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Sex Differences in Coronary Artery Disease: Insights From the KoRean wOmen'S chest pain rEgistry (KoROSE)

  • Hack-Lyoung Kim;Myung-A Kim
    • Korean Circulation Journal
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    • v.53 no.10
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    • pp.655-676
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    • 2023
  • Interest in sex differences in coronary artery disease (CAD) has been steadily increasing. Concurrently, most of the data on these differences have primarily been Western-oriented. The KoRean wOmen'S chest pain rEgistry (KoROSE), started in 2011, has since published numerous research findings. This review aims to summarize the reported differences between men and women in CAD, integrating data from KoROSE. Cardiovascular risk in postmenopausal women escalates dramatically due to the decrease in estrogen levels, which normally offer cardiovascular protective effects. Lower estrogen levels can lead to abdominal obesity, insulin resistance, increased blood pressure, and endothelial dysfunction in older women. Upon analyzing patients with CAD, women are typically older and exhibit more cardiovascular risk factors than men. Diagnosing CAD in women tends to be delayed due to their symptoms being more atypical than men's. While in-hospital outcome was similar between sexes, bleeding complications after percutaneous coronary intervention occur more frequently in women. The differences in long-term prognosis for CAD patients between men and women are still a subject of ongoing debate. Pregnancy and reproductive factors also play a significant role as risk factors for cardiovascular disease in women. A notable sex disparity exists, with women found to use fewer cardiovascular protective drugs and undergo fewer interventional or surgical procedures than men. Additionally, women participate less frequently than men in clinical research. Through concerted efforts to increase awareness of sex differences and mitigate sex disparity, personalized treatment can be provided. This approach can ultimately improve patient prognosis.

Clinico-Morphological Profile and Receptor Status in Breast Cancer Patients in a South Indian Institution

  • Ghosh, Saptarshi;Sarkar, Shreyasee;Simhareddy, Samara;Kotne, Sivasankar;Rao, Pammidimukkala Bramh Ananda;Turlapati, Satya Prakash Venkatachalam
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.18
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    • pp.7839-7842
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    • 2014
  • Background: Breast cancer is the most common malignancy in women worldwide and the second most common cancer in females in India. Receptor status may be important for survival. Objective: To analyse and correlate the clinical and morphological parameters with receptor status in breast carcinoma patients in a tertiary care institution in Southern India. Materials and Methods: This retrospective study involved 320 patients of breast cancer diagnosed in an oncology hospital over a period of $3^{1/2}$ years. Data was analysed using SPSS Version 21. Results: Some 60.6% patients with breast carcinomas belonged to the age group of 40 to 60 years. The most common histological type was infiltrating ductal carcinoma, not otherwise specified, accounting for 84.4% of patients. On immunohistochemistry, estrogen receptor (ER) and progesterone receptor (PR) were expressed in 56.3% and 53.1% of cases, respectively. Conclusions: Breast cancers in India, a developing country, occur in younger women and tend to be more aggressive with lower rates of ER and PR expression and higher histological tumor grades. Both ER and PR status of the tumors had significant associations with the patient age, pathological TNM stage and histological tumor grade.

Effects of the Mother-Medical Staff Partnership on Mothers' Condition Management Ability for Children with Chronic Allergic Diseases (만성 알레르기 질환 아동의 어머니-의료진 간 파트너십이 어머니의 아동 상태 관리능력에 미치는 영향)

  • Son, Hae Kyoung;Song, Hyo Bin;Kim, Dong Hee
    • Child Health Nursing Research
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    • v.24 no.1
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    • pp.101-108
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    • 2018
  • Purpose: This study aimed to identify the effects of the mother-medical staff partnership on mothers' condition management ability for children with chronic allergic diseases. Methods: A total of 109 Korean mothers caring for a child with a chronic allergic diseases, identified according to the allergic march, such as food allergy, atopic dermatitis, allergic rhinitis, and allergic asthma, were recruited from the pediatric department of a general hospital in Seoul through convenience sampling. Data were collected using structured self-reported questionnaires from August 1, 2017 to October 31, 2017. and analyzed by descriptive statistics and multiple regression using SPSS version 22.0. Results: The Mother-medical staff partnership had a statistically significant effect on mothers' condition management ability for children with chronic allergic diseases (p<.05). Among the general characteristics, satisfaction with nursing services had a statistically significant effect on mothers' condition management ability (p<.05). Conclusion: In conclusion, strategies to support children with chronic allergic diseases, as well as their caregivers, should consider the mother-medical staff partnership as part of a family-centered approach.

