A practical guide to the evaluation of benign endometrial conditions in biopsy and curettage material

Sampling of the endometrium, via biopsy or dilation and curettage, is an important diagnostic tool in a wide variety of clinical scenarios, ranging from infertility and abnormal uterine bleeding to cancer surveillance in high-risk populations. This review describes the most common methods for endometrial sampling used currently and discusses the issue of specimen adequacy from an evidence-based perspective. It also focuses on select benign conditions involving the endometrium in the setting of abnormal uterine bleeding, ranging from anatomic/structural lesions to patterns indicative of a dysfunctional menstrual cycle. The topic of endometrial sampling evaluation in the context of recurrent pregnancy loss is also discussed, with insights on documentation of endometrial changes during the ovulatory phase and the diagnosis of endometritis.     

绝经后骨质疏松人群发生椎体骨折的相关危险因素回归分析

目的分析绝经后骨质疏松人群发生椎体骨折相关危险因素。方法纳入2018年6月至2019年5月86例在我院就诊的绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)患者临床资料,其中单纯PMOP患者43例作为对照组,PMOP椎体骨折患者43例作为试验组。两组均进行临床一般资料收集,并完善骨密度、血清实验室指标等相关检查,对PMOP椎体骨折的相关危险因素作多因素回归分析。结果试验组L1~4、全髋及股骨颈骨密度均低于对照组,试验组HOMA-IR指数及糖尿病发生率均高于对照组,差异有统计学意义(P<0.05)。试验组与对照组血清骨钙素(bone gla-protein,BGP)[(14.5±5.07) ng/ml vs.(18.1±5.48) ng/ml]、Ⅰ型原胶原N-端前肽(procollagen type 1N-peptide,PINP)[(58.4±19.52) ng/ml vs.(41.7±20.16) ng/ml]、血清Ⅰ型胶原羧基端肽(type 1 collagen carboxy terminal peptide,β-CTX)[(0.5±0.26) ng/ml vs.(0.3±0.23) ng/ml]、血清25-(OH) D [(15.9±7.24) ng/ml vs.(21.4±8.06) ng/ml]、骨源性碱性磷酸酶(bone alkaline phosphatase,b ALP)[(20.1±6.85) ng/ml vs.(14.0±5.44) ng/ml]、血清雌二醇(serum estradiol,E2)[(33.6±5.21) pg/ml vs.(42.4±11.58) pg/ml]指标比较差异均有统计学意义(P<0.05)。Logistic多因素回归分析显示,PINP、β-CTX、b ALP与PMOP椎体骨折呈正相关性,BGP、25-(OH) D与PMOP椎体骨折呈负相关性(P<0.05)。结论 PINP、β-CTX、b ALP、BGP、25-(OH) D是PMOP椎体骨折发生的危险因素,对预测及防治PMOP椎体骨折具有重要的指导意义。     

日常膳食锌摄入水平与绝经后女性骨密度之间的关系：一项基于DRYAD数据库的二次分析

目的明确每日膳食锌摄入量与绝经后女性骨密度之间的相关性。方法采用Empowerstats和R软件对DRYAD数据库数据进行二次分析,通过线性回归探索每日膳食锌摄入量与绝经后女性骨密度之间的线性关系,并采用广义加性模型进行曲线拟合分析二者间的非线性关系。结果该研究共纳入282例绝经后女性。在调整年龄、每日钙摄入量后,每日膳食锌摄入量和绝经后女性髋骨骨密度存在阈值关联。当每日摄入锌超过32.9 mg时,每日锌摄入量每增加1 mg,髋骨骨密度增加4.87 mg/cm2(P0.05)。结论每日膳食锌摄入量与绝经后女性骨密度之间存在阈值效应关系,这将为今后绝经后女性预防骨质疏松的营养支持与补充提供依据和指导。     

Birth weight,weight over the adult life course and risk of breast cancer

Breast cancer has been suggested to potentially have prenatal origins. We examined associations between birth weight, body mass index (BMI) at four-time points over 25 years of adulthood, and risk of postmenopausal breast cancer, with emphasis on whether the association between birth weight and risk of breast cancer was mediated by weight and height changes over the adult life course. Postmenopausal women (n = 70,397) aged 50–79 years without breast cancer at enrollment (1993–1998) were followed up to 25 years. Weight and height were measured at baseline. Birth weight, and weights at ages 18, 35 and 50 were self-reported. Breast cancer cases were centrally adjudicated. Compared to women with birth weight of 6–8 pounds, women with birth weight of <6 pounds had lower risk of breast cancer (HR = 0.88 95% CI: 0.79–0.99). 44% and 21% of the relationship between birth weight and breast cancer risk was mediated by adult height and weight at baseline, respectively. Birth weight of 8 pounds or more was not associated with risk of postmenopausal breast cancer. Weight gain in adulthood was associated with increased risk of breast cancer regardless of time periods. In conclusion, lower birthweight was associated with lower risk of postmenopausal breast cancer, and this reduction in risk was significantly mediated by childhood or adolescent growth, especially by adult height. Our data suggest that reaching and maintaining a healthy weight during adulthood is key in the prevention of breast cancer.     

