Low bone mineral density in pre-menopausal women one year after gastric bypass / Baixa densidade mineral óssea em mulheres pré-menopausadas um ano após bypass gástrico

Introduction: Nutritional deficiencies, hormonal changes and severe weight loss after Roux-en-Y Gastric Bypass (RYGB) can promote changes in bone metabolism which may lead to a reduction in bone mineral density (BMD). Objective: to investigate the prevalence of osteopenia/osteoporosis and factors associated with BMD in pre-menopausal women who underwent RYGB. Methodology: a cross-sectional study conducted with secondary data of patients followed-up in a specialized center for obesity treatment. Variables studied: biochemical and anthropometric data, body composition by multifrequency bioimpedance and BMD of the lumbar spine (LS), total femur (TF) and femur neck (FN) by dual-energy X-ray absorptiometry. For statistical analysis, the SPSS® software and a 5% significance level were utilized. Results: seventy-two (72) pre-menopausal women were evaluated. Mean age, BMI and mean post-surgery time was 38.7±6.5 years, 25.8±2.5 kg/m² and 13.1±1.7 months, respectively. The prevalence of osteopenia in at least one of the densitometry sites was 13.9%, with LS being the most frequent site. A lower LS BMD was associated with greater weight loss, higher percentage of body fat before surgery and lower post-surgery serum vitamin D levels. There was a positive correlation between skeletal muscle mass index adjusted for height in the pre-surgery period and LS BMD (r=0.361; p=0.010) and TF (r=0.404; p=0.004). Conclusion: a relevant prevalence of osteopenia was detected in pre-menopausal women after RYGB, mainly in the LS.

Introdução: o Bypass Gástrico em Y de Roux (BPGYR) pode promover mudanças no metabolismo ósseo decorrentes de deficiências nutricionais, alterações hormonais e perda severa de peso, podendo acarretar redução da Densidade Mineral Óssea (DMO). Objetivo: investigar a prevalência de osteopenia/osteoporose e fatores associados à DMO em mulheres pré-menopausadas submetidas à BPGYR. Metodologia: estudo transversal com dados secundários de pacientes acompanhadas em um serviço especializado no tratamento da obesidade. Variáveis estudadas: dados bioquímicos e antropométricos, composição corporal por bioimpedância multifrequencial e DMO de coluna lombar (CL), fêmur total (FT) e colo do fêmur (CF) por Absorciometria por Dupla Emissão de Raios X. Para análise estatística foi utilizado o programa SPSS®, com o nível de significância de 5%. Resultados: foram avaliadas 72 mulheres pré-menopausadas, com média de idade e de IMC de 38,7±6,5 anos e 25,8±2,5 kg/m², respectivamente, e tempo médio de pós-operatório de 13,1±1,7 meses. A prevalência de osteopenia em pelo menos um dos sítios densitométricos foi de 13,9%, sendo a CL o sítio mais frequente. Uma menor DMO na CL se associou a maior perda de peso, maior percentual de massa gorda antes da cirurgia e níveis séricos menores de vitamina D pós-operatória. Observou-se correlação positiva entre o índice de massa muscular esquelética ajustada pela altura no pré-operatório e a DMO da CL (r=0,361; p=0,010) e do FT (r=0,404; p= 0,004). Conclusão: detectou-se prevalência relevante de osteopenia em mulheres pré-menopausadas após BPGYR, principalmente na CL.

Effect of ribociclib on productivity losses due to breast cancer in young women in Brazil

ABSTRACT OBJETIVE To evaluate the effect of ribociclib versus endocrine therapy on productivity losses due to advanced breast cancer. METHODS Productivity data from the MONALEESA-7 trial, obtained from the results of the application of the Work Productivity and Activity Impairment (WPAI) questionnaire on progression-free survival state (43-month follow-up), were extrapolated to the 10,936 Brazilian prevalent cases of premenopausal women with hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer. Productivity loss was determined by quantifying the economic costs of workforce dropout over time in both treatment arms and by discounting the economic costs of absenteeism and presenteeism from workforce retention. A human capital approach was used. RESULTS Net productivity gains in the ribociclib arm were estimated at USD 4,285,525.00, representing 316,609 added work hours over 43 months and a mean of 2,009 added work weeks per year. CONCLUSIONS The phase III MONALEESA-7 trial productivity results applied to the Brazilian premenopausal prevalent cases of hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer showed that treatment with ribociclib + endocrine therapy improves workforce participation compared with endocrine therapy alone in premenopausal women with hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) metastatic breast cancer, with potential economic gains for the Brazilian society.

