Perspectives in clinical research of acupuncture on menopausal symptoms

Seventy percentage of perimenopausal and early postmenopausal women will experience menopause symptoms.Primary menopause symptoms in Western countries included hot flashes,insomnia,somatic pain,depression,and fatigue. Hot flashes were most commonly treated.Menopausal hormone replacement therapy (HRT) continues to have a clinical role in the management of vasomotor symptoms,but since 2002 there has been a marked global decline in its use due to concerns about the risks and benefits of HRT;consequently many women with menopause symptoms are now seeking alternatives including acupuncture.Acupuncture has a long tradition of use for the treatment of different menopause symptoms.Its effectiveness has been studied for natural menopause or chemical and surgery induced menopause.Here we provide an update on recent advances in the field for clinicians.The recent systematic reviews on acupuncture in menopausal symptoms suggest that acupuncture is an effective and valuable option for women suffering from menopause.However,the science of acupuncture therapies is still inadequate to sufficiently support the benefits of acupuncture therapies.Finally,we discuss our points of view on clinical trials of acupuncture for menopause symptoms.     

Complementary and alternative medicine in the treatment of menopausal symptoms

A large number of women will pass through menopause each year. Women in menopausal transition experience a variety of menopausal symptoms. Although hormonal therapy remains the most effective treatment,side effects have been reported by several large studies.An increased number of women seek the use of complementary and alternative medicine(CAM) for treating menopausal symptoms.This review analyzes the evidence from systematic reviews,randomized controlled trials and epidemiological studies of using herbal medicine(Black cohosh, Dong quai,St John’s wart,Hops,Wild yam,Ginseng,and evening primrose oil) and acupuncture for the treatment of menopausal symptoms.Evidence supporting the efficacy and safety of most CAM for relief of menopausal symptoms are limited. Future larger and better controlled studies testing the effectiveness of these treatments are needed.     

Yin-yang Balance Therapy on Regulating Cancer Stem Cells

Researches have shown that cancer stem cells, regulated by the niche where they reside, are the roots of oncogenesis, relapse and metastasis. To date, very few treatments have targeted on cancer stem cells. The authors study that the regulated factors in the niche share the characteristics of yin-yang in the theory of traditional Chinese medicine, which has confirmed its therapeutic effects in the prevention and treatment of cancer. So the authors presume that the mechanisms of traditional Chinese medicine on the prevention and treatment of cancer may be related to the yin-yang balance of the niche of cancer stem cells.     

Comprehensive Therapy of Pancreatic Cancer by Integrative Traditional and Western Medicine

In recent 20 years, there has been an increasing trend in the incidence of pancreatic cancer both at home and abroad. An estimated 31 860 new cases and 31 270 deaths are expected to occur in the United States in 2004 due to this disease, the 4th and 5th leading cause of cancer death for men and women respectively. In China, new cases of pancreatic cancer continue to increase and are 6     

Aspirin and esophageal squamous cell carcinoma: bedside to bench

Objective To review the advances of studies on clinical results of aspirin＇s chemopreventive effect against esophageal squamous cell carcinoma （ESCC） and evidences for mechanisms of the antitumoural effects of aspirin in experimental research.Data sources A comprehensive search of the PubMed literatures without restriction on the publication date was carried out using keywords such as aspirin and esophageal cancer.Study selection Articles associated with aspirin and esophageal cancer are analyzed.Results This review focuses on the current evidence for use of aspirin as a chemopreventive agent in ESCC.Aspirin is the most widely used among all nonsteroidal anti-inflammatory drugs （NSAIDs）,which is cheap and acceptable to patients.Several observational results provide the further investigation of prevention and therapy of aspirin or similar drugs in esophageal cancer.Data from case control studies,cohort studies and randomized controlled trials （RCTs） also give some support of a beneficial role of aspirin on ESCC.Experimental data suggest that aspirin may prevent carcinogenesis of ESCC by favorably affecting proliferation,apoptosis,or other as yet unidentified growth-regulating processes.But the mechanism by which aspirin influence on esophageal squamous cell carcinoma needs further investigation.Conclusion A wealth of evidences ranging from clinical data to experimental results are building to suggest that aspirin has significant effects in reducing both the incidence and mortality of ESCC.     

