Predicting age at menopause

Macrophages in the tissues have been shown to express receptor for urokinase-type plasminogen activator (uPAR) on their cell surface which plays an important role in cell invasion and attachment. We examined the effects of inflammatory mediators on the expression of uPAR employing U937 cells which have monocyte/macrophage-like characteristics. U937 cells were incubated with various mediators such as interleukins (IL), tumor necrosis factors (TNF), dexamethasone, thrombin, fibrin fragment D, bradykinin, complement C5a, and components of the extracellular matrix. The uPAR expression on the cell surface was then analyzed by radio-ligand binding assay using 125I-scuPA. The strongest enhancement of uPAR was observed in the cells stimulated by TNF alpha and TNF beta. IL-1 beta, IL-6, and C5a also increased the uPA binding sites with various patterns of affinity change. Dexamethasone decreased the uPA binding sites without changing the affinity. Fibrin fragment D and IL-3 reduced the affinity without changing the number of receptors. These findings suggest that the expression of uPAR in inflammatory cells could be modulated by various inflammatory mediators.     

Genes control the cessation of a woman's reproductive life: a twin study of hysterectomy and age at menopause

A classical twin study was performed to assess the extent to which genetic factors explain individual differences in age at menopause and (indications for) hysterectomy. It was further examined whether a genetic effect on the timing of the menopause was mediated through a genetic effect on age at menarche. The subjects were 275 monozygotic and 353 dizygotic female twin pairs. Maximum likelihood model fitting was used to estimate genetic and environmental variance components, Kaplan-Meier survival analysis was used to account for censored data, and the Cox proportional hazards model was used to adjust for potential confounders. A model specifying additive genetic and unique environmental factors showed the best fit to the data, yielding a heritability (h2) for age at menopause of 63%. The significance of the genetic effect was confirmed by the survival analysis and was not affected by adjustment for confounders. Both early and late menopause were found to be significantly influenced by genetic factors. Hysterectomy also showed considerable heritability (h2 = 59%), as did its two main indications: fibroids (h2 = 69%) and menorrhagia (h2 = 55%). The genetic contribution to the variance in age at menarche was estimated to be 45%, with the majority (37%) being due to dominant genetic effects. No correlation was found between age at menopause and age at menarche, suggesting different genetic mechanisms. This study provides convincing evidence for the importance of genetic factors in determining natural and surgical menopause. Understanding how genes control the timing of menopause and exploring whether these genes are indirectly associated with disease are important areas for future study.     

Secular trends in menopause age

Serum and colostrum from 73 sows were collected. The serum samples were tested by Immuno. Peroxidase Monolayer Assay (IPMA) and the corresponding colostrum samples with the indirect Immuno fluorescent Antibody (IFA) technique. All serum positive sows were colostrum positive and all colostrum negative were serum negative. Eight sows only reacted positively in the colostral testing. Compared to the serum standard test the specificity was 82.6% and the sensitivity 100%. The observed agreement between both tests was 89.2%. In addition all serum samples were also tested with the IF test (IFT). Of the eight sows which were negative in the IPMA serum test and positive in the IFA colostrum test, three were found positive when the serum was tested with IFA. Consequently, the observed agreement was higher at 93.2%. After the suitability of colostrum for porcine reproductive and respiratory syndrome (PRRS) diagnosis was demonstrated, 1915 colostrum samples collected from 135 different farms were tested in a comparative study with the IPMA and IFA techniques. Of the 1915 colostrum samples 139 were positive with both IPMA and IFA. With IPMA only, 43 samples were positive compared with 192 samples found positive with the IFA technique. A total of 1541 samples were negative in both tests. The observed agreement between both tests was 87.5%. The quotient of the observed agreement minus chance agreement and the maximum possible agreement beyond chance level (Kappa Quotient) was 0.49. In 90% of the farms that tested IFA positive there was a seroconversion of more than 50% of all colostrum tested. By comparison only 29% of the IPMA positive farms were positive with more than 50%. Based on the epidemiological findings on PRRS it was concluded that the IFA technique indicates a higher sensitivity for the detection of PRRS virus antibodies in sow colostrum. Finally the possible advantages and disadvantages of sow colostrum testing and serum testing are discussed.     

