BACKGROUND & AIMS: Calcitriol has been widely used in the management of osteoporosis, but its efficiency is a matter of controversy. It is not known whether combinations of calcitriol and antiresorptive agents such as etidronate and calcitonin are superior to calcitriol alone in the treatment of postmenopausal osteoporosis. To make this determination, 30 Turkish women with postmenopausal osteoporosis between 45 and 68 years of age were randomized to receive either intermittent cyclical etidronate (400 mg/day, for 14 days) followed by 60 days of cyclical calcitriol therapy 0.25 microg twice daily (group 1; n = 10), or calcitriol 0.25 microg twice daily (group 2; n = 10), or calcitriol 0.25 microg/day in combination with 100 IU intranasal salmon calcitonin taken every other day (group 3; n = 10) through a 1-year period. Bone mineral density (BMD) of lumbar spine (L2 to L4) was determined for each patient by dual-photon absorptiometry (153Gd) at baseline, after 6 months, and at the end of the study. There was no significant difference among groups with respect to mean spinal BMD at baseline, after 6, and after 12 months. No significant spinal BMD changes occurred in any group from baseline, after 6 months, and after 12 months. Four patients in groups 1 and 2 and five patients in group 3 developed hypercalcemia at least once during therapy. Hypercalciuria occurred at least once in 9, 10, and 7 patients in groups 1, 2, and 3, respectively. One patient in group 2 developed a renal stone at the end of the study. Mean urine hydroxyproline levels did not change significantly in any group with respect to baseline. The data suggest that one-year treatment with calcitriol, given either alone or in combination with antiresorptive agents, does not improve spinal BMD in Turkish women with postmenopausal osteoporosis, and is associated with a high rate of adverse events.

背景与目标： 骨化三醇已被广泛用于骨质疏松症的治疗，但其有效性尚有争议。在绝经后骨质疏松症的治疗中，骨化三醇和抗再吸收剂（如依替膦酸酯和降钙素）的组合是否优于单独的骨化三醇尚不清楚。为了确定这一点，将30例年龄在45至68岁之间的绝经后骨质疏松症的土耳其妇女随机接受间歇性周期性依替膦酸治疗（400 mg /天，持续14天），然后接受60天周期性钙三醇治疗，每天两次，每次0.25 microg（组） 1； n = 10），或每天两次两次钙钙三醇0.25微克（组2； n = 10），或每隔一天服用100 IU鼻内鲑降钙素与钙三醇0.25微克/天组合（组3； n = 10），通过1年期限。在基线，6个月后和研究结束时，通过双光子吸收法（153Gd）为每位患者确定腰椎（L2至L4）的骨密度（BMD）。各组之间在基线，6个月后和12个月后的平均脊柱骨密度没有显着差异。从基线，6个月和12个月后的任何组中，没有明显的脊柱BMD变化发生。在治疗期间，第1组和第2组的4名患者和第3组的5名患者至少发生一次高钙血症。高钙尿症分别在第1、2和3组的9、10和7名患者中至少发生一次。在研究结束时，第2组的一名患者出现了肾结石。相对于基线，平均尿羟脯氨酸水平在任何组中均无显着变化。数据表明，单独或与抗吸收药联合使用骨化三醇治疗一年并不能改善绝经后骨质疏松症的土耳其妇女的脊柱BMD，并且不良反应发生率较高。

BACKGROUND & AIMS: OBJECTIVE:To evaluate the maternal and neonatal outcomes of pregnancies complicated with isolated oligohydramnios at term, managed by induction of labor. METHODS:We conducted a retrospective case-control study. 138 women with uncomplicated oligohydramnios at term [amniotic fluid index (AFI) < or =5 cm] and a low Bishop score (< or =6) underwent induction of labor with prostaglandin E2. These women were compared to 67 women who underwent induction of labor at 42 weeks' gestation and 276 women at low-risk pregnancy and spontaneous onset of labor, matched for parity and race. RESULTS:Cesarean section (CS) rate was similar in the study and the post-date group (17.4 and 17.9%, respectively), but significantly higher than the spontaneous labor group (5.8%, OR 3.42, 95% CI 1.75-6.68). No differences were found with other outcomes. CONCLUSION:Pregnancies with isolated oligohydramnios at term apparently are not at higher risk of perinatal complications, but induction of labor is associated with increased rate of CS.

背景与目标： 目的：评估足月妊娠并通过引产管理的妊娠合并轻度羊水过少的孕妇和新生儿的结局。
方法：我们进行了一项回顾性病例对照研究。 138名足月[羊水指数（AFI）<或= 5 cm]且Bishop评分低（<或= 6）的单纯性羊水过少的妇女接受前列腺素E2引产。将这些妇女与67名在42周妊娠时引产的妇女和276名在低危妊娠和自发性发作的妇女进行比较，以实现同等和种族匹配。
结果：剖宫产（CS）率在研究中和后期组相似（分别为17.4和17.9％），但显着高于自然分娩组（5.8％，或3.42，95％CI 1.75-6.68） 。与其他结果无差异。
结论：足月妊娠少羊水过少的孕妇显然没有围产期并发症的高风险，但是引产与CS发生率增加有关。

BACKGROUND & AIMS: :Japanese people in both Japan and in Hawaii have a lower incidence of hip fractures than white people in Hawaii or on the mainland of the United States. Hip fractures usually occur after a fall, and differing incidence rates of falls might contribute to the observed differences in hip fracture rates. To investigate this possibility we undertook a prospective study of falls among elderly Japanese men and women living in Hawaii using intensive surveillance methods similar to those used in studies of predominantly white populations. For our Japanese participants, the incidence rates of total falls were 139 per 1000 person years for men and 276 per 1000 person years for women. Age adjusted rate ratios of falls for predominantly white populations compared with our Japanese participants ranged from 1.8 to 2.3 for women and from 2.6 to 4.7 for men. The risk of injuries when they did fall, however, was not lower for our Japanese participants than reported for white participants. For our Japanese population, past falls, female gender, and daytime hours were associated with an increased incidence of falls.

