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。

BACKGROUND & AIMS: :Menopausal hormone treatment (MHT) may limit progression of cardiovascular disease (CVD) but poses a thrombosis risk. To test targeted candidate gene variation for association with subclinical CVD defined by carotid artery intima-media thickness (CIMT) and coronary artery calcification (CAC), 610 women participating in the Kronos Early Estrogen Prevention Study (KEEPS), a clinical trial of MHT to prevent progression of CVD, were genotyped for 13,229 single nucleotide polymorphisms (SNPs) within 764 genes from anticoagulant, procoagulant, fibrinolytic, or innate immunity pathways. According to linear regression, proportion of European ancestry correlated negatively, but age at enrollment and pulse pressure correlated positively with CIMT. Adjusting for these variables, two SNPs, one on chromosome 2 for MAP4K4 gene (rs2236935, β = 0.037, P value = 2.36 × 10(-06)) and one on chromosome 5 for IL5 gene (rs739318, β = 0.051, P value = 5.02 × 10(-05)), associated positively with CIMT; two SNPs on chromosome 17 for CCL5 (rs4796119, β = -0.043, P value = 3.59 × 10(-05); rs2291299, β = -0.032, P value = 5.59 × 10(-05)) correlated negatively with CIMT; only rs2236935 remained significant after correcting for multiple testing. Using logistic regression, when we adjusted for waist circumference, two SNPs (rs11465886, IRAK2, chromosome 3, OR = 3.91, P value = 1.10 × 10(-04); and rs17751769, SERPINA1, chromosome 14, OR = 1.96, P value = 2.42 × 10(-04)) associated positively with a CAC score of >0 Agatston unit; one SNP (rs630014, ABO, OR = 0.51, P value = 2.51 × 10(-04)) associated negatively; none remained significant after correcting for multiple testing. Whether these SNPs associate with CIMT and CAC in women randomized to MHT remains to be determined.

背景与目标： ：更年期激素治疗（MHT）可能会限制心血管疾病（CVD）的进展，但会带来血栓形成的风险。为了测试与颈动脉内膜中层厚度（CIMT）和冠状动脉钙化（CAC）定义的亚临床CVD相关的靶向候选基因变异，610名妇女参加了Kronos早期雌激素预防研究（KEEPS），这是一项MHT的临床试验为了预防CVD的进展，对来自抗凝，促凝，纤溶或先天免疫途径的764个基因中的13,229个单核苷酸多态性（SNP）进行了基因分型。根据线性回归，欧洲血统的比例呈负相关，而入学年龄和脉压与CIMT呈正相关。调整这些变量后，有两个SNP，一个在MAP4K4基因的2号染色体上（rs2236935，β= 0.037，P值= 2.36×10（-06）），一个在5号染色体上的IL5基因（rs739318，β= 0.051，P值） = 5.02×10（-05）），与CIMT正相关； CCL5在17号染色​​体上的两个SNP（rs4796119，β= -0.043，P值= 3.59×10（-05）; rs2291299，β= -0.032，P值= 5.59×10（-05））与CIMT呈负相关;更正了多个测试之后，只有rs2236935仍然很重要。使用Logistic回归，当我们调整腰围时，两个SNP（rs11465886，IRAK2、3号染色体，OR = 3.91，P值= 1.10×10（-04）;以及rs17751769，SERPINA1、14号染色体，OR = 1.96，P值= 2.42×10（-04））与CAC得分> 0 Agatston单位正相关;一个负相关的SNP（rs630014，ABO，OR = 0.51，P值= 2.51×10（-04））;校正多次测试后，没有一个保持显着水平。这些SNP是否与CIMT和CAC相关联，随机分为MHT患者。

