Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-04-15 Cooperative journals: 《中国全科医学》
Abstract： Background The prevalence of pelvic floor dysfunction in postmenopausal women is progressively increasing，leading to a significant impact on both their physical and mental well-being due to stress urinary incontinence. Objective This study investigates the impact of menopausal hormone therapy（MHT）in conjunction with Kegel exercises on pelvic floor structure and clinical symptoms in individuals experiencing mild to moderate stress urinary incontinence（SUI）. Methods A total of 75 patients with menopausal syndrome accompanied by mild to moderate SUI who visited the Menopause Clinic at Beijing Shijitan Hospital in 2022 were selected. They were allocated into the MHT group and the control group in a 2∶1 ratio using a random number table method，and the MHT group was further randomly divided into subgroups receiving Tibolone and estrogen and progestogen therapy（EPT）in a 1∶1 ratio. Both the control group and the MHT group underwent pelvic floor muscle training（PFMT），commonly referred to as Kegel exercises，for 15-30 minutes per session，2-3 times daily，and 2-3 times weekly，over a continuous period of 12 months. The control group received KunTai capsules orally in combination with PFMT，with 4 capsules taken per dose，3 times a day，for 12 months. The MHT group received menopausal hormone therapy in conjunction with PFMT. The EPT subgroups include continuous combined estrogen-progestin therapy（1 mg estradiol valerate + 10 mg dydrogesterone，once daily），continuous sequential estrogen-progestin therapy（femoston 12 courses），and the Tibolone subgroup takes tibolone orally，all of which were administered continuously for 12 months. The study examined serum estradiol（E2）and follicle-stimulating hormone（FSH）levels within and between groups and subgroups before and after treatment. In addition，measurements were obtained for urethral rotation angle（URA），bladder detrusor thickness（BDT），posterior vesicourethral angle（PVUA），levator hiatus area（LHA），urinary incontinence quantification，urinary incontinence score，clinical efficacy，as well as changes in the modified Kupperman Menopausal Index（KMI）score，and the modified oxford staging（MOS）. Results Upon completion of the study，7 participants from the MHT group were lost to follow-up（5 in the Tibolone subgroup and 2 in the EPT subgroup），with 3 participants from the control group also lost to follow-up. In the end，a total of 65 participants were included. After 1 year of treatment，there were no statistically significant differences in FSH，E2，and MOS between the MHT group and the control group（P>0.05）. After 1 year of treatment，there were no statistically significant differences in PUVA，BDT，and URA between the MHT group and the control group（P>0.05）.However，the LHA of the MHT group was significantly lower than that of the control group（P=0.028）. After 1 year of treatment，there were no statistically significant differences in PUVA，BDT，URA，and LHA between the EPT and Tibolone subgroups（P>0.05）. Statistically significant differences were found in the comparison of clinical efficacy between the control group and the MHT group（P=0.010）. Conversely，no statistically significant differences were observed in the comparison of clinical efficacy between the EPT and Tibolone subgroups（P=0.724）. After 1 year of treatment，the MHT group showed lower urinary incontinence quantity，urinary incontinence score，and KMI score compared to the control group（P<0.05）. Before and after the treatment，there were no statistically significant differences in urinary incontinence quantity，urinary incontinence score，and KMI score between the EPT and Tibolone subgroups（P>0.05）. Conclusion The combination of MHT with PFMT yields a positive effect on the pelvic floor structure and markedly alleviates symptoms of urinary incontinence. Nevertheless，there is no significant differences between EPT and Tibolone in the improvement of pelvic floor structure and alleviation of clinical symptoms in patients.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2023-09-21 Cooperative journals: 《中国全科医学》
Abstract： Background In recent years，the symptoms of perimenopausal hearing loss（PMS-HL）have received widespread attention，but there is no targeted treatment. Zuoci pill has been used clinically for a hundred years，but there is no relevant research on the treatment of PMS-HL with this drug. Objective To explore the mechanism and therapeutic targets of Zuoci pill on PMS-HL through further validation of animal experiments based on the network pharmacology and molecular docking technology. Methods The active components and action targets of Zuoci pill were obtained through TCMSP and Uniprot databases，and the protein targets of PMS-HL were obtained through GeneCards，OMIM，TTD，DrugBank，and PharmGKB databases according to the composition of Zuoci pill from inception to February 2023，the intersection was taken to screen the potential therapeutic targets of Zuoci pill for the treatment of PMS-HL，and the "drug-active ingredient-target" interaction network diagram was constructed. The protein interaction analysis function of the String database was utilized to screen core targets. The Metascape database was used for enrichment analysis of the function of the proteins and pathways. Molecular docking of the core proteins was performed using Autodock and Pymol software to determine the binding capacity between key active ingredients and core targets. The menopausal animal model was established from September 2022 to January 2023，including Sham operation group（SHAM）group，ovariectomized（OVX）group，and Zuoci pill（ZCW）group，and serum level of the key protein interleukin 1β（IL-1β）was detected and statistically analyzed using SPSS 26. Results There were 90 active components，226 potential protein targets，2 481 PMS-HL related targets，and 150 Zuoci pill and PMS-HL intersection targets for the compounds in the Zuoci pill formula. A total of 183 items for biological process，103 items for molecular function，and 103 items for cellular components were obtained in the Gene Ontology（GO）function. The top three Kyoto Encyclopedia of Genes and Genomes（KEGG）were cancer pathways，lipid and atherosclerotic lesion pathway，and receptor activation pathway for chemical carcinogenesis. Molecular docking showed that the main active ingredients of Zuoci pill in treating PMS-HL were quercetin，kaempferol，stigmasterol，β- Sitosterol，isorhamnetin，diosgenin，tetrahydrostilbene and kaempferone；the active components of Zuoci pill can bind to the core target proteins of serine/threonine kinase 1（AKT1），cellular tumor antigen p53（TP53），interleukin 6（IL-6），vascular endothelial growth factor（VEGFA），cystatinase 3（CASP3），IL-1β， epidermal growth factor receptor（EGFR），and estrogen receptor 1（ESR1）stably. Comparison of serum IL-1β level among the three groups of rats showed statistically significant difference（F=11.73，P<0.001）. Conclusion The 90 active ingredients in Zuoci pill，such as quercetin，act on 226 potential proteins such as AKT1 to regulate the antioxidant stress of tissues and cells，metabolism of blood lipids and glucose，and anti-tumor pathway，directly or indirectly protect the perimenopausal hearing function，IL-1β may be one of the key target proteins.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2023-08-23 Cooperative journals: 《中国全科医学》
