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Cardiovascular health in patients with premature ovarian insufficiency. Management of long-term consequences. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2018; 17:109-111. [PMID: 30357009 PMCID: PMC6196783 DOI: 10.5114/pm.2018.78551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/27/2018] [Indexed: 11/17/2022]
Abstract
Cardiovascular diseases (CVDs) represent the world’s leading cause of death among women. Women with premature ovarian insufficiency (POI) may be at higher risk of cardiovascular disease, such as myocardial infarction or stroke, than women with normal menopause. The increased burden may be mediated by a worsening of cardiovascular risk factors, such as lipid profiles, with accompanying loss of ovarian function. In contrast, the increased burden may be caused by factors that precede and potentially contribute to both CVD events and ovarian decline, such as smoking. Women with X chromosome-related POI like Turner syndrome (TS) are a distinct group with unique medical needs. Regardless of the cause, women with POI may serve as an important population to target for CVD screening and prevention strategies. These strategies should include the use of CVD risk stratification tools to identify women who may benefit from lifestyle modification and pharmacological therapy to prevent CVD.
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Roy-O’Reilly M, McCullough LD. Age and Sex Are Critical Factors in Ischemic Stroke Pathology. Endocrinology 2018; 159:3120-3131. [PMID: 30010821 PMCID: PMC6963709 DOI: 10.1210/en.2018-00465] [Citation(s) in RCA: 208] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/04/2018] [Indexed: 02/06/2023]
Abstract
Ischemic stroke is a devastating brain injury resulting in high mortality and substantial loss of function. Understanding the pathophysiology of ischemic stroke risk, mortality, and functional loss is critical to the development of new therapies. Age and sex have a complex and interactive effect on ischemic stroke risk and pathophysiology. Aging is the strongest nonmodifiable risk factor for ischemic stroke, and aged stroke patients have higher mortality and morbidity and poorer functional recovery than their young counterparts. Importantly, patient age modifies the influence of patient sex in ischemic stroke. Early in life, the burden of ischemic stroke is higher in men, but stroke becomes more common and debilitating for women in elderly populations. The profound effects of sex and age on clinical ischemic stroke are mirrored in the results of experimental in vivo and in vitro studies. Here, we review current knowledge on the influence of age and sex in the incidence, mortality, and functional outcome of ischemic stroke in clinical populations. We also discuss the experimental evidence for sex and age differences in stroke pathophysiology and how a better understanding of these biological variables can improve clinical care and enhance development of novel therapies.
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Affiliation(s)
- Meaghan Roy-O’Reilly
- Department of Neurology, University of Texas Health Science Center, Houston, Texas
| | - Louise D McCullough
- Department of Neurology, University of Texas Health Science Center, Houston, Texas
- Correspondence: Louise D. McCullough, MD, PhD, Department of Neurology, University of Texas Health Science Center, 6431 Fannin Street, Houston, Texas 77030. E-mail:
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Yang L, Lin L, Kartsonaki C, Guo Y, Chen Y, Bian Z, Xie K, Jin D, Li L, Lv J, Chen Z. Menopause Characteristics, Total Reproductive Years, and Risk of Cardiovascular Disease Among Chinese Women. Circ Cardiovasc Qual Outcomes 2018; 10:CIRCOUTCOMES.117.004235. [PMID: 29117982 PMCID: PMC5704734 DOI: 10.1161/circoutcomes.117.004235] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 10/17/2017] [Indexed: 12/26/2022]
Abstract
Supplemental Digital Content is available in the text. Background— Previous studies, mostly of Western women, have reported inconsistent findings on the association of menopause characteristics (status, age, and time since menopause) and total reproductive years with risk of cardiovascular disease (CVD). Methods and Results— The China Kadoorie Biobank recruited 302 632 women in 2004 to 2008 from 10 regions across China. During 9-year follow-up, 19 393 incident cases of stroke, 18 611 of ischemic heart disease, and 4978 CVD deaths occurred. Cox regression yielded adjusted hazard ratios relating each menopause characteristic and total reproductive years to CVD risk. Among 274 233 women with no prior CVD at baseline, 134 010 were naturally postmenopausal women (mean [SD] age at menopause of 48.6 [4.0] years and total reproductive years 32.7 [4.4]). Compared with premenopausal women, naturally peri- or postmenopausal women were at a higher risk of either fatal or nonfatal CVD. Among women who had had menopause, inverse associations were observed between age at menopause and risks of CVD mortality, incident ischemic heart disease, stroke, and subtypes of stroke, with 1.5% higher risk of CVD death (P<0.001), 0.7% for incident ischemic heart disease (P=0.002), and 0.5% for incident stroke (P=0.02) for every 1 year lower age at menopause. Compared with women who had menopause at age 48 to 50 years, lower age at menopause (ie, <43 years) was associated with 14% higher risk of CVD death and 6% higher risks of both incident ischemic heart disease and stroke. Higher risks of both fatal and nonfatal CVD were also found in women with 5 to 10, 10 to 15, 15 to 20, or >20 years since menopause compared with <5 years since menopause. Total reproductive years were inversely associated with risks of both fatal and nonfatal CVD, with 1.4% lower risk of CVD death per additional reproductive year (P<0.001). Conclusions— Women with younger age at menopause, longer time since menopause, or fewer total reproductive years had a higher risk of CVD.
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Affiliation(s)
- Ling Yang
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.).
| | - Liling Lin
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
| | - Christiana Kartsonaki
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
| | - Yu Guo
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
| | - Yiping Chen
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
| | - Zheng Bian
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
| | - Kaixu Xie
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
| | - Donghui Jin
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
| | - Liming Li
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
| | - Jun Lv
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
| | - Zhengming Chen
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
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Abstract
OBJECTIVE To determine if the greater risk of ischemic stroke observed in women living with HIV infection (WLWH) compared with HIV-uninfected women persists after accounting for both traditional and sex-specific stroke risk factors. METHODS We performed an observational cohort study of WLWH (n = 1214) and demographics-matched HIV-uninfected women (n = 12 041) seen between 1996 and 2011 at two tertiary care hospitals in Boston. We used Cox proportional hazards regression analyses to model time to ischemic stroke, adjusting first for demographics and traditional stroke risk factors and then for sex-specific stroke risk factors, including menopause and estrogen use. We also constructed demographics-adjusted Cox models to identify HIV-related risk factors associated with ischemic stroke among WLWH. RESULTS The incidence of ischemic stroke was higher among WLWH compared with HIV-uninfected women [incidence rate ratio 2.39, 95% confidence interval (CI) 1.62-3.43]. After adjusting for demographics and traditional stroke risk factors, HIV infection was associated with almost twice the risk of ischemic stroke (hazard ratio 1.93, 95% CI 1.31-2.85). The association of HIV with ischemic stroke persisted after inclusion of sex-specific stroke risk factors in the model (hazard ratio 1.89, 95% CI 1.28-2.81). Among WLWH, longer duration of antiretroviral therapy was associated with lower ischemic stroke risk (hazard ratio 0.86 per year, 95% CI 0.76-0.96). CONCLUSION The increased risk of ischemic stroke among WLWH compared with HIV-uninfected women persisted after adjusting for both traditional and sex-specific stroke risk factors. Further investigation into the mechanisms of elevated stroke risk among WLWH, including immunologic factors, will be key for developing targeted preventive strategies for this at-risk population.
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Torrealday S, Kodaman P, Pal L. Premature Ovarian Insufficiency - an update on recent advances in understanding and management. F1000Res 2017; 6:2069. [PMID: 29225794 PMCID: PMC5710309 DOI: 10.12688/f1000research.11948.1] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2017] [Indexed: 12/11/2022] Open
Abstract
Premature ovarian insufficiency is a complex and relatively poorly understood entity with a myriad of etiologies and multisystem sequelae that stem from premature deprivation of ovarian sex hormones. Timely diagnosis with a clear understanding of the various comorbidities that can arise from estrogen deficiency is vital to appropriately counsel and treat these patients. Prompt initiation of hormone therapy is critical to control the unsolicited menopausal symptoms that many women experience and to prevent long-term health complications. Despite ongoing efforts at improving our understanding of the mechanisms involved, any advancement in the field in recent decades has been modest at best and researchers remain thwarted by the complexity and heterogeneity of the underpinnings of this entity. In contrast, the practice of clinical medicine has made meaningful strides in providing assurance to the women with premature ovarian insufficiency that their quality of life as well as long-term health can be optimized through timely intervention. Ongoing research is clearly needed to allow pre-emptive identification of the at-risk population and to identify mechanisms that if addressed in a timely manner, can prolong ovarian function and physiology.
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Affiliation(s)
- Saioa Torrealday
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - Pinar Kodaman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lubna Pal
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
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Abstract
The concept of the ovarian continuum can be understood as a process that occurs during a woman's lifetime and begins during intrauterine life with fertilization. Women start their reproductive years with approximately five hundred thousand follicles containing oocytes, of which only around five hundred will be released during ovulation. Ovulation has been recognized as an event linked with reproduction; however, recent evidence supports the role of ovulation as a sign of health. The use of biomarkers that help women recognize ovulation enables them to identify their health status. This knowledge helps medical healthcare providers in the prevention, diagnosis, and treatment of different pathologies related with endocrine disorders, gynecological abnormalities, autoimmune, genetic, and neoplastic diseases, as well as pregnancy-related issues. The knowledge of the ovarian continuum and the use of biomarkers to recognize ovulation should be considered a powerful tool for women and medical professionals. Summary The ovarian continuum is a process that occurs during a woman's lifetime. It begins during intrauterine life with fertilization and ends with menopause. This process can be greatly affected by different conditions such as changes in hormonal levels and illnesses. Therefore, understanding and promoting the knowledge and use of biomarkers of ovulation in women is a key aspect to consider when evaluating their health status. The knowledge and education about the ovarian continuum should be taken into account as a powerful tool for women and medical professionals.
