Receiving Hormone Replacement Therapy Research Articles

Intrauterine device use in adolescence: a narrative review.

Contraceptive use in adolescence remains a challenging issue. Adolescents are at high risk of unintended pregnancies and sexual transmitted infections. During the past few decades intrauterine devices are recommended from global health organization, including the American Academy of Pediatrics, American College of Obstetricians and Gynecologists and World Health Organization as a method of contraception for adolescents. Intrauterine devices are part of the long-acting reversible contraceptives (LARCs) and include the copper bearing device (CU-IUD) and the levonorgestrel intrauterine system (LNG-IUS). IUDs are a safe and effective contraceptive method for adolescents with a failure rate less than 1%. Their use is not limited only in contraception. LNG-IUS 52 mg is approved for treating heavy menstrual bleeding and protection from endometrial hyperplasia in women receiving hormone replacement therapy. It can also be an effective tool in the management of dysmenorrhea, while CU-IUD can provide emergency contraception. Nevertheless, IUDs remain underutilized in this group of population. Adolescents' lack of proper education about contraception and sexual behavior creates myths and misconceptions about the possible side effects and the suitability of IUDs in this age group. Furthermore, health care providers remain skeptical and hesitate to suggest IUDs to adolescents. Other barriers including high cost, concern about confidentiality and difficulties in access contribute to its limited use. It is of high importance to eliminate barriers and offer more accessible contraceptive services to adolescents.

Analysis of KLRB1-Mediated Immunosuppressive Regulation in Adamantinomatous Craniopharyngioma.

Adamantinomatous craniopharyngioma (ACP) is the most common type of craniopharyngioma (CP). Under the current surgery and/or radiotherapy strategies, the survival rate is high, but the long-term quality of life is poor because of the relationship between the hypothalamic-pituitary axis and the tumor. Many studies had shown that endocrine deficiencies caused by craniopharyngiomas of the hypothalamic-pituitary axis persist throughout almost the entire life of the patients after surgery, requiring them to receive hormone replacement therapy. Thus, we need to explore new treatments to improve the prognosis of patients. In recent years, there are more and more studies on the immunotherapy of various tumors. However, due to the rarity of the disease, immunotherapy for ACP is rarely researched. The discovery of the tumor immune-suppressive checkpoint KLRB1 (killer cell lectinlike receptor B1), which encodes CD161, may provide a novel target for the treatment of ACP. Data analysis of retrospective RNA sequencing was conducted in a cohort of 51 pediatric samples in the GSE94349 dataset, and the results were well validated in the GSE68015 dataset including 31 pediatric samples. We used R language as the main tool for statistical analysis and graphical work. Our research showed that KLRB1 was enriched in ACP. Additionally, the expression of KLRB1 was positively related to immune functions and most inflammatory responses of ACP. We found that most of the T lineage-related immune responses were positively correlated with KLRB1 expression, and KLRB1 played an important role in the activation of inflammatory processes. KLRB1 is a promising target for immunotherapeutic strategies.

Eff ect of platelet-rich autoplasma on endometrial thickness and receptor sensitivity to estrogen and progesterone.

The effect of platelet-rich autoplasma on endometrial thickness and receptor sensitivity to estrogen and progesterone. This prospective clinical study included 200 patients. The participants in the study were divided into two groups. The first control group received hormone replacement therapy (HRT). The second study group received an intrauterine infusion of platelet-rich autoplasma (PRP group). On the 19th day of the menstrual cycle, an ultrasound examination was performed to assess endometrial thickness, as well as an immunohistochemical analysis to determine receptor sensitivity to estrogen and progesterone. In the course of the study, we found that the use of platelet-rich autoplasma increased the thickness of the endometrium by 0.85 mm; the average thickness of the endometrium in the group who received PRP therapy was 8.25 (8.25-8.61) mm; and in the group of patients who only received HRT, it was 7.40 (7.34-7.65) mm. The sensitivity of receptors to estrogen in the experimental group increased by 3.5, in the experimental group it was 75.00 (71.43-74.22), and in the control group it was 71.50 (67.05-70.85). The sensitivity of receptors to progesterone also increased by 9.0, in the experimental group it was 95.0 (91.4-93.8), and in the control group it was 86.0 (83.47-86.27). Due to the action of platelet factors, PRP therapy has a positive effect on the endometrium, increasing its thickness and improving its receptivity. Therefore, it can be concluded that this method can find great practical application to improve the outcomes of assisted reproductive technology programs.

