Epidemiology of major age-related diseases in women compared to men

Many observations indicate that women have a longer life expectancy than men. Population-based studies report that mortality and morbidity are higher in men than in women. The gender difference is constant in cardiovascular disease, cancer and dementia, the more frequent diseases in industrialized countries; these chronic conditions strongly influence longevity and quality of life in old persons. Biological, behavioral and environmental factors emerge as major contributors to the difference in mortality, morbidity and case fatality. However, the causes of gender differences remain poorly understood.     

Directional coronary atherectomy in women compared with men

The influence of gender on the procedural outcome of directional coronary atherectomy (DCA) is controversial. This study of 373 consecutive patients (418 lesions) undergoing DCA demonstrates that the procedural success rate of DCA is significantly lower in women compared with men (72.7 vs. 82.9%, p = 0.011). Women have significantly smaller coronary arteries than men (2.5 mm vs. 2.7 mm, p = 0.028) and were older than men (66 vs. 61 years, p = 0.0001). Multivariate analysis identifies small coronary vessel size rather than female gender per se as an independent predictor of poor procedural outcome. Procedural success rates in women with coronary vessel size ≥ 2.5 mm is significantly higher (92.2%) than in women with coronary vessel size < 2.5 mm (73.1%), and parallels that in men with vessel size ≥ 2.5 mm (89.3%). Inability to engage the ostium of the coronary artery adequately with the guiding catheter and to cross the lesion with the atherectomy device is significantly more common in women compared with men. Major ischemic complication rates are similar in women and men (8.5 vs. 8.7%). Groin complications are significantly more common in women compared with men (13.5 vs. 2.9%). We conclude that procedural success rates in women may be improved by careful patient selection, with particular attention to small vessel size. DCA is best performed in vessels > 2.5 mm in diameter.     

无创联合检查对原发性肺癌的诊断价值

目的探讨无创综合诊断方法对原发性肺癌的诊断价值。方法回顾性分析120例可疑肺癌患者的门诊病历资料。结合临床症状分析综合应用各种无创检查（胸部x线、CT、血清肿瘤标记物、痰脱落细胞学）联合诊断肺癌的灵敏度、特异度。结果单从典型临床症状诊断肺癌的灵敏度为11．8％、特异度为25．9％、正确率为15％、误诊率（假阳性率）为74．1％、漏诊率（假阴性率）88．2％。临床症状＋影像学检查诊断肺癌的灵敏度为46．2％、特异度为40．7％、正确率为45．0％、误诊率为59．3％、漏诊率53．8％。临床症状＋影像学检查＋血清肿瘤标记物＋痰细胞学检查,诊断肺癌的灵敏度为80．7％、特异度为77．8％、正确率为80％、误诊率22．2％、漏诊率19．3％。结论临床症状、影像学检查、血清肿瘤标记物及痰脱落细胞学的无创综合诊断方法诊断肺癌具有较高的灵敏度及特异度,门诊医生应加强筛查意识,增加肺癌的检出率。     

Bronchoalveolar lavage in the diagnosis of peripheral, primary lung cancer.

Numerous case reports have shown the advantage of using bronchoalveolar lavage (BAL) in cytologic diagnosis of primary and secondary malignant neoplasms of the respiratory system. The aim of this study was to determine the usefulness of BAL in the diagnosis of peripheral, primary lung cancer. Of 1,864 patients referred to the Bronchological Department for endoscopic examination, 145 patients were studied: six with large cell lung cancer, 22 with adenocarcinoma, 15 with alveolar cell lung cancer, 40 with small cell lung cancer, and 62 with squamous cell lung cancer. In 94 patients (64.8 percent), BAL was diagnostic, revealing malignant cells. In 52 (35.9 percent) of these patients, the cytologic diagnosis agreed with the final pathologic diagnosis of the resected tumor. The result of BAL was affected by the type of cancer and size of the tumor. Highest yields were seen in adenocarcinoma (59.2 percent) and alveolar cell lung cancer (80 percent). The average size of the tumor in the group with correct cell typing was 4.9 +/- 1.8 cm; in patients with nondiagnostic BAL, the average size was 2.6 +/- 1.2 cm. BAL provided the highest (statistically significant, p less than 0.05) diagnostic yield (64.8 percent) in comparison with other sampling techniques: brush biopsy (29.8 percent), catheter biopsy (26.8 percent), and forceps biopsy (32.7 percent). The diagnostic yield of BAL and transbronchial fine needle aspiration biopsy (58.3 percent) did not significantly differ. BAL proved to be a valuable diagnostic tool in detecting peripheral, primary, pulmonary malignant neoplasms.     

