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Bariatric surgery has long-term beneficial effects on body weight and metabolic status, but there is an apparent lack of comprehensive cardiometabolic, renal, liver, and metabolomic/lipidomic panels, whereas the underlying mechanisms driving the observed postoperative ameliorations are still poorly investigated. We aimed to study the long-term effects of bariatric surgery on metabolic profile, cardiorenal and liver outcomes in association with underlying postoperative gut hormone adaptations. 28 individuals who underwent bariatric surgery [17 sleeve gastrectomy (SG), 11 Roux-en-Y gastric bypass (RYGB)] were followed up 3, 6 and 12 and at 10 years following surgery. Participants at 10 years were cross-sectionally compared with an age-, sex- and adiposity-matched group of non-operated individuals (n = 9) and an age-matched pilot group of normal-weight individuals (n = 4). There were durable effects of surgery on body weight and composition, with an increase of lean mass percentage persisting despite some weight regain 10 years postoperatively. The improvements in metabolic and lipoprotein profiles, cardiometabolic risk markers, echocardiographic and cardiorenal outcomes persisted over the ten-year observation period. The robust improvements in insulin resistance, adipokines, activin/follistatin components and postprandial gastrointestinal peptide levels persisted 10 years postoperatively. These effects were largely independent of surgery type, except for a lasting reduction of ghrelin in the SG subgroup, and more pronounced increases in proglucagon products, mainly glicentin and oxyntomodulin, and in the cardiovascular risk marker Trimethylamine-N-oxide (TMAO) within the RYGB subgroup. Despite similar demographic and clinical features, participants 10 years after surgery showed a more favorable metabolic profile compared with the control group, in conjunction with a dramatic increase of postprandial proglucagon product secretion. We demonstrate that cardiorenal and metabolic benefits of bariatric surgery remain robust and largely unchanged ten years postoperatively and are associated with durable effects on gastrointestinal- muscle- and adipose tissue-secreted hormones. ClinicalTrials.gov : NCT04170010. [Display omitted] • The effects on weight, glucose homeostasis, inflammation, cardiorenal, and liver function after bariatric surgery persist 10 years postoperatively. • Bariatric surgery also exerts persistent effects on adipokines, activins/follistatins and metabolomic/lipidomic profiles. • Robust postprandial increases gut hormones, particularly proglucagon-derived peptides, underlie these improvements. • These effects are largely independent of surgery type. • Operated individuals retain vastly upregulated postprandial beneficial gut peptide secretion compared with unoperated controls. [ABSTRACT FROM AUTHOR]

In this study a completely autonomous, zero-emission photovoltaic (PV)-based system is modeled for residential applications. Apart from the PV subsystem, an electrolyzer-hydrogen storage-fuel cell subsystem is integrated to the system to fully fulfill a varying load profile throughout the year. The fuel cell and electrolyzer components are based on proton exchange membrane technology. The model allows quantification of energy and power flows, such as power input from the PV subsystem, conversion of electricity to hydrogen, and re-production of electricity. The system components are sized to satisfy demand, which is varied through a case study conducted to investigate system performance at different capacities. The economic performance of the proposed system is assessed with a detailed cost model. The proposed system (base case) results in a unit cost of electricity at 0.216 EUR/kWh for a system capacity of 100 households, which is moderately higher than the current cost of electricity in Cyprus. A parametric study including those economic parameters with a high degree of uncertainty is conducted to investigate the sensitivity and future potential of the system. The results show that the unit cost of electricity for the proposed system can be reduced below the current cost, making the system competitive, if electrolyzer/fuel cell lifetime is increased, while the specific costs of the electrolyzer and the PV are reduced. [ABSTRACT FROM AUTHOR]

The purpose of this study is to investigate the potential of a small-scale, combined-cooling-heating-and-power system, consisting of a 1 MW e gas turbine subsystem coupled to a 0.5 MW e photovoltaic (PV) subsystem for application in Cyprus. The proposed system is completely autonomous, without any interconnections to a central power grid. To allow maximum utilization of the electricity generated by the PV subsystem, an electrolyzer unit is coupled to the system to convert excess renewable electricity to hydrogen. The generated hydrogen is injected to the natural gas supply for the gas turbine. For the generation of useful cooling and heating, the system recovers heat from the flue gas exiting the gas turbine; the recovered heat is supplied to a heat-activated absorption chiller/heater to generate cooling or heating. An electric chiller/heater is integrated to the system to supplement thermal energy when necessary. The thermal energy is supplied to nearby buildings through a district energy network. The annual average primary energy ratio of the proposed system is 0.806. For an assumed system lifetime of 20 years, the lifecycle cost of the proposed system is 11.12 million USD, resulting to a unit cost of electricity at 0.06 USD/kWh, which is a 62% reduction of the current cost in Cyprus. The results of the parametric study suggest that the economic performance of the proposed system is highly dependent on price fluctuations of the unit cost of natural gas, while the specific cost of the electrolyzer unit is also critical. The proposed system could become an important candidate for power and thermal energy generation in Cyprus as a measure to reduce the presently high cost of electricity. [ABSTRACT FROM AUTHOR]

