The effect of physical activity on weight loss is mediated by eating self-regulation

Objective

This study tested whether different forms of physical activity (PA) were associated with eating self-regulation during weight control, and if changes in eating behavior mediated the relationship between PA and weight loss, in overweight/obese women.

Methods

239 women (37.6 ± 7.0 years; 31.3 ± 4.1 kg/m²) participated. The intervention group received a 12-month group behavioral treatment designed to increase autonomy and self-regulation for weight control. Controls received a health education program. Assessments included body weight, structured and lifestyle exercise/PA, and eating self-regulation.

Results

Moderate + vigorous and lifestyle PA were associated with 12-month change in most eating variables (p < 0.05) and with body weight change (p < 0.01). Mediation analysis showed that flexible cognitive restraint and emotional eating fully mediated the relation between lifestyle PA and weight change (effect ratio: 0.63). About 34% of the effect of moderate + vigorous PA on weight change was explained by these same mediators (partial mediation).

Conclusion

Exercise and PA may positively influence weight control through eating self-regulation. Flexible dietary control and reduced emotional overeating are mechanisms by which an active lifestyle can contribute to long-term weight management.

Practice implications

Regular exercise and PA can contribute to improved eating behaviors during weight management. This could represent an important incentive for people seeking weight control.     

Psychological insulin resistance in geriatric patients with diabetes mellitus

Objective

To determine the extent to which geriatric patients with diabetes mellitus experience psychological insulin resistance (PIR).

Methods

A total of 67 unselected geriatric patients with diabetes (mean age 82.8 ± 6.7 years, diabetes duration 12.2 [0.04–47.2] years, 70.1% female) were recruited in a geriatric care center of a university hospital.A comprehensive geriatric assessment (CGA) was performed including WHO-5, Hospital Anxiety and Depression Scale (HADS), Mini Mental State Examination (MMSE) and Barthel-Index. We assessed PIR using the Barriers of Insulin Treatment Questionnaire (BIT) and the Insulin Treatment Appraisal Scale in a face-to-face interview.

Results

Insulin-naïve patients (INP) showed higher PIR scores than patients already on insulin therapy (BIT-sum score: 4.3 ± 1.4 vs. 3.2 ± 1.0; p < 0.001). INP reported in the BIT increased fear of injection and self-testing (2.4 ± 2.4 vs. 1.3 ± 0.8; p = 0.016), expect disadvantages from insulin treatment (2.7 ± 1.6 vs. 1.9 ± 1.4; p = 0.04), and fear of stigmatization by insulin injection (5.2 ± 2.3 vs. 3.6 ± 2.6; p = 0.008). Fear of hypoglycemia, however, did not differ significantly (6.3 ± 2.8 vs. 5.1 ± 3.1; p = 0.11). Depression was not shown to be a barrier to insulin therapy.

Conclusion

INP with diabetes have a significantly more negative attitude toward insulin therapy in comparison to patients already on insulin.

Practice implications

Systematic assessment of barriers of insulin therapy, individualized diabetes treatment plans and information of patients may help to overcome such negative attitudes, leading to quicker initiation of therapy, improved adherence to treatment and a better quality of life.     

Association of the FTO and ADRB2 genes with body composition and fat distribution in obese women

Objective

The aim of this study was to investigate whether the polymorphisms of the fat mass and obesity-associated gene (FTO, rs9939609:T > A) and the β2-adrenergic receptor gene (ADRB2, rs1042714:Gln > Glu) are associated with weight loss in dieting obese premenopausal women and the association of these SNPs with body weight, body composition and distribution of fat mass.

Methods

75 obese (BMI > 30) premenopausal women participated in the intervention including a 3-month weight reduction period and a subsequent 9-month weight maintenance period. Weight and height were measured and BMI calculated. Body composition and fat mass distribution were assessed by dual energy X-ray absorptiometry.