背景与目标： ：在日本和夏威夷，日本人的髋部骨折发生率比夏威夷或美国大陆的白人低。髋部骨折通常在跌倒后发生，跌倒的发生率不同可能会导致观察到的髋部骨折发生率的差异。为了调查这种可能性，我们进行了一项前瞻性研究，研究了居住在夏威夷的日本老年男性和女性跌倒的情况，采用了与主要针对白人人口的研究相似的强化监视方法。对于我们的日本参与者，男性总跌倒发生率是每千人年139例，女性每千人年276例。与日本人相比，以白人为主的年龄调整后的跌倒比率，女性为1.8到2.3，男性为2​​.6到4.7。但是，我们的日本参与者跌倒时受伤的风险并不比白人参与者低。对于我们的日本人口来说，以往的跌倒，女性性别和白天营业时间与跌倒发生率增加相关。

BACKGROUND & AIMS: :An inverse relationship between age and human papillomavirus (HPV) prevalence has been reported in many developed countries, but information on this relationship is scarce in many other parts of the world. We carried out a cross-sectional study of sexually active women from the general population of 15 areas in 4 continents. Similar standardised protocols for women's enrolment, cervical specimen collection and PCR-based assays for HPV testing were used. HPV prevalence in different age groups was compared by study area. 18,498 women aged 15-74 years were included. Age-standardised HPV prevalence varied more than 10-fold between populations, as did the shape of age-specific curves. HPV prevalence peaked below age 25 or 35, and declined with age in Italy, the Netherlands, Spain, Argentina, Korea and in Lampang, Thailand and Ho Chi Minh, Vietnam. This was not the case in Songkla, Thailand nor Hanoi, Vietnam, where HPV prevalence was low in all age groups. In Chile, Colombia and Mexico, a second peak of HPV prevalence was detected among older women. In the poorest study areas in Asia (Shanxi, China and Dindigul, India), and in Nigeria, HPV prevalence was high across all age groups. The substantial differences observed in age-specific curves of HPV prevalence between populations may have a variety of explanations. These differences, however, underline that great caution should be used in inferring the natural history of HPV from age-specific prevalences.

背景与目标： ：许多发达国家已经报告了年龄与人乳头瘤病毒（HPV）患病率之间的反比关系，但世界上其他许多地方都缺乏有关这种关系的信息。我们对来自四大洲15个地区的总人口中的性活跃妇女进行了横断面研究。使用了类似的标准化协议进行女性入组，子宫颈标本采集和基于PCR的HPV检测方法。通过研究区域比较了不同年龄组的HPV患病率。其中包括18,498名15-74岁的女性。年龄标准化的HPV患病率在不同人群之间变化超过10倍，特定年龄曲线的形状也是如此。 HPV感染率在25岁或35岁以下达到峰值，在意大利，荷兰，西班牙，阿根廷，韩国以及泰国南邦和越南胡志明市随着年龄的增长而下降。在泰国的宋卡和越南的河内，情况并非如此，那里的所有年龄段的人乳头瘤病毒感染率都很低。在智利，哥伦比亚和墨西哥，在老年妇女中发现了HPV感染率的第二高峰。在亚洲最贫困的研究地区（中国山西和印度的丁迪古尔）以及尼日利亚，所有年龄段的人乳头瘤病毒感染率都很高。在人群之间HPV流行的年龄特定曲线中观察到的实质差异可能有多种解释。但是，这些差异强调，应根据年龄特定的患病率推断HPV的自然病史时应格外谨慎。

BACKGROUND & AIMS: PURPOSE:Consistent condom use is critical to efforts to prevent sexually transmitted infections among adolescents, but condom use may decline as relationships and contraceptive needs change. The purpose of this research is to assess changes in condom non-use longitudinally in the context of changes in relationship quality, coital frequency and hormonal contraceptive choice. METHODS:Participants were women (aged 14-17 years at enrollment) recruited from three urban adolescent medicine clinics. Data were collected at three-month intervals using a face-to-face structured interview. Participants were able to contribute up to 10 interviews, but on average contributed 4.2 interviews over the 27-month period. Independent variables assessed partner-specific relationship quality (five items; scale range 5-25; alpha = .92, e.g., this partner is a very important person to me); and, number of coital events with a specific partner. Additional items assessed experience with oral contraceptive pills (OCP) use and injected depo medroxy-progesterone acetate (DMPA). The outcome variable was number of coital events without condom use during the past three months. Analyses were conducted as a three-level hierarchical linear growth curve model using HLM 6. The Level 1 predictor was time, to test the hypothesis that condom non-use increases over time. Level 2 predictors assessed relationship quality and coital frequency across all partners to assess hypotheses that participants' condom non-use increases over time as a function of relationship quality and coital frequency. Level 3 predictors assessed the participant-level influence of OCP or DMPA experience on time-related changes in condom non-use. RESULTS:A total of 176 women reported 279 sex partners and contributed 478 visits. Both average coital frequency and average condom non-use linearly increased during the 27-month follow-up. At any given follow-up, about 35% reported recent OCP use, and 65% reported DMPA use. HLM analyses showed that condom non-use increased as a function of time (beta = .12; p = .03, Level 1 analysis). Increased condom non-use over time was primarily a function of increased coital frequency (beta = .01; p = .00), although higher levels of relationship quality were associated with increased condom non-use at enrollment (beta = .44; p = .00, Level 2 analysis). The temporal rise in condom non-use significantly increased among DMPA users (beta = .06; p = .00) but not OCP users (Level 3 analysis) (beta = -.04; p = .06). CONCLUSIONS:Developmentally, relationship characteristics and coital frequency appear to have increasing weight in decisions about condom use. Hormonal contraceptive methods are not equivalently associated with the overall temporal decline in condom use. Future research associated with dual contraceptive/condom use should address differential factors associated condom use in combination with different hormonal methods.

