10 Jahre Women's Health Initiative (WHI): Was haben wir gelernt?

Die im Jahre 2002 erschienene erste Publikation von Daten aus der WHI-Studie hat zu einer unbegründeten Angst vor der postmenopausalen ERT/HRT geführt. Die seither gerade auch aus der WHI veröffentlichte neuere Evidenz zur ERT/ HRT zeigt dagegen, dass bei frühem Beginn nach der Menopause der Nutzen einer ERT/HRT klar die allfälligen Risiken überwiegt. Es ist unbestritten, dass die ERT/HRT die wirksamste Methode zur Behandlung von klimakterischen Beschwerden bleibt. Zudem ist innerhalb des so genannten „günstigen Fensters“ (Beginn der Hormongabe innert der ersten 10 Jahre nach der Menopause oder vor dem Alter von 60 Jahren) eine ERT/HRT die Methode der Wahl zur primären Osteoporoseprävention. Innerhalb dieser Altersgruppe sind die kardiovaskuläre Morbidität und Mortalität ebenso wie die totale Mortalität bei Frauen unter einer Östrogengabe signifikant geringer als bei nichtsubstituierten Frauen. Unter Östrogenen allein ist das Brustkrebsrisiko in der WHI-Studie im Vergleich zu Placebo bis zu einer medianen Beobachtungsdauer von 11,8 Jahren auch bei Frauen mit einem BMI < 25 reduziert, in der Nurses’ Health Study steigt es bis zu einer Einnahmedauer von 19,9 Jahren nicht an. Auch unter kombinierter Östrogen-Gestagen-Gabe erhöht sich in der WHI-Studie das Mammakarzinom-Risiko bis zu einer Einnahmedauer von 5,6 Jahren nicht. Danach besteht gemäß der WHI-Studie ein Trend zu einer Risikozunahme (< 1,0 per 1000 Frauen pro Einnahmejahr). SERMs eignen sich vor allem zum Einsatz bei asymptomatischen Frauen mit erhöhtem vertebralem Fraktur- und vermehrtem Brustkrebsrisiko. Nach verschiedenen Daten könnten die einzelnen Gestagene ein unterschiedliches Risikoprofil besitzen. Auch die dänische DOPS-Studie kommt nach 10 Jahren einer randomisierten Behandlung mit ERT/HRT zum Schluss, dass Frauen mit frühem Beginn der Hormoneinnahme nach der Menopause ein signifikant reduziertes Risiko für Mortalität, Herztod oder Myokardinfarkt besitzen, ohne dass die erkennbaren Risiken für Krebs, VTE oder CVI ansteigen. Ab 1–2 Jahren nach der Menopause kann auch Tibolon verwendet werden. Unter transdermaler Östrogengabe ist im Gegensatz zur peroralen Einnahme kein Anstieg des venösen thromboembolischen (VTE) Risikos zu erwarten, das Risiko für zerebrovaskuläre Insulte (CVI) ist gering oder nicht vorhanden. Da therapiebedürftige klimakterische Symptome über Jahre auftreten können, gibt es keine fixe obere Grenze der Einnahmedauer, wobei die Indikation für eine ERT oder HRT (inklusive SERM) regelmäßig reevaluiert werden soll. Dabei ist die niedrigste noch wirksame Hormondosierung zu verwenden und insbesondere bei Risikopatientinnen für VTE und CVI das Östrogen transdermal zu verabreichen

Sexualmedizinische Behandlungsfälle – Entwicklungen 1980 – 1990 – 2004

Sexual dysfunctions can adversely affect men's and women's satisfaction with life over a prolonged period. Besides sexual medicine services in primary medical care, in Switzerland there exist specialized consultation services at University Hospitals. The assessment of the case histories of three years (1980, 1990, and 2004) of the Sexual Medicine Consultation Service at Zurich University Hospital provided the following results: the most common disorders are lack/loss of libido in women and erectile dysfunction in men. Treatment options for sexual disorders have become more differentiated in recent years. The collaboration between the doctors making the referral and the sexual medicine specialists improved markedly between 1980 and 2004. After a diagnostic assessment and a primary treatment in the specialized consultation service, many patients are referred back to the referring doctors for further treatment. Basic and further training in sexual medicine ought to be intensified and improved

Endocrinology: Nuclear maturity and oocyte morphology after stimulation with highly purified follicle stimulating hormone compared to human menopausal gonadotrophin