Results

At baseline, the AA homozygotes of the FTO gene were 10.1 kg heavier (p = 0.031), they had higher BMI (p = 0.038), and greater waist and greater hip circumference (p = 0.08 and p = 0.067, respectively) compared to the TT homozygotes. Gln/Gln carriers of the ADRB2 gene had smaller gynoid fat-% compared with both the Gln/Glu and Glu/Glu carriers (p = 0.050 and p = 0.009, respectively). The Gln homozygotes had also smaller total body fat-% and higher total body lean mass-% than that of the Glu homozygotes (p = 0.018 and p = 0.019, respectively).

Conclusion

FTO genotype was associated with body weight in general, whereas ADRB2 genotype was associated with fat distribution. However, all women in the study group lost weight similarly independently of their genotypes. Neither the FTO nor ADRB2 genotype had statistically significant effect on weight reduction or weight maintenance.     

Empathy in high-tech and high-touch medicine

Objective

Surgeons and psychiatrists have been described as two contrary groups, the one healing by hands and the other by words. Empathy is needed in every physician–patient relationship. We tested whether (1) surgeons and psychiatrists show different levels of cognitive and emotional empathy; (2) measurements of cognitive and emotional empathy correlate with physician-specific empathy; and (3) gender, experience, and career choices are influencing factors.

Methods

56 surgeons and 50 psychiatrists participated. We measured empathy with the Jefferson Scale of Physician Empathy (JSPE), cognitive empathy with the Reading the Mind in the Eyes Test Revised (RME-R6), and emotional empathy with the Balanced Emotional Empathy Scale (BEES).

Results

Male psychiatrists scored significantly higher than that of male surgeons (118.0 ± 9.86 vs. 107.5 ± 13.84; p = 0.0006) in the JSPE. Analytically trained psychiatrists scored significantly higher in the JSPE than that of behaviorally trained psychiatrists (p = 0.024, F test, adjusted for gender). Both the RME and the BEES correlated positively with the JSPE.

Conclusion

Higher scores for empathy were found in male psychiatrists than in male surgeons.

Practice implications

Further research is needed to learn about the effects of general medical training on empathy.     

The change of insulin levels after six weeks antidepressant use in drug-naïve major depressive patients

Background

A reciprocal relationship between diabetes risk and depression has been reported. There are few studies investigating glucose–insulin homeostasis before and after short-term antidepressant treatment in drug-naïve major depressive disorder (MDD) patients.

Methods

This study included 104 healthy controls and 50 drug-naïve MDD patients diagnosed according to the DSM-IV criteria. These MDD patients were randomly assigned to receive fluoxetine or venlafaxine for six weeks. Depressive symptoms, body mass index, fasting plasma levels of glucose and insulin were measured.

Results

Compared to the healthy controls, the fasting plasma insulin and the homeostasis model of assessment for pancreatic β-cell secretory function (HOMA-β) was significantly lower in the MDD patients before antidepressant treatment (7.7±4.8 μIU/mL vs. 5.1±4.2 μIU/mL, p=0.006; 114.2±72.3% vs. 74.8±52.0%, p=0.005, respectively). However, these indices were not correlated with depression severity. After 6 weeks of fluoxetine or venlafaxine treatment, the level of HOMA-β borderline significantly increased (108.1±75.5%, p=0.059).

Limitations

The study was limited by the follow-up duration and lack of a placebo group.

Conclusions

Antidepressants might affect insulin secretion independently of the therapeutic effects on MDD. Further studies are needed to investigate the long-term effects of antidepressants on insulin regulation in MDD patients.     

A 12-month randomized controlled trial of balance training in elderly women with osteoporosis: Improvement of quality of life

Objective

Physical and psychological incapacity, including fear of falling is related to decreased satisfaction with life in osteoporosis (OP). The impact of a balance exercise program on improving the quality of life is not well established. We have, therefore, investigated the effect of 12-month Balance Training Program in quality of life, functional balance and falls in elderly OP women.

