Maturitas最新文献_第3页

Associations between the incidence of Fuchs' endothelial corneal dystrophy and menopausal hormone therapy use and exposure to endogenous estrogen 福氏内皮角膜营养不良症的发病率与更年期激素疗法的使用和内源性雌激素暴露之间的关系。

IF 3.9 2区医学 Q2 GERIATRICS & GERONTOLOGY

Maturitas

Pub Date : 2024-10-15 DOI: 10.1016/j.maturitas.2024.108132

Amy E. Millen , Jing Nie , Yihua Yue , Chris A. Andrews , Jean Wactawski-Wende , Robert B. Wallace , Aladdin H. Shadyab , Sangita P. Patel

Objectives

End-stage Fuchs' endothelial corneal dystrophy is a leading cause of corneal blindness, with a higher prevalence in females than in males. Few modifiable risk factors have been identified. We examined associations between menopausal hormone therapy use (never/past/current), duration of hormone therapy use, estimated lifetime exposure to endogenous estrogen, and serum estradiol with incident Fuchs' endothelial corneal dystrophy in a cohort of postmenopausal women.

Study design

This was a prospective analysis in the Women's Health Initiative Observational Study.

Main outcome measures

Incident cases of Fuchs' endothelial corneal dystrophy were identified from the Women's Health Initiative Observational Study baseline (1993–1998) through 2019 using Medicare claims data.

Results

In 22,980 women, 1382 incident cases of Fuchs' endothelial corneal dystrophy (annualized incidence rate and 95 % confidence interval = 5.0 [4.8–5.3] cases per 1000 person-years) were identified. The adjusted hazard ratios and 95 % confidence intervals for Fuchs' endothelial corneal dystrophy were 1.02 (0.88–1.18) and 0.89 (0.79–0.997) for past and current hormone therapy use (vs. never use) at baseline, respectively. Adjusted hazard ratios (95 % confidence interval) were 0.90 (0.79–1.03) and 0.95 (0.84–1.08), p-trend = 0.36, for ≤10 and > 10 years, respectively, of hormone therapy use compared with no use; and the adjusted hazard ratio (95 % confidence interval) was 1.01 (0.88–1.15), p-trend = 0.87, for 46.7–59.0 versus 13.8–41.0 years of estimated lifetime exposure to endogenous estrogen. No statistically significant associations were observed with serum estradiol concentrations in a subset of participants.

Conclusions

In this cohort of postmenopausal women, current hormone therapy use (vs. never use) showed evidence of protection against the development of Fuchs' endothelial corneal dystrophy; however, duration of hormone therapy use, estimated lifetime exposure to endogenous estrogen, or serum estradiol concentrations were not significantly associated with a decreased risk of Fuchs' endothelial corneal dystrophy.

目的：终末期福氏角膜内皮营养不良症是角膜失明的主要原因，女性发病率高于男性。目前几乎没有发现可改变的风险因素。我们研究了绝经后妇女队列中更年期激素治疗使用（从未/过去/现在）、激素治疗使用持续时间、估计终生暴露于内源性雌激素和血清雌二醇与福氏角膜内皮营养不良发病率之间的关系：研究设计：这是妇女健康倡议观察研究中的一项前瞻性分析：利用医疗保险报销数据，从妇女健康倡议观察研究基线（1993-1998年）至2019年期间确定福氏内皮角膜营养不良的发病病例：结果：在22980名女性中，发现了1382例福克斯内皮角膜营养不良病例（年发病率和95%置信区间=每1000人年5.0 [4.8-5.3]例）。基线时曾使用和目前使用激素疗法（与从未使用激素疗法相比）的福氏内皮角膜营养不良调整后危险比和 95 % 置信区间分别为 1.02 (0.88-1.18) 和 0.89 (0.79-0.997)。与未使用激素疗法相比，使用激素疗法≤10年和>10年的调整后危险比（95%置信区间）分别为0.90（0.79-1.03）和0.95（0.84-1.08），p-趋势=0.36；估计终生接触内源性雌激素46.7-59.0年与13.8-41.0年的调整后危险比（95%置信区间）为1.01（0.88-1.15），p-趋势=0.87。在一部分参与者中，没有观察到与血清雌二醇浓度有统计学意义的关联：结论：在这批绝经后妇女中，目前使用激素疗法（与从未使用激素疗法相比）有证据表明可以预防福氏内皮角膜营养不良症的发生；但是，使用激素疗法的持续时间、估计终生暴露于内源性雌激素的时间或血清雌二醇浓度与福氏内皮角膜营养不良症风险的降低并无显著关联。