Association between dietary intake of creatine and female reproductive health: Evidence from NHANES 2017-2020.

The hormonal changes in women influence creatine dynamics, emphasizing its potential importance during menstruation, pregnancy, postpartum, menopause, and postmenopause. Yet, limited research explores creatine's impact on female reproductive health at the population level. Our study investigated the relationship between dietary creatine intake and reproductive health indices in US women using data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). We extracted a dataset containing females aged 12 years and above who provided details about their reproductive health and dietary habits. Daily creatine intake was quantified as a relative amount (mg per kg body mass) and did not include creatine from dietary supplements and pharmacological agents. A daily requirement for dietary creatine for healthy women was employed to classify respondents into two separate subpopulations: (1) suboptimal intake of creatine (<13 mg per kg body mass per day) or (2) recommended intake (dietary creatine ≥ 13 mg per kg body mass per day). A total of 4522 female participants from the NHANES study (age 44.5 ± 20.5 years) provided data on their reproductive health and dietary intake. The average daily creatine intake for the group was 10.5 ± 10.8 mg per kg body mass. The odds ratio for having irregular periods in women consuming ≥13 mg of creatine per kg body mass daily (recommended intake) compared to those with suboptimal intake was 0.75 (95% CI, from 0.66 to 0.86), indicating a significant association between higher intake of dietary creatine and lower risk of oligomenorrhea (p < .001). Moreover, women consuming less than 13 mg of creatine per kg body mass faced an increased risk of fetal macrosomia (OR 1.26; p = .04), pelvic infection (OR 1.68; p = .01), hysterectomy (OR 1.42; p < .001), oophorectomy (OR 1.54; p < .001), and receiving hormone replacement therapy (OR 1.26; p = .02). Consuming a creatine-rich diet has been linked to lower risks of reproductive issues in US women aged 12 and above. Those consuming ≥13 mg of creatine per kg body mass daily showed notably lower risks of irregular menstrual periods, obstetric conditions, and pelvic pathology. Further studies are needed to confirm these potential benefits.

Exogenous Estrogen in the Development of Head and Neck Cancer

Sex differences in head and neck cancer (HNC) incidence suggest a potential contribution of sex hormones. To assess the role of exogenous estrogen exposure in the development of HNC in female patients. This large multicenter cohort study using clinical records from the TriNetX real-world database included 20 years of data (through May 31, 2023) from 87 health care organizations. The TriNetX database was searched for medical records for female patients with and without exogenous estrogen exposure according to their chronological age. Cohort 1 included 731 366 female patients aged 18 to 45 years old with regular oral contraceptive (OC) intake and cohort 2 included 3 886 568 patients in the same age group who did not use OC. Cohort 3 comprised 135 875 female patients at least 50 years old receiving hormone replacement therapy (HRT), whereas cohort 4 included 5 875 270 patients at least 50 years old without HRT. Propensity score matching was performed for the confounders age, alcohol dependence, and nicotine dependence. Data analyses were performed in May 2023. Diagnosis of HNC (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision: C00-C14), and after propensity score matching (1:1 nearest-neighbor greedy matching), a risk analysis to investigate risk differences and risk ratios (RRs) with a 95% CI. Among the 718 101 female patients in each of cohorts 1 and 2 (mean [SD] age at diagnosis, 25.9 [6.7] years), those with OC intake had a higher risk of an HNC diagnosis (RR, 1.47; 95% CI, 1.21-1.78) than those without OC use. Among the 131 835 female patients in each of cohorts 3 and 4 (mean [SD] age, 67.9 [12.0] years), those with postmenopausal HRT intake had a lower risk of an HNC diagnosis (RR, 0.77; 95% CI, 0.64-0.92) than those without HRT use. The findings of this cohort study illustrate a positive association between OC and a negative association between HRT and the development of HNC in female patients. Given the limitations of the TriNetX database, future research should include detailed information on the intake of OC and HRT and reproductive health information (eg, age at menarche/menopause, number of pregnancies) to more accurately define the strength and direction of the possible association between exogeneous estrogen exposure and the development of HNC in female patients.

Previous cancers in women diagnosed with premature ovarian insufficiency: A nationwide population-based case-control study.