背景与目标： 目的：持续使用避孕套对于预防青少年性传播感染至关重要，但是随着人际关系和避孕需求的变化，避孕套的使用可能会减少。这项研究的目的是在关系质量，性交频率和激素避孕选择的变化的背景下，纵向评估未使用安全套的变化。
方法：参与者是从三个城市青少年医学诊所招募的女性（入学年龄为14-17岁）。使用面对面的结构化访谈，每三个月收集一次数据。参加者最多可以贡献10个访谈，但在27个月内平均贡献了4.2个访谈。自变量评估了特定于伴侣的关系质量（五个项目；等级范围5-25；α= 0.92，例如，这个伴侣对我来说是非常重要的人）；以及与特定伴侣发生性行为的次数。其他项目评估了口服避孕药（OCP）的使用经验和注射醋酸去甲羟孕酮（DMPA）的经验。结果变量是在过去三个月中未使用安全套的性交事件的数量。使用HLM 6作为三级分层线性增长曲线模型进行了分析。1级预测因子是时间，以检验安全套不使用随时间增加的假设。 2级预测变量评估了所有伴侣之间的关系质量和性交频率，以评估以下假设：参与者不使用安全套会随着时间的推移而增加，这是关系质量和性交频率的函数。 3级预测变量评估了OCP或DMPA经验对安全套不使用时间相关变化的参与者水平影响。
结果：总共176名妇女报告了279个性伴侣，并贡献了478次探视。在27个月的随访中，平均性交频率和平均不使用安全套均呈线性增加。在任何给定的随访中，约35％的患者报告了最近的OCP使用，而65％的患者报告了DMPA的使用。 HLM分析表明，不使用安全套随时间增加（β= .12； p = .03，1级分析）。随着时间的推移，不使用安全套的增加主要是性交频率增加的函数（β= .01； p = .00），尽管较高的关系质量与入学时不使用安全套的增加有关（β= .44； p = .00，第2级分析）。在DMPA用户中，未使用安全套的时间增加显着增加（β= .06； p = .00），但在OCP用户中则没有（水平3分析）（β= -.04； p = .06）。
结论：在发展上，关系特征和性交频率似乎在有关使用安全套的决策中具有越来越大的重要性。激素避孕方法与使用避孕套的总体时间下降没有同等的联系。与双重避孕/避孕套使用相关的未来研究应解决与不同激素方法结合使用避孕套相关的差异因素。

BACKGROUND & AIMS: The exact mechanism for the decrease in intestinal calcium absorption with age is not yet understood. A decrease with age in serum 1,25-dihydroxyvitamin D (1,25(OH)2D) or a decrease in the intestinal vitamin D receptor (VDR) protein concentration are possible causes. The objective of this study was to examine the effect of age on these factors. Fifty-nine young women age 25-35 years were compared with 41 elderly women age 65-83 years who underwent measurements of VDR, calcium absorption using a 20 mg and 100 mg calcium carrier, and calciotropic hormones. Calcium absorption by both tests was lower in the elderly women compared with the young women (p < 0.05). Serum 1,25(OH)2D and duodenal VDR protein concentration were not significantly different between the two age groups. Serum 1,25(OH)2D correlated with the 20 mg calcium absorption test in both young (r = 0.35, p < 0.007) and elderly women (r = 0.58, p < 0.0001) and with the 100 mg calcium absorption in the elderly (r = 0.32; p < 0.05). VDR did not correlate with calcium absorption in young women or elderly women, nor did VDR correlate with serum 1,25(OH)2D and serum 25-hydroxyvitamin D. In summary, the decrease in calcium absorption cannot be explained by a decrease in intestinal VDR. The correlation between serum 1,25(OH)2D and both calcium absorption tests only accounts for 12-30% of the variance in the age-related change in the calcium absorption tests. Other factors, not yet understood, are responsible for the decline in calcium absorption with age.