Research Progress on Animal Models of Menopausal Syndrome： A Review / 中国实验方剂学杂志

In order to explore the pathological mechanism of perimenopausal syndrome and seek prevention and treatment measures， it is necessary to establish animal models that similar to human perimenopausal syndrome， so as to provide reference for drug research， new drug development and clinical application. In this paper， the keywords of "perimenopausal period" "perimenopausal syndrome" "menopause" "menopausal syndrome""menopausal period" "menopausal syndrome" and "animal" were searched in China National Knowledge Infrastructure （CNKI）， Chongqing Weipu， China Biomedical Literature Database （CBM） and Pubmed. In addition， the selection of domestic peripheral menopausal syndrome model animals in recent years and the advantages and disadvantages of corresponding models were summarized. A total of 673 studies were identified， of which 61 were included in the analysis. The most common animal model of perimenopausal syndrome is castration model， while the immunodeficiency model is less used. With the aging of the population and the rapid increase of psychosocial stress， the incidence of perimenopausal syndrome is high. Therefore， it is particularly important to explore the mechanism of perimenopausal syndrome. According to the experimental purpose， experimental period， experimental technology and other factors， the selection of appropriate model animals and modeling methods is the key of the success of the experiment of perimenopausal syndrome.

Prevalência e fatores associados à constipação em mulheres na pré-menopausa: um estudo de base comunitária / Prevalence and factors associated with constipation in premenopausal women: a community-based study

ABSTRACT BACKGROUND: Intestinal constipation is characterized by problems related to evacuation, and presents high prevalence in the female gender. This condition has demonstrated negative effects on the development of daily activities, causing damage to the physical and emotional well-being of individuals who are diagnosed with it. Studies that investigate what health impairments intestinal constipation can cause are scarce in the literature. OBJECTIVE: This study aimed to verify the prevalence and factors associated with intestinal constipation in premenopausal women living in Northeastern Brazil. METHODS: It is a cross-sectional study. This was carried out in the northeast of Brazil. Participated 195 women, adult and middle age. Social conditions, habits and lifestyle, clinical aspects and obstetric history were investigated. Constipation was diagnosed using the Rome III Criteria. Multivariate analysis was conducted using Poisson Regression with robust variance to analyze the relationship between intestinal constipation and independent variables. A statistical significance level of P<0.05 was considered. RESULTS: Most of the women were between 25 and 39 years old (49.2%) and had an income of up to one minimum wage (79.5%). The intestinal constipation prevalence was 35.4%. In the final multivariate regression model, hemorrhoid clinical aspects (P=0.01), pain (P=0.001) and a burning sensation (P=0.01) on bowel movement, and sexual dysfunction (P=0.03) remained associated with constipation. CONCLUSION: The present study found a significant prevalence of constipation among premenopausal women and clinical factors such as hemorrhoids, pain and a burning sensation, and sexual dysfunction were associated with intestinal constipation.