To investigate the occurrence of previous cancer diagnoses in women suffering from premature ovarian insufficiency (POI) and compare it with the general population, shedding light on the association between cancer, cancer treatments, and POI. We conducted a nationwide case-control study based on registry data from various sources, including the Social Insurance Institution, Finnish Population Information System, and Finnish Cancer Registry spanning from 1953 to 2018. Our participants comprised all women in Finland who, between 1988 and 2017, received hormone replacement therapy reimbursement for ovarian insufficiency before the age of 40 years (n = 5221). Controls, matched in terms of age and municipality of residence, were selected from the Finnish Population Information System (n = 20 822). Our main exposure variable was a history of cancer diagnosis preceding the diagnosis of POI. We analyzed odds ratios (OR) to compare the prevalence of previous cancers in women with POI with that in controls, stratifying results based on cancer type, age at cancer diagnosis, and the time interval between cancer diagnosis and POI. We also assessed changes in OR for previous cancer diagnoses over the follow-up period. Out of the women diagnosed with POI, 21.9% had previously been diagnosed with cancer, resulting in an elevated OR of 36.5 (95% confidence interval [CI] 30.9 to 43.3) compared with 0.8% of the controls. The risk of developing POI was most pronounced during the first 2 years following a cancer diagnosis, with an OR of 103 (95% CI 74.1 to 144). Importantly, this risk remained elevated even when the time interval between cancer and POI exceeded 10 years, with an OR of 5.40 (95% CI 3.54 to 8.23). This study reveals that 21.9% of women with POI have a history of cancer, making the prevalence of cancer among these women 27.5 times higher than age-matched controls in the Finnish population. The risk of developing POI is most substantial in the first 2 years following a cancer diagnosis. These findings underscore the role of cancer treatments as an etiological factor for POI and emphasize the importance of recognizing the risk of POI in cancer survivors for early diagnosis and intervention.

Effect of age of initiation of mammography breast cancer screening.

Mammography is an excellent resource to reduce the burden of premature death associated with breast cancer; however, screening is only recommended between the ages of 50 and 69 years. To compare the frequency of suspicious and non-diagnostic mammograms for breast cancer when screening Chilean women between the ages of 40 and 50 years. Cross-sectional study nested in a breast cancer screening programme in Chilean women >40 years old, conducted between 2017 and 2021. Demographic variables and risk factors are described. To establish the effect of age on screening, we calculated the number needed to screen for a Breast Imaging Reporting and Data Reporting System 4 or 5 mammogram when screening over 40 years or over 50 years. We studied 137,690 women screened for breast cancer since the age of 40 years. The median age was 54 years (range 40-93 years). 64.7% of women were postmenopausal, 4.79% were nulliparous and 14% of post-menopausal women were receiving hormone replacement therapy. To find a suspicious mammogram, 170 women over 40 years and 149 women over 50 years would have to be screened. By changing the starting age of screening from 50 to 40 years 21 more women would have to be screened to detect a suspicious mammogram and if screened from age 50 and not from age 40 years 21% of total suspicious mammograms would remain unidentified.

A Case of Secondary Growth Hormone Deficiency that Developed into Cirrhosis after Several Years of Interrupted Growth Hormone Replacement Therapy.

This case report describes a patient who received hormone replacement therapy for secondary panhypopituitarism and subsequently developed diabetes. His physician decided to discontinue growth hormone (GH) replacement, which was previously deemed contraindicated. Following the diagnosis of fatty liver, the patient began to exhibit liver damage that progressed over the ensuing years, ultimately leading to cirrhosis. Common factors linked to cirrhosis were excluded, leading to the belief that GH deficiency over several years was the primary contributor to cirrhosis. Therefore, when treating patients with GH insufficiency and diabetes, clinicians should carefully consider the potential implications of GH replacement therapy.

Effects of Hormone Replacement Therapy on Autoimmune Markers and Clinical Outcomes in Pediatric Patients with Hashimoto's Thyroiditis

