Allelic variants of the estrogen receptor genes and frailty phenotype in postmenopausal women.

OBJECTIVE: The prevalence of frailty has been related to menopause. Our main objective was to investigate whether single nucleotide polymorphisms (SNPs) of the estrogen receptor (ER) ERα and ERß genes were related to the frailty phenotype in a population of community-dwelling postmenopausal women. METHODS: A cross-sectional study was performed in which we selected five SNPs, three in the ERα gene and two in the ERß. Linear regression was used to estimate the percentage of phenotypic variance after adjusting for confounding variables. RESULTS: A total of 470 women (mean ± standard deviation age 63.83 ± 8.16 years) were included, of whom 137 women were frail. The SNP rs3798577 of the ERα gene was the only variant associated with frailty, but this significance faded in the multivariant analysis. Body mass index (p = 0.012), number of comorbidities (0 vs. ≥2, p = 0.002) and two reproductive variables, number of miscarriages (none vs. ≥2, p = 0.036) and of childbirths (one vs. ≥3, p = 0.008), were independently related to frailty. CONCLUSION: The five SNPs of the ERα and ERß genes tested were not correlated with frailty. Other SNPs of the ER warrant analysis to clarify whether variance in the gene response affects frailty status.

ClinPrior: an algorithm for diagnosis and novel gene discovery by network-based prioritization.

BACKGROUND: Whole-exome sequencing (WES) and whole-genome sequencing (WGS) have become indispensable tools to solve rare Mendelian genetic conditions. Nevertheless, there is still an urgent need for sensitive, fast algorithms to maximise WES/WGS diagnostic yield in rare disease patients. Most tools devoted to this aim take advantage of patient phenotype information for prioritization of genomic data, although are often limited by incomplete gene-phenotype knowledge stored in biomedical databases and a lack of proper benchmarking on real-world patient cohorts. METHODS: We developed ClinPrior, a novel method for the analysis of WES/WGS data that ranks candidate causal variants based on the patient's standardized phenotypic features (in Human Phenotype Ontology (HPO) terms). The algorithm propagates the data through an interactome network-based prioritization approach. This algorithm was thoroughly benchmarked using a synthetic patient cohort and was subsequently tested on a heterogeneous prospective, real-world series of 135 families affected by hereditary spastic paraplegia (HSP) and/or cerebellar ataxia (CA). RESULTS: ClinPrior successfully identified causative variants achieving a final positive diagnostic yield of 70% in our real-world cohort. This includes 10 novel candidate genes not previously associated with disease, 7 of which were functionally validated within this project. We used the knowledge generated by ClinPrior to create a specific interactome for HSP/CA disorders thus enabling future diagnoses as well as the discovery of novel disease genes. CONCLUSIONS: ClinPrior is an algorithm that uses standardized phenotype information and interactome data to improve clinical genomic diagnosis. It helps in identifying atypical cases and efficiently predicts novel disease-causing genes. This leads to increasing diagnostic yield, shortening of the diagnostic Odysseys and advancing our understanding of human illnesses.

Nerve gaps repaired with acellular nerve allografts recellularized with Schwann-like cells: Preclinical trial.

BACKGROUND: Acellular nerve allografts (ANA) recellularized with mesenchymal stem cells (MSC) or Schwann cells (SC) are, at present, a therapeutic option for peripheral nerve injuries (PNI). This study aimed to evaluate the regenerative and functional capacity of a recellularized allograft (RA) compared with autograft nerve reconstruction in PNI. METHODS: Fourteen ovines were randomly included in two groups (n=7). A peroneal nerve gap 30 mm in length was excised, and nerve repair was performed by the transplantation of either an autograft or a recellularized allograft with SC-like cells. Evaluations included a histomorphological analysis of the ANA, MSC pre differentiated into SC-like cells, at one year follow-up functional limb recovery (support and gait), and nerve regeneration using neurophysiological tests and histomorphometric analysis. All evaluations were compared with the contralateral hindlimb as the control. RESULTS: The nerve allograft was successfully decellularized and more than 70% of MSC were pre differentiated into SC-like cells. Functional assessment in both treated groups improved similarly over time (p <0.05). Neurophysiological results (latency, amplitude, and conduction velocity) also improved in both treated groups at twelve months. Histological results demonstrated a less organized arrangement of nerve fibers (p <0.05) with an active remyelination process (p <0.05) in both treated groups compared with controls at twelve months. CONCLUSIONS: ANA recellularized with SC-like cells proved to be a successful treatment for nerve gaps. Motor recovery and nerve regeneration were satisfactorily achieved in both graft groups compared with their contralateral nontreated nerves. This approach could be useful for the clinical therapy of PNI.

