Do peripartum and postmenopausal women with primary liver cancer have a worse prognosis? A nationwide cohort in Taiwan

BACKGROUND While primary liver cancer(PLC)is one of the most common cancers around the world,few large-scale population-based studies have been reported that evaluated the clinical survival outcomes among peripartum and postmenopausal women with PLC.AIM To investigate whether peripartum and postmenopausal women with PLC have lower overall survival rates compared with women who were not peripartum and postmenopausal.METHODS The Taiwan National Health Insurance claims data from 2000 to 2012 was used for this propensity-score-matched study.A cohort of 40 peripartum women with PLC and a reference cohort of 160 women without peripartum were enrolled.In the women with PLC with/without menopause study,a study cohort of 10752 menopausal females with PLC and a comparison cohort of 2688 women without menopause were enrolled.RESULTS Patients with peripartum PLC had a non-significant risk of death compared with the non-peripartum cohort[adjusted hazard ratios(aHR)=1.40,95%confidence intervals(CI):0.89-2.20,P=0.149].The survival rate at different follow-up durations between peripartum PLC patients and those in the non-peripartum cohort showed a non-significant difference.Patients who were diagnosed with PLC younger than 50 years old(without menopause)had a significant lower risk of death compared with patients diagnosed with PLC at or older than 50 years(postmenopausal)(aHR=0.64,95%CI:0.61-0.68,P<0.001).The survival rate of women<50 years with PLC was significantly higher than older women with PLC when followed for 0.5(72.44%vs 64.16%),1(60.57%vs 51.66%),3(42.92%vs 31.28%),and 5 year(s)(37.02%vs 21.83%),respectively(P<0.001).CONCLUSION Peripartum females with PLC have no difference in survival rates compared with those patients without peripartum.Menopausal females with PLC have worse survival rates compared with those patients without menopause.

Postmenopausal women with hyperandrogenemia:Three case reports

BACKGROUND Diagnosing hyperandrogenemia in postmenopausal women is very difficult.It occasionally manifests as excessive hair growth or with no clinical manifestations,and is therefore often misdiagnosed or missed altogether.Ovarian steroid cell tumors that cause hyperandrogenemia in women account for approximately 0.1%of all ovarian tumors.Due to the low incidence,corresponding imaging reports are rare,so ovarian steroid cell tumors lacks typical imaging findings to differ-entiate it from other ovarian tumors.Therefore,we summarized its clinical and imaging characteristics through this case series,and elaborated on the differential diagnosis of steroid cell tumors.CASE SUMMARY We report three cases of postmenopausal women with hyperandrogenemia.Only 1 patient showed virilization symptoms,the other two patients were completely asymptomatic.All patients underwent total hysterectomy+bilateral adnexe-ctomy.Histological results showed one case of Leydig cell tumor and two cases of benign,non-specific steroid cell tumor.After the operation,the androgen levels of all patients returned to normal,and there was no clinical recurrence since follow-up.CONCLUSION Although virilization caused by increased serum testosterone levels is an important clinical feature of ovarian steroid cell tumors,it is often asymptomatic.A solid,slightly hypoechoic,round or oval mass with uniform internal echo,richer blood flow in the solid part,and low resistance index are typical imaging features of ovarian steroid cell tumors.Diagnosis of ovarian steroid cell tumors after menopause is challenging,but surgery can be used for both diagnosis and clear treatment.

Adjuvant tamoxifen switched to exemestane treatment in postmenopausal women with estrogen receptor-positive early breast cancer:A pragmatic,multicenter,and prospective clinical trial in China