Objective: Hashimoto’s Thyroiditis (HT), a chronic autoimmune thyroiditis, is the predominant cause of hypothyroidism in regions without iodine deficiency. HT is characterized by the loss of immunological tolerance of the thyroid gland, leading to autoimmune attacks. This study aimed to compare the autoantibody profiles, along with clinical and laboratory findings, of patients diagnosed with Hashimoto’s disease who were either receiving treatment or followed without treatment. Material and Methods: Clinical manifestations, laboratory data, and thyroid ultrasonography (USG) findings of patients diagnosed with Hashimoto’s thyroiditis receiving hormone therapy and those followed without treatment were compared in our clinic. Results: Among a total of 249 patients, 116 received hormone replacement therapy, while 133 were followed without treatment. The mean age of all patients was 13.91±3.71 years, with a mean age at diagnosis of 11.51±3.79 years. After twelve months of follow-up, the untreated group showed an increase in serum fT4 and antiTPO levels (p=0.012 and p=0.001), with no significant difference found in serum TSH, fT3, and antiTG levels. Those receiving treatment exhibited a significant decrease in serum TSH levels and a significant increase in serum fT4 levels (p=0.002 and p&amp;lt;0.001, respectively). Although there was an increase in serum antiTPO and antiTG levels over time, no change was detected in serum fT3 levels. Clinical improvement was significantly greater in the treatment group (p=0.044). Conclusion: It has been concluded that early initiation of hormone replacement therapy in Hashimoto’s thyroiditis can mitigate negative clinical effects during follow-up, contributing to patient comfort and alleviating clinical complaints.

Glut4 expression in pro-atherogenic monocytes is associated with estrogen induced ROS formation

Abstract Background Glucose transporter (GLUT) 4 was shown to be expressed on monocytes with dynamic alterations. Moreover, increased formation of monocyte related reactive oxygen species (ROS) is an important marker for atherosclerosis and estrogen is known to increase ROS. However, the impact of estrogen on human monocytes have not been investigated. This is of great importance as a high number of aging women receive hormone replacement therapy (HRT) due to meno-pause symptoms. This was shown to be associated with high risk for ischemic events. In this study, we investigated the impact of estrogen on human monocytes about membrane expression of GLUT4 and ROS formation. Methods In this pilot study, we investigated human leukocytes from 88 healthy volunteers (54 female and 34 male) and 114 patients (56 female and 58 male) treated in the department of Cardiology, Pneumology and Vascular medicine, University Hospital Düsseldorf. Buffy coat was extracted out of whole blood by centrifugation and analysed by flow-cytometry. Amount of CD14+ and CD16+ monocytes was measured in % of all leukocytes in all participants. ROS and GLUT4 expression were assessed for monocyte type in dependence from increasing estrogen concentrations in a sub cohort by in-vitro incubation representing physiological peak and HRT concentrations (0, 500 and 2000 pM). Results Mean age of healthy volunteers was 31,2 years. Mean age of patients was 75,9 years. In patients, 51% were male, 58% had arterial hypertension, 33% diabetes mellitus type II, 16% were smokers and 19% were obese. Antiatherogenic monocytes (CD16+) were stable in males but decreased with age in females (female: r=-0.3130 p=0.0010; male: r=-0.1011 p=0.3946). In contrast, pro-atherogenic monocytes (CD14+) increased with age in females (female: r=0.4013 p=&amp;lt;0.0001; male: r=0.09135 p=0.4389). Increasing estrogen concentrations induced ROS formation in all monocytes in a dose dependent manner (0 – 947±124, 500 - 1312±258, 2000 - 1248±629 geometric mean, p=0.0327 [one-way ANOVA]). Separation in CD14+ and CD16+ monocytes revealed that this effect was only driven by increase in CD14+ monoctyes (0 - 1021±325, 500- 1160±239, 2000 – 513 geometric mean, p=0.0179), whereby CD16+ monocytes did not show relevant increase. GLUT4 membrane expression was inversely related to increasing estrogen levels with decrease in CD14+ (0 - 578±81, 500- 498±55, 2000- 507±41 geometric mean, p=0.0131) and numerical reduction in CD16+ monocytes by high estrogen levels (0- 592±77, 500 - 544±80, 2000- 537±72 geometric mean, p=0.0784) Conclusion In this study, we could show that high estrogen levels induce decrease of GLUT4 membrane expression in human monocytes. This might be associated with increased ROS formation in pro-atherogenic CD14+ monocytes which are already increased with age in women. This might reflect a relevant mechanism for the increased rate of ischemic events by HRT.

Healthcare and support experiences of adolescents and young adults diagnosed with 47,XXY, 47,XXX, and 48,XXYY.