Dentate Gyrus Somatostatin Cells are Required for Contextual Discrimination During Episodic Memory Encoding.

Memory systems ought to store and discriminate representations of similar experiences in order to efficiently guide future decisions. This problem is solved by pattern separation, implemented in the dentate gyrus (DG) by granule cells to support episodic memory formation. Pattern separation is enabled by tonic inhibitory bombardment generated by multiple GABAergic cell populations that strictly maintain low activity levels in granule cells. Somatostatin-expressing cells are one of those interneuron populations, selectively targeting the distal dendrites of granule cells, where cortical multimodal information reaches the DG. Nonetheless, somatostatin cells have very low connection probability and synaptic efficacy with both granule cells and other interneuron types. Hence, the role of somatostatin cells in DG circuitry, particularly in the context of pattern separation, remains uncertain. Here, by using optogenetic stimulation and behavioral tasks in mice, we demonstrate that somatostatin cells are required for the acquisition of both contextual and spatial overlapping memories.

[How to manage risk in the surgical area. A Modal Analysis of Failures and Surgical Effects]. / Cómo gestionar el riesgo en el área quirúrgica. Análisis modal de fallos y efectos quirúrgicos.

OBJECTIVE: First to identify the areas of improvement in the surgical area before and during the performance of a surgical procedure in general surgery through the application of a Modal Analysis of Failures and Effects. Second to establish preventive measures to avoid adverse events in the surgical area. METHOD: A multidisciplinary working group was created in a university hospital for risk management in the General Surgery Operating Room Unit. The Modal Analysis of Faults and Effects was used. Potential risks for the patient in the ante-surgery and within the operating room were identified. The Risk Priority Index was calculated and preventive measures were established for all of them, with special interest when the Risk Priority Index was higher than 100. Preventive measures were developed based on the detected risks as well as those responsible for them. RESULTS: We identified a greater number of risks when the patient is in the operating room than in the ante-surgery room. Those with a higher risk priority index were: anticoagulated or antiaggregated patients, urinary tract infections, osteoarticular or neuropathic problems, patients not prepared for colon surgery, errors in laterality and leaving compresses in the operative field. CONCLUSIONS: A risk map has been developed in our organization, allowing the design of strategies to improve Patient Safety in the Surgical area. Training is a key aspect to improve Patient Safety.

The appearance of malnutrition in hematological inpatients prolongs hospital stay: the need for nutritional surveillance during hospitalization / La aparición de desnutrición en el paciente hematológico ingresado alarga la estancia: la necesidad de vigilancia nutricional en el ingreso

Introduction: oncohematological diseases are associated with a high prevalence of malnutrition during hospitalization. Our aim was to analyze the appearance and repercussions of malnutrition in well-nourished hematological inpatients at admission. Method: a prospective one-year study conducted in hematology inpatients. The Malnutrition Screening Tool (MST) was used at admission and repeated weekly. Patients with a negative screening at admission who developed malnutrition during hospitalization constituted our study sample. A nutritional evaluation and intervention was performed. We also analyzed the effect of newly diagnosed malnutrition on patients’ outcomes in comparison with the outcomes of patients that remained well-nourished during hospitalization. Results: twenty-one percent of hematological inpatients who were well nourished at admission developed malnutrition during hospitalization. Of the patients, 62.4% needed a nutritional intervention (100% oral supplements, 21.4% diet changes, 5.2% parenteral nutrition). After intervention, an increase in real intake was achieved (623 kcal and 27.3 g of protein/day). Weight loss was slowed and visceral protein was stabilized. Length of stay was 8.5 days longer for our sample than for well-nourished patients. Conclusions: newly diagnosed malnutrition appeared in one in five hematological well-nourished inpatients, leading to a longer length of stay. Nutritional intervention improved intake and nutritional status. Nutritional surveillance should be mandatory