Objective:This post-approval safety study assessed the efficacy and safety of exemestane after 2-3 years of tamoxifen treatment among postmenopausal women with estrogen receptor-positive(ER+)early breast cancer in China.Methods:Enrolled patients had received 2-3 years of tamoxifen and were then switched to exemestane for completion of 5 consecutive years of adjuvant endocrine therapy.The primary endpoint was the time from enrollment to the first occurrence of locoregional/distant recurrence of the primary breast cancer,appearance of a second primary or contralateral breast cancer,or death due to any cause.Other endpoints included the proportion of patients experiencing each event,incidence rate per annum,relationships between human epidermal growth factor receptor 2 status and time to event,and relationship between disease history variables and time to event.Results:Overall,558 patients were included in the full analysis set:397(71.1%)completed the study,20experienced an event,and 141 discontinued[47 owing to an adverse event(AE);37 no longer willing to participate].Median duration of treatment was 29.5(range,0.1-57.7)months.Median time to event was not reached.Eventfree survival probability at 36 months was 91.4%(95%CI,87.7%-95.1%).The event incidence over the total exposure time of exemestane therapy was 3.5 events/100 person-years(20/565).Multivariate analysis showed an association between tumor,lymph node,and metastasis stage at initial diagnosis and time to event[hazard ratio:1.532(95%CI,1.129-2.080);P=0.006].Most AEs were grade 1 or 2 in severity,with arthralgia(7.7%)being the most common treatment-related AE.Conclusions:This study supports the efficacy and safety of exemestane in postmenopausal Chinese women with ER+breast cancer previously treated with adjuvant tamoxifen for 2-3 years.No new safety signals were identified in the Chinese population.

Association of Bisphenol A Exposure with Circulating Sex Hormone Concentrations in Men and Postmenopausal Women

A total of 1 116 middle-aged and elderly men and 1 442 postmenopausal women were recruited in this study. Whether bisphenol A exposure was associated with circulating sex hormone concentrations was studied. Univariate analysis revealed that the urinary bisphenol A concentration was negatively correlated with the serum levels of luteinizing hormone （B=-0.061, P〈0.0001） and follicle-stimulating hormone （B=-0.086, P〈0.0001） in men, and with the serum levels of follicle-stimulating hormone （B=-0.037, P=0.018） and sex hormone-binding globulin （B=-0.043, P=0.006） in women. However, no significant association was observed between the serum levels of urinary bisphenol A and circulating sex hormone after adjustment for the potential confounders.

Association of the MTHFR C677T polymorphism and bone mineral density in postmenopausal women:a meta-analysis

Osteoporosis is a condition characterized by low bone mineral density （BMD） and micro-architectural changes in the bone tissue.The risk of osteoporosis is partly determined by genetic factors.The role of C677T polymorphism of methylenetetrahydrofolate reductase （MTHFR） gene has been investigated in postmenopausal osteoporosis.However,the relationship between MTHFR polymorphism and BMD is still controversial.We carried out a meta-analysis of 5,833 subjects to evaluate the association of MTHFR and BMD in postmenopausal women.Databases of MEDLINE,Web of Science,Scopus and CNKI were retrieved for all publications relating to MTHFR polymorphism and BMD in postmenopausal women.Five eligible studies were selected for meta-analysis.All these articles studied the association of MTHFR polymorphism and BMD of the femoral neck and lumbar spine in postmenopausal women.Our analysis suggested that postmenopausal women with the TT genotype had lower femoral neck BMD than the women with the CC/CT genotype,and the weighted mean difference （WMD） was-0.01 g/cm 2 [95% confidence interval （CI）：（-0.01,-0.01）,P 0.01].However,BMD of the lumbar spine of postmenopausal women with the TT genotype was not significantly different from that of women with the CC/CT genotype.In the random effects model,the WMD between the TT and TC/CC genotype was-0.01 g/cm 2 [95% CI：（-0.04,0.01）,P=0.32].The C677T polymorphism of the MTHFR gene is associated with BMD of the femoral neck in postmenopausal women.Women with the TT genotype of the MTHFR gene have lower BMD,suggesting that the TT genotype may be a risk factor for postmenopausal osteoporosis.

