NEW THERAPEUTIC OPTION AND INSIGHTS INTO THE IMPACT OF SYMPTOM SEVERITY ON QUALITY OF LIFE IN WOMEN WITH INTERSTITIAL CYSTITIS

Background: Interstitial Cystitis (IC) is a poorly understood condition of urinary bladder characterized by pelvic pain, urinary frequency, urgency and nocturia in the absence of other obvious pathology. The public health significance of IC is related to its profound impact on patients' physical and emotional Quality of Life (QOL). The actual prevalence rate is unknown, and estimates range widely from 67/100,000 to 575/100,000. The majority of IC cases are females in the midlife age. This research addressed 1) the extent to which socio-demographic and clinical factors affect both symptom severity and QOL in IC patients, 2) the impact of symptom severity on QOL and 3) the efficacy of a combination of oral and intravesical Pentosan Polysulfate Sodium (PPS) as a new therapeutic option for IC. Methods: Forty one women with IC (age 20-71 years) were studied. Demographic, reproductive and clinical characteristics as well as QOL measures were evaluated in a cross-sectional design to assess the first two aims. To examine the third aim, participants were randomized to receive either a combination of oral plus intravesical PPS (treatment group) or oral PPS plus intravesical placebo (placebo group) in a clinical trial design. The main outcomes were the changes in subjective and objective measures of symptom severity, QOL and sexual functions. Results: Unmarried patients reported more severe symptoms compared to married patients. Being unemployed, obese, currently unmarried and never pregnant were associated with a decrement in at least one QOL domain. Moreover, symptom severity was associated with worse QOL on 4 domains, (p<0.05). On the other hand, the results from the clinical trial showed a greater significant reduction in symptom severity among the treatment group compared to the placebo group (46% reduction vs. 24% reduction respectively, p=0.04) and significant improvement in all QOL domains in the treatment group compared to the baseline (p<0.05). Conclusion: Being unmarried and symptom severity are important factors that may disturb the QOL in IC patients. Moreover, the use of intravesical PPS simultaneously with oral PPS is an effective therapeutic option. The findings of this research will open a new option for IC patients to reduce their devastating symptoms and to improve their quality of life

Design of a Selective Continuous Test Runner

This study presents the design of a selective continuous test runner, which has not been done before. Previous studies present only a continuous test runner with random or semi-random test cases selection techniques. Here we present the concept of influence graph which is constructed directly by using source code and then use this influence graph to detect any influence on any test case and run the tests on the background. For that purpose three algorithms were designed; one for building the influence graph for the first time, another for enhancing the influence graph according to code modifications, and the third for marking relevant test cases for retesting. We created an Integrated Development Environment (IDE) for test purpose. The mentioned algorithms were implemented on this IDE. Experimental results show: (1) Influence graphs helped efficiently in detecting the changed test cases, (2) The proposed technique worked well with large projects, and (3) The selective continuous test runner helped in detecting logic deviations in a more effective and fast way than the regular test running schemas

Postmenopausal Women With Greater Paracardial Fat Have More Coronary Artery Calcification Than Premenopausal Women: The Study of Women's Health Across the Nation (SWAN) Cardiovascular Fat Ancillary Study.

BackgroundVolumes of paracardial adipose tissue (PAT) and epicardial adipose tissue (EAT) are greater after menopause. Interestingly, PAT but not EAT is associated with estradiol decline, suggesting a potential role of menopause in PAT accumulation. We assessed whether volumes of heart fat depot (EAT and PAT) were associated with coronary artery calcification (CAC) in women at midlife and whether these associations were modified by menopausal status and estradiol levels.Methods and resultsEAT and PAT volumes and CAC were measured using electron beam computed tomography scans. CAC was evaluated as (1) the presence of CAC (CAC Agatston score ≥10) and (2) the extent of any CAC (log CAC Agatston score &gt;0). The study included 478 women aged 50.9&nbsp;years (58% pre- or early perimenopausal, 10% late perimenopausal, and 32% postmenopausal). EAT was significantly associated with CAC measures, and these associations were not modified by menopausal status or estradiol. In contrast, associations between PAT and CAC measures were modified by menopausal status (interaction-P≤0.01). Independent of study covariates including other adiposity measures, each 1-SD unit increase in log PAT was associated with 102% higher risk of CAC presence (P=0.04) and an 80% increase in CAC extent (P=0.008) in postmenopausal women compared with pre- or early perimenopausal women. Additional adjustment for estradiol and hormone therapy attenuated these differences. Moreover, the association between PAT and CAC extent was stronger in women with lower estradiol levels (interaction P=0.004).ConclusionsThe findings suggest that PAT is a potential menopause-specific coronary artery disease risk marker, supporting the need to monitor and target this fat depot for intervention in women at midlife

Ectopic cardiovascular fat in middle-aged men: effects of race/ethnicity, overall and central adiposity. The ERA JUMP study.