Percutaneous transluminal coronary angioplasty in women compared with men

Objectives. This study compares in-hospital and long-term outcome after angioplasty in women and men.Background. The recognition that coronary artery disease is the most common cause of death in women has increased interest in outcome studies of coronary artery disease in women.Methods. Patients who had previous coronary revascularization and those who underwent angioplasty in the setting of acute myocardial infarction were excluded. Angioplasty was performed with standard methods. Clinical data were retrieved from a clinical data base and analyzed with standard statistical methods. p]Results. There were 2,845 women and 7,940 men. The women were older (62 ± 11 vs. 57 ± 10 years) and had more hypertension (54.5% vs. 40.1%), diabetes (19.3% vs. 11.7%), grade III to IV angina (71.5% vs. 58.4%) and congestive failure (4.3% vs. 2.1%) than men (all p < 0.0001). More men had a previous myocardial infarction (35.4% vs. 31.0%) and were taller and weighed more (all p < 0.0001). The men had lower ejection fractions and more multivessel disease (31.0% vs. 25.2%) (both p < 0.0001). In women there was a trend toward more Q wave myocardial infarctions (1.1% vs. 0.75%, p = 0.10), and hospital mortality was higher (0.7% vs. 0.1%, p < 0.0001). Angina at follow-up was more common in women (40.2% vs. 26.7%, p < 0.0001). The multivariate correlates of in-hospital death were short stature, reduced ejection fraction and multivessel disease, with trends for older age and female gender. Five-year survival was 95% in men and 92% in women (p = 0.0002), However, female gender was not a multivariate correlate of long-term survival and was accounted for by other characteristics, primarily age. The multivariate correlates of long-term survival were older age, congestive failure, reduced ejection fraction, multivessel disease, diabetes, hypertension and a trend for severe angina. No difference between women and men was noted in long-term freedom from myocardial infarction. There were more additional procedures in men than in women.Conclusions. Despite higher in-hospital mortality, long-term mortality and clinical outcome were similar in both genders when age and body habitus were accounted for.     

多原发肺癌的鉴别诊断和治疗选择

随着诊断手段的发展、筛查意识的提高和人口老龄化,全球多原发肺癌的检出率持续上升.多原发肺癌的诊断难点在于和转移病灶的鉴别.由于缺乏可靠的分子标志物来鉴别转移和原发病灶,所以多原发肺癌的诊断和临床处理仍受到限制.该文综述近年来多原发肺癌的发病机制、生物标志物、诊断和治疗选择方面的进展.     

Qualitative difference in follicle-stimulating hormone activity in the pituitaries of young women compared to that of men and elderly women

The possible existence of qualitative differences between FSH in pituitaries from men and women of different ages was investigated with the use of an in vitro bioassay, an in vitro bioassay, and a RIA. Aqueous extracts were made from pituitaries obtained at autopsy and frozen until extracted. The FSH activities per pituitary and the ratios of FSH activities as obtained with the three assay methods were similar for young and elderly men. The ratios of in vivo biological to in vitro biological FSH activities were similar for men and postmenopausal women and significantly higher than the corresponding ratio for FSH from young women. With the in vivo bioassay the activity in the extracts of pituitaries from men and young women were similar, whereas extracts from postmenopausal women had significantly higher activity. With the in vitro bioassay the extracts from young women and elderly women had a similar content of FSH activity, whereas the FSH level in the extracts of male pituitaries was significantly lower. The results of the RIA correlated well with those of the in vitro bioassay. In conclusion, the results show that FSH in pituitaries from young women has a biological activity that is qualitatively different from FSH of men and elderly women. The relatively low in vivo biological activity of FSH from young women compared to FSH from men and elderly women was most likely due to a more rapid clearance of the hormone from the circulation of the test animal.     

多原发肺癌诊断的分子生物学检测

多原发肺癌(MPLC)在肺癌中相对少见。近年来随着人们对体检的重视以及影像学特别是高分辨率CT和PET/CT技术的发展,越来越多的患者被诊断出多发性肺癌,而区分多发性肺癌究竟是MPLC还是肺内转移显得尤为重要,因为这直接关系到肿瘤的分期以及后续治疗的选择。本文根据现有文献对分子生物学检测在MPLC诊断上的研究进展进行综...     