背景与目标： 随着年龄的增长，肠道钙吸收减少的确切机制尚不清楚。血清1,25-二羟基维生素D（1,25（OH）2D）随年龄的减少或肠道维生素D受体（VDR）蛋白质浓度的减少是可能的原因。这项研究的目的是研究年龄对这些因素的影响。比较了59名年龄在25-35岁之间的年轻女性与41位年龄在65-83岁之间的女性，这些女性进行了VDR测量，使用20 mg和100 mg钙载体的钙吸收量以及亲钙性激素。与年轻女性相比，老年女性的两种测试中的钙吸收均较低（p <0.05）。在两个年龄组之间，血清1,25（OH）2D和十二指肠VDR蛋白浓度无显着差异。血清1,25（OH）2D与年轻（r = 0.35，p <0.007）和老年妇女（r = 0.58，p <0.0001）的20 mg钙吸收测试以及老年人的100 mg钙吸收相关（r ＝ 0.32； p ＜0.05）。 VDR与年轻妇女或老年妇女的钙吸收无关，也不与血清1,25（OH）2D和血清25-羟维生素D相关。 VDR。血清1,25（OH）2D与两种钙吸收试验之间的相关性仅占钙吸收试验中与年龄相关的变化方差的12％至30％。钙吸收随着年龄的增长而下降的其他原因尚不明确。

BACKGROUND & AIMS: BACKGROUND:Choline is essential for fetal brain development, and it is not known whether a typical American diet contains enough choline to ensure optimal brain development. OBJECTIVE:The study was undertaken to determine whether supplementing pregnant women with phosphatidylcholine (the main dietary source of choline) improves the cognitive abilities of their offspring. DESIGN:In a double-blind, randomized controlled trial, 140 pregnant women were randomly assigned to receive supplemental phosphatidylcholine (750 mg) or a placebo (corn oil) from 18 wk gestation through 90 d postpartum. Their infants (n = 99) were tested for short-term visuospatial memory, long-term episodic memory, language development, and global development at 10 and 12 mo of age. RESULTS:The women studied ate diets that delivered ∼360 mg choline/d in foods (∼80% of the recommended intake for pregnant women, 65% of the recommended intake for lactating women). The phosphatidylcholine supplements were well tolerated. Groups did not differ significantly in global development, language development, short-term visuospatial memory, or long-term episodic memory. CONCLUSIONS:Phosphatidylcholine supplementation of pregnant women eating diets containing moderate amounts of choline did not enhance their infants' brain function. It is possible that a longer follow-up period would reveal late-emerging effects. Moreover, future studies should determine whether supplementing mothers eating diets much lower in choline content, such as those consumed in several low-income countries, would enhance infant brain development.

背景与目标： 背景：胆碱对胎儿脑部发育至关重要，尚不清楚典型的美国饮食中是否含有足够的胆碱以确保最佳的脑部发育。
目的：本研究旨在确定孕妇补充磷脂酰胆碱（胆碱的主要饮食来源）是否能改善其后代的认知能力。
设计：在一项双盲，随机对照试验中，从怀孕18周到产后90天，随机分配了140名孕妇接受补充磷脂酰胆碱（750毫克）或安慰剂（玉米油）。他们的婴儿（n = 99）在10和12个月大时接受了短期视觉空间记忆，长期情境记忆，语言发展和整体发展的测试。
结果：这些妇女所研究的饮食中，食物中的胆碱/日摄入量约为360毫克/天（孕妇的推荐摄入量约为80％，哺乳期妇女的推荐摄入量约为65％）。磷脂酰胆碱补充剂的耐受性良好。在全球发展，语言发展，短期视觉空间记忆或长期情境记忆方面，各组没有显着差异。
结论：孕妇食用含适量胆碱饮食的磷脂酰胆碱不能增强婴儿的脑功能。较长的随访期可能会显示出较晚出现的影响。此外，未来的研究应确定补充食用胆碱含量低得多的饮食的母亲（如在几个低收入国家食用的饮食）是否会增强婴儿的大脑发育。

BACKGROUND & AIMS: :The effect of ascorbic acid on iron retention from a diet with predicted low iron bioavailability (containing minimal meat and ascorbic acid) was investigated in iron-depleted premenopausal women. Eleven women were depleted of storage iron (indicated by serum ferritin) through a combination of diet (5.0 mg Fe/2000 kcal for 67-88 d) and phlebotomy. They then consumed a diet containing 13.7 mg Fe/2000 kcal, supplemented with placebo or ascorbic acid three times daily (1500 mg total) with meals for 5.5 wk. Ascorbic acid improved apparent iron absorption (balance method) [38 +/- 2% (means +/- SEM) vs 27 +/- 2%]. Ascorbic acid also improved hemoglobin, erythrocyte protoporphyrins, and serum iron but not hematocrit, serum ferritin, iron-binding capacity, or transferrin saturation. In iron-depleted women consuming a diet with predicted poor iron availability, ascorbic acid supplementation enhanced body iron retention for 5.5 wk.