Introducción: las enfermedades oncohematológicas asocian una elevada prevalencia de malnutrición, especialmente durante la hospitalización. Objetivo: analizar la aparición de malnutrición y su repercusión en pacientes normonutridos al ingreso. Métodos: estudio prospectivo de un año en una cohorte de ingresados hematológicos. El Malnutrition Screening Tool (MST) se realizó al ingreso, repitiéndose semanalmente. Los pacientes con cribado negativo al ingreso que desarrollaron malnutrición durante la hospitalización constituyeron nuestra muestra. Se realizó evaluación e intervención nutricional, analizando el efecto de la aparición de malnutrición en el pronóstico, comparado con los pacientes que permanecieron normonutridos. Resultados: el 21% de los pacientes normonutridos al ingreso desarrolló malnutrición en la hospitalización. El 62.4% precisó intervención nutricional (100% suplementos orales, 21,4% cambios dietéticos, 5.2% nutrición parenteral). La intervención logró un aumento de ingesta real de 623 kcal y 27,3 g proteína/día, frenando la pérdida de peso y estabilizando las proteínas viscerales. La estancia fue 8,5 días mayor en nuestra muestra que en los pacientes que permanecieron normonutridos. Conclusiones: uno de cada cinco ingresados normonutridos al ingreso desarrolló malnutrición en la hospitalización, asociando mayor estancia. La intervención nutricional puede mejorar la ingesta y el estado nutricional, por tanto, la vigilancia nutricional debería ser obligatoria

The appearance of malnutrition in hematological inpatients prolongs hospital stay: the need for nutritional surveillance during hospitalization.

INTRODUCTION: Introduction: oncohematological diseases are associated with a high prevalence of malnutrition during hospitalization. Our aim was to analyze the appearance and repercussions of malnutrition in well-nourished hematological inpatients at admission. Method: a prospective one-year study conducted in hematology inpatients. The Malnutrition Screening Tool (MST) was used at admission and repeated weekly. Patients with a negative screening at admission who developed malnutrition during hospitalization constituted our study sample. A nutritional evaluation and intervention was performed. We also analyzed the effect of newly diagnosed malnutrition on patients' outcomes in comparison with the outcomes of patients that remained well-nourished during hospitalization. Results: twenty-one percent of hematological inpatients who were well nourished at admission developed malnutrition during hospitalization. Of the patients, 62.4% needed a nutritional intervention (100% oral supplements, 21.4% diet changes, 5.2% parenteral nutrition). After intervention, an increase in real intake was achieved (623 kcal and 27.3 g of protein/day). Weight loss was slowed and visceral protein was stabilized. Length of stay was 8.5 days longer for our sample than for well-nourished patients. Conclusions: newly diagnosed malnutrition appeared in one in five hematological well-nourished inpatients, leading to a longer length of stay. Nutritional intervention improved intake and nutritional status. Nutritional surveillance should be mandatory.

INTRODUCCIÓN: Introducción: las enfermedades oncohematológicas asocian una elevada prevalencia de malnutrición, especialmente durante la hospitalización. Objetivo: analizar la aparición de malnutrición y su repercusión en pacientes normonutridos al ingreso. Métodos: estudio prospectivo de un año en una cohorte de ingresados hematológicos. El Malnutrition Screening Tool (MST) se realizó al ingreso, repitiéndose semanalmente. Los pacientes con cribado negativo al ingreso que desarrollaron malnutrición durante la hospitalización constituyeron nuestra muestra. Se realizó evaluación e intervención nutricional, analizando el efecto de la aparición de malnutrición en el pronóstico, comparado con los pacientes que permanecieron normonutridos. Resultados: el 21% de los pacientes normonutridos al ingreso desarrolló malnutrición en la hospitalización. El 62.4% precisó intervención nutricional (100% suplementos orales, 21,4% cambios dietéticos, 5.2% nutrición parenteral). La intervención logró un aumento de ingesta real de 623 kcal y 27,3 g proteína/día, frenando la pérdida de peso y estabilizando las proteínas viscerales. La estancia fue 8,5 días mayor en nuestra muestra que en los pacientes que permanecieron normonutridos. Conclusiones: uno de cada cinco ingresados normonutridos al ingreso desarrolló malnutrición en la hospitalización, asociando mayor estancia. La intervención nutricional puede mejorar la ingesta y el estado nutricional, por tanto, la vigilancia nutricional debería ser obligatoria.