Several studies have shown that high concentrations of luteinizing hormone (LH) in the follicular phase of stimulation can have a negative effect on oocyte quality, pregnancy rate and incidence of miscarriage. The aim of the present study was to examine the effects of highly purified follicle stimulating hormone (FSH HP) on ovarian stimulation and particularly on nuclear maturity and morphological appearance of the oocyte in intracytoplasmic sperm injection (ICSI) therapy and to compare the results with human menopausal gonadotrophin (HMG) stimulation. For this purpose, 50 patients for ICSI (HMG: 30; FSH HP: 20) and 26 patients for in-vitro fertilization (TVF; HMG: 14, FSH HP: 12) were stimulated with either HMG of FSH HP using a short-term protocol. Patients were divided into the two groups according to the first letter of their family name. No differences were observed among the groups in relation to patient age, duration of stimulation, number of aspirated oocytes or maturity of the oocyte-cumulus complex. After removal of the cumulus-corona cells in the ICSI oocytes, a significantly higher proportion of oocytes in the FSH HP group were nuclear mature (metaphase II) than in the HMG group (FSH HP: 88.8%, HMG: 80.6%; P = 0.009). Furthermore, in the FSH HP group, significantly fewer oocytes with dark cytoplasm were observed (FSH HP: 14.4%, HMG: 22.4%; P = 0.02). Fertilization, cleavage and pregnancy rates (FSH HP 38%, HMG: 34% per retrieval) were comparable in both groups. Based on the results obtained, it can be concluded that the short-term FSH HP treatment protocol synchronizes oocyte maturation better than comparable stimulation with HM

Ja zu einer zeitgemässen Fortpflanzungsmedizin

Am 14. Juni 2015 wird über die Änderung des Artikels 119 der Bundesverfassung (BV) abgestimmt. Die Annahme dieser Änderung ist nicht nur für die Zulassung der Präimplantationsdiagnostik (PID) unabdingbar, sondern schafft ganz grundsätzlich den gesetzlichen Rahmen für die Durchführung einer zeitgemässen Reproduktionsmedizin. Letztere wird nicht nur eine effizientere Behandlung ermöglichen, sondern auch Komplikationen für Mutter und Kind vermeiden helfen

Abnormal chromosomal arrangements in human oocytes

Ninety-one human oocytes, lacking signs of fertilization 50 h after insemination in vitro, were investigated cytogenetically to assess the frequency and type of chromosomal abnormalities. Chromosome spreading permitted adequate karyotyping in 55 oocytes. Non-determined numerical aberrations occurred with the following frequencies: hypohaploidy, 10.9% (6/55), hyperhapJoidy, 14.5% (8/55) and hyperdiploidy, 3.6% (2/55). Total aneuploidy occurred with a frequency of 29.1% and was observed in oocytes from 30 patients. No correlation was found between specific chromosomal aberrations and type of infertility, stimulation treatment or gonadotrophin levels. On the other hand, the frequency of aneuploidy was significantly higher (P 35 years of age. Two chromosomal complements (3.6%) had structural rearrangements; one oocyte had both structural and numerical chromosomal abnormalities and the other had differently condensed regions on the long arms of three chromosomes from group C. The overall frequency of chromosomal aberrations was 32.7%. Only two samples contained an additional set of polar body chromosomes. Thirteen oocytes presented sperm chromosomes in an arrested stage of premature chromosome condensation of the G1, phase and four oocytes showed asynchronous condensation of pronuclear chromosomes. Finally, it was concluded that the high proportion of chromosomal aberrations observed in human oocytes may contribute significantly to abnormal embryonic development in vitr