背景与目标： ：在缺铁的绝经前妇女中研究了抗坏血酸对铁的生物滞留量具有预期低铁含量（含少量肉和抗坏血酸）的饮食中铁保留的影响。通过饮食（5.0 mg Fe / 2000 kcal，67-88 d）和静脉放血相结合，耗尽了11名妇女的铁储备（以血清铁蛋白表示）。然后，他们进食了含有13.7 mg Fe / 2000 kcal的饮食，每天补充3次（共1500 mg）安慰剂或抗坏血酸，并进餐5.5周。抗坏血酸提高了表观铁的吸收（平衡法）[38 /-2％（平均值/-SEM）对27 /-2％]。抗坏血酸还可以改善血红蛋白，红血球原卟啉和血清铁，但不能改善血细胞比容，血清铁蛋白，铁结合能力或转铁蛋白饱和度。在饮食中铁含量低的女性中，铁的可利用性预计较差，补充抗坏血酸可增加体内铁保持5.5周的能力。

BACKGROUND & AIMS: BACKGROUND:Evidence-based guidelines recommend limited perioperative diagnostic imaging for new breast cancer diagnoses. For patients aged >65 years, conventional imaging use (mammography, plain radiographs, and ultrasound) has remained stable, whereas advanced imaging (computed tomography [CT], nuclear medicine scans [positron emission tomography/bone scans], and magnetic resonance imaging [MRI]) use has increased. In this study, the authors evaluated traditional and advanced imaging use among younger patients (aged ≤ 65 years) undergoing breast cancer surgery. METHODS:The MarketScan Commercial Claims and Encounters Research Database from 2005 through 2008 was analyzed to evaluate the use of conventional and advanced diagnostic imaging associated with surgery for ductal carcinoma in situ (DCIS) or stage I through III invasive breast cancer. RESULTS:The study cohort included 52,202 women (13% with DCIS and 87% with stage I-III breast cancer). The proportion of patients undergoing conventional imaging remained stable, whereas the average number of conventional imaging tests per patient increased from 4.21 tests in 2005 to 4.79 tests per patient in 2008 (P < .0001). For advanced imaging, the proportion of women who underwent imaging increased from 48.8% in 2005 to 68.8% in 2008 (P < .0001), as did the number of tests per patient (from 1.53 tests in 2005 to 1.98 tests in 2008; P < .0001). MRI examinations accounted for nearly all of the increase in advanced imaging. Patients who underwent MRI examinations received significantly more traditional imaging tests compared with to those who did not, indicating that these tests are additive and are not replacing traditional imaging. CONCLUSIONS:The current results demonstrate that the use of perioperative breast MRI has increased among women aged <65 years. Further study is indicated to determine whether the benefits of this procedure justify increased use.

背景与目标： 背景：基于证据的指南建议对新的乳腺癌诊断进行有限的围手术期诊断成像。对于65岁以上的患者，传统的影像学检查（乳房X线照片，X线平片和超声检查）保持稳定，而高级影像学（计算机断层扫描[CT]，核医学扫描[正电子发射断层扫描/骨扫描]和磁共振成像[ MRI]）的使用有所增加。在这项研究中，作者评估了接受乳腺癌手术的年轻患者（≤65岁）的传统和高级成像使用情况。
方法：对2005年至2008年的MarketScan商业索赔和遭遇研究数据库进行了分析，以评估与导管原位癌（DCIS）或I至III期浸润性乳腺癌手术相关的常规和高级诊断成像的使用。
结果：该研究队列包括52,202名妇女（13％的DCIS患者和87％的I-III期乳腺癌患者）。接受常规影像学检查的患者比例保持稳定，而每名患者的常规影像学检查的平均次数从2005年的4.21次检查增加到2008年的4.79次检查（P <.0001）。对于高级影像学，接受影像学检查的女性比例从2005年的48.8％增加到2008年的68.8％（P <.0001），每位患者的检查次数也从2005年的1.53次增加到2008年的1.98次； P <.0001）。 MRI检查几乎占了高级影像学增长的全部。与未接受MRI检查的患者相比，接受过MRI检查的患者接受的传统成像检查要多得多，这表明这些检查是相加的，并且不能替代传统成像。
结论：目前的结果表明，<65岁的女性围手术期乳房MRI的使用有所增加。指示需要进一步研究以确定该程序的益处是否可证明增加使用量是合理的。

BACKGROUND & AIMS: :Nut consumption is associated with a reduced risk of type 2 diabetes mellitus (T2DM). The aim of the present study was to assess the effects of adding peanuts (whole or peanut butter) on first (0-240 min)- and second (240-490 min)-meal glucose metabolism and selected gut satiety hormone responses, appetite ratings and food intake in obese women with high T2DM risk. A group of fifteen women participated in a randomised cross-over clinical trial in which 42·5 g of whole peanuts without skins (WP), peanut butter (PB) or no peanuts (control) were added to a 75 g available carbohydrate-matched breakfast meal. Postprandial concentrations (0-490 min) of glucose, insulin, NEFA, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), cholecystokinin (CCK), appetitive sensations and food intake were assessed after breakfast treatments and a standard lunch. Postprandial NEFA incremental AUC (IAUC) (0-240 min) and glucose IAUC (240-490 min) responses were lower for the PB breakfast compared with the control breakfast. Insulin concentrations were higher at 120 and 370 min after the PB consumption than after the control consumption. Desire-to-eat ratings were lower, while PYY, GLP-1 and CCK concentrations were higher after the PB intake compared with the control intake. WP led to similar but non-significant effects. The addition of PB to breakfast moderated postprandial glucose and NEFA concentrations, enhanced gut satiety hormone secretion and reduced the desire to eat. The greater bioaccessibility of the lipid component in PB is probably responsible for the observed incremental post-ingestive responses between the nut forms. Inclusion of PB, and probably WP, to breakfast may help to moderate glucose concentrations and appetite in obese women.