Sex chromosome aneuploidies (SCAs) are among the most common chromosomal conditions. There is little scholarship on how adolescents and young adults (AYAs) affected by SCA engage with and adapt to their diagnosis. In order to understand how AYAs adapt to a SCA diagnosis, we conducted a secondary analysis of qualitative interviews with AYAs. Eight in-depth semi-structured interviews with individuals with a diagnosis of 47,XXY, 47,XXX, and 48,XXYY were analyzed for iterative themes related to adaptation to a SCA diagnosis in accordance with standard qualitative methodology. Our findings suggest that the process of adaptation is highly variable and complex and is mediated by external factors including diagnosis delivery and community support. Factors associated with adaptation include feeling understood and supported by healthcare providers; researching the condition; receiving hormone replacement therapy; and receiving support from a community of peers. As access to prenatal and pediatric genetic testing continues to expand, non-genetic pediatric providers are increasingly likely to interact with individuals with SCAs as part of their initial diagnostic odyssey or ongoing medical management. Understanding the diversity of lived experiences of AYAs with SCAs is helpful for healthcare providers to facilitate holistic care and provide meaningful support to patients.

The Effect of TSH Suppression Therapy on the Efficacy and Immune Function of Postoperative Patients with Thyroid Cancer

Objective: To investigate the efficacy and immune function of thyroid stimulating hormone (TSH) suppression therapy in postoperative thyroid cancer patients. Methods: Sixty thyroid cancer patients admitted from July 2020–July 2022 were recruited and randomly divided into two groups. The control group (30 patients) received hormone replacement therapy, while the study group (30 patients) received TSH suppression therapy. The thyroid function, clinical efficacy, immune function, and tumor markers of the two groups were compared. Results: After treatment, the levels of free triiodothyronine (FT3) and thyroxine (FT4) in both groups increased significantly, while TSH levels decreased significantly. Moreover, the magnitude of change in the study group was greater than that in the control group (P &lt; 0.05). The total effective rate in the study group was significantly higher as compared to the control group (P &lt; 0.05). After treatment, the levels of CD3+ and CD4+ cells in both groups of patients increased significantly, with the study group showing significantly higher levels than the control group, whereas the level of CD8+ cells decreased significantly, with the study group having lower levels than the control group (P &lt; 0.05). After treatment, the levels of Tg and CEA in both groups were significantly lowered as compared to before treatment, and the levels of Tg and CEA in the study group were significantly lower than the control group (P &lt; 0.05). Conclusion: TSH suppression therapy in postoperative thyroid cancer patients can improve thyroid function, suppress the levels of tumor markers, and enhance immune function, thereby achieving good clinical outcomes.

(285) From the Proscription to the Prescription of Masturbation

Abstract Introduction The number of new women entering menopause each day in the US is around 6000. Unfortunately, in later life, it becomes increasingly common that a woman may arrive at this stage alone due to separation, divorce, the passing of a partner, or that the partner's decreased health and sexual function constrain the woman's sexual activity, satisfaction, and desire. The number of women with the aforementioned sexual limitations is higher than the number of women that maintain their sexual functioning. Additionally, the lack of sexual activity has been proven to accelerate the deterioration of the structures and functions of the pelvic floor and the genitourinary area. Objective All of the signs and symptoms of the Genitourinary Syndrome of Menopause (atrophy, dryness, recurrent UTI, dyspareunia, anal incontinence, pelvic organ prolapse, vaginal stenosis, labial fusion, or vulvar obliteration) can be easily found in women without sexual penetrative activity. However, this could be prevented and/or treated in great part with the maintenance of the partnered or solitary penetrative sexual activity. Methods An analysis of peer-reviewed articles on the topic of masturbation and its outcomes on women’s health, along with its data were used to assess the need for increasing the prescription of masturbation for the benefit of improved genitourinary health. Results Masturbation decreases as we age, markedly in women, studies and reports on masturbation activity show; 53% activity in Caucasian men aged 55 - 64, and 19% in women of the same age. At ages 64 – 65 there is a decrease to 33% in men and 10% in women. The result is that these women develop a stark increase in the number of genitourinary pathologies. Frequently absent in those who remain sexually active with a partner or through penetrative masturbation. Not only does the mechanical action of engaging in sexual physical therapy with a partner or with penetrative masturbation preserve the structures and functions of the genitourinary system. But in accordance with several neuroendocrinological studies, arousal and orgasms, increase the number of steroid receptors in the vital organs of the body improving their metabolism and integrity thus increasingly maintaining our health. In addition, if they don't receive hormone replacement therapy for the preservation of sexual function and prevention of genitourinary pathologies, the final results are usually catastrophic. Conclusions The number of women affected by the mentally castrating sexual education in which masturbation is not accepted is extremely high. This is despite the fact that masturbation among both younger and older women is related to a more consistent orgasm, compared with partnered sex. Historically speaking masturbation has been forbidden or taboo for centuries, mainly by religion, and has been extremely difficult to change in the mind of most adults, especially women. There is no doubt that partnered sexual activity and/or penetrative masturbation play a very important role in the health of the pelvic floor functions, just as in the general, psychological, and emotional health. Disclosure No

