheong
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, 27-31 Wright Street, Clayton, VIC 3168, Australia
| | - A Rosamilia
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, 27-31 Wright Street, Clayton, VIC 3168, Australia Monash University Department of Obstetrics and Gynaecology, Monash Medical Centre, 246 Clayton Road, Clayton, VIC 3168, Australia
| | - C E Gargett
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, 27-31 Wright Street, Clayton, VIC 3168, Australia Monash University Department of Obstetrics and Gynaecology, Monash Medical Centre, 246 Clayton Road, Clayton, VIC 3168, Australia
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Abstract
Alzheimer disease (AD) is a crippling neurodegenerative disorder. It is more common in females after menopause. Estrogen probably has a protective role in cognitive decline. Large amount of research has been carried out to see the benefits of hormone replacement therapy with regards to Alzheimer still its neuroprotective effect is not established. Recent studies suggest a reduced risk of AD and improved cognitive functioning of post-menopausal women who used 17 β-estradiol in the critical period. Use of 17 β-estradiol in young and healthy post-menopausal women yields the maximum benefit when the neurons are intact or neuronal stress has just started. Hence intervention in the critical period is key in the prevention or delay of AD in post-menopausal women.
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Affiliation(s)
- Nayer Jamshed
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Fouzia Firdaus Ozair
- Department of Forensic Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Meera Ekka
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
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Zhou J, Chen Y, Huang Y, Long J, Wan F, Zhang S. Serum follicle-stimulating hormone level is associated with human epidermal growth factor receptor type 2 and Ki67 expression in post-menopausal females with breast cancer. Oncol Lett 2013; 6:1128-1132. [PMID: 24137476 PMCID: PMC3796423 DOI: 10.3892/ol.2013.1516] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 07/25/2013] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to determine the association between levels of the gender hormones, follicle-stimulating hormone (FSH), luteinizing hormone (LH), progesterone (P) and prolactin (PRL), and two breast cancer molecular markers, human epidermal growth factor receptor 2 (Her-2) and Ki67, in post-menopausal patients with breast cancer. A retrospective study of the serum hormone levels of FSH, LH, P and PRL and the expression status of Her-2 and Ki67 was performed using 187 post-menopausal females with breast cancer. Her-2+ breast cancer patients exhibited higher serum FSH levels compared with Her-2− patients (69.47±3.219 vs. 58.56±1.516 IU/l). The patients with high Ki67 expression [immunohistochemistry (IHC), 3+] displayed higher FSH (72.51±4.616 vs. 60.53±1.476 IU/l) and LH (32.33±1.916 vs. 26.98±0.8852 IU/l) levels than those with lower Ki67 expression. No correlation was identified between the FSH, LH, P and PRL hormone levels, tumor stages and lymphovascular invasion (LVI). In conclusion, a higher serum FSH level was identified in Her-2+ post-menopausal patients with breast cancer. Higher serum FSH and LH levels were also observed in breast cancer patients with high Ki67 expression. FSH and LH may function in the progression of breast cancer.
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Affiliation(s)
- Jun Zhou
- Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences of Zhejiang, Cancer Institute of Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China ; Department of Surgery, The Women's Hospital of Zhejiang University, Hangzhou, Zhejiang 310006, P.R. China
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Swift DL, Weltman JY, Patrie JT, Barrett EJ, Gaesser GA, Weltman A. Evaluation of racial differences in resting and postprandial endothelial function in postmenopausal women matched for age, fitness and body composition. Ethn Dis 2013; 23:43-48. [PMID: 23495621 PMCID: PMC3995405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE We investigated endothelial function at rest and after a high-fat meal challenge in African American (AA) and Caucasian postmenopausal women matched for age, body mass index, percent fat and fitness level. DESIGN Pilot study. SETTING University of Virginia General Clinical Research Center. PARTICIPANTS Eight AA and 8 Caucasian postmenopausal women. INTERVENTION PARTICIPANTS underwent a VO2 peak treadmill protocol, percent fat assessment, and brachial artery flow-mediated dilation measurements (baseline and 4 hours following a high-fat meal). MAIN OUTCOMES MEASURES Baseline and postprandial flow mediated dilation (FMD) following a high-fat meal. RESULTS FMD values were similar in AA (5.4%, 95% CI: 3.3, 7.4) and Caucasian women (4.0%, 95% CI: 2.0, 6.1). There was no significant change in FMD from baseline to four hours following the meal challenge within groups (AA: .9%, P = .397, Caucasian: 2.3%, P = .063) or between groups (P = .449), despite a significant increase in triglycerides (AA: 81.8 mg/dL, P < .001, Caucasian: 99.7 mg/dL, P = .004). CONCLUSIONS The present pilot study found that when postmenopausal AA and Caucasian women are matched for age, fitness and body composition, reported racial differences in resting endothelial function were not observed. Additionally, there were no racial differences in postprandial endothelial function or metabolism following a high-fat meal.
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Affiliation(s)
- Damon L Swift
- Department of Human Services, General Clinical Research Center, University of Virginia, Charlottesville, Virginia, USA.
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Madanmohan, Bhavanani AB, Dayanidy G, Sanjay Z, Basavaraddi IV. Effect of yoga therapy on reaction time, biochemical parameters and wellness score of peri and post-menopausal diabetic patients. Int J Yoga 2012; 5:10-5. [PMID: 22346060 PMCID: PMC3276926 DOI: 10.4103/0973-6131.91696] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Yogic practices may aid in the prevention and management of diabetes mellitus (DM) and reduce cardiovascular complications in the population. The present study has been undertaken to evaluate the effect of yoga therapy on reaction time, biochemical parameters and wellness score of peri and post-menopausal diabetic patients. Materials and Methods: 15 peri and post-menopausal patients receiving standard medical treatment for type 2 DM were recruited and reaction time and biochemical investigations were done before and after a comprehensive yoga therapy program comprising of three times a week sessions for six weeks. A post-intervention, retrospective wellness questionnaire compiled by ACYTER was used to evaluate the comparative feelings of the patients after the therapy program. Results: Yoga training reduced auditory reaction time (ART) from right as well as left hand, the decrease being statistically significant (P<0.05) for ART from the right hand. There was a significant (P<0.01) decrease in fasting and postprandial blood glucose levels as well as low density lipoprotein. The decrease in total cholesterol, triglycerides, and very low density lipoprotein and increase in high density lipoprotein was also statistically significant (P<0.05). All the lipid ratios showed desirable improvement with a decrease (P<0.01) of TC/HDL and LDL/HDL ratios and increase (P<0.05) in the HDL/LDL ratio. Discussion or Conclusion: Shortening of RT implies an improvement in the information processing and reflexes and is the first such report in diabetic patients. This has clinical significance and is worth further exploration with wider, well controlled, randomized studies in the diabetic population. Changes in blood glucose levels may be due to improved insulin sensitivity, decline in insulin resistance and increased sensitivity of the pancreatic b cells to glucose signals. Yoga improved the ‘heart friendly’ status of lipid profile in our subjects and as our participants were peri and post-menopausal, the decrease in cardiovascular risk profile is of greater significance. A comprehensive yoga therapy program has the potential to enhance the beneficial effects of standard medical management of diabetes mellitus and can be used as an effective complementary or integrative therapy program.
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Affiliation(s)
- Madanmohan
- Professor and Head, Department of Physiology and Program Director, ACYTER, JIPMER, Puducherry, India
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