Effects of Soymilk on Serum Insulinemic Status and High Sensitivity C-Reactive Protein Levels in Healthy Postmenopausal Women of Bangladesh

Background: Postmenopausal women are at increased risk for cardiac diseases because many risk factors are aggravated by menopause. Isoflavones are phytoestrogens present in natural sources, and they may modulate risk factors favorably, involving mechanisms similar to estrogen. The study aimed to assess the effects of soymilk on serum insulinemic status and hs-C reactive protein (CRP) levels of postmenopausal women of Bangladesh. Methods: Thirty-six women (aged 50 ± 5 years, M ± SD) participated in a randomized, un-blind, open-ended, crossover study design for 52 days. During the study period, the patients made four visits (before and after the intervention including the washout period). The soymilk group consumed 350 mL of milk twice a day for 21 days;the milk contained ~30 mg of isoflavones. Fasting blood glucose (FBG), postprandial glucose (PPG), HbA1c, serum insulin, and hs-CRP were measured on day 0, day 21, day 31, and day 51 with a 10-day washout period. Paired t-test was performed to determine the effects of soymilk on the CVD risks among postmenopausal women and a student t-test was performed for group comparison. Statistical tests were considered significant at p value of ≤0.05. Results: The mean (±SD) BMI of the postmenopausal women was 25.14 ± 3.55 kg/m2. In the consumption of soymilk no significant changes were found in glycemic, insulinemic, and hs-CRP levels between and within the groups. After crossover, a significant change was observed in FBG (5.18 ± 0.49 vs 5.56 ± 0.43, p = 0.005) in the soymilk group. No significant changes were observed in other parameters within or between the groups. However, FBG and hs-CRP levels were found to improve but not significantly at the end of 51 days. Conclusions: Soy isoflavones did not improve serum insulinemic status and hs-C reactive protein (CRP) levels among Bangladeshi postmenopausal women. Further studies need to be elucidated by considering a follow-up study with a large sample size.

Effect of mistletoe combined with carboxymethyl cellulose on dry eye in postmenopausal women

AIM： To investigate the protective effect of mistletoe combined with carboxymethyl cellulose eye drops on dry eye in postmenopausal women.METHODS： Sixty postmenopause female patients diagnosed of dry eye were assigned randomly to mistletoe combined with carboxymethyl cellulose eye drops treatment group（n=30） and control group treated with normal saline eye drops（n=30）. The subjective symptoms of ocular surface, Ocular Surface Disease Index（OSDI）, tear film function tests, tear protein and corneal morphology by confocal scanning microscopy were analyzed before treatment and at 1, 2, 4 and 8 wk after treatment respectively. To ensure the safety of the trial, all patients were examined with systolic pressure, diastolic pressure, glutamic-pyruvic transaminase, glutamic oxaloacetic transaminase, urine creatinine, and blood urea nitrogen at 8 wk after treatment.RESULTS： There were no obvious differences between two groups before the treatment（P〉0.05）. In two months after the treatment, the symptoms of ocular surface, OSDI, tear protein, and tear film function were only slightly changed in normal saline eye drops group. However, all indices were improved after the treatment of mistletoe combined with carboxymethyl cellulose eye drops group（P〈0.05）. In addition, the average amount of corneal epithelium basal cells and inflammatory cells of mistletoe treated group were 3174±379 and 38±25 cells/mm2, significantly decreased as compared to the control group with 4309±612 and 158± 61 cells/mm2, respectively. In the control group, althoughnerves still maintained straight under corneal epithelium, the number of nerves were significantly decreased, as compared with normal female. In the mistletoe treated group, the number of nerves was only slightly reduced, compared with normal female.CONCLUSION： Mistletoe combined with carboxymethyl cellulose eye drops can alleviate the symptoms and signs of dry eye symptoms.

