Menopausal symptoms and associated factors in HIV-positive women

Objective

To evaluate menopausal symptoms and their associated factors in HIV-positive women.

Methods

A cross-sectional study was conducted with 537 women of 40–60 years of age, 273 of whom were HIV-positive and 264 HIV-negative. The women were interviewed to obtain data on their sociodemographic characteristics and menopausal symptoms.

Results

The mean age of the seropositive women was 47.7 ± 5.8 years compared to 49.8 ± 5.3 for the seronegative women (p < 0.001). Bivariate analysis showed a lower prevalence of vasomotor symptoms in the seropositive group (p = 0.009), specifically hot flashes (p < 0.002) and sweating (p = 0.049). Vaginal dryness was also less prevalent in this group (p < 0.005). There were no statistically significant differences between the groups with respect to depression or insomnia. Multiple analysis showed that hot flashes were associated with being peri- or postmenopausal (PR = 2.12; 95%CI: 1.52–2.94). Vaginal dryness was less common in women without a partner (PR = 0.67; 95%CI: 0.49–0.90) and was associated with older age (PR = 1.03; 95%CI: 1.01–1.06) and being in the peri- or postmenopause (PR = 1.69; 95%CI: 1.10–2.60). Depression was inversely associated with being employed (PR = 0.74; 95%CI: 0.58–0.96) and directly associated with the presence of chronic diseases (PR = 1.30; 95%CI: 1.01–1.067). Insomnia was associated with a lower body mass index (PR = 0.96; 95%CI: 0.95–0.97) and with being peri- or postmenopausal (PR = 1.48; 95%CI: 1.11–1.97). No correlation was found between HIV serological status and any of the menopausal symptoms.

Conclusions

In this study, after controlling for confounding variables, HIV infection was not found to be associated with vasomotor, genitourinary or psychological symptoms or with insomnia.     

Duloxetine for major depressive disorder and daytime and nighttime hot flashes associated with the menopausal transition

Background

We sought to obtain preliminary data regarding the efficacy of duloxetine for major depressive disorder (MDD) during the menopausal transition. The secondary outcomes were vasomotor symptoms (VMS, or hot flashes), specifically assessed as daytime or nighttime, and anxiety.

Methods

After a single-blind placebo lead-in, peri- and postmenopausal women with MDD (n = 19) received eight weeks of open-label treatment with duloxetine (60 mg/day). The Hamilton Rating Scale for Depression (17-item) (HAM-D) was the primary outcome measure. Hot flashes were monitored prospectively using daily diaries, the Greene Climacteric Scale (GCS), and the Hot Flash-Related Daily Interference Scale (HFRDIS). Anxiety was measured with the Generalized Anxiety Disorder scale (GAD-7).

Results

Of 19 participants treated with duloxetine, 16 (84.2%) were evaluable (returned for ≥1 follow up), and 13 (68.4%) completed the study. Three discontinued due to side effects. The pre-treatment and final median HAM-D scores were 15 (interquartile range [IQR] 14–18), and 6.5 (IQR 4–11.5), respectively, reflecting a significant decrease (p = .0006). The response and remission rates were 56.3% (all responders were also remitters, having ≥50% decrease in HAM-D scores and final scores ≤7). Anxiety improved with treatment (p = .012). GCS and HFRDIS scores decreased significantly. Among those who reported hot flashes at baseline, number and severity of hot flashes improved significantly overall (p = .009 and p = .008, respectively). Daytime but not nighttime hot flashes improved significantly.

Conclusions

These data support further study of duloxetine for the treatment of a spectrum of symptoms associated with the menopausal transition.     

Self-reported menopausal symptoms in a racially diverse population and soy food consumption

Objectives

Evaluate the association of self-reported vasomotor symptom (VMS) frequency with race/ethnicity among a diverse midlife US population and explore menopause symptom differences by dietary soy isoflavone (genistein + daidzein) consumption.

Study design

Cross-sectional population-based study of peri- and postmenopausal women, ages 45–58.