Using deep neural networks along with dimensionality reduction techniques to assist the diagnosis of neurodegenerative disorders.

The analysis of neuroimaging data is frequently used to assist the diagnosis of neurodegenerative disorders such as Alzheimer's disease (AD) or Parkinson's disease (PD) and has become a routine procedure in the clinical practice. During the past decade, the pattern recognition community has proposed a number of machine learning-based systems that automatically analyse neuroimaging data in order to improve the diagnosis. However, the high dimensionality of the data is still a challenge and there is room for improvement. The development of novel classification frameworks as TensorFlow, recently released as open source by Google Inc., represents an opportunity to continue evolving these systems. In this work, we demonstrate several computer-aided diagnosis (CAD) systems based on Deep Neural Networks that improve the diagnosis for AD and PD and outperform those based on classical classifiers. In order to address the small sample size problem we evaluate two dimensionality reduction algorithms based on Principal Component Analysis and Non-Negative Matrix Factorization (NNMF), respectively. The performance of developed CAD systems is assessed using 4 datasets with neuroimaging data of different modalities.

How to Improve Speaking Skills in Plastic Surgery Training? Survey in Residents Participants in Pecha Kucha Contest.

BACKGROUND: Little is known about educational games in Plastic Surgery training. Pecha kucha game has proved to be helpful tool to improve communicative skills. This study survey in resident participants in Pecha Kucha contest assessed how to improve speaking skills in plastic surgery training. METHODS: In the second edition of Pecha Kucha contest of the Mexican Society of Plastic Surgery, a survey was conducted with the residents to know the utility of this educational game. RESULTS: Twenty-six residents participated in the survey. Most of them from the Universidad Nacional Autonoma de México. Most of the residents considered it to be a good tool in order to improve communication skills and helpful for their future practice. The amount of time to present an idea was considered enough to express an idea. The most common proportion between words and images was 20-80% in the presentation. CONCLUSION: Pecha Kucha helped to improve communication skills during residents' training. We encourage other plastic surgery societies to incorporate educational games in their national and international meetings.

The hip fracture surgery in elderly patients (HIPELD) study to evaluate xenon anaesthesia for the prevention of postoperative delirium: a multicentre, randomized clinical trial.

BACKGROUND: Postoperative delirium occurs frequently in elderly hip fracture surgery patients and is associated with poorer overall outcomes. Because xenon anaesthesia has neuroprotective properties, we evaluated its effect on the incidence of delirium and other outcomes after hip fracture surgery. METHODS: This was a phase II, multicentre, randomized, double-blind, parallel-group, controlled clinical trial conducted in hospitals in six European countries (September 2010 to October 2014). Elderly (≥75yr-old) and mentally functional hip fracture patients were randomly assigned 1:1 to receive either xenon- or sevoflurane-based general anaesthesia during surgery. The primary outcome was postoperative delirium diagnosed through postoperative day 4. Secondary outcomes were delirium diagnosed anytime after surgery, postoperative sequential organ failure assessment (SOFA) scores, and adverse events (AEs). RESULTS: Of 256 enrolled patients, 124 were treated with xenon and 132 with sevoflurane. The incidence of delirium with xenon (9.7% [95% CI: 4.5 -14.9]) or with sevoflurane (13.6% [95% CI: 7.8 -19.5]) were not significantly different (P=0.33). Overall SOFA scores were significantly lower with xenon (least-squares mean difference: -0.33 [95% CI: -0.60 to -0.06]; P=0.017). For xenon and sevoflurane, the incidence of serious AEs and fatal AEs was 8.0% vs 15.9% (P=0.05) and 0% vs 3.8% (P=0.06), respectively. CONCLUSIONS: Xenon anaesthesia did not significantly reduce the incidence of postoperative delirium after hip fracture surgery. Nevertheless, exploratory observations concerning postoperative SOFA-scores, serious AEs, and deaths warrant further study of the potential benefits of xenon anaesthesia in elderly hip fracture surgery patients. CLINICAL TRIAL REGISTRATION: EudraCT 2009-017153-35; ClinicalTrials.gov NCT01199276.

