BACKGROUND & AIMS: :Osteoporosis maintains a special position in today's medicine, regarding both its growing incidence and its clinical and social consequences--fractures, leading to the loss of self-dependence, disabilities and higher mortality rates. It was thought for many years that osteoporosis affected mainly women after menopause. At present, it is known that the problem concerns men, as well. In the present review, similarities and differences between osteoporosis in either sex are discussed, concentrating on epidemiological and pathogenetic aspects, as well as on therapeutic differences.

背景与目标： : 骨质疏松症在当今医学中保持着特殊的地位，无论是其发病率的增长还是其临床和社会后果-骨折，导致丧失自我依赖性，残疾和更高的死亡率。多年来，人们一直认为骨质疏松症主要影响更年期后的妇女。目前，众所周知，这个问题也涉及男性。在本综述中，讨论了两种性别的骨质疏松症之间的异同，重点是流行病学和致病方面以及治疗上的差异。

BACKGROUND & AIMS: INTRODUCTION:Stress urinary incontinence (SUI) is a chronic disease which occurs in 50% of women with urinary incontinence. It is estimated that in association with a longer life span and ageing of the population, this disorder will become even more prevalent and will exert an increasingly stronger effect on the deterioration of the quality of life. OBJECTIVE:The objective of the study is analysis of the factors affecting the occurrence of SUI. METHODOLOGY:The analysis covered 260 patients aged 27-82. The criterion of enrolment into the study was: diagnosis of SUI without disorders of pelvi-genital statics, and negative obstetric history (nulliparous and non-pregnant women). The investigations covered, among other things, the effect surgeries in the area of the lesser pelvis, body mass index (BMI), cigarette smoking, concomitant internal diseases, and hormonal therapy, with consideration of the division into two groups: women before and after menopause. Statistical analysis was performed by means of chi 2 Pearson, t-Student test, and Fisher-Freeman-Halton test for p<0.05. RESULTS:The results of the analysis unequivocally indicate that the age of patients (p=0.0001), body mass index (BMI) (p=0.0001), and surgical procedure for the removal of the uterus by laparotomy (p=0.0001) exert the greatest effect on the occurrence of SUI in pre- and postmenopausal women. The effect of the remaining etiologic factors is rather controversial. CONCLUSION:A comprehensive analysis of risk factors may contribute to the improvement of the results of treatment and quality of life of pre- and postmenopausal patients.

背景与目标：

BACKGROUND & AIMS: To assess the cost-effectiveness of interventions to prevent osteoporosis, it is necessary to estimate total health care expenditures for the treatment of osteoporotic fractures. Resources utilized for the treatment of many diseases can be estimated from secondary databases using relevant diagnosis codes, but such codes do not indicate which fractures are osteoporotic in nature. Therefore, a panel of experts was convened to make judgments about the probabilities that fractures of different types might be related to osteoporosis according to patient age, gender, and race. A three-round Delphi process was applied to estimate the proportion of fractures related to osteoporosis (i.e., the osteoporosis attribution probabilities) in 72 categories comprised of four specific fracture types (hip, spine, forearm, all other sites combined) stratified by three age groups (45-64 years, 65-84 years, 85 years and older), three racial groups (white, black, all others), and both genders (female, male). It was estimated that at least 90% of all hip and spine fractures among elderly white women should be attributed to osteoporosis. Much smaller proportions of the other fractures were attributed to osteoporosis. Regardless of fracture type, attribution probabilities were less for men than women and generally less for non-whites than whites. These probabilities will be used to estimate the total direct medical costs associated with osteoporosis-related fractures in the United States.