Glucagon-like peptide-1 receptor agonists (GLP-1RA) and bariatric surgery have proven to be effective treatments for obesity and cardiometabolic conditions. We aimed to explore the early metabolomic changes in response to GLP-1RA (liraglutide) therapy vs. placebo and in comparison to bariatric surgery. Three clinical studies were conducted: a bariatric surgery cohort study of participants with morbid obesity who underwent either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) studied over four and twelve weeks, and two randomized placebo-controlled, crossover double blind studies of liraglutide vs. placebo administration in participants with type 2 diabetes (T2D) and participants with obesity studied for three and five weeks, respectively. Nuclear magnetic resonance spectroscopy-derived metabolomic data were assessed in all eligible participants who completed all the scheduled in-clinic visits. The primary outcome of the study was to explore the changes of the metabolome among participants with obesity with and without T2D receiving the GLP-1RA liraglutide vs. placebo and participants with obesity undergoing bariatric surgery during the three to five-week study period. In addition, we assessed the bariatric surgery effects longitudinally over the twelve weeks of the study and the differences between the bariatric surgery subgroups on the metabolome. The trials are registered with ClinicalTrials.gov , numbers NCT03851874 , NCT01562678 and NCT02944500. Bariatric surgery had a more pronounced effect on weight and body mass index reduction (−14.19 ± 5.27 kg and − 5.19 ± 5.27, respectively, p < 0.001 for both) and resulted in more pronounced metabolomic and lipidomic changes compared to liraglutide therapy at four weeks postoperatively. Significant changes were observed in lipoprotein parameters, inflammatory markers, ketone bodies, citrate, and branched-chain amino acids after the first three to five weeks of intervention. After adjusting for the amount of weight loss, a significant difference among the study groups remained only for acetoacetate, β-hydroxybutyrate, and citrate (p < 0.05 after FDR correction). Glucose levels were significantly reduced in all intervention groups but mainly in the T2D group receiving GLP-1RA treatment. After adjusting for weight loss, only glucose levels remained significant (p = 0.001 after FDR correction), mainly due to the glucose change in the T2D group receiving GLP-1RA. Similar results with those observed at four weeks were observed in the surgical group when delta changes at twelve weeks were assessed. Comparing the two types of bariatric surgery, an intervention effect was more pronounced in the RYGB subgroup regarding total triglycerides, triglyceride-rich lipoprotein size, and trimethylamine-N-oxide (p for intervention: 0.031, 0.028, 0.036, respectively). However, after applying FDR correction, these changes deemed to be only suggestive; only time effects remained significant with no significant changes persisting in relation to the types of bariatric surgery. The results of this study suggest that the early metabolomic, lipid and lipoprotein changes observed between liraglutide treatment and bariatric surgery are similar and result largely from the changes in patients' body weight. Specific changes observed in the short-term post-surgical period between bariatric vs. nonsurgical treated participants, i.e., acetoacetate, β-hydroxybutyrate, and citrate changes, may reflect changes in patient diets and calorie intake indicating potential calorie and diet-driven metabolomics/lipidomic effects in the short-term postoperatively. Significant differences observed between SG and RYGB need to be confirmed and extended by future studies. • Bariatric surgery had a more pronounced effect on weight loss, metabolomic and lipidomic changes compared to liraglutide. • Early metabolomic and lipidomic differences between bariatric surgery and liraglutide are attributed mainly to weight loss. • Acetoacetate, β-hydroxybutyrate and citrate changes may reflect reduced calorie intake and diet-driven metabolomic and lipidomic alterations postoperatively. • Roux-en-Y gastric bypass and sleeve gastrectomy exhibit similar effects on metabolomic, lipid, and lipoprotein parameters. [ABSTRACT FROM AUTHOR]

A solar-heating-and-cooling (SHC) system, consisting of a flat-plate solar collector array, a hot water storage tank, and an absorption chiller unit is designed and modeled to satisfy thermal loads (space heating, domestic hot water, and space cooling). The system is applied for Nicosia, Cyprus, a location with prolonged summer-like conditions, where heating demand is moderate, while space cooling demand is comparatively very high. The study investigates the potential of a solar system installed and operated onsite in a detached single-family household to satisfy all necessary thermal loads. The hot water storage tank is also connected to an auxiliary heater (diesel-fired boiler) to supplement solar heating, when needed. The main purpose of the study is to model the overall system and contact a parametric study that will determine the optimum economic system performance in terms of design parameters. The system is compared, through a cost analysis, to an electric heat pump (EHP) system. It is found that the optimum system combination of solar collector area and volumetric capacity of the hot water storage tank is 70 m 2 and 2000 L, respectively. The total annualized cost (in USD) for the optimum SHC system is $3,719. The sensitivity analysis showed that the SHC system would be unfavorable to compete with EHP technology, if the solar collector cost is above $360/m 2 . [ABSTRACT FROM AUTHOR]