Age at natural menopause and mortality

The inadvertent hypothermia that is often seen after anesthesia in a cool environment has been associated with delays in recovery from anesthesia and longer stays in the PACU. This quality assurance/performance improvement study was undertaken to determine the following: (1) the effectiveness of current interventions for preventing intraoperative hypothermia, (2) whether there were any apparent differences in effectiveness among the current methods for preventing intraoperative hypothermia, and (3) was intraoperative hypothermia associated with delays in discharge from the PACU. Data were completed on 502 patients. Despite longer surgical procedures, those patients treated intraoperatively with the Bair Hugger (Augustine Medical Inc, Eden Prairie, MN) were less likely to arrive in the PACU hypothermic than those who did not receive this treatment. Patients who arrived in the PACU hypothermic had longer PACU stays than patients who arrived normothermic. As a result of these findings, changes in nursing practice in the PACU and in the availability of the Bair Hugger in the operating rooms were made.     

DHEA as physiological replacement therapy at menopause

BACKGROUND: We report on a case of combined sciatic nerve block and 3-in-1 block for amputation of lower limb in an ASA IV-V patient 6 days after intraoperative cardiopulmonary resuscitation following induction of general anaesthesia. CASE REPORT: A 54-year old male patient was admitted for necrosectomy of a crural ulcer due to end-stage peripheral vascular disease and non-insulin dependent diabetes mellitus. The patient also suffered from toxic cardiomyopathy. After induction for general anaesthesia the haemodynamic situation deteriorated progressively and ended up in cardiac arrest with consequent successful cardiopulmonary resuscitation. The operation was cancelled and the patient was admitted to the intensive-care unit, where he was extubated after 2 days of further haemodynamic stabilisation. Following development of a septic situation of the lower limb the patient was again admitted for amputation six days after the cardiopulmonary resuscitation. Regional anaesthesia was conducted with a combination of a sciatic nerve block via the posterior approach and a 3-in-1 block facilitated by ultrasonographic guidance. For each of the blocks we used 20 mL mepivacaine 1%. Sensory blockade was sufficient and the patient remained haemodynamic and respiratorily stable. DISCUSSION AND CONCLUSIONS: The combined sciatic and 3-in-1 block is a rarely used technique, but for haemodynamically unstable patients it is a safe method for surgery of the lower limb.     

Relative contributions of age and menopause to the vertebral bone density of healthy Japanese women

The relative contributions of age and menopause to vertebral bone mineral density were evaluated based on the estimated weights for age- and menopause-related bone loss components using a mathematical model in 177 healthy female volunteers ages 35-81 years, living in a community in Fukui, Japan. Bone mineral density was determined by dual X-ray absorptiometry. The model used was that which afforded the best fit among the eight possible models to the data observed. Each model was composed of a linear function for the age-related component and a different type of function for the menopausal component, without interaction between them. The weights for these components in each model were estimated by the least-squares method. The coefficient of determination and Akaike information criterion disclosed that among the eight models tested, the model affording the best fit was composed of a logarithmic decrease in bone density with an increase in years since menopause, up to 10 years postmenopausal, with no further decline thereafter. In this model, the weights for both components were statistically significant and the type III sum of squares of the menopausal component was greater than that of the age-related component. We suggest that both age and menopause made significant contributions to the decline in vertebral bone mineral density, with the contribution of menopause being greater than that of age.     

An event history analysis of age at last menstrual period: correlates of natural and surgical menopause among midlife Wisconsin women

Population aging coupled with heightened consumerism among those using the health care system have increased public and research interest in menopause. Despite these trends, we know little about the process of menstrual cessation. This paper reviews previous claims regarding secular trends in menopausal age by considering how menstrual cessations differ by type: (1) that due to surgical intervention such as hysterectomy, and (2) that due to "natural" (non-surgical) menopause. Analyses of menopause that exclude hysterectomized women are flawed, because such women constitute a high proportion of American women at midlife. Competing risk survival analysis techniques are applied to model the shape of the underlying hazards for reproductive organ surgery versus "natural" menopause among 3506 midlife women from the Wisconsin Longitudinal Study. Weibull models are used to evaluate effects of a variety of possible correlates (including education, mental ability, occupation, family background, fertility experience, smoking behavior and hormone therapy). While socioeconomic parameters do contribute to observed differences in age at menstrual cessation, these factors operate through more proximate health-related behaviors (such as smoking in the case of natural menopause and fertility for surgical menopause).     