Higher Lifetime Exposure to Gonadal Hormones is Associated With Lower White Matter Hyperintensities Burden: A UK Biobank Study in Post-Menopausal Women (P6-5.006)

<h3>Objective:</h3> The aim of this study was to examine the relationship between lifetime exposure to endogenous and exogenous gonadal hormones on white matter hyperintensities (WMH) in post-menopausal women. <h3>Background:</h3> The onset of menopause accelerates the development of brain biomarkers of small vessel disease, such as WMH, supporting the cerebrovascular-protective effects of hormones. However, whether this effect is influenced by lifetime exposure to hormones is unclear. <h3>Design/Methods:</h3> Two measures of lifetime endogenous hormone exposure (ENHE) were explored: 1) cumulative number of years with a natural menstrual cycle and 2) cumulative number of live childbirths in women having never received hormone replacement therapy (HRT, n=6039). For exogenous hormone exposure (EXHE): 1) the use of oral HRT and 2) topical HRT (n=246). WMH volume was obtained from preprocessed T2-FLAIR images. <h3>Results:</h3> In a linear model adjusted for intracranial volume, age, oral contraceptive use, socio-demographics, and cardiovascular risk factors, both ENHEcycle and EMNHEparity were negatively associated with WMH (R2 = 0.30, F = 241, DF = 6027, p&lt;0.0001; βparity = −0.025, p = 0.006; βcycle = −0.003 p = 0.017). For EXHE, women who received topical HRT had significantly lower WMH volume than oral HRT (t=1.99, p= 0.048) after correcting for intracranial volume, age, socio-demographics, cardiovascular risk factors, ENHEcycle and ENHEparity. <h3>Conclusions:</h3> Our results provide further evidence that lifetime exposure to endogenous hormones appears to have an independent protective effect on WMH burden, and extending this with exogenous topical HRT may confer additional protection. The stronger effect of parity may be due to prolonged exposure to elevated estrogen resulting in long-lasting structural or functional changes in the small cerebral vessels. <b>Disclosure:</b> Dr. Perron has nothing to disclose. Miss Cote has nothing to disclose. Prof. Lepage has nothing to disclose. Dr. Bocti has nothing to disclose. Kevin Whittingstall has nothing to disclose.

The Role of Anamnesis in Modern Ophthalmic Practice: a Clinical Case

Eyes’ dryness continues to be the most frequent complication after LASIK. As a rule, it disappear in the vast majority of patients during the first year after surgery. The conducted studies indicate that complaints of eyes’ dryness in the preoperative period significantly increase the risk of developing a severe form of dry eye syndrome in the postoperative period, especially in middle-aged women (45–59 years) and older. The clinical case presented in this article indicates the development of a severe form of dry eye syndrome after LASIK in a middle-aged patient receiving hormone replacement therapy for menopause, complaining of a feeling of dryness and discomfort in the eyes in the preoperative period, with intolerance to contact lenses and taking antidepressants in the absence of signs of severe dry eye in the preoperative period. Consequently, surgical intervention led to the development of the mentioned above condition. It is confirmed by the literature data indicating that the above factors can cause the development of a severe form of dry eye syndrome after LASIK. Taking into account the fact that tear production tests do not always correlate with the intensity of complaints of dryness, burning sensation, pain in the eyes, the most important component at the stage of deciding on the feasibility of refractive surgery in a particular patient is the collection of anamnesis and clinical picture. When preparing patients with a history of dry eye syndrome for refractive surgery, it is necessary to inform them that they have a significantly increased risk of developing dry eye syndrome. It may persist in the long-term postoperative period, and possibly go into a chronic form. Candidates for refractive surgery in the presence of complaints characteristic of dry eye syndrome can only be those patients who respond well to therapy aimed at relieving these symptoms in the preoperative period. Taking into account the multicomponent nature of pain in dry eye syndrome — nociceptive pain, which is formed at the stage of receptor irritation in the corneal tissue, and neuropathic pain that occurs with the participation of the peripheral and central nervous system, a comprehensive approach is needed in the treatment of dry eye syndrome.

Focus on Liver Function Abnormalities in Patients With Turner Syndrome: Risk Factors and Evaluation of Fibrosis Risk.