BACKGROUND: Data concerning the long-term efficacy of laparoscopic sleeve gastrectomy in the treatment of morbid obesity remain scarce. In this retrospective, the authors present 5-year followup of 30 patients having undergone laparoscopic sleeve gastrectomy. METHODS: Since 2004, 30 patients underwent laparoscopic sleeve gastrectomy and completed 5 years of follow-up. Five patients were subsequently subjected to laparoscopic Roux-en-Y gastric bypass and were excluded from further analysis. The remaining 25 patients comprised the study population. RESULTS: Mean excess weight loss was 65.2 ± 6.1%, 64.7 ± 5.6%, 62 ± 4.9%, 58.2 ± 5.5%, and 56.4 ± 5.8% for the first 5 years, respectively. There were no deaths, nor any major morbidity. Remission of comorbidities was observed in 40% to 80.9% of cases. CONCLUSIONS: Laparoscopic sleeve gastrectomy is a safe and effective means of treatment of morbid obesity both in the short and in the long term. More research is needed to better predict which patient will benefit most from this operation. [ABSTRACT FROM AUTHOR]

Abstract: Background: Nutritional deficiencies are highly prevalent in obese patients. Bariatric surgery has been associated with adverse effects on homeostasis of significant vitamins and micronutrients, mainly after gastric bypass. The aim of the present study was to compare the extent of long-term postsurgical nutritional deficiencies between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Methods: This cross-sectional, pilot study included 95 patients who underwent RYGB or SG surgery with a mean follow-up of 4 years. Demographic, anthropometric, and biochemical parameters were compared according to the type of surgery. Results: Both types of surgery were associated with significant nutritional deficiencies. Vitamin B12 deficiency was significantly higher in patients with RYGB compared with SG (42.1% versus 5%, P = .003). The type of surgery was associated neither with anemia nor with iron or folate deficiency (SG versus RYGB: anemia, 54.2% versus 64.3%, P = .418; folate deficiency, 20% versus 18.4%, P = .884; iron deficiency, 30% versus 36.4%, P = .635). Conclusion: During a mean follow up period of 4 years postRYGB or SG, patients were identified with several micronutrient deficiencies, including vitamin D, folate, and vitamin B12. SG may have a more favorable effect on the metabolism of vitamin B12 compared with RYGB, being associated with less malabsorption. Adherence to supplemental iron and vitamin intake is of primary significance in all cases of bariatric surgery. [Copyright &y& Elsevier]

Abstract: Sleeve gastrectomy (SG) has gained enormous popularity both as a first-stage procedure in high-risk super-obese patients and as a stand-alone procedure. The objective of this study was to evaluate the long-term weight loss results after SG published in the literature and compare them with the well-documented short-term and mid-term weight loss results. A detailed search in PubMed using the keywords “sleeve gastrectomy” and “long-term results” found 16 studies fulfilling the criteria of this study. A total of 492 patients were analyzed, with a follow-up of at least 5 years after laparoscopic sleeve gastrectomy (LSG) (373 at 5 years, 72 at 6 years, 13 at 7 years, and 34 at 8 or more years). Of the total number of patients, 71.1% were women (15 studies, n = 432 patients). Mean patient age was 45.1 years (15 studies, n = 432 patients). Mean preoperative body mass index in all 16 studies was 49.2 kg/m2. The mean percentage excess weight loss (%EWL) was 62.3%, 53.8%, 43%, and 54.8% at 5, 6, 7, and 8 or more years after LSG, respectively. The overall mean %EWL (defined as the average %EWL at 5 or more years after LSG) was 59.3% (12 studies, n = 377 patients). The overall attrition rate was 31.2% (13 studies). LSG seems to maintain its well-documented weight loss outcome at 5 or more years postoperatively, with the overall mean %EWL at 5 or more years after LSG still remaining>50%. The existing data support the role of LSG in the treatment of morbid obesity. [Copyright &y& Elsevier]

Abstract: Although increasing evidence supports an association between endogenous sex hormones and cardiovascular disease, the results still remain controversial. This study aims to examine the association between endogenous sex hormones and indices of vascular function and structure. Serum follicle-stimulating hormone, luteinizing hormone, estradiol, testosterone, sex hormone–binding globulin, dehydroepiandrosterone sulfate (DHEAS), and Δ4-androstenedione were measured in 120 healthy postmenopausal women aged 41 to 60 years. Possible associations with surrogate markers of subclinical atherosclerosis, arterial stiffness, and endothelial function were investigated. Indices of arterial structure included carotid and femoral intima-media thickness and atheromatous plaques presence. Indices of arterial function included flow-mediated dilation of the brachial artery, carotid-femoral pulse wave velocity (PWV), and augmentation index. Total testosterone and free androgen index (FAI) were the most important predictors of common carotid artery intima-media thickness (β = 0.376 and β = 0.236, P < .001 and P = .014, respectively). Similarly, FAI was the only significant independent predictor of PWV (β = 0.254, P = .027) after adjusting for age, smoking, body mass index, homeostasis model assessment of insulin resistance, and blood lipids. Free estrogen index showed a positive association with PWV, independently of age, smoking, and body mass index, but not of homeostasis model assessment of insulin resistance and blood lipids. Age-adjusted levels of DHEAS exhibited a significant independent negative association with measures of augmentation index. Follicle-stimulating hormone, luteinizing hormone, estradiol, sex hormone–binding globulin, and Δ4-androstenedione were not associated with any of the vascular parameters independently of traditional cardiovascular risk factors. Higher serum testosterone and FAI are associated with subclinical atherosclerosis in healthy recently menopausal women. This association is independent of traditional cardiovascular risk factors or insulin resistance. On the contrary, serum DHEAS exhibits a negative association with arterial stiffness. [Copyright &y& Elsevier]