Methods

Sixty consecutive women with senile OP were randomized into a Balance Training Group (BT) of 30 patients and no intervention control group (CG) of 30 patients. The BT program included techniques to improve balance over a period of 12 months (1 h exercise session/week and home-based exercises). The quality of life was evaluated before and at the end of the trial using the Osteoporosis Assessment Questionnaire (OPAQ), functional balance was evaluated by Berg Balance Scale (BBS). Falls in the preceding year were noted and compared to the period of study.

Results

The comparison of OPAQ variations (INITIAL–FINAL) revealed a significant improvement in quality of life in all parameters for BT compared to CG: well-being (1.61 ± 1.44 vs. −1.46 ± 1.32, p < 0001), physical function (1.30 ± 1.33 vs. −0.36 ± 0.82, p < 0.001), psychological status (1.58 ± 1.36 vs. −1.02 ± 0.83, p < 0.001), symptoms (2.76 ± 1.96 vs. −0.63 ± 0.87, p < 0.001), social interaction (1.01 ± 1.51 vs. 0.35 ± 1.08, p < 0.001). Of note, this overall benefit was paralleled by an improvement of BBS (−5.5 ± 5.67 vs. +0.5 ± 4.88 p < 0.001) and a reduction of falls in 50% in BT group vs. 26.6% for the CG (RR: 1.88, p < 0.025).

Conclusion

The long-term Balance Training Program of OP women provides a striking overall health quality of life improvement in parallel with improving functional balance and reduced falls.     

Four tumor necrosis factor alpha genes polymorphisms and periodontitis risk in a Chinese population

Background

Tumour necrosis factor-alpha (TNF-alpha) has been implicated in the pathogenesis of generalized aggressive periodontitis (AgP) and chronic periodontitis (CP). The objective of the present study was to evaluate the association of four TNF-alpha gene polymorphisms (−1031T/C, −857C/T, −308G/A and −238G/A) with susceptibility to AgP and CP in a Chinese population.

Methods

A hospital-based case-control study was conducted in in patients with CP (n = 180), AgP (n = 180) and healthy controls (n = 180). Gene promoter polymorphisms were analyzed by polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) assay. Genotype and allele frequencies were analyzed using the chi-square test and logistic regression analysis.

Results

TNF-alpha −1031CC genotype was significantly higher [odds ratio (OR) = 2.36, 95% confidence interval (CI) = 1.03, 5.43; P = 0.04] in patients with CP compared with healthy controls. TNF-alpha −308AA genotype was significantly higher (OR = 2.71, 95% CI = 1.09, 6.73; P = 0.03) in patients with AgP compared with healthy controls. No association was found of TNF-alpha −857C/T and −238G/A polymorphisms with susceptibility to AgP or CP.

Conclusions

Our data demonstrated that TNF-alpha −1031CC genotype was a risk factor for CP, and that TNF-alpha −308AA genotype was a risk factor for AgP. But there is a lack of association of TNF-alpha −857C/T and −238G/A polymorphisms with susceptibility to AgP or CP in a Chinese population.     

A small-change approach delivered via telephone promotes weight loss in veterans: Results from the ASPIRE-VA pilot study

Objective

High rates of overweight and obesity (70%) among US veterans pose a significant threat of obesity-related chronic disease and disability. The purpose of this pilot study was to demonstrate feasibility and impact of a phone-based small-change weight loss intervention (ASPIRE-VA) with veterans.

Methods

Participants received a pedometer, food log book, and treatment manual outlining the small change program. Participants then scheduled weekly phone calls with a lifestyle coach, during which they reviewed the prior week's goals and developed new goals for the following week. Primary outcome was weight loss measured at 12 weeks, compared to baseline.

