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Highlights • The start-up plane Poiseuille flow of a Bingham fluid is considered. • The analytical expression for the velocity in the core is given. • The analytical solution is extended to include the velocity in the yielded zone. • Strict bounds on the validity of the analytical solution are provided. Abstract The start-up flow of a Bingham plastic in a channel is considered and Safronchik's solution [1] for the initial evolution of the yield surface and the core velocity is revisited. Stricter time bounds for the validity of the above solution are derived and the solution is extended to include the velocity profile in the evolving yielded zone. Comparisons are made with another approximate solution derived under the assumption that the velocity in the yielded zone is parabolic adjusting with the evolving yield surface. This approximation performs well for small values of the yield stress, or, equivalently, for large values of the imposed pressure gradient. [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]

Highlights • The circular Couette flow of Herschel–Bulkley fluids is analysed. • The conditions under which the rates of strain share a common point are specified. • The errors when using apparent instead of true shear rates are highlighted. • The errors in the calculated material parameters are discussed. • The findings of the present work are demonstrated on experimental data. Abstract We analyse the circular Couette flow of Herschel–Bulkley fluids to investigate the validity of the assumption that the rate of strain distributions across the gap share a common point. It is demonstrated that this is true only with fully-yielded Bingham -plastic flow. In other cases, e.g., in partially-yielded Bingham-plastic flow or fully-yielded Herschel–Bulkley flow, the common point for the fully-yielded Bingham case provides a good approximation for determining material constants only if the gap is sufficiently small. We also revisit the important issue of determining material properties of viscoplastic fluids by using "true values" for the rate of strain and demonstrate that the material properties can be very different from those obtained using "apparent' values for the rate of strain. [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]

Background: Single-incision laparoscopic surgery has attracted a great deal of interest in the surgical community in recent years, including bariatric surgery. Single-incision laparoscopic sleeve gastrectomy (SILSG) has been proposed as an alternative to the multiport laparoscopic procedure; however, it has yet to meet wide acceptance and application.Objective: We aim to summarize existing data on SILSG and check the procedure's feasibility, technical details, safety, and, if possible, outcomes.Materials and Methods: We checked the most important databases for studies concerning SILSG and included all these that summarized the criteria placed and contained the data needed for this review. We excluded case reports.Results: Nineteen studies complied with the criteria of our review, containing a total of 1679 patients. Their mean age has been 38.91 years and the mean preoperative body mass index has been 41.8 kg/m2. In majority of cases (60.5%), a left upper quadrant incision has been preferred and in 97.6%, a commercially available multiport system has been picked. A wide variety of instruments have been used and mean operating time has been 94.6 minutes. One conversion to open surgery has been reported and 7.4% required the placement of additional ports. There was a complication rate of 7.38% (most common being bleeding with a rate of 2.5%) and a reoperation rate of 2.8%. Mean excess weight loss for a follow-up of 1 year was achieved in 53.7% of patients and was 70.06%. A tendency for less analgesia and better wound satisfaction has been reported.Conclusions: SILSG is safe and feasible. However, there is insufficient evidence to recommend it as the new gold standard for sleeve gastrectomy in the place of conventional laparoscopic sleeve gastrectomy. Randomized controlled trials are needed to analyze the results and the possible benefits of this technique. [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]

Objective. Nutritional deficiencies are common after bariatric surgery. We aimed to assess the prevalence and possible predictors of secondary hyperparathyroidism (SHPT) in bariatric patients. Methods. A total of 95 patients who had undergone Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) were assessed after a median of 3 years after surgery. Anthropometric/demographic and weight-loss parameters were compared according to the presence of SHPT, independently for men/premenopausal women and postmenopausal women. Results. SHPT was highly prevalent (men/premenopausal women, 52.1%; postmenopausal women, 31.9%). Among men/premenopausal women, multivariate analysis indicated that SHPT was predicted by (a) 25-hydroxyvitamin D levels (Exp(B) = 0.869, P-value = 0.037), independently of age, sex, smoking; (b) calcium (Exp(B) = 0.159, P-value = 0.033) and smoking, independently of age and sex; (c) magnesium (Exp(B) = 0.026, P-value = 0.046) and smoking, independently of age and sex. Among postmenopausal women, SHPT was predicted by menopausal age independently of age, smoking, and levels of 25-hydroxyvitamin D or calcium. The development of SHPT was not associated with the type of surgery. Conclusions. RYGB and SG exhibited similar effects regarding the regulation of the hypothalamus-pituitary-parathyroid axis after surgery. Vitamin D status and menopausal age appear to determine SHPT on the long term. SHPT should be sought and vigorously treated with calcium and vitamin D supplementation. [ABSTRACT FROM AUTHOR]

Purpose/Aim: To evaluate the association between the Bsm1 vitamin D receptor polymorphism and the calcium-vitamin D-parathormone axis following bariatric surgery. Materials and Methods: This cross-sectional study included 86 morbidly obese patients, who underwent either gastric bypass or sleeve gastrectomy, with a mean follow-up of four years. Calcium metabolism indices and bone turnover markers were assessed according to the presence of secondary hyperparathyroidism and the Bsm1 vitamin D receptor genotypes. Results: Secondary hyperparathyroidism (42.2% of sample) was associated with lower levels of 25hydroxyvitamin D and elevated markers of bone turnover. In subjects without secondary hyperparathyroidism, presence of the unfavorable B allele resulted in higher levels of parathormone (Bb and BB vs. bb genotype: 50.3 ± 8.2 pg/dl vs. 44.4 ± 10.7 pg/dl, p = .011, adjusted for weight loss, baseline body mass index, 25hydroxyvitamin D, surgical procedure, and duration after surgery). In the whole sample, patients bearing the unfavorable B allele exhibited lower weight loss, a parameter that was negatively associated with markers of bone resorption. Conclusions: Secondary hyperparathyroidism is highly prevalent after bariatric surgery. Bsm1 vitamin D receptor polymorphism may have an effect in early stages of calcium metabolism imbalance, while no association is detected in patients who have already developed secondary hyperparathyroidism. Moreover, vitamin D receptor polymorphism is associated with post-surgery weight loss, a process related to bone turnover. [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]