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Affiliation(s)
- Pilar Vigil
- Biomedical Division, Reproductive Health Research Institute (RHRI), Santiago, Chile.,Pontificia Universidad Católica de Chile, Vicerrectoría de Comunicaciones, Santiago, Chile
| | - Carolina Lyon
- Biomedical Division, Reproductive Health Research Institute (RHRI), Santiago, Chile
| | - Betsi Flores
- Biomedical Division, Reproductive Health Research Institute (RHRI), Santiago, Chile
| | - Hernán Rioseco
- Biomedical Division, Reproductive Health Research Institute (RHRI), Santiago, Chile
| | - Felipe Serrano
- Biomedical Division, Reproductive Health Research Institute (RHRI), Santiago, Chile
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Chow EJ, Chen Y, Hudson MM, Feijen EAM, Kremer LC, Border WL, Green DM, Meacham LR, Mulrooney DA, Ness KK, Oeffinger KC, Ronckers CM, Sklar CA, Stovall M, van der Pal HJ, van Dijk IWEM, van Leeuwen FE, Weathers RE, Robison LL, Armstrong GT, Yasui Y. Prediction of Ischemic Heart Disease and Stroke in Survivors of Childhood Cancer. J Clin Oncol 2017; 36:44-52. [PMID: 29095680 DOI: 10.1200/jco.2017.74.8673] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose We aimed to predict individual risk of ischemic heart disease and stroke in 5-year survivors of childhood cancer. Patients and Methods Participants in the Childhood Cancer Survivor Study (CCSS; n = 13,060) were observed through age 50 years for the development of ischemic heart disease and stroke. Siblings (n = 4,023) established the baseline population risk. Piecewise exponential models with backward selection estimated the relationships between potential predictors and each outcome. The St Jude Lifetime Cohort Study (n = 1,842) and the Emma Children's Hospital cohort (n = 1,362) were used to validate the CCSS models. Results Ischemic heart disease and stroke occurred in 265 and 295 CCSS participants, respectively. Risk scores based on a standard prediction model that included sex, chemotherapy, and radiotherapy (cranial, neck, and chest) exposures achieved an area under the curve and concordance statistic of 0.70 and 0.70 for ischemic heart disease and 0.63 and 0.66 for stroke, respectively. Validation cohort area under the curve and concordance statistics ranged from 0.66 to 0.67 for ischemic heart disease and 0.68 to 0.72 for stroke. Risk scores were collapsed to form statistically distinct low-, moderate-, and high-risk groups. The cumulative incidences at age 50 years among CCSS low-risk groups were < 5%, compared with approximately 20% for high-risk groups ( P < .001); cumulative incidence was only 1% for siblings ( P < .001 v low-risk survivors). Conclusion Information available to clinicians soon after completion of childhood cancer therapy can predict individual risk for subsequent ischemic heart disease and stroke with reasonable accuracy and discrimination through age 50 years. These models provide a framework on which to base future screening strategies and interventions.
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Affiliation(s)
- Eric J Chow
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yan Chen
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Melissa M Hudson
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabeth A M Feijen
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Leontien C Kremer
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William L Border
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel M Green
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lillian R Meacham
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel A Mulrooney
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kirsten K Ness
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kevin C Oeffinger
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cécile M Ronckers
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles A Sklar
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marilyn Stovall
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Helena J van der Pal
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Irma W E M van Dijk
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Flora E van Leeuwen
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rita E Weathers
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Leslie L Robison
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gregory T Armstrong
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yutaka Yasui
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
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Weidner K, Croy I, Siepmann T, Brähler E, Beutel M, Bittner A. Menopausal syndrome limited to hot flushes and sweating a representative survey study. J Psychosom Obstet Gynaecol 2017; 38:170-179. [PMID: 28351196 DOI: 10.1080/0167482x.2017.1291624] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE The menopausal syndrome is described as a series of various physical and nonphysical symptoms attributed to perimenopausal changes in hormone levels. However, evidence is biased by focusing research on the target group of middle aged women only. To overcome this bias, we examined the occurrence of menopausal symptoms during the entire life span in both women and men. METHODS Therefore, we studied the occurrence of menopausal symptoms with the widely used Menopause Rating Scale (MRS) across the entire life span in both women and men. To this end, we performed a nationwide cross-sectional survey study in Germany in which we examined a representative sample of 2527 persons aged from 14 to 95 years. Additionally, sociodemographic factors and self-efficacy were surveyed. RESULTS Although the overall MRS score was generally higher for women compared to men, there was no specific peak for the time of menopause. Instead the score increased linearly with age for both sexes. Furthermore, it was stronger associated with sociodemographic variables and self-efficacy than with the sex of the participants. Among all assessed symptoms, only hot flushes and sweating, but none of the others, emerged as specific for the menopausal episode. CONCLUSIONS Our data indicate that among symptoms commonly classified as menopausal only hot flushes and sweating appear to be specific for the perimenopausal episode. Other symptoms may be caused by a multifactorial etiopathogenesis including physical, sociodemographic, cultural and psychological factors that, in turn, might benefit from multimodal treatment regimes.
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Affiliation(s)
- Kerstin Weidner
- a Department of Psychotherapy and Psychosomatic Medicine , University hospital C. G. Carus, Technische Universität Dresden , Dresden , Germany
| | - Ilona Croy
- a Department of Psychotherapy and Psychosomatic Medicine , University hospital C. G. Carus, Technische Universität Dresden , Dresden , Germany
| | - Timo Siepmann
- a Department of Psychotherapy and Psychosomatic Medicine , University hospital C. G. Carus, Technische Universität Dresden , Dresden , Germany.,b Department of Neurology , University hospital C. G. Carus, Technische Universität Dresden , Dresden , Germany
| | - Elmar Brähler
- c Department for Psychosomatic Medicine and Psychotherapy , University Medical Center of the Johannes Gutenberg University , Mainz , Germany.,d Department of Medical Psychology and Medical Sociology , University of Leipzig , Leipzig , Germany
| | - Manfred Beutel
- c Department for Psychosomatic Medicine and Psychotherapy , University Medical Center of the Johannes Gutenberg University , Mainz , Germany
| | - Antje Bittner
- a Department of Psychotherapy and Psychosomatic Medicine , University hospital C. G. Carus, Technische Universität Dresden , Dresden , Germany
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Vitamin D 3 Reverses the Hippocampal Cytoskeleton Imbalance But Not Memory Deficits Caused by Ovariectomy in Adult Wistar Rats. Neuromolecular Med 2017; 19:345-356. [PMID: 28689355 DOI: 10.1007/s12017-017-8449-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 07/01/2017] [Indexed: 01/06/2023]
Abstract
The objective of study was to investigate changes caused by ovariectomy (OVX) on aversive and non-aversive memories, as well as on cytoskeleton phosphorylating system and on vitamin D receptor (VDR) immunocontent in hippocampus. The neuroprotective role of vitamin D was also investigated. Ninety-day-old female Wistar rats were divided into four groups: SHAM, OVX, VITAMIN D and OVX + VITAMIN D; 30 days after the OVX, vitamin D supplementation (500 IU/kg), by gavage, for 30 days was started. Results showed that OVX impaired short-term and long-term recognition, and long-term aversive memories. OVX altered hippocampal cytoskeleton phosphorylating system, evidenced by the hyperphosphorylation of glial fibrillary acidic protein (GFAP), low molecular weight neurofilament subunit (NFL), medium molecular weight neurofilament subunit (NFM) and high molecular weight neurofilament subunit (NFH), and increased the immunocontent of c-Jun N-terminal protein kinases (JNK), Ca2+/calmodulin-dependent protein kinase II (PKCaMII) and of the sites phosphorylated lysine-serine-proline (KSP) repeats, Ser55 and Ser57. Vitamin D reversed the effects caused by OVX on cytoskeleton in hippocampus, but it was not able to reverse the effects on memory.
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Agaba P, Meloni S, Sule H, Ocheke A, Agaba E, Idoko J, Kanki P. Factors associated with early menopause among women in Nigeria. J Virus Erad 2017; 3:145-151. [PMID: 28758022 PMCID: PMC5518243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Effective antiretroviral therapy has prolonged the survival of patients with HIV. Accordingly, studies of the consequences of ageing are increasingly important. We determined the prevalence of early menopause (EM) and its associated factors in a cohort of HIV-infected and HIV-negative controls in Jos, Nigeria. METHODS HIV-infected women accessing care in an ambulatory setting and their negative counterparts from the general population were included. Menopause was defined as having gone one year since the last menstrual period. EM was defined as the onset of menopause at ≤45 years of age. Baseline characteristics were compared and logistic regression analyses were used to determine factors independently associated with EM. RESULTS Out of a total of 253 women included, 58 attained menopause early, giving an EM prevalence of 22.9% (95% confidence interval [CI] 17.9-28.6%). Women with EM were younger (P<0.001) and had been infected with HIV for a shorter period (P=0.007). Baseline CD4+ cell count (P=0.66) and viral load (P=0.15) were similar among those with and without EM. For all subjects, HIV infection (adjusted odds ratio [AOR}=10.95, 95% CI 1.39-86.33) and sexual activity (AOR=2.37, 95% CI 1.24-4.52) were associated with EM while early menarche (AOR=14.88, 95% CI 1.37-161.10) and sexual activity (AOR=2.02, 95% CI 1.03-3.96) were independently associated with EM. CONCLUSION Over a quarter of our postmenopausal women attained menopause early. No HIV-related factor predicted EM in this study. A better understanding of ageing in these women is important to determine a more appropriate disease-management approach during this period of life.