背景与目标： 为了评估预防骨质疏松症的干预措施的成本效益，有必要估算用于治疗骨质疏松性骨折的医疗保健总支出。可以使用相关的诊断代码从二级数据库中估算用于治疗许多疾病的资源，但是这些代码并未指出哪些骨折本质上是骨质疏松的。因此，召集了一个专家小组，根据患者的年龄，性别和种族来判断不同类型的骨折可能与骨质疏松症有关的可能性。采用三轮Delphi程序来估计与骨质疏松症相关的骨折的比例 (即骨质疏松症归因概率)，包括由三个年龄组 (45-64岁，65-84岁，85岁及以上)，三个种族群体 (白人，黑人，所有其他) 和两个性别 (女性，男性)。据估计，在老年白人妇女中，至少90% 的髋部和脊柱骨折应归因于骨质疏松症。其他骨折的比例要小得多，这归因于骨质疏松症。无论骨折类型如何，男性的归因概率低于女性，非白人的归因概率通常低于白人。这些概率将用于估算美国与骨质疏松症相关的骨折相关的总直接医疗费用。

BACKGROUND & AIMS: :Combining the measurement of bone mineral density (BMD) and the classification of the trabecular structure in cancellous bone improves the estimation of the degree of osteoporosis. A fractal method for the automatic quantitative classification of the trabecular structure in midvertebral slices of lumbar vertebrae is introduced. This method is based on the computation of the fractal dimension (box counting method) for varying binarization thresholds. Radiographic images from 30 lumbar vertebrae and CT images from an additional 16 lumbar vertebrae were analysed by calculating the dimension D in dependency of the threshold value T. The function D(T) was normalized by the average image grey value, eliminating the bone mineral density from the computations. The results show that the images of the lumbar vertebrae have fractal properties, and the function D(T) has a typical behaviour that allows the discrimination of the degree of osteoporosis. With two parameters extracted from the function D(T) the correlation coefficients with BMD were both -79% for the radiographic images, and -93% and -91% for the CT data, respectively.

背景与目标： : 结合骨密度 (BMD) 的测量和松质骨中小梁结构的分类，可以改善对骨质疏松症程度的估计。介绍了一种用于腰椎中段椎板小梁结构自动定量分类的分形方法。此方法基于分形维数 (盒计数法) 的计算来改变二值化阈值。通过根据阈值T计算尺寸D来分析来自30个腰椎的放射线图像和来自另外16个腰椎的CT图像。函数D(T) 通过平均图像灰度值进行归一化，从而从计算中消除了骨矿物质密度。结果表明，腰椎图像具有分形特性，函数D(T) 具有典型的行为，可以区分骨质疏松症的程度。利用从函数D(T) 中提取的两个参数，射线照相图像与BMD的相关系数分别为-79%，CT数据与-93% 和-91%。

BACKGROUND & AIMS: OBJECTIVE:The aim of the study was to investigate the impact of hormone therapy (HT) on the ocular surface and intraocular pressure in postmenopausal women. METHODS:This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. PubMed, EMBASE, Cochrane Library of Systematic Reviews, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure were searched from inception to November 2019 without language restrictions. Only randomized controlled trials that evaluated the impact of HT on the ocular surface and intraocular pressure in postmenopausal women were eligible. The trials had to report at least one of the following outcomes: break-up time, Schirmer test, corneal staining, ocular surface symptom score, and intraocular pressure. Two investigators independently extracted the information, assessed the risk of bias, and evaluated the publication bias. All data were analyzed by Review Manager V.5.3. Sensitivity analysis and subgroup analysis were performed to find the source of heterogeneity and evaluate the different effects among subgroups. RESULTS:Nine randomized controlled trials (N = 612) were included. The HT group showed significant improvements compared with the control group in break-up time (mean difference [MD] = 2.09, 95% confidence interval [CI] 1.00-3.19, P = 0.0002), Schirmer test without anesthesia (MD = 4.17, 95% CI 1.55-6.80, P = 0.002), Schirmer test with anesthesia (MD = 1.44, 95% CI 0.71-2.18, P = 0.0001), and corneal staining scores (standardized mean difference [SMD] = -0.85, 95% CI -1.39 to -0.30, P = 0.002). Moreover, significant beneficial effects were observed on all four symptoms, including dryness (SMD = -1.21, 95% CI -1.99 to -0.44, P = 0.002), foreign body sensation (SMD = -1.02, 95% CI -1.29 to -0.76, P < 0.00001), ocular fatigue (SMD = -1.74, 95% CI -2.12 to -1.36, P < 0.00001), and burning (SMD = -0.53, 95% CI -0.78 to -0.29, P < 0.0001) after HT. Subgroup analysis revealed that, in terms of break-up time, postmenopausal women younger than 55 years achieved more improvements (MD = 0.88, 95% CI 0.16-1.59, P = 0.02) than women older than 55 years old (MD = 2.60, 95% CI -1.34 to 6.55, P = 0.20), and the estrogen subgroup received more benefits (MD = 3.11, 95% CI 0.93-5.30, P = 0.005) than the estrogen plus progestogen subgroup (MD = 0.42, 95% CI -0.02 to 0.85, P = 0.06). Sensitivity analysis and subgroup analysis suggested that the heterogeneity might derive from the methodological quality, the age of participants, and the intervention of the control group. Intraocular pressure (MD = -1.54, 95% CI -3.39 to 0.32, P = 0.10) was not evidently decreased after HT. No more specific adverse events (relative risk  = 1.66, 95% CI 0.41-6.77, P = 0.48) were found in the HT group. CONCLUSIONS:Our study revealed that HT could improve ocular surface function in postmenopausal women effectively and safely, especially for those who were younger than 55 years, and estrogen only showed more improvements than estrogen plus progestogen. The effectiveness of HT in treating dry eye in postmenopausal women is, however, still a controversial topic. In addition, we did not find HT led to a significant reduction of intraocular pressure.