BACKGROUND & AIMS: :Screening programs can reduce the burden of disease, however, they can be associated with raised levels of anxiety. The risk of endometrial and ovarian cancer is increased in hereditary nonpolyposis colorectal cancer (HNPCC). There is no prospective evidence to support screening for gynecological disease in HNPCC, however, current recommendations include the use of ultrasound and endometrial biopsy. This study assesses the impact of screening for gynecological cancer on self-reported symptoms of anxiety, depression, and perceptions of health. Women from HNPCC families attending gynecological screening (n = 26) completed the Hospital Anxiety and Depression Scale and the ShortForm36v2 questionnaires prior to screening with transvaginal ultrasound, outpatient/office hysteroscopy, endometrial biopsy, and ovarian tumor marker assessment (CA125). The same questionnaires were completed at 3 and 6 months following screening (15/26). Women in HNPCC families attending for gynecological screening did not have excess symptoms of anxiety or depression at baseline in subjective comparison to other populations. The process of screening and false positive screening results had no significant impact on symptoms of anxiety and depression or perceptions of health. We conclude that within the limitations of analysis in this small study group, screening for gynecological disease in HNPCC does not appear to be associated with any psychological morbidity.

背景与目标： ：筛查程序可以减轻疾病的负担，但是，它们可能与焦虑水平上升有关。遗传性非息肉病性结直肠癌（HNPCC）会增加子宫内膜和卵巢癌的风险。没有前瞻性证据支持筛查HNPCC中的妇科疾病，但是，当前的建议包括使用超声和子宫内膜活检。这项研究评估了筛查妇科癌症对自我报告的焦虑，抑郁和健康观症状的影响。接受妇科筛查的HNPCC家庭妇女（n = 26）在通过阴道超声，门诊/宫腔镜检查，子宫内膜活检和卵巢肿瘤标志物评估（CA125）进行筛查之前，完成了医院焦虑和抑郁量表和ShortForm36v2问卷。筛选后的3个月和6个月完成了相同的问卷调查（15/26）。与其他人群相比，从主观上看，参加妇科筛查的HNPCC家庭中的妇女在基线时没有过多的焦虑或抑郁症状。筛查的过程和假阳性筛查结果对焦虑和抑郁症状或健康感知没有显着影响。我们得出的结论是，在这个小型研究小组的分析范围内，HNPCC妇科疾病筛查似乎与任何心理疾病均不相关。

BACKGROUND & AIMS: :Lack of applicable safety data has effected an ease in federal restriction on the inclusion of women in clinical trials, particularly because: (1) they consume more prescription and over-the-counter medications than do men; (2) most require some type of drug therapy during pregnancy; and (3) many drugs that have been withdrawn from the market had higher health risks for women. The desire for more women-specific data prompted the Women's Health Initiative (WHI) studies, which reported an unfavorable risk-benefit relationship for hormone replacement therapy (HRT), as well as no significant reduction in disease or fracture risk with calcium and vitamin D supplementation but possible kidney stone development. Although the health risks were minimal, physicians feared any possible litigation involved with the use of HRT and were concerned with any possible adverse effects from calcium supplementation, and therefore altered their prescribing practices. Women, fearing any long-term health risks, also began seeking alternative treatments. However, the safety of these alternative therapies may be questionable, because they often are not subjected to extensive scrutiny and do not require federal approval. Alternative prescription drug treatments may have long-term adverse consequences that will only become evident with years of use. It is important to recognize that over-generalization and extrapolation of data may deny appropriate treatment to certain subgroups of women who may benefit.

背景与目标： ：缺乏适用的安全性数据，使得联邦限制了将女性纳入临床试验的难度，这尤其是因为：（1）与男性相比，她们消耗更多的处方药和非处方药； （2）大多数在怀孕期间需要某种药物治疗； （3）从市场上撤出的许多药物对妇女的健康风险更高。对更多女性特定数据的需求促使妇女健康计划（WHI）开展了研究，该研究报告说激素替代疗法（HRT）的风险-收益关系不利，并且钙和维生素D不会显着降低疾病或骨折的风险补充，但可能有肾结石发展。尽管健康风险很小，但医生担心使用HRT可能引起任何诉讼，并且担心补充钙可能产生的不利影响，因此改变了他们的处方习惯。妇女由于担心任何长期健康风险，也开始寻求替代疗法。但是，这些替代疗法的安全性可能会受到质疑，因为它们通常不会受到广泛的审查，也不需要联邦政府的批准。替代处方药治疗可能会产生长期的不良后果，这种不良后果只有在多年使用后才会显现出来。重要的是要认识到，过度概括和外推数据可能会拒绝为可能受益的某些女性亚群提供适当的治疗。