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Affiliation(s)
- Patricia Agaba
- Department of Family Medicine,
University of Jos/Jos University Teaching Hospital,
Nigeria,APIN Centre, Jos University Teaching Hospital,
Jos,
Nigeria,Corresponding author: Patricia A Agaba,
Department of Family Medicine,
University of Jos/Jos University Teaching Hospital,
2 Murtela Mohammed Way,
PMB 2076,
Jos,
Plateau State,
Nigeria
,
| | - Seema Meloni
- Department of Immunology and Infectious Diseases,
Harvard TH Chan School of Public Health,
Boston,
MA,
USA
| | - Halima Sule
- Department of Family Medicine,
University of Jos/Jos University Teaching Hospital,
Nigeria,APIN Centre, Jos University Teaching Hospital,
Jos,
Nigeria
| | - Amaka Ocheke
- Department of Obstetrics & Gynaecology,
University of Jos/Jos University Teaching Hospital,
Nigeria
| | - Emmanuel Agaba
- Department of Medicine,
University of Jos/Jos University Teaching Hospital,
Nigeria
| | - John Idoko
- Department of Medicine,
University of Jos/Jos University Teaching Hospital,
Nigeria
| | - Phyllis Kanki
- Department of Immunology and Infectious Diseases,
Harvard TH Chan School of Public Health,
Boston,
MA,
USA
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61
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Agaba P, Meloni S, Sule H, Ocheke A, Agaba E, Idoko J, Kanki P. Factors associated with early menopause among women in Nigeria. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30333-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Sullivan SD, Sarrel PM, Nelson LM. Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause. Fertil Steril 2017; 106:1588-1599. [PMID: 27912889 DOI: 10.1016/j.fertnstert.2016.09.046] [Citation(s) in RCA: 221] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/16/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
Abstract
Primary ovarian insufficiency (POI) is a rare but important cause of ovarian hormone deficiency and infertility in women. In addition to causing infertility, POI is associated with multiple health risks, including bothersome menopausal symptoms, decreased bone density and increased risk of fractures, early progression of cardiovascular disease, psychologic impact that may include depression, anxiety, and decreased perceived psychosocial support, potential early decline in cognition, and dry eye syndrome. Appropriate hormone replacement therapy (HRT) to replace premenopausal levels of ovarian sex steroids is paramount to increasing quality of life for women with POI and ameliorating associated health risks. In this review, we discuss POI and complications associated with this disorder, as well as safe and effective HRT options. To decrease morbidity associated with POI, we recommend using HRT formulations that most closely mimic normal ovarian hormone production and continuing HRT until the normal age of natural menopause, ∼50 years. We address special populations of women with POI, including women with Turner syndrome, women with increased risk of breast or ovarian cancer, women approaching the age of natural menopause, and breastfeeding women.
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Affiliation(s)
| | - Philip M Sarrel
- Obstetrics, Gynecology, and Reproductive Sciences and Psychiatry, Yale University, New Haven, Connecticut
| | - Lawrence M Nelson
- Intramural Research Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
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Lockhart PA, Martin P, Johnson MA, Shirtcliff E, Poon LW. The Relationship of Fertility, Lifestyle, and Longevity Among Women. J Gerontol A Biol Sci Med Sci 2017; 72:754-759. [PMID: 27519884 DOI: 10.1093/gerona/glw158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 07/23/2016] [Indexed: 11/14/2022] Open
Abstract
Longevity in women has been found to be associated with several reproductive factors; the age of women when they give birth, their total number of children, and the age at which they experience menopause. In the context of expectations from the evolutionary theory of aging, the focus of this study examined relationships between lifetime reproduction, age at menopause and longevity, while accounting for various lifestyle factors. The purpose of this study was to assess fertility and age at onset of menopause in 197 women of the Georgia Centenarian Study. It was hypothesized that greater lifetime reproduction would predict earlier menopause and subsequently an earlier death. An independent t test was computed to assess ethnic differences between Caucasian and African American participants. Two block-wise multiple regression analyses were computed to evaluate the impact of low socioeconomic status in childhood, the age at the time of the first childbirth, the total number of children, smoking and alcohol use, incidence of heart disease and stroke, and the age at onset of menopause on longevity. Results from this study suggest a positive association between the total number of children to the age at onset of menopause and longevity. However, when considering the lifestyle factor of smoking, the association of the total number of children to longevity is diminished.
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Affiliation(s)
- Peggy A Lockhart
- Department of Human Development and Family Studies, Iowa State University, Ames
| | - Peter Martin
- Department of Human Development and Family Studies, Iowa State University, Ames
| | | | | | - Leonard W Poon
- Department of Gerontology, University of Georgia, Athens
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Falsetti L, Viticchi G, Buratti L, Balucani C, Marra AM, Silvestrini M. From head to toe: Sex and gender differences in the treatment of ischemic cerebral disease. Pharmacol Res 2017; 121:240-250. [PMID: 28506796 DOI: 10.1016/j.phrs.2017.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 03/27/2017] [Accepted: 05/09/2017] [Indexed: 11/27/2022]
Abstract
Stroke is a major cause of mortality and morbidity, particularly in the older ages. Women have a longer life expectancy and are more likely to experience stroke than men. Interestingly, the increased risk of ischemic stroke in women seems to be independent from age or classical cardiovascular risk factors. Notwithstanding the fact that stroke outcomes and survival are usually poorer in women, current evidence suggests that thrombolysis, antiplatelet and anticoagulant therapies are more beneficial in women than in men. A possible explanation of this paradox might be that females are often undertreated and they have fewer chances to be submitted to an effective and timely treatment for stroke than the male counterpart. The first step in the attempt to solve this obvious discrimination is surely to emphasize any reasons for differences in the therapeutic approach in relation to gender and then to denounce the lack of a sustainable motivation for them. In this article, we aimed to review the existing literature about gender-related differences on efficacy, administration and side effects of the most common drugs used for the treatment of ischemic stroke. The most striking result was the evidence that the therapeutic approach for stroke is often different according to patients' gender with a clear detrimental prognostic effect for women. A major effort is necessary to overcome this problem in order to ensure equal right to treatment without any sexual discrimination.
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Affiliation(s)
- Lorenzo Falsetti
- Internal and Sub-intensive Medicine Department, A.O.U. "Ospedali Riuniti", Ancona, Italy; University of Bologna, Cardio-Nephro-Thoracic Sciences PhD School, Italy.
| | - Giovanna Viticchi
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Laura Buratti
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Clotilde Balucani
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, New York, United States
| | | | - Mauro Silvestrini
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
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Aortic hemodynamics and white matter hyperintensities in normotensive postmenopausal women. J Neurol 2017; 264:938-945. [PMID: 28389742 PMCID: PMC5413519 DOI: 10.1007/s00415-017-8476-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/13/2017] [Accepted: 03/27/2017] [Indexed: 12/02/2022]
Abstract
Hypertension is associated with development of white matter hyperintensities (WMH) in the brain, which are risk factors for mild cognitive impairment. Hormonal shifts at menopause alter vascular function putting women at risk for both hypertension and WMH. Elevations in aortic hemodynamics precede the appearance of clinically defined hypertension but the relationship of aortic hemodynamics to development of WMH in women is not known. Therefore, this study aimed to characterize aortic hemodynamics in relationship to WMH in postmenopausal women. Aortic systolic and diastolic blood pressure (BP), aortic augmentation index (Alx) and aortic round trip travel time (Aortic TR) by tonometry were examined in 53 postmenopausal women (age 60 ± 2 years). WMH was calculated from fluid-attenuated inversion recovery MRI using a semi-automated segmentation algorithm. WMH as a fraction of total white matter volume positively associated with aortic systolic BP (regression coefficient = 0.018; p = 0.04) after adjusting for age. In addition, WMH fraction was positively associated with AIx (0.025; p = 0.04), and inversely associated with Aortic TR (−0.015; p = 0.04) after adjusting for age. Our results suggest that assessing aortic hemodynamics may identify individuals at risk for accelerated development of WMH and guide early treatment to reduce WMH burden and cognitive impairment in the future.
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BRCA mutation genetic testing implications in the United States. Breast 2016; 31:224-232. [PMID: 27931006 DOI: 10.1016/j.breast.2016.11.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 11/22/2016] [Accepted: 11/28/2016] [Indexed: 12/14/2022] Open
Abstract
BRCA mutation carriers have a very high risk of breast and ovarian cancer by age 70, in the ranges 47%-66% and 40%-57%, respectively. Additionally, women with BRCA mutation-associated breast cancer also have an elevated risk of other or secondary malignancies. Fortunately, the breast and ovarian cancer outcome for BRCA1/2 mutation carriers is at least as good as for non-carriers with chemoprevention, prophylactic surgeries and appropriate use of therapies. Therefore, identification of those who might have a mutation is important so that genetic counseling, testing, screening and prevention strategies can be applied in a timely manner. This article reviews the impact of genetic testing in general, timing of genetic testing after diagnosis and prior knowledge of mutation status in BRCA carriers with newly diagnosed breast cancer. Additionally, risk-reducing surgeries including the prophylactic contralateral mastectomy, and bilateral salpingo-oophorectomy and the sensitivity of BRCA-defective breast cancer cell lines to differential chemotherapeutic agents will be discussed.