Decentralized, liquefied natural gas-fueled, trigeneration plants are considered as alternatives to centralized, electricity-only generating power plants to improve efficiency and minimize running costs. The proposed system is analyzed in terms of efficiency and cost. Electrical power is generated with a gas turbine, while waste heat is recovered and utilized effectively to cover heating and cooling needs for buildings located in the vicinity of the plant. The high quality of cooling energy carried in the LNG fluid is used to cool the air supply to the air compressor. Waste heat is recovered with heat exchangers to generate useful heating in the winter period, while in the summer period an integrated double-effect absorption chiller converts waste heat to useful cooling. For the base system (10 MWe), net electrical efficiency is up to 36.5%, while the primary energy ratio reaches 90%. The payback period for the base system is 4 years, for a lifecycle cost of 221.6 million euros and an investment cost of 13 million euros. The base system can satisfy the needs of more than 21,000 average households, while an equivalent conventional system can only satisfy the needs of 12,000 average households. [ABSTRACT FROM AUTHOR]

Abstract: A standard method used to determine material properties of semi-solid slurries is the squeeze flow experiment; a fixed amount of material is squeezed under constant force or velocity and the relation between the force and the displacement of the sample provides information about the rheology of the slurry. The objective of this work is to contribute to the further development of the squeeze flow methodology in order to accurately determine material properties. This is achieved by a model that accounts for the finite yield stress and the thixotropy of the slurry. More specifically a structural viscoplastic model based on the Bingham plastic constitutive equation is proposed. The yield stress is assumed to vary linearly with the structural parameter which follows a first-order rate equation accounting for the material structure break-down and build-up. Numerical experiments of squeeze flow under either constant load or constant velocity are presented and discussed. Comparisons with their non-thixotropic counterparts are made in the case of compression under constant load. The development of the yielded/unyielded regions in relation to material structural changes is analyzed. The numerical results show that initially thixotropy does not affect the flow. However, once the structure is destroyed, the unyielded regions grow slower than the non-thixotropic case allowing for longer compression of the sample. Under constant force the structure may be destroyed at the early stages of the compression but at a later time it re-builds steadily till the cessation of the flow experiment. Under constant velocity, however, the structure is destroyed steadily. Depending then on the case, the final internal structure of the squeezed material can vary significantly. This is an important issue that needs to be taken into consideration in the evaluation of the material parameters. [Copyright &y& Elsevier]

The article discusses the highlights of the 3rd meeting on "Viscoplastic Fluids: From Theory to Application, organized by the Hellenic Society of Rheology, held in Limassol, Cyprus on November 1 to 5, 2009. The event tackled various topics including elastocapillarity and viscoelastoplasticity, yield-stress liquids and the concept of yield stress. It also featured a workshops on the elastic behavior of viscoplastic fluids, the discrete element method simulations of unsteady granular flows, and freezing fouling of waxes.

Background: Laparoscopic Roux-en-Y gastric bypass (RYGBP) for morbid obesity is a challenging operation. The application of robotic techniques has been shown to ease the technical difficulties and reduce perioperative morbidity, mainly because it facilitates the construction of the gastrojejunal anastomosis (GJ). Robotic laparoscopic RYGBP (LRYGBP) has been reported either as totally robotic with manual suturing of the GJ or as robotically assisted with the use of the robot only for the construction of the GJ. A totally robotic LRYGBP with a combined stapled and manual GJ has never been reported. Patients and Methods: Nine consecutive patients underwent totally robotic LRYGBP. The GJ was fashioned with a combination of the linear stapler and manual suturing. Results: Mean preoperative body mass index was 45.3 ± 4.7 kg/m2. In 1 case, we had to undock the Da Vinci Surgical System at the time of the jejunojejunostomy due to unfavorable ergonomics. Mean time to dock the robot was 16.3 ± 3.3 minutes, whereas mean total operative time was 197.2 ± 12.3 minutes. Immediate postoperative morbidity and mortality equaled zero. One patient developed a stenosis of the GJ amenable to endoscopic dilatation. The mean excess weight loss rate 1-year postoperative was 79% ± 15%. Conclusion: Totally robotic LRYGBP can duplicate precisely any conventional technique without any compromise in operative time, short- or long-term results. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this work is to simulate shear rejuvenation and aging effects in shear thinning yield stress fluids in a typical rotational rheometer and to provide a common framework to describe the behavior of yield stress materials in general. This is particularly important in the determination of material constants under both steady and unsteady conditions. The breakdown and buildup of structure are studied using a theory based on the Herschel–Bulkley flow model that it is consistent with experimental data. The theory is implemented using a novel computational method. Interestingly, the simulations reveal the existence of time-dependent shear banding that occurs within the gap when the macroscopically imposed shear rate is below a certain critical value. Shear banding is analyzed in detail and results showing the effects of major parameters on the phenomenon are presented. [Copyright &y& Elsevier]

Abstract: Numerical simulations are undertaken for the transient squeeze flow between parallel plates under a constant load. The conservation equations are solved via the finite element method in space and the Crank–Nicolson method in time. The constitutive equation used to describe the semi-concentrated fiber suspension is an integral equation proposed by Dinh and Armstrong for fiber-filled Newtonian liquids. New results are obtained for both random and aligned fibers and for different levels of squeeze force, and these are compared with the corresponding Newtonian ones, which are slightly lower. The fiber orientation in the flow field is also obtained for different points in the material. [Copyright &y& Elsevier]

Abstract: The flow and shape evolution during the compression of a finite amount of a Bingham plastic is investigated by means of numerical simulations. The problem relates to the popular compression test used for the rheological characterization of non-Newtonian fluids. The flow is modelled in Lagrangian coordinates using the Papanastasiou regularization for the Bingham plastic and a mixed-Galerkin finite element method. Simulations have been performed for compression under both constant load and constant velocity. Results for various Reynolds and Bingham numbers are presented and discussed. [Copyright &y& Elsevier]

Abstract: Semisolid materials are suspensions of metal alloys which are processed while in a mushy state. In this state, the suspensions behave as viscoplastic materials with time-dependent material properties. During processing, the material is injected at high speed into a mold cavity with the process lasting only fractions of a second. The short-term transient material response is thus very important for the understanding of the rheology and the further development of the process. A theory based on the Herschel–Bulkley flow model appropriate for the short-term breakage of welded bonds in semisolid metal slurries is proposed. The “strength” of the slurry due to these bonds is assumed to be a function of a coherency parameter which is proportional to the number of welded bonds that break during the application of shear. The evolution of this parameter is described by a first-order kinetics. Using a novel and simple computational method, well suited for free and moving-boundary problems, we study the flow between two coaxial cylinders and obtain accurate results for the evolution of the structure, the extent of the yielded domain and the evolution of the stress. The results and conclusions apply directly to the design and analysis of rotational rheometer experiments for semisolid metal slurries and suspension systems exhibiting similar behavior. [Copyright &y& Elsevier]