EFFICACY AND EFFICIENCY IN USE OF ANTIBIOTICS FOR PREVENTIEN OF POST - OPERATIVE INFECTIEN: RECENT DEVELOPMENTS

Bacterial resistance to commonly used antibiotics is a major problem, especially in hospitals. This problem has emerged in large part because of widespread and uncontrolled use of antibiotics.In order to slow the rate of development of resistant bacteria, it has been necessary to re-examine the ways in which antibiotics are used, so as to reduce unnecessary use.The use of antibiotics for the prevention of post-operative infection is especially important in this respect. Surveys have shown that it accounts for a large percentage of all in-hospital antibiotic use and misuse.In fact, in 1982, a survey of prophylactic antibiotic use on general surgery wards at Hunan Medical College showed that 95% of prophylactic antibiotic use was unnecessary according to current medical standards.In order to update knowledge of the principles of antibiotic use in the prevention of post-operative infection, a review of the recent literature was done. Prophylactic antibiotics are most effective when adequate tissue levels o     

Association of the MTHFR C677T polymorphism and bone mineral density in postmenopausal women：a meta-analysis

Osteoporosis is a condition characterized by low bone mineral density （BMD） and micro-architectural changes in the bone tissue.The risk of osteoporosis is partly determined by genetic factors.The role of C677T polymorphism of methylenetetrahydrofolate reductase （MTHFR） gene has been investigated in postmenopausal osteoporosis.However,the relationship between MTHFR polymorphism and BMD is still controversial.We carried out a meta-analysis of 5,833 subjects to evaluate the association of MTHFR and BMD in postmenopausal women.Databases of MEDLINE,Web of Science,Scopus and CNKI were retrieved for all publications relating to MTHFR polymorphism and BMD in postmenopausal women.Five eligible studies were selected for meta-analysis.All these articles studied the association of MTHFR polymorphism and BMD of the femoral neck and lumbar spine in postmenopausal women.Our analysis suggested that postmenopausal women with the TT genotype had lower femoral neck BMD than the women with the CC/CT genotype,and the weighted mean difference （WMD） was-0.01 g/cm 2 [95% confidence interval （CI）：（-0.01,-0.01）,P 0.01].However,BMD of the lumbar spine of postmenopausal women with the TT genotype was not significantly different from that of women with the CC/CT genotype.In the random effects model,the WMD between the TT and TC/CC genotype was-0.01 g/cm 2 [95% CI：（-0.04,0.01）,P=0.32].The C677T polymorphism of the MTHFR gene is associated with BMD of the femoral neck in postmenopausal women.Women with the TT genotype of the MTHFR gene have lower BMD,suggesting that the TT genotype may be a risk factor for postmenopausal osteoporosis.     

燕窝：食物还是药物？

Edible bird’s nest(EBN) is derived from the saliva of certain types of swiflets.It is consumed in many parts of the world for its nutritional and medicinal values.Although many claims have been made on the therapeutic and healthpromoting effects of EBN,scientific documentations regarding these effects are very limited in published literature.It is not until recently that the biological effects of EBN are being investigated and evidence-based studies are being conducted.Several studies have found that EBN may enhance cell proliferation and differentiation and various beneficial effects have been reported in vitro as well as in vivo.While these studies point towards the potential use of EBN in the treatment or even prevention of several diseases,the mechanisms of action of EBN remain largely unknown and more explorations are needed.This review is one of the very few scientific reviews on EBN which focuses on recent evidence-based discoveries.     