Adherence to Pharmacotherapy in Post-Menopausal Women with Hypertension or Metabolic Syndrome: Real World Experience

Background: Adherence to medications is dependent upon a variety of factors, including individual characteristics of the patient, interactions with health care providers, and medication complexity. Even though several studies were conducted to test intervention strategies, results are uncertain. Aim: The aim of the study is to assess if a tailored combined intervention strategy improves medication adherence in a large population of post-menopausal women affected by hypertension or metabolic syndrome. Methods: We enrolled 6833 patients aged 50 to 69 years, 85.7% with hypertension, and 14.3% with metabolic syndrome. A network between patients, general practitioners, and cardiologists was established. Interventions included education, adequate information to patients, a simplified scheme of treatment, and periodic adherence assessment. These were either delivered as healthcare provider supports or using modern technology. Medication adherence was estimated by the proportion of days covered for all classes of drugs after the index date. Results: Non-adherent hypertensive women were 297 (5%), and those with metabolic syndrome were 73 (7.4%) (p Conclusions: The rate of non-adherence in both settings of postmenopausal women was 7.7%, much lower than that described in the literature. This rate was increased in patients with metabolic syndrome;probably it is related to the complexity of the therapeutic scheme or to a poor consciousness of the disease. Therefore, implementing a tailored combined intervention can improve significantly patients’ adherence to medical therapy.

Effects of vibration therapy on bone mineral density in postmenopausal women with osteoporosis

Background Jaw osteonecrosis possibly associated with the administration of bisphosphonates is expected to be treated with a non-pharmacologic approach. This study aimed to determine whether noninvasive, mechanically mediated vibration would inhibit the decline in bone mineral density （BMD） that follows menopause, enhance the BMD of the lumbar and femoral neck, and reduce chronic back pain in postmenopausal women with osteoporosis. Methods A total of 116 postmenopausal women with osteoporosis participated in this study, and they were divided into groups A （66 patients） and B （50）. Group A received vibration treatment （Subjects vertically stand on the vibration platform, with a vibration frequency of 30 Hz, amplitude of 5 mm; they received the treatment five times per week, ten minutes each time and totally for six months）, whereas women of group B served as controls without any treatment. L2-4 BMD, bilateral femoral neck BMD, and body mass index （BMI） were recorded before the treatment or at the third and sixth months of the treatment respectively. After the ending of the treatment, the change of BMD in each group was compared and analyzed. Chronic back pain was evaluated by visual analogue scale （VAS） at baseline and the third and sixth months of the treatment. Results Of the 116 women, 94 including 51 women from group A （（61.23±8.20） years） and 43 women from group B （（63.73±5.45） years）, completed the study. There were no significant differences in baseline characteristics including age, BMI, menopausal years, lumbar BMD, femoral neck BMD, and VAS between the two groups. The lumbar BMD of the 51 women in group A increased by 1.3% （P=0.034） after vibration treatment for 3 months and by 4.3% at the sixth month （P=0.000）. The lumbar BMD in group B was decreased at the third month, but there was not statistical significance （P〉0.05） At the sixth month, it was decreased by 1.9% （P 〈0.05）. The femoral neck BMD of the 51 women in group A was slightly increased after vibration treatment for 3 months, but without statistical significance （P 〉0.05）. At the sixth month, the BMD was increased by 3.2% （P 〈0.05）. In group B, the BMD was not decreased significantly （P=0.185） at the third month, but decreased significantly at the sixth month （1.7%） （P 〈0.05） compared with the baseline. Chronic back pain （VAS） reduced more significantly in group A at the third and the sixth months （P 〈0.05） after vibration therapy in comparison with the baseline. The BMI was not significantly changed in the two groups during the period of follow-up. Conclusions Vibration therapy appears to be useful in reducing chronic back pain and increasing the femoral neck and lumbar BMD in postmenopausal women with osteoporosis.

Effect of Half-dose and Standard-dose Conjugated Equine Estrogens Combined with Natural Progesterone or Dydrogesterone on Components of Metabolic Syndrome in Healthy Postmenopausal Women： A Randomized Controlled Trial