背景与目标：

BACKGROUND & AIMS: :The transcription factors Runx2 and estrogen receptor-alpha (ERalpha) are involved in numerous normal and disease processes, including postmenopausal osteoporosis and breast cancer. Using indirect immunofluorescence microscopy and pull-down techniques, we found them to colocalize and form complexes in a ligand-dependent manner. Estradiol-bound ERalpha strongly interacted with Runx2 directly through its DNA-binding domain and only indirectly through its N-terminal and ligand-binding domains. Runx2's amino acids 417-514, encompassing activation domain 3 and the nuclear matrix targeting sequence, were sufficient for interaction with ERalpha's DNA-binding domain. As a consequence of the interaction, Runx2's transcriptional activation activity was strongly repressed, as shown by reporter assays in COS7 cells, breast cancer cells, and late-stage MC3T3-E1 osteoblast cultures. Metaanalysis of gene expression in 779 breast cancer biopsies indicated negative correlation between the expression of ERalpha and Runx2 target genes. Selective ER modulators (SERM) induced ERalpha-Runx2 interactions but led to various functional outcomes. The regulation of Runx2 by ERalpha may play key roles in osteoblast and breast epithelial cell growth and differentiation; hence, modulation of Runx2 by native and synthetic ERalpha ligands offers new avenues in selective ER modulator evaluation and development.

背景与目标： : 转录因子Runx2和雌激素受体 α (ERalpha) 参与许多正常和疾病过程，包括绝经后骨质疏松症和乳腺癌。使用间接免疫荧光显微镜和下拉技术，我们发现它们以配体依赖性方式共定位并形成复合物。雌二醇结合的ERalpha直接通过其DNA结合结构域与Runx2强烈相互作用，仅通过其N端和配体结合结构域间接相互作用。Runx2的氨基酸417-514，包括活化结构域3和核基质靶向序列，足以与ERalpha的DNA结合结构域相互作用。作为相互作用的结果，Runx2的转录激活活性被强烈抑制，如COS7细胞，乳腺癌细胞和晚期MC3T3-E1成骨细胞培养物中的报告分析所示。对779乳腺癌活检组织中基因表达的荟萃分析表明，ERalpha和Runx2靶基因的表达呈负相关。选择性ER调节剂 (SERM) 诱导ERalpha-Runx2相互作用，但导致各种功能结果。ERalpha对Runx2的调节可能在成骨细胞和乳腺上皮细胞的生长和分化中起关键作用; 因此，天然和合成的ERalpha配体对Runx2的调节为选择性ER调节剂的评估和开发提供了新的途径。