Identification of nitric oxide synthase in human and bovine oviduct

Nitric oxide synthase (NOS) is responsible for the biological production of nitric oxide (NO) in several organs. NOS activity has also been localized in the reproductive tract, although direct evidence for its presence in the human or bovine oviduct is still lacking. In the present study, four different techniques were used to identify the presence of NOS activity in human (n = 11) and bovine (n = 9) oviduct: (i) conversion of [3H]-L-arginine to [3H]-L-citrulline; (ii) production of nitrite/nitrate (NO2/NO3; stable NO metabolites); (iii) identification of NADPH-diaphorase activity; and (iv) immunostaining with antiserum to endothelial NOS. Cytosolic extracts from human ampullary segments of the Fallopian tube, obtained from post-partum patients (n = 4), converted [3H]-L-arginine to [3H]-L-citrulline (21.0 ± 8.8 fmol/mg protein/min). This conversion rate was significantly (P <0.05) reduced in the presence of either EDTA or N-monomethyl-L-arginine monoacetate (L-NMMA), an inhibitor of NOS activity. When bovine (n = 3) ampullary segments were incubated for 36 h in Hanks' balanced salt solution, the concentration of NO2/NO3 in the medium was increased (P <0.05) if segments were pretreated with lipopolysaccharide (LPS; an inducer of inducible NOS), but not after treatment with LPS + L-NMMA. Additionally, epithelial cells cultured from ampullary segments showed positive staining both for NADPH-diaphorase activity and with antiserum to endothelial NOS. The results of the present study provide direct evidence for the presence of both the Ca2+ -dependent constitutive form of NOS, as well as the inducible form of NOS activity in human and bovine oviduct. Since the oviduct plays a key role in the reproductive process, it is possible that the two forms of NOS may be involved in the physiological regulation of oviduct functio

Особенности ВЭД по закупке шкур животных на международных аукционах для переработки на территории ТС

Актуальность выбранной темы обусловлена тем, что особое место на российском рынке верхней одежды приходится на меховое сырье и изделия из него. С одной стороны, в условиях суровых климатических условий делают меховую одежду в России незаменимой и обеспечивают высокий спрос на эти дорогостоящие изделия в зимний период. С другой стороны, меховые изделия являются самыми дорогостоящими по сравнению с другими товарами легкой промышленности и относятся к товарам класса "люкс", т. е. к предметам роскоши. Были исследованы законодательная база, а так же товарная номенклатура мехового сырья. Проанализированы проблемы и тенденции в данной области. Итогом работы являются рекомендации, разработанные для улучшения текущей обстановки в сфере мехового сырья.The relevance of the chosen topic is due to the fact that the special place in the Russian market of outerwear is for fur raw materials and products from it. On the one hand, in conditions of severe climatic conditions, fur clothing in Russia is indispensable and provides a high demand for these expensive products in the winter. On the other hand, fur products are the most expensive compared to other products of light industry and belong to luxury goods, ie, to luxury goods. Legislative base, as well as commodity nomenclature of fur raw materials were investigated. The problems and trends in this area are analyzed. The result of the work are recommendations developed to improve the current situation in the field of fur raw materials

Recommendations for raloxifene use in daily clinical practice in the Swiss setting

Background/aim: Raloxifene is the first selective estrogen receptor modulator that has been approved for the treatment and prevention of osteoporosis in postmenopausal women in Europe and in the US. Although raloxifene reduces the risk of invasive breast cancer in postmenopausal women with osteoporosis and in postmenopausal women at high risk for invasive breast cancer, it is approved in that indication in the US but not in the EU. The aim was to characterize the clinical profiles of postmenopausal women expected to benefit most from therapy with raloxifene based on published scientific evidence to date. Methods: Key individual patient characteristics relevant to the prescription of raloxifene in daily practice were defined by a board of Swiss experts in the fields of menopause and metabolic bone diseases and linked to published scientific evidence. Consensus was reached about translating these insights into daily practice. Results: Through estrogen agonistic effects on bone, raloxifene reduces biochemical markers of bone turnover to premenopausal levels, increases bone mineral density (BMD) at the lumbar spine, proximal femur, and total body, and reduces vertebral fracture risk in women with osteopenia or osteoporosis with and without prevalent vertebral fracture. Through estrogen antagonistic effects on breast tissue, raloxifene reduces the risk of invasive estrogen-receptor positive breast cancer in postmenopausal women with osteoporosis and in postmenopausal women at high risk for invasive breast cancer. Finally, raloxifene increases the incidence of hot flushes, the risk of venous thromboembolic events, and the risk of fatal stroke in postmenopausal women at increased risk for coronary heart disease. Postmenopausal women in whom the use of raloxifene is considered can be categorized in a 2×2 matrix reflecting their bone status (osteopenic or osteoporotic based on their BMD T-score by dual energy X-ray absorptiometry) and their breast cancer risk (low or high based on the modified Gail model). Women at high risk of breast cancer should be considered for treatment with raloxifene. Conclusion: Postmenopausal women between 50 and 70years of age without climacteric symptoms with either osteopenia or osteoporosis should be evaluated with regard to their breast cancer risk and considered for treatment with raloxifene within the framework of its contraindications and precaution