RESUMO CONTEXTO: A constipação intestinal é caracterizada por problemas relacionados à evacuação, e apresenta alta prevalência no gênero feminino. Essa condição tem demonstrado efeitos negativos no desenvolvimento das atividades diárias, causando prejuízos no bem-estar físico e emocional dos indivíduos que são diagnosticados com ela. Estudos que investiguem quais prejuízos à saúde a constipação intestinal pode ocasionar são escassos na literatura. OBJETIVO: Este estudo teve como objetivo verificar a prevalência e os fatores associados à constipação intestinal em mulheres na pré-menopausa residentes no nordeste do Brasil. MÉTODOS: Estudo transversal realizado no Nordeste do Brasil. Participaram 195 mulheres adultas e de meia idade. Condições sociais, hábitos e estilo de vida, aspectos clínicos e história obstétrica foram investigados. A constipação foi diagnosticada através dos Critérios de Roma III. A análise multivariada foi conduzida através da Regressão de Poisson com variância robusta, para analisar a relação entre constipação intestinal e variáveis independentes. Considerou-se o nível de significância estatística de P≤0,05. RESULTADOS: A maioria das mulheres estava na faixa etária de 25 a 39 anos (49,2%) e possuía renda de até um salário mínimo (79,5%). A prevalência da constipação intestinal foi de 35,4%. No modelo final da regressão multivariada, os aspectos clínicos hemorroidas (P<0,01), dor (P<0,001) e ardor (P<0,01) ao evacuar e disfunção sexual (P<0,03) permaneceram associados à constipação. CONCLUSÃO: O presente estudo encontrou uma prevalência significativa de constipação entre mulheres na pré-menopausa e fatores clínicos como hemorroidas, dor e ardor na evacuação, e disfunção sexual se associaram a constipação intestinal.

A Study on the Clinical and Pathological Evaluation of Dysfunctional Uterine Bleeding

Background: Abnormal uterine bleeding, a commongynecological problem is caused by a range of etiologies thatmay be functional or organic. Histo-pathological analysis ofendometrial sample is considered gold standard for the studyof endometrial pathology. Thus here we made an attempt tostudy endometrial pattern in women with AUB and correlatethat with clinical parameters.Materials and Methods: This hospital based study involved 50patients with AUB and attending Varun Arjun Medical Collegeand Rohilkhand Hospital. The patients were divided asreproductive (<40), perimenopausal (41-50) and postmenopausal group (>50). The endometrial samples wereprocessed and histopathological analysis was conducted.Result: Most of study patients were under reproductive agegroup (52.8%) and multigravid (28%). Functional abnormalitieswere the common causes of AUB (72%). Menorrhagia wasmost frequent bleeding pattern observed (36%) followed bymetrorrhagia (18%). In case of reproductive age group andperimenopausal, the common histopathological abnormalitywas proliferative endometrium (18% and 12%) while for postmenopausal age group, it was 8 %. For primipara groupdisordered proliferative endometrium (8%), for multipara groupproliferative endometrium (24%) and for grand multiparagroup endometrial hyperplasia (10%) were the most frequentlyobserved abnormalities. A single case of malignancy wasobserved in post-menopausal multipara female.Conclusion: Histopathological study of endometrial biopsyhelps the clinicians in selecting the appropriate therapeuticapproach. It is simple and cheap method hence should beused as first line strategy thus reducing the need of otherexpensive and complicated approaches.

Malignant Melanoma Of Uterine Cervix In A Young Female.

Malignant melanoma is a rare cancer, its incidence being 1% of all cancers. Malignant melanoma of the female genital tract is even rarer with incidence of 3% to 7% of all malignant melanomas. It usually occurs in postmenopausal women. We present a case of malignant melanoma of the uterine cervix in a multiparous premenopausal 29 year old female. She underwent a modified radical hysterectomy. She was stage III and was treated with external beam radiotherapy to the pelvis followed by brachytherapy. Since then the patient was on regular follow up until she developed lung metastasis. Malignant melanoma of the cervix has very less data in literature. Through this case report we will emphasize on the role of radiotherapy in malignant melanoma of uterine cervix.