Outcomes

Recent VMS frequency, VMS ever; recent symptom bother (hot flashes, night sweats, headache and joint-ache).

Results

Of 18,500 potentially eligible women, 9325 returned questionnaires (50.4% response); 3691 were excluded (premenopausal, missing data, taking hormones). Of 5634 remaining women, 82.1% reported hot flashes ever, 73.1% reported night sweats ever; 48.8% and 38.6% reported recent hot flashes or night sweats, respectively. Compared with White women, Chinese, Japanese, Vietnamese, other Asian (each p < 0.001) and Filipino (p < 0.01) women less commonly reported ever having hot flashes; Asian women less commonly reported recent VMS bother (p < 0.001). Black women more commonly reported hot flashes ever (p < 0.05) and recent VMS bother (p < 0.05). Compared with non-Hispanic White women, Hispanic women were less likely to report hot flashes (p < 0.05) or night sweats (p < 0.001) ever. Women were classified by isoflavone consumption: (1) none (n = 1819), (2) 0.01–4.30 mg/day (n = 1931), (3) 4.31–24.99 mg/day (n = 1347) and (4) ≥25 mg/day (n = 537). There were no group differences in recent VMS number/day: (1) 7.0 (95% CI 6.5, 7.5); (2) 6.4 (95% CI 6.0, 7.1); (3) 7.0 (95% CI 6.3, 8.2); and (4) 6.8 (95% CI 6.1, 7.7).

Conclusions

Menopausal symptoms, independent of isoflavone intake, varied considerably by race/ethnicity and were least common among Asian races.     

下丘脑弓状核KNDy神经元参与围绝经期潮热发生的机制

潮热是围绝经期女性最常见的特异性症状,严重危害女性的身心健康和生活质量。由于潮热的发病机制尚未明确,且现有的雌激素替代疗法存在诸多局限和禁忌,故探讨潮热的发病机制并寻找新的治疗靶点尤为迫切和重要。近年研究提示,围绝经期雌激素降低时下丘脑弓状核（ARC）中KNDy神经元异常是引起潮热的关键因素。部分学者认为,ARC中KNDy神经元通过调控促性腺激素释放激素及其下游促黄体生成素的脉冲释放参与潮热的发生;而另有学者认为,ARC中KNDy神经元通过调控下丘脑视前区的正中视前核在潮热发生过程中发挥关键作用。我们就上述两种关于ARC KNDy神经元与潮热发生之间的关系及其参与潮热的可能机制进行总结和概括,为探寻诊治围绝经期潮热的新靶点和新方法奠定理论基础。     

碘伏湿敷会阴伤口时间的临床研究

目的 探讨产后应用0．5％碘伏持续湿敷会阴伤口的最佳时间。方法 选取2003年9～12月有会阴伤口的产妇204例为实验组1，选取2004年9～12月有会阴伤口的产妇204例为实验组2。于产后伤口缝合完毕，分别用0．5％碘伏持续湿敷会阴伤口2h及1h，比较2组产后24h会阴伤口水肿及愈合情况。结果 实验组1会阴伤口局部肿胀无脓性分泌物34例，局部红肿伴针眼少许脓性分泌物为3例，会阴伤口红肿率18．14％，愈合良好率98．53％；实验组2会阴伤口局部肿胀无脓性分泌物43例，局部红肿伴针眼少许脓性分泌物为5例，会阴伤口红肿率23．53％，愈合良好率97．55％；2组会阴伤口均无出现部分裂开伴有脓液流出。2实验组会阴伤口水肿及愈合情况无显著性差异（P〉0．05）。结论 产后用0．5％碘伏持续湿敷会阴伤口的最佳时间为1h，能有效减轻会阴伤口水肿，明显地降低会阴伤口的感染率，促进伤口愈合。     