Background： Menopausal hormone therapy （MHT） has been proven to have beneficial effects on several components of metabolic syndrome. However, the effects vary according to different regimens, dosages, and duration of MHT. The aim of the study was to evaluate the effect of standard-dose 0.625 mg conjugated equine estrogen （CEE） and half-dose 0.3 mg CEE daily with different progestogens in a continuous sequential regimen on postmenopausal metabolic parameters in generally healthy postmenopausal women. Methods： A prospective, open-label, randomized controlled clinical trial was conducted between February 2014 and December 2015. Totally 123 Chinese postmenopausal women with climacteric symptoms were included in this study and were randomly assigned to three groups： Group A received CEE 0.3 mg/micronized progesterone （MP） 100 mg daily; Group B received CEE 0.625 mg/MP 100 mg daily; and Group C received CEE 0.625 mg/dydrogesterone 10 mg daily. Drugs were given in a continuous sequential pattern. The duration of treatment was 12 months. Clinical, anthropometrical, and metabolic variables were measured. Data were analyzed according to intention-to-treat analysis, using Student＇s t-test and analysis of variance. Results： A total of 107 participants completed the 12-month follow-up and were included in the data analysis. At 12 months of treatment, high-density lipoprotein cholesterol and apolipoprotein A significantly increased, and low-density lipoprotein cholesterol, fasting glucose, and glycosylated hemoglobin significantly decreased in Groups B and C, compared with baseline （all P 〈 0.05）. Among the three groups, only Group C showed significantly increased triglycerides compared with baseline （ 1.61 ± 0.80 mmol/L vs. 1.21 ± 0.52 mmol/L, P 0.026）. Each group showed a neutral effect on total cholesterol, lipoprotein A, apolipoprotein B, and fasting insulin levels. No cardiovascular and venous thromboembolic events occurred in the three groups. Conclusions： Among Chinese postmenopausal women, half-dose CEE was not sufficient to induce a favorable lipid and carbohydrate profile compared with standard-dose CEE. Adding natural MP may counterbalance the TG-increasing effect of CEE.

Association between serum resistin level and cardiovascular events in postmenopausal women with acute coronary syndrome undergoing percutaneous coronary intervention

Background As an adipocytokine, resistin has been proposed as a link between inflammation, metabolic disorder and atherosclerosis. The aim of the study is to evaluate whether serum resistin is associated with acute coronary syndrome （ACS） and major adverse cardiovascular events （MACEs） among postmenopausal women with ACS undergoing percutaneous coronary intervention （PCI）. Methods A total of 106 consecutive postmenopausal women who underwent coronary angiography for evaluation of suspected myocardial ischemia were enrolled. Pre-procedure serum resistin, inflammatory and metabolic biomarkers were measured. All participants were followed for seven years for MACEs, including cardiovascular death, recurrent nonfatal myocardial infarction, and re-PCl. Results Patients with ACS （n=69） had significantly higher resistin levels than those without coronary artery disease （CAD） （n=37） （4.61 （1.79-10.80） ng/ml vs. 2.36 （0.85-4.15） ng/ml, P=0.002）. Correlation analysis revealed positive correlations between resistin levels and inflammatory and metabolic factors （P 〈0.05）. A follow-up of a mean of 83.4 months showed that patients with ACS suffered more MACEs than those without （13.0% vs. 2.7%, P=0.05）. Adjusted for cardiovascular risks, inflammatory and metabolic factors, multiple Logistic regression analysis indicated that an elevated resistin level was an independent predictor of ACS onset （OR=1.139, 95% CI 1.024-1.268, P=0.017） and of MACEs after PCI （OR=1.099, 95% CI 1.015-1.189, P=-0.019）. To clarify the association between resistin levels and MACEs, ACS patients were divided into two subgroups on the basis of resistin levels. Compared with the low resistin subgroup （≤4.35 ng/ml, n=32）, patients in the high resistin subgroup （〉4.35 ng/ml, n=37） were more prone to suffer MACEs （21.6% vs. 3.1%, P=0.015）. Kaplan-Meier analysis showed a significantly lower event-free survival rate in ACS patients with high resistin levels than in the low resistin subgroup （78.4% vs. 96.9%, Log rank 5.594, P=0.018）. Conclusion An elevated serum resistin level is associated with ACS and cardiovascular events and acts as a predictor in progression of ACS in postmenopausal women.

