Estrogen therapy affects right hemisphere functioning in postmenopausal women

It has been suggested that hormone therapy (HT) in postmenopausal women differentially affects verbal and visuo-spatial abilities which mainly rely on left hemisphere (LH) and right hemisphere (RH) functioning, respectively. Thus, it seems likely that HT-related effects on cognition are driven by associated hormonal changes and their impact on functional brain organization, and functional cerebral asymmetries (FCAs) in particular. The present study investigated HT-related effects on FCAs in sixty-seven postmenopausal women who received hormone therapy either with estrogen (E) alone (n =  14), an E-gestagen combination (n =  22) or without HT (control group, n =  31). Saliva levels of free E and progesterone (P) were analyzed using chemiluminescence assays. FCAs were measured with the visual half-field (VHF) technique using a word matching and a figural comparison task. In agreement with previous results, a postmenopausal control group showed a left hemisphere (LH) advantage in the verbal task and a right hemisphere (RH) advantage in visuo-spatial processing. In contrast, both HT groups revealed significantly reduced FCAs in the figural comparison task as a result of an E-related decrease in RH performance. The findings suggest that E-therapy in postmenopausal women can affect visuo-spatial abilities by modulating the functional brain organization and RH functioning in particular.     

Incidences of breast cancer throughout long-term hormone replacement therapy

OBJECTIVE: To report the main incidences related to diagnosis of breast cancer in a randomly selected cohort population of women treated with conjugated equine estrogens (CEE), always in conjunction with the opposed progestin, medroxy progesterone acetate (MPA) throughout prolonged oral administration. MATERIAL AND METHODS: One hundred and seventy-eight women were subsequently studied before and during the treatment (cohort study). The profile of studied patients included family and personal histories, gynecological and breast examinations, basal hormonal levels, bone mass concentration (BMC) as well as total cholesterol levels and their fractions. The usual clinical cut off age was applied at the beginning of treatment according to following criteria: (a) women less than 60 years old (91.60%), and (b) women more than 60 years old (8.40%), by assuming that a primary protective effect of HRT might be lost or diminished after surpassing this age threshold. In all the treated women were thoroughly advised about the importance of diet, exercises and self-determination. Both oral CEE 0.625 mg/daily and either 2.5 mg/daily or 5 mg/daily of MPA were administrated in accordance with The American Fertility Society Meeting after 1995 (Seattle) recommendations, following two patterns: (1) cycles or perimenopausal women: from days 1 to 25, and (2) postmenopausal women, from Monday to Friday. No other specific treatments were prescribed. Statistical analysis was performed by using SPSS 12.0 and G-stat 2.0. RESULTS: Evaluation of basal hormonal levels, BMC, cholesterol levels and their fractions were not included in the current study. Data from the statistical analysis of 178 treated women were as follow: mean duration of treatment 8.06 years for all women; in the younger age group 7.97, and in the older age group 9.04. Total of 1405.5 woman-years of follow-up, 119 women for more than 5 years (66.85%), and more times (68.18%) with CEE plus MPA 5 mg/daily regime. Dropouts occurred in 34 women (19.10%). Main incidences: no deaths occurred during the treatment. Four cardiovascular events (2.24%) were reported. No spontaneous bone fractures were documented. Nonetheless, there were 11 bone fractures of traumatic origin (6.17%), none of them hip fractures. Four breast cancer. Likewise, one diagnosis of breast cancer in each of 45 treated women from our series was evidenced. One hundred and twenty-one women (67.97%) without incidences. COMMENTS: In our cohort study advices on diet, exercises and self-determination were reinforced for 1405.5 woman-years of follow-up. Combined CEE plus MPA for more than 5 years are no more risk related to breast cancer and cardiovascular events versus shorter treatments. Long-term CEE plus MPA were well tolerated and we did not find statistical evidence which would allow deducing higher rates of morbidity in those entities. Likewise, no deaths were document during the treatments.     