背景与目标： ：食用坚果与降低2型糖尿病（T2DM）的风险有关。本研究的目的是评估添加花生（全脂或花生酱）对第一次（0-240分钟）和第二次（240-490分钟）膳食葡萄糖代谢的影响，以及选定的肠饱腹感激素反应，食欲等级患有T2DM风险较高的肥胖女性的饮食和食物摄入量。一组15名妇女参加了一项随机交叉临床试验，在该试验中，将75克可利用的碳水化合物匹配的42·5克无皮的全花生（WP），花生酱（PB）或无花生（对照）添加了早餐餐。早餐后评估餐后血糖，胰岛素，NEFA，胰高血糖素样肽1（GLP-1），肽YY（PYY），胆囊收缩素（CCK），食欲和摄食的浓度（0-490分钟）。标准午餐。与对照早餐相比，PB早餐的餐后NEFA增量AUC（IAUC）（0-240分钟）和葡萄糖IAUC（240-490分钟）响应较低。 PB摄入后120和370分钟时的胰岛素浓度高于对照组摄入后的胰岛素浓度。与对照组相比，PB摄入后的按需饮食评分较低，而PYY，GLP-1和CCK浓度较高。 WP导致了类似但不重要的影响。早餐中添加PB可减轻餐后血糖和NEFA的浓度，增强肠饱腹感激素的分泌并减少进食的欲望。 PB中脂质成分的更大生物可及性可能是观察到的坚果形式之间渐增的消味后反应的原因。在早餐中加入PB和可能的WP可能有助于减轻肥胖女性的葡萄糖浓度和食欲。

BACKGROUND & AIMS: OBJECTIVE:Breast-feeding is associated with maternal health, such as electrolyte metabolism, lipid profile and body component change. The aim of this study was to evaluate the relationship between duration of breast-feeding and obesity in postmenopausal women. METHODS:We analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012, a cross-sectional study in a Korean population. A total of 6621 postmenopausal women were analyzed. RESULTS:Body mass index and waist circumference were greater in women who had breast-fed for 6 months or more than in those who had not (BMI: 23.7±0.1 vs 24.5±0.1, P<0.0001; WC: 80.6±0.4 vs 82.8±0.3, P<0.001). This association persisted after adjustment for confounding factors (BMI: odds ratio[OR]1.54, 95% confidence interval[CI] 1.19-2.0; WC: OR1.67, 95% CI 1.29-2.17). The duration of breast-feeding tended to increase with increasing BMI and WC (P for trend, 0.001 for each). The proportions of women with greater BMI and WC increased with increasing duration of breast-feeding (27.3% in ≤6 months vs 41.2% in >18months, P<0.0001). CONCLUSION:The results of this study suggest that prolonged breast-feeding may be associated with greater BMI and WC among postmenopausal women.

背景与目标： 目的：母乳喂养与孕妇健康有关，例如电解质代谢，脂质分布和身体成分变化。这项研究的目的是评估绝经后妇女的母乳喂养时间与肥胖之间的关系。
方法：我们分析了2010-2012年韩国国民健康与营养检查调查（KNHANES）的数据，这是一项针对韩国人群的横断面研究。总共对6621名绝经后妇女进行了分析。
结果：母乳喂养6个月或更长时间的妇女的身体质量指数和腰围比没有母乳的妇女更大（BMI：23.7±0.1 vs 24.5±0.1，P <0.0001; WC：80.6±0.4 vs 82.8 ±0.3，P <0.001）。调整混杂因素（BMI：比值比[OR] 1.54，95％置信区间[CI] 1.19-2.0； WC：OR1.67，95％CI 1.29-2.17）后，这种关联仍然存在。母乳喂养的时间倾向于随着BMI和WC的增加而增加（趋势P，每种0.001）。 BMI和WC较高的女性比例随着母乳喂养时间的增加而增加（≤6个月为27.3％，而> 18个月为41.2％，P <0.0001）。
结论：这项研究的结果表明，延长母乳喂养可能与绝经后妇女的BMI和WC升高有关。

BACKGROUND & AIMS: PURPOSE:Many women with hormone receptor-positive breast cancer discontinue effective aromatase inhibitor (AI) treatment due to joint symptoms. METHODS:We conducted a single-arm, open-label, phase II study evaluating glucosamine-sulfate (1,500 mg/day) + chondroitin-sulfate (1,200 mg/day) for 24 weeks to treat joint pain/stiffness in postmenopausal women with early stage breast cancer who developed moderate-to-severe joint pain after initiating AIs. The primary endpoint was improvement in pain/stiffness at week 24 assessed by the Outcome Measure in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT-OARSI) criteria. Secondary endpoints assessed changes in pain, stiffness, and function using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index for hips/knees and the Modified Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands (M-SACRAH) for hands/wrists. The Brief Pain Inventory (BPI) assessed pain interference, severity, and worst pain. RESULTS:Of 53 patients enrolled, 39 were evaluable at week 24. From baseline to week 24, 46 % of patients improved according to OMERACT-OARSI criteria. At week 24, there were improvements (all P < 0.05) in pain and function as assessed by WOMAC and M-SACRAH, and in pain interference, severity, and worst pain as assessed by BPI. Estradiol levels did not change from baseline. The most commonly reported side effects were headache (28 %), dyspepsia (15 %), and nausea (17 %). CONCLUSIONS:In this single-arm study, 24 weeks of glucosamine/chondroitin resulted in moderate improvements in AI-induced arthralgias, with minimal side effects, and no changes in estradiol levels. These results suggest a need to evaluate efficacy in a placebo-controlled trial.

