Efficacy and Safety Investigation of Kuntai Capsule for the Add-back Therapy of Gonadotropin Releasing Hormone Agonist Administration to Endometriosis Patients: A Randomized,Double-blind,Blank- and Tibolone-controlled Study

Background:

As a Chinese Traditional Medicine product, Kuntai capsule could improve the peri-menopausal symptoms in postmenopausal women. But it is still not clear whether Kuntai capsule has a good effect on alleviating peri-menopausal symptoms induced by gonadotropin releasing hormone agonist (GnRH-a) treatment. The purpose of this study was to investigate the clinical effectiveness and safety of Kuntai capsule, on peri-menopausal symptoms in endometriosis (EMS) patients, with postoperative GnRH-a treatment.

Methods:

Ninety EMS ovarian cyst women with postoperative GnRH-a administration were enrolled in the study, and were randomly divided into Kuntai group, Tibolone group, or blank Control group. The therapeutic strategy in Kuntai group was 4 Kuntai capsules tid,po for 12 weeks after the first GnRH-a injection, while Tibolone 2.5 mg qd, po for 12 weeks in Tibolone group. There was no drug addition in Control group. Climacteric complaints were evaluated by Kupperman menopausal index (KMI) and hot flash/sweating score. Liver and renal functions, lipid profile, serum sex hormone levels and endometrial thickness were measured, and the frequency of adverse events in Kuntai and Tibolone groups was recorded.

Results:

(1) Before GnRH-a therapy, the baseline parameter results were comparable in the three groups (P > 0.05). (2) After GnRH-a therapy, KMI and hot flash/sweating scores in all the three groups increased significantly (P < 0.05). At the 4^th week after GnRH-a therapy, KMI and hot flash/sweating score results were as follows: Control group > Kuntai group > Tibolone group (P < 0.05); at the 8^th and 12^th week after GnRH-a therapy, KMI and hot flash/sweating score in Control group were significantly higher than the other two groups (P < 0.05), and no significant difference was identified between Kuntai and Tibolone group (P > 0.05). (3) No statistical change took place in the liver and renal functions and lipid profile in all the three groups after the treatment (P > 0.05). (4) The posttherapeutic serum follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) level and endometrial thickness decreased significantly in all the three groups (P < 0.05). After therapy, serum E2 level in Tibolone group was obviously higher than the other two groups (P < 0.05), while FSH and LH levels were obviously lower (P < 0.05). (5) The incidence of vaginal bleeding, breast distending pain in Tibolne group was obviously higher than Kuntai group (P < 0. 05).

Conclusions:

Kuntai capsule is effective on the peri-menopausal symptoms induced by postoperative GnRH-a administration to EMS patients, although its clinical effect might be a few weeks later than Tibolone. Kuntai capsule might be a little safer than Tibolone tablet.     

265名文昌市妊娠妇女口腔健康知识及行为调查

目的 了解文昌市妊娠妇女的口腔健康知识和行为及相关因素.方法 采用问卷调查方式对文昌市人民医院妇和文昌市庆龄妇幼保健院265名产检妇女进行调查.结果 265名被调查者中,孕期口腔健康知识平均得分2.2分(总分5分),婴幼儿相关口腔健康知识2.1(总分6分).孕妇在怀孕前后每天刷牙次数均在2次以上占总人数的87.5％,而怀孕前后每天使用牙签次数都在2次以上20.0％,18.5％在怀孕前做过口腔检查,38.1％的孕妇认为口腔检查没有问题或没有必要.结论 该地区妊娠期妇女口腔健康知识和妊娠期口腔保健行为有待加强.     

雌激素替代治疗对绝经后妇女血管内皮舒张功能的影响

为了探讨雌激素抗动脉粥样硬化和降低冠心病发病危险的机制 ,采用无创性高分辨超声法观察雌激素替代治疗对绝经后妇女血管内皮依赖性舒张功能的影响 ,于治疗前后测量血清雌二醇、一氧化氮和血脂水平。结果发现 ,绝经后妇女较绝经前妇女血清雌二醇和一氧化氮下降 (P <0 .0 0 1) ,肱动脉血流介导的舒张反应较绝经前明显下降 (3.84 %± 2 .18%比 10 .0 5 %± 3.18% ,P <0 .0 0 1) ;短期雌激素替代治疗后雌二醇和一氧化氮水平较治疗前极显著升高 (P <0 .0 0 1) ,肱动脉血流介导的舒张反应也显著改善 (9.16 %± 3.0 2 % ,P <0 .0 0 1) ,而雌激素替代治疗并未使血脂发生明显改善 (P >0 .0 5 )。相关分析发现肱动脉血流介导的舒张反应与雌二醇和一氧化氮呈正相关(r值分别为 0 .5 6 4和 0 .72 9,P <0 .0 0 1) ,与总胆固醇呈负相关 (r为 - 0 .36 9,P <0 .0 5 )。结果提示短期雌激素替代治疗可明显改善绝经后妇女内皮依赖性舒血管功能障碍 ,且与血脂的改善无关 ,可能与雌激素的直接血管保护作用有关。     