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引用次数: 0

Morning tiredness and insomnia symptoms are associated with increased blood pressure in midlife women 晨间疲倦和失眠症状与中年女性血压升高有关

IF 3.9 2区医学 Q2 GERIATRICS & GERONTOLOGY

Maturitas

Pub Date : 2024-10-10 DOI: 10.1016/j.maturitas.2024.108131

Ville Rimpilä , Katja Valli , Tero Vahlberg , Tarja Saaresranta

Objectives

The objective of this study was to investigate how blood pressure, sleep architecture, sleep-disordered breathing, body habitus, and levels of serum follicle-stimulating hormone are associated with symptoms of insomnia and sleep quality during menopausal transition.

Methods

64 healthy premenopausal women (aged 45–47 years) were recruited to the study. Data were collected at baseline and at 10-year follow-up during sleep laboratory and laboratory visits. A sleep questionnaire was used to evaluate sleep quality and insomnia symptoms. Data were analysed using multiple linear and logistic regression with a backward method.

Results

During the menopausal transition, a change in insomnia symptoms was associated with a change in morning systolic blood pressure (β = 0.114 (CI95% 0.023–0.205), p = 0.016). At follow-up, at the age of 56, a higher percentage of REM sleep was associated with a lower odds of restless sleep (OR = 0.842 (95 % CI 0.742–0.954), p = 0.007), while both higher systolic and diastolic evening blood pressure was associated with an increased odds of morning tiredness.

OR = 1.047 (95 % CI 1.003–1.092), p = 0.034 and OR = 1.126 (95 % CI 1.018–1.245), p = 0.007, respectively.

Conclusions

In healthy midlife women, a change blood pressure is related to the development of insomnia symptoms during menopausal transition. In postmenopausal women, a high evening blood pressure may be associated with morning tiredness and a reduced amount of REM sleep may be perceived as restless sleep.

本研究旨在探讨血压、睡眠结构、睡眠呼吸紊乱、体型和血清卵泡刺激素水平与绝经过渡期失眠症状和睡眠质量的关系。在睡眠实验室和化验室访问期间，收集了基线和 10 年随访的数据。睡眠问卷用于评估睡眠质量和失眠症状。结果在绝经过渡期，失眠症状的变化与早晨收缩压的变化相关（β = 0.114 (CI95% 0.023-0.205), p = 0.016）。在 56 岁的随访中，快速动眼期睡眠比例越高，睡眠不安的几率越低（OR = 0.842 (95 % CI 0.742-0.954), p = 0.007），而晚间收缩压和舒张压越高，晨起疲倦的几率越高。OR=1.047（95 % CI 1.003-1.092），p=0.034；OR=1.126（95 % CI 1.018-1.245），p=0.007。在绝经后妇女中，晚间血压高可能与早晨疲倦有关，快速眼动睡眠量减少可能被认为是睡眠不安。

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引用次数: 0

The role of menopausal symptoms on future health and longevity: A systematic scoping review of longitudinal evidence 更年期症状对未来健康和寿命的影响：对纵向证据的系统性范围审查。

IF 3.9 2区医学 Q2 GERIATRICS & GERONTOLOGY

Maturitas

Pub Date : 2024-09-30 DOI: 10.1016/j.maturitas.2024.108130

Robin Andrews , Arron Lacey , Kate Bache , Emma J. Kidd

Women live longer than men but spend more years in poor health. Menopausal symptoms are not generally associated with adverse health outcomes. However, increasingly, evidence suggests they can significantly impact future health and longevity. Understanding the long-term effects of menopausal symptoms will enable clinicians to identify risk factors and intervene with modifications to support healthy aging.

This review examined the scope of research investigating the association between menopausal symptoms and future health outcomes. We searched for longitudinal cohort studies. Date and geographical restrictions were not applied. Articles were screened and data extracted using standardised methods.

Included studies examined the role of menopausal symptoms on future health developments using a sample who had experienced menopause and were deemed healthy at baseline, with clear reporting of their menopausal status at symptom assessment.

We identified 53 eligible studies with data from over 450,000 women enrolled in 28 longitudinal cohorts.