绝经前子宫内膜癌保留生育功能治疗及前瞻性进展

对于未生育子宫内膜癌患者的保守治疗目前存在较多争议,首先药物剂量,给药方式,治疗时间等尚无明确标准,又因其复发率较高,患者完成分娩后是否需要切除子宫尚无定论。通过阅读大量文献及临床前瞻性研究,药物治疗主要以低剂量为主,治疗时间一般约9-12个月,治疗方面除传统单纯口服激素治疗外,近年来又逐步开展单独左炔诺孕酮宫内节育器治疗,宫内节育器与促性腺激素释放激素类似物(GnRHa)联合治疗,宫腔镜手术与激素联合治疗等。后续通过辅助生殖技术也使怀孕率逐年升高。研究表明,现阶段对于绝经前子宫内膜癌保留生育功能的治疗是非常有希望的,但仍需大量临床试验来逐步完善治疗策略。本文结合临床实践体会和文献报道,重点就其适应证选择、治疗前评估、治疗方案、疗效评价、病情监测、治疗后的生育问题等做一综述如下。     

绝经后骨质疏松运动疗法的研究进展

绝经后骨质疏松是一种发生于绝经后妇女的慢性骨代谢疾病,目前其治疗还主要靠药物,但长期使用药物的一些副作用使一些患者不愿意采用药物疗法。因此,其治疗和预防目前仍具有挑战,正日益成为一个公众健康问题。体育运动是防治绝经后骨质疏松的一种非药物疗法,由于其简便、副作用少,近年来备受医患人员的亲睐。本文在查阅国内外相关文献的基础上,对有氧运动、抗阻力运动、平衡和本体感受训练、振动训练和水中训练等不同运动疗法在绝经后骨质疏松防治中的研究进展进行了综述。     

The menopause,hormone replacement therapy and breast cancer

Concern exists that the reduction in breast cancer risk associated with the onset of the menopause will be negated with exposure to hormone replacement therapy (HRT). Evidence from large-scale randomised HRT trials support observational data that have shown a modest increase in breast cancer risk with long-term use (i.e. >15 years) of combined therapy, although this falls following HRT cessation suggesting a growth-promoting effect. Randomised evidence demonstrates that the efficacy of anti-estrogens, aromatase inhibitors and raloxifene in the treatment and chemoprevention of breast cancer are restricted to women with oestrogen receptor positive (ER +ve) disease; however, HRT has not been associated conclusively with a predominance of hormone sensitive breast cancer. Despite stimulating the breast cancer cell growth, HRT has not been shown to increase breast cancer recurrence or mortality when prescribed to breast cancer survivors experiencing oestrogen deficiency symptoms and randomised trials have been recommended and commenced. In conjunction with controlled breast cancer trials demonstrating a therapeutic benefit of high dose estrogens and interest in the use of additive oestrogen therapy in patients developing resistance to oestrogen deprivation, the dogma that HRT is an absolute contra-indication following diagnosis is challenged.     

Effect of coca-leaf chewing on salivary progesterone assays

Although there is evidence for reduced fertility in Andean and Himalayan populations at higher altitudes, factors other than hypoxia may be primarily responsible. A valuable approach in the investigation of these fertility determinants is the use of salivary steroid assays. However, coca-leaf chewing—a ubiquitous practice among high altitude Andean populations—has negative consequences for the accurate measurement of ovarian steroids. This report evaluates the effects of coca-leaf chewing on assays of salivary progesterone. Study participants include naive and habitual users of coca leaf from La Paz and El Alto, Bolivia. Approximately 300 saliva samples were collected immediately before, during, and after coca-leaf chewing. The series includes samples with and without the alkaloid enhancer typically used by coca-leaf chewers. Coca chewing produces false salivary progesterone values that mimic luteal phase values. On the basis of this study, an appropriate protocol is developed for the collection of salivary samples in coca-leaf chewing populations. These results verify the feasibility of salivary assays, even for very difficult field conditions, and highlight the necessity of establishing suitable collection procedures before full field implementation of saliva sampling. © 1993 Wiley-Liss, Inc.     

Thérapies ciblées et biomarqueurs compagnons dans les cancers de la prostate métastatiques

Treatment of castration-resistant prostate cancer has undergone a revolution over the past 3 years with the approval of five new therapies, including new hormonal therapies (abiraterone and enzalutamide) and bone-targeted agents (denosumab, radium-223). New targeted agents have improved survival and quality of life. Currently, companion biomarkers are lacking for a better individualization of treatment.     