We investigate numerically the interactions of two-dimensional jets of Bingham plastic and Herschel–Bulkley fluids with a vertical surface at a distance from the die exit. This problem simulates the early stages of filling of a planar cavity. Our main objective is to explain the flow instabilities observed during the processing of semisolid materials. The effects of the Reynolds and Bingham numbers and of the inlet boundary conditions on both the filling and the stability of the jet are established by means of numerical time-dependent calculations. [Copyright &y& Elsevier]

AbstractObjectiveMethodsResultsConclusionsThis study aimed to assess the possible association of adherence to the Mediterranean diet (MD) with muscle strength and body composition.The cross-sectional study evaluated 112 postmenopausal women (aged 41–71 years). Fasting blood samples were obtained for biochemical/hormonal assessment. The Mediterranean Dietary Score (MedDietScore) was calculated and used to stratify adherence by tertiles (low [T1], moderate [T2] or high [T3]). Handgrip strength (HGS) was measured by dynamometry and body composition with dual-X-ray absorptiometry.Women with low–moderate MedDietScore (T1/T2) had lower HGS values than those with higher scores (19.5 ± 4.9 kg vs. 21.9 ± 3.9 kg, p = 0.023). A linear stepwise increase of HGS values per MedDietScore tertile was found (T1 vs. T2 vs. T3: 18.4 ± 4.4 kg vs. 20.6 ± 5.2 kg vs. 21.9 ± 3.9 kg, ANOVA p-value for linear trend = 0.009, ANCOVA p-value = 0.026). Multivariable models confirmed that HGS values were independently associated with the MedDietScore (β-coefficient = 0.266, p = 0.010). Lean mass values were associated with the MedDietScore (β-coefficient = 0.205, p = 0.040). All models were adjusted for age and cardiometabolic risk factors.The data suggest that the higher the adherence to the MD, the better the muscle strength and lean mass in postmenopausal women. Prospective studies are required to evaluate the significance of these observations in cardiovascular prevention strategies at midlife. [ABSTRACT FROM AUTHOR]

Background: Female sexual dysfunction (FSD) has been suggested to be correlated with the burden of cardiovascular risk factors. Aim: We aimed to evaluate the possible association between functional indices of vascular function and FSD scores in apparently healthy postmenopausal women. Methods: This cross-sectional study included 116 postmenopausal women who underwent assessment of endothelial function with measurement of flow-mediated dilation (FMD) of the branchial artery and arterial stiffness estimation with measurement of the carotid-femoral pulse wave velocity (PWV). We used the Greene Climacteric Scale to evaluate vasomotor symptomatology, the Female Sexual Function Index (FSFI) to evaluate FSD and the Beck Depression Inventory to evaluate mood disorder. Low sexual function was defined as an FSFI score <26.55. Outcomes: These included FSFI and low sexual function scores as well as measures of PWV and FMD. Results: Sexual function scores were associated with measures of blood pressure (normal vs low sexual function; systolic blood pressure: 120.2 ± 15.0 mm Hg vs 113.4 ± 14.6 mm Hg; analysis of covariance P =.026; diastolic blood pressure: 75.9 ± 10.5 mm Hg vs 70.3 ± 9.9 mm Hg; analysis of covariance P =.012; both adjusted for age, body mass index, current smoking, and PWV). Systolic blood pressure, but not diastolic blood pressure, was associated with FSFI (B = 0.249, P =.041) and PWV (B = 0.392, P <.001). PWV measures were associated with FSFI (B = −0.291, P =.047) and pulse pressure (B = 0.355, P =.017). FMD measures were also associated with FSFI (B = 0.427, P =.033). All models were adjusted for age, body mass index, current smoking, insulin resistance, vasomotor symptomatology, and Beck Depression Inventory. Clinical implications: Our findings demonstrate that lower scores of sexual function are associated with deteriorated vascular function mainly manifested as arterial stiffening, further contributing to systolic blood pressure changes. Strengths and limitations: The strength of this study is the carefully selected healthy sample of postmenopausal women, with simultaneous assessment of climacteric symptomatology and mood disorders. The limitations include the small sample size, the cross-sectional design, and the recruitment of consecutive outpatients of a university menopause clinic. Conclusion: Longitudinal studies and interventions to improve FSD should further assess the clinical relevance of these findings. [ABSTRACT FROM AUTHOR]

Simple Summary: Single-Nucleotide-Polymorphisms in long non-coding RNAs are correlated with esophageal carcinogenesis, yet research remains restricted in Asian ethnicities. Herein, FFPE specimens were obtained from surgically treated esophageal cancer patients for genotyping deriving from European ancestry. HULC rs7763881 polymorphism was not associated with cancer predisposition. LINC00951 rs11752942 was underrepresented in Ca19.9 elevated subgroup. HOTAIR rs920778 was more frequent in both worse differentiation grade and positive Signet Ring Cell and Ca19.9 subgroups. POLR2E rs3787016 was identified less frequently in Adenocarcinoma, Signet Ring Cell, and Diffuse histological subtypes, as well as in Perineural, Lymphovascular, and Perivascular Invasion positive, while it was found more often in CEA positive subgroup of the whole cancer cohort. Taken together, these lncRNAs polymorphisms are promising not only as future therapeutic agents but also as novel markers for predictive analysis of esophageal cancer risk and oncological outcomes including survival. Long non-coding RNAs' HOTAIR rs920778, LINC00951 rs11752942, POLR2E rs3787016, and HULC rs7763881 are progressively reported having a close genetic affinity with esophageal carcinogenesis in the East. Nonetheless, their correlation with variables already endorsed as significant prognostic factors in terms of staging, guiding treatment and predicting recurrence, metastasis, and survival have yet to be explored. Herein, we investigated their prognostic value by correlating them with clinicopathological and laboratory prognostic markers in esophageal cancer in the West. Formalin-fixed paraffin-embedded tissue specimens from 95 consecutive patients operated on for esophageal cancer between 2014 and 2018 were compared with 121 healthy community controls. HULC was not detected differently in any of the cancer prognostic subgroups. LINC00951 was underrepresented in Ca19.9 elevated subgroup. HOTAIR was more frequent in both worse differentiation grade and positive Signet-Ring-Cell and Ca19.9 subgroups. POLR2E was identified less frequently in Adenocarcinoma, Signet-Ring-Cell, and Diffuse histologies, as well as in Perineural, Lymphovascular, and Perivascular Invasion positive, while it was overrepresented in CEA positive subgroup. These lncRNAs polymorphisms may hold great potential not only as future therapeutic agents but also as novel markers for predictive analysis of esophageal cancer risk, clinical outcome, and survival. Clinical implications of these findings need to be validated with prospective larger sample-size studies. [ABSTRACT FROM AUTHOR]