Background: Significant renal artery stenosis (RAS) in a solitary functioning kidney (SFK) represents one of the most acceptable indications for renal revascularization. Percutaneous transluminal renal artery stenting (PTRAS) is increasingly being used as a first line treatment for renal revascularization, associated with renal function improvement or stabilization in the majority of the patients with solitary kidneys, but also with deterioration in up to 38% of the cases. Atheroembolism during PTRAS has been postulated as a potential cause for this acute renal function worsening. The aim of this study was to report on the feasibility, safety, and early outcomes of PTRAS in a series of patients with SFK using distal embolic protection (DEP). Methods: All PTRAS procedures in SFKs performed under DEP between June 2002 and September 2007 were reviewed. Renal function, blood pressure, and the number of anti-hypertensive medications were assessed pre- and post-intervention. Renal function improvement and deterioration were defined as a 20% increase and decrease in serum creatinine, respectively, compared with preoperative values. Primary and primary assisted patency rates were also calculated. Statistical differences between values before and after intervention were determined by the Student t test and statistical significance was taken at P < .05. Results: Protected PTRAS was performed in 14 patients with a SFK (9 men, 6 women, mean age 65.6 ± 6.8 years). All patients were hypertensive and had varying degrees of azotemia. Mean pre-intervention stenosis degree was 86.8% ± 7.8%. Immediate technical success was obtained in 100% of the patients. Renal function was cured (7.1%), improved (50%), or stabilized (42.9%) in all 14 (100%) patients after the procedure and no deterioration was noticed in any patient at 6-month follow-up. Pre- and postintervention serum creatinine levels were 3.01 ± 1.15 mg/dL and 2.16 ± 0.68 mg/dL, respectively, (P = .02). Hypertension was improved in 6 (42.9%) patients and stabilized in the remaining 8 (57.1%). Primary patency was 100% and 90% at 1 and 3 years, respectively, while primary assisted patency remained 100% for the whole follow-up period (mean, 31.8 ± 19.4 months). Conclusion: These findings suggest that in patients with a SFK, protected PTRAS represents a safe and effective treatment for halting the progression of renal dysfunction to renal loss and warrants further investigation. [Copyright &y& Elsevier]

Purpose: This study evaluated the feasibility, safety, and efficacy of primary stenting in atherosclerotic stenoses and occlusions of the infrarenal aorta. Methods: Between January 2003 and December 2006, 12 patients (6 men) with a mean age of 66.3 ± 4.1 years who had infrarenal aortic occlusive disease were treated with primary stenting (aortic stenosis, 8; chronic total aortobiiliac occlusion, 4). Reasons for referral were severe claudication in six patients (50%), ischemic rest pain in four (33.3%), and minor tissue loss in two (16.7%). Three patients (25%) had chronic renal failure and were on dialysis. Follow-up was performed in all 12 patients. Results: Technical success was 91.7% because one patient had a residual stenosis >30% after stent placement and balloon postdilation owing to severe calcification of the aorta. However, clinical and immediate hemodynamic success was achieved in all 12 patients (100%). The preprocedural mean resting ankle-brachial index (ABI) values of 0.56 ± 0.13 at the right side and 0.59 ± 0.15 at the left were increased to 0.97 ± 0.04 and 0.95 ± 0.06, respectively, after treatment (P < .01). At the end of the mean follow-up of 18.3 months (range, 6-37 months), the primary clinical and hemodynamic patency was 91.7% ± 7.98%, and the mean resting ABI values were 0.96 ± 0.04 for the right and 0.92 ± 0.1 for the left side (P < .01 compared with preinterventional values). None of the patients in the study underwent reintervention. An access-related groin hematoma developed in one patient, but no other major or minor complications occurred. One patient died 8 months after the procedure of chronic renal failure complications. Conclusion: Primary stenting is feasible, safe, and effective for the whole spectrum of aortic occlusive disease. Especially for patients with infrarenal aortic stenoses, it is recommended as the first-line treatment and should be considered as a viable alternative to surgery for total aortoiliac occlusions. [Copyright &y& Elsevier]