Project profile: a multicenter study on breast cancer in young women in Latin America (PRECAMA study) / Perfil de Proyecto: Un estudio multicéntrico sobre el cáncer de mama en mujeres jóvenes en América Latina (estudio PRECAMA)

Abstract: Objective: To describe the rationale and the methodology of a multicenter project to study the etiology of breast cancer in young Latin American women. Materials and methods: The International Agency for Research on Cancer has established an international collaborative population-based case-control study in four countries in Latin America: Chile, Colombia, Costa Rica, and Mexico (the PRECAMA study). Standardized methodologies were developed to collect information on reproductive variables, lifestyle, anthropometry, diet, clinical and pathological data, and biological specimens. The study will be extended to other countries in the region. Conclusion: PRECAMA is unique in its multidisciplinary approach that combines genetics, genomics, and metabolomics with lifestyle factors. The data generated through this project will be instrumental to identify major risk factors for molecular subtypes of breast cancer in young women, which will be important for prevention and targeted screening programs in Latin America.

Resumen: Objetivo: Describir la justificación y la metodología para el establecimiento de un proyecto multicéntrico sobre el cáncer de mama en mujeres jóvenes de América Latina. Material y métodos: La Agencia Internacional para la Investigación del Cáncer (IARC) ha establecido un estudio colaborativo internacional de casos y controles con base poblacional en cuatro países de América Latina: Chile, Colombia, Costa Rica y México (el estudio PRECAMA). Se han desarrollado metodologías estandarizadas para recolectar información sobre variables reproductivas, estilos de vida, antropometría y dieta, datos clínicos y patológicos y muestras biológicas. Conclusión: PRECAMA es único en su enfoque multidisciplinario. Los datos generados a través de este proyecto serán fundamentales para identificar los principales factores de riesgo del cáncer de mama en mujeres jóvenes. Los hallazgos serán relevantes para la prevención y los programas de detección oportuna en América Latina, con beneficios clínicos inmediatos.

Correlation estradiol levels and physical activities with lipid profile levels of premenopausal women, in Padang city, Indonesia

Background: In premenopausal women, low estradiol levels and lack of physical activity can result in dyslipidemia. Dyslipidemia is a risk factor for coronary heart disease (CHD). The incidence of CHD occurs a lot in premenopausal age compared to productive age, the percentage of women who experience higher CHD than men. Objective was to determine the correlation of estradiol levels and physical activity with lipid profiles in premenopausal women in Padang City.Methods: This research was carried out in Padang City. The study was observational, cross-sectional design. The study sample was 79 premenopausal women. Estradiol levels were assessed by the ELISA method, physical activity was assessed by an international physical activity (IPAQ) questionnaire, lipid profiles were assessed by colorimetric enzymatic methods. Correlation of estradiol levels with lipid profile levels were analyzed using the Pearson correlation test. Correlation of physical activity with lipid profile level using the ANOVA test.Results: The mean estradiol level of respondents was 144.68pg/ml, the mean physical activity of respondents is heavy physical activity as much as 41.8%, the mean cholesterol level of respondents was 194.76mg/dl, the mean triglyceride level of respondents was 118.75mg/dl, the mean LDL cholesterol level of respondents was 120.64mg/dl, the mean HDL cholesterol level was 53.18mg/dl.Conclusions: There were significant correlation between estradiol levels with triglyceride levels and LDL cholesterol. There was significant correlation physical activity with total cholesterol levels and triglyceride levels. There was no correlation between estradiol levels with total cholesterol and HDL cholesterol. There was no correlation physical activity with LDL cholesterol and HDL cholesterol.

Serum anti-Mullerian hormone and homocysteine in premenopausal females with and without cardiovascular disease

Background: The objective of this study is to assess the association of anti-Mullerian hormone (AMH) and homocysteine (Hcy) levels in premenopausal females with and without cardiovascular disease.Methods: A case control study was conducted in premenopausal, menopausal and normal fertile females (n=30) with and without cardiovascular disease in a tertiary care hospital and research centre in central India. Fasting sample obtained was assessed for AMH and Hcy levels. Results were compared and data was analyzed.Results: The levels of AMH and Hcy were significantly altered in premenopausal and menopausal females as compared to normal fertile females. Moreover, there was a weak correlation when intergroup comparison was made between the parameters in females with and without cardiovascular disease.Conclusions: A prospective study with a larger sample size to assess levels of AMH need to be performed to provide insight in premenopausal females for the early detection cardiovascular disease.