Patients with locally advanced gastric cancer (LAGC) often require multivisceral resection (MVR) of the involved organs to achieve R0 resection and local disease control. The aim of the present study was to systematically review all available literature on the postoperative and long-term outcomes of MVR for gastric cancer. The PubMed database was systematically searched by two independent investigators for studies concerning MVR for LAGC. In total, 30 original studies with 3362 patients met our inclusion criteria. R0 resection was achieved in 67.77% (95% CI, 65.75–69.73%) of patients. The spleen, colon and pancreas comprised the most frequently resected organs in the context of MVR. Pancreatic fistulae (10.08%, 95% CI, 7.99–12.63%), intraabdominal abscesses (9.92%, 95% CI, 7.85–12.46%) and anastomotic leaks (8.09%, 95% CI, 6.23–10.45%) constituted the most common postoperative complications. Using the available data, we estimated the mean 1-year survival at 62.2%, 3-year survival at 33.05%, and 5-year survival at 30.21% for the entire cohort. The survival rates were mainly correlated with lymphatic invasion, tumor size and patient age. Therefore, gastrectomy, together with MVR, is feasible and may offer a survival advantage compared to gastrectomy alone or no other surgical treatment in a selected group of patients. Consequently, both patient and tumor characteristics should be carefully assessed to optimize candidate selection. [ABSTRACT FROM AUTHOR]

Background Postmenopausal sexual function presupposes the integration of hormonal, neural, and vascular interactions and is subject to optimal crosstalk among psychological, interpersonal, cultural, and environmental factors. Sense of coherence (SOC) reflects a person's ability to cope with stressors and may influence the occurrence of menopausal symptoms and sexual dysfunction. Aim To investigate the association of severity of climacteric symptoms, cardiometabolic risk factors, and SOC with sexual function in postmenopausal women. Methods Overall 281 sexually active postmenopausal women without significant psychopathology or cardiovascular disease attending the Menopause Unit of Aretaieion Hospital were evaluated by the Female Sexual Function Index (FSFI), Greene Climacteric Scale, Beck Depression Scale, and Sense of Coherence Scale. Hormonal and biochemical parameters and cardiometabolic risk factors were evaluated. FSFI scores <26.5 were considered pathologic. Outcomes Total and subdomain scores of sexual response were determined. Results Pathologic FSFI scores were found in 79.7% of the sample. Linear models of multivariable regression analysis showed that FSFI scores were associated with (1) Beck scores (b  = −0.200; 95% CI, −0.472 to −0.073, P  = .001), vasomotor symptom severity (b  = −0.324; 95% CI, −0.985 to 0.051; P <.001), and age and (2) SOC (b  = 0.150, 95% CI, 0.036-0.331; P  = .008), vasomotor symptom severity (b  = −0.361; 95% CI, −0.743 to 0.245; P <.001), and age. Both models were adjusted for menopausal age, diabetes mellitus, hypertension, type of menopause, and menopausal hormone therapy intake. SOC was associated with Beck depression scores (β = −0.487, P <.001; Greene Climacteric Scale total scores, β = −0.199, P <.001). FSFI score <26.5 vs >26.5 was associated with SOC (odds ratio, 0.982; 95% CI, 0.563 to 1.947; P  = .006) and moderate to severe vasomotor symptom severity (odds ratio, 2.476; 95% CI, 1.478 to 3.120; P  = .009) independent of age, diabetes mellitus, hypertension, menopausal hormone therapy intake, type of menopause, or Beck depression classification. Clinical Implications The results indicate the importance of psychometric assessment of postmenopausal women when presenting with scores of low sexual function. The severity of vasomotor symptoms should also be addressed in any case. Strengths and Limitations This is the first study investigating the relationship between SOC and sexuality in menopause in a carefully selected homogenous population. Limitations included the cross-sectional design and the fact that sexual distress was not assessed. Conclusions Pathologic FSFI scores were highly prevalent in this sample of postmenopausal women. FSFI is associated positively with age and severity of vasomotor symptoms and negatively with SOC. [ABSTRACT FROM AUTHOR]

Purpose : The aim of this study was to investigate the actual incidence of symptomatic Petersen’s hernias (PH) as well as identify risk factors for their occurrence. Methods: Search was performed in Medline (via PubMed), Web of Science, and Cochrane library, using the keywords “Petersen Or Petersen’s AND hernia” and “Internal hernia.” Only studies of symptomatic PH were eligible. Fifty-three studies matched our criteria and were included. Risk of bias for each study was independently assessed using the checklist modification by Hoy et al. Analysis was performed using random-effects models, with subsequent subgroup analyses. Results: A total of 81,701 patients were included. Mean time interval from index operation to PH diagnosis was 17.8 months. Total small bowel obstruction (SBO) events at Petersen’s site were 737 (0.7%). SBO incidence was significantly higher in patients without defect closure (1.2% vs 0.3%, p < 0.01), but was not significantly affected by anastomosis fashion (retrocolic 0.7% vs antecolic 0.8%, p = 0.99). SBO incidence was also not significantly affected by the surgical approach (laparoscopic = 0.7% vs open = 0.1%, p = 0.18). However, retrocolic anastomosis was found to be associated with marginally, but not significantly, increased SBO rate in patients with Petersen’s space closure, compared with the antecolic anastomosis (p = 0.09). Conclusion: PH development may occur after any gastric operation with gastrojejunal anastomosis. Contrary to anastomosis fashion and surgical approach, defect closure was demonstrated to significantly reduce SBO incidence. Limitations of this study may include the high heterogeneity and the possible publication bias across the included studies. [ABSTRACT FROM AUTHOR]