Spontaneous internal carotid recanalization has been infrequently observed, and when it has been reported, it has most commonly occurred early after a stroke. We report a case of a patient with late spontaneous recanalization of the internal carotid artery (ICA) that occurred within 6 months to 1 year after the initial diagnosis of occlusion during the course of a stroke. This event allowed the patient to undergo a successful surgical intervention. A suggestion is made about the mechanism of this phenomenon and an implication about changes in the follow-up strategies of these patients is presented. [Copyright &y& Elsevier]

Bariatric surgery leads to profound and sustainable weight loss. Gastrointestinal hormones are involved in energy and glucose homeostasis, thus postoperative changes of their circulating levels may be mediating future weight loss. To investigate how the circulating concentrations of gastrointestinal hormones change in response to the most common types of bariatric operation and whether these changes can predict future weight loss. We measured circulating GLP-1, GLP-2, oxyntomodulin, glicentin, glucagon, major proglucagon fragment (MPGF), ghrelin, GIP, PYY after overnight fasting and/or after a mixed meal test (MMT) in: a) 14 subjects that have undergone either an adjustable gastric banding [AGB] (n = 9) or a Roux-en-Y bypass (RYGB) (n = 5) (Pilot study 1), b) 28 subjects that have undergone either a vertical sleeve gastrectomy (n = 17) or a RYGB (n = 11) before and three, six and twelve months after surgery. In addition to the expected associations with GLP-1, the most robust increases were observed in postprandial levels of oxyntomodulin and glicentin three months after VSG or RYGB (but not after AGB) and are associated with degree of weight loss. Oxyntomodulin and glicentin levels at the third and sixth month postoperative visit are positively associated with feeling of satiety which may be underlying the observed associations with future weight loss. Beyond GLP-1, early postprandial changes in circulating oxyntomodulin and glicentin are predictors of weight loss after bariatric surgery, possibly through regulation of satiety. Further studies should focus on underlying mechanisms, and their potential as attractive therapeutic tools against obesity and related comorbidities. • Among 9 hormones, postprandial Oxm and Glicentin increase most after bariatric surgery. • Early postoperative increase in Oxm and Glicentin predicts future weight loss. • Postoperative increase of satiety feeling is associated with plasma Oxm and Glicentin. [ABSTRACT FROM AUTHOR]

Breast cancer is a common malignancy among women. Despite an increase in incidence, breast cancer mortality has drastically dropped over the last 20 years. This change has been attributed to advances in screening, diagnosis, and treatment. This review summarises recent updates in the clinical approach to breast cancer. Advances in genetics have facilitated the stratification of the risk of recurrence in early-stage breast cancer. Advances in biology have led to the development of novel therapies (poly-ADP-ribose polymerase inhibitors, cyclin-dependent kinase 4/6 inhibitors, HER2 targeted agents). Their combination with endocrine (tamoxifen, aromatase inhibitors, GnRH-analogues, fulvestrant) and systematic therapy (anthracyclines, taxanes) in early and advanced disease have improved clinical outcomes. In the near future, neoadjuvant strategies in specific breast cancer subgroups (triple-negative breast cancers) and novel strategies (immune-modulatory agents) could further improve histopathological responses and survival. Radical mastectomies have been widely replaced by breast-conserving operations, while the traditional axillary dissection is being replaced with sentinel node techniques. Breast cancer therapeutics represents a great challenge due to patients' heterogeneous molecular and clinical characteristics, while the identification of reliable and easily reproducible predictive factors could further improve individualized treatment. [ABSTRACT FROM AUTHOR]

As type 2 diabetes mellitus (T2DM) is affected by both chronological and ovarian ageing, it is common in postmenopausal women. This review analyses and critically appraises the literature regarding the optimal therapeutic strategies for T2DM in women after menopause. Lifestyle interventions, including changes in dietary habits and physical exercise in everyday life targeting a modest weight loss (5%), represent the cornerstone of management. Limited intake of alcohol and sodium, as well as smoking cessation, are additional lifestyle changes for both endothelial and bone health. Regarding medications, postmenopausal women should be initially treated with metformin, concurrently with lifestyle intervention. If glycosylated haemoglobin (HbA1c) remains over the target level (usually ≥7%), dipeptidyl peptidase-4 inhibitors (DPP-4i) or glucagon-like peptide-1 receptor agonists (GLP-1RA) should be preferred. Thiazolidinediones (TZDs) and canagliflozin should be avoided in postmenopausal women with increased fracture risk. Insulin should be used with caution to avoid hypoglycaemia. Bariatric surgery is a well established and effective therapeutic option for both weight loss and glycaemic control in very obese patients with T2DM; however, metabolic benefits should be balanced against nutritional deficiencies that often present after surgery. Proper control of hypertension, with avoidance of hypotension, is of great importance as a measure against falls. Annual tests for retinopathy and neuropathy are crucial for the same reason. Menopausal hormone therapy (MHT) has a beneficial effect on glucose homeostasis, reduces the risk of new-onset T2DM and improves glucose control in women with T2DM. T2DM has been considered a cardiovascular disease equivalent, which meant that postmenopausal women with the disease could not take MHT but current evidence supports an individualised approach to this issue. Therapeutic strategies for women with T2DM after menopause should aim to maximise benefits for metabolic, cardiovascular and bone health with the minimum of adverse effects, bearing in mind that most women will spend more than one-third of their life being of postmenopausal status. [ABSTRACT FROM AUTHOR]

