瑞宁得治疗绝经后妇女晚期乳腺癌临床研究

目的 研究瑞宁得（ａｎａｓｔｒｏｚｏｌｅ）治疗绝经后妇女晚期乳腺癌的临床疗效和不良反应。方法 采用多中心开放非随机自身对照方法，６１例绝经妇女晚期乳腺癌患者口服瑞宁得每日１次，每次１ｍｇ连服４－６周，疗前２周内及治疗４周后的３天内检测血中雌二醇（Ｅ２）水平，同时评价疗效和不良反应。结果 ６０例可评价疗效和不良反应，部分缓解（ＰＲ）１３例，好转（ＭＲ）２例，缓解率２１．７％，有效率２５．０％，绝经时     

High-frequency vibration training increases muscle power in postmenopausal women

OBJECTIVE: To test whether training on a high-frequency (28Hz) vibrating platform improves muscle power and bone characteristics in postmenopausal women. DESIGN: Randomized controlled trial with 6-month follow-up. SETTING: Outpatient clinic in a general hospital in Italy. PARTICIPANTS: Twenty-nine postmenopausal women (intervention group, n=14; matched controls, n=15). INTERVENTION: Participants stood on a ground-based oscillating platform for three 2-minute sessions for a total of 6 minutes per training session, twice weekly for 6 months. The controls did not receive any training. Both groups were evaluated at baseline and after 6 months. MAIN OUTCOME MEASURES: Muscle power, calculated from ground reaction forces produced by landing after jumping as high as possible on a forceplate, cortical bone density, and biomarkers of bone turnover. RESULTS: Over 6 months, muscle power improved by about 5% in women who received the intervention, and it remained unchanged in controls (P=.004). Muscle force remained stable in both the intervention and control groups. No significant changes were observed in bone characteristics. CONCLUSION: Reflex muscular contractions induced by vibration training improve muscle power in postmenopausal women.     

绝经后期妇女生活质量和保健现状调查

目的探讨绝经对妇女生活质量的影响,为中老年妇女保健工作提供依据。方法随机选择城乡已绝经妇女1,860名为研究对象,对其生活质量、保健状况进行横断面调查,资料由Epilnfo5．0和SPSS10．0统计软件包处理。结果被调查妇女的平均绝经年龄（48．3±3．8）（35～55）岁,平均绝经年限是（6．5±2．8）（1～10）年。有65．9％的妇女出现绝经后期综合征,改良Kupperman评分13项中以躯体症状（68．5％）、性生活不适（46．2％）、泌尿系症状（31．6％）为主,症状程度与绝经年限有关。采用激素替代疗法、钙剂的妇女仅占15．6％,且用药不规范,时间较短。结论绝经对妇女生活质量有很大影响,绝经后期保健应引起高度重视。     

绝经后肥胖女性骨密度与血管内皮功能的关系研究

目的 探讨绝经后肥胖女性中骨密度(BMD)与血管内皮功能的相关性.方法 选择自然绝经1～5年的单纯肥胖者(体重指数≥25kg/m2),年龄40～55岁,按照双能X线检测结果选择正常骨量组39例,骨量减少组37例和骨质疏松组19例.所有受试者测定体脂、BMD、骨矿含量(BMC)和血管内皮功能,包括血流介导的内皮依赖性血管舒张(EDD)和硝酸甘油介导的非内皮依赖性血管舒张.结果 骨质疏松组平均年龄和平均绝经时间显著高于正常骨量组和骨量减少组(P<0.05或P<0.01).骨质疏松组及骨量减少组BMD和BMC均显著低于正常骨量组(P<0.05或P<0.01).骨质疏松组EDD显著低于正常体重组和骨量减少组(分别为5.45±2.99、7.76±3.70和7.32±3.41,均P<0.05).相关分析显示各部位的BMD、BMC均与EDD相关(P<0.05和P<0.01).结论 肥胖女性绝经后骨质疏松与血管内皮功能异常有关,对绝经后肥胖女性低骨量人群干预治疗可能有助于防治动脉硬化及心血管疾病.     

The role of physical activity in the prevention of osteoporosis in postmenopausal women—An update

Context and objective

Osteoporosis causes an increase in bone fragility. Its clinical significance mainly refers to (hip) fractures secondary to (low or moderate) trauma. In Europe and North America about 6% of men and 21% of women aged 50–84 years are classified to have osteoporosis. Although it is well accepted that exercise is essential for the management of osteoporosis, the exact role of physical activity in the primary and secondary prevention of osteoporotic fractures is still controversial.

Methods

The MEDLINE database and reference lists of selected publications were systematically searched for randomized controlled trials and prospective cohort studies, respectively, published since January 2000 regarding the association of physical activity and osteoporosis in postmenopausal women.

Results

Two prospective cohort studies indicate the clinical relevance of this association by showing an inverse relationship between physical activity and the risk of hip fracture. There is convincing evidence that physical activity effectively slows bone loss in postmenopausal women in a dose-dependent manner. Exercise programs may increase bone mineral density.

Conclusion

In order to maximize the goals of public health most effective, individually adapted, intense, high impact exercise programs are needed. However, they may be complicated to communicate and adherence on the population level may be hard to achieve. These programs must be weighed against popular and applicable existing programs (e.g. aerobic classes, Tai Chi, and walking) which appear to be easier to adhere to but appear to be less effective in the prevention of osteoporotic fractures in the individual postmenopausal women.     