BACKGROUND & AIMS: PURPOSE:The purpose of this study was to assess demographic characteristics of women prescribed beta-blocker (beta-blocker) medication and compare to those not using beta-blocker medication, and to determine if there are differences in depression and fatigue among women who used beta-blockers compared to nonusers 6-12 months after myocardial infarction (MI). DATA SOURCES:This was a descriptive cross-sectional study of 84 women (61 using beta-blockers and 23 not using beta-blockers) aged 65 and older who were 6-12 months post-MI. Women had their height and weight measured and completed a Demographic Health Form, the Geriatric Depression Scale, and the Revised Piper Fatigue Scale (RPFS). CONCLUSIONS:While most of the women were taking beta-blockers after MI (74%), significantly fewer Black women were taking beta-blockers (chi(2) = 5.086, p = 0.032). Most of the beta-blocker users were overweight or obese. There were no significant differences in age, t(82) = 0.7, p = 0.486; body mass index, t(82) = 0.76, p = 0.445; income, chi(2)(df = 2) = 3.219, p = 0.075; mean depression, t(82) = 1.648, p = 0.103; or fatigue scores, t(82) = 0.993, p = 0.324, between beta-blocker users and nonusers. More of those not taking beta-blockers reported fatigue with significantly higher fatigue in the affective meaning dimension of the RPFS, t(82) = 2.272, p = 0.03. IMPLICATIONS FOR PRACTICE:beta-Blocker medication continues to be underutilized in older women. Because no difference was noted in fatigue and depression in the two groups, these may mean that these side effects are not barriers in prescribing this medication post-MI. Nurse practitioners are in pivotal positions to monitor the ongoing physiological and psychological sequelae post-MI and implement interventions to improve their outcomes.

背景与目标： 目的：本研究的目的是评估处方使用β-受体阻滞剂（β-blocker）药物的女性的人口统计学特征，并将其与未使用β-受体阻滞剂的女性进行比较，并确定使用这种药物的女性在抑郁和疲劳方面是否存在差异心肌梗塞（MI）后6至12个月与非使用者相比，β受体阻滞剂的使用率更高。
数据来源：这是一项描述性横断面研究，涉及MI后6-12个月的84位65岁及以上的女性（61位使用β受体阻滞剂，23位未使用β阻滞剂）。对妇女的身高和体重进行测量，并填写人口健康表格，老年抑郁量表和修订的派珀疲劳量表（RPFS）。
结论：虽然大多数女性在心梗后服用β受体阻滞剂（74％），但黑人妇女服用β阻滞剂的比例却明显减少（chi（2）= 5.086，p = 0.032）。大多数的β受体阻滞剂使用者超重或肥胖。年龄无显着差异，t（82）= 0.7，p = 0.486；体重指数，t（82）= 0.76，p = 0.445；收入，chi（2）（df = 2）= 3.219，p = 0.075;平均抑郁，t（82）= 1.648，p = 0.103; β受体阻滞剂使用者与非使用者之间的疲劳评分，t（82）= 0.993，p = 0.324。在没有服用β受体阻滞剂的人中，有更多人报告说疲劳感在RPFS的情感意义维度上明显更高，t（82）= 2.272，p = 0.03。
实践的意义：老年妇女使用β受体阻滞剂的药物仍未得到充分利用。由于两组在疲劳和抑郁方面均未见差异，这可能意味着这些副作用并非在心梗后开这种药的障碍。护士执业医师处于关键地位，以监测心梗后持续的生理和心理后遗症，并实施干预措施以改善其结局。

BACKGROUND & AIMS: :The objective of this study was to answer the question of whether a double instead of triple embryo transfer strategy in patients over 38 years would substantially reduce the number of multiple pregnancies while maintaining the chance of a term live birth at an acceptable level. A randomized controlled two-centre trial was performed. Forty-five patients, 38 years or older, were randomized. Double embryo transfer over a maximum of four cycles (DET group) or triple embryo transfer over a maximum of three cycles (TET group) was performed. The cumulative term live birth rate was 47.3% after four cycles in the DET group and 40.5% after three cycles in the TET group. The difference between the DET and the TET group was 6.8% in favour of the DET group (95% CI -25 to 38). The multiple pregnancy rates in the DET and TET group were 0% (95% CI 0 to 24) and 30% (95% CI 7 to 65) respectively (P = 0.05). In the DET patients, the mean number of treatment cycles was 2.9 compared with 2.1 in the TET group (P = 0.01). In women of 38 years and older, double embryo transfer after IVF may result in similar cumulative term live birth rates compared with triple embryo transfer, provided that a higher number of treatment cycles is accepted.