Fertility-sparing treatment in women with endometrial cancer

  • Won, Seyeon;Kim, Mi Kyoung;Seong, Seok Ju
    • Clinical and Experimental Reproductive Medicine
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    • v.47 no.4
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    • pp.237-244
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    • 2020
  • Endometrial cancer (EC) in young women tends to be early-stage and low-grade; therefore, such cases have good prognoses. Fertility-sparing treatment with progestin is a potential alternative to definitive treatment (i.e., total hysterectomy, bilateral salpingo-oophorectomy, pelvic washing, and/or lymphadenectomy) for selected patients. However, no evidence-based consensus or guidelines yet exist, and this topic is subject to much debate. Generally, the ideal candidates for fertility-sparing treatment have been suggested to be young women with grade 1 endometrioid adenocarcinoma confined to the endometrium. Magnetic resonance imaging should be performed to rule out myometrial invasion and extrauterine disease before initiating fertility-sparing treatment. Although various fertility-sparing treatment methods exist, including the levonorgestrel-intrauterine system, metformin, gonadotropin-releasing hormone agonists, photodynamic therapy, and hysteroscopic resection, the most common method is high-dose oral progestin (medroxyprogesterone acetate at 500-600 mg daily or megestrol acetate at 160 mg daily). During treatment, re-evaluation of the endometrium with dilation and curettage at 3 months is recommended. Although no consensus exists regarding the ideal duration of maintenance treatment after achieving regression, it is reasonable to consider maintaining the progestin therapy until pregnancy with individualization. According to the literature, the ovarian stimulation drugs used for fertility treatments appear safe. Hysterectomy should be performed after childbearing, and hysterectomy without oophorectomy can also be considered for young women. The available evidence suggests that fertility-sparing treatment is effective and does not appear to worsen the prognosis. If an eligible patient strongly desires fertility despite the risk of recurrence, the clinician should consider fertility-sparing treatment with close follow-up.

A Simple Dosing Scheme for Intravenous Busulfan Based on Retrospective Population Pharmacokinetic Analysis in Korean Patients

  • Choe, Sang-Min;Kim, Gayeong;Lim, Hyeong-Seok;Cho, Sang-Heon;Ghim, Jong-Lyul;Jung, Jin-Ah;Kim, Un-Jib;Noh, Gyu-Jeong;Bae, Kyun-Seop;Lee, Dong-Ho
    • The Korean Journal of Physiology and Pharmacology
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    • v.16 no.4
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    • pp.273-279
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    • 2012
  • Busulfan is an antineoplastic agent with a narrow therapeutic window. A post-hoc population pharmacokinetic analysis of a prospective randomized trial for comparison of four-times daily versus once-daily intravenous busulfan was carried out to search for predictive factors of intravenous busulfan (iBu) pharmacokinetics (PK). In this study the population PK of iBu was characterized to provide suitable dosing recommendations. Patients were randomized to receive iBu, either as 0.8 mg/kg every 6 h or 3.2 mg/kg daily over 4 days prior to hematopoietic stem cell transplantation. In total, 295 busulfan concentrations were analyzed with NONMEM. Actual body weight and sex were significant covariates affecting the PK of iBu. Sixty patients were included in the study (all Korean; 23 women, 37 men; mean [SD] age, 36.5 [10.9] years; weight, 66.5 [11.3] kg). Population estimates for a typical patient weighing 65 kg were: clearance (CL) 7.6 l/h and volume of distribution (Vd) 32.2 l for men and 29.1 L for women. Inter-individual random variabilities of CL and $V_d$ were 16% and 9%. Based on a CL estimate from the final PK model, a simple dosage scheme to achieve the target $AUC_{0-inf}$ (defined as median AUC0-inf with a once-daily dosage) of 26.18 $mg/l{\cdot}hr$, was proposed: $24.79{\cdot}ABW^{0.5}mg$ q24h, where ABW represents the actual body weight in kilograms. The dosing scheme reduced the unexplained interindividual variabilities of CL and Vd of iBu with ABW being a significant covariate affecting clearance of iBU. We propose a new simple dosing scheme for iBu based only on ABW.