BACKGROUND & AIMS: :Background Warfarin, a vitamin K antagonist, has been shown to affect bone mineral density and cause osteoporosis. However, studies investigating the relationship between non-vitamin K antagonist oral anticoagulants (NOACs) and osteoporosis are limited. We thus compared the risk of osteoporosis in patients with atrial fibrillation treated with either NOACs or warfarin. Methods and Results This nationwide, retrospective cohort study used Taiwan's National Health Insurance Research Database. All adult patients in Taiwan who were newly diagnosed with atrial fibrillation and treated with NOACs or warfarin between January 2012 and December 2015 were included and classified into their respective cohorts. Patients who received NOACs were subcategorized into the rivaroxaban, dabigatran, and apixaban subgroups. Propensity score matching was performed for each head-to-head comparison. Adjusted hazard ratios (aHRs) for the risk of osteoporosis were calculated using Cox proportional hazards regression models, with adjustment for confounders. Overall, 17 008 patients were included, with 8504 in each cohort. NOACs were associated with a lower osteoporosis risk than warfarin (aHR=0.82; 95% CI=0.68-0.97). A subgroup effect of treatment duration was identified (namely, the lower osteoporosis risk with NOAC compared with warfarin became stronger in those with longer treatment duration [P for interaction <0.001]). Furthermore, significantly lower risks of osteoporosis were observed in the rivaroxaban (aHR=0.68; 95% CI=0.55-0.83) and apixaban (aHR=0.38; 95% CI=0.22-0.66) subgroups, but not in the dabigatran subgroup (aHR=1.04; 95% CI=0.85-1.27). Conclusions Compared with warfarin, rivaroxaban and apixaban were associated with a significantly lower risk of osteoporosis in patients with atrial fibrillation.

背景与目标： 背景: 华法林是一种维生素k拮抗剂，已被证明会影响骨矿物质密度并引起骨质疏松症。然而，研究非维生素k拮抗剂口服抗凝剂 (NOACs) 与骨质疏松症之间关系的研究有限。因此，我们比较了使用NOACs或华法林治疗的房颤患者的骨质疏松症风险。方法和结果这项全国性的回顾性队列研究使用了台湾的国民健康保险研究数据库。纳入了台湾所有新诊断为房颤并在2012年1月和2015年12月之间接受NOACs或华法林治疗的成年患者，并将其分类为各自的队列。接受NOACs的患者分为利伐沙班，达比加群和阿哌沙班亚组。对每次头对头比较进行倾向评分匹配。使用Cox比例风险回归模型计算骨质疏松症风险的校正风险比 (aHRs)，并对混杂因素进行校正。总体而言，包括17 008名患者，每个队列中有8504名。与华法林相比，NOACs与更低的骨质疏松症风险相关 (aHR = 0.82; 95% CI = 0.68-0.97)。确定了治疗持续时间的亚组效应 (即，在治疗持续时间较长的患者中，与华法林相比，NOAC降低的骨质疏松症风险变得更强 [相互作用P <0.001])。此外，在利伐沙班 (aHR = 0.68; 95% CI = 0.55-0.83) 和阿哌沙班 (aHR = 0.38; 95% CI = 0.22-0.66) 亚组中观察到明显更低的骨质疏松症风险，但在达比加群亚组中没有观察到 (aHR = 1.04; 95% CI = 0.85-1.27)。结论与华法林相比，利伐沙班和阿哌沙班与房颤患者发生骨质疏松的风险显著降低相关。

BACKGROUND & AIMS: :Strontium (Sr)-doped calcium sulfate hemihydrate (SrCSH) bioactive materials have been demonstrated to promote osteoporotic bone repair, being associated with the stimulation of bone formation and a reduction in bone resorption. However, the rapid degradation and absorption of SrCSH affects its clinical value. In order to delay the degradation time of SrCSH and improve the utilization of Sr2+, chitosan (CS)-coated SrCSH microspheres (CS-SrCSH) are prepared by electrostatic interaction between CS and SrCSH. X-ray diffraction analysis verifies that SrCSH coated by CS does not alter the phase composition of the SrCSH. It was observed that CS-SrCSH microspheres have uniform particle size. More importantly, the in vivo and in vitro degradation time of CS-SrCSH microspheres is significantly longer than that of SrCSH, and the release rate of Sr2+ is stable, achieving a sustained release effect. Furthermore, CS-SrCSH-based cement is used to repair critical-sized OVX rat tibial defects. The in vivo results reveal that CS-SrCSH exhibits a long-term capability for osteogenesis, angiogenesis and bone metabolism inhibition. In conclusion, the controllable degradation of CS-SrCSH-based cements described here could be beneficial for the repair of bone defects, especially in the osteoporotic bone.