Cardiovascular disease, psychiatric disorders, diabetes, and reduced bone mineral density were positively associated with menopausal symptoms. Breast cancer was associated with an asymptomatic menopause. Psychological menopausal symptoms and cognitive decline improved after menopause, except among women from low socioeconomic backgrounds.

These findings demonstrate that menopausal symptoms are important indicators for future health risks. Future work should investigate the impact of underexplored menopausal symptoms on future health, such as sleeping problems and urogenital issues, and evaluate whether treating menopausal symptoms could lead to improvements in future health outcomes. Should future research continue to support these findings, clinical guidelines should be updated to support clinical decision-making in menopause care.

女性的寿命比男性长，但健康状况不佳的年数却比男性多。更年期症状一般与不良健康后果无关。然而，越来越多的证据表明，更年期症状会严重影响未来的健康和寿命。了解更年期症状的长期影响将有助于临床医生识别风险因素并采取干预措施，以支持健康的老龄化。本综述探讨了更年期症状与未来健康结果之间关系的研究范围。我们搜索了纵向队列研究。日期和地域不受限制。我们采用标准化方法对文章进行筛选并提取数据。所纳入的研究使用经历过更年期并在基线时被认为是健康的样本来研究更年期症状对未来健康发展的影响，这些样本在症状评估时明确报告了其更年期状态。我们确定了 53 项符合条件的研究，其数据来自 28 个纵向队列中超过 45 万名妇女。心血管疾病、精神疾病、糖尿病和骨矿物质密度降低与更年期症状呈正相关。乳腺癌与无症状更年期有关。心理更年期症状和认知能力下降在绝经后有所改善，但社会经济背景较差的妇女除外。这些研究结果表明，更年期症状是未来健康风险的重要指标。未来的工作应调查未被充分探索的更年期症状对未来健康的影响，如睡眠问题和泌尿生殖系统问题，并评估治疗更年期症状是否能改善未来的健康状况。如果未来的研究继续支持这些发现，则应更新临床指南，以支持更年期护理的临床决策。

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引用次数: 0

Efficacy and safety of an ultra-low-dose 0.005 % estriol vaginal gel in the prevention of urinary tract infections in postmenopausal women with genitourinary syndrome of menopause: A randomized double-blind placebo-controlled trial 超低剂量 0.005 % 雌三醇阴道凝胶预防绝经后泌尿生殖系统综合征妇女尿路感染的有效性和安全性：随机双盲安慰剂对照试验。

IF 3.9 2区医学 Q2 GERIATRICS & GERONTOLOGY

Maturitas

Pub Date : 2024-09-28 DOI: 10.1016/j.maturitas.2024.108128

Nuno Muiños Fernández , Juan Ignacio Martínez Salamanca , José Ignacio Pardo González de Quevedo , M. Pilar Diz Morales , Lourdes Palomo Alameda , Susana Duce Tello , Milagros González Béjar , Alejandra Rabanal Carrera , Javier Rosado Martín , Laura Noguera Vera , Ana Doyle Sanchez , Amelia Rodríguez Mariblanca , Eva García Aguilar

Objectives

This study evaluated the efficacy of an ultra-low-dose 0.005 % estriol vaginal gel in the prevention of urinary tract infections in postmenopausal women with genitourinary syndrome of menopause.

Study design

Randomized, double-blind, placebo-controlled, multicenter clinical trial conducted across 28 Spanish sites involving specialists in gynecology, urology, and primary care. A total of 108 postmenopausal women were randomly assigned in a 1:1 ratio to receive 1 g of vaginal gel with 50 micrograms of estriol or an identical moisturizing vaginal gel without estriol.

Main outcome measures

The primary outcome was the number of episodes of urinary tract infection by the end of the 24-week treatment. Secondary measures encompassed percentage of patients without recurrence, time to first recurrence, use of antibiotic treatment, vaginal pH, safety, and tolerability, among others.

Results

The incidence rate of urinary tract infections (new cases per 100 women-year) was 26 % lower in the group that received estriol vs. the group that received placebo (32.34 vs. 43.76 (RR = 0.74) p < 0.001). The frequency of urinary tract infections fell during treatment in all patients in the estriol group. Favorable pH changes from baseline were observed in the estriol arm at all follow-up visits.

Conclusions

Ultra-low-dose 0.005 % estriol vaginal gel is safe and effective in preventing recurrent urinary tract infections in postmenopausal women with genitourinary syndrome of menopause, reducing the incidence and potentially decreasing the susceptibility to urogenital infections by improving vaginal pH.