Perspectives on Nutrition Needs for the New Millennium for South Asian Regions

South Asia is the most populated region of the world with several nutritional challenges,Though per capita food energy supply,child survival and life expectancy have imporved,and even today large segments of the population are below the poverty line with high infant and maternal mortality rates.It is important of recognize the crucial role of nutrition throughout the life cycle-from conception to old age.It is very necessary now to move from food security to nutrition security and improve the quality of foods both in macro-and micronutrients in order to break the transgenerational effects of malnutrition.The key solutions to the problems should address the issue of social development,population stabilization,enviromental degradation and inadequate health and nutritional serveices.Strategies for empowering women and actuating community participation as sustainable programmes for human development,measures to reduce underweight and stunting in children and prevention of micronutrient malnutrition across the population are required.Enhancing food and nutrition security though innovative diversified agriculture and dietary practices,prevention and control of infection,promotion of food safelty and fortification of staples with appropriate attention on emerging chronic disorders are essential.Population control measures to stabilize the fertility rates.iotechnological approaches for genetically modified foods,nutrition surveillance based on assessment,analysis and action to address the logistic, technical and compliance issues with emphasis on promotion of breast feeding and complementary foods with adequate attention on the reproductive needs of adolescent girls,pregnant mothers and lactating women would eliminate low birth weight,stunting,and chronic energy deficiency in vulnerable groups.Focused studies on bioavaibility of micronutrients and its enhancement,innovative horticulture interventions,fortifications.social marketing strategies would promote the intake of micronutrient and phytonutrient rich foods.In-depth epidemiological research,an insight into foetal orgins of adult disease and nutrition-genes interaction and life style alterations will avert the emerging epidemic of chronic diet related disorders.An investment in preventing foetal malnutrition improves nutrition of women in reproductive age,infant and child nutrition and prevents the onset of chronic disease in adult life.Human resource development,IEC measured,technology transfer,operational and logistic research,building of databases,integrated,intersectoral,multidisciplinary plans and sound management information system and surveillance with net working and experience sharing in the region will hepl to overcome the common challenges and lay the foundation for a better scenario in these regions in the near future.     

Hormone replacement therapy (HRT) and ischaemic heart disease: getting to the heart of the matter

Numerous observational studies have previously shown that estrogen therapy (ERT) or estrogen/progestin hormone replacement therapy (HRT) can significantly reduce the risk of Coronary Artery Disease (CAD) in healthy postmenopausal women by up to 50%. However, due to statistical limitations inherent in these earlier studies, several large randomised trials are now under way. The results from some of these randomised trials are expected sometime in 2005 and will certainly help confirm or refute the present perceived cardio-protective effects of ERT/HRT in healthy menopausal women. On the other hand, the role of hormonal therapy in menopausal women with established CAD is more controversial. Although results from earlier observational trials have been encouraging, more recent randomised controlled data from the Heart and Estrogen/Progestin Replacement (HER) study and the Estrogen Replacement and Atherosclerosis (ERA) study have been more sober. In fact, both have generally reported on the failure of ERT/HRT to reduce the overall rate of ischaemic cardiovascular events or to halt the progression of coronary atherosclerosis in menopausal women with established CAD. However, these studies are not without their own limitations. As such, more future trials will be needed before the role of postmenopausal hormone therapy in the secondary prevention of CAD can be firmly established.     

Evaluation of hormone replacement therapy

Hormone Replacement Therapy (HRT), once considered as the gold standard of treatment of menopausal symptoms and osteoporosis, introduced about seventy years ago still continuing with lot of controversies. Menopause, a transitional period of women's life, is not an illness when oestrogen level falls leading to its consequences. Results of earlier observational studies showed beneficial effects of HRT including cardiovascular protection. But all recent randomized controlled trials have failed to prove these positive effects, rather increases the cardiovascular risk and breast cancer. Women's Health Initiative(WHI), one of the recent randomized controlled trials was stopped prematurely in 2002 due to unfavorable risk-benefit ratio. HRT is not the only way of treating the menopausal symptoms and other consequences of estrogen deficiency. There are suitable alternatives without bearing the risk of HRT. Vasomotor symptoms with hot flushes and sweating experienced by about 75 percent of menopausal women can be treated with alternatives like phyto-estrogens, selective estrogen receptor modulators (SERMs), clonidine, selective serotonin reuptake inhibitors, acupuncture, exercise, behavioral therapy etc. HRT is no longer considered as the first line of treatment of postmenopausal osteoporosis. It can be treated with alternatives like regular weight bearing exercise, balanced calcium rich diet, maintaining weight, avoidance of bone robbers, (like excess alcohol, caffeine, smoking), use of SERMs etc. Use of HRT should be individualized and rationalized considering its risks and benefits.     

雌激素对绝经妇女心血管的作用

心血管病一直是绝经妇女致残和致死的主要病因。评价激素替代治疗（HRT）是否对心脏有保护作用的随机临床试验有的已经完成,有的正在进行中。然而,对HRT能否预防治疗心血管病尚存在争论。3年以来,所进行的HRT一级、二级预防试验以及对于动脉粥样硬化解剖学方面作用的临床研究结果显示,雌激素替代治疗并不能减少已有冠心病妇女的心血管事件,也不能减慢她们的动脉粥样硬化进展。相比之下,也有资料提示HRT作为一级预防,对无冠心病临床表现的妇女可能有作用。     