Liver function abnormalities (LFAs) have been described in patients with Turner syndrome (TS). Although a high risk of cirrhosis has been reported, there is a need to assess the severity of liver damage in a large cohort of adult patients with TS. Evaluate the types of LFAs and their respective prevalence, search for their risk factors, and evaluate the severity of liver impairment by using a noninvasive fibrosis marker. This was a monocentric retrospective cross-sectional study. Data were collected during a day hospital visit. The main outcome measures were liver enzymes (alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase), FIB-4 score, liver ultrasound imaging, elastography, and liver biopsies, when available. 264 patients with TS were evaluated at a mean age of 31.15 ± 11.48 years. The overall prevalence of LFAs was 42.8%. The risk factors were age, body mass index, insulin resistance, and an X isochromosome (Xq). The mean FIB-4 sore of the entire cohort was 0.67 ± 0.41. Less than 10% of patients were at risk of developing fibrosis. Cirrhosis was observed in 2/19 liver biopsies. There was no significant difference in the prevalence of LFAs between premenopausal patients with natural cycles and those receiving hormone replacement therapy (P = .063). A multivariate analysis adjusted for age showed no statistically significant correlation between hormone replacement therapy and abnormal gamma-glutamyl transferase levels (P = .12). Patients with TS have a high prevalence of LFA. However, 10% are at high risk of developing fibrosis. The FIB-4 score is useful and should be part of the routine screening strategy. Longitudinal studies and better interactions with hepatologists should improve our knowledge of liver disease in patients with TS.

Severity and risk factors of interval breast cancer in Queensland, Australia: a population-based study

BackgroundInterval breast cancers (BC) are those diagnosed within 24 months of a negative mammogram. This study estimates the odds of being diagnosed with high-severity BC among screen-detected, interval, and other symptom-detected BC (no screening history within 2 years); and explores factors associated with being diagnosed with interval BC.MethodsTelephone interviews and self-administered questionnaires were conducted among women (n = 3,326) diagnosed with BC in 2010–2013 in Queensland. Respondents were categorised into screen-detected, interval, and other symptom-detected BCs. Data were analysed using logistic regressions with multiple imputation.ResultsCompared with screen-detected BC, interval BC had higher odds of late-stage (OR = 3.50, 2.9–4.3), high-grade (OR = 2.36, 1.9–2.9) and triple-negative cancers (OR = 2.55, 1.9–3.5). Compared with other symptom-detected BC, interval BC had lower odds of late stage (OR = 0.75, 0.6–0.9), but higher odds of triple-negative cancers (OR = 1.68, 1.2–2.3). Among women who had a negative mammogram (n = 2,145), 69.8% were diagnosed at their next mammogram, while 30.2% were diagnosed with an interval cancer. Those with an interval cancer were more likely to have healthy weight (OR = 1.37, 1.1–1.7), received hormone replacement therapy (2–10 years: OR = 1.33, 1.0–1.7; > 10 years: OR = 1.55, 1.1–2.2), conducted monthly breast self-examinations (BSE) (OR = 1.66, 1.2–2.3) and had previous mammogram in a public facility (OR = 1.52, 1.2–2.0).ConclusionThese results highlight the benefits of screening even among those with an interval cancer. Women-conducted BSE were more likely to have interval BC which may reflect their increased ability to notice symptoms between screening intervals.

The Comparative Study of the Administration of the Combination Preparation of Isoflavones and Hyaluronic Acid in Menopausal Women for the Treatment of the Symptoms of Menopause, Urogenital Atrophy and Oteoporosis in Relation to Existing Hormone Replacement Therapies.

Menopause is characterized by a series of symptoms and effects from the various systems and organs, for which, the decline in estrogen production from the ovaries is considered responsible. The aim of this study was to make comparative study of the administration of the combination preparation of isoflavones and hyaluronic acid in menopausal women for the treatment of the symptoms of menopause, urogenital atrophy and osteoporosis in relation to existing hormone replacement therapies. In this five-year, double-blind, placebo-controlled clinical study, a total of 274 postmenopausal women were enrolled and classified into three groups. Participants in group A, were 96 women who did not receive Hormone Replacement Therapy (HRT), in the second group, 92 received daily treatment with tibolone (2.5 mg) as monotherapy, and in the third group, 86 received treatment with a pharmaceutical formulation of hyaluronic acid 120 mg and isoflavones. MF11RCE 80 mg. In the postmenopausal women of our study, a significant reduction of postmenopausal symptoms was found in both groups B and C of participants who received hormone replacement preparations compared to group A who did not receive HRT. Furthermore, no difference in efficacy was observed between the administered preparations of isoflavones and tibolone. The combination of isoflavones and hyaluronic acid has the same efficacy as tibolone in menopausal symptoms.