Results

Fourteen sedentary (4471 ± 2315 steps per day), obese (37.0 ± 4.2 BMI), middle aged (53.8 ± 12.5) male (64%) and female (36%) participants were enrolled. At 12 weeks participants exhibited significant weight loss (−3.8 ± 3.6 kg; p = .002) and increased intake of fruits and vegetables (+2.2 ± 3.1 daily servings; p = .03); though no change in walking (+786 ± 2288 daily steps; p = .24).

Conclusion

Results suggest that a phone-based small change program is feasible and beneficial for promoting weight loss in overweight/obese veterans.

Practice implications

This telephone-based program has the potential to reduce rates of overweight and obesity among veterans and thus prevent and improve prognosis of associated chronic conditions.     

Arm span increases predictive value of models for prevalent vertebral deformities: The Japanese Population-based Osteoporosis (JPOS) Study

Objective

We examined anthropometric indicators to improve predictive ability of asymptomatic vertebral fracture screening models.

Study design and setting

Data were obtained from the 1996 Japanese Population-based Osteoporosis (JPOS) Study. McCloskey–Kanis criteria diagnosed vertebral deformities on X-ray absorptiometric images in 693 women aged ≥50.The multiple logistic regression model included age, height, weight, postmenopausal status, total hip BMD, and arm span (AS) or sitting height as explanatory variables. Akaike's information criterion (AIC) evaluated model goodness-of-fit.

Results

Age-adjusted AS and sitting height in subjects with and without vertebral deformities were 147.2 ± 0.6 cm and 148.5 ± 0.2 cm (P = 0.055), 78.5 ± 0.5 cm and 79.9 ± 0.2 cm (P = 0.007), respectively. Every 5-cm increase in AS indicated 1.5-fold increased risk of prevalent vertebral deformity in the model including age, height, weight, postmenopausal status, and BMD. Including the explanatory variable AS in models yielded better predictive accuracy than excluding AS (AIC, 441.7 vs 446.6, respectively). Sitting height did not significantly influence model predictive ability.

Conclusion

Predictive accuracy of model for vertebral fracture including age, height, weight, postmenopausal status, and BMD improved when AS was added as an explanatory variable. Models to screen for asymptomatic vertebral fractures should include AS.     

Evaluation of a novel educational strategy,including inhaler-based reminder labels,to improve asthma inhaler technique

Objective

To evaluate the feasibility, acceptability and effectiveness of a brief intervention about inhaler technique, delivered by community pharmacists to asthma patients.

Methods

Thirty-one pharmacists received brief workshop education (Active: n = 16, Control: n = 15). Active Group pharmacists were trained to assess and teach dry powder inhaler technique, using patient-centered educational tools including novel Inhaler Technique Labels. Interventions were delivered to patients at four visits over 6 months.

Results

At baseline, patients (Active: 53, Control: 44) demonstrated poor inhaler technique (mean ± S.D. score out of 9, 5.7 ± 1.6). At 6 months, improvement in inhaler technique score was significantly greater in Active cf. Control patients (2.8 ± 1.6 cf. 0.9 ± 1.4, p < 0.001), and asthma severity was significantly improved (p = 0.015). Qualitative responses from patients and pharmacists indicated a high level of satisfaction with the intervention and educational tools, both for their effectiveness and for their impact on the patient–pharmacist relationship.

Conclusion

A simple feasible intervention in community pharmacies, incorporating daily reminders via Inhaler Technique Labels on inhalers, can lead to improvement in inhaler technique and asthma outcomes.

Practice implications

Brief training modules and simple educational tools, such as Inhaler Technique Labels, can provide a low-cost and sustainable way of changing patient behavior in asthma, using community pharmacists as educators.     

Impact of laparoscopic surgery on thoracoabdominal mechanics and inspiratory muscular activity

Objective

To evaluate the effect of laparoscopic surgery on pulmonary volume distributions and inspiratory muscles activity. Respiratory consequences associated with postoperative pain were also evaluated.