The Association between Low Vitamin D Status and Autoimmune Thyroid Disease in Korean Premenopausal Women: The 6th Korea National Health and Nutrition Examination Survey, 2013–2014 / 가정의학회지

BACKGROUND: This study aimed to analyze the association of low vitamin D status with thyroid autoimmunity and dysfunction in the Korean population according to sex and menopausal status in women. METHODS: This study was based on the data acquired from the 6th Korea National Health and Nutrition Examination Survey. We enrolled 4,356 subjects who had data of thyroid function, antithyroid peroxidase antibody (TPOAb), and serum 25-hydroxyvitamin D (25[OH]D) levels. We excluded subjects who were pregnant and who had a history of thyroid disease or thyroid cancer, and those with transient thyroid dysfunction who tested negative for TPOAb (TPOAb[−]). RESULTS: TPOAb positivity (TPOAb[+]) with thyroid dysfunction (subclinical and overt hypothyroidism) was more prevalent in the vitamin D deficient group than in the vitamin D insufficient and sufficient groups including premenopausal (P=0.046) and postmenopausal women (P=0.032), although no significant differences were observed in men. The mean serum 25(OH)D level was significantly lower in the TPOAb(+) with thyroid dysfunction group than in the TPOAb(+) with euthyroidism and TPOAb(−) groups of premenopausal women (P=0.001), although no significant differences were observed in men and postmenopausal women. Multivariate binary logistic regression analysis, adjusted for age, body mass index, and current smoking status, showed that vitamin D insufficiency and deficiency were significantly associated with TPOAb(+) with thyroid dysfunction in premenopausal women (P<0.001), although no significant associations were observed in men and postmenopausal women. CONCLUSION: Low vitamin D status was significantly associated with thyroid autoimmunity and dysfunction in the Korean population, especially in premenopausal women.

Efficacy of Combined Aromatase Inhibitor and Luteinizing Hormone-Releasing Hormone Agonist in Premenopausal Metastatic Breast Cancer

PURPOSE: Endocrine therapy is the preferred treatment for hormone receptor (HR)-positive metastatic breast cancer (MBC). We investigated the efficacy of combined aromatase inhibitor (AI) and luteinizing hormone-releasing hormone (LHRH) agonist in premenopausal patients with HR-positive MBC. METHODS: We retrospectively analyzed the medical records of 21 HR-positive premenopausal MBC patients treated with combined AI and LHRH agonist therapy. RESULTS: The median follow-up period was 32.9 months. The overall response rate was 47.6%, with three complete responses (14.3%) and seven partial responses (33.3%). Nine patients (42.9%) achieved stable disease lasting more than 6 months; thus, the clinical benefit rate was 90.4%. The median time to progression was 45.4 months. No patients experienced grade 3 or 4 toxicity. CONCLUSION: Combined AI and LHRH agonist treatment safely and effectively induced remission or prolonged disease stabilization, suggesting that this could be a promising treatment option for HR-positive premenopausal patients with MBC.

Relationship between Age at Menarche and Metabolic Syndrome in Premenopausal Women: Korea National Health and Nutrition Examination Survey 2013–2014 / 가정의학회지

BACKGROUND: Early menarche may be associated with increased risk of cardiovascular disease. The aim of this study was to evaluate the relationship between age at menarche and metabolic syndrome (MetS) in Korean premenopausal women. METHODS: We used nationally representative data from the Korea National Health and Nutrition Examination Survey from 2013 to 2014, and 3,023 premenopausal women aged 20–55 years were our subjects. We defined early menarche as age at first menstrual period less than 12 years. Multivariable logistic regression analysis was used to evaluate the relationship between age at menarche and MetS after adjusting for current age, and socioeconomic, lifestyle, and reproductive variables. RESULTS: MetS was much more common in women aged 40–55 years than in women aged 20–39 years (4.1% vs. 15.1%). Compared with women who experienced menarche at age 12–15 years, the risk of MetS in the early menarche group was not higher in either age group, after adjusting for current age, and socioeconomic, lifestyle, and reproductive variables (odds ratio [OR], 1.767; 95% confidence interval [CI], 0.718–4.351 in those aged 20–39 years; OR, 1.780; 95% CI, 0.775–4.085 in those aged 40–55 years). The risk of MetS in women with menarche at age ≥16 years was not higher than in women with menarche at age 12–15 years. CONCLUSION: Early or late menarche was not associated with an increased risk of MetS in premenopausal Korean women. Even before menopause, current age has a major influence on the development of MetS.