Risk of critical limb ischemia in long-term uterine cancer survivors: A population-based study.

The risk of critical limb ischemia (CLI) which causes ischemic pain or ischemic loss in the arteries of the lower extremities in long-term uterine cancer (UC) survivors remains unclear, especially in Asian patients, who are younger at the diagnosis of UC than their Western counterparts. To conduct a nationwide population-based study to assess the risk of CLI in UC long-term survivors. UC survivors, defined as those who survived for longer than 5 years after the diagnosis, were identified and matched at a 1:4 ratio with normal controls. Stratified Cox models were used to assess the risk of CLI. From 2000 to 2005, 1889 UC survivors who received surgery alone or surgery combined with radiotherapy (RT) were classified into younger (onset age < 50 years, n = 894) and older (onset age ≥ 50 years, n = 995) groups. While compared with normal controls, the younger patients with diabetes, hypertension, and receiving hormone replacement therapy (HRT) were more likely to develop CLI. In contrast, the risk of CLI was associated with adjuvant RT, obesity, hypertension, and HRT in the older group. Among the UC survivors, those who were diagnosed at an advanced age (> 65 years, aHR = 2.48, P = 0.011), had hypertension (aHR = 2.18, P = 0.008) or received HRT (aHR = 3.52, P = 0.020) were at a higher risk of CLI. In this nationwide study, we found that the risk factors associated with CLI were similar in both cohorts except for adjuvant RT that was negligible in the younger group, but positive in the older group. Among the survivors, hypertension, advanced age, and HRT were more hazardous than RT. Secondary prevention should include CLI as a late complication in UC survivorship programs.

Experience of mitotane successful in the treatment of metastatic adrenocortical cancer

Background. Adrenocortical cancer (ACC) is a rare malignant endocrine tumor endowed with an aggressive biological potential and a poor prognosis. Surgical adrenalectomy remains the only radical treatment for local ACC. The overall 5-year survival rate of stages with local ACC varies from 56% to 96% and depends on the level of surgical training of a specialized center and the use of adjuvant therapy. Mitotan is the only approved chemotherapeutic agent for the adjuvant treatment of both the primary tumor and relapse and metastases.Aim. To evaluate the experience of mitotane successful use in a young patient with recurrent ACC using the experience of a large medical institution.Clinical observation. Patient R., 31 years old, is under dispensary observation for recurrent adrenocortical cancer of the left adrenal gland T1N0M0 stage 1, class 3. Progression from 2015, 2017, February 2019, April 2019, September 2020 (in the bed, MTS to the left kidney, MTS to the retroperitoneal tissue, MTS to the soft tissues of the lumbar region on the left, MTS to the lungs). Eradication of the tumor tissue was performed surgically, followed by morphological confirmation of the removed foci. For the first time, the diagnosis was established at the age of 23 during an examination for Itsenko-Cushing’s syndrome. Morphologically, the diagnosis of ACC was established after a histological examination of the tumor biopsy obtained by left-sided adrenalectomy (adrenocortical cancer, ki67 up to 20%).During a scheduled dispensary examination in September 2020, according to CT scan of the chest with contrast, two foci were identified in the right lung: in C1 — 10 * 15 mm, in C2 — 30 * 21 mm. By decision of the council (consisting of an oncologist-endocrinologist, a thoracic surgeon and a chemotherapist), a decision was made to prescribe mitotane with dose titration under the control of the level of mitotane in the blood until it reaches 14–20 ng/l, without morphological examination of the foci. Hypocorticism was corrected by the simultaneous use of hydrocortisone with mitotane at a dose of 20 mg per day under the control of ACTH levels. In X-ray evaluation by CT of the chest with a frequency of 3 months, the therapeutic effect in the form of a decrease in the size of the foci (RESIST1.1) occurred in the first 3 months. Mitotan was canceled in November 2021 after complete regression of tumor foci according to CT scan of the chest (pneumosclerosis areas 10*4 mm). Currently, the patient is receiving hormone replacement therapy with hydrocortisone 25 mg per day and is under dispensary observation.Conclusion. Clinical observation has demonstrated the successful use of mitotane in the treatment of metastatic adrenocortical cancer.