Hormone replacement therapy and high S phase in breast cancer

CONTEXT: Prolonged postmenopausal hormone replacement therapy (HRT) is associated with increased incidence of breast cancer and, paradoxically, reduced breast cancer mortality. The biological rationale for this discrepancy has not been explored. OBJECTIVE: To compare the prognostic characteristics of cancers arising in women who have used HRT with those in women who never have used HRT. DESIGN: Prospective cohort study from December 1989 to November 1996. SETTING: Teaching hospital in a large midwestern metropolitan area. PATIENTS: Cohort of 331 postmenopausal women who presented consecutively with 349 invasive breast cancers. MAIN OUTCOME MEASURES: Estrogen receptor (ER) status (ER positive vs ER negative) and S phase (low vs high) for current HRT users vs never users. RESULTS: The frequency of high S-phase fraction among cancers in women who were using HRT was markedly increased compared with that in women who had never used HRT (adjusted odds ratio [OR], 2.82; 95% confidence interval [CI], 1.04-7.66). However, the greater frequency of high S-phase fraction was limited to women with ER-positive cancers (for HRT users vs never users, OR, 5.25; 95% CI, 1.36-20.28; for ER-negative cancers in HRT users vs never users, OR, 1.08; 95% CI, 0.20-5.86). CONCLUSIONS: Use of HRT appears to stimulate growth of ER-positive but not ER-negative breast cancer as measured by S-phase fraction. The prognostic significance of high S-phase fraction in current HRT users who have ER-positive tumors is unknown.     

激素替代疗法在绝经后妇女中运用的新进展

伴随着HRT的逐步出现,还有一些大型的学术研究的进行,在2003年世界卫生组织对WHI与WHIMS的研究成果进行了说明,医学界对HRT的好坏做了相当激烈的讨论,本文主要是围绕激素替代疗法在绝经后妇女中运用的新进展进行说明。     

减量雌孕激素替代治疗绝经后妇女的阴道出血模式

【目的】探讨减量雌孕激素替代疗法 (HRT)的阴道出血模式。【方法】自然绝经 1年以上妇女 30例 ,连续联合应用半量诺更宁 :1mg 17β 雌二醇 (E2 ) 0 5mg醋酸炔诺酮 (NETA) 2 4周 ,观察阴道出血时间、出血量、体质量、体质量指数(bodymassindex ,BMI)、子宫内膜厚度、用药后症状改善的时间。【结果】用药后阴道出血 10例 ,无阴道出血 2 0例。出血者多数表现为点滴状出血 ,随用药时间延长 ,出血率明显降低 ,在阴道出血的病例中 ,平均年龄 48岁 ,平均绝经年龄 44岁 ,与无阴道出血组比较有显著差异。使用半量HRT 2 4周后 ,BMI平均增加为 0 7kg/cm2 。用药 1个月后 ,严重的轰热、烦躁、多汗有缓解 ,2个月后Kupperman评分有显著差异。减量HRT对关节痛的缓解效果不明显。【结论】减量HRT能缓解低雌激素症状 ,出血率低 ,安全性高 ,临床上值得尝试用于年龄较大的绝经后老年妇女。     

激素替代疗法对妇女绝经期症状与子宫及其循环的影响

目的：观察激素替代疗法对妇女绝经期症状、子宫及其循环的影响。方法：３０例病人分２组，使用贴皮及口服雌孕激素前后，观察子宫体积、内膜厚度，Ｋｕｐｐｅｒｍａｎ评分，血清Ｅ２、ＦＳＨ、彩超测子宫动脉搏动指数及阻力指数；用ｔ检验统计。结果：用雌孕激素后，Ｋｕｐｐｅｒｍａｎ评分，子宫动脉搏动指数及阻力指数明显下降，子宫体积无变化，子宫内膜增厚，已上升，ＦＳＨ下降；口服组改善血脂构成。结论：激素替代疗法可改善绝经期症状，降低子宫循环阻力，增加子宫血供；口服者可改善血脂构成。     

Hormone replacement therapy, prothrombotic mutations, and the risk of incident nonfatal myocardial infarction in postmenopausal women