Introduction: Sleeve gastrectomy (SG) is currently the most commonly performed bariatric procedure worldwide. The aim of the present study was to evaluate the long-term efficacy of SG as a stand-alone bariatric procedure. Methods: A single-center retrospective analysis of 104 patients who underwent SG as a stand-alone bariatric procedure between January 2005 and December 2009. Weight loss, weight regain, remission or improvement of comorbidities and the new onset of comorbidities were the main outcomes of the study. Results: The percent excess body weight loss (%EBWL), percent excess body mass weight (BMI) loss (%EBMIL), and percent total body weight loss (%TBWL) were 59 ± 25, 69 ± 29, and 29 ± 12, respectively, after a mean follow-up of 13.4 years. At the last follow-up, nearly two thirds of patients (67.3%) had an %EBWL greater than 50. The percentage of patients who experienced significant weight regain ranged from 47 to 64%, depending on the definition used for weight regain. The rate of improvement or remission of hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea, and degenerative joint disease at a mean follow-up of 13.4 years was 40%, 94.7%, 70%, 100%, and 42.9%, respectively. The new onset of gastroesophageal reflux disease (GERD) symptoms in the same period was 43%. Conclusion: Our data supports that SG results in long-lasting weight loss in the majority of patients and acceptable rates of remission or improvement of comorbidities. Weight regain and GERD may be issues of particular concern during long-term follow-up after SG. [ABSTRACT FROM AUTHOR]

We provide benchmark results for a transient variant of the lid-driven cavity problem, where the lid motion is suddenly stopped and the flow is left to decay under the action of viscosity. Results include Newtonian as well as Bingham flows, the latter having finite cessation times, for Reynolds numbers Re ∈ [1, 1000] and Bingham numbers Bn ∈ [0, 10]. The finite-volume method and Papanastasiou regularisation were employed. A combination of Re and Bn, the effective Reynolds number, is shown to convey more information about the flow than either Re or Bn alone. A time scale which characterises the flow independently of the geometry and flow parameters is proposed. [ABSTRACT FROM AUTHOR]

We study the flow of a thixotropic fluid around a cylinder. The rheology of the fluid is described by means of a structural viscoplastic model based on the Bingham constitutive equation, regularised using the Papanastasiou regularisation. The yield stress is assumed to vary linearly with the structural parameter, which varies from zero (completely broken structure) to one (fully developed skeleton structure), following a first-order rate equation which accounts for material structure break-down and build-up. The results were obtained numerically using the Finite Element Method. Simulations were performed for a moderate Reynolds number of 45, so that flow recirculation is observed behind the cylinder, but vortex shedding does not occur. The effects of the Bingham number and of the thixotropy parameters are studied. The results show that the viscous character of the flow can be controlled within certain limits through these parameters, despite the fact that the Reynolds number is fixed. [ABSTRACT FROM AUTHOR]

Background: Pyometra (P) leads to sepsis and multiple organ dysfunction syndrome. Toll-like receptors (TLRs) recognize pathogens which can cause P. The aim of this study was to investigate TLR-7 and -9 via the MYD88 pathway and the nuclear factor kappa B (NFκB) response in the uterus of a P mouse model before and after ovariohysterectomy (RP) as well as potential lung injury. Materials and Methods: 200 female C57BL/6J mice were randomly divided into groups (N = 10/subgroup; sham 1, 2, 3, 7; P1, 2, 3, 7; 1RP1, 2, 3, 7; 2RP1, 2, 3, 7; 3RP1, 2, 3, 7) according to the day of euthanasia. Pathogens were administrated in the groups P and RP in order to induce P. Results: Alterations in blood chemistry, histopathology, and RT-qPCT analysis before (P) and after RP were observed. Significant correlations were also found between MYD88, NFκB, and TLR9 in P and RP groups in the lungs and in RP groups in the uterus, suggesting that the immune system responded via the TLR9-MYD88 pathway. Conclusions: This is the first report of immunohistochemical TLR-7 and -9 localization and of TLR-7, -9, MYD88, and NFκB mRNA expression in the uterus causing lung injury in a P mouse model. [ABSTRACT FROM AUTHOR]

Highlights: [•] Results for a wide range of Reynolds and Bingham numbers are provided. [•] The performance of SIMPLE/multigrid for solving viscoplastic flows is assessed. [•] High truncation errors near the yield surfaces limit the finite volume accuracy. [•] Adaptive mesh refinement is efficient in reducing the discretisation errors. [ABSTRACT FROM AUTHOR]

Abstract: We investigate the performance of the finite volume method in solving viscoplastic flows. The creeping square lid-driven cavity flow of a Bingham plastic is chosen as the test case and the constitutive equation is regularised as proposed by Papanastasiou [J. Rheol. 31 (1987) 385–404]. It is shown that the convergence rate of the standard SIMPLE pressure-correction algorithm, which is used to solve the algebraic equation system that is produced by the finite volume discretisation, severely deteriorates as the Bingham number increases, with a corresponding increase in the non-linearity of the equations. It is shown that using the SIMPLE algorithm in a multigrid context dramatically improves convergence, although the multigrid convergence rates are much worse than for Newtonian flows. The numerical results obtained for Bingham numbers as high as 1000 compare favourably with reported results of other methods. [Copyright &y& Elsevier]

Contradictory results have been reported regarding a relationship between serum lipid levels and bone mineral density. The purpose of this study was to further investigate a possible relationship between those parameters in Greek postmenopausal women. A total of 591 patients followed at a tertiary hospital were examined for seven different lipid factors in relation to dual-emission X-ray absorptiometry measurements at the lumbar spine. Lipoprotein-a was the only lipid measurement that univariately showed an almost significant trend of association with bone mass category (analysis of variance [ANOVA] p value 0.062 for Ln(Lipoprotein-a)). In multiple regression, it was noted that a non-significant negative trend of association of high density lipoprotein (HDL) cholesterol and Apolipoprotein AI with lumbar T-score ( p value 0.058 and 0.075, respectively). In age subgroup analysis, Lipoprotein-a and Ln(Lipoprotein-a) presented a negative correlation with lumbar T-score for women with age ≥ 53 years ( p value 0.043 and 0.070, respectively), while a negative correlation of HDL and Apolipoprotein AI levels with lumbar T-score remained in women with age < 53 years ( p value 0.039 and 0.052, respectively). The findings do not support a strong relationship between lipid levels and bone mass measurements. [ABSTRACT FROM AUTHOR]