The Prevalence and Associated Factors of the Metabolic Syndrome in Pre-menopausal Housewives: An Analysis of the 2010~2015 Korean National Health and Nutrition Examination Survey

PURPOSE: The purpose of this study is to estimate the prevalence of the metabolic syndrome in pre-menopausal housewives and to explore controllable and uncontrollable factors regarding metabolic syndrome. METHODS: The study population of this cross-sectional survey was from the Korean Health and Nutrition Examination Survey (KHANES) 2010 through 2015, including the fifth and sixth population-based studies. The criteria for metabolic syndrome include waist circumference, blood pressure, fasting plasma glucose, triglyceride, high-density lipoprotein (HDL) based on Korean Clinical Practice Guideline for Metabolic Syndrome by the Korean Academy of Family Medicine 2015. RESULTS: Among the 2,498 subjects, 247 subjects had metabolic syndrome and the prevalence was estimated to be 9.9%. The number of subjects who met the criterion of HDL was 936 (36.2%), which was the most prevalent among the criteria for metabolic syndrome. Statistically significant (p < .05) factors include age, livinghood benefit group, perceived health status, obesity, family history of DM, sleeping time, awareness of stress,leukocyte, and erythrocyte count. The odds ratio of obesity in the BMI ≥25 group was 12.59 times as high as that of the BMI < 25 group (p < .001) for metabolic syndrome. CONCLUSION: The prevalence of metabolic syndrome in pre-menopausal housewives in the survey was not low, and it is necessary to develop and apply comprehensive health habit management programs to improve controllable factors including exercise and food intake.

The Association between Fat Mass, Lean Mass and Bone Mineral Density in Premenopausal Women in Korea: A Cross-Sectional Study / 가정의학회지

BACKGROUND: We investigated the association between body composition, especially truncal or non-truncal fat mass (FM), and bone mineral density (BMD) in premenopausal women in Korea. METHODS: A cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey IV and V (2008–2011). Total lean mass (LM), total FM (TFM), truncal FM, and non-truncal FM, and BMD of the total femur, femoral neck (FN), and lumbar spine were measured using dual-energy X-ray absorptiometry. The association between body composition and BMD was analyzed using multiple linear regression. The risk of low BMD according to quartiles of TFM, truncal FM, and non-truncal FM was calculated using logistic regression. Subgroup analysis according to body mass index was also performed. RESULTS: In 4,343 premenopausal women, total LM was positively associated with BMD regardless of weight adjustment. TFM, truncal FM, and non-truncal FM were inversely associated with BMD after adjusting for weight. Odds ratios (ORs) for low BMD and 95% confidence intervals (CIs) of the highest quartile of TFM, truncal FM, and non-truncal FM compared with the lowest quartile were calculated. The risk of low BMD of the FN was higher in the highest quartile of TFM (OR, 4.48; 95% CI, 1.11–18.01) and truncal FM (OR, 5.48; 95% CI, 1.75–17.20). Truncal FM and not-truncal FM had an inverse association with BMD in the non-obese and obese subgroups of women. CONCLUSION: Total LM has a protective effect on BMD and FM can have a detrimental effect on BMD besides its skeletal loading effect.