Study registration N°: 2018-001481-42. Date of registration: 09-04-2018.

研究目的本研究评估了超低剂量 0.005 % 雌三醇阴道凝胶对绝经后泌尿生殖系统综合征妇女预防尿路感染的疗效：随机、双盲、安慰剂对照、多中心临床试验，在西班牙 28 个地点进行，涉及妇科、泌尿科和初级保健专家。共有 108 名绝经后妇女按 1:1 的比例被随机分配接受 1 克含 50 微克雌三醇的阴道凝胶或相同的不含雌三醇的保湿阴道凝胶：主要结果：24周治疗结束时的尿路感染次数为主要结果。次要指标包括无复发患者的百分比、首次复发的时间、抗生素治疗的使用、阴道pH值、安全性和耐受性等：结果：接受雌三醇治疗组与接受安慰剂治疗组相比，尿路感染发生率（每 100 名妇女年新增病例数）降低了 26%（32.34 vs. 43.76 (RR = 0.74) p 结论：雌三醇治疗组与安慰剂治疗组的尿路感染发生率（每 100 名妇女年新增病例数）降低了 26%：超低剂量 0.005 % 雌三醇阴道凝胶对预防患有更年期泌尿生殖系统综合征的绝经后妇女的复发性尿路感染安全有效，通过改善阴道 pH 值降低了尿路感染的发病率并可能降低其易感性。研究注册编号：2018-001481-42。注册日期：2018-04-0909-04-2018.

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引用次数: 0

A systematic review and meta-analysis investigating differences in chronic inflammation and adiposity before and after menopause 对绝经前后慢性炎症和肥胖差异的系统回顾和荟萃分析研究

IF 3.9 2区医学 Q2 GERIATRICS & GERONTOLOGY

Maturitas

Pub Date : 2024-09-26 DOI: 10.1016/j.maturitas.2024.108119

Laura E. Pernoud , Paul A. Gardiner , Sean D. Fraser , Kirsten Dillon-Rossiter , Melinda M. Dean , Mia A. Schaumberg

Background

Menopause represents a pivotal physiological transition characterized by hormonal fluctuations and an augmented susceptibility to chronic diseases. The relationship between menopause and heightened disease risk may be attributed in part to alterations in low-grade chronic inflammation and adiposity.

Methods

Three databases were searched for studies assessing differences in inflammation and body adiposity between pre- and postmenopausal women. Meta-analysis examined the association between menopausal status and key inflammatory biomarkers, including leptin, adiponectin, interleukin-6, tumour necrosis factor-α and c-reactive protein, and indices of body adiposity (fat mass, waist circumference, waist-to-hip-ratio and body mass index). The National Institute of Health Quality Assessment Tool for Observational and Cross-sectional studies was used to evaluate quality of studies, and GRADE-assessed evidence certainty.

Results

Levels of adiponectin and leptin were higher in postmenopausal women than in premenopausal women [(1.30 μg/ml, 95 % CI; 0.56 to 2.03 μg/ml, p = 0.001), (0.88 ng/ml; 95 % CI: 0.22 to 1.52; p = 0.008)]. A trend towards significance was observed for tumour necrosis factor-α (0.59 pg/ml, 95 % CI; −0.07 to 1.26 pg/ml, p = 0.080), with no significant differences in interleukin-6 and c-reactive protein [(0.83 pg/ml, 95 % CI; −0.24 to 1.91 pg/ml, p = 0.128), (0.06 mg/ml, 95 % CI; −0.17 to 0.29, p = 0.606)]. Postmenopausal women had greater waist circumference, waist-to-hip-ratio and body mass index than premenopausal women [(0.74 cm; 95 % CI: 1.02 to 0.47; p ≤0.001), (0.78; 95 % CI: 1.47 to −0.09; p = 0.027), (0.31 kg/m²; 95 % CI: 0.50 to 0.12; p = 0.001)].

Conclusions

Postmenopausal women had higher adipokine levels and greater adiposity. However, given the low certainty of the available evidence, future prospective cohort studies assessing inflammatory changes over the menopausal transition are warranted to inform future clinical decisions. Protocol registered on the Open Science Framework (OSF-ID: 10.17605/OSF.IO/DY8T6).