Abstract: The time-dependent, compressible extrusion of a Carreau fluid is solved over the reservoir-die-extrudate region using finite elements in space and a fully implicit scheme in time. A nonmonotonic slip law based on experimental data on polyethylene melts is assumed to hold along the die wall and the velocity at the entrance of the reservoir is taken to be fixed and uniform. As in the case of the extrudate-swell flow, the combination of compressibility and nonlinear slip leads to self-sustained oscillations of the pressure drop and of the mass flow rate in the unstable regime. The effects of the reservoir volume, the imposed flow rate, and the capillary length on the amplitude and the frequency of the pressure and free surface oscillations are studied and comparisons are made with experimental observations. [Copyright &y& Elsevier]

To evaluate the effectiveness of a structured education program on lifestyle habits, which is also incorporating teaching on deep breathing, progressive muscle relaxation, and guided visualization, in the control of various components of the climacteric symptomatology in peri- and postmenopausal women. Sixty-one women aged 40–65 years with varying climacteric and stress symptoms were included in this study. Women were randomly assigned to the intervention group (31) or the control group (30). The intervention group followed an 8-week stress management program. The following parameters were assessed at baseline and at the end of the 8-week follow-up period in both groups: climacteric symptoms (Green Climacteric Scale (GCS)), sleep quality (Pittsburg Sleep Quality Index (PSQI)), mood status (Depression-Anxiety-Stress Scale), self-esteem (Rosenberg Self-esteem Scale), and health-related control (health locus of control (HLC)). A mixed-model ANOVA showed significant time × group × GCS interaction (within subjects: F = 23.830, p value<0.001; between subjects: F = 39.078, p value<0.001). With regard to HLC, there was a non-significant between subjects but a significant within-subjects effect (HLC × group × time, F = 3.848, p value = 0.024). Regarding DASS scores, there was a significant between-subjects' effect (F = 10.258, p value = 0.003) but a non-significant within-subjects' effect. With regard to PSQI, the analysis showed significant within-subjects' effects (PSQI × group × time: F = 4.691, p value = 0.003) and non-significant between-subjects' effects (F = 0.022, p = 0.883). Finally, regarding RSS, there was a significant within-subjects' (RSS × group × time, F = 4.183, p value = 0.029) but non-significant between-subjects' effect (F = 1.582, p value = 0.213). Stress management may offer an alternative approach to the management of climacteric symptoms. [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]

Anti-Müllerian hormone (AMH), which is secreted by granulosa cells of late preantral and small antral follicles, is a marker of ovarian reserve. The association of ovarian reserve with subclinical atherosclerosis in women of reproductive age is currently unknown. We primary investigated whether AMH levels are associated with markers of subclinical atherosclerosis in healthy, normally menstruating women. In this cross-sectional study, vascular structure and function were assessed by measurement of carotid and femoral intima–media thickness (IMT), flow-mediated dilation, carotid–femoral pulse wave velocity and augmentation index. Lipid profile and serum AMH concentrations were also measured. Seventy premenopausal women, aged 32.7 ± 6.5 years, were included. Mean AMH levels were lower in smokers than in non-smokers and negatively associated with total cholesterol (TC) levels. An inverse association between mean AMH concentrations and femoral and carotid IMT in all segments was observed. No correlation with other markers of subclinical atherosclerosis or established cardiovascular (CV) risk factors was found. After multivariable adjustment, the association between AMH concentrations and combined carotid IMT or carotid bulb IMT remained significant. In conclusion, in healthy, normally ovulating women, AMH concentrations are negatively associated with subclinical atherosclerosis indices and TC levels, independently of established CV risk factors. [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]

Aims: It has been suggested recently that follistatin (FST) and its homologous protein, follistatin‐like 3 (FSTL3), may be a therapeutic target in the treatment of type 2 diabetes because of their glucose‐regulatory effects in rodents. Materials and Methods: We investigated this hypothesis in humans by studying the physiology of a possible glycaemia–follistatin feedback loop, that is, whether glucose, but not lipid intake (oral or intravenous), can regulate circulating FST and FSTL3 in healthy humans (n = 32), whether the levels of follistatins change in response to various types of bariatric operation in morbidly obese individuals, with or without type 2 diabetes (n = 41), and whether such changes are associated prospectively with improvement of glucose homeostasis/insulin sensitivity. Results: In healthy individuals, circulating FST decreases after intravenous or oral glucose intake compared to controls, indicating the presence of a negative feedback mechanism. In morbid obesity, insulin resistance, glycaemia, circulating FST and FSTL3 are all reduced (by 22%‐33%) after Roux‐en‐Y gastric bypass (RYGB) and sleeve gastrectomy. Importantly, the changes in circulating FST 3 months after bariatric surgery are associated prospectively with the changes in glucose, insulin, HOMA‐IR and HbA1c observed 6 months postoperatively in individuals with and without type 2 diabetes. Conclusions: Our findings provide evidence of an important role of FST in glucose homeostasis in healthy individuals as well as in severely obese individuals with insulin resistance and type 2 diabetes. Our data extend recent results from animal studies to humans and support the need for further evaluation of FST inactivation strategies for targeting hyperglycaemia and insulin resistance. [ABSTRACT FROM AUTHOR]

Background: The incidence of colorectal cancer (CRC) is expected to increase by 80% in year 2035. Even though advantages in treatment of CRC have being made over the last decades, the outcome remains poor. Recently, several inflammatory markers including pretreatment neutrophil to lymphocyte ratio (NLR), have being used as prognostic factors, since host inflammatory response to cancer is believed to determine disease progression. The aim of this study is to evaluate the prognostic significance of pretreatment NLR, in terms of overall survival (OS), 5-year survival, disease-free survival (DFS) and recurrence, in CRC patients who underwent curative resection.Methods: We retrospectively reviewed 296 patients, who were submitted to elective surgery as first therapeutic option in curative intent, between January 2010 and December 2015. Pretreatment NLR, as well as demographics, clinical, histopathologic, and laboratory data were analyzed. Univariate and multivariate analyses were conducted to identify prognostic factors associated with OS, 5-year survival, DFS and recurrence.Results: The cutoff point of NLR was calculated with Kaplan-Meier curves and log-rank test to 4.7. Univariate and multivariate analyses disclosed elevated NLR as a significant dismal prognostic factor for DFS (HR 1.88; 95% CI 1.01-3.52; p = 0.048), 5-year survival (HR 2.14; 95% CI 1.12-4.10; p = 0.021) and OS (HR 2.11; 95% CI 1.11-4.03; p = 0.023). In a subgroup analysis, in patients with stage II CRC, NLR > 4.7 was a stronger poor predictor for DFS (HR 2.76; 95% CI 1.07-7.13; p = 0.036), 5-year survival (HR 3.84; 95% CI 1.39-10.63; p = 0.01) and OS (HR 3.62; 95% CI 1.33-4.82; p = 0.012). After adjusting stage for gender, age, location of the primary tumor, differentiation, as well as the presence of perineural, vascular, and lymphovascular invasion, the significance of NLR > 4.7 became more prominent for DFS (HR 2.85; 95% CI 1.21-6.73; p = 0.0176), 5-year survival (HR 4.06; 95% CI 1.66-9.93; p = 0.002) and OS (HR 4.07; 95% CI 1.69-9.91; p = 0.002) in stage II patients.Conclusion: Pretreatment NLR > 4.7 is a poor prognostic factor for DFS, 5-year survival and OS in CRC patients undergoing curative resection. The dismal prognostic effect of NRL is magnified in Stage II CRC patients. [ABSTRACT FROM AUTHOR]