背景与目标： : 掺锶 (Sr) 的半水硫酸钙 (SrCSH) 生物活性材料已被证明可促进骨质疏松的骨修复，与刺激骨形成和减少骨吸收有关。然而，SrCSH的快速降解和吸收影响了其临床价值。为了延缓SrCSH的降解时间并提高Sr2的利用率，通过CS和SrCSH之间的静电相互作用制备了壳聚糖 (CS) 包覆的SrCSH微球 (CS-SrCSH)。X射线衍射分析验证了用CS涂覆的SrCSH不会改变SrCSH的相组成。观察到CS-SrCSH微球具有均匀的粒径。更重要的是，cs-srcsh微球的体内外降解时间明显长于SrCSH，且Sr2 + 的释放速率稳定，达到了缓释效果。此外，基于cs-srcsh的水泥用于修复临界尺寸的OVX大鼠胫骨缺损。体内结果表明，cs-srcsh具有长期的成骨，血管生成和骨代谢抑制能力。总之，本文所述的基于cs-srcsh的水泥的可控降解可能有利于骨缺损的修复，尤其是在骨质疏松的骨中。

BACKGROUND & AIMS: :Osteoporosis is an important skeletal disease characterized by bone weakness and high risk of fracture in postmenopausal women. Tea consumption is known to play an important role in the prevention or alleviation of osteoporosis. However, the therapeutic effects of aqueous extracts of white tea (WT) have not been evaluated in osteoporosis rat models. The aim of this study was to investigate the potential anti-osteoporotic role of WT in ovariectomized (OVX) rats. WT was given orally at 0.5% w/v doses for 12 weeks in OVX rats. Biochemical parameters in blood samples, bone tartrate-resistant acid phosphatase (TRAP), C-terminal telopeptide of type 1 collagen (CTX) and estradiol levels were evaluated. Bone mineral density and bone mineral content values were measured in the left femur. In addition to histopathological examination, osteolcalcin, osteopontin and TUNEL levels were determined. OVX group data demonstrated that bone loss occurred by thinning of the metaphyseal growth plates of the femur. Similarly, the levels of TRAP and CTX, markers of osteoclastic activity, were found to be high concurrently with a decrease in femoral bone mineral density. In addition, increased osteolcalcin and osteopontin levels were present in the metaphyseal growth zones. On the other hand, while TRAP and CTX levels were suppressed in the OVX-WT group, bone mineral content increased. In ad-dition, TUNEL, osteocalcin and osteopontin positivity decreased in the right femoral metaphysis growth zones, proliferating zone and resting zone cells. These results showed that chronic WT consumption has a protective effect by reducing bone resorption in OVX-induced osteoporotic rats.

背景与目标： : 骨质疏松症是一种重要的骨骼疾病，其特征是绝经后妇女的骨骼无力和高骨折风险。众所周知，饮茶在预防或减轻骨质疏松症中起着重要作用。然而，尚未在骨质疏松症大鼠模型中评估白茶 (WT) 水提取物的治疗作用。这项研究的目的是研究WT在去卵巢 (OVX) 大鼠中的潜在抗骨质疏松作用。在OVX大鼠中以0.5% w/v剂量口服WT 12周。评估血液样本中的生化参数，抗骨酒石酸酸性磷酸酶 (TRAP)，1型胶原蛋白的C末端肽 (CTX) 和雌二醇水平。测量左股骨的骨矿物质密度和骨矿物质含量值。除组织病理学检查外，还确定了骨钙素，骨桥蛋白和TUNEL水平。OVX组数据表明，股骨干phy端生长板变薄会导致骨质流失。同样，发现破骨细胞活性标志物TRAP和CTX的水平很高，同时股骨骨矿物质密度降低。此外，在干phy端生长区域中存在骨钙素和骨桥蛋白水平升高。另一方面，尽管OVX-WT组的TRAP和CTX水平受到抑制，但骨矿物质含量增加。另外，TUNEL，骨钙素和骨桥蛋白阳性在右股骨干端生长区，增殖区和静息区细胞中降低。这些结果表明，长期消耗WT通过减少OVX诱导的骨质疏松大鼠的骨吸收而具有保护作用。