Abstract： Background Menopause will cause series of pathophysiologic changes and long-term complications（coronary heart disease，cerebrovascular disease，osteoporosis，etc.），among which coronary heart disease is the top killer of health. Objective To investigate the effects of menopausal status and aging on common risk factors for coronary heart disease（CHD）in middle-aged women，such as increased carotid intima-media thickness（CIMT），hypertension，dyslipidemia，diabetes，and obesity. Methods A total of 556 healthy premenopausal women aged 45 to 54 years who received regular physical examinations at the physical examination center of Beijing Shijitan Hospital affiliated to Capital Medical University in 2018 were initially selected，with 89 excluded according to relevant criteria，and 467 women were finally included as study subjects. The included subjects were divided into the pre-menopausal group（n=176）and postmenopausal group（n=291）according to whether they were postmenopausal during a 3-year follow-up period. Changes in BMI，waist circumference，blood glucose，blood pressure，blood lipids and other indicators were monitored，inter- and intra-group comparisons were performed before and after the follow-up period. Multivariate logistic regression analysis was used to explore the effects of menopausal status and age on the incidence of risk factors for coronary heart disease in middle-aged women. Results The average age of 467 subjects was （47.6±2.3）years old. Compared with baseline，waist circumference，uric acid（UA），total cholesterol（TC），triglyceride（TG），and low density lipoprotein cholesterol（LDL-C）levels increased，fasting blood glucose（FBG）level decreased after 3 years（P<0.05）. The results of inter-group comparison showed that there was no significant difference in waist circumference，BMI，TG，FBG and high density lipoprotein cholesterol（HDL-C）levels between the two groups after three years（P<0.05）；the levels of UA，TC and LDL-C in the menopausal group were higher than those in the pre-menopausal group，and the difference was statistically significant（P<0.05）. The results of intra-group comparison showed that the waist circumference in the two groups after 3 years was higher than baseline（P<0.05）；the levels of UA，TC and TG in the pre-menopausal group after 3 years were higher than the baseline（P<0.05）；the levels of UA，TC，TG and LDL-C in the postmenopausal group after 3 years were higher than the baseline（P<0.05）. Multivariate Logistic regression analysis showed that age ≥ 50 years old was a high-risk factor for increased CIMT in middle-aged women（OR=2.475，95%CI=1.049-5.838，P=0.038）. Conclusions The changes in waist circumference and TG in middle-aged women are mainly affected by age，the changes of LDL-C are mainly affected by menopausal status，and the changes of TC and UA are affected by both menopausal status and increased age. Age≥50 years is a high risk factor for increased CIMT in middle-aged women，and the changes of metabolic indicators such as UA，TC and LDL-C precede changes in CIMT after menopause.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2023-05-11 Cooperative journals: 《中国全科医学》
Abstract： Background Overweight/obese women are a growing population with high incidence of depression，anxiety and psychological abnormalities. Due to lack of effective responsive measures to emotions and behaviors，weight loss outcomes are often unsatisfactory in overweight/obese women with anxiety and depression. And less attention has been paid to weight loss outcomes and emotions in this group. Objective To explore the effect of daily self-weighing supported by online supervision on body composition and emotions in overweight/obese women with anxiety and depression. Methods A prospective，randomized，controlled study was conducted with 92 overweight/obese women with mild to moderate anxiety and depression voluntarily recruited from Beijing's Haidian District from October to December 2019. The subjects were randomized into an experimental group（n=46） and a control group（n=46） at a ratio of 1 ∶ 1，and treated with weight control interventions for three months：besides eating the appropriate food combinations with scientific and individualized guidance and excising rationally，the experimental group measured their body weight daily with online supervision from the special member of our research group and reported the data to the group，while the control group measured their body weight per month，which was collected by our research group through monthly telephone follow-up. Body composition measurement result，anxiety assessed using Self-Rating Anxiety Scale（SAS） and depression assessed using Self-Rating Depression Scale（SDS） were compared at baseline and three months after the intervention. Results All the participants completed the questionnaire assessment and follow-up. After the intervention，the control group had higher average body weight，BMI，body fat percentage and body fat as well as larger average visceral fat area than the experimental group（P<0.05）. Reduced body weight，BMI，body fat percentage，body fat and visceral fat area were seen in the experimental group after intervention（P<0.05）. The SAS score and SDS score in the experimental group were also lowered after intervention（P<0.05）. The average post-intervention scores of SAS and SDS in the experimental group were lower than those in the control group（P<0.05）. Conclusion In overweight/obese women with anxiety and depression，daily self-weighing with online supervision contributes to weight and fat loss and the improvement of anxiety and depression symptoms，which is a simple，effective and safe intervention measure.
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