围绝经期妇女月经状况与心血管疾病的关系

目的：调查城市社区围绝经期女性中心血管疾病的患病率及其危险因素,并探讨绝经与心血管疾病危险因素之间的关系。方法采用现况调查的方法入选社区年龄40岁～59岁围绝经期妇女,填写调查问卷,内容包括：人口学特征、月经情况、身高体重、心血管疾病患病情况。根据月经状况将入选人群分为月经规律组、月经不规律组和绝经后期组。结果入选女性中,高血压和冠心病患病率分别为23.5%和7.7%,超重、肥胖、高脂血症及糖尿病的患病率分别为25.3%、2.4%、10.4%和6.2%,三组中绝经后期组超重、肥胖、高脂血症及其糖尿病比例最高。绝经后期组、月经不规律组及月经规律组中高血压的患病率分别为13.6%、5.8%和4.1%,具有统计学意义（P＆lt;0.01）。月经不规律组中冠心病患病率高于月经规律组（P＆lt;0.01）,月经不规律组中高脂血症患病率高于月经规律组（P＆lt;0.01）。结论高血压、高血脂、冠心病、肥胖和超重是城市社区围绝经期女性中最常见的心血管疾病。心血管疾病患病率及其危险因素从绝经过渡期即开始增加。     

Management of Spigelian hernia caused by necrobiotic fibroma of the uterus in a pregnant woman

INTRODUCTIONSpigelian hernias are a rare type of hernia through the Spigelian aponeurosis. Spigelian hernias are very uncommon and constitute only 0.12% of all abdominal wall hernias. These hernias are located in the aponeurosis of the internal oblique muscle and transverse abdominal muscle.PRESENTATION OF CASEA 30-year-old woman at 28 weeks’ gestation was admitted to the obstetrics department due to pain and swelling in the anterior abdominal right region. On inspection, we suspected either a lipoma, a spontaneous hematoma, a tumor of the abdominal wall, or a Spigelian hernia. A Doppler USG and abdominal and pelvic Magnetic Resonance Imaging revealed necrobiotic fibroma of the uterus in Spigelian hernia. The patient was started on dual analgesic and corticotherapy. Overall, the patient improved one week after the acute episode and had no further pain during her gynecologic follow-up.DISCUSSIONWe have reported a first case of Spigelian hernia that was complicated by uterine fibroid. The clinical presentation varies, depending on the contents of the hernial sac and the degree of herniation. MRI is the preferred method for accurately identifying masses of the abdominal wall. Our treatment options were based on the extent of the acute-phase reaction and the venous thrombosis.CONCLUSIONIt is important to differentiate this rare Spigelian hernia from other hernias as the treatment for this hernia is medical rather than surgical. Before the final choice of treatment is made, digestive surgeons should bear this rare hernia in mind.     

Menopausal Symptoms and Sleep Quality During Menopausal Transition and Postmenopause

Background:

Menopausal symptoms and sleep difficulty were physiological processes that were affected by genetic and other factors. This study was to investigate the prevalence of menopausal symptoms and sleep quality in menopausal transition (MT) and postmenopause (PM) women in Taiyuan, Shanxi.

Methods:

A community-based survey of women''s menopausal symptoms and sleep quality was conducted between July 2012 and May 2013 at six municipal districts of Taiyuan, Shanxi. A sample of 2429 women aged 40–59 years was divided into four groups: early MT, late MT, early PM, and late PM. Sleep quality in the past 2 weeks before the interview was recorded. The data were analyzed using SPSS 16.0.