Background context The prevalence of skeletal fractures shows a marked geographic variability; however, data regarding the Greek population remain limited. Purpose To evaluate the frequency of asymptomatic vertebral fractures (VFs), and potential risk factors, in a large sample of Greek postmenopausal women. Study design A cross-sectional study at the University Menopause Clinic. Patient sample Four hundred fifty-four postmenopausal women aged 35 to 80 years, with an average menopausal age of 9.2±7.1 years. Outcome measures They included medical history, anthropometric and biochemical parameters, bone mineral density (BMD) at lumbar spine (LS) and femoral neck (FN), and LS lateral radiographs. Methods Lumbar spine lateral radiographs were evaluated according to quantitative procedures, aiming to identify VFs. Anthropometric and biochemical parameters and values of BMD were compared according to the presence of VFs. Results A total of 37 (8.15%) women had at least one VF. Lumbar spine and FN-osteoporosis was identified in up to 23.1% and 40.9% subjects with prevalent VFs, respectively. The prevalence of VFs was largely associated with age, with women aged 60 years or more presenting an up to fourfold risk compared with younger women. Moreover, the presence of VFs was associated with higher menopausal age, advanced age at menarche, a history of early menopause, and prolonged lactation. Lower LS-BMD and, especially, FN-BMD were negatively associated with VF prevalence (prevalent VF vs. no VF: LS-BMD, 0.89±0.16 g/cm 2 vs. 0.98±0.16 g/cm 2 , p=.010; FN-BMD, 0.72±0.10 g/cm 2 vs. 0.81±0.12 g/cm 2 , p=.008). Conclusions Asymptomatic VFs are common among Greek healthy middle-aged postmenopausal women. More than 50% subjects with prevalent VFs present with normal BMD or osteopenia. Age and bone density classification at the FN presented the strongest association with the prevalence of VFs. [ABSTRACT FROM AUTHOR]

Abstract: Background: The menopausal status is closely related with cardiovascular disease (CVD). Nevertheless, it is still not included in risk stratification by total cardiovascular risk estimation systems. The present study aimed to evaluate the extent of subclinical vascular disorders in young healthy postmenopausal women. Methods: This cross-sectional study consecutively recruited 120 healthy postmenopausal women without clinically overt CVD or diabetes, aged 41–60years and classified as not high-risk by the Heartscore (<5%). In addition to risk factors used for Heartscore calculations, years since menopause and associated risk factors (triglycerides (range 37–278mg/dl), waist circumference (62–114cm), fasting blood glucose (69–114mg/dl) and HOMA-IR (0.44–5)) were also assessed. Carotid–femoral pulse wave velocity, carotid and femoral intima–media thickness in the abnormal range as well as atheromatous plaques both in carotid and femoral arteries were used to define the presence of subclinical atherosclerosis. Results: Subclinical atherosclerosis and the presence of at least one plaque were identified in 55% and 28% of women, respectively. Subjects with subclinical atherosclerosis had higher age, years since menopause, HOMA-IR and blood pressure. By multivariate analysis years since menopause and systolic blood pressure independently determined subclinical atherosclerosis while 79% of intermediate-risk women (Heartscore 2–4.9%) being in menopause for at least 4years would be reclassified to a higher risk for the presence of atherosclerosis. Conclusion: Subclinical atherosclerosis was highly prevalent in postmenopausal women with low to medium Heartscore. Thus our data suggest that menopausal status and associated risk factors should be additionally weighted in risk calculations, regarding primary prevention strategies in this population. [Copyright &y& Elsevier]

Abstract: Objective: To compare the prevalence of subclinical atherosclerosis between postmenopausal women and men of similar age early after the onset of menopause. Methods: In the first part of this cross-sectional study 186 non-diabetic young postmenopausal women (n =101, menopausal age ≤10 years) and men (n =85) aged 40–60 years without overt CVD were consecutively recruited from the outpatients clinics of an academic hospital. Subclinical carotid atherosclerosis was assessed by high-resolution ultrasonography. The presence of carotid atherosclerosis was defined as either increased carotid intima-media thickness (IMT>0.9mm) and/or the presence of plaques. In the second part, 1:1 matching for age and traditional risk factors (hyperlipidemia, smoking, hypertension and BMI) was performed between men and women of this cohort resulting in a matched sub-sample of 76 subjects. Results: By multivariate analysis, gender was not an independent determinant of any measure of carotid atherosclerosis. In the matched sub-sample, carotid IMT and the number of segments with atherosclerosis did not significantly differ between women and men (0.734±0.119mm and 1.47±1.6 versus 0.717±0.138mm and 1.47±1.5, p =0.575 and p =0.999, respectively). Also, the prevalence of increased IMT (60.5% in both genders), carotid plaques and subclinical atherosclerosis (31.6% and 63.2% versus 28.9% and 65.8%, p =0.803 and p =0.811, respectively) was similar between men and women. Conclusions: The prevalence and severity of carotid atherosclerosis was similar between men and young postmenopausal women matched for traditional risk factors. Whether these women may be better risk stratified irrespective of gender should be further assessed in prospective studies. [Copyright &y& Elsevier]