Genetic variations of genes encoding the endothelial nitric oxide synthase (eNOS) and the NADH/NADPH oxidase system are related with atherosclerosis in the general population, but their significance in women is not sufficiently assessed. We investigated the potential association between the G894T polymorphism of the NOS3 gene and the C242T polymorphism of the CYBA gene with subclinical vascular disease. Seventy (70) healthy, normally ovulating, premenopausal women were recruited for this study. Venous blood samples were obtained for biochemical/hormonal assessment as well as for genotyping, using real-time PCR. Sonographically assessed indices of vascular structure and function included carotid and femoral intima-media thickness (IMT), flow-mediated dilation (FMD), carotid-femoral pulse-wave velocity (PWV), and augmentation index. The prevalence of wild type, heterozygote, and homozygote genotype was 44.3% (31/70), 54.3% (38/70), and 1.4% (1/70) for the G894T polymorphism and 38.6% (27/70), 31.4% (22/70), and 30.0% (21/70) for the C242T polymorphism, respectively. After multivariable adjustment, the hC242T polymorphism was a predictor of both internal carotid IMT (b-coefficient − 0.119, p = 0.011) and combined-IMT (b-coefficient − 0.061, p = 0.015). Systolic blood pressure, lipids, and hC242T determined values of FMD (b-coefficient − 1.604, p = 0.034). Concerning the NOS3 G894T polymorphism, carriers of the polymorphic variant had higher values of IMT and PWV compared to the wild-type subgroup (carotid bulb-IMT and PWV, heterozygotes/homozygotes vs wild type 0.7 ± 0.2 vs 0.6 ± 0.1 mm; 7.1 ± 0.8 vs 6.6 ± 0.7 m/s; p = 0.048 and p = 0.029, respectively). These differences, however, were rendered non-significant in the multivariable analysis. In healthy premenopausal women, the CYBA C242T polymorphism is an independent determinant of endothelial function and subclinical atherosclerosis of the carotid arteries. The NOS3 G894T polymorphic variant also correlated with atherosclerosis, an association probably mediated by the traditional risk factors for CVD. The relevance of these findings in the clinical setting remains to be elucidated. [ABSTRACT FROM AUTHOR]

Background: The present study aims to examine the association of the metabolic syndrome (MS) as well as of the triglyceride-glucose index (TyG-Index), a novel marker of insulin resistance, with subclinical atherosclerosis in a cohort of postmenopausal women, stratified according to their body mass index.Methods: A total of 473 informed-consenting, non-diabetic postmenopausal women, without overt cardiovascular disease, were included in this study. We aimed to compare the association between structural and functional indices of subclinical atherosclerosis (i.e. carotid artery intima-media thickness (IMT), flow-mediated dilation of the brachial artery, pulse wave velocity (PWV)) with the TyG-index or MS, separately for lean and overweight/obese women.Results: The TyG-Index correlated significantly with carotid IMT (r=0.155, p=0.012) and PWV (r=0.157, p=0.013) only in the group of lean women. Multivariate analysis showed that subclinical atherosclerosis was predicted by MS, in the overweight/obese group (OR=2.517, 95% CI: 1.078-5.878, p=0.033), and by the TyG-Index the lean group (OR=3.119, 95% CI: 1.187-8.194, p<0.001). Using a TyG-Index cut-off value of 8.0 in the lean subpopulation, women above the cut-off had 44.1% prevalence of subclinical atherosclerosis compared to 29.4% in women below the cut-off (p=0.043).Conclusions: The TyG-Index is associated with carotid atherosclerosis and arterial stiffness mainly in lean postmenopausal women, while the MS serves as a better predictor of subclinical atherosclerosis in overweight/obese women. The TyG-Index may prove a useful marker for identifying high-risk women in the normal-weight postmenopausal population. [ABSTRACT FROM AUTHOR]

The changing hormonal milieu during the menopausal transition may contribute to the development of memory disorders. We aimed to assess the association of sex hormones with memory function in a sample of Greek middle-aged women. This pilot study included 44 women with subjective memory complaints. Memory performance was evaluated using the Hopkins Verbal Learning Test (HVLT), the Brief Visuospatial Memory test (BVMT), and the verbal digits backwards test (VSPAN), to assess verbal, visuospatial, and working memory performance, respectively. Menopausal symptoms were assessed using the Green Climacteric Scale. VSPAN backwards scores were positively associated with log-transformed free androgen index (logFAI), in models adjusted for age, education, log-transformed free estrogen index (logFEI), hypertension, and the intensity of menopausal symptoms. BVMT total scores were predicted by logFAI (b-coefficient = 0.424, p value = 0.002), education, and combined climacteric symptomatology, in a model adjusted for age, logFEI, and hypertension. Women with circulating estradiol above the median value of 10 pg/mL had better total HTLV total scores compared to women with estradiol values below the median (HTLV total scores, estradiol ≤ 10 pg/mL vs. > 10 pg/mL: 24.2 ± 3.6 vs. 30.0 ± 7.9, p value = 0.007 unadjusted). This association was affected by education and remained independent of menopausal symptoms and testosterone levels, education, and hypertension (model R 2 = 22.3%; b-coefficient = 0.318, p value = 0.024). Endogenous total estradiol is associated with verbal episodic memory, while logFAI is associated with working memory performance and visuospatial episodic memory in this sample of postmenopausal women. These associations were not influenced by age, education, or menopausal symptoms. Larger studies are necessary to evaluate the significance of our findings. [ABSTRACT FROM AUTHOR]