CONTEXT: Estrogens are known to be prothrombotic, and findings from the Heart and Estrogen/progestin Replacement Study suggest that in women with clinically recognized heart disease, hormone replacement therapy (HRT) may be associated with early harm and late benefit in terms of coronary events. OBJECTIVE: To assess whether, as hypothesized, prothrombotic mutations modify the association between HRT use and incidence of first myocardial infarction (MI). DESIGN AND SETTING: Population-based, case-control study conducted in a Seattle-based health maintenance organization. PARTICIPANTS: Cases were 232 postmenopausal women aged 30 to 79 years who had their first nonfatal MI between 1995 and 1998. Controls were a stratified random sample of 723 postmenopausal women without MI who were frequency-matched to cases by age, calendar year, and hypertension status. MAIN OUTCOME MEASURE: Risk of first nonfatal MI based on current use of HRT and the presence or absence of coagulation factor V Leiden and prothrombin 20210 G-->A variants among cases and controls, stratified by hypertension. RESULTS: One hundred eight MI cases and 387 controls had hypertension and 124 MI cases and 336 controls did not. Among hypertensive women, the prothrombin variant was a risk factor for MI (odds ratio [OR], 4.32; 95% confidence interval [CI], 1.52-12.1) and, in this stratum, there was also a significant interaction between use of HRT and presence of the prothrombin variant on risk of MI. Compared with nonusers of HRT with wild-type genotype, women who were current users and who had the prothrombin variant (n = 8) had a nearly 11-fold increase in risk of a nonfatal MI (OR, 10.9; 95% CI, 2.15-55.2). The interaction with the prothrombin variant was more pronounced in analyses assuming 100% compliance than in those assuming 80% compliance with HRT. The interaction was absent among nonhypertensive women and was less pronounced if hypertensive and nonhypertensive women were combined into 1 group. No interaction was found for factor V Leiden in either hypertensive or nonhypertensive women. Among hypertensive women, the estimates were affected only in trivial ways by adjustment, and the interaction with the prothrombin variant was specific to HRT. CONCLUSIONS: Our results suggest that among postmenopausal hypertensive women, the association between HRT use and MI risk differed between those with and without the prothrombin 20210 G-->A variant. If these findings are confirmed in other studies, screening for the prothrombin variant may permit a better assessment of the risks and benefits associated with HRT in postmenopausal women.     

Decrease in breast cancer incidence following a rapid fall in use of hormone replacement therapy in Australia

OBJECTIVE: To determine if the recent rapid fall in use of hormone replacement therapy (HRT) in Australia has been followed by a reduction in breast cancer incidence among women aged 50 years or older, but not among younger women. DESIGN AND SETTING: Analysis of trends in annual prescribing of HRT, using Pharmaceutical Benefits Scheme data, and in annual age-standardised breast cancer incidence rates in Australian women for the period 1996-2003. RESULTS: In Australia, prescribing of HRT increased from 1996 to 2001, but dropped by 40% from 2001 to 2003. Age-standardised breast cancer incidence rates in women aged > or = 50 years also increased to 2001 but declined thereafter. The incidence rates in this age group were lower by 6.7% (95% CI, 3.9%-9.3%; P < 0.001) in 2003 compared with 2001, equivalent to 600 (95% CI, 350-830) fewer breast cancers (out of about 9000 incident breast cancers annually for women this age). There was no significant change in breast cancer incidence for women aged < 50 years. CONCLUSIONS: While other factors may have contributed to a recent reduction in breast cancer incidence among Australian women aged > or = 50 years, the available evidence suggests that much of the decrease is due to the recent fall in use of HRT. This is consistent with other evidence that the HRT-associated increase in risk of breast cancer is reversible after ceasing use of HRT.     

绝经妇女激素替代治疗的困境与中医药治疗更年期综合征的前景

随着妇女平均寿命的延长，绝经后的问题日益受到全社会的广泛关注，旨在改善妇女生活质量的激素替代治疗(HRT)所引发的问题也不断涌现。2002年7月，美国国立卫生研究院心脏、肺和血液研究所宣布。妇女健康初始行动(WHI)在健康绝经后妇女中使用雌激素加孕激素的临床试验由于乳腺癌发病相对风险增加26％，且并无总体益处予以提前终止。在上述对HRT弊端新认识的背景下，中医中药面临着前所未有的走向世界的新契机。大量临床和实验研究证明，中医中药对更年期综合征引起的各种症状有较好的治疗效果，而且副作用少，因此中医辨证治疗有望替代或补充雌激素疗法对更年期综合征的治疗作用，最大限度地减少完全用雌激素替代治疗所引起的副作用。