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Fleseriu M, Hashim IA, Karavitaki N, Melmed S, Murad MH, Salvatori R, Samuels MH. Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2016; 101:3888-3921. [PMID: 27736313 DOI: 10.1210/jc.2016-2118] [Citation(s) in RCA: 474] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To formulate clinical practice guidelines for hormonal replacement in hypopituitarism in adults. PARTICIPANTS The participants include an Endocrine Society-appointed Task Force of six experts, a methodologist, and a medical writer. The American Association for Clinical Chemistry, the Pituitary Society, and the European Society of Endocrinology co-sponsored this guideline. EVIDENCE The Task Force developed this evidence-based guideline using the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. CONSENSUS PROCESS One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of the Endocrine Society, the American Association for Clinical Chemistry, the Pituitary Society, and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines. CONCLUSIONS Using an evidence-based approach, this guideline addresses important clinical issues regarding the evaluation and management of hypopituitarism in adults, including appropriate biochemical assessments, specific therapeutic decisions to decrease the risk of co-morbidities due to hormonal over-replacement or under-replacement, and managing hypopituitarism during pregnancy, pituitary surgery, and other types of surgeries.
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Affiliation(s)
- Maria Fleseriu
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
| | - Ibrahim A Hashim
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
| | - Niki Karavitaki
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
| | - Shlomo Melmed
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
| | - M Hassan Murad
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
| | - Roberto Salvatori
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
| | - Mary H Samuels
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
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Menopausal Age and Chronic Diseases in Elderly Women: A Cross-Sectional Study in Northeast China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13100936. [PMID: 27669270 PMCID: PMC5086675 DOI: 10.3390/ijerph13100936] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/08/2016] [Accepted: 09/14/2016] [Indexed: 01/29/2023]
Abstract
Many factors affect menopausal age, and early or late onset of menopause may be associated with many chronic health problems. However, limited data are available regarding this phenomenon in the Northeast China population. For this study, 2011 elderly women were selected as a sample from participants in a cross-sectional survey performed using stratified, clustered multistage, and random sampling methods. Early menopause was more prevalent in subjects born from 1943 to 1947 (OR = 1.708, 95% CI = 1.205, 2.420) and 1933 to 1937 (OR = 2.445, 95% CI: 1.525, 3.921) and in physical laborers (OR = 1.413, 95% CI = 1.021, 1.957). Women with less than nine years of education (OR = 0.515, 95% CI: 0.327, 0.812) and who were current smokers (OR = 0.577, 95% CI: 0.347, 0.959) were less likely to have late menopause. BMIs between 25 and 30 (OR = 1.565, 95% CI: 1.152, 2.125) and greater than 30 (OR = 2.440, 95% CI: 1.482, 4.016) were associated with later menopausal age. Late menopause was positively associated with diabetes (OR = 1.611, 95% CI: 1.142, 2.274) but protective against chronic gastroenteritis/peptic ulcers (OR = 0.533, 95% CI: 0.333, 0.855). Results showed that (1) Being born in an earlier year, having a lower education, and engaging in physical labor were associated with an earlier menopausal age, while a higher BMI was associated with a later menopausal age; and that (2) menopausal age was associated with diabetes and gastroenteritis in elderly women living in Northeast China.
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Prokai L, Nguyen V, Szarka S, Garg P, Sabnis G, Bimonte-Nelson HA, McLaughlin KJ, Talboom JS, Conrad CD, Shughrue PJ, Gould TD, Brodie A, Merchenthaler I, Koulen P, Prokai-Tatrai K. The prodrug DHED selectively delivers 17β-estradiol to the brain for treating estrogen-responsive disorders. Sci Transl Med 2016. [PMID: 26203081 DOI: 10.1126/scitranslmed.aab1290] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Many neurological and psychiatric maladies originate from the deprivation of the human brain from estrogens. However, current hormone therapies cannot be used safely to treat these conditions commonly associated with menopause because of detrimental side effects in the periphery. The latter also prevents the use of the hormone for neuroprotection. We show that a small-molecule bioprecursor prodrug, 10β,17β-dihydroxyestra-1,4-dien-3-one (DHED), converts to 17β-estradiol in the brain after systemic administration but remains inert in the rest of the body. The localized and rapid formation of estrogen from the prodrug was revealed by a series of in vivo bioanalytical assays and through in vivo imaging in rodents. DHED treatment efficiently alleviated symptoms that originated from brain estrogen deficiency in animal models of surgical menopause and provided neuroprotection in a rat stroke model. Concomitantly, we determined that 17β-estradiol formed in the brain from DHED elicited changes in gene expression and neuronal morphology identical to those obtained after direct 17β-estradiol treatment. Together, complementary functional and mechanistic data show that our approach is highly relevant therapeutically, because administration of the prodrug selectively produces estrogen in the brain independently from the route of administration and treatment regimen. Therefore, peripheral responses associated with the use of systemic estrogens, such as stimulation of the uterus and estrogen-responsive tumor growth, were absent. Collectively, our brain-selective prodrug approach may safely provide estrogen neuroprotection and medicate neurological and psychiatric symptoms developing from estrogen deficiency, particularly those encountered after surgical menopause, without the adverse side effects of current hormone therapies.
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Affiliation(s)
- Laszlo Prokai
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA. AgyPharma LLC, Mansfield, TX 76063, USA.
| | - Vien Nguyen
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Szabolcs Szarka
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Puja Garg
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA. Vision Research Center and Departments of Ophthalmology and Basic Medical Science, University of Missouri-Kansas City, School of Medicine, Kansas City, MO 64108, USA
| | - Gauri Sabnis
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Heather A Bimonte-Nelson
- Department of Psychology, Arizona State University, Tempe, AZ 85287, USA. Arizona Alzheimer's Consortium, Tempe, AZ 85014, USA
| | - Katie J McLaughlin
- Department of Psychology, Arizona State University, Tempe, AZ 85287, USA
| | - Joshua S Talboom
- Department of Psychology, Arizona State University, Tempe, AZ 85287, USA. Arizona Alzheimer's Consortium, Tempe, AZ 85014, USA
| | - Cheryl D Conrad
- Department of Psychology, Arizona State University, Tempe, AZ 85287, USA
| | - Paul J Shughrue
- Department of Pharmacology, Elan Pharmaceuticals Inc., South San Francisco, CA 94080, USA
| | - Todd D Gould
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD 21201, USA. Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA. Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Angela Brodie
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Istvan Merchenthaler
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Peter Koulen
- Vision Research Center and Departments of Ophthalmology and Basic Medical Science, University of Missouri-Kansas City, School of Medicine, Kansas City, MO 64108, USA
| | - Katalin Prokai-Tatrai
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA. AgyPharma LLC, Mansfield, TX 76063, USA
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Schaufelberger SA, Rosselli M, Barchiesi F, Gillespie DG, Jackson EK, Dubey RK. 2-Methoxyestradiol, an endogenous 17β-estradiol metabolite, inhibits microglial proliferation and activation via an estrogen receptor-independent mechanism. Am J Physiol Endocrinol Metab 2016; 310:E313-22. [PMID: 26732685 PMCID: PMC4773653 DOI: 10.1152/ajpendo.00418.2015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/22/2015] [Indexed: 11/22/2022]
Abstract
17β-Estradiol (estradiol) inhibits microglia proliferation. 2-Methoxyestradiol (2-ME) is an endogenous metabolite of estradiol with little affinity for estrogen receptors (ERs). We hypothesize that 2-ME inhibits microglial proliferation and activation and contributes to estradiol's inhibitory effects on microglia. We compared the effects of estradiol, 2-hydroxyestradiol [2-OE; estradiol metabolite produced by cytochrome P450 (CYP450)], and 2-ME [formed by catechol-O-methyltransferase (COMT) acting upon 2-OE] on microglial (BV2 cells) DNA synthesis, cell proliferation, activation, and phagocytosis. 2-ME and 2-OE were approximately three- and 10-fold, respectively, more potent than estradiol in inhibiting microglia DNA synthesis. The antimitogenic effects of estradiol were reduced by pharmacological inhibitors of CYP450 and COMT. Inhibition of COMT blocked the conversion of 2-OE to 2-ME and the antimitogenic effects of 2-OE but not 2-ME. Microglia expressed ERβ and GPR30 but not ERα. 2,3-Bis(4-hydroxyphenyl)-propionitrile (ERβ agonist), but not 4,4',4''-(4-propyl-[1H]-pyrazole-1,3,5-triyl)trisphenol (ERα agonist) or G1 (GPR30 agonist), inhibited microglial proliferation. The antiproliferative effects of estradiol, but not 2-OE or 2-ME, were partially reversed by ICI-182,780 (ERα/β antagonist) but not by 1,3-bis(4-hydroxyphenyl)-4-methyl-5-[4-(2-piperidinylethoxy)phenol]-1H-pyrazole (ERα antagonist) or G15 (GPR30 antagonist). Lipopolysaccharide increased microglia iNOS and COX-2 expression and phagocytosing activity of microglia; these effects were inhibited by 2-ME. We conclude that in microglia, 2-ME inhibits proliferation, proinflammatory responses, and phagocytosis. 2-ME partially mediates the effects of estradiol via ER-independent mechanisms involving sequential metabolism of estradiol to 2-OE and 2-ME. 2-ME could be of potential therapeutic use in postischemic stroke injuries. Interindividual differences in estradiol metabolism might affect the individual's ability to recover from stroke.
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Affiliation(s)
- Sara A Schaufelberger
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - Marinella Rosselli
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - Federica Barchiesi
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - Delbert G Gillespie
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Edwin K Jackson
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Raghvendra K Dubey
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland; and Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Abstract
The term premature ovarian insufficiency (POI) describes a continuum of declining ovarian function in a young woman, resulting in an earlier than average menopause. It is a term that reflects the variable nature of the condition and is substantially less emotive than the formerly used “premature ovarian failure” which signaled a single event in time. Contrary to the decline in the age of menarche seen over the last 3-4 decades there has been no similar change in the age of menopause. In developed nations, the average age for cessation of menstrual cycles is 50-52 years. The age is younger among women from developing nations. Much has been written about POI despite a lack of good data on the incidence of this condition. It is believed that 1% of women under the age of 40 years and 0.1% under the age of 30 years will develop POI. Research is increasingly providing information about the pathogenesis and treatments are being developed to better preserve ovarian function during cancer treatment and to improve fertility options. This narrative review summarizes the current literature to provide an approach to best practice management of POI.