BACKGROUND & AIMS: :Bisphosphonates have been shown to increase bone mineral density in patients with established osteoporosis as well as those with osteopenia. The evidence conclusively shows a reduction in fracture rates in patients on the more potent nitrogen containing bisphosphonates. Indeed, significant vertebral fracture rate reduction has been demonstrated after only 1 year of therapy. Alendronate, a second-generation bisphosphonate, and risedronate, a third-generation bisphosphonate, are first line medications for the treatment of osteoporosis given their efficacy in preventing both vertebral and non-vertebral fractures. There is evidence that vertebral fractures may be prevented by intermittent cyclic therapy with etidronate. All three have been shown to increase bone mineral density in the spine, with alendronate and risedronate producing significant increases in hip bone density. Calcitonin has demonstrated the ability to reduce vertebral fracture rates with minimal changes in bone density. Calcitonin is also beneficial in reducing the bone pain associated with fractures.

背景与目标： : 已证明双膦酸盐可增加已确定的骨质疏松症患者以及骨质减少的患者的骨矿物质密度。证据最终表明，使用更有效的含氮二膦酸盐的患者骨折率降低。实际上，仅经过1年的治疗，就已证明椎体骨折率显着降低。第二代双膦酸盐阿仑膦酸盐和第三代双膦酸盐利塞膦酸盐是治疗骨质疏松症的一线药物，因为它们在预防椎骨和非椎骨骨折方面均具有功效。有证据表明，间歇性的周期性治疗可以预防椎体骨折。已显示所有这三个都增加了脊柱的骨矿物质密度，阿仑膦酸盐和利塞膦酸盐显着增加了髋部骨密度。降钙素已证明能够以最小的骨密度变化降低椎体骨折率。降钙素在减轻与骨折相关的骨痛方面也是有益的。

BACKGROUND & AIMS: :This study investigated the association between body composition and risk of atrial fibrillation (AF) in postmenopausal women. In a retrospective analysis we assessed data from 5704 postmenopausal women (age 70.7 ± 6.5 yrs.) who in 1999-2001 participated in The Prospective Epidemiological Risk Factor study with body composition assessed by dual-energy X-ray absorptiometry. Outcomes were obtained from Danish Health Registries and body composition association to risk of AF was evaluated by univariable and multivariable Cox Hazard regression. 850 women developed AF after baseline. High lean body mass was associated with increased risk of AF in multivariable analyses, adjusting for body mass index (BMI), height or weight (adjusted for: BMI, hazard ratio (HR) 1.49, 95% Confidence Interval (1.22-1.80); height, HR 1.27 (1.03-1.56); weight, 1.33 (1.06-1.65)). Height and weight were associated with increased risk of AF in multivariable analyses adjusting for body composition measures. When adjusting for total lean mass, only height remained statistically significant (HR 1.34 (1.09-1.64)). In a cohort of elderly Caucasian women, high lean body mass, height and weight were associated with increased risk of AF and the variables remained significant after adjusting for age and other known risk factors of AF.

背景与目标： : 这项研究调查了绝经后妇女的身体成分与房颤 (AF) 风险之间的关系。在一项回顾性分析中，我们评估了1999-2001年参加前瞻性流行病学危险因素研究的5704名绝经后妇女 (年龄70.7   ±   6.5  岁) 的数据，并通过双能x线骨密度仪评估了身体成分。从丹麦健康登记处获得结果，并通过单变量和多变量Cox风险回归评估身体成分与AF风险的关联。850妇女在基线后发生房颤。在多变量分析中，高瘦体重与房颤风险增加相关，调整了体重指数 (BMI)，身高或体重 (调整为: BMI，风险比 (HR) 1.49，95% 置信区间 (1.22-1.80); 身高，HR 1.27 (1.03-1.56); 重量，1.33 (1.06-1.65))。在调整身体成分测量的多变量分析中，身高和体重与房颤风险增加相关。当调整总瘦体重时，只有身高保持统计学显著 (HR 1.34 (1.09-1.64))。在一个老年白人女性队列中，高瘦体重，身高和体重与房颤风险增加相关，并且在调整年龄和其他已知的房颤危险因素后，这些变量仍然很重要。