背景更年期是一个关键的生理过渡时期，其特点是激素波动和慢性疾病易感性增加。方法在三个数据库中搜索了评估绝经前和绝经后女性炎症和身体脂肪含量差异的研究。Meta 分析研究了绝经状态与主要炎症生物标志物（包括瘦素、脂肪连通素、白细胞介素-6、肿瘤坏死因子-α 和 c 反应蛋白）以及身体肥胖指数（脂肪量、腰围、腰臀比和体重指数）之间的关系。采用美国国立卫生研究院观察性和横断面研究质量评估工具评估研究质量，并采用 GRADE 评估证据的确定性。结果绝经后妇女的脂肪连素和瘦素水平高于绝经前妇女[（1.30 μg/ml，95 % CI；0.56 至 2.03 μg/ml，p = 0.001），（0.88 ng/ml；95 % CI：0.22 至 1.52；p = 0.008）]。肿瘤坏死因子-α呈显著性趋势（0.59 pg/ml，95 % CI；-0.07 至 1.26 pg/ml，p = 0.080），白细胞介素-6 和 c 反应蛋白[（0.83 pg/ml，95 % CI；-0.24 至 1.91 pg/ml，p = 0.128），（0.06 mg/ml，95 % CI；-0.17 至 0.29，p = 0.606）]无显著差异。绝经后妇女的腰围、腰臀比和体重指数高于绝经前妇女[（0.74 厘米；95 % CI：1.02 至 0.47；p ≤0.001），（0.78; 95 % CI: 1.47 to -0.09; p = 0.027)，(0.31 kg/m2; 95 % CI: 0.50 to 0.12; p = 0.001)].结论绝经前妇女的脂肪因子水平更高，脂肪含量更大。然而，鉴于现有证据的确定性较低，未来有必要开展前瞻性队列研究，评估绝经过渡期的炎症变化，为未来的临床决策提供依据。协议已在开放科学框架（OSF-ID：10.17605/OSF.IO/DY8T6）上注册。

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引用次数: 0

Menopause and endometriosis 更年期和子宫内膜异位症

IF 3.9 2区医学 Q2 GERIATRICS & GERONTOLOGY

Maturitas

Pub Date : 2024-09-26 DOI: 10.1016/j.maturitas.2024.108129

Chiara Cassani , Sara Tedeschi , Laura Cucinella , Vittoria Morteo , Cristina Angela Camnasio , Lara Tiranini , Ellis Martini , Rossella E. Nappi

The shift in paradigm from the belief that endometriosis exclusively affects women of reproductive age has brought attention to its manifestation in postmenopausal patients. Despite this emerging awareness, there remains a dearth of information in the literature regarding postmenopausal endometriosis, with uncertainties surrounding its prevalence, clinical significance, optimal management strategies, and prognosis. Clinical manifestations of endometriosis in menopausal patients lack specificity, with pain onset possible at any stage of life. The primary approach for symptomatic postmenopausal endometriosis continues to be surgical excision, serving both diagnostic and therapeutic purposes while mitigating the risk of coexisting malignancies. Managing the disease in postmenopausal women presents challenges due to possible contraindications for menopausal hormone therapy and the elevated risk of recurrence and malignant transformation. However, conclusive data regarding the appropriateness of menopausal hormone therapy in women with endometriosis or a history of the disease are lacking. Current recommendations lean towards prioritizing combined menopausal hormone therapy formulations or tibolone over estrogen-only therapies due to their potentially higher malignancy risk. The possible increased risk of osteoporosis and cardiovascular disease in postmenopausal women with endometriosis is likely linked to a history of surgical menopause at an earlier age, but more research is warranted. This narrative review summarizes the available literature and provides insights into the intricate connection between endometriosis and menopause, shedding light on pathogenesis, symptoms, oncologic risk, diagnosis, and treatment.

子宫内膜异位症只影响育龄妇女的观念已经发生了转变，人们开始关注其在绝经后患者中的表现。尽管人们开始意识到这一点，但有关绝经后子宫内膜异位症的文献资料仍然十分匮乏，其发病率、临床意义、最佳治疗策略和预后都存在不确定性。绝经期患者的子宫内膜异位症临床表现缺乏特异性，疼痛可能在生命的任何阶段发作。绝经后无症状子宫内膜异位症的主要治疗方法仍然是手术切除，既能达到诊断和治疗目的，又能降低并发恶性肿瘤的风险。由于绝经后妇女可能有绝经激素治疗禁忌症，而且复发和恶变的风险较高，因此治疗绝经后妇女的子宫内膜异位症是一项挑战。然而，对于患有子宫内膜异位症或有此病史的女性是否适合绝经激素治疗，目前还缺乏确凿的数据。目前的建议倾向于优先选择联合绝经激素治疗配方或替勃龙，而不是纯雌激素疗法，因为它们潜在的恶性肿瘤风险较高。患有子宫内膜异位症的绝经后妇女患骨质疏松症和心血管疾病的风险可能会增加，这可能与绝经年龄较早的手术史有关，但还需要进行更多的研究。这篇叙述性综述总结了现有的文献，对子宫内膜异位症与绝经之间错综复杂的联系进行了深入探讨，阐明了发病机制、症状、肿瘤风险、诊断和治疗。