A translational approach from an animal model identifies CD80 as a candidate gene for the study of bone phenotypes in postmenopausal women.

This study represented a translational study that first compared gene expression of B cells of BM from ovariectomized and control mice, and then analyzed some of the differentially expressed genes in women. Results showed novel genetic associations with bone phenotypes and points to the CD80 gene as relevant in postmenopausal bone loss. INTRODUCTION: Osteoporosis is a multifactorial disease with a strong genetic component. However, to date, research into osteoporosis has only been able to explain a small part of its heritability. Moreover, several components of the immune system are involved in the regulation of bone metabolism. Among them, B cells occupy a prominent place. METHODS: The study consisted of two stages. In the first, gene expression in bone marrow B cells is compared between ovariectomized and SHAM control mice using microarrays. In the second, we studied the association of polymorphisms in some differentially expressed genes (DEG) in a cohort of postmenopausal women. RESULTS: The present study has found 2791 DEG (false discovery rate (FDR) <5%), of which 1569 genes were upregulated (56.2%) and 1122 genes (43.8%) were downregulated. Among the most altered pathways were inflammation, interleukin signaling, B cell activation, TGF-beta signaling, oxidative stress response, and Wnt-signaling. Sixteen DEG were validated by MALDI-TOF mass spectrometry or qPCR. The translational stage of the study genotyped nine single nucleotide polymorphisms (SNPs) of DEG or related and detected association with bone mineral density (BMD) (nominal P values), while adjusting for confounders, for SNPs in the CD80, CD86, and HDAC5 genes. In the logistic regression analysis adjusted for confounders, in addition to the SNPs in the aforementioned genes, the SNPs in the MMP9 and SOX4 genes were associated with an increased risk of osteoporosis. Finally, two SNPs (in the CD80 and SOX6 genes) were associated with an increased risk of bone fragility fracture (FF). However, after Bonferroni correction for multiple testing, only the association between CD80 with BMD and risk of osteoporosis remained significant. CONCLUSION: These results show that the use of animal models is an appropriate method for identifying genes associated with human bone phenotypes.

Genetic testing among Spanish pediatric neurologists: Knowledge, attitudes and practices.

Advances in genetic testing applied to child neurology have enabled the development of genetic tests with greater sensitivity in elucidating an etiologic diagnosis for common neurological conditions. The objective of the current study was to examine child neurologists' perspectives and insights into genetic testing. We surveyed 118 Spanish child neurologists, exploring their knowledge, attitudes, and practices concerning genetic tests. All of them had requested at least one genetic test in the past six months. Global developmental delay or intellectual disability in absence of a strong specific etiologic suspicion and autism spectrum disorders were the disorders for which genetic testing was most frequently requested. The most commonly requested genetic test was CGH-array. Overall, child neurologist perception of readiness for making genetic-related decisions was not bad, although many would like to have a greater support from geneticists and were interested in increasing the time dedicated to genetics within their continuing education program. These data have important implications for future practice, research, and education.

A modified chemical protocol of decellularization of rat sciatic nerve and its recellularization with mesenchymal differentiated schwann-like cells: morphological and functional assessments.