Abstract: Background: There is conflicting evidence regarding the association of vitamin D status with bone mineral density (BMD) in adult patients with multiple sclerosis (MS). We evaluated cross-sectionaly the determinants (including vitamin D levels) of low BMD in patients with relapsing-remitting MS (RRMS). Methods: The BMD at lumbar level (L2-L4) and femoral neck was measured in consecutive adult, ambulatory, RRMS patients by dual-energy X-ray absorptiometry. Blood samples were collected for total serum calcium, phosphorus, magnesium, 25-hydroxyvitamin D3 and parathormone. Osteopenia and osteoporosis were defined according to the World Health Organization operational BMD definition. MS severity was assessed using the EDSS-score. Cross-sectional associations were evaluated using Spearman''s correlation-coefficient and multiple linear regression models. Results: A total of 119 patients were evaluated (mean age 39.2±10.4years; 40% men). Osteopenia at lumbar spine (L2-L4) and femoral neck was present in 26% (95%CI: 18%–35%) and 50% (95%CI: 41%–60%) of the patients respectively. Osteoporosis was documented at lumbar spine and femoral neck of 3% (95%CI: 0%-8%) and 11% (95%CI: 6%–18%) of the study population respectively. There was no correlation (p>0.1) of 25-hydroxyvitamin D3 levels with any of BMD measurements (including Z- and T-scores) both in lumbar spine and in femoral neck. Increasing MS duration and increasing dosage of intravenous corticosteroids were independently and negatively associated with both lumbar spine and femoral neck BMD. Conclusions: We documented no correlation between vitamin D levels and decreased BMD at femoral neck and lumbar spine in RRMS patients. Vitamin D insufficiency appears not to be the underlying cause of secondary osteoporosis in MS. [Copyright &y& Elsevier]

Abstract: Objectives: The aim of the present study was to evaluate how sociodemographic parameters, lifestyle indicators and intensity of climacteric symptoms affect the quality of life (QOL) of Greek community dwelling middle-aged women. Study design: This population survey included 1140 middle-aged women aged 45–65 who represented 1% of the whole female population of this age group in Greece, stratified by residential area. Main outcome measures: Participants were asked to complete a questionnaire concerning sociodemographic and anthropometric parameters, medical history, the Utian quality of life (QOL) scale and the Greene climacteric scale rating menopausal symptoms. Results: In the univariate analysis, normal body mass index, married status, higher education, employment, good financial status, physical exercise and a high calcium diet were associated with higher total QOL scores (p-value<0.001). Multivariate regression analysis showed that higher total QOL scores were predicted by being married (separated/divorced/widowed: beta=−3.17, p-value=0.008), by physical exercise (beta=4.84 and beta=4.57 for 1–3h and >3h per week respectively, p-value<0.001) and by a good financial status (beta=7.05, p-value<0.001), while a higher score in the Greene scale resulted in lower total QOL scores (beta=−0.77, p-value<0.001). Women with a better QOL were more health conscious and more probable to have utilized the public health preventive resources. Conclusions: Menopause as a life event has no effect on the QOL of Greek middle-aged women. On the contrary, the presence and intensity of climacteric symptoms have a negative impact on all aspects of QOL. Marital and financial status, as well as physical exercise, are also significant predictors of QOL. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate alterations in the concentrations of osteoprotegerin (OPG), RANKL and the OPG/RANKL ratio in pre-eclamptic women during the puerperium. Study design: This cross-sectional study was performed in the maternity ward of Aretaieio Hospital in Athens, Greece. Fifteen pregnant women with severe pre-eclampsia and 15 matched controls with premature rupture of the membranes were recruited. Fasting blood samples were obtained antepartum, immediately after diagnosing pre-eclampsia (median: 32nd gestational week), and during the 3rd–6th day postpartum, to estimate levels of circulating OPG and RANKL as well as the OPG/RANKL ratio. The anthropometric parameters evaluated included body mass index and blood pressure. Results: Mean circulating OPG levels decreased significantly in both groups in the postpartum period (controls: 43.7±19.1ng/ml vs 22.9±9.1ng/ml, p =0.008; pre-eclamptic group: 72.3±49.9 vs 49.7±40.9ng/ml, p =0.002). The antepartum OPG/RANKL ratio was elevated in hypertensive pregnancies (2.41±1.72) compared to normotensive pregnancies (1.45±0.63), but the difference did not reach statistical significance (p =0.1). The OPG/RANKL ratio decreased in the control group (0.76±0.30, NS) following delivery, while it remained unchanged in the pre-eclamptic women (1.63±1.40, p =0.13). Consequently, the postpartum OPG/RANKL ratio was significantly higher in the pre-eclamptic women compared to control women (1.63±1.40 vs 0.76±0.30, p =0.01). Levels of RANKL demonstrated no significant alterations during puerperium in both cases. Conclusion: Pregnancies complicated with pre-eclampsia exhibit higher OPG levels and OPG/RANKL ratios, compared to control pregnancies, which might be compatible with lower bone turnover. The significance of this finding with respect to bone metabolism remains to be elucidated in larger studies. [Copyright &y& Elsevier]