Results:

The prevalence of menopausal symptoms was 49.8%. Mild, moderate, and severe symptoms were observed in 28.9%, 18.5%, and 2.5% of participants, respectively. The highest prevalence of menopausal symptoms occurred in the early postmenopausal stage; the subsequences were the late postmenopausal stage and the early MT stage. Interestingly, among the 13 items of modified Kupperman index, the five most common symptoms were fatigue, arthralgia and myalgia, decreased libido, insomnia, and nervousness. Meanwhile, 55% perimenopausal women had poor sleep.

Conclusions:

Menopausal symptoms are common but mild among women in Taiyuan, Shanxi during MT and PM. In these stages, the prevalence of poor sleep is high.     

Hot flash severity in hormone therapy users/nonusers across the menopausal transition

OBJECTIVES: The purpose of this study was to examine the pattern of and factors that influence hot flash severity across the menopausal transition (MT) and early postmenopause (PM). METHODS: Women from the Seattle Midlife Women's Health Study (N=302) provided data for these analyses: at least one annual health questionnaire and a menstrual calendar. A subset of women provided a first morning voided urine specimen from 1997 through 2005. Urine samples were assayed for estrone glucuronide and FSH. Linear mixed effects modeling was used to identify change in hot flash severity scores over time, including the relationship to age, MT-related, psychosocial and lifestyle factors. RESULTS: Increases in hot flash severity were associated with late transition stage, early postmenopause, use of HRT, duration of early transition stage, age of entry into early PM and level of FSH. Age of entry into early transition and estrone levels were associated with decreased hot flash severity. Not associated with hot flash severity were being in early transition stage, age of entry into or duration of late transition stage and all of the psychosocial (anxiety, stress, depressed mood) and lifestyle variables (BMI, activity level, sleep, alcohol use). CONCLUSIONS: Variables associated with reproductive aging independently predicted changes in hot flash severity; psychosocial and lifestyle variables did not. The effect of age dropped out when factors associated with reproductive aging were considered. Use of HRT ameliorated but did not eliminate severe hot flashes suggesting that there is room for alternative approaches less likely to cause harm.     

Experience and attitudes toward menopause in Chinese women living in Sydney--a cross sectional survey

OBJECTIVES: To investigate the menopausal experience of Chinese women living in Sydney and to explore the prevalence of symptoms, and the relationship between the frequency of symptoms and various socio-demographic factors. METHODS: A cross-sectional survey was conducted among 310 Chinese women aged between 45 and 65 years. The menopause-specific quality of life (MENQOL) questionnaire was used to collect information on menopausal symptoms. The MENQOL questionnaire was translated into Chinese by an experienced bilingual health worker and then translated back into English by a different interpreter for accuracy. RESULTS: The mean and median ages at menopause for this study were 50.3 and 50.5 years, respectively (95% CI 49.8-50.8 years). Only 34% of women reported hot flushes, and 27% reported night sweats. Chinese women in Sydney more commonly reported psychological symptoms such as poor memory and physical symptoms such as dry skin, aching in muscles and joints and decreased physical strength. Changes in sexual desire and vaginal dryness were significantly different in perimenopausual women, compared with premenopausal and postmenopausal women. CONCLUSIONS: Chinese women living in Sydney report fewer vasomotor symptoms compared with Caucasian women. Menopause was still experienced negatively, especially in its impact on sexual function and muscular-skeletal symptoms.     

2011-2017年孕妇生殖道无乳链球菌检出及其耐药性变化

目的了解某地区孕妇生殖道无乳链球菌的感染及其耐药状况,为临床诊断与治疗提供依据。方法收集2011年1月—2017年12月广东省人民医院产科病区及门诊孕妇送检的生殖道分泌物培养的结果,比较分析各年份无乳链球菌检出情况及耐药率变化趋势。结果共送检31 569份生殖道分泌物标本,检出病原菌1 940株,其中无乳链球菌591株,占30.46%。无乳链球菌在生殖道分泌物标本中的检出率为1.87%;2011—2017年无乳链球菌药敏结果中,未发现对青霉素、氨苄西林、奎奴普丁/达福普汀、利奈唑胺、替考拉宁、万古霉素耐药菌株;对环丙沙星、左氧氟沙星、克林霉素、红霉素的耐药率较高,分别为19.80%～28.97%、19.80%～28.95%、26.73%～39.29%、44.05%～66.34%;对四环素的耐药率最高,为80.37%～94.29%,但有逐年下降的趋势（P＜0.05）。结论无乳链球菌为孕妇生殖道感染的主要病原菌,分析其耐药性,合理、规范的使用抗菌药物,可减少孕妇及新生儿无乳链球菌感染的发生。