Prevalence of site-specific thigh sarcopenia in Japanese men and women

The purpose of this study was to compare the prevalence of severe sarcopenia detected by total skeletal muscle mass (SM) index and of site-specific thigh sarcopenia for differing age groups in men and women. Japanese nonobese men and women aged 20 to 85 (n = 1,994, 55 % women) had muscle thickness (MTH) measured by ultrasound at six sites on the anterior and posterior aspects of the body. SM was estimated from ultrasound-derived prediction equations. Site-specific thigh sarcopenia was calculated using ultrasound-measured MTH at the anterior and posterior aspects of the thigh (MTH ratio, anterior 50 %/posterior 50 % thigh MTH (A50/P50 MTH)). Sarcopenia was defined as a SM index (SM divided by height²) of >2 standard deviations (SD) below the mean for young adults. Site-specific thigh sarcopenia was defined as a ratio of A50/P50 MTH of >2 SD below the mean for young adults. Age was inversely correlated to SM index and A50/P50 MTH in men (r = −0.480 and r = −0.522) and women (r = −0.243 and r = −0.516). The prevalence rate of sarcopenia was less than 3 % for women under the age of 60, 7 % for ages 60–69, and 24 % for ages 70–80. In men, the prevalence rate of sarcopenia was less than 7 % under the age of 50, 18 % for ages 50–59, 33 % for ages 60–69, and 47 % for ages 70–85. Compared to the sarcopenia estimated by SM index, there was a higher prevalence of site-specific thigh sarcopenia observed in both sexes. These results suggest that site-specific thigh sarcopenia appears before it is able to be detected at the whole body level.     

Prevalence of sleep-disordered breathing in middle-aged Korean men and women

With many epidemiologic studies made to establish the prevalence of sleep-disordered breathing (SDB) and obstructive sleep apnea syndrome (OSAS) in Western countries, no such data have been reported in Korea. The purpose of this study was to examine the prevalence of SDB and OSAS, and their related factors in Korean adults aged 40-69 years. Among the total of 5,020 participants at the baseline examination of the Korean Health and Genome Study, a random sample of 457 men and women was studied with employment of overnight full polysomnography to determine the prevalence of SDB and OSAS. The prevalence of SDB (apnea-hypopnea index > or = 5) was 27% and 16% in men and women, respectively. When OSAS was defined by an apnea-hypopnea index > or = 5 plus excessive daytime sleepiness, its prevalence was 4.5% in men and 3.2% in women. Logistic regression analyses showed that sex, body mass index, and hypertension were closely associated with the risk of SDB. Our findings show that SDB is a common problem in the Korean adult population. Understanding and treatment of SDB may be essential in terms of intervention to reduce the risk of related medical problems.     

外科手术前患者慢性阻塞性肺疾病患病率及漏诊率调查

目的研究外科手术前患者慢性阻塞性肺疾病(COPD)的患病率、漏诊率以及与高危因素的关系。方法选择2007年11月至12月在复旦大学附属中山医院准备行胸腹部非急诊手术的339例患者,所有患者经肺功能室检查,记录并分析其一般情况、暴露史和肺功能检查结果。结果COPD的患病率21.8%,漏诊率83.8%。53.1%暴露史阳性,吸烟和职业暴露分别为43.1%和18.6%;两类暴露人群的患病率分别为34.2%和36.5%。暴露史阴性受检者的患病率为8.8%,漏诊率为71.4%。在50岁以上的受检者中,暴露史阳性和阴性的患病率分别为38.0%和10.0%。男性患病率为25.1%,高于女性的15.2%(P=0.04),但Logistic回归分析显示患病率同性别无关(OR=0.80,95%CI:0.42～1.51),同暴露史有关(OR=4.22,95%CI:2.35～8.34)。肺癌和非肺癌患者COPD的患病率相似。新检出的的COPD漏诊者中,Ⅰ级30.6%,Ⅱ级56.5%,Ⅲ级11.3%,Ⅳ级1.9%。结论外科患者多数有吸烟和职业暴露等COPD高危因素,长期职业暴露所占比重较大。COPD的患病率高,漏诊现象严重,且病情多已达到或超过中度水平。     

Greater oxidative stress in healthy young men compared with premenopausal women

Coronary risk factors, including age, hypertension, diabetes mellitus, hyperlipidemia, and smoking, are associated with enhanced oxidative stress, which is implicated as a potential mechanism for atherogenesis and atherosclerotic cardiovascular diseases. Male sex is one of the well-known cardiovascular risk factors. We tested the hypothesis that oxidative stress is greater in men than in women. Plasma thiobarbituric acid-reactive substances (TBARS) and urinary 8-isoprostaglandin F2alpha (8-iso-PGF2alpha) were measured in 52 young men and 51 age-matched women. The subjects were healthy, were not smokers, and were not taking any medications or vitamins. Age, blood pressure, plasma cholesterol, and glucose did not differ between the groups. Baseline TBARS (2.32 +/- 0.11 [men] versus 1.87 +/- 0.09 [women] nmol/mL, P<0.01) and 8-iso-PGF2alpha (292 +/- 56 [men] versus 164 +/- 25 [women] pg/mg creatinine, P<0.05) were higher in men than in women. Supplementation of antioxidant vitamins for 4 weeks in men produced a significant reduction in TBARS and 8-iso-PGF2alpha by 34% (P<0.01) and 48% (P<0.05), respectively. Plasma superoxide dismutase, catalase, and vitamin E levels were comparable between the groups. Enhanced oxidative stress in men may provide a biochemical link between male sex and atherosclerotic diseases related to oxidative stress.