Abstract: Background: Leptin and ghrelin are increasingly being recognized as cardiotropic hormones, promoting or inhibiting the atherosclerotic process, respectively. Apoptosis may be one pathway through which the actions of these hormones are mediated. Sex hormones are reported to influence the secretion and action of ghrelin and leptin. Objective: To evaluate (1) the association of circulating ghrelin and leptin with selected markers of receptor-mediated apoptosis and (2) the effect of estrogen monotherapy, low dose estrogen–progestin therapy, tibolone and raloxifene on serum ghrelin and leptin in healthy postmenopausal women. Methods: Eighty eight postmenopausal women aged 44–62 years were randomly allocated to daily (1) conjugated equine estrogens 0.625mg (CEE), (2) 17β-estradiol 1mg plus norethisterone acetate 0.5mg (E2/NETA), (3) tibolone 2.5mg, (4) raloxifene HCl 60mg or (5) no treatment. Serum markers of apoptosis sFas, Fas-ligand (Fas-L) and caspase-1 were measured at baseline. Serum leptin and ghrelin were measured at baseline and at 3 months. Results: Body Mass Index (BMI) and estradiol levels correlated positively, while FSH correlated negatively with serum leptin (BMI: r =0.646, p =0.005, estradiol: r =0.432, p =0.001, FSH: r =−0.401, p =0.002). Insulin levels associated positively with circulating leptin (r =0.394, p =0.011) and negatively with circulating ghrelin (r =−0.401, p =0.009). Serum leptin decreased significantly in E2/NETA group (baseline: 2.882±0.76ng/ml, 3 months: 2.687±0.66ng/ml, p =0.043), while it increased significantly in the raloxifene group (baseline: 2.671±0.54ng/ml, 3 months: 2.839±0.47ng/ml). Ghrelin levels decreased significantly only in the raloxifene group (baseline: 1634±592pg/ml, 3 months: 1408±534pg/ml). Conclusion: Apoptosis may be a pathway through which leptin exerts a pro-atherogenic effect. Low dose HT may act carioprotectively by decreasing letpin levels in healthy recently menopaused women. [Copyright &y& Elsevier]

Abstract: Objectives: To study the effect of standard and low-dose estrogen–progestin therapy (EPT), tibolone and raloxifene on the incidence of vaginal spotting/bleeding and endometrial thickness over a 5-year period. Methods: Seven hundred eighty-six postmenopausal women were studied in an open prospective design. Vaginal spotting/bleeding and endometrial thickness as assessed by transvaginal ultrasonography was compared between six categories of women over a 5-year period: three categories in women on continuous combined estrogen–progestin therapy, one category under tibolone, one category under raloxifene and one under no treatment. More specifically, women received tibolone 2.5mg (N =204), raloxifene HCl 60mg (N =137), conjugated equine estrogens 0.625mg/medroxyprogesterone acetate 5mg (N =122), 17β-estradiol 2mg/norethisterone acetate 1mg (N =58), 17β-estradiol 1mg/norethisterone acetate 0.5mg (N =76) or no therapy (controls, N =189). Women with suspected endometrial pathology were referred for hysteroscopy. Results: Bleeding/spotting incidence was highest among standard dose EPT users (conjugated equine estrogens 0.625mg/medroxyprogesterone acetate 5mg: 40.1%, 17β-estradiol 2mg/norethisterone acetate 1mg: 44.8%, p <0.001 compared to controls). Low-dose EPT associated with lower incidence of spotting/bleeding (34.1%). The incidence under tibolone and raloxifene was 22.5% and 2.9%, respectively, while 3.2% of women not receiving therapy reported vaginal spotting/bleeding. Mean endometrial thickness was not significantly affected in any of the groups studied. The drop-out rate due to spotting/bleeding was higher in the two higher dose EPT regimens. After logistic regression analysis, age at baseline was the only significant predictor of subsequent spotting/bleeding (b =−0.25, S.E.=0.09, p =0.006), while menopausal age and pre-treatment serum FSH had marginal significance. Conclusions: EPT, tibolone and raloxifene do not appear to associate with significant changes in endometrial thickness in the majority of cases. The low-dose EPT regimen associated with a decreased incidence of unscheduled spotting/bleeding compared to the standard dose regimens. Tibolone expressed a favorable endometrial profile, as seen in its effect on unscheduled spotting/bleeding and mean endometrial thickness. Raloxifene associated with the lowest incidence in S/B and the lowest drop-out rate.s [Copyright &y& Elsevier]