Methods

This study enrolled 20 patients without lung disease performed spirometry and chest wall kinematic analyses (i.e., chest wall, upper and lower ribcage and abdominal volumes), and measured the activity of inspiratory muscular before and 2 days after laparoscopic surgery. Pain was also assessed.

Results

After laparoscopy, the patients demonstrated decreased volumes in all three thoracoabdominal compartments: abdomen (ABD), upper and lower rib cage (URC and LRC, respectively) compared with the pre-operative measurements: ABD = 0.38 ± 0.20 L vs. 0.55 ± 0.25 L; URC = 0.45 ± 0.18 L vs. 0.55 ± 0.21 L; and LRC = 0.31 ± 0.18 L vs. 0.41 ± 0.23 L; p < 0.05. A reduction in the inspiratory muscular activity after surgery was also observed (sternocleidomastoid: 10.6 ± 5.1 × 10⁻³ mV vs. 12.8 ± 6.3 × 10⁻³ mV; intercostals: 16.8 ± 12.4 × 10⁻³ mV vs. 25.1 ± 21.3 × 10⁻³ mV; p < 0.05). In addition, lower volumes during deep breathing were observed in patients who reported significant pain than those who did not (0.51 ± 0.17 L vs. 0.79 ± 0.29 L; p < 0.05, respectively).

Conclusion

Laparoscopic surgery reduces chest wall ventilation and inspiratory muscular activity during deep breathing. The effects appear to depend on the patient's reported pain level.     

Association of myasthenia gravis with polymorphisms in the gene of histamine N-methyltransferase

Introduction

Histamine N-methyltransferase (HNMT) is the main metabolizing enzyme of histamine. Histamine modulates immune responses and plays a role in the pathogenesis of autoimmune disorders.

Methods

The non-synonymous HNMT C314T polymorphism and the A939G single-nucleotide polymorphism (SNP) influencing HNMT mRNA stability were genotyped in 213 patients with myasthenia gravis (MG) and 342 healthy controls.

Results

The carrier frequency of the A allele of the A939G SNP was over-represented among patients with anti-AchR and anti-Titin antibodies (P = 0.05 and P = 0.004, respectively); the presence of the minor G allele was protective against anti-AchR and anti-Titin positive MG (OR = 0.67 and OR = 0.54, respectively). The combination of the G allele carrier status with wild-type C314C homozygosity was also protective against MG (OR = 0.55, P = 0.008) and against the development of anti-AchR antibodies (OR = 0.37, P = 0.01).

Discussion

The A939G HNMT polymorphism is associated with autoimmune MG, while no association with C314T SNP was found.     

Does health coaching change patients’ trust in their primary care provider?

Objective

To assess the impact of health coaching on patients’ in their primary care provider.

Methods

Randomized controlled trial comparing health coaching with usual care.

Participants

Low-income English or Spanish speaking patients age 18–75 with poorly controlled type 2 diabetes, hypertension and/or hyperlipidemia.

Main outcome measure

Patient trust in their primary care provider measured by the 11-item Trust in Physician Scale, converted to a 0–100 scale.

Analysis

Linear mixed modeling.

Results

A total of 441 patients were randomized to receive 12 months of health coaching (n = 224) vs. usual care (n = 217). At baseline, the two groups were similar to those in the usual care group with respect to demographic characteristics and levels of trust in their provider. After 12 months, the mean trust level had increased more in patients receiving health coaching (3.9 vs. 1.5, p = 0.47), this difference remained significant after adjustment for number of visits to primary care providers (adjusted p = .03).

Conclusions

Health coaching appears to increase patients trust in their primary care providers.

Practice Implications

Primary care providers should consider adding health coaches to their team as a way to enhance their relationship with their patients.     

Consumer health information technology in an adult public health primary care clinic: A heart health education feasibility study

Objective

To explore the feasibility and short term outcomes of using an interactive kiosk integrated into office flow to deliver health information in a primary care clinic.