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Affiliation(s)
- Anna J Fenton
- Women's Health Division, Christchurch Women's Hospital, Christchurch, New Zealand
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Baber RJ, Panay N, Fenton A. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric 2016; 19:109-50. [DOI: 10.3109/13697137.2015.1129166] [Citation(s) in RCA: 520] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Ahnstedt H, McCullough LD, Cipolla MJ. The Importance of Considering Sex Differences in Translational Stroke Research. Transl Stroke Res 2016; 7:261-73. [PMID: 26830778 DOI: 10.1007/s12975-016-0450-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/10/2016] [Accepted: 01/12/2016] [Indexed: 12/30/2022]
Abstract
Stroke is the second leading cause of death worldwide, and differences between men and women have been documented in incidence, prevalence, and outcome. Here, we reviewed the literature on sex differences in stroke severity, mortality, functional outcome, and response to therapies after ischemic stroke. Many of the sex differences in stroke severity and mortality are explained by differences in baseline demographics such as older age in women. However, women account for more stroke deaths, consistently suffer from worse stroke outcomes, and are more often institutionalized and permanently disabled than men. These sex differences in functional outcome are equalized after treatment with tissue plasminogen activator (tPA) and women may benefit more from treatment than men. However, this may depend on race, as African-American women have less of a response to tPA than other groups. Regarding endovascular treatments, the few existing studies that have investigated sex differences in stroke outcome point to equal benefit in both sexes; however, many clinical trials are relatively underpowered to detect sex differences. Further, we considered sex-specific effects in animal models of stroke and present recommendations for the performance of stroke studies in female animals. The male-biased use of research animals is distinguished from the clinical situation where there is a disproportionate and growing female stroke population. Stroke in women is greatly understudied, and including both sexes is especially important in both preclinical and clinical studies that evaluate potential stroke therapies.
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Affiliation(s)
- Hilda Ahnstedt
- Department of Neurological Sciences, University of Vermont, 149 Beaumont Ave., HSRF 416A, Burlington, VT, 05405, USA
| | - Louise D McCullough
- Department of Neurology, University of Texas Health Science Center, Houston, TX, USA
| | - Marilyn J Cipolla
- Department of Neurological Sciences, University of Vermont, 149 Beaumont Ave., HSRF 416A, Burlington, VT, 05405, USA. .,Department of Pharmacology, University of Vermont, Burlington, VT, USA.
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Tao XY, Zuo AZ, Wang JQ, Tao FB. Effect of primary ovarian insufficiency and early natural menopause on mortality: a meta-analysis. Climacteric 2015; 19:27-36. [DOI: 10.3109/13697137.2015.1094784] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
OBJECTIVE We investigated whether younger age at natural menopause confers a risk of heart failure. We also examined a possible modifying effect of tobacco smoking. METHODS This study used the population-based Swedish Mammography Cohort; 22,256 postmenopausal women with information on age at natural menopause were followed from 1997 through 2011. First event of heart failure was ascertained through the Swedish National Patient Register and the Cause of Death Register. Cox proportional hazards regression analyses were conducted to estimate multivariable-adjusted hazard ratios (HRs) and 95% CIs. RESULTS During a mean follow-up of 13 years, we ascertained 2,532 first events of heart failure hospitalizations and deaths. The mean age at menopause was 51 years. Early natural menopause (40-45 y), compared with menopause at ages 50 to 54 years, was significantly associated with heart failure (HR, 1.40; 95% CI, 1.19 to 1.64). In analyses stratified by smoking status, similar HRs were observed for this age group among never smokers (HR, 1.33; 95% CI, 1.06 to 1.66) and ever smokers (HR, 1.39; 95% CI, 1.09 to 1.78). Among ever smokers, increased incidence (HR, 1.25; 95% CI, 1.06 to 1.47) of heart failure could be detected even among those who entered menopause at ages 46 to 49 years. We found a significant interaction between age at natural menopause and smoking (P = 0.019). CONCLUSIONS This study indicates that women who experience early natural menopause are at increased risk for developing heart failure and that smoking can modify the association by increasing the risk even among women who enter menopause around ages 46 to 49 years.
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Yang HJ, Suh PS, Kim SJ, Lee SY. Effects of Smoking on Menopausal Age: Results From the Korea National Health and Nutrition Examination Survey, 2007 to 2012. J Prev Med Public Health 2015; 48:216-24. [PMID: 26265667 PMCID: PMC4542296 DOI: 10.3961/jpmph.15.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/23/2015] [Indexed: 11/25/2022] Open
Abstract
Objectives: Decreased fertility and impaired health owing to early menopause are significant health issues. Smoking is a modifiable health-related behavior that influences menopausal age. We investigated the effects of smoking-associated characteristics on menopausal age in Korean women. Methods: This study used data from the Korea National Health and Nutrition Examination Survey from 2007 to 2012. Menopausal age in relation to smoking was analyzed as a Kaplan-Meier survival curve for 11 510 women (aged 30 to 65 years). The risk of entering menopause and experiencing early menopause (before age 48) related to smoking were assessed using a Cox proportional hazards model. Results: The menopausal age among smokers was 0.75 years lower than that among non-smokers (p<0.001). The results of the Cox proportional hazards model showed pre-correction and post-correction risk ratios for entering menopause related to smoking of 1.26 (95% confidence interval [CI], 1.09 to 1.46) and 1.27 (95% CI, 1.10 to 1.47), respectively, and pre-correction and post-correction risk ratios for experiencing early menopause related to smoking of 1.36 (95% CI, 1.03 to 1.80) and 1.40 (95% CI, 1.05 to 1.85), respectively. Conclusions: Smokers reached menopause earlier than non-smokers, and their risk for experiencing early menopause was higher.
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Affiliation(s)
- Hee Jung Yang
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea
| | - Pae Sun Suh
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea
| | - Soo Jeong Kim
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea
| | - Soon Young Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea
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Calvet GA, Grinsztejn BGJ, Quintana MDSB, Derrico M, Jalil EM, Cytryn A, de Andrade ACV, Moreira RI, Alves MR, Veloso Dos Santos VG, Friedman RK. Predictors of early menopause in HIV-infected women: a prospective cohort study. Am J Obstet Gynecol 2015; 212:765.e1-765.e13. [PMID: 25557206 DOI: 10.1016/j.ajog.2014.12.040] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 11/03/2014] [Accepted: 12/17/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study sought to investigate the age at natural menopause and its predictors in a cohort of human immunodeficiency virus (HIV)-infected women in Rio de Janeiro, Brazil. STUDY DESIGN HIV-infected women ≥30 years of age were included. Menopause was defined as having ≥1 year since the last menstrual period. Early age at natural menopause was defined as the onset of menopause at ≤45 years of age. Multivariate Cox proportional hazards analysis was applied. RESULTS A total of 667 women were included, and the median age at baseline was 34.9 years (interquartile range, 30.9-40.5 years). In all, 507 (76%) women were premenopausal, and 160 (24%) reached menopause during the observational period; of these, 36 of 160 (27%) had early menopause. The median age at natural menopause was 48 years (interquartile range, 45-50 years). Menarche at <11 years of age (hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.23-3.37), cigarette smoking during the observational period (HR, 1.59; 95% CI, 1.08-2.33), chronic hepatitis C virus (HCV) infection (HR, 2.53; 95% CI, 1.27-5.07), and CD4 count <50 cells/mm(3) (HR, 3.07; 95% CI, 1.07-8.80) were significantly associated with an earlier age at natural menopause. The magnitudes of the effects of menarche at <11 years of age (HR, 2.7; 95% CI, 1.23-5.94), cigarette smoking during the observational period (HR, 3.00; 95% CI, 1.39-6.45), chronic HCV infection (HR, 6.26; 95% CI, 2.12-18.52), and CD4 count <50 cells/mm(3) (HR, 6.64; 95% CI, 1.91-23.20) were much higher and significantly associated with early natural menopause. CONCLUSION Early natural menopause was frequent among the HIV-infected women. In addition to menarche and cigarette smoking, which are menopausal factors among women in general, HIV-related immunodeficiency and chronic HCV were additional predictors for an earlier age at natural menopause. Adequate management of HIV in women is critical, as early onset of menopause has been associated with increased morbidity and mortality.
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Affiliation(s)
- Guilherme Amaral Calvet
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
| | | | | | - Monica Derrico
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Emilia Moreira Jalil
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Andrea Cytryn
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | - Marcelo Ribeiro Alves
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Ruth Khalili Friedman
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Abstract
Menopause is an inevitable component of ageing and encompasses the loss of ovarian reproductive function, either occurring spontaneously or secondary to other conditions. It is not yet possible to accurately predict the onset of menopause, especially early menopause, to give women improved control of their fertility. The decline in ovarian oestrogen production at menopause can cause physical symptoms that may be debilitating, including hot flushes and night sweats, urogenital atrophy, sexual dysfunction, mood changes, bone loss, and metabolic changes that predispose to cardiovascular disease and diabetes. The individual experience of the menopause transition varies widely. Important influential factors include the age at which menopause occurs, personal health and wellbeing, and each woman's environment and culture. Management options range from lifestyle assessment and intervention through to hormonal and non-hormonal pharmacotherapy, each of which has specific benefits and risks. Decisions about therapy for perimenopausal and postmenopausal women depend on symptomatology, health status, immediate and long-term health risks, personal life expectations, and the availability and cost of therapies. More effective and safe therapies for the management of menopausal symptoms need to be developed, particularly for women who have absolute contraindications to hormone therapy. For an illustrated summary of this Primer, visit: http://go.nature.com/BjvJVX.