BACKGROUND & AIMS: BACKGROUND:Oestrogens usually stimulate the progression of oestrogen receptor (ER)-positive breast cancer. Paradoxically, high-dose oestrogens suppress the growth of these tumours in certain circumstances. METHODS:We prospectively examined the efficacy and safety of ethinylestradiol treatment (3 mg per day oral) in postmenopausal patients with advanced or recurrent ER-positive breast cancer who had previously received endocrine therapies, especially those with resistance to aromatase inhibitors. RESULTS:Eighteen patients were enrolled with the median age of 63 years and the mean observation time of 9.2 months. Three cases withdrew within 1 week due to oestrogen flare reactions with nausea, fatigue and muscle-skeletal pain. The response rate was 50% (9 out of 18), and the clinical benefit rate was 56% (10 out of 18). The stable disease (<6 months) was 17% (3 out of 18) and another 2 cases were judged as progressive disease. Time-to-treatment failure including 2 on treatment was a median of 5.6 months (range 0.1 to 14.5(+)). Although vaginal bleeding or endometrial thickening was observed in patients receiving long-term treatment, there were no severe adverse events, such as deep venous thrombosis or other malignancies. CONCLUSION:Although the mechanism of this treatment has not been fully understood, our data may contribute to change the common view of late-stage endocrine therapy.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:To investigate the effects of age, body mass index (BMI), bone mineral density (BMD), and levels of serum 25-hydroxyvitamin D (25OHD) on hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis. METHODS:A total of 252 postmenopausal women patients, whose bone density had reached the threshold of osteoporosis and age ≥50 years (50-98 years), collected from the Second Affiliated Hospital of Fujian Medical University from January 2015 to December 2018, were performed by retrospective analysis. According to whether or not they had a hip fracture, including femoral neck fracture or intertrochanteric fracture, the patients were divided into two groups, including 117 cases (50-84 years old) in the non-hip fracture group and 135 cases (57-98 years old) in the hip fracture group. BMD was measured by Hologic Discovery A DXA bone mineral densitometer. Levels of serum 25OHD were detected by ROCHE detection instrument. Comparisons of age, BMI, bone density of femoral neck, and levels of serum 25OHD between the two groups were performed by using the Student's t-test. Furthermore, the statistically significant factors were analyzed by multiple regression analysis to investigate the independent risk factors of hip fracture. RESULTS:The group without hip fracture: 117 cases; average age: 67.4 ± 8.5 years; BMI: 22.3 ± 3.2 kg/m2 ; bone density of femoral neck: (0.504 ± 0.067) g/cm2 ; T-value of femoral neck: -3.1 ± 0.6; levels of serum 25OHD: (24.9 ± 8.5) ng/mL. The group with brittle hip fracture: 135 cases; average age: 80.7 ± 7.6 years; BMI: 20.3 ± 3.5 kg/m2 ; bone density of femoral neck: (0.426 ± 0.077) g/cm2 ; T-value of femoral neck: -3.8 ± 0.7; levels of serum 25OHD: (15.9 ± 8.9) ng/mL. Age, BMI, bone density of femoral neck, and 25OHD level of the group without hip fracture were markedly lower than hip fracture group (P < 0.05). The results of logistic regression analysis suggested that age, bone density of femoral neck, and levels of serum 25OHD were independent risk factors for fragile hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis. CONCLUSION:Higher age, lower levels of bone density and 25OHD are the main risk factors of hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis.