Influence of age and menopause on serum lipids and lipoproteins in healthy women

This study was carried out to investigate the effect of selenium supplementation at a therapeutic level on the isolated ileum contractions and the acetylcholine responses in New Zealand rabbits. While no difference with respect to the controls was found in the spontaneous ileum contraction frequencies a significant increase in the contraction amplitude was noted after 15 days of supplementation. Increasing concentrations of acetylcholine in the perfusion solution resulted in a significant increase of the contraction amplitudes in the supplemented animals as compared to controls. The tissue selenium levels and the gluthathione peroxidase activities were also found significantly higher than the controls. No difference was observed between the contraction numbers in the two groups. These findings indicate that selenium supplementation does not influence the smooth muscle resting potential.     

Managing the menopause

This article discusses the effects of the menopause and ways in which nurses can advise women on help and treatments that are available to help allay their symptoms. This article should be read in conjunction with other CE articles and these are referred to at the appropriate points.     

Skeletal responsiveness to thyroid hormone is not altered at menopause

The relative effects of exogenous adenosine applied intraluminally or extraluminally were compared on first-order pig retinal arteries in an isolated perfused artery preparation. First-order retinal arteries with at least one side branch were cannulated and perfused at a constant flow in an environmentally-controlled organ bath on the stage of an inverted microscope. Vessels were precontracted with 10(-4) methoxamine applied extraluminally, which produced a sustained contraction. Then, either extraluminal or intraluminal adenosine was added in increasing concentrations from 10(-9) to 10(-3) M. During these procedures continuous measurements of external vessel diameter were made. The average external diameter of the retinal arterial segments used was 127.6 +/- 2.3 microns (n = 13). Extraluminal methoxamine (10(-4) M) constricted the vessels to 77.9 +/- 2.0% (n = 9) and 78.8 +/- 0.8% (n = 4) of the control value for the vessels later exposed to extraluminal and intraluminal adenosine respectively. Extraluminal adenosine caused a dose-dependent dilatation which commenced between 10(-7) M and 10(-6) M, and reached a percentage dilatation of 22.6 +/- 1.8% (n = 9) at 10(-3) M. For concentrations of 10(-4) M and above, spontaneous oscillations in diameter were observed for extraluminally-applied adenosine with an average period of 0.46 +/- 0.02 (n = 9) cycles per minute. The average percentage diameter oscillation was +/- 7.1% of the mean diameter. In contrast, intraluminal adenosine failed to cause dilatation or spontaneous oscillations at all concentration values, although the dilatory ability of these vessels was confirmed by intraluminal application of the Ca2+ channel blocker verapamil. In conclusion this study has demonstrated that the two sides of the retinal artery wall are differentially sensitive to adenosine, with the intraluminal route being ineffective. In vivo, in hypoxic or ischemic situations, adenosine is released by extraluminal neural tissue and minimizes tissue damage, partially by acting as a signaller of metabolic status to the vasculature leading to vasodilatation and hence increased local blood flow. This study shows that delivery of adenosine for therapeutic purposes through an intraluminal route is not a feasible proposition. This isolated, perfused artery technique has considerable potential to improve our understanding of uptake mechanisms, metabolism and vasoactivity of the retinal vessel wall.     

Prospective epidemiological study of rheumatism in the Irkutsk Region

The changes in the prevalence and primary incidence of rheumatism in the region were analyzed by the epidemiological surveys and notifications made in 1961 to 1994. During this period, the primary incidence rates showed a 70-fold decrease, mainly due to those among females and children. The paper presents changes in the pattern of risk factors of rheumatism and defines the prevalence decrease rate of rheumatism in three follow-up periods. A comprehensive rehabilitation programme for rheumatic patients has been worked out.     

