Yield of capsule endoscopy in obscure gastrointestinal bleeding:A comparative study between premenopausal and menopausal women

AIM To evaluate differences in capsule endoscopy(CE) performed in the setting of obscure gastrointestinal bleeding(OGIB) among premenopausal women(PMW) and menopausal women(MW).METHODS Retrospective, single-center study, including female patients submitted to CE in the setting of OGIB between May 2011 and December 2016. Patients were divided into 2 groups according to age, considering fertile age as ≤ 55 years and postmenopausal age as > 55 years. The diagnostic yield(DY), the rebleeding rate and the time to rebleed were evaluated and compared between groups. Rebleeding was defined as a drop of Hb > 2 g/dL or need for transfusional support or presence of melena/hematochezia.RESULTS A hundred and eighty three female patients underwent CE for OGIB, of whom 30.6%(n = 56) were PMW and 69.4%(n = 127) were MW. The DY was 30.4% in PMW and 63.8% in MW. The most common findings were angiodysplasias in both groups(PMW: 21.4%, MW: 44.9%)(P = 0.003). In PMW, only 1.8% required therapeutic endoscopy. In 17.3% of MW, CE findingsled to additional endoscopic treatment. Rebleeding at 1, 3 and 5 years in PMW was 3.6%, 10.2%, 10.2% and 22.0%, 32.3% and 34.2% in MW. Postmenopausal status was significantly associated with higher DY(P < 0.001), TY(P = 0.003), rebleeding(P = 0.031) and lower time to rebleed(P = 0.001).CONCLUSION PMW with suspected OGIB are less likely to have significant findings in CE. In MW DY, need for endoscopic treatment and rebleeding were significantly higher while time to rebleed was lower.

Impaired of Sexuality in Premenopausal Breast Cancer Patients

Introduction: The treatment modalities for Breast cancer may impair the sexual function of women, especially in the pre-menopausal period. Treatment in this group of women has a huge impact in quality of life. The main objective of this study was to evaluate the prevalence of sexual dysfunction (SD) after treatment for breast cancer among women who were premenopausal at the diagnosis of neoplasia. Material and Methods: All women diagnosed with premenopausal breast cancer at one outpatient clinic from March 2019 to September 2020 were selected. Participants answered two sexual function questionnaires (the Female Sexual Function Index [FSFI-19] and Female Sexual Quotient [QS-F]) and a quality of life [QOL] questionnaire [EORTC QLQ-C30]). Sociodemographic and tumor characteristics were also studied. Results: Fifty-eight pre-menopausal women were included. Sexual dysfunction (SD) was observed in 43 participants (74.1%) according to the FSFI-19, while 31 (53.4%) had SD according to the QS-F. The functional and general health scales of the EORTC QLQ-C30 were positively related to the FSFI-19 and QS-F scores, while the symptom scale was negatively related to the FSFI-19 and QS-F scores. There was no relationship between chemotherapy, hormone therapy, or surgery with the FSFI-19 and QSF scores. A diagnosis of depression was negatively related to the total FSFI-19 scores. Conclusion: Pre-menopausal breast cancer women showed high rates of female SD. None breast cancer treatment modality was related to SD. The only studied variable associated with SD was depression.

Clinical and angiographic characteristics of premenopausal women with coronary artery disease

Background Coronary artery disease （CAD） is generally considered as a disease of middle-aged men. It is widely accepted that the risk for CAD of premenopausal women is low because of hormone protection. Based on our clinical experience, more and more premenopausal women suffer from angina and myocardial infarction without adequate concern. Even now, there are still limited detailed data to describe the characteristics, mechanism and prognosis of premenopausal CAD patients. This article aimed to analyze the clinical and angiographic characteristics of premenopausal women with CAD. Methods A total of 565 premenopausal women and 721 postmenopausal women （56-60 years old） who underwent coronary angiography for the first time from April 2004 to December 2007 were enrolled. The clinical data and coronary angiographic characteristics （presence, localization, length and severity） were compared between the premenopausal and postmenopausal CAD groups. Results Premenopausal CAD patients presented less frequently with hypertension, diabetes mellitus and dyslipidemia compared with postmenopausal CAD patients （55.0% vs 66.0%, 15.0% vs 31.5%, 23.9% vs 37.4%, respectively; all P 〈0.05）. Although we found more frequent involvement of single vessel in premenopausal CAD （43.2% vs 26.9%, P=0）, and triple vessels in postmenopausal （56-60 years old） CAD patients （33.8% vs 20.4%, P=0）, much more severe lesions （z90%） at left main （2.9% vs 1.1%, P=0.048） and proximal left anterior descending artery （LAD） （28.2% vs 16.6%, P=0） in the premenopausal CAD group were found. Conclusion Premenopausal women with chest discomfort are always found to have obvious atherosclerosis, more .inclined to be located at the left main and proximal LAD, which is a strong predictor of an adverse clinical outcome.