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引用次数: 0

Protective and harmful social and psychological factors associated with mood and anxiety disorders in perimenopausal women: A narrative review 与围绝经期妇女情绪和焦虑症相关的保护性和有害的社会和心理因素：叙述性综述

IF 3.9 2区医学 Q2 GERIATRICS & GERONTOLOGY

Maturitas

Pub Date : 2024-09-18 DOI: 10.1016/j.maturitas.2024.108118

Kayla McElhany , Seema Aggarwal , Geri Wood , Jennifer Beauchamp

Perimenopause is often called a window of vulnerability for the development or exacerbation of mood and anxiety disorders. Evidence points to social and psychological factors contributing to the onset of mood and anxiety disorders or the symptoms of depression and anxiety during perimenopause. Therefore, the purpose of this narrative review was to synthesize the findings of studies examining associations between social and psychological factors and the development of mood and anxiety disorders and the symptoms of depression and anxiety during perimenopause. PsychINFO, Ovid MEDLINE, and CINAHL were searched for studies (published between January 2014 and November 2023) assessing the social and psychological factors associated with perimenopausal mood and anxiety disorders and the symptoms of depression and anxiety. These factors were categorized as either protective or harmful. Study quality was assessed using STROBE guidelines. The search yielded 17 studies. Social support was identified as a social factor protective against perimenopausal depression and anxiety. Resiliency characteristics were reported to be protective psychological factors associated with fewer depressive symptoms. Mental health history, family history of major depressive disorder, trait anxiety and neuroticism, stressful life events, adverse childhood events, and chronic stress were categorized as harmful psychological factors associated with depression during perimenopause. Limited research has been conducted to understand factors associated with perimenopausal anxiety. The identification of these social and psychological factors associated with mood and anxiety disorders during perimenopause will help lead to earlier detection of women at risk and the development of multifaceted interventions.

围绝经期通常被称为情绪和焦虑症的易发期或加重期。有证据表明，社会和心理因素是导致围绝经期出现情绪和焦虑障碍或抑郁和焦虑症状的原因。因此，本叙事性综述的目的是综述有关社会和心理因素与围绝经期情绪和焦虑症的发生以及抑郁和焦虑症状之间关系的研究结果。我们在 PsychINFO、Ovid MEDLINE 和 CINAHL 中检索了评估与围绝经期情绪和焦虑障碍以及抑郁和焦虑症状相关的社会和心理因素的研究（发表于 2014 年 1 月至 2023 年 11 月）。这些因素被分为保护性因素和有害因素。研究质量根据 STROBE 指南进行评估。搜索结果显示有 17 项研究。社会支持被认为是围绝经期抑郁和焦虑的保护性社会因素。据报道，复原力特征是与较少抑郁症状相关的保护性心理因素。心理健康史、重度抑郁症家族史、特质焦虑和神经质、生活压力事件、不良童年事件和慢性压力被归类为与围绝经期抑郁相关的有害心理因素。有关围绝经期焦虑症相关因素的研究十分有限。确定这些与围绝经期情绪和焦虑症相关的社会和心理因素，将有助于及早发现高危妇女，并制定多方面的干预措施。

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引用次数: 0

Ultra-low dose estradiol and dydrogesterone for the treatment of menopausal symptoms in a pooled, multi-ethnic population 在多种族人群中使用超低剂量雌二醇和地屈孕酮治疗更年期症状

IF 3.9 2区医学 Q2 GERIATRICS & GERONTOLOGY

Maturitas

Pub Date : 2024-09-17 DOI: 10.1016/j.maturitas.2024.108117

John C. Stevenson , Mulan Ren , Elke Kahler , Marcelo Graziano Custodio , Rossella Elena Nappi , Tetiana Tatarchuk , Tommaso Simoncini , Viktoriya Karpova , Qi Yu

Objectives

Evidence suggests ethnicity-specific differences in postmenopausal symptoms, highlighting the need for therapies that are efficacious across different ethnicities. We evaluated the efficacy of an ultra-low dose combination of 0.5 mg estradiol and 0.25 mg dydrogesterone (E 0.5 mg/D 2.5 mg) in alleviating vasomotor symptoms across a multi-ethnic population.