The functional reconstruction of large neural defects usually requires the use of peripheral nerve autografts, though these have certain limitations. As a result, interest in new alternatives for autograft development has risen. The acellular peripheral nerve graft is an alternative for peripheral nerve injury repair, but to date there is not a standardized chemical decellularization method widely accepted. The objective of this study was to propose a modified chemical protocol of decellularization of rat sciatic nerve and its recellularization in vitro with mesenchimal differentiated Schwann-like cells. After the transplantation, an evaluation of its regeneration was performed using morphological and functional tests. The study consisted of two phases; in phase 1, different concentrations and times of exposure of rat sciatic nerves to detergents were tested, to establish a modified chemical protocol for nerve decellularization. The chemical treatment with 3% triton X-100 and 4% sodium deoxycholate for 15 days allowed a complete decellularization whilst conserving the extracellular matrix of the harvested nerve. In phase 2, the decellularized and recellularized alografts were compared against autografts. The morphological analysis showed a higher positivity to specific myelin antibodies in the recellularized group compared to the autograft. There were no differences in this parameter between the control limb and the experimental limb (recellularized group). The functional analysis showed no statistical differences at week 15 in the Sciatic Function Index in the autograft group vs the other groups. This study sets the morphological and functional bases for posterior studies about nerve defects regeneration in humans.

Association of N-cadherin levels and downstream effectors of Rho GTPases with dendritic spine loss induced by chronic stress in rat hippocampal neurons.

Chronic stress promotes cognitive impairment and dendritic spine loss in hippocampal neurons. In this animal model of depression, spine loss probably involves a weakening of the interaction between pre- and postsynaptic cell adhesion molecules, such as N-cadherin, followed by disruption of the cytoskeleton. N-cadherin, in concert with catenin, stabilizes the cytoskeleton through Rho-family GTPases. Via their effector LIM kinase (LIMK), RhoA and ras-related C3 botulinum toxin substrate 1 (RAC) GTPases phosphorylate and inhibit cofilin, an actin-depolymerizing molecule, favoring spine growth. Additionally, RhoA, through Rho kinase (ROCK), inactivates myosin phosphatase through phosphorylation of the myosin-binding subunit (MYPT1), producing actomyosin contraction and probable spine loss. Some micro-RNAs negatively control the translation of specific mRNAs involved in Rho GTPase signaling. For example, miR-138 indirectly activates RhoA, and miR-134 reduces LIMK1 levels, resulting in spine shrinkage; in contrast, miR-132 activates RAC1, promoting spine formation. We evaluated whether N-cadherin/ß-catenin and Rho signaling is sensitive to chronic restraint stress. Stressed rats exhibit anhedonia, impaired associative learning, and immobility in the forced swim test and reduction in N-cadherin levels but not ß-catenin in the hippocampus. We observed a reduction in spine number in the apical dendrites of CA1 pyramidal neurons, with no effect on the levels of miR-132 or miR-134. Although the stress did not modify the RAC-LIMK-cofilin signaling pathway, we observed increased phospho-MYPT1 levels, probably mediated by RhoA-ROCK activation. Furthermore, chronic stress raises the levels of miR-138 in accordance with the observed activation of the RhoA-ROCK pathway. Our findings suggest that a dysregulation of RhoA-ROCK activity by chronic stress could potentially underlie spine loss in hippocampal neurons.

[Extrinsic allergic alveolitis: An initial form of presentation as a fever of unknown origin]. / Alveolitis alérgica extrínseca: forma de presentación inicial como fiebre de origen desconocido.

Extrinsic allergic alveolitis is characterised by an inflammatory immune process with pulmonary impairment caused by inhalation of organic dust. It is considered an occupational disease and is a very significant cause of temporary and permanent disability that can be prevented. The diagnosis is not often easy, but it is important to make it in the early stages, when the disease is still reversible.

Alveolitis alérgica extrínseca: forma de presentación inicial como fiebre de origen desconocido / Extrinsic allergic alveolitis: an initial form of presentation as a fever of unknown origin

La alveolitis alérgica extrínseca se caracteriza por un proceso inflamatorio inmunológico con afectación pulmonar producida por inhalación de polvo orgánico. Se considera una enfermedad laboral y es una causa muy importante de incapacidad transitoria y permanente que se puede evitar. Ocasionalmente el diagnóstico no es sencillo, pero es importante realizarlo en los primeros estadios, cuando todavía es reversible la enfermedad (AU)

Extrinsic allergic alveolitis is characterised by an inflammatory immune process with pulmonary impairment caused by inhalation of organic dust. It is considered an occupational disease and is a very significant cause of temporary and permanent disability that can be prevented. The diagnosis is not often easy, but it is important to make it in the early stages, when the disease is still reversible (AU)

Endometrial response to concurrent treatment with vaginal progesterone and transdermal estradiol.