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81
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Faubion SS, Kuhle CL, Shuster LT, Rocca WA. Long-term health consequences of premature or early menopause and considerations for management. Climacteric 2015; 18:483-91. [PMID: 25845383 PMCID: PMC4581591 DOI: 10.3109/13697137.2015.1020484] [Citation(s) in RCA: 300] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIM To review the current evidence concerning the long-term harmful effects of premature or early menopause, and to discuss some of the clinical implications. MATERIAL AND METHODS Narrative review of the literature. RESULTS Women undergoing premature or early menopause, either following bilateral salpingo-oophorectomy or because of primary ovarian insufficiency, experience the early loss of estrogen and other ovarian hormones. The long-term consequences of premature or early menopause include adverse effects on cognition, mood, cardiovascular, bone, and sexual health, as well as an increased risk of early mortality. The use of hormone therapy has been shown to lessen some, although not all of these risks. Therefore, multiple medical societies recommend providing hormone therapy at least until the natural age of menopause. It is important to individualize hormone therapy for women with early estrogen deficiency, and higher dosages may be needed to approximate physiological concentrations found in premenopausal women. It is also important to address the psychological impact of early menopause and to review the options for fertility and the potential need for contraception, if the ovaries are intact. CONCLUSIONS Women who undergo premature or early menopause should receive individualized hormone therapy and counseling.
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Affiliation(s)
- Stephanie S. Faubion
- Women’s Health Clinic, Division of General Internal Medicine, Mayo Clinic, 200 First Street, Rochester, MN, USA 55905
| | - Carol L. Kuhle
- Women’s Health Clinic, Division of General Internal Medicine, Mayo Clinic, 200 First Street, Rochester, MN, USA 55905
| | - Lynne T. Shuster
- Women’s Health Clinic, Division of General Internal Medicine, Mayo Clinic, 200 First Street, Rochester, MN, USA 55905
| | - Walter A. Rocca
- Division of Epidemiology, Department of Health Sciences Research, and Department of Neurology, Mayo Clinic, 200 First Street, Rochester, MN, USA 55905
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82
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Maclaran K, Panay N. Current Concepts in Premature Ovarian Insufficiency. WOMENS HEALTH 2015; 11:169-82. [PMID: 25776291 DOI: 10.2217/whe.14.82] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Premature ovarian insufficiency (POI) is a life-changing diagnosis, with profound physical and psychological consequences. Unfortunately, there are many deficiencies in our understanding of the condition as the underlying etiology and optimum management strategies are poorly understood. Improved awareness of POI and its long-term implications has led to increased research interest in recent years. Current research has allowed a greater understanding of the changing epidemiology in POI, genetic factors in its etiology and randomized controlled trials of hormone therapy are underway to provide evidence for treatment. This article reviews the latest literature on POI to summarize current understanding and future directions.
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Affiliation(s)
- Kate Maclaran
- West Middlesex University Hospital NHS Trust, Twickenham Road, Isleworth, Middlesex TW7 6AF, UK
| | - Nick Panay
- Queen Charlotte's & Chelsea and Chelsea & Westminster Hospitals, West London Menopause & PMS Centre, Du Cane Road, London W12 0HS, UK
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83
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Spanish consensus on premature menopause. Maturitas 2014; 80:220-5. [PMID: 25578643 DOI: 10.1016/j.maturitas.2014.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/03/2014] [Accepted: 11/12/2014] [Indexed: 01/20/2023]
Abstract
INTRODUCTION While we recognise that the term premature menopause is more accepted by most non-specialist health care providers and by the general population, 'primary ovarian insufficiency' (POI) is currently considered the most apposite term to explain the loss of ovarian function, because it better explains the variability of the clinical picture, does not specify definitive failure, and highlights the specific ovarian source. Its pathogenesis involves a congenital reduction in the number of primordial follicles, poor follicle recruitment, or accelerated follicular apoptosis. However, its cause is unknown in most cases. AIM This guide analyses the factors associated with the diagnosis and treatment of POI and provides recommendations on the most appropriate diagnostic and therapeutic measures for women under 40 years of age who experience POI. METHODOLOGY A panel of experts from various Spanish scientific societies related to POI (Spanish Menopause Society, Spanish Fertility Society, and Spanish Contraception Society) met to reach a consensus on these issues. RESULTS Hormonal therapy (HT) is considered the treatment of choice to alleviate the symptoms of hypoestrogenism and to prevent long-term consequences. We suggest that HT should be continued until at least age 51, the average age at natural menopause. The best treatment to achieve pregnancy is oocyte/embryo donation. If a patient is to undergo treatment that will reduce her fertility, she should be informed of this issue and the available techniques to preserve ovarian function, mainly vitrification of oocytes.
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85
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Age at menopause, reproductive history, and venous thromboembolism risk among postmenopausal women: the Women's Health Initiative Hormone Therapy clinical trials. Menopause 2014; 21:214-20. [PMID: 23760439 DOI: 10.1097/gme.0b013e31829752e0] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aims to investigate venous thromboembolism (VTE) risk in relation to age at menopause, age at menarche, parity, bilateral oophorectomy, and time since menopause, as well as any interaction with randomized hormone therapy (HT) assignment, among postmenopausal women. METHODS Using pooled data from the Women's Health Initiative HT clinical trials including 27,035 postmenopausal women aged 50 to 79 years who had no history of VTE, we assessed the risk of VTE in relation to age at menopause, age at menarche, parity, bilateral oophorectomy, and time since menopause by Cox proportional hazards models. Linear trends, quadratic relationships, and interactions of reproductive life characteristics with HT on VTE risk were systematically tested. RESULTS During follow-up, 426 women reported a first VTE, including 294 non-procedure-related events. No apparent interaction of reproductive life characteristics with HT assignment on VTE risk was detected, and there was not a significant association between VTE and age at menarche, age at menopause, parity, oophorectomy, or time since menopause. However, analyses restricted to non-procedure-related VTE showed a U-shaped relationship between age at menopause and thrombotic risk that persisted after multivariable analysis (P < 0.01). Compared with women aged 40 to 49 years at menopause, those who had early menopause (age <40 y) or late menopause (age >55 y) had a significantly increased VTE risk (hazard ratio [95% CI]: 1.8 [1.2-2.7] and 1.5 [1.0-2.4], respectively). CONCLUSIONS Reproductive life characteristics have little association with VTE and do not seem to influence the effect of HT on thrombotic risk among postmenopausal women. Nevertheless, early and late onset of menopause might be newly identified risk factors for non-procedure-related VTE.
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86
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Roy-O'Reilly M, McCullough LD. Sex differences in stroke: the contribution of coagulation. Exp Neurol 2014; 259:16-27. [PMID: 24560819 PMCID: PMC4127336 DOI: 10.1016/j.expneurol.2014.02.011] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/09/2014] [Accepted: 02/12/2014] [Indexed: 12/15/2022]
Abstract
Stroke is now the leading cause of adult disability in the United States. Women are disproportionately affected by stroke. Women increasingly outnumber men in the elderly population, the period of highest risk for stroke. However, there is also a growing recognition that fundamental sex differences are present that contribute to differential ischemic sensitivity. In addition, gonadal hormone exposure can impact coagulation and fibrinolysis, key factors in the initiation of thrombosis. In this review we will discuss sex differences in stroke, with a focus on platelets, vascular reactivity and coagulation.
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Affiliation(s)
| | - Louise D McCullough
- University of Connecticut Health Center, School of Medicine, USA; The Stroke Center at Hartford Hospital, USA.
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87
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88
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Mittal M, Savvas M, Narvekar N, Panay N, Hamoda H. A cross-sectional national questionnaire survey assessing the clinical attitudes of members of the British Menopause Society to the management of women with premature ovarian insufficiency. Post Reprod Health 2014; 20:90-97. [PMID: 24973048 DOI: 10.1177/2053369114540883] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To explore the current clinical attitudes of members of the British Menopause Society to the management of premature ovarian insufficiency. DESIGN An electronic cross-sectional questionnaire survey. SETTING Members of the British Menopause Society. POPULATION All members of the British Menopause Society with a valid email address. METHOD Completion of an electronic survey. MAIN OUTCOME MEASURES Investigations and treatment options and preferences for the management of women with premature ovarian insufficiency. RESULTS A total of 130 questionnaires were returned and analysed. The majority of responses were from Hospital Consultants (n = 55/130; 42.3%). A total of 53/124 (42.7%) clinicians routinely performed a bone density scan. A total of 73/130 (56.2%) clinicians would prescribe hormone replacement therapy in preference to combined ethinyl estradiol and progesterone (COC; 27/130, 20.8%). A total of 44/108 (40.7%) routinely prescribed oral estradiol in preference to transdermal administration (62/108, 57.4%). A total of 26/128 (20.3%) prescribed oral micronised progesterone, 31/128 (24.2%) oral progestogens, while 42/128 (32.8%) preferred the intra-uterine system. Fertility concerns remain an important aspect of care, with 33.9% (n = 39/115) of clinicians indicating that more than 50% of their patients had a concern regarding their fertility. CONCLUSION The majority of clinicians indicated a preference for hormone replacement therapy instead of the COC as their choice of hormone replacement in women with premature ovarian insufficiency. However, there was a significant variation in practices. This information can be useful in counselling women and in guiding clinical practitioners. The results highlight the need for further research to determine the optimal regimens for the management of women with premature ovarian insufficiency.
