Association of hormone therapy and changes of objective sleep quality in women of late menopausal transition with sleep disorder: a preliminary study.

OBJECTIVE: The aim of this study was to investigate changes in objective sleep quality with hormone therapy (HT) in women with late menopausal transition. METHODS: Healthy midlife women with sleep difficulty who received HT were included. Those undergoing late menopausal transition were screened. Sleep patterns and self-reported questionnaires were collected before and 10 weeks after starting HT. RESULTS: Ten women who met the criteria (age, 50.1 ± 2.8 years) showed higher sleep efficiency and shorter wakefulness after sleep onset (WASO) 10 weeks after starting HT. However, no significant change was found in objective sleep quality after adjustment for multiple comparisons: sleep efficiency, 84.2 ± 7.7 versus 88.2% ± 4.7%, P = 0.037, adjusted P = 0.259; WASO, 59.0 ± 27.2 minutes versus 41.4 ± 17.4 minutes, P = 0.020, adjusted P = 0.140; average duration per awakening, 2.9 ± 1.0 minutes versus 2.2 ± 0.5 minutes, P = 0.033, adjusted P = 0.231. A better score of subjective sleep quality in the Pittsburgh Sleep Quality Index was observed 10 weeks after starting HT (2.0 ± 0.0 vs 1.2 ± 0.4, P = 0.006, adjusted P = 0.042), but sensitivity analysis did not show consistent results after adjustment for multiple comparisons (2.0 ± 0.0 vs 1.1 ± 0.4, P = 0.020, adjusted P = 0.140). Total scores of the Insomnia Severity Index and Menopause Rating Scale were better 10 weeks after starting HT (Insomnia Severity Index, 14.7 ± 3.0 vs 9.1 ± 3.8, P = 0.010; Menopause Rating Scale, 29.0 ± 5.2 vs 21.6 ± 3.0, P = 0.009) with consistent results in sensitivity analyses. There was no difference in the Epworth Sleepiness Scale before and after HT (7.2 ± 1.7 vs 8.6 ± 4.5, P = 0.309). The change in each objective sleep quality variable before and after HT showed strong positive or negative correlations with the change in only a few items in subjective sleep quality. CONCLUSION: Women in the late menopausal transition period showed higher sleep efficiency and shorter WASO after HT; however, multiple comparisons showed no statistically significant difference in objective sleep quality between before and after HT.

Reproductive Life Span and Severe Hypoglycemia Risk in Postmenopausal Women with Type 2 Diabetes Mellitus.

BACKGROUND: Estrogen promotes glucose homeostasis, enhances insulin sensitivity, and maintains counterregulatory responses in recurrent hypoglycemia in women of reproductive age. Postmenopausal women with type 2 diabetes mellitus (T2DM) might be more vulnerable to severe hypoglycemia (SH) events. However, the relationship between reproductive factors and SH occurrence in T2DM remains unelucidated. METHODS: This study included data on 181,263 women with postmenopausal T2DM who participated in a national health screening program from January 1 to December 31, 2009, obtained using the Korean National Health Insurance System database. Outcome data were obtained until December 31, 2018. Associations between reproductive factors and SH incidence were assessed using Cox proportional hazards models. RESULTS: During the mean follow-up of 7.9 years, 11,279 (6.22%) postmenopausal women with T2DM experienced SH episodes. A longer reproductive life span (RLS) (≥40 years) was associated with a lower SH risk compared to a shorter RLS (<30 years) (adjusted hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.69 to 0.80; P for trend <0.001) after multivariable adjustment. SH risk decreased with every 5-year increment of RLS (with <30 years as a reference [adjusted HR, 0.91; 95% CI, 0.86 to 0.95; P=0.0001 for 30-34 years], [adjusted HR, 0.80; 95% CI, 0.76 to 0.84; P<0.001 for 35-39 years], [adjusted HR, 0.74; 95% CI, 0.68 to 0.81; P<0.001 for ≥40 years]). The use of hormone replacement therapy (HRT) was associated with a lower SH risk than HRT nonuse. CONCLUSION: Extended exposure to endogenous ovarian hormone during lifetime may decrease the number of SH events in women with T2DM after menopause.

Salicylic acid-induced transcriptional reprogramming by the HAC-NPR1-TGA histone acetyltransferase complex in Arabidopsis.

Plant immunity depends on massive expression of pathogenesis-related genes (PRs) whose transcription is de-repressed by pathogen-induced signals. Salicylic acid (SA) acts as a major signaling molecule in plant immunity and systemic acquired resistance triggered by bacterial or viral pathogens. SA signal results in the activation of the master immune regulator, Nonexpressor of pathogenesis-related genes 1 (NPR1), which is thought to be recruited by transcription factors such as TGAs to numerous downstream PRs. Despite its key role in SA-triggered immunity, the biochemical nature of the transcriptional coactivator function of NPR1 and the massive transcriptional reprogramming induced by it remain obscure. Here we demonstrate that the CBP/p300-family histone acetyltransferases, HACs and NPR1 are both essential to develop SA-triggered immunity and PR induction. Indeed HACs and NPR1 form a coactivator complex and are recruited to PR chromatin through TGAs upon SA signal, and finally the HAC-NPR1-TGA complex activates PR transcription by histone acetylation-mediated epigenetic reprogramming. Thus, our study reveals a molecular mechanism of NPR1-mediated transcriptional reprogramming and a key epigenetic aspect of the central immune system in plants.