ABSTRACT Objective To describe the effect of the intermittent administration of vaginal progesterone and a low-dose estradiol patch on endometrial stability, as assessed by the rate of amenorrhea and endometrial stimulation. Methods This was an open study in which 64 moderately symptomatic, postmenopausal women were treated in the outpatient clinic of our University Hospital for different intervals up to 1 year. The treatment consisted of a combination of patches delivering 25 µg/day estradiol and intravaginal pills containing 100 mg of micronized progesterone. Patches and pills were administered concomitantly in a twice-a-week protocol. The endometrial response was assessed by endovaginal ultrasound completed with suction biopsy when required. Results Both cumulative amenorrhea and no-bleeding rates increased progressively and reached 88.9% and 100.0%, respectively, by the 12th month. Isolated or repetitive episodes of bleeding, bleeding and spotting, or only spotting were reported by three, four, and 12 women, respectively. Endometrial thickness remained unaltered. Endometrium was atrophic in the seven women in whom a biopsy was performed. Conclusion The substantially reduced progestogen load determined by this combination achieved an acceptable incidence of spotting or bleeding when associated with a low estrogenic dose. There was no apparent endometrial stimulation. Additional studies are required to confirm this observation.

Association of ACACB polymorphisms with obesity and diabetes.

Acetyl-CoA carboxylase beta, encoded by the ACAB gene, plays an important role in the oxidation of fatty acids. The aim of this study was to check the hypothesis that allelic variants of ACACB influence the risk of obesity and type 2 diabetes mellitus. Twenty five tagging single nucleotide polymorphisms (SNPs) capturing common variants of the ACACB gene were selected and analyzed in two cohorts including 1695 postmenopausal women of the general population and in 161 women with severe obesity (BMI>35). In vitro binding of transcription factors was explored by electrophoretic mobility shift assays (EMSA). T alleles at the rs2268388 locus were overrepresented in women with severe obesity (18% vs. 10% in controls; OR 1.74 [95% confidence interval 1.30-2.47]), which was statistically significant after multiple-test adjustment (p=0.0004). Likewise, T alleles at the rs2268388 locus and C alleles at the rs2239607 locus were associated with diabetes, in the discovery as well as in the replication cohorts, even after women with severe obesity were excluded (OR 3.6 and 2.8, for TT and CC homozygotes, respectively). Allelic differences in the binding affinity for nuclear proteins were revealed in vitro by EMSA and competition experiments were consistent with the binding of glucorticoid receptor and serum response factor. In conclusion, common polymorphisms of ACACB gene are associated with obesity and, independently, with type 2 diabetes in postmenopausal women, suggesting that the activity of acetyl-CoA carboxylase beta plays an important role in these disorders related to energy metabolism.

The impact of chocolate on cardiovascular health.

Cardiovascular disease is the leading determinant of mortality and morbidity in women. Functional foods are attracting interest as potential regulators of the susceptibility to disease. Supported by epidemiological evidence, chocolate has emerged as a possible modulator of cardiovascular risk. Chocolate, or cocoa as the natural source, contains flavanols, a subclass of flavonoids. The latter years have witnessed an increasing number of experimental and clinical studies that suggest a protective effect of chocolate against atherogenesis. Oxidative stress, inflammation, and endothelial function define three biological mechanisms that have shown sensitivity to chocolate. Moreover, the consumption of chocolate has been involved in the protective modulation of blood pressure, the lipid profile, the activation of platelets, and the sensitivity to insulin. Dark chocolate seems more protective than milk or white chocolate. Despite this array of benefits, there is a lack of well designed clinical studies demonstrating cardiovascular benefit of chocolate. The high caloric content of chocolate, particularly of some less pure forms, imposes caution before recommending uncontrolled consumption.