Ovarian Thecoma Fibroma Causing Menstrual Disorder &Infertility: Dramatic Resolution with Surgery

Purpose: To report the case of successfully managed oligo-amenorrhoea with infertility as a result of thecoma fibroma in a young Nigerian Igbo woman. Case Presentation: She was a 24-year-old, married, nulliparous woman who presented with 5 years history of oligomenorrhoea and 18 months history of infertility. Following her menarche at 14 years of age, she had a regular 30-day menstrual cycle with 4 - 6 days moderate flow. Symptoms of oligomenorrhoea worsened to amenorrhoea over time with menstrual flow occurring only when a progesterone agent was used. Clinical evaluation revealed no abnormalities in the systems apart from the presence of left adnexal mass on pelvic examination. Radiological test suggested benign left adnexal mass. Results: She had surgical removal of the mass after work up. Her normal menstrual flow resumed 48 hours following surgery and became regular thereafter. The histopathology report confirmed thecoma-fibroma. She commenced sexual intercourse 12 weeks after surgery. At 18 weeks post operative period, she presented with amenorrhoea and pregnancy symptoms. Intra-uterine pregnancy was confirmed with a pelvic ultrasound scan. She was managed in antenatal clinic till 38 weeks gestational age when she had spontaneous vaginal delivery of a live female neonate that weighed 3 kg with good APGAR scores. She is currently being followed up. Conclusion: Ovarian thecoma-fibroma is a rare cause of menstrual irregularities and infertility in young women. Surgical removal could result in a dramatic and favourable clinical response, as in the case presented.

Bone Loss in Women with Type 1 Diabetes

Background: Although osteoporosis has been investigated and debated in the diabetic population over the past decades, very little is known about the spontaneous changes in bone mineral density (BMD) and biochemical markers of bone turnover in pre- and postmenopausal type 1 diabetic (T1DM) women over time. Aim: To measure spontaneous changes in BMD and biochemical markers of bone turnover in pre- and postmenopausal T1DM women. Subjects: 53 T1DM women (31 premenopausal and 22 postmenopausal) from the outpatient clinic were enrolled in the study in 1993 and 35 (22 premenopausal, 13 postmenopausal) were reexamined in 1997. Method: BMD was measured at femoral neck (f.n.), spine (L2 - L4), total body and forearm with DXA or SXA in 53 T1DM women. 4 years later a re-scan was carried out on 35 T1DM. Results: In premenopausal subjects a yearly decrease less than 1% at f.n., spine, forearm and total body was observed, though only statistically significant (s.s.) at f.n., p ≤ 0.05. In postmenopausal subjects a s.s. decrease less than 2% was observed at f.n., forearm and total body, p ≤ 0.05. In general, osteopenic or osteoporotic values were observed at the measured skeletal sites. Only at f.n. a lower s.s. BMD compared to age-matched reference women was seen. Conclusion: Small or non-significant changes in BMD and biochemical markers of bone turnover were observed in pre- and postmenopausal T1DM subjects after a 4-year period.

Effect of aerobic exercise on insulin resistance and centra1 adiposity disappeared after the discontinuation of intervention in overweight women

目的:本研究旨在分析有氧运动干预停止后,运动对超重/肥胖女性腹部脂肪含量和胰岛素抵抗(HOMA-IR)的作用是否消失。方法:研究对象来自2项相似的独立有氧运动干预研究。研究Ⅰ中,15名绝经后并患有糖尿病的超重,肥胖女性(BMI=24-33 kg/m^2,年龄52-65岁)完成为期8个月的有氧运动干预,并在干预停止后2年随访。研究Ⅱ中,12名绝经前的超重/肥胖妇女(BMI=25-35 kg/m^2,年龄30-50岁)接受为期6周的有氧运动干预,并在干预停止后4年随访。运动方案中,运动强度为60%-75%最大摄氧量、每次30-60 min,每周3-5次运动。通过双能X线(DXA Prodigy;研究1)或生物电阻抗(Inbody 720;研究Ⅱ)测定脂肪含量。用化学荧光免疫法测定血浆葡萄糖和胰岛素水平,算出胰岛素抵抗水平(HOMA-IR)。结果:8个月和6周中等强度有氧运动干预均能有效降低HOMA-IR(-18.9%,p=0.012;-26.7%,p=0.046),8个月的有氧运动干预使上腹部脂肪含量降低(-6.2%,p=0.021),但这些作用在干预停止后的随访中均消失。结论:有氧运动干预能有效降低超重/肥胖女性的腹部脂肪含量和胰岛素抵抗水平。但无论短期还是长期有氧运动,在干预停止后其产生的益处都消退。因此,为获得长期益处,有必要维持长期有氧运动。