Background/objectivesHigher volumes of ectopic cardiovascular fat (ECF) are associated with greater risk of coronary heart disease (CHD). Identifying factors that are associated with ECF volumes may lead to new preventive efforts to reduce risk of CHD. Significant racial/ethnic differences exist for overall and central adiposity measures, which are known to be associated with ECF volumes. Whether racial/ethnic differences also exist for ECF volumes and their associations with these adiposity measures remain unclear.Subjects/methodsBody mass index (BMI), computerized tomography-measured ECF volumes (epicardial, pericardial and their summation) and visceral adipose tissue (VAT) were examined in a community-based sample of 1199 middle-aged men (24.2% Caucasians, 7.0% African-Americans, 23.6% Japanese-Americans, 22.0% Japanese, 23.2% Koreans).ResultsSignificant racial/ethnic differences existed in ECF volumes and their relationships with BMI and VAT. ECF volumes were the highest among Japanese-Americans and the lowest among African-Americans. The associations of BMI and VAT with ECF differed by racial/ethnic groups. Compared with Caucasians, for each 1-unit increase in BMI, African-Americans had lower, whereas Koreans had higher increases in ECF volumes (P-values&lt;0.05 for both). Meanwhile, compared with Caucasians, for each 1-unit increase in log-transformed VAT, African-Americans, Japanese-Americans and Japanese had similar increases, whereas Koreans had a lower increase in ECF volumes (P-value&lt;0.05).ConclusionsRacial/ethnic groups differed in their propensity to accumulate ECF at increasing level of overall and central adiposity. Future studies should evaluate whether reducing central adiposity or overall weight will decrease ECF volumes more in certain racial/ethnic groups. Evaluating these questions might help in designing race-specific prevention strategy of CHD risk associated with higher ECF

What do Spanish men know about menopause?

Objective: The aim of the study is to evaluate the knowledge that men have about menopause and to analyze whether sociodemographic aspects influence in this knowledge. Methods: 560 consecutive surveys were collected during 2019. The surveys were completed anonymously, voluntarily and without incentives by men. A maximum score of 45 points was considered for the knowledge analysis. Results: The mean age was 49.13 ± 11.1 years. The most frequent source of information to obtain knowledge about menopause were friends (61.4%). The mean of the questionnaire score was 20.69 ± 6.1. The most frequent symptoms associated with menopause were hot flashes and vaginal dryness (93.7%; 48%) and the best-known treatment to improve vaginal health was lubricants at 69.5%. The most common treatment men know for improving menopause symptoms was menopause hormone treatment; however, 27.9% of men think there is no treatment for menopause. Differences between ages in numbers and grades were found (p=0.032). The scores by levels of study showed statistically differences (primary school, high school, professional training and university education (men with a higher level of education had significantly more knowledge) (p=0.013). Differences were showed in men who obtained information from health staff with respect to other sources (p<0.001). Conclusions: The knowledge in men in this sample is limited. Differences between ages, level of education and sources of information were found. No differences were found between public and private hospitals. The teaching of this knowledge should be carried out by trained personnel, preferably health staff.pre-print224 K

The menopause transition and women\u27s health at midlife: a progress report from the Study of Women\u27s Health Across the Nation (SWAN)