补佳乐与米索前列醇在绝经后取环中的效果比较

目的:比较补佳乐(戊酸雌二醇片)与米索前列醇在绝经后取环中的用药效果,旨在寻找一种较理想的绝经后取环的方法。方法:选取绝经期要求取环妇女180例,随机分为3组:对照组40例,术前无处理;补佳乐组70例,术前口服补佳乐(2 mg,Qd),连用10天;米索组70例,术前2 h阴道放置米索前列醇400μg。比较3组的宫颈扩张程度,手术时间,术中不良反应及手术成功率有无差异。结果:对照组在宫颈扩张程度,手术时间,术中不良反应及手术成功率与补佳乐组及米索组差异均有统计学意义(P<0.01),而补佳乐组与米索组在宫颈扩张程度,手术时间及手术成功率上差异无统计学意义,但在不良反应中两组差异有统计学意义(P<0.01)。结论:在绝经后取环术前使用补佳乐或米索前列醇能有效减轻患者的痛苦,使手术较易进行,其中补佳乐在减轻患者术中不适方面优于米索前列醇。     

高原地区妇女绝经后阴道出血临床分析

目的:探讨高原地区妇女绝经后阴道出血的相关因素。方法:对291例绝经后阴道出血患者的临床资料进行分析。结果:生殖系统炎症52.23%,功能失调性子宫出血20.28%,生殖系统肿瘤15.46%。生殖系统肿瘤中恶性肿瘤11.34%,并且随着年龄的增长,绝经年限的延长,其发病率呈增高趋势。高原地区各民族妇女恶性肿瘤发病率差异有统计学意义(P=10.8,P<0.01),藏族妇女恶性肿瘤发病率相对较高。结论:绝经后阴道出血的主要因素是生殖系统炎性病变,其次是功能失调性子宫出血、生殖系统肿瘤。藏族妇女绝经后阴道出血中,恶性肿瘤发病率相对较高,高原地区绝经后阴道出血发生恶性肿瘤仍占一定比例,医患双方不可忽视。     

绝经后妇女宫颈细胞学检查异常的临床分析

目的 探讨绝经后妇女宫颈病变的特点及其筛查和诊断方法.方法 选取180例宫颈超薄液基细胞技术(TCT)检查结果异常的绝经后妇女为绝经组,另选取同期宫颈TCT检查异常的未绝经妇女180例为未绝经组,均行阴道镜下宫颈多点活检和高危型人乳头状瘤病毒(HPV)检测.结果 绝经组中宫颈糜烂者84例(46.7%),未绝经组中124例(68.9%),两者间差异有统计学意义(P＜0.05).绝经组与未绝经组中阴道镜下宫颈活检组织病理学诊断为慢性炎症者分别为122例(67.8%)和80例(44.5%),宫颈上皮内瘤变(CIN)Ⅰ～Ⅱ分别为42例(23.3%)和81例(45.0%),CINⅢ分别为4例(2.2%)和15例(8.3%),浸润癌分别为12例(6.7%)和4例(2.2%),两组间差异有统计学意义(P＜0.05);高危型HPV(+)者分别为57例(31.7%)和95例(52.8%),差异有统计学意义(P＜0.05).结论 绝经后妇女宫颈细胞学检查异常有其特殊性,临床上提倡TCT筛查辅助阴道镜下组织病理学检查及高危型HPV感染的检测.     

Grip Strength May Facilitate Fracture Prediction in Perimenopausal Women with Normal BMD: A 15-Year Population-Based Study

The aim of the present study was to investigate the ability of grip strength measurements to predict fracture risk in perimenopausal women according to bone mineral density (BMD). A random sample of 971 perimenopausal women from the Kuopio Osteoporosis Risk Factor and Prevention study cohort was measured with dual-energy X-ray absorptiometry (DXA) at the femoral neck and grip strength with a pneumatic squeeze dynamometer in 5-year intervals from baseline (1989-1991). Fractures during the 15-year follow-up were recorded based on self-reports and validated from medical records. In the total sample and in osteopenic or osteoporotic women (T score < -1, n = 284) grip strength was not significantly associated with fracture-free survival rate (P = nonsignificant in Cox regression). In women with normal baseline BMD (N-BMD, T score > -1, n = 687) the lowest grip strength quartile had a significantly lower fracture-free survival rate in the Cox proportional hazard model (P = 0.005, hazard ratio [HR] = 2.0). In the multivariate Cox regression model, T score and grip strength were the only significant predictors of 15-year fracture-free survival in the N-BMD group and a risk index (RI) was formed according to HRs of these two variables. High RI (0-5 points) was associated with significantly lower 15-year fracture-free survival rate (P = 0.001, HR = 0.137) in the N-BMD group. In contrast, 5-year T score was no better a predictor of fractures in the baseline N-BMD group (P = 0.04, HR = 0.36). In conclusion, grip strength predicts 15-year fracture-free survival in perimenopausal women with N-BMD, while 5-year DXA does not seem to be any better a predictor of fracture risk. DXA measurements could be coupled with simple and cost-effective grip strength measurements. Controlling BMD in women with N-BMD could be abandoned.     

Power Doppler of the Urethra in Continent or Incontinent, Pre- and Postmenopausal Women

Urethral pressure should exceed bladder pressure, both at rest and on stress, for urinary continence to occur. A decrease in urethral pressure is a major factor explaining the pathogenesis of urinary incontinence. A number of elements, such as smooth and striated periurethral muscles, and connective, vascular and elastic tissues, contribute to urethral pressure. The periurethral vessels are influenced by hormonal changes during the menstrual cycle, during pregnancy and postmenopause. We studied the periurethral vessels in 97 women, 57 of whom were incontinent and 40 continent, using power color Doppler velocimetry. The number of periurethral vessels, systolic peak, minimum diastolic values, pulsatility and resistance indexes, as well as systolic–diastolic ratio, were assessed. Statistically significant differences were found between incontinent women in the premenopausal period and those in the postmenopausal period, regarding the number of periurethral vessels, systolic peak, minimum diastolic values, pulsatility and resistance indexes.