Study design

Data from two controlled trials were pooled to form a dataset of 583 postmenopausal women from across Europe and China. Participants were randomized to receive treatment with E 0.5 mg/D 2.5 mg or placebo for 12 weeks.

Main outcome measures

The main efficacy variable was absolute change in the number of hot flushes from baseline to end of treatment. Health-related quality of life and safety were also assessed.

Results

Change in the number of hot flushes per day was greater with E 0.5 mg/D 2.5 mg versus placebo (mean difference − 1.5, 95 % confidence interval − 2.1, −1.0; p < 0.001). Participants treated with E 0.5 mg/D 2.5 mg reported improvement in health-related quality of life (including psychological symptoms, vaginal dryness), and high amenorrhea rates. Combined E 0.5 mg/D 2.5 mg was well tolerated: there were no differences between groups in the percentage of participants with at least one serious adverse event or treatment-emergent serious adverse events. Analysis of change in body weight indicated no differences between groups.

Conclusions

This pooled analysis demonstrates the consistent efficacy of E 0.5 mg/D 2.5 mg in the treatment of menopause-related symptoms across a multi-ethnic population of postmenopausal women.

目的有证据表明，绝经后症状存在种族特异性差异，因此需要在不同种族间采用有效的疗法。我们评估了 0.5 毫克雌二醇和 0.25 毫克地屈孕酮的超低剂量组合（E 0.5 毫克/D 2.5 毫克）在缓解多种族人群血管运动症状方面的疗效。主要结果测量主要疗效变量为从基线到治疗结束期间潮热次数的绝对变化。结果E 0.5 mg/D 2.5 mg与安慰剂相比，每天潮热次数的变化更大（平均差异-1.5，95%置信区间-2.1, -1.0; p <0.001）。接受 E 0.5 mg/D 2.5 mg 治疗的参与者报告称，与健康相关的生活质量（包括心理症状、阴道干涩）有所改善，且闭经率较高。E 0.5 mg/D 2.5 mg联合用药的耐受性良好：出现至少一种严重不良事件或治疗引发的严重不良事件的受试者比例在各组之间没有差异。结论这项汇总分析表明，E 0.5 mg/D 2.5 mg 在治疗绝经后妇女的绝经相关症状方面具有一致的疗效。

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引用次数: 0

Sex differences in the predictors of skeletal muscle microvascular reactivity in older individuals 预测老年人骨骼肌微血管反应性的性别差异

IF 3.9 2区医学 Q2 GERIATRICS & GERONTOLOGY

Maturitas

Pub Date : 2024-09-13 DOI: 10.1016/j.maturitas.2024.108115

Thiago Silveira Alvares , Felipe Mattioni Maturana , Rogerio Nogueira Soares

Aging is associated with an increased risk of cardiovascular disease and vascular dysfunction. Reduced nitric oxide bioavailability is considered one of the key mechanisms underlying vascular dysfunction in large arteries of older adults. However, the relationship between cardiovascular disease risk factors, nitric oxide bioavailability, and skeletal muscle microvascular reactivity, an early hallmark in cardiovascular disease progression, is unclear in older individuals. Also uncertain is whether this relationship is influenced by sex. Therefore, this study assessed the association between cardiovascular disease risk factors, circulating markers of nitric oxide availability (plasma nitrate and nitrite), and skeletal muscle microvascular reactivity in older individuals. First, we confirmed in a cohort of young and older individuals that aging is associated with skeletal muscle microvascular dysfunction. Next, we observed that skeletal muscle microvascular reactivity (P = 0.653; η² = 0.016) and circulating nitric oxide metabolites (Nitrate: P = 0.641, η² = 0.011; Nitrite: P = 0.560, η² = 0.017; NOx: P = 0.639, η² = 0.011) did not differ between older males and females. Finally, using multivariate regression models, we found that: (i) the number of cardiovascular risk factors was negatively associated with skeletal muscle microvascular reactivity in older males and females (B = −0.132, P = 0.044); (ii) the relationship between plasma nitrite and skeletal muscle microvascular reactivity was influenced by sex (F = 6.837, P = 0.016); and (iii) skeletal muscle microvascular reactivity in older females displayed a strong positive association with plasma nitrite (R² = 0.720, P < 0.001). While the impact of cardiovascular disease risk factors on skeletal muscle microvascular reactivity was not influenced by sex, sex-related discrepancies were found in the relationship between nitric oxide bioavailability and skeletal muscle microvascular reactivity in older individuals.

