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.

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.

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 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.

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.

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.

Effect of gender on the reliability of COVID-19 rapid antigen test among elderly

Defining con-founders that affect the reliability of diagnostic tests for coronavirus disease 2019 is vital to breaking the chain of infection.The elderly population is a higher risk group for the emerging virus.However,gender seems to exert a critical role in modifying the infection risk among women owing to hormonal changes.The menopause transition is an exceptional period for older women where the protective and immunomodulatory effects of the estrogen hormone are lost.Accordingly,attention should be given to postmenopausal women since they will have an increased risk compared to their pre-menopausal peers.