几种外源激素对杜仲剥皮再生的影响

杜仲剥皮后,在暴露表面,分别涂以适当浓度的乙烯利、2,4-D、萘乙酸(NAA)和赤霉素(GA),以及 NAA GA 等植物激素,可看到不同的反应。发现用2,4-D、GA 和 NAA处理的,木栓形成层和维管形成层的发生都早于对照,而用乙烯利处理的,只是木栓形成层的发生提早。只有用 NAA 处理的,木栓形成层和维管形成层的发生都与对照相似。     

4 630例绝经后妇女阴道微生态状况分析

目的 分析绝经后妇女阴道微生态状况,为临床诊疗提供实验室依据。 方法 以2018年1月至2019年9月在我院妇科门诊就诊的4 630例绝经后妇女作为研究对象,对其阴道微生态检查结果进行回顾性分析。 结果 4 630例患者中阴道微生态正常者409例(8.83%),阴道微生态异常者4 221例(91.17%)。阴道微生态异常者中不能通过镜检明确病原菌者1 758例(37.97%),包含优势菌异常1 406例(30.37%)、菌群抑制351例(7.58%)、菌群增殖过度1例(0.02%);通过镜检明确病原菌者2 463例(53.20%),包含细菌性阴道病(BV)1 237例(26.72%)、需氧菌性阴道炎(AV)1 001例(21.62%)、外阴阴道假丝酵母菌病(VVC)159例(3.43%)、滴虫性阴道炎(TV)66例(1.43%)。不同年龄段绝经后妇女阴道微生态构成存在差异,其阴道清洁度(Ⅲ/Ⅳ)、菌群密集度(未见/Ⅰ)、菌群密集度(Ⅳ)、菌群多样性(未见/Ⅰ)、菌群多样性(Ⅳ)、优势菌(无)、优势菌(G+大杆菌)、优势菌(G-弧形菌)、优势菌(G+球菌)、VVC、TV、β 氨基半乳糖苷酶(+)、唾液酸苷酶(+)、过氧化氢(+)、阴道pH>4.5、微生态异常发生率在不同年龄段之间的分布差异均有统计学意义(均P结论 阴道微生态异常在妇科门诊绝经后妇女中发生率较高,且不同年龄段妇女阴道微生态异常构成存在差异,提示应结合年龄治疗阴道疾病,同时积极恢复阴道微生态环境。     

Lack of association of ovariectomy-induced obesity with overeating and the reduction of physical activities

Obesity commonly occurs in postmenopausal women, increasing the risk of various diseases. Estrogen can prevent obesity by activating lipid metabolism and suppressing depressive behavior. However, the reasons for obesity in postmenopausal women are not clearly elucidated.To mimic the effect of estrogen decline in postmenopausal women, we analyzed the behavior and the lipid metabolism-related genes, PPARγ and CD36 in ovariectomized (OVX) mice. The OVX mice showed increased visceral fat mass and PPARγ and CD36 expression in the visceral fat. In contrast, they were not significantly affected in terms of physical activity and food intake. Further, subcutaneous supplementation of estrogen effectively suppressed the increase in subcutaneous and visceral fat mass in OVX mice.We conclude that obesity in postmenopausal women is unlikely to be caused by overeating and reduction in physical activity, and subcutaneous supplementation of estrogen is an effective strategy to prevent obesity in postmenopausal women.     

绝经后妇女阴道微生态改变与人乳头瘤病毒感染的相关性

目的 探讨绝经后妇女阴道微生态改变与人乳头瘤病毒(HPV)感染的相关性。 方法 选取2018年3月至2019年3月就诊于周口市中心医院妇科门诊绝经后妇女873例为研究对象,根据感染的HPV DNA基因分型结果分组,检测研究对象阴道分泌物的清洁度、病原体及阴道微生态相关指标,对阴道微生态改变和HPV感染相关性进行统计分析。 结果 873例调查对象中有137例(15.7%)HPV感染者。HPV感染组和未感染组相比较,清洁度(χ2=20.2,P2=17.8,P2=14.0,P2=15.5,P2=8.7,P=0.003)差异有统计学意义,菌群多样性、H2O2阳性率差异无统计学意义(均P>0.05)。多因素回归分析显示清洁度、菌群密集度、pH值异常和白细胞酯酶阳性率异常与HPV感染明显相关(均P结论 绝经后HPV感染患者存在阴道微生态失调,且HPV感染与清洁度、菌群密集度、pH值异常和白细胞酯酶阳性率异常有关。