Effects of exercise therapy on bone mineral density in earlypostmenopausal women: a controlled trial

The purpose of this article is to determine the effect of a well-designed combined aerobic,resistance,and extension exercise program on bone mineral density(BMD)in postmenopausal women.The population comprised 45 postmenopausal women,who exercised over 12 months(exercise group),and 36 women who served as a non-training control group.BMD of the hip,and lumbar spine was measured at the baseline and 12th month.Repeated measurement analysis of variance and nonparametric test were utilized to compare differences between the exercise group and controls.Thirty-six out of 45 persons in the exercise group and 36 controls completed the study.Average compliance was 82.2%for the whole exercise group at the 12th month.All the subjects had decreased BMD,but the rate of bone loss was lower in the exercise group than in the control group at the L4 and hip.Although the exercise program in this study may probably reduce the rate of bone loss in weight-bearing skeletal sites,we do not suggest the exercise by itself be viewed as prevention or treatment for osteoporosis.Further,the exact dose-response relationship of exercise and bone mass in early postmenopause is not clear.

The relationship between sex hormones and extent of coronary artery disease in postmenopausal women

The prevalence of coronary artery disease （CAD） in women increases with menopause. Results from the studies on the role of endogenous sex hormones on CAD in postmenopausal women are conflicting. The present study evaluated the relationship between endogenous sex hormones and extent of CAD in postmenopausal women and the associations of sex hormones with CAD risk factors.

THE CHANGES OF BONE VOLUME AND TURNOVER IN POSTMENOPAUSAL WOMEN WITH OSTEOPOROSIS：A REPORT OF 293 BONE BIOPSIES

bone biopsies of ooteoporosis in postmenopausal women were analyzed. The results showed that the mean ttabecular bone volume was(10.6 ± 5. 47)%, which is 29'3% less than the low value of normal range(15%).There were 186 (63. 5%)cases in normal turnover,75(25.6 %)cases in high turnover,and 32 (10.9%)tases in low turnover.In comparison with the normal turnover group ,the osteoid volume and surface,mineralization surface, corrected mineralization rate,osteoclast number, and bone formation rate were elevated (P<0.01), but mineralization lag time was reduced (P< 0' 01) in the high turnover group,and all the above parameters in the low turnover group were opposite (P <0.05 0. 01).In comparison with the 3 agegroups (51￣60, 60￣70,>70),the bone volume and osteoid volume dropped as the age increased. Both high and low turnover situations appeared in the 51￣60 age group,waied had the highest ratio in the 61￣70 age group and the lowest ratio in the >70 age group. All these changes of bone volume and turnover reflect the heterogeneity of etiology and complicacy of pathogenesis in this disease.Bone biopsy is not only to distinguish osteoPOrosis from ostcomalacla, but also to determine the turnover type and direct clinical treatment.

Effects of Aerobic Exercise on Atherosclerotic Risk in Postmenopausal Women

Introduction To study the effects of aerobic exercise on lipid metabolism,endothelial function,and oxidative stress reaction in postmenopausal women,in order to prevent and control atherosclerosis.Methods Thirty-two women with natural menopause were randomly divided into an exercise group and a control group.Participants in the exercise group(n=16)took part in a 3-month aerobic training program according to their exercise pre-scription,while participants in the control group(n=16)maintained their usual lifestyles.Lipids,endothelial function,and oxidative stress-related indicators were measured before and after the intervention.Results After 3 months of aerobic training at an intensity of 50-60%of cardiorespiratory fitness,serum total cholesterol and low-density lipoprotein cholesterol decreased significantly(P<0.05),and high-density lipoprotein cholesterol increased significantly(P<0.01).A significant reduction in endothelin(P<0.01)and a significant increase in nitric oxide(P<0.05)were also observed.The training intervention also delayed the increase in homocysteine and cysteine aspartate-specific protease-3 in postmenopausal women.Conclusions Aerobic exercise had a positive effect on blood lipids,endothelial function,and oxidative stress of postmeno-pausal women,and these changes may mitigate the risk of atherosclerosis occurrence.Similar exercise programs could be used as a primary atherosclerosis prevention strategy for postmenopausal women.