Melatonin improves bone mineral density at the femoral neck in postmenopausal women with osteopenia: a randomized controlled trial

Melatonin is known for its regulation of circadian rhythm. Recently, studies have shown that melatonin may have a positive effect on the skeleton. By increasing age, the melatonin levels decrease, which may lead to a further imbalanced bone remodeling. We aimed to investigate whether treatment with melatonin could improve bone mass and integrity in humans. In a double‐blind RCT, we randomized 81 postmenopausal osteopenic women to 1‐yr nightly treatment with melatonin 1 mg (N = 20), 3 mg (N = 20), or placebo (N = 41). At baseline and after 1‐yr treatment, we measured bone mineral density (BMD) by dual X‐ray absorptiometry, quantitative computed tomography (QCT), and high‐resolution peripheral QCT (HR‐pQCT) and determined calciotropic hormones and bone markers. Mean age of the study subjects was 63 (range 56–73) yr. Compared to placebo, femoral neck BMD increased by 1.4% in response to melatonin (P < 0.05) in a dose‐dependent manner (P < 0.01), as BMD increased by 0.5% in the 1 mg/day group (P = 0.55) and by 2.3% (P < 0.01) in the 3 mg/day group. In the melatonin group, trabecular thickness in tibia increased by 2.2% (P = 0.04), and volumetric bone mineral density (vBMD) in the spine, by 3.6% (P = 0.04) in the 3 mg/day. Treatment did not significantly affect BMD at other sites or levels of bone turnover markers; however, 24‐hr urinary calcium was decreased in response to melatonin by 12.2% (P = 0.02). In conclusion, 1‐yr treatment with melatonin increased BMD at femoral neck in a dose‐dependent manner, while high‐dose melatonin increased vBMD in the spine. Further studies are needed to assess the mechanisms of action and whether the positive effect of nighttime melatonin will protect against fractures.     

绝经后妇女骨密度和血清骨转换指标与骨桥蛋白水平的相关性研究

目的探讨绝经后妇女循环骨桥蛋白(OPN)水平与骨转换和骨密度(BMD)之间的关系。方法 2015年7月至2017年8月,共有287名绝经后妇女纳入本研究。分析血清OPN水平,核因子κB(NF-κB)配体受体激活剂(RANKL)和骨转换标志物。采用双能X线吸收仪测定BMD。结果根据世界卫生组织(WHO)标准,102名受试者(35.5%)被诊断为骨质疏松症,125名(43.6%)骨质减少,60名(20.9%)正常骨密度。骨质疏松组的OPN水平显著高于骨量减少组和正常组(均为P0.001)。OPN诊断绝经后骨质疏松症的临界值为10.2 ng/mL,敏感性为90.1%,特异性为56.8%,曲线下面积为0.949。血清OPN和骨质疏松症组中甲状旁腺激素(PTH),腰椎BMD和股骨颈骨密度呈负相关,与I型前胶原氨基端前肽(PINP),I型的羧基端交联端肽胶原(CTX)和RANKL呈正相关。在多元回归分析中,腰椎骨密度,PTH和RANKL可以作为血清OPN水平的预测指标。结论 OPN血清水平与BMD呈负相关,与中国绝经后妇女骨转换水平呈正相关。     

绝经后女性2型糖尿病伴骨质疏松患者骨密度与骨代谢指标的相关性分析

目的分析研究绝经后女性2型糖尿病伴骨质疏松症患者骨密度与骨代谢指标的相关性。方法选取2013年10月至2017年05月于重庆医科大学附属第一医院内分泌内科住院的绝经后女性2型糖尿病患者385名。搜集其基本资料、骨代谢指标及骨密度等。根据T值将这些患者分为骨质疏松组(233例)、骨量减少组(101例)和骨量正常组(51例),比较三组间骨代谢指标的变化,并对骨密度(bone mineral density,BMD)与各项骨代谢指标进行相关性分析。结果 1型前胶原氨基末端前肽(Type I procollagen N-terminal propeptide,P1NP)、骨钙素(bone Gla protein,BGP)在骨质疏松组显著高于骨量减少组、骨量正常组(P0.05);随着骨密度的降低,1型胶原羧基端肽β特殊序列(β-Carboxyl terminal peptide,β-CTX)逐渐升高,骨质疏松组、骨量减少组与骨量正常组相比较差异有统计学意义(P0.05);Spearman等级相关分析示P1NP、BGP、β-CTX与骨密度呈负相关,25(OH)D_3与骨密度呈现正相关。结论绝经后女性2型糖尿病伴骨质疏松症患者骨密度与骨代谢指标有一定的相关性,有助于预测骨折风险并及时抗骨质疏松治疗。     