10%氯化钠冰溶液湿敷对小儿强刺激性药物输液外渗肿胀的影响

目的探讨10%氯化钠冰溶液湿敷对患儿强刺激性药物静脉输液外渗肿胀的效果。方法将180例静脉输液外渗患儿随机分为对照组和实验组,各90例。实验组给予在4℃冰箱中提前预冷的10%氯化钠溶液湿敷,对照组则采用临床常规的50%硫酸镁溶液湿敷。结果实验组湿敷总有效率为100%,对照组为72.2%,2组湿敷效果差异具有统计学意义(P0.05)。结论 10%氯化钠冰溶液湿敷减轻小儿输液外渗肿胀的效果显著优于50%硫酸镁溶液湿敷。     

星状神经节阻滞治疗乳腺癌术后患者潮热症的效果分析

目的：观察星状神经节阻滞对乳腺癌术后患者潮热症的治疗效果。方法将乳腺癌术后患者随机分为治疗组和对照组各30例,治疗组在对照组治疗基础上加用星状神经节阻滞（C6水平气管旁入路法）,分别于治疗前及治疗后2、4、8周随访,利用潮热评分表（Hot -Flash Score）比较二组潮热分值的变化情况。结果按潮热评分量表积分标准统计,治疗组治疗前症状积分与治疗后2、4、8周症状积分相比差异有统计学意义（P＜0．01）;对照组治疗前症状积分与治疗后2、4、8周症状积分相比差异有统计学意义（P＜0．01）;二组治疗后各时间点症状积分比较差异有统计学意义（P＜0．01）。按症状疗效评定标准统计,二组治疗后各时间节点的总有效率比较差异有统计学意义（P＜0．01）。结论星状神经节阻滞技术可以显著降低乳腺癌术后患者的潮热评分,提高生活质量,从而增加内分泌药物治疗的依从性。     

不同产地枸杞多糖含量的比较研究

目的 比较不同产地枸杞多糖的含量。方法 采用热水浸提法分别提取宁夏、浙江和四川产枸杞中的多糖成分,苯酚-硫酸法测定枸杞多糖含量。结果 浙江产枸杞多糖含量0.830%,宁夏产枸杞多糖含量0.769%,四川产枸杞多糖含量0.590%。结论 不同产地枸杞多糖含量不同,可能与环境、采摘时间及加工过程等有关。     

基于射野区域剂量验证新算法的研究与应用

【摘要】 目的 对病人放射治疗计划的质量保证（QA）,重新定义并计算gamma（γ）通过率(%GP),统计分析靶区剂量冷点和危及器官的剂量热点。方法 随机选取6例调强放射治疗（IMRT）计划并匿名纳入本研究,从治疗计划系统（TPS）中输出DICOM文件。在等中心平面重建感兴趣区域（ROI）轮廓和相应剂量,用与模体中实际测量值进行 分析,新方法以射野区域为计算区域,并统计靶区剂量冷点与危及器官剂量热点,利用剂量面积直方图（DMH）评估TPS的准确性。结果 传统方法的 通过率受计算区域（阈值）选择影响较大,而新方法不受阈值选择的影响,且能得到靶区和正常器官各自的验证情况,能够提供更多的临床信息。结论 新方法实现了%GP的临床可解释,使 评估更贴合临床评估,能够更好的发现治疗计划是否存在问题,更好的指导临床工作。     

100例产后尿潴留的临床处理方法探讨

目的探讨产后尿潴留的有效处理方法。方法将100例产后尿潴留的产妇随机分成观察组和对照组,各50例。观察组应用半导体激光治疗仪治疗后再应用热敷及诱导排尿,对照组单用热敷及诱导排尿,观察两组产妇在治疗3d的疗效。结果经过3d的治疗,观察组产妇尿潴留临床处理总有效率为96.0%,对照组为80.0%;观察组产妇尿潴留临床处理总有效率明显高于对照组,差异有统计学意义(P<0.05)。结论半导体激光治疗仪治疗尿潴留有一定的治疗效果,与热敷及诱导排尿联用效果明显,能较快、有效地治愈尿潴留。