Relationship between baseline monocyte to high-density lipoprotein cholesterol ratio and acute heart failure in postmenopausal women with acute coronary syndromes

Monocyte to high-density lipoprotein cholesterol ratio(MHR)becomes a novel cardiovascular prognostic predictor.The retrospective study was performed to investigate the relationship between MHR and acute heart failure(AHF)in postmenopausal women with acute coronary syndromes(ACS).Methods A cohort of 127 postmenopausal women diagnosed with ACS were enrolled.They underwent coronary angiography in Shantou Central Hospital(Shantou,China)from December 2014 and July 2016.The patients were assigned to two groups based on the admission MHR:low MHR group(MHR≤0.3677,n=51)and high MHR group(MHR>0.3677,n=76).The relationship between MHR and AHF was assessed by logistic regression analysis.Results Left ventricular ejection fraction of the low MHR group(64.2%±8.8%)was higher than that of the high MHR group(57.6%±12.9%)(P=0.002).Fractional shortening of the low MHR group(35.4%±6.4%)was higher than that of the high MHR group(30.6%±8.9%)(P=0.001).Hospitalization days of high MHR group(11.4±6.6 days)was longer than that of low MHR group(8.4±3.5 days)(P=0.006).Incidence of AHF(21%)in the high MHR group was higher than that in the low MHR group(4%)(P=0.008).MHR(OR:25.701,95%CI:3.099-213.143,P=0.003)could be an independent predictor for AHF in postmenopausal women with acute coronary syndromes.Conclusions The incidence of AHF in high baseline MHR group was higher than that in low baseline MHR group.This study demonstrated that high MHR level was a risk factor for AHF in postmenopausal women with ACS.

Relationship of serum GDF11 levels with bone mineral density and bone turnover markers in postmenopausal Chinese women

Growth differentiation factor 11 （GDF11） is an important circulating factor that regulates aging. However, the role of GDF11 in bone metabolism remains unclear. The present study was undertaken to investigate the relationship between serum GDF11 level, bone mass, and bone turnover markers in postmenopausal Chinese women. Serum GDF11 level, bone turnover biochemical markers, and bone mineral density （BMD） were determined in 169 postmenopausal Chinese women （47-78 years old）. GDF11 serum levels increased with aging. There were negative correlations between GDF11 and BMD at the various skeletal sites. After adjusting for age and body mass index （BMI）, the correlations remained statistically significant. In the multiple linear stepwise regression analysis, age or years since menopause, BMI, GDF11, and estradiol were independent predictors of BMD. A significant negative correlation between GDF11 and bone alkaline phosphatase （BAP） was identified and remained significant after adjusting for age and BMI. No significant correlation was noted between cross-linked N-telopeptides of type I collagen （NTX） and GDF11. In conclusion, GDF11 is an independent negative predictor of BMD and correlates with a biomarker of bone formation, BAP, in postmenopausal Chinese women. GDF11 potentially exerts a negative effect on bone mass by regulating bone formation.

Bone density, microarchitecture and stiffness in Caucasian and Caribbean Hispanic postmenopausal American women

Hispanic Americans of Caribbean origin are a fast-growing subset of the US population, but there are no studies on bone density, microstructure and biomechanical integrity in this minority group. In this study, we aimed to compare Caucasian and Caribbean Hispanic postmenopausal American women with respect to these characteristics. Thirty-three Caribbean Hispanics were age-matched to thirty-three Caucasian postmenopausal women. At the lumbar spine, the Hispanic women had significantly lower areal bone mineral density （aBMD）. At the radius by high-resolution peripheral quantitative computed tomography （HR-pQCT）, there were minimal differences between Hispanic and Caucasian women. At the tibia, Hispanic women had lower trabecular volumetric bone density and trabecular number, and higher trabecular separation. Individual trabecula segmentation （ITS） analyses indicated that at the tibia, Hispanic women not only had significantly lower bone volume fraction, but also had significantly lower rod bone volume fraction, plate trabecular number, rod trabecular number and lower plate-plate, plate-rod and rod-rod junction densities compared to Caucasian women. The differences in bone quantity and quality contributed to lower whole bone stiffness at the radius, and both whole bone and trabecular bone stiffness at the tibia in Hispanic women. In conclusion, Hispanic women had poorer bone mechanical and microarchitectural properties than Caucasian women, especially at the load-bearing distal tibia.