Prospective study of Streptococcus milleri hepatic abscess

RATIONALE AND OBJECTIVES: The authors compared the postocclusion hyperemic responses of the brachial artery after occluding blood flow proximal to and distal to the studied area. MATERIALS AND METHODS: Response of the brachial artery to hypoxia was evaluated with duplex Doppler ultrasound in 13 healthy subjects. A pneumatic tourniquet was first positioned 2-5 cm superior to the left elbow, proximal to the area of artery studied. Two hours later the response was remeasured with the tourniquet positioned 2-5 cm inferior to the elbow, distal to the artery studied. Arterial diameter, mean and peak flow velocities, and heart rate were assessed. RESULTS: No significant differences were observed between measurements of baseline and postischemic arterial diameter, percentage diameter change, baseline mean arterial blood flow velocity, baseline peak arterial blood flow velocity, or postischemic heart rate obtained with proximal occlusion of the artery and those obtained with distal occlusion. In contrast, mean and peak postischemic arterial blood flow velocity and preocclusion heart rate were higher in measurements made during proximal artery occlusion. Significant correlation was found between measurements of percentage change in artery diameter obtained with proximal artery occlusion and those obtained with distal occlusion (r = 0.611, P < .05). CONCLUSION: There are no major differences in postischemic changes in brachial artery diameter related to reactive hyperemia between blood flow occlusion applied proximal and distal to the studied area. However, there are significant differences in the mean and peak systolic velocities. Either occlusion site can be used for clinical studies if arterial diameter change is monitored, but if velocity measurements are being compared, a single occlusion site should be chosen.     

Prospective study of atherosclerotic disease progression in the renal artery

BACKGROUND: The aim of this study was to determine the incidence of and the risk factors associated with progression of renal artery disease in individuals with atherosclerotic renal artery stenosis (ARAS). METHODS AND RESULTS: Subjects with >/=1 ARAS were monitored with serial renal artery duplex scans. A total of 295 kidneys in 170 patients were monitored for a mean of 33 months. Overall, the cumulative incidence of ARAS progression was 35% at 3 years and 51% at 5 years. The 3-year cumulative incidence of renal artery disease progression stratified by baseline disease classification was 18%, 28%, and 49% for renal arteries initially classified as normal, <60% stenosis, and >/=60% stenosis, respectively (P=0.03, log-rank test). There were only 9 renal artery occlusions during the study, all of which occurred in renal arteries having >/=60% stenosis at the examination before the detection of occlusion. A stepwise Cox proportional hazards model included 4 baseline factors that were significantly associated with the risk of renal artery disease progression during follow-up: systolic blood pressure >/=160 mm Hg (relative risk [RR]=2.1; 95% CI, 1.2 to 3.5), diabetes mellitus (RR=2.0; 95% CI, 1.2 to 3.3), and high-grade (>60% stenosis or occlusion) disease in either the ipsilateral (RR=1.9; 95% CI, 1.2 to 3.0) or contralateral (RR=1.7; 95% CI, 1.0 to 2.8) renal artery. CONCLUSIONS: Although renal artery disease progression is a frequent occurrence, progression to total renal artery occlusion is not. The risk of renal artery disease progression is highest among individuals with preexisting high-grade stenosis in either renal artery, elevated systolic blood pressure, and diabetes mellitus.     

Older women's experience of the menopause

Older women are often stereotyped as less productive and less healthy, bemoaning the end of their fertile life and crying out for hormone replacement therapy (HRT). The author of this article challenges these images and suggests that the menopause marks a beginning rather than an end. Nurses should take a more positive approach to women entering the later part of their lives.     

Prospective study of mutant frequencies at the hprt and T-cell receptor gene loci in pediatric cancer patients during chemotherapy

With the use of three different hematopoietic cell lineages, the downregulation of telomerase activity was found to be a general response to the induction of differentiation. The decrease in telomerase activity occurred as early as 24 h when HL-60 and K562 cells were cultured in the presence of 1alpha, 25 dihydroxyvitamin D3 (VD3), all-trans-retinoic acid (ATRA) and hemin, and completely disappeared after 3 days. On the other hand, MEG-01 cells showed a marked inhibition of telomerase activity after 6 days of culture with 12-0-tetradecanoylphorbal 13-acetate (TPA). The analysis of telomeric DNA in the HL-60 cells and K562 cells demonstrated no detectable loss of telomeric DNA with cellular differentiation, with a loss of telomerase activity. The repression of telomerase is a common molecular event during leukemic cell differentiation.