衰老与心血管疾病和血管功能障碍的风险增加有关。一氧化氮生物利用率降低被认为是老年人大动脉血管功能障碍的关键机制之一。然而，心血管疾病风险因素、一氧化氮生物利用率和骨骼肌微血管反应性（心血管疾病进展的早期标志）之间的关系在老年人中还不清楚。此外，这种关系是否受性别影响也不确定。因此，本研究评估了心血管疾病风险因素、一氧化氮可用性循环标志物（血浆硝酸盐和亚硝酸盐）与老年人骨骼肌微血管反应性之间的关系。首先，我们在一组年轻人和老年人中证实，衰老与骨骼肌微血管功能障碍有关。其次，我们观察到骨骼肌微血管反应性（P = 0.653; η2 = 0.016）和循环一氧化氮代谢物（硝酸盐，P = 0.641; η2 = 0.016）的变化：硝酸盐：P = 0.641，η2 = 0.011；亚硝酸盐：P = 0.560，η2 = 0.011：P=0.560，η2=0.017；NOx：P = 0.639，η2 = 0.011）在老年男性和女性之间没有差异。最后，通过多变量回归模型，我们发现(i) 在老年男性和女性中，心血管危险因素的数量与骨骼肌微血管反应性呈负相关（B = -0.132，P = 0.044）；(ii) 血浆亚硝酸盐与骨骼肌微血管反应性之间的关系受性别影响（F = 6.837，P = 0.016）；(iii) 老年女性骨骼肌微血管反应性与血浆亚硝酸盐呈强正相关（R2 = 0.720，P <0.001）。虽然心血管疾病风险因素对骨骼肌微血管反应性的影响不受性别影响，但在老年人一氧化氮生物利用度与骨骼肌微血管反应性之间的关系中发现了与性别有关的差异。

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引用次数: 0

Better understanding fall risk: AI-based computer vision for contextual gait assessment 更好地了解跌倒风险：基于人工智能的计算机视觉进行情境步态评估

IF 3.9 2区医学 Q2 GERIATRICS & GERONTOLOGY

Maturitas

Pub Date : 2024-09-10 DOI: 10.1016/j.maturitas.2024.108116

Jason Moore , Peter McMeekin , Samuel Stuart , Rosie Morris , Yunus Celik , Richard Walker , Victoria Hetherington , Alan Godfrey

Contemporary research to better understand free-living fall risk assessment in Parkinson's disease (PD) often relies on the use of wearable inertial-based measurement units (IMUs) to quantify useful temporal and spatial gait characteristics (e.g., step time, step length). Although use of IMUs is useful to understand some intrinsic PD fall-risk factors, their use alone is limited as they do not provide information on extrinsic factors (e.g., obstacles). Here, we update on the use of ergonomic wearable video-based eye-tracking glasses coupled with AI-based computer vision methodologies to provide information efficiently and ethically in free-living home-based environments to better understand IMU-based data in a small group of people with PD. The use of video and AI within PD research can be seen as an evolutionary step to improve methods to understand fall risk more comprehensively.

目前，为更好地了解帕金森病（PD）患者自由生活时跌倒风险评估的研究通常依赖于使用可穿戴式惯性测量单元（IMU）来量化有用的时间和空间步态特征（如步幅、步长）。虽然使用惯性测量单元有助于了解某些内在的肢体残疾跌倒风险因素，但由于它们不能提供外在因素（如障碍物）的信息，因此仅使用它们是有局限性的。在此，我们将介绍使用符合人体工程学的可穿戴式视频眼动跟踪眼镜，结合基于人工智能的计算机视觉方法，在自由生活的家庭环境中高效、道德地提供信息，以更好地了解一小群帕金森病患者基于 IMU 的数据。在帕金森氏症研究中使用视频和人工智能可视为一种进化步骤，有助于改进方法，更全面地了解跌倒风险。

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引用次数: 0