Browsing by Subject "Estrogen Replacement Therapy"

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    Commentary: Launch of a quality improvement network for evidence-based management of uncommon pediatric endocrine disorders: Turner syndrome as a prototype
    (Oxford University Press, 2015-04) Rosenfeld, Robert L.; DiMeglio, Linda A.; Mauras, Nelly; Ross, Judith; Shaw, Natalie D.; Greeley, Siri A.W.; Haymond, Morey; Rubin, Karen; Rhodes, Errin T.; Medicine, School of Medicine
    BACKGROUND: Traditional, hypothesis-oriented research approaches have thus far failed to generate sufficient evidence to achieve consensus about the management of children with many endocrine disorders, partly because of the rarity of these disorders and because of regulatory burdens unique to research in children. OBJECTIVE: The Pediatric Endocrine Society is launching a quality improvement network in spring 2015 for the management of pediatric endocrine disorders that are relatively uncommon in any single practice and/or for which there is no consensus on management. DESIGN: The first of the quality improvement programs to be implemented seeks to improve the care of 11- to 17-year-old girls with Turner syndrome who require initiation of estrogen replacement therapy by providing a standardized clinical assessment and management plan (SCAMP) for transdermal estradiol treatment to induce pubertal development. The SCAMP algorithm represents a starting point within current best practice that is meant to undergo refinement through an iterative process of analysis of deidentified data collected in the course of clinical care by a network of pediatric endocrinologists. CONCLUSION: It is anticipated that this program will not only improve care, but will also result in actionable data that will generate new research hypotheses and changes in management of pediatric endocrine disorders.
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    Menopause and Big Data: Word Adjacency Graph Modeling of Menopause-Related ChaCha® Data
    (Wolters Kluwer, 2017-07) Carpenter, Janet S.; Groves, Doyle; Chen, Chen X.; Otte, Julie L.; Miller, Wendy; School of Nursing
    OBJECTIVE: To detect and visualize salient queries about menopause using Big Data from ChaCha. METHODS: We used Word Adjacency Graph (WAG) modeling to detect clusters and visualize the range of menopause-related topics and their mutual proximity. The subset of relevant queries was fully modeled. We split each query into token words (ie, meaningful words and phrases) and removed stopwords (ie, not meaningful functional words). The remaining words were considered in sequence to build summary tables of words and two and three-word phrases. Phrases occurring at least 10 times were used to build a network graph model that was iteratively refined by observing and removing clusters of unrelated content. RESULTS: We identified two menopause-related subsets of queries by searching for questions containing menopause and menopause-related terms (eg, climacteric, hot flashes, night sweats, hormone replacement). The first contained 263,363 queries from individuals aged 13 and older and the second contained 5,892 queries from women aged 40 to 62 years. In the first set, we identified 12 topic clusters: 6 relevant to menopause and 6 less relevant. In the second set, we identified 15 topic clusters: 11 relevant to menopause and 4 less relevant. Queries about hormones were pervasive within both WAG models. Many of the queries reflected low literacy levels and/or feelings of embarrassment. CONCLUSIONS: We modeled menopause-related queries posed by ChaCha users between 2009 and 2012. ChaCha data may be used on its own or in combination with other Big Data sources to identify patient-driven educational needs and create patient-centered interventions.
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    The Effect of Estrogen Repletion on Osteoblast Differentiation and DNA Synthesis in Ovariectomized Rats
    (1995) Miller, Ronald L.; Garetto, Lawrence P.; Bidwell, Joseph; Katona, Thomas R.; Roberts, W. Eugene; Shanks, James; Wohlford, Mark E.
    Previous studies have demonstrated that estrogen plays a significant role in bone mass conservation. To investigate the role that estrogen plays in osteoblast differentiation, the fractional distribution of periodontal ligament (PDL) osteoblast precursor cells was determined. Twenty six-month old female rats (Charles River Co.) were divided into two groups. Both groups were ovariectomized (OVX). Thirty-five days after ovariectomy one group (OVX+E) received supplemental daily injections of estrogen (0. 1 mg/kg Ethinyl Estradiol) for three days. After sacrifice, PDL sections through the mesial root of the maxillary first molar were prepared for microscopic analysis. Using a nuclear morphometric assay, the fibroblast-like cells of the POL were identified as early osteoprogenitor (A+A'), preosteoblast (C+D) or nonosteogenic (B) cells (i.e., A+A'=40-79 μm3; 8=80-119 μm3; C+D>120 μm3). Comparison of the OVX and OVX+E groups showed that treatment with estrogen increased early osteoprogenitor (A+A') cell and decreased preosteoblast (C+D) cell fractional distributions. No changes were seen in the non-osteogenic (B) cell group (expressed as% cell type, mean±SEM for n=4-8 rats/group; *p<0.05). Specimens were also stained with 5-Bromo- 2'-deoxyuridine (BrdU) to localize cells undergoing DNA synthesis. Both OVX and OVX+E groups showed minimal random BrdU staining throughout the PDL. Group= OVX A+A’= 8.8 ± 1.8 B= 30.2 ± 2.3 C+D= 60.8 ± 2.6 Group= OVX+E A+A’= 21.9 ± 2.6* B= 36.0 ± 2.2 C+D= 41.6 ± 3.8* The data suggest a block in proliferation of both less-differentiated precursor cells and preosteoblasts in estrogen-deficient animals. Furthermore, they suggest that estrogen may be required for normal preosteoblast differentiation leading to osteoblast production.