Association between menopausal symptoms and metabolic syndrome in postmenopausal women.

PURPOSE: Menopausal symptoms are major concerns of postmenopausal women. Metabolic syndrome (MetS) is a risk factor for cardiovascular disease, and menopause is associated with an increased prevalence of MetS. The purpose of this study was to determine the association between menopausal symptoms and MetS in postmenopausal women. METHODS: We selected 183 women who attended St. Vincent Hospital of the Catholic University of Korea in 2008 and 2009 and divided them into two groups (with and without MetS). Menopausal status was assessed with the Menopause Rating Scale (MRS) questionnaire. The body mass index and waist-to-hip ratio were determined, and the serum fasting glucose, lipid profile, and blood pressure were measured in all participants. RESULTS: Of 183 postmenopausal women, 64 (35.0%) had MetS. A significant increase was observed in the total MRS score and the total somatic symptom subscale score in the MetS group (p = 0.021, p = 0.043, respectively). Vasomotor symptoms such as hot flashes and sweating occurred with higher frequency in the MetS group than in those without MetS (p = 0.034). High triglyceride levels and an increase of the number of components of MetS were associated with a higher total subscale score of somatic symptoms (p = 0.044, p = 0.039, respectively). CONCLUSIONS: These results showed that a higher total subscale score and a higher frequency of somatic symptoms such as hot flashes and sweating were present in the MetS group. Larger scale studies are needed to clarify the association between other menopausal symptoms and MetS in postmenopausal women.

Comparison of selective uterine artery double ligation at the isthmic level of uterus and bipolar uterine artery coagulation in total laparoscopic hysterectomy.

In this article, we would like to compare the clinical characteristics and effectiveness of selective uterine artery double ligation and bipolar uterine artery coagulation in total laparoscopic hysterectomy (TLH) retrospectively. TLH was performed on 72 patients with selective uterine artery double ligation and on 312 patients with uterine artery bipolar coagulation in tertiary university hospital from January 2004 through January 2006. Both groups were similar with respect to age, body mass index, parities, rate of menopause and uterine weight. The mean transfusion, postoperative hospital stay and drain insertion in the selective uterine artery double ligation group were significantly lower than those in the bipolar uterine artery coagulation group in TLH, respectively (p < .05). There were no differences in the hemoglobin, hematocrite change, additional operations, operation time, rate of complication between the two kinds of operation (p > .05). In conclusion, selective uterine artery double ligation in TLH showed lower transfusion rate, less hospitalization and less discomfort due to drain than bipolar uterine artery coagulation. Also, it did not take a longer time for operation and thus provides a feasible and secure method to manage uterine vessels at the level of uterine isthmus inside of the broad ligament.

Antioxidant effect of estrogen on bovine aortic endothelial cells.

OBJECTIVE: This study discussed the role of estrogen as an antioxidant in the damage of vascular endothelial cells. DESIGN: We treated bovine aortic endothelial cells (bAEC) either with 1mM of H(2)O(2) alone or with 1 microM of 17beta-estradiol (E(2)) for 24h followed by 1mM of H(2)O(2) for 3h. The cell survival was evaluated by MTT assay, cellular apoptosis by fluorescence activated cell sorter (FACS) and Hoechst 33342 staining, oxidative stress by intracellular reactive oxygen species (ROS) and apoptosis after oxidative stress by western blotting for phospho-p38, p38, and Bcl-2. RESULTS: MTT assay showed that bAEC viability was reduced to 55.7+/-3.0% and 39.1+/-3.7% after 30 and 60 min of H(2)O(2) treatment, respectively. E(2) and H(2)O(2) treated cells did not show significant decrease in the cell survival. Similarly the FACS analysis and Hoechst 33342 stain showed that the latter decreased cellular apoptosis induced by H(2)O(2). Intracellular ROS increased by 181.6+/-68.9% in the former and by 37.0+/-3.9% in the latter (P<0.05). The expression of phospho-p38 mitogen-activated protein kinase (MAPK) was higher in the latter. CONCLUSIONS: E(2) mediates antioxidant effects on the oxidative stress induced by H(2)O(2). This antioxidant effect on bAEC may elucidate the scientific basis of hormone therapy for maintaining cardiovascular integrity in postmenopausal women.

Antioxidant effects of equol on bovine aortic endothelial cells.

This study is to examine the effects of equol on the H(2)O(2)-induced death of bovine aortic endothelial cells (bAECs) and the mechanism of its protective effects. MTT[3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide] assay showed that in the control group, cell survival rate decreased significantly, each in proportion to the duration of the H(2)O(2) stimulation (P<0.05), but, in the equol-pretreated group, such decrease was not statistically significant. After Hoechst 33342 staining, in the equol-pretreated group the number of cells with apoptotic morphology decreased significantly. Equol pretreatment effectively inhibited the H(2)O(2)-induced cell death by the reduction of intracellular ROS production (P<0.05). Incubation of bAECs with equol increased the expression of phospho-p38 MAPK and Bcl-2 after the H(2)O(2) exposure compared with their expression without the equol pretreatment. Furthermore, SB203580 inhibited phospho-p38 MAPK expression and increased apoptotic cell death. This study proves equol has a significant antioxidant effect on the bAECs that were exposed to H(2)O(2).