Body Composition, Gynecologic-Obstetric Variables, and Prolactin Levels in Patients with Breast Cancer

Objective: The aim of this study was to determine body composition, gynecological, and obstetric data, sex hormones, and prolactin serum levels in pre- (PREW) and postmenopausal women (PMW) with breast cancer (BC) and compare them with a control group (CG) of healthy women. Methodology: BC patients without treatment or use of hormone replacement therapy, or hormonal birth control, and without data of metastasis were included. CG was matched for age, BMI, and menstrual cycle status. FSH, LH, E2, progesterone, testosterone, and prolactin (PRL) were measured using radioimmunoassay kits. Comparisons between BC and CG were made with “t” tests, and with the Mann-Whitney U-test;χ2 test was used to compare the qualitative variables between the groups. Results: Seventy-two patients with BC, and 74 CG women were evaluated. Both groups presented overweight data, BMI (kg/mt2) = 27.21 ± 5.51 vs. 28.40 ± 4.66, p = ns, for BC patients and CG, respectively. In PREW, the age at menarche was later in BC patients compared to the CG (13.3 ± 1.36 years vs. 12.41 ± 1.27 years, p = 0.005). The PMW with BC presented a higher age at menarche and menopause compared to the women of the CG (13.51 ± 1.48 vs. 12.91 ± 1.41, p = 0.09, and 49.03 ± 2.86 vs. 45.5 ± 8.78, p = 0.03, respectively). PRL levels were significantly higher in PMW with BC, in comparison with the CG;median and minimum and maximum values (min-max) were: 14.7 ng/mL (3.6 - 52.7) vs. 5.9 ng/mL (1.9 - 33.3), p = 0.005). A higher percentage of PMW with BC (26.0% vs. 7.1%, χ2 = 5.57, p = 0.01) presented hyperprolactinemia (PRL serum levels > 20 ng/mL), compared to the GC. Conclusions: The higher levels of PRL in PMW with BC compared with CG, suggest a proliferative effect of this hormone in the affected breast tissue. This study demonstrates the need to use biological markers such as PRL to determine the risk of BC in PMW.

Difference in symptom manifestation between postmenopausal and premenopausal women in acute uncomplicated cystitis:A multi-institutional pilot study

Objectives:We aimed to prospectively compare lower urinary tract symptoms in premenopausal and postmenopausal women with acute uncomplicated cystitis before and after antibiotic therapy.Materials and methods:This study included adult women with acute uncomplicated cystitis who visited 4 institutions between 2019 and 2020.After registration,we administered oral antibiotics and prospectively documented the changes in lower urinary tract symptoms from the first visit to a follow-up visit at 1 week using the Core Lower Urinary Tract Symptoms Score(CLSS)questionnaire.Results:After treatment,pyuria disappeared in 60 of the 66 patients(14 premenopausal and 46 postmenopausal).The CLSS total score(range)changed from 13(3-29)to 4(0-18)with a significant improvement in all CLSS items.At baseline,nocturia,urgency,and urgency incontinence were more prominent in postmenopausal women than in premenopausal women.In contrast,baseline urethral pain and quality of life index were more severe in premenopausal women than in postmenopausal women.After treatment,the CLSS total score was still higher in postmenopausal women,as reflected by the relatively higher scores for nocturia and urgency,irrespective of the comparable scores for urethral pain and the quality of life index in the 2 groups.Conclusions:Our results suggest that if storage symptoms persist,they should be carefully interpreted according to menopausal status.