背景与目标：

BACKGROUND & AIMS: :In large-scale epidemiological studies on endogenous sex steroids and cancer risk, direct immunoassays of circulating hormone levels have the advantage of being fast and comparatively inexpensive while requiring only small sample volumes. On the other hand, indirect assays after organic extraction and chromatographic prepurification have the advantage of reducing specific interferences and matrix effects and hence are thought to have better validity. We compared direct assays of testosterone (T, six different assays), Delta4-androstenedione (A, four assays), estrone (E(1), one assay), and 17beta-estradiol (E(2), five assays) with measurements obtained by an indirect assay in a representative subset of 20 postmenopausal women who were part of a large prospective cohort study. Within-batch reproducibilities of the subject rankings by relative hormone levels were good (intraclass correlations >0.89) for all direct assays tested. Between batches, reproducibilities generally were also acceptable (r > 0.80) to good (r > 0.90) in terms of Pearson's correlations. The between-batch reproducibility in terms of intraclass correlations was systematically lower in terms of Pearson's correlations, however, because of between-batch variations in the absolute scale of measurements. The relative validity of direct versus indirect assays in terms of the subjects' ranking by relative hormone levels was also high for most of the kits tested for T, A, and E(1) (Pearson's correlations between 0.70 and 0.89) but was high for only two kits of five tested for E(2) (correlations of 0.86 and 0.84). On an absolute scale, mean measurement values were generally higher for direct assays than for the indirect assay and, for each hormone, varied substantially, depending on the kit used. Overall, the results of this study show that, with careful selection, commercial kits for direct radioimmunoassays of steroid hormones in postmenopausal serum can be found that may allow a reliable estimation of relative risks in epidemiological studies. However, standardization of the absolute scale of assays remains problematic.

背景与目标： : 在有关内源性类固醇和癌症风险的大规模流行病学研究中，循环激素水平的直接免疫测定具有快速且相对便宜的优势，而仅需要少量样本量。另一方面，有机萃取和色谱预纯化后的间接测定具有减少特定干扰和基质效应的优势，因此被认为具有更好的有效性。我们比较了睾丸激素的直接测定 (T，六种不同的测定)，Delta4-androstenedione (A，四种测定)，雌酮 (E(1)，一种测定) 和17β-雌二醇 (E(2)，五个试验)，通过间接试验在20名绝经后妇女的代表性子集中获得测量结果，这些妇女是一项大型前瞻性队列研究的一部分。对于所有测试的直接测定，受试者按相对激素水平排名的批内再现性良好 (类内相关性> 0.89)。在批次之间，就皮尔逊相关性而言，再现性通常也是可接受的 (r > 0.80) 至良好 (r> 0.90)。就类内相关性而言，批次间的可重复性在皮尔逊相关性方面系统地较低，但是，由于测量绝对规模的批次间变化。对于大多数测试的T，A，和E(1) (0.70和0.89之间的皮尔逊相关性)，但对于仅针对E(2) 测试的五个试剂盒中的两个试剂盒 (0.86和0.84的相关性) 来说是很高的。在绝对规模上，直接测定的平均测量值通常高于间接测定的平均测量值，并且对于每种激素，根据所使用的试剂盒，其差异很大。总体而言，这项研究的结果表明，通过仔细选择，可以发现用于绝经后血清中类固醇激素直接放射免疫测定的商业试剂盒，可以在流行病学研究中可靠地估计相对风险。然而，测定绝对规模的标准化仍然存在问题。

BACKGROUND & AIMS: OBJECTIVE:To assess the interaction of the MTHFR C677T polymorphism with changes in lipid and glucose metabolism effected by oral hormone replacement therapy (HRT) in postmenopausal women. METHODS:In this open-label, prospective, interventional study, parameters of lipid and glucose metabolism, as well as homocysteine, were assessed in 97 postmenopausal women at baseline and 1 year after the initiation of HRT. Participants were stratified into three subgroups, according to the MTHFR C677T polymorphism (wild-type: CC genotype; heterozygous: CT genotype; homozygous for the mutant variable: TT genotype). RESULTS:The TT genotype was associated with an elevation of total and low density lipoprotein (LDL) cholesterol, while CT and CC genotypes were associated with a reduction of total cholesterol and LDL cholesterol after 1 year of HRT (p = 0.032 for total cholesterol and p = 0.002 for LDL cholesterol). Women with the TT genotype had higher glucose levels in contrast to women with the CC genotype who had lower glucose levels after 1 year of HRT (p = 0.011). Additionally, CC carriers under HRT had a significant elevation of apolipoprotein A1 levels (p = 0.018), contrarily to CT and TT genotypes. CONCLUSION:While HRT was associated with favorable changes in lipid and metabolic parameters in carriers of the CC genotype, this effect was not evident in carriers of the T allele. The MTHFR C677T polymorphism may modify the effect of HRT on lipid and metabolic parameters in postmenopausal women.

背景与目标：