OBJECTIVE: Our initial understanding of the menopause transition (MT) has been framed by clinical samples of women seeking treatment rather than by population-based studies. The Study of Women\u27s Health Across the Nation (SWAN) initiated in 1996 with an overall goal to define the MT, to characterize its biological and psychosocial antecedents and sequelae in an ethnically and racially diverse sample of midlife women. METHODS: This review summarizes the central findings of SWAN to date that can inform women and their healthcare providers about the impact of the MT and midlife aging on overall health and well-being. RESULTS: SWAN characterized changes in reproductive axis and menstrual cycle patterns that informed the development of the reproductive aging staging system Staging of Reproductive Aging Workshop+10; MT-related symptoms and mental health (vasomotor symptoms, sleep complaints, psychological symptoms, cognitive performance, and urogenital and sexual health); and physiological systems and functions (cardiovascular and cardiometabolic health, bone health, physical function performance) that are influenced by the MT. SWAN demonstrated substantial interrelations among these changes and significant racial/ethnic differences in the rate and magnitude of change in multiple health indictors in midlife women. The findings point to midlife as a critical stage for adopting healthy behavior and preventive strategies. CONCLUSIONS: Over the past 23 years, SWAN has advanced our understanding of the impact of the MT and midlife aging on health and well-being in women. SWAN will be instrumental to determine whether MT-related changes during midlife are related to unfavorable health and well-being in early old age

Extragonadal Effects of Follicle-Stimulating Hormone on Osteoporosis and Cardiovascular Disease in Women during Menopausal Transition

The risk of osteoporosis and cardiovascular disease increases significantly in postmenopausal women. Until recently, the underlying mechanisms have been primarily attributed to estrogen decline following menopause. However, follicle-stimulating hormone (FSH) levels rise sharply during menopausal transition and are maintained at elevated levels for many years. FSH receptor has been detected in various extragonadal sites, including osteoclasts and endothelial cells. Recent advances suggest FSH may contribute to postmenopausal osteoporosis and cardiovascular disease. Here, we review the key actions through which FSH contributes to the risk of osteoporosis and cardiovascular disease in women as they transition through menopause. Advancing our understanding of the precise mechanisms through which FSH promotes osteoporosis and cardiovascular disease may provide new opportunities for improving health-span for postmenopausal women

Associations of HDL metrics with coronary artery calcium score and density among women traversing menopause

The cardioprotective association of high-density lipoprotein cholesterol (HDL-C) may vary by menopause stage or estradiol level. We tested whether associations of comprehensive HDL metrics (HDL subclasses, phospholipid and triglyceride content, and HDL cholesterol efflux capacity [HDL-CEC]) with coronary artery calcium (CAC) score and density vary by menopause stage or estradiol level in women transitioning through menopause. Participants (N = 294; mean age [SD]: 51.3 [2.9]) had data on HDL metrics and CAC measures at one or two time points during the menopause transition. Generalized estimating equations were used for analyses. Effect modifications by menopause stage or estradiol level were tested in multivariable models. In adjusted models, menopause stage modified the associations of specific HDL metrics with CAC measures. Higher small HDL particles (HDL-P) concentrations (p-interaction = 0.008) and smaller HDL size (p-interaction = 0.02) were associated with greater odds of CAC presence in late perimenopause than in pre/early perimenopause stage. Women in the highest estradiol tertile, but not the lower tertiles, showed a protective association of small HDL-P with CAC presence (p-interaction = 0.007). Lower large HDL-P concentrations (p-interaction = 0.03) and smaller HDL size (p-interaction = 0.03) were associated with lower CAC density in late perimenopause than in postmenopause stage. Associations of HDL phospholipid and triglyceride content and HDL-CEC with CAC measures did not vary by menopause stage or estradiol level. We concluded that HDL subclasses may impact the likelihood of CAC presence and the stability of coronary plaque differently over the menopause transition. Endogenous estradiol levels may contribute to this observation

Meta-analysis for individual participant data with a continuous exposure: A case study

OBJECTIVE: Methods for meta-analysis of studies with individual participant data and continuous exposure variables are well described in the statistical literature but are not widely used in clinical and epidemiological research. The purpose of this case study is to make the methods more accessible. STUDY DESIGN AND SETTING: A two-stage process is demonstrated. Response curves are estimated separately for each study using fractional polynomials. The study-specific curves are then averaged pointwise over all studies at each value of the exposure. The averaging can be implemented using fixed effects or random effects methods. RESULTS: The methodology is illustrated using samples of real data with continuous outcome and exposure data and several covariates. The sample data set, segments of Stata and R code, and outputs are provided to enable replication of the results. CONCLUSION: These methods and tools can be adapted to other situations, including for time-to-event or categorical outcomes, different ways of modelling exposure-outcome curves, and different strategies for covariate adjustment