背景与目标： ：这项研究的目的是要回答这样一个问题：在38岁以上的患者中，采用双重胚胎移植而不是三次胚胎移植策略是否会显着减少多次怀孕的次数，同时将足月活产的机会维持在可接受的水平。进行了一项随机对照的两中心试验。随机选择了38名38岁或以上的患者。进行了最多四个周期的两次胚胎移植（DET组）或执行了最多三个周期的三胚胎移植（TET组）。 DET组四个周期后的累计足月活产率为47.3％，TET组三个周期后的累计足月活产率为40.5％。 DET和TET组之间的差异为6.8％，而DET组为95％CI -25至38。 DET和TET组的多重妊娠率分别为0％（95％CI 0至24）和30％（95％CI 7至65）（P = 0.05）。在DET患者中，平均治疗周期数为2.9，而TET组为2.1（P = 0.01）。在38岁及以上的女性中，如果接受更多的治疗周期，IVF后两次胚胎移植可能会产生与三次胚胎移植相比相近的累计足月活产率。

BACKGROUND & AIMS: :The effect of body mass index (BMI) and obesity on apolipoprotein (apo) A-I levels and kinetics was examined by gender. Apo A-I kinetics were determined with a primed, constant infusion of deuterated leucine in the fed state in 19 men and 13 postmenopausal women. Compared with nonobese men, nonobese women had a higher level of high-density lipoprotein cholesterol (HDL-C) and apo A-I due to a 48% higher apo A-I production rate (PR) (P = .05). Obesity had no significant effects on apo A-I kinetics in women. In contrast, compared with nonobese men, obese men had a 9% lower apo A-I level due to a 64% higher fractional catabolic rate (FCR) partially offset by a 47% higher PR. Obese women had a 52% higher HDL-C than obese men (50 vs 33 mg/dL, respectively; P = .012), a finding related to the faster apo A-I FCR in obese men. BMI was directly correlated with apo A-I FCR (r = 0.84, P < .001) and PR (r = 0.79, P < .001) in men but not in women. Sixty-two percent of the variability in PR and 71% of the variability in FCR were due to BMI in men and only 3% and 23%, respectively, in women. In conclusion, BMI has a significant effect on apo A-I PR and FCR in men but not in women.

背景与目标： ：通过性别检查了体重指数（BMI）和肥胖对载脂蛋白（apo）A-I水平和动力学的影响。在19名男性和13名绝经后女性中，在喂食状态下，经初次，恒定输注氘代亮氨酸测定了Apo A-I动力学。与非肥胖男性相比，非肥胖女性具有较高水平的高密度脂蛋白胆固醇（HDL-C）和载脂蛋白A-I，这是因为载脂蛋白A-I的产生率（PR）升高了48％（P = 0.05）。肥胖对女性的载脂蛋白A-I动力学没有显着影响。相比之下，与非肥胖男性相比，肥胖男性的分解代谢率（FCR）提高了64％，而部分PR升高了47％，因此脂蛋白A-I水平降低了9％。肥胖女性的HDL-C比肥胖男性高52％（分别为50和33 mg / dL； P = 0.012），这一发现与肥胖男性更快的apo A-I FCR有关。男性的BMI与apo A-I FCR（r = 0.84，P <.001）和PR（r = 0.79，P <.001）直接相关，而与女性无关。 PR变异性的62％和FCR变异性的71％是由于男性的BMI而引起的，而女性分别仅为3％和23％。总之，BMI对男性的apo A-I PR和FCR有明显影响，而对女性则没有。