Drug flibanserin–in hypoactive sexual desire disorder

Hypoactive sexual desire disorder(HSDD)is a widely known type of female sexual dysfunction that could also cause emotional distress and relationship problems.Flibanserin,a benzimidazole,was being studied as a treatment for premenopausal women with hypoactive sexual desire disorder because there was no accurate drug therapy available at the time(HSDD).The US Food and Drug Administration(FDA)approved Flibanserin in 2015 for the treatment of generalised acquired HSDD in premenopausal women.It has a high affinity for postsynaptic 5-HT-1A receptors(agonist)and 5-HT-2A receptors(antagonist),and it tends to work by increasing dopamine and noradrenaline levels in the brain while decreasing serotonin levels.This review was to assess Flibanserin efficacy and safety and it is found the drug Flibanserin benefits did not outweigh the risks in premenopausal and postmenopausal women.

Efficacy of self-made Gengnian decoction on phosphatidylinositol 3-kinases/protein kinase B/mammalian target of rapamycin signaling pathway in perimenopausal rats

OBJECTIVE:To investigate the efficacy of self-made Gengnian decoction on expressions of phosphatidylinositol 3-kinase(PI3 K),protein kinase B(Akt)and mammalian target of rapamycin(m TOR)in ovarian tissues of perimenopausal rats.They were identified with symptom pattern of kidney-Yang deficiency in terms of Traditional Chinese Medicine.METHODS:Female Sprague-Dawley rats aged10-12 months were selected.Estrous cycle was observed by vaginal smears of keratinocytes to screen the perimenopausal model rats.The chosen rats were randomly divided into five groups,including perimenopausal model of kidney-Yang deficiency group(24 rats),self-made Gengnian decoction of high-dose group(24 rats),self-made Gengnian decoction of middle-dose group(24 rats),self-made Gengnian decoction of low dose group(24 rats)and tibolone control group(24 rats).In addition,rats aged 4-6 months were selected as young control group.The perimenopausal model rats of kidney-Yang deficiency were prepared by alternative intramuscular injection of hydrocortisone 5 mg·kg^-1·d^-1The successfully prepared models in self-made Gengnian decoction of high-dose,middle-dose and low-dose groups and tibolone control group were given self-made Gengnian decoction 26.4,13.2 and 6.6 mg·kg^-1·d^-1,and tibolone tablets solvent 0.22 mg·kg^-1·d^-1,respectively,through intragastric administration.Models group and young control group were given the same dose of normal saline,1 time a day for 15 consecutive days.24 h after the last administration,blood and ovarian tissues were collected after anesthesia with 20%ethyl carbamate.The follicles of different levels in ovarian tissue were observed and counted by histopathological hematoxylin-eosin staining.Enzyme linked immunosorbent assay was applied to test insulin-like growth factor-1(IGF-1)level in the serum of experimental rats.The expression levels of PI3 K,phosphorylated-Akt(p-Akt)and phosphorylated-m TOR(p-m TOR)m RNA in ovarian tissue were detected by quantitative real-time polymerase chain reaction.RESULTS:The total follicle counts of perimenopausal model rats with kidney-Yang deficiency were significantly reduced,and the number of follicles(mainly increased in preantral follicles and antral follicles)in perimenopausal model rats with kidney-Yang deficiency was significantly increased after intervention of high and middle doses of Gengnian decoction and tibolone(P<0.05).Compared with normal rats in young control group,the levels of IGF-1 in serum of perimenopausal rats with kidney-Yang deficiency were significantly decreased(P<0.01),and those intervened by high dose of Gengnian decoction and tibolone were significantly up-regulated.The relative expression levels of PI3 K,p-Akt,p-m TOR m RNA in ovarian tissues of perimenopausal rats with kidney-Yang deficiency were significantly lower than those of young rats(P<0.01),and those intervened by high dose of Gengnian decoction and tibolone were significantly up-regulated(P<0.05).CONCLUSION:Self-made Gengnian decoction can increase the levels of IGF-1,PI3 K,Akt and m TOR m RNA expression in serum.