血清维生素E水平与绝经后早期女性骨密度相关性研究

目的评估绝经后早期妇女维生素E水平与骨质疏松症之间的关系。方法收集人体测量数据,骨质疏松症的危险因素,维生素E血清水平,和其他可能影响绝经后妇女骨密度的血清参数。通过多变量逻辑回归和多元线性回归分析232名绝经后早期女性骨质疏松症与年龄、绝经年龄、体质量指数、骨钙素、钙、维生素D和维生素E(分别以25羟维生素D和α-生育酚:脂质比率测定)、骨碱性磷酸酶、吸烟状况、体力活动和饮酒量之间的关系。结果在多变量逻辑回归中,较低的维生素E:脂质比率与骨质疏松症相关。在腰椎BMD作为因变量的多变量线性模型中,维生素E:脂质比率与腰椎BMD明显相关(F比率=6. 28,P=0. 001)。腰椎的BMD在维生素E:脂质比率的最高三分位数中显著高于最低三分位数。使用多变量调整的BMD后,绝经后女性(3. 1±0. 5μmol/mmol)的绝经后女性(3. 6±0. 6μmol/mmol)的平均维生素E:脂质比率显着低于正常(无骨质疏松症和骨质减少)。结论本研究表明维生素E可能会增加健康绝经后妇女的骨密度。     

金刚丸调节Hippo信号通路mRNA表达防治OVX大鼠骨质疏松作用机制

摘要：目的 基于Hippo信号通路核心基因mRNA表达，探索具有补肾填精壮骨之效的金刚丸治疗去卵巢（ovariectomized,OVX）大鼠骨质疏松症的疗效机制。方法 通过OVX法建立绝经后骨质疏松症（postmenopausal osteoporosis,PMOP）大鼠模型，分正常组、假手术组、模型组、金刚丸高剂量组、金刚丸中剂量组、金刚丸低剂量组、仙灵骨葆对照组、骨化三醇对照组。灌胃12周后，通过X射线骨密度仪检测骨密度、镜下观察股骨头显微形态结构、ELISA法检测血清ALP、实时定量RT-PCR检测骨组织Mst2、Lats1、Taz mRNA表达。结果 ①与正常组比较，模型组股骨骨密度显著降低（P＜0.01）、骨微结构显著破坏、血清ALP显著降低（P＜0.01）、骨组织Mst2、Lats1 mRNA表达显著升高（P＜0.01）、Taz mRNA表达显著降低（P＜0.01）；②与模型组比较，除金刚丸低剂量组外，各给药组的骨密度均显著升高（P＜0.01），各给药组骨微结构破坏均得到改善、血清ALP均显著升高（P＜0.01）、骨组织Mst2、Lats1 mRNA表达均显著降低（P＜0.01）、Taz mRNA表达均显著升高（P＜0.01），均以金刚丸高剂量组最为显著。结论 骨组织Hippo信号通路核心基因Mst2、Lats1 mRNA表达上调，Taz mRNA表达下调可能是PMOP的发病机制之一；金刚丸可能通过下调骨组织Hippo信号通路核心基因Mst2、Lats1 mRNA表达、上调Taz mRNA表达的机制，有效防治PMOP。     

骨化三醇治疗女性绝经后骨质疏松性髋部骨折的效果及对骨代谢水平、骨密度影响

目的:探讨骨化三醇治疗女性绝经后骨质疏松性髋部骨折的效果及对骨代谢水平、骨密度影响。方法:选取某院2017年1月~2018年1月收治的120例绝经后骨质疏松性髋部骨折患者为研究对象,采用随机数字表方法分为治疗组和对照组各60例,对照组予以常规治疗,治疗组在对照组的基础上予以骨化三醇口服,两组均治疗9个月,比较两组的骨痛情况、治疗前后的骨代谢水平[骨型碱性磷酸酶(BALP)、抗酒石盐酸性磷酸酶异构体(TRACP-5b)]及骨密度。结果:治疗组的疼痛分级明显优于对照组(P<0.05);治疗组的BALP、TRACP-5b水平显著低于对照组(P<0.05);治疗组的骨密度显著大于对照组(P<0.05)。结论:骨化三醇治疗绝经后骨质疏松性髋部骨折能够明显改善骨痛症状,提高骨密度及骨强度。