Edema idiopático. Presentación de un caso y revisión de la literatura / Idiopathic edema. Case report and literature review

El edema idiopático es un diagnóstico de exclusión, caracterizado por la acumulación de líquido en tejido intersticial en mujeres premenopáusicas en ausencia de patología cardiaca, renal o hepática. Típicamente los laboratorios y estudios complementarios son normales. El tratamiento es la Espironolactona debido al Hiperaldosteronismo secundario concomitante. De no ser efectivo, puede ser añadido o cambiado a un diurético tiazídico a la menor dosis efectiva. Es frecuente la resistencia a este grupo farmacológico.

Idiopathic edema is a diagnosis of exclusion, characterized by the accumulation of fluid in interstitial tissue in premenopausal women in the absence of cardiac, renal or hepatic pathology. Typically laboratories and complementary studies are normal. Treatment is Spironolactone due to concomitant secondary hyperaldosteronism. If not effective, it can be added or changed to a thiazide diuretic at the lowest effective dose. Resistance to this pharmacological group is frequent.

Clinical and pathological characteristics of endometrial carcinoma in premenopausal and postmenopausal patients / 上海交通大学学报（医学版）

Objective·To analyze the clinical and pathological characteristics of endometrial carcinoma patients before and after menopause. Methods·Fifty-two premenopausal cases and 150 postmenopausal cases with endometrial carcinoma from December 2013 to March 2017 in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. Results·The ratio of patients with hypertension in premenopausal group was 28.8％, which was significantly lower than that in postmenopausal group (P<0.01). In premenopausal group, the proportion of G3 in histological grading was 8.3％, and the ratio of deep myometrial invasion was 13.5％, all of which were significantly lower than those of postmenopausal group (P<0.05). The ratio of ovarian involvement was as high as 17.6％, which was significantly higher than that of postmenopausal group (P<0.05). There were no significant differences between the two groups in other clinical-pathological parameters such as obesity, diabetes, CA125, CA199, surgical-pathological staging, pathological type, vascular involvement, and lymph node metastasis. Conclusion·Premenopausal endometrial carcinoma is less malignant, while the probability of ovarian involvement is higher.

Acupoints selection pattern in acupuncture-moxibustion treatment of perimenopausal syndrome from 2007 to 2016 / 针灸推拿医学（英文版）

Objective: To discuss the acupoints selection pattern in acupuncture-moxibustion treatment of perimenopausal syndrome (PMS) from 2007 to 2016. Methods: Clinical literatures related to PMS treated with acupuncture-moxibustion published from 2007 to 2016 were collected from Chinese Biomedical Literature Database (CBM), Chongqing VIP Database (CQVIP), China National Knowledge Infrastructure (CNKI), and Wanfang Academic Journal Full-text Database (Wanfang). The retrieved data underwent descriptive analysis, cluster analysis and association pattern analysis to determine the acupoints selection principle in acupuncture-moxibustion treatment of PMS. Results: The top five acupoints used in acupuncture-moxibustion treatment of PMS were Sanyinjiao (SP 6), Shenshu (BL 23), Guanyuan (CV 4), Baihui (GV 20), and Shenmen (HT 7). The leading 4 meridians were Bladder Meridian, Conception Vessel, Spleen Meridian, and Governor Vessel. The clustering analysis showed that the 5 core acupoint groups were: ① Sanyinjiao (SP 6); ② Shenshu (BL 23) and Guanyuan (CV 4); ③ Baihui (GV 20), Shenmen (HT 7), Zusanli (ST 36), Ganshu (BL 18) and Taichong (LR 3); ④ Taixi (KI 3), Pishu (BL 20), Xinshu (BL 15), Qihai (CV 6) and Neiguan (PC 6); ⑤ Sishencong (EX-HN 1), Zhongwan (CV 12), Hegu (LI 4), Yintang (GV 29), Fengchi (GB 20), Zhongji (CV 3) and Feishu (BL 13). The three most significant acupoints were Sanyinjiao (SP 6), Shenshu (BL 23) and Guanyuan (CV 4). Acupoint groups based on syndrome differentiation included: ① Hegu (LI 4), Zhongwan (CV 12) and Sishencong (EX-HN 1); ② Feishu (BL 13), Zhongji (CV 3), Fengchi (GB 20) and Yintang (GV 29); ③ Xinshu (BL 15), Pishu (BL 20), Qihai (CV 6), Neiguan (PC 6) and Taixi (KI 3);④ Ganshu (BL 18), Zusanli (ST 36), Shenmen (HT 7), Taichong (LR 3) and Baihui (GV 20). The analysis of association pattern elaborated that Shenshu (BL 23) and Sanyinjiao (SP 6) won the highest support rate in the paired groups; Ganshu (BL 18), Shenshu (BL 23) and Sanyinjiao (SP 6) had the highest support rate among the acupoint groups. Conclusion: The data mining results of acupuncture-moxibustion treatment of PMS substantially conform to the general principle in traditional acupuncture-moxibustion theories, able to reflect the acupoints selection and grouping pattern and provide references for acupuncture-moxibustion treatment of PMS.