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Affiliation(s)
- Monica Mittal
- King's College Hospital NHS Foundation Trust, Assisted Conception Unit, London, UK
| | - Michael Savvas
- King's College Hospital NHS Foundation Trust, Assisted Conception Unit, London, UK
| | - Nitish Narvekar
- King's College Hospital NHS Foundation Trust, Assisted Conception Unit, London, UK
| | - Nick Panay
- Queen Charlotte's and Chelsea & Westminster Hospitals, London, UK
| | - Haitham Hamoda
- King's College Hospital NHS Foundation Trust, Assisted Conception Unit, London, UK
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89
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Hoda MN, Bhatia K, Hafez SS, Johnson MH, Siddiqui S, Ergul A, Zaidi SK, Fagan SC, Hess DC. Remote ischemic perconditioning is effective after embolic stroke in ovariectomized female mice. Transl Stroke Res 2014; 5:484-90. [PMID: 24385308 PMCID: PMC4092232 DOI: 10.1007/s12975-013-0318-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 11/13/2013] [Accepted: 12/11/2013] [Indexed: 01/20/2023]
Abstract
Remote ischemic conditioning is neuroprotective in young male rodents after experimental stroke. However, it has never been tested in females whom remain at higher risk of stroke injury after menopause. We tested remote ischemic perconditioning therapy (RIPerC) at 2 h after embolic stroke in ovariectomized (OVX) female mice with and without intravenous tissue plasminogen activator (IV-tPA) treatment. We assessed cerebral blood flow (CBF), neurobehavioral outcomes, infarction, hemorrhage, edema, and survival. RIPerC therapy with and without IV-tPA improved the CBF and neurobehavioral outcomes and reduced the infarction, hemorrhage, and edema significantly. Late IV-tPA alone at 4 h post-stroke neither improved the neurobehavior nor reduced the infarction but aggravated hemorrhage and mortality in OVX mice. RIPerC therapy prevented the increased mortality during late IV-tPA. Our study demonstrates for the first time that RIPerC therapy is effective in OVX females.
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Affiliation(s)
- Md Nasrul Hoda
- Department of Medical Laboratory, Imaging and Radiologic Sciences, Georgia Regents University, Augusta, GA USA
- Department of Neurology, Georgia Regents University, 1120 15th St, CA 1014, Augusta, GA 30912 USA
- Program in Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia, Augusta, GA USA
- Charlie Norwood VA Medical Center, Augusta, GA USA
| | - Kanchan Bhatia
- Department of Medicine, Georgia Regents University, Augusta, GA USA
| | - Sherif S. Hafez
- Department of Physiology, Georgia Regents University, Augusta, GA USA
| | | | - Shahneela Siddiqui
- Department of Neurology, Georgia Regents University, 1120 15th St, CA 1014, Augusta, GA 30912 USA
| | - Adviye Ergul
- Department of Physiology, Georgia Regents University, Augusta, GA USA
- Program in Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia, Augusta, GA USA
- Charlie Norwood VA Medical Center, Augusta, GA USA
| | - Syed Kashif Zaidi
- Center of Excellence in Genomic Medicine Research, King Abdul Abdulaziz University, PO Box 80216, Jeddah, 21589 Kingdom of Saudi Arabia
| | - Susan C. Fagan
- Department of Neurology, Georgia Regents University, 1120 15th St, CA 1014, Augusta, GA 30912 USA
- Program in Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia, Augusta, GA USA
- Charlie Norwood VA Medical Center, Augusta, GA USA
| | - David C. Hess
- Department of Neurology, Georgia Regents University, 1120 15th St, CA 1014, Augusta, GA 30912 USA
- Program in Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia, Augusta, GA USA
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90
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Abstract
A literature search was done using PubMed. The age at natural menopause (ANM) depends on various factors like genetic, environmental, socioeconomic, reproductive, dietary, and lifestyle of which some like nulliparity, vegetarian diet, smoking, high fat intake, cholesterol, and caffeine accelerates; while others like parity, prior use of oral contraceptive pills, and Japanese ethnicity delays the ANM. ANM is an important risk factor for long-term morbidity and mortality; and hence, the need to identify the modifiable risk factors like diet and lifestyle changes. Delayed menopause is associated with increased risk of endometrial and breast cancer, while early ANM enhances the risk for cardiovascular diseases and osteoporosis. The correlation between diet and ANM has not been extensively studied; however, whatever studies have been done till now point towards role of high intake of total calories, fruits, and proteins in delaying the ANM, while high polyunsaturated fat intake accelerates it. The role of dietary soy, total fat, saturated fat, red meat, and dietary fiber in determining the ANM has been controversial and needs further studies to substantiate it. The lifestyle factors like current smoking and vigorous exercise have been significantly associated with early menopause, while moderate alcohol consumption delays the ANM. Large prospective studies are needed to study the association of ANM and other modifiable factors like passive smoking fish consumption, soy, and various types of tea. The knowledge of modifiable determinants of ANM can help in setting up menopausal clinics and initiating health programs specially in developing countries.
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Affiliation(s)
- Shilpa Sapre
- Department of Obstetrics and Gynecology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Ratna Thakur
- Department of Obstetrics and Gynecology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
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91
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Prolonged Diuretic Activity and Calcium-Sparing Effect of Tropaeolum majus: Evidence in the Prevention of Osteoporosis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:958291. [PMID: 25028592 PMCID: PMC4083603 DOI: 10.1155/2014/958291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 05/27/2014] [Indexed: 01/13/2023]
Abstract
Although several studies indicate high effectiveness in the use of the hydroethanolic extract from Tropaeolum majus (HETM) as a diuretic, the impact of its prolonged use in the presence of low estrogen levels remains unclear. Thus, the aim of this study was to investigate the diuretic effects of prolonged administration of HETM in ovariectomized rats and their interrelationship between calcium excretion and bone turnover. Forty-two female Wistar rats were ovariectomized (OVX) and treated orally with different doses of HETM (3, 30, and 300 mg/kg) for 4 weeks. On the first day of treatment and at weekly intervals for four weeks the diuretic activity was evaluated. Electrolyte concentrations and creatinine levels were estimated from urine sample of each rat. The serum lipids, urea, creatinine, and osteocalcin were also measured at the end of the experiment. The data revealed that the HETM was able to sustain its diuretic effect after prolonged treatment. Moreover, its use has not affected the urinary calcium or potassium excretion, reduces lipid levels, and maintains osteocalcin levels similarly to untreated rats. These findings support the potential of HETM as a candidate to be used in clinical conditions in which the renal loss of calcium is not desired.
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92
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Scott EL, Zhang QG, Vadlamudi RK, Brann DW. Premature menopause and risk of neurological disease: basic mechanisms and clinical implications. Mol Cell Endocrinol 2014; 389:2-6. [PMID: 24462786 PMCID: PMC4040297 DOI: 10.1016/j.mce.2014.01.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 01/14/2014] [Accepted: 01/14/2014] [Indexed: 10/25/2022]
Abstract
Since basic scientific studies in the 1990s revealed dramatic gender differences in neurological damage from cerebral ischemia, significant evidence has accumulated for a neuroprotective role of ovarian-derived 17β-Estradiol (E2). Intriguingly, observational studies have further suggested that early and prolonged loss of ovarian E2 (premature menopause) leads to a doubled lifetime risk for dementia and a fivefold increased risk of mortality from neurological disorders, but some controversy remains. Here, we briefly summarize and analyze clinical cohort studies assessing the detrimental neurological outcomes of premature menopause. Furthermore, we discuss current basic science studies elucidating the molecular mechanisms underlying the enhanced risk of neurological disease in prematurely menopausal women and the "window of opportunity" for estrogen benefit. Finally, we highlight four critical issues in the field that require collaboration between basic scientists and clinicians for successful resolution, with the ultimate goal of maintaining optimal neurological health in prematurely menopausal women.
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Affiliation(s)
- Erin L Scott
- University System of Georgia MD/PhD Program, Georgia Regents University, Augusta, GA 30912, USA; Institute of Molecular Medicine and Genetics, Georgia Regents University, Augusta, GA 30912, USA
| | - Quan-Guang Zhang
- Institute of Molecular Medicine and Genetics, Georgia Regents University, Augusta, GA 30912, USA
| | - Ratna K Vadlamudi
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Darrell W Brann
- Institute of Molecular Medicine and Genetics, Georgia Regents University, Augusta, GA 30912, USA.
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93
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Pérez-López FR. Long-term consequences of LNG-IUS vs. hysterectomy for menorrhagia. Climacteric 2014; 17:308-9. [PMID: 24827480 DOI: 10.3109/13697137.2014.908578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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94
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Gao HH, Gao LB, Wen JM. Genetic polymorphisms in the ESR1 gene and cerebral infarction risk: a meta-analysis. DNA Cell Biol 2014; 33:605-15. [PMID: 24772998 DOI: 10.1089/dna.2013.2270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A number of studies have documented that estrogen receptor α (ESR1) may play an important role in the development and progression of cerebral infarction, but many existing studies have yielded inconclusive results. This meta-analysis was performed to evaluate the relationships between ESR1 genetic polymorphisms and cerebral infarction risk. The PubMed, CISCOM, CINAHL, Web of Science, Google Scholar, EBSCO, Cochrane Library, and CBM databases were searched for relevant articles published before October 1, 2013, without any language restrictions. Meta-analysis was conducted using the STATA 12.0 software. Seven case-control studies were included with a total of 1471 patients with cerebral infarction and 4688 healthy control subjects. Two common single-nucleotide polymorphisms (SNPs) in the ESR1 gene (rs2234693 T>C and rs9340799 A>G) were assessed. Our meta-analysis results revealed that ESR1 genetic polymorphisms might increase the risk of cerebral infarction. Subgroup analysis by SNP type indicated that both rs2234693 and rs9340799 polymorphisms in the ESR1 gene were strongly associated with an increased risk of cerebral infarction. Further subgroup analysis by ethnicity showed significant associations between ESR1 genetic polymorphisms and increased risk of cerebral infarction among both Asians and Caucasians. In the stratified subgroup analysis by gender, the results suggested that ESR1 genetic polymorphisms were associated with an increased risk of cerebral infarction in the female population. However, there were no statistically significant associations between ESR1 genetic polymorphisms and cerebral infarction risk in the male population. Meta-regression analyses also confirmed that gender might be a main source of heterogeneity. Our findings indicate that ESR1 genetic polymorphisms may contribute to the development of cerebral infarction, especially in the female population.