Age of Diagnosis of Breast Cancer in China: Almost 10 Years Earlier than in the United States and the European Union

  • Song, Qing-Kun;Li, Jing;Huang, Rong;Fan, Jin-Hu;Zheng, Rong-Shou;Zhang, Bao-Ning;Zhang, Bin;Tang, Zhong-Hua;Xie, Xiao-Ming;Yang, Hong-Jian;He, Jian-Jun;Li, Hui;Li, Jia-Yuan;Qiao, You-Lin;Chen, Wan-Qing
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.22
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    • pp.10021-10025
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    • 2014
  • Background: The study aimed to describe the age distribution of breast cancer diagnosis among Chinese females for comparison with the United States and the European Union, and provide evidence for the screening target population in China. Materials and Methods: Median age was estimated from hospital databases from 7 tertiary hospitals in China. Population-based data in China, United States and European Union was extracted from the National Central Cancer Registry, SEER program and GLOBOCAN 2008, respectively. Age-standardized distribution of breast cancer at diagnosis in the 3 areas was estimated based on the World Standard Population 2000. Results: The median age of breast cancer at diagnosis was around 50 in China, nearly 10 years earlier than United States and European Union. The diagnosis age in China did not vary between subgroups of calendar year, region and pathological characteristics. With adjustment for population structure, median age of breast cancer at diagnosis was 50~54 in China, but 55~59 in United States and European Union. Conclusions: The median diagnosis age of female breast cancer is much earlier in China than in the United States and the European Union pointing to racial differences in genetics and lifestyle. Screening programs should start at an earlier age for Chinese women and age disparities between Chinese and Western women warrant further studies.

Breast Lesions in Adolescents and Young Women in Pakistan - a 5 Year Study of Significance of Early Recognition

  • Khurshid, Amna;Faridi, Naveen;Arif, Afreen M.;Naqvi, Hanna;Tahir, Muhammad
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.6
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    • pp.3465-3467
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    • 2013
  • Background: Breast cancer is the most frequent malignant disease amongst young women. If we review local data in Pakistan then breast cancer represents approximately a third of all cancers in females. The age standardized incidence rate (ASR) world per 100,000 is 53.8 and crude incidence rate is 30.9. We have observed during our surgical pathology practice and it is also reported by other Asian studies that breast carcinoma is amongst the leading malignancies in the region and the patients are at least a decade younger than counterparts in developed nations. Age is an important issue in effective screening, diagnosis and management of breast cancer, especially in this geographical region where late presentation and poor prognosis are a hallmark of the disease. Objective: The aim of this study is to determine the frequency of malignant breast lesions in symptomatic young females presenting with breast lumps. Materials and Methods: This is a retrospective study conducted at the Pathology Department, Liaquat National Hospital and Medical College, Karachi. Descriptive and pathology data of malignant breast tumors 1st January 2004 to 31st December 2009 were reviewed, using the departmental archived data. It included both male and female patients up to the age of 25 years. Results: A total of 714 surgical specimens from/of symptomatic breast lesions were received at the pathology department of Liaquat National Medical, in the five years study period, in young females. There were 575 (80%) benign, 119 (16%) inflammatory and 20 (2.8%) malignant lumps. Conclusions: The obtained data for females only up to 25 years of age suggest a massive burden which requires urgent attention. Early assessment of lesions is essential in order to avoid mortality from malignancies.