The menopause transition is associated with adverse changes in cardiometabolic risk factors. We aimed to examine the association of the metabolic syndrome (MS) and its features with indices of vascular structure and function in a population of asymptomatic postmenopausal women. A total of 473 informed-consenting, nondiabetic postmenopausal women were included in the study. The MS was defined according to the Joint Definition. We evaluated the association between the presence of MS and indices of vascular structure (carotid artery intima-media thickness (IMT); atherosclerotic plaques) and function (flow-mediated dilatation (FMD); pulse wave velocity (PWV)). The mean age of women was 56.4 ± 6.7 and the mean menopausal age was 7.91 ± 6.31. The MS was present in 17.3% of our population. Mean values of PWV increased linearly with the accumulation of features of the MS. IMT was higher in women with the MS compared to women without the MS (0.78 ± 0.12 mm vs. 0.74 ± 0.11,p = .003). Multivariate analysis showed that the presence of the MS was independently associated with common carotid artery IMT (b = 0.149,p = .001), PWV (b = 0.114,p = .012) as well as central systolic and diastolic blood pressure (b = 0.293,p < .001 andb = 0.163,p < .001 respectively). The presence of the MS is associated with subclinical atherosclerosis already in the first postmenopausal decade of this sample of asymptomatic, nondiabetic women. Additional evidence is required to support the causative effect of these associations. [ABSTRACT FROM AUTHOR]

Overt or subclinical thyroid dysfunction may affect the risk of fragility fractures. The aim of the present study was to assess the association of thyroid function and autoimmunity with vertebral fractures (VF) in a large sample of Greek postmenopausal women. This cross-sectional study recruited 335 euthyroid postmenopausal women, aged 35-79 years. Euthyroidism was verified by serum thyroid-stimulating hormone (TSH) within the laboratory reference range (0.4-4.5 μIU/mL). VFs were diagnosed by lumbar spine lateral radiographs, according to quantitative procedures. Serum free triiodothyronine (FT3), free thyroxine (FT4), TSH, as well as levels of anti-thyroglobulin (anti-TG) and thyroid peroxidase antibodies (anti-TPO) were compared according to the presence of VFs. Multivariate logistic regression showed that the presence of VFs was predicted independently by ln-TSH levels (OR = 0.290, p = 0.037) and positive anti-TG antibodies (OR = 3.308, p = 0.026) in models adjusted for age, menopausal age, and ln-HOMA-IR. Stepwise logistic regression analysis showed that the presence of VFs was predicted by menopausal age (OR = 1.120, p = 0.001), ln-TSH (OR = 0.312, p = 0.052), and thyroid autoimmunity (anti-TG and anti-TPO positive: OR = 6.637, p = 0.007) in a model that also included age and ln-HOMA-IR. Women with lower circulating TSH had higher risk of having a VF, independently of age, menopausal age, and insulin resistance. The presence of positive anti-TG/anti-TPO antibodies also indicated an elevated risk of fracture. Levels of thyroid hormones had no apparent effect on the risk of fracture. Further studies are necessary to establish the significance of our findings. [ABSTRACT FROM AUTHOR]

Purpose/Aim of the study: We evaluated possible associations between the severity of multiple sclerosis (MS) and levels of sex hormones as well as biochemical parameters in a sample of ambulatory patients.Material and methods: This cross-sectional study recruited 133 adults (52 men, 66 premenopausal and 15 postmenopausal women), with relapsing-remitting MS. Fasting venous blood samples were drawn for biochemical and hormonal evaluation. These parameters were tested for possible associations with MS severity, assessed using the Expanded Disability Status Scale (EDSS)-scores.Results: Follicle-stimulating hormonecorrelated with mean EDSS scores (r= −0.369,p= 0.038) in the premenopausal subgroup. However, this association became non-significant in the age-adjusted multivariate analysis (p= 0.141; power = 67%, typeαerror 0.10). Free androgen exhibited a borderline negative effect on EDSS-scores in the subgroup of men (r= −0.367,p= 0.093), which was lost after adjusting for age and duration of disease (p= 0.192; statistical power = 93%, typeαerror 0.05). Levels of estradiol tended to affect disability status of postmenopausal women (normal–mild vs. severe impairment: 23.33 ± 11.73pg/mL vs. 14.74 ± 6.30pg/mL,p= 0.095). Levels of sex hormones or indices of glycemic metabolism did not differ between patients presenting with EDSS scores higher or lower than the median value.Conclusion: Sex hormones and indices of glucose metabolism exhibited only a middle effect on EDSS scoring, which was not independent from the presence of confounders like age and duration of MS. The present study highlights the need for additional research, in order to elucidate the role of sex hormones and insulin resistance in the course of MS. [ABSTRACT FROM AUTHOR]

Background: Intracholecystic papillary-tubular neoplasms are rare precursor lesions of gallbladder cancer. They were proposed as a separate pathologic entity in 2012 by Adsay et al. for the unification of a variety of massforming precursor lesions including papillary adenomas, tubulopapillary adenomas, intestinal adenomas, and others. They are considered homologous to intrapapillary mucinous neoplasms of the pancreas and intrabiliary papillary neoplasms of the common bile duct. In contrast with the commoner flat-type precursor gallbladder cancer lesions, they follow a more indolent clinical course and probably different genetic pathways to carcinogenesis. They are largely uninvestigated with only a handful of studies providing biological and clinical information. Choledochal cysts are dilation of the common bile duct. Diagnosis is usually established during childhood, and only a minority of patients are diagnosed at adulthood. They are of major clinical importance as they are known predisposing factors for biliary carcinogenesis. Case presentation: The current report describes a patient with a simultaneous diagnosis of choledochal cyst and intracholecystic papillary-tubular neoplasm. The patient underwent excision of the extrahepatic biliary tree for a Todani I choledochal cyst, and histological examination of the specimen revealed an intracholecystic papillarytubular neoplasm of the gallbladder. Authors describe diagnostic and clinical course of the patient alongside clinical and biological characteristics of these rare lesions. Conclusions: To the best of our knowledge, this is the first report of a patient with a simultaneous diagnosis of choledochal cyst and intracholecystic papillary-tubular neoplasm. Those rare lesions shed light on different forms of gallbladder cancer carcinogenesis and its relationship with choledochal cysts and cholestasis. [ABSTRACT FROM AUTHOR]