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Affiliation(s)
- Hong-Hua Gao
- Department of Neurology, The Fourth Affiliated Hospital of China Medical University , Shenyang, People's Republic of China
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Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL, Howard VJ, Lichtman JH, Lisabeth LD, Piña IL, Reeves MJ, Rexrode KM, Saposnik G, Singh V, Towfighi A, Vaccarino V, Walters MR. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:1545-88. [PMID: 24503673 PMCID: PMC10152977 DOI: 10.1161/01.str.0000442009.06663.48] [Citation(s) in RCA: 622] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this statement is to summarize data on stroke risk factors that are unique to and more common in women than men and to expand on the data provided in prior stroke guidelines and cardiovascular prevention guidelines for women. This guideline focuses on the risk factors unique to women, such as reproductive factors, and those that are more common in women, including migraine with aura, obesity, metabolic syndrome, and atrial fibrillation. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through May 15, 2013. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA Stroke Council methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS We provide current evidence, research gaps, and recommendations on risk of stroke related to preeclampsia, oral contraceptives, menopause, and hormone replacement, as well as those risk factors more common in women, such as obesity/metabolic syndrome, atrial fibrillation, and migraine with aura. CONCLUSIONS To more accurately reflect the risk of stroke in women across the lifespan, as well as the clear gaps in current risk scores, we believe a female-specific stroke risk score is warranted.
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96
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Sood R, Faubion SS, Kuhle CL, Thielen JM, Shuster LT. Prescribing menopausal hormone therapy: an evidence-based approach. Int J Womens Health 2014; 6:47-57. [PMID: 24474847 PMCID: PMC3897322 DOI: 10.2147/ijwh.s38342] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The constantly changing landscape regarding menopausal hormone therapy (MHT) has been challenging for providers caring for menopausal women. After a decade of fear and uncertainty regarding MHT, reanalysis of the Women’s Health Initiative data and the results of recent studies have provided some clarity regarding the balance of risks and benefits of systemic MHT. Age and years since menopause are now known to be important variables affecting the benefit-risk profile. For symptomatic menopausal women who are under 60 years of age or within 10 years of menopause, the benefits of MHT generally outweigh the risks. Systemic MHT initiated early in menopause appears to slow the progression of atherosclerotic disease, thereby reducing the risk of cardiovascular disease and mortality. During this window of opportunity, MHT might also provide protection against cognitive decline. In older women and women more than 10 years past menopause, the risk-benefit balance of MHT is less favorable, particularly with regard to cardiovascular risk and cognitive impairment. For women entering menopause prematurely (<40 years), MHT ameliorates the risk of cardiovascular disease, osteoporosis, and cognitive decline. Nonoral administration of estrogen offers advantages due to the lack of first-pass hepatic metabolism, which in turn avoids the increased hepatic synthesis of clotting proteins, C-reactive protein, triglycerides, and sex hormone-binding globulin. The duration of combined MHT use is ideally limited to less than 5 years because of the known increase in breast cancer risk after 3–5 years of use. Limitations to use of estrogen only MHT are less clear, since breast cancer risk does not appear to increase with use of estrogen alone. For women under the age of 60 years, or within 10 years of onset of natural menopause, MHT for the treatment of bothersome menopausal symptoms poses low risk and is an acceptable option, particularly when nonhormonal management approaches fail.
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Affiliation(s)
- Richa Sood
- Division of General Internal Medicine, Women's Health Clinic, Mayo Clinic, Rochester, MN, USA
| | - Stephanie S Faubion
- Division of General Internal Medicine, Women's Health Clinic, Mayo Clinic, Rochester, MN, USA
| | - Carol L Kuhle
- Division of General Internal Medicine, Women's Health Clinic, Mayo Clinic, Rochester, MN, USA
| | - Jacqueline M Thielen
- Division of General Internal Medicine, Women's Health Clinic, Mayo Clinic, Rochester, MN, USA
| | - Lynne T Shuster
- Division of General Internal Medicine, Women's Health Clinic, Mayo Clinic, Rochester, MN, USA
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97
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Rocca WA, Shuster LT, Brown RD. Could estrogen protect younger menopausal women from stroke? Expert Rev Neurother 2014; 12:363-5. [DOI: 10.1586/ern.12.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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98
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MALINOWSKI JENNIFER, FARBER-EGER ERIC, CRAWFORD DANAC. Development of a data-mining algorithm to identify ages at reproductive milestones in electronic medical records. PACIFIC SYMPOSIUM ON BIOCOMPUTING. PACIFIC SYMPOSIUM ON BIOCOMPUTING 2014:376-87. [PMID: 24297563 PMCID: PMC3905575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Electronic medical records (EMRs) are becoming more widely implemented following directives from the federal government and incentives for supplemental reimbursements for Medicare and Medicaid claims. Replete with rich phenotypic data, EMRs offer a unique opportunity for clinicians and researchers to identify potential research cohorts and perform epidemiologic studies. Notable limitations to the traditional epidemiologic study include cost, time to complete the study, and limited ancestral diversity; EMR-based epidemiologic studies offer an alternative. The Epidemiologic Architecture for Genes Linked to Environment (EAGLE) Study, as part of the Population Architecture using Genomics and Epidemiology (PAGE) I Study, has genotyped more than 15,000 patients of diverse ancestry in BioVU, the Vanderbilt University Medical Center's biorepository linked to the EMR (EAGLE BioVU). We report here the development and performance of data-mining techniques used to identify the age at menarche (AM) and age at menopause (AAM), important milestones in the reproductive lifespan, in women from EAGLE BioVU for genetic association studies. In addition, we demonstrate the ability to discriminate age at naturally-occurring menopause (ANM) from medically-induced menopause. Unusual timing of these events may indicate underlying pathologies and increased risk for some complex diseases and cancer; however, they are not consistently recorded in the EMR. Our algorithm offers a mechanism by which to extract these data for clinical and research goals.
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Affiliation(s)
- JENNIFER MALINOWSKI
- Center for Human Genetics Research, Vanderbilt University, 2215 Garland Avenue, 519 Light Hall, Nashville, TN 37232, USA
| | - ERIC FARBER-EGER
- Center for Human Genetics Research, Vanderbilt University, 1207 17 Avenue, Suite 300, Nashville, TN 37232, USA
| | - DANA C. CRAWFORD
- Department of Molecular Physiology and Biophysics, Center for Human Genetics Research, 2215 Garland Avenue, 519 Light Hall, Nashville, TN 37232, USA
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99
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Corona JC, de Souza SC, Duchen MR. PPARγ activation rescues mitochondrial function from inhibition of complex I and loss of PINK1. Exp Neurol 2013; 253:16-27. [PMID: 24374061 DOI: 10.1016/j.expneurol.2013.12.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 12/05/2013] [Accepted: 12/17/2013] [Indexed: 01/19/2023]
Abstract
Parkinson's disease has long been associated with impaired mitochondrial complex I activity, while several gene defects associated with familial Parkinson's involve defects in mitochondrial function or 'quality control' pathways, causing an imbalance between mitochondrial biogenesis and removal of dysfunctional mitochondria by autophagy. Amongst these are mutations of the gene for PTEN-induced kinase 1 (PINK1) in which mitochondrial function is abnormal. Peroxisome proliferator-activated receptor gamma (PPARγ), a nuclear receptor and ligand-dependent transcription factor, regulates pathways of inflammation, lipid and carbohydrate metabolism, antioxidant defences and mitochondrial biogenesis. We have found that inhibition of complex I in human differentiated SHSY-5Y cells by the complex I inhibitor rotenone irreversibly decrease mitochondrial mass, membrane potential and oxygen consumption, while increasing free radical generation and autophagy. Similar changes are seen in PINK1 knockdown cells, in which potential, oxygen consumption and mitochondrial mass are all decreased. In both models, all these changes were reversed by pre-treatment of the cells with the PPARγ agonist, rosiglitazone, which increased mitochondrial biogenesis, increased oxygen consumption and suppressed free radical generation and autophagy. Thus, rosiglitazone is neuroprotective in two different models of mitochondrial dysfunction associated with Parkinson's disease through a direct impact on mitochondrial function.
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Affiliation(s)
- Juan Carlos Corona
- Department of Cell and Developmental Biology, University College London, London WC1E 6BT, UK
| | - Senio Campos de Souza
- Department of Cell and Developmental Biology, University College London, London WC1E 6BT, UK
| | - Michael R Duchen
- Department of Cell and Developmental Biology, University College London, London WC1E 6BT, UK.
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100
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Pitkin J. Should HRT be duration limited? MENOPAUSE INTERNATIONAL 2013; 19:167-174. [PMID: 24336246 DOI: 10.1177/1754045313507176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Hormone Replacement Therapy (HRT) has received consistently bad press, despite re-analysis of previous data new studies and supporting Consensus Statements from leading national and international societies. Many women have been convinced by women's journals and the media not to even consider HRT as an option and, General Practitioners, still limit duration to 5 years or, will, arbitrarily, discontinue prescriptions in the early 50s. This article seeks to make sense of our current position. Previous and new evidence on the safety of HRT is reviewed. New data on the long-term consequences of non-treatment of women with Premature Ovarian Insufficiency (POI) is presented and the dichotomy of the older female workforce is explored. From this, a logical plan of management emerges.
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Affiliation(s)
- Joan Pitkin
- North West London Hospitals, NHS Trust, Harrow, UK
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