背景与目标： 目的：许多患有激素受体阳性乳腺癌的妇女由于关节症状而停止有效的芳香化酶抑制剂（AI）治疗。
方法：我们进行了单臂，开放标签，II期研究，评估硫酸氨基葡萄糖（1500毫克/天）硫酸软骨素（1200毫克/天）持续24周，以治疗绝经后早期女性的关节痛/僵硬启动AI后发展为中度至重度关节痛的乳腺癌。主要终点是通过风湿病临床试验和国际骨关节炎研究协会（OMERACT-OARSI）标准中的结果评估标准评估的第24周疼痛/僵硬的改善。次要终点使用西安大略省和麦克马斯特大学骨关节炎（WOMAC）指数评估臀部/膝盖的疼痛，僵硬和功能的变化，以及评估手的慢性类风湿病影响（M-SACRAH）的改良评分/ wrists。简短疼痛清单（BPI）评估了疼痛的干扰，严重程度和最严重的疼痛。
结果：在入组的53例患者中，有39例在第24周得到了评估。从基线到第24周，根据OMERACT-OARSI标准，有46％的患者得到了改善。在第24周时，WOMAC和M-SACRAH评估的疼痛和功能以及BPI评估的疼痛干扰，严重程度和最严重疼痛得到改善（所有P <0.05）。雌二醇水平与基线相比没有变化。最常见的副作用是头痛（28％），消化不良（15％）和恶心（17％）。
结论：在这项单臂研究中，葡萄糖胺/软骨素的24周可导致AI引起的关节痛适度改善，副作用最小，且雌二醇水平无变化。这些结果表明需要在安慰剂对照试验中评估疗效。

BACKGROUND & AIMS: OBJECTIVE:The aim was to investigate birth characteristics, obstetric and neonatal outcomes of the first childbirth in women with Marfan syndrome by use of Swedish national registers since pregnancy-related outcomes in women with Marfan syndrome have only been sparsely investigated. STUDY DESIGN:In this national population-based cohort study and matched case-control study of Swedish women born 1973-1993, women with Marfan syndrome (n=273) were compared to women without the condition (n=1 017 265). The study population was followed until 2013. A total of 364 553 mother-firstborn-offspring pairs were analyzed. Sixty-one women with Marfan syndrome became mothers. Women with Marfan syndrome were also compared to 543 healthy controls. RESULTS:Women with Marfan syndrome were more often born preterm (p<0.001), small-for-gestational age (p<0.001), and delivered by cesarean section (p=0.001). Women with Marfan syndrome had no increased risk of giving birth by cesarean section (p=0.079). No increased neonatal risks in their children were found. Women with Marfan syndrome were less likely to give birth than those without (p<0.001). There were no maternal deaths. CONCLUSIONS:Women with Marfan syndrome were more likely to be born preterm, SGA and by cesarean section. These increased risks of preterm birth and SGA babies were not found in connection with their own first childbirth. Pregnancies with known fetal Marfan syndrome have to be carefully monitored. The results are important for obstetricians giving preconception counseling and treating women with Marfan syndrome. Further studies are needed to evaluate risks during pregnancy and long-term effects of pregnancy on the cardiovascular status of women with Marfan syndrome.

背景与目标： 目的：目的是通过瑞典国家登记簿调查马凡综合征女性的首次分娩的出生特征，产科和新生儿结局，因为仅对马凡综合征女性的妊娠相关结局进行了稀疏调查。
研究设计：在这项基于全国人群的队列研究和匹配的病例对照研究中，对1973年至1993年出生的瑞典妇女进行了比较，将患有马凡氏综合症（n = 273）的妇女与没有该病的妇女（n = 1 017 265）进行了比较。研究人群一直追踪到2013年。共分析了364 553对母亲-第一胎-后代。六十一名患有马凡氏综合症的妇女成为母亲。还比较了患有马凡氏综合症的女性和543名健康对照者。
结果：马凡氏综合征的妇女更早产（p <0.001），小胎龄（p <0.001），并通过剖宫产分娩（p = 0.001）。患有马凡氏综合症的妇女通过剖宫产术分娩的风险没有增加（p = 0.079）。没有发现孩子的新生儿患病风险增加。患有马凡氏综合症的妇女比没有马芬综合症的妇女分娩的可能性更低（p <0.001）。没有孕产妇死亡。
结论：马凡氏综合征的女性更可能早产，SGA和剖宫产。未发现早产和SGA婴儿的这些增加的风险与他们的初生有关。患有已知胎儿马凡氏综合征的孕妇必须进行仔细监测。这些结果对于产科医生进行孕前咨询和治疗患有马凡氏综合症的妇女非常重要。需要进一步的研究来评估妊娠期间的风险以及妊娠对马凡氏综合症女性心血管状况的长期影响。