Bilateral Salpingo-oophorectomy Compared to Gonadotropin-Releasing Hormone Agonists in Premenopausal Hormone Receptor?Positive Metastatic Breast Cancer Patients Treated with Aromatase Inhibitors / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Although combining aromatase inhibitors (AI) with gonadotropin-releasing hormone agonists (GnRHa) is becoming more common, it is still not clear if GnRHa is as effective as bilateral salpingo-oophorectomy (BSO). MATERIALS AND METHODS: We retrospectively analyzed data of 66 premenopausal patients with hormone receptor– positive, human epidermal growth factor receptor 2–negative recurrent and metastatic breast cancer who had been treated with AIs in combination with GnRHa or BSO between 2002 and 2015. RESULTS: The median patient age was 44 years. Overall, 24 (36%) received BSO and 42 (64%) received GnRHa. The clinical benefit rate was higher in the BSO group than in the GnRHa group (88% vs. 69%, p=0.092). Median progression-free survival (PFS) was longer in the BSO group, although statistical significance was not reached (17.2 months vs. 13.3 months, p=0.245). When propensity score matching was performed, the median PFS was 17.2 months for the BSO group and 8.2 months for the GnRHa group (p=0.137). Multivariate analyses revealed that the luminal B subtype (hazard ratio, 1.67; 95% confidence interval [CI], 1.08 to 2.60; p=0.022) and later-line treatment (≥ third line vs. first line; hazard ratio, 3.24; 95% CI, 1.59 to 6.59; p=0.001) were independent predictive factors for a shorter PFS. Incomplete ovarian suppression was observed in a subset of GnRHa-treated patients whose disease showed progression, with E2 levels higher than 21 pg/mL. CONCLUSION: Both BSO and GnRHa were found to be effective in our AI-treated premenopausal metastatic breast cancer patient cohort. However, further studies in larger populations are needed to determine if BSO is superior to GnRHa.

The Examination of Ovarian Reserve in Premenopausal Patients with Hormone Receptor Positive Breast Cancer / 이화의대지

The evaluation of menopausal status is an important subject in the field of treatment of hormone receptor positive breast cancer. According to the menopausal status, endocrine therapy should be categorized by individual patient. However, the gonadal injury caused by various therapeutic drugs and its recovery would confuse the interpretation of clinical and biological markers for ovarian reserve. There are some methods to examine the functional ovarian reserve indirectly. Ultrasonography for counting follicles is a relatively reliable procedure, although it is not feasible because of time-labor consumption and high cost. Biological marker from blood samples such as serum follicle stimulating hormone (FSH), serum estradiol (E2), serum inhibin, or anti-Müllerian hormone (AMH) would be a better choice. The examination of serum FSH and E2 is already recommended as biomarkers for measuring functional ovarian reserve in many guidelines. However, there are limitation of serum FSH and E2 in patients with chemotherapy-induced amenorrhea and treated by tamoxifen. AMH is promising biomarker in the field of infertility treatment even in the patients treated by chemotherapy. It might be a possible biomarker to determine the menopausal status for decision-making whether aromatase inhibitor could be applicable or not in hormone positive breast cancer patients with chemotherapy induced amenorrhea or treated by tamoxifen.