Clinical Characteristics and Treatment Result of Laryngeal Cysts (후두에 발생한 낭종의 임상양상 및 치료 결과)

  • Kim, Tae-Su;Kang, Woo-Suk;Choi, Seong-Ho;Roh, Jong-Lyel;Kim, Sang-Yoon;Nam, Soon-Yuhl
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.17 no.1
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    • pp.53-55
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    • 2006
  • Background and Objectives: The purposes of this study are to find out clinical causes, clinical characteristics and treatment outcomes in relation to anatomical location of laryngeal cyst. Subjects and Method: A retrospective study of medical records was carried out for 170 patients with cysts on vocal cord, epiglottis, vallecula, arytenoid and aryepiglottic fold. Results: There were 83 cases of epiglottic cysts, 41 cases of vallecular cysts, 35 cases of intracordal cysts, 3 cases of arytenoid cysts and 2 cases of aryepiglottic cysts. Laryngeal cysts were more common in men than in women, and the ratio between men and women was 2:1. The age of patients ranged from 7 to 90 years, with their average age being 52 years. The most common symptom was voice change at intracordal cysts and globus sensation at vallecular and epiglottic cysts. The most common cause of intracordal cysts were voice abuse. But other location of laryngeal cysts doesn't have common causes. The average size of cysts was 0.3cm at vocal cord, 1.43cm at epiglottis, 1.4cm at vallecula, 0.9cm at arytenoid and 1cm at aryepiglottis. Recurrence was observed in 7 cases from 1 months to 18 months following the operation. Size of all recurred cysts was over the average. Conclusion: Physicians should be aware of changes in clinical patterns of laryngeal cysts according to location and have long follow-up period at large cysts after operation.

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Descriptive Study on Sexuality for Women with Gynecological Cancer (부인암 여성의 성생활에 대한 서술적 연구)

  • Nho, Ju-Hee;Park, Young-Sook
    • Women's Health Nursing
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    • v.18 no.1
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    • pp.17-27
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    • 2012
  • Purpose: This study aimed to identify sexuality for women with gynecological cancer. Methods: A total of seven women with gynecological cancer agreed to participate in this study. The data were collected utilizing in-depth semi-structured interviews style. A descriptive study design was used in this study. The interviews were analyzed using inductive content analysis methodology. Results: Three themes identified were: 'women with gynecological cancer who give up their sexual life due to misunderstanding and fear', 'women with gynecological cancer who control their body and mind for recovery', 'women with gynecological cancer resume their sexual life with their partner's will'. Conclusion: To improve sexual health and quality of life for women with gynecological cancer, we need to develop programs related to sexual health. An adjusted sexual health program will contribute to increased sexual health and quality of life for women with gynecological cancer.

Clinicopathological Correlation of Cervical Carcinoma: A Tertiary Hospital Based Study

  • Shruthi, Pannayanapalya Suresh;Kalyani, Raju;Lee, Jun Kai;Narayanaswamy, Mariyappa
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.4
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    • pp.1671-1674
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    • 2014
  • Background: To study the clinical presentation of cervical carcinoma correlating with histopathological findings in a tertiary hospital situated in the southern part of India catering to rural and semi-urban populations Materials and Methods: 199 cases histopathologically diagnosed as cervical cancer over a period of one year were considered for the study. Clinical details of the patients were noted with the help of semi-structured proforma. The data was analysed by descriptive analysis using SPSS software. Results: Out of 199 patients, 109 had moderately differentiated squamous cell carcinoma, 51 poorly differentiated and 35 well differentiated. Adenocarcinomas numbered only four. 121 cases were in the age group of 40-59 years, 59 in 60-80 years and 19 in 20-39 years. All four cases of adenocarcinoma were seen between 40-59 years. 95 (47.7%) cases were in women who had 4 or more children, 120 presented with white discharge, 89 with bleeding per vagina and 68 had constitutional symptoms. Most of the patients with adenocarcinoma presented with bleeding per vagina. 151 was in stage IIIB, 29 in stage IIB, 14 in stage IVA and 5 in stage IB. Conclusions: Screening of cervical cancer should be emphasised in women with white discharge especially in rural areas for early detection of dysplastic cells and reduce mortality and morbidity in productive age. In addition health education has to be given to women regarding the awareness of hygiene, risk factors and symptoms of cervical cancer.