BACKGROUND & AIMS: :In a previous study it was shown that lower factor XI (FXI) levels in women with heavy menstrual bleeding (HMB). Our aim was to determine the single-nucleotide variants (SNVs) in the F11 gene in women with HMB. In addition, an extensive literature search was performed to determine the clinical significance of each SNV. Patients referred for HMB (PBAC-score >100) were included. With direct sequencing analysis of all 15 exons and flanking introns of the F11 gene, 29 different non-structural SNVs were detected in 49 patients with HMB. Interestingly, most of these SNVs have previously been associated with venous thrombosis instead of bleeding. These findings have not helped to elucidate the molecular basis of HMB. They also question the specificity of previously reported F11 variations in patients with thrombosis. More studies are needed to explain the lower FXI levels seen in patients with HMB. IMPACT STATEMENT Women with mild deficiencies of factor XI (FXI) (< 70%) are prone to excessive bleeding during menstruation. Bleeding manifestations are not well correlated with plasma FXI levels and bleeding episodes can vary widely among patients with similar low FXI levels. In a previous study we showed that women with heavy menstrual bleeding (HMB) had normal, but on average, lower levels of FXI than controls. In light of these findings, we performed F11 gene analysis to determine the single-nucleotide variants (SNVs) in women with HMB and performed an extensive literature search to determine the clinical significance of each SNV. By direct sequencing analysis of the F11 gene we found 29 different non-structural SNVs in 49 women with heavy menstrual bleeding. Remarkably, a number of these SNVs have previously been implicated in thrombosis. These findings have not helped to elucidate the molecular basis of lower FXI levels in HMB. They also question the specificity of previously reported F11 variations in patients with thrombosis. More studies are needed to explain the lower FXI levels seen in patients with HMB.

背景与目标： ：以前的研究表明，月经量大出血（HMB）的女性中的XI因子（FXI）水平较低。我们的目的是确定患有HMB的女性F11基因中的单核苷酸变异体（SNV）。另外，进行了广泛的文献检索以确定每个SNV的临床意义。包括接受HMB转诊的患者（PBAC评分> 100）。通过对F11基因的所有15个外显子和侧翼内含子进行直接测序分析，在49例HMB患者中检测到29种不同的非结构性SNV。有趣的是，大多数这些SNV以前都与静脉血栓形成有关，而不是与出血有关。这些发现无助于阐明HMB的分子基础。他们还质疑先前报道的F11变异在血栓形成患者中的特异性。需要更多的研究来解释HMB患者中较低的FXI水平。影响力陈述轻度缺乏XI因子（FXI）（<70％）的女性在月经期间容易流血过多。出血表现与血浆FXI水平没有很好的相关性，并且在FXI水平低的患者中出血事件可能差异很大。在先前的研究中，我们显示月经出血严重（HMB）的妇女的FXI水平正常，但平均水平低于对照组。根据这些发现，我们进行了F11基因分析，以确定HMB妇女的单核苷酸变异（SNV），并进行了广泛的文献检索以确定每种SNV的临床意义。通过对F11基因的直接测序分析，我们在49名经期出血严重的女性中发现了29种不同的非结构性SNV。值得注意的是，这些SNV中有许多以前都与血栓形成有关。这些发现无助于阐明HMB中较低的FXI水平的分子基础。他们还质疑先前报道的F11变异在血栓形成患者中的特异性。需要更多的研究来解释HMB患者中较低的FXI水平。

BACKGROUND & AIMS: :We explored the attitudes of women at midlife to web-based interventions for promoting physical activity. 145 women volunteered to participate in one of four online forums. The forums were for four major racial/ethnic groups. 90 volunteers were recruited for the online forums (29 Whites, 23 Hispanics, 21 African Americans, and 17 Asians). Two sets of topics on attitudes to physical activity and racial/ethnic contexts were used. Each topic had some introductory questions and related prompts, and these were posted on the online forum sites in a serial fashion during the six-month period. We used a thematic analysis. Four major themes emerged: (1) 'a matter of the source of the information'; (2) 'I can pace myself'; (3) 'lack of interpersonal interactions'; and (4) 'culture-specificity and low cost.' The women in all ethnic groups thought that the source of the information was much more important than the medium of the information (e.g. web-based, booklet or face-to-face). They liked the self-controllability in web-based interventions. They preferred web-based interventions to other types of interventions because of easy accessibility, but they were concerned about lack of interpersonal interaction. None of the White or African American women indicated the need for culture-specificity in web-based interventions, but Hispanic and Asian women indicated that culture-specific interventions should be provided. Web-based interventions appear to have several advantages over conventional approaches to promoting physical activity.

背景与目标： ：我们探讨了中年妇女对基于网络的干预以促进体力活动的态度。 145名妇女自愿参加了四个在线论坛之一。该论坛是针对四个主要的种族/族裔群体的。招募了90位志愿者参加在线论坛（29位白人，23位西班牙裔，21位非裔美国人和17位亚裔）。使用了关于体育活动态度和种族/种族背景的两组主题。每个主题都有一些介绍性问题和相关提示，并且在六个月内以串行方式在网上论坛站点上发布了这些问题。我们使用了主题分析。出现了四个主要主题：（1）“信息来源的问题”； （2）“我可以自己调整自己的步伐”； （3）“缺乏人际交往”； （4）“文化专用性和低成本”。所有种族的妇女都认为，信息的来源比信息的媒介（例如基于网络的，小册子或面对面的）重要得多。他们喜欢基于网络的干预中的自我控制能力。由于易于访问，他们更喜欢基于Web的干预措施，而不是其他类型的干预措施，但是他们担心缺乏人际互动。白人或非裔美国妇女都没有表示需要在基于网络的干预措施中采用特定文化的干预措施，但拉美裔和亚洲妇女表示应提供针对特定文化的干预措施。与传统的促进身体活动的方法相比，基于Web的干预措施似乎具有一些优势。