Methods

Fifty-one adults with BMI ≥25 were randomly assigned to use a kiosk with attached devices to receive a six-week healthy eating/weight monitoring (intervention) or general health/BP monitoring (attention-control) program. Outcomes were measured at baseline, 8 weeks (post) and three month follow-up.

Results

Participants completed an average of 2.73 weekly sessions, with transportation and time given as limiting factors. They found the kiosk easy to use (97%), liked the touchscreen (94%), and would use the kiosk again (81%). Although there were no differences between groups, the 27 completing all assessments showed reduced weight (p = .02), and decreased systolic (p = .01) and diastolic BP (p < .001) at follow-up. Although healthy eating behaviors increased, the change was not statistically significant.

Conclusion

Using a kiosk within a clinic setting is a feasible method of providing health information and self-monitoring. Multi-session educational content can provide beneficial short-term outcomes in overweight adults.

Practice implications

A kiosk with attached peripherals in a clinic setting is a viable adjunct to provider education, particularly in medically underserved areas.     

XbaI polymorphism of the estrogen receptor alpha gene influences the effect of raloxifene on the endothelial function

Objectives

Cardiovascular disease is the leading cause of death in postmenopausal women and estrogen deficiency may be an important factor in its development. The selective estrogen receptor modulator, raloxifene, exerts a part of its actions through the estrogen receptor alpha (ESR1) activation. We explored if polymorphisms of the ESR1 modify the effects of 6 months raloxifene treatment on endothelial function.

Methods

A total of 53 postmenopausal women, mean age 59.7 ± 6.2, finished the prospective clinical trial. The PvuII, XbaI, and P325P polymorphisms of the ESR1 gene were analyzed. In all subjects endothelium-dependent flow mediated dilatation (FMD) and cell adhesion molecules (CAM) ICAM-1, VCAM-1 and E-selectin were measured before and after 6 months of raloxifene treatment.

Results

There was no difference in FMD between the ESR1 genotypes, at baseline. After raloxifene treatment, the FMD was significantly greater in subjects with XX genotype of XbaI polymorphism compared to xx (p = 0.03) and borderline greater when compared to Xx genotype (p = 0.053). The FMD increased significantly with raloxifene treatment in women with Xx genotype of XbaI and Pp genotype of PvuII polymorphisms (p = 0.027 and p = 0.034, respectively). The P325P polymorphism did not influence the FMD after raloxifene. None of the ESR1 gene polymorphisms had any impact on the levels of CAM before or after the treatment. When analysing the whole group, a significant decrease in E-selectin (p < 0.001) and a small increase in ICAM-1 levels (p = 0.029) was observed with raloxifene treatment, but no influence on VCAM-1 levels or FMD overall was seen.

Conclusion

Our data suggest that XbaI and possibly PvuII polymorphisms of the ESR1 gene influence the impact of raloxifene treatment on endothelial function. This effect could be of pharmacogenomic and clinical importance.     

New psycho-pedagogic approach to obesity treatment: A 5-year follow-up

Objective

The aim of the present study was to evaluate the body weight evolution in obese patients admitted for a 2-week residential program and followed-up on ambulatory basis, as well as to evaluate factors having impact on weight evolution after 5 years.

Methods

Thirty-nine obese patients participated in a 2-week structured interdisciplinary weight loss program, involving individual and group therapies, and including physical activity, nutritional education and standard cognitive-behavioral techniques. Patients were then followed-up regularly by their general practitioners for 5 years.

Results

After 5 years, 33 subjects completed the study. Seventy percent of the patients lost weight or maintained their weight loss. Total score for dietary structure, eating behavior disorders, dietary surveillance and weight management strategies, as evaluated by a validated questionnaire, was significantly lower in the weight loss group (22.4 ± 4.3) as compared to maintenance group (24.4 ± 6.1, p < 0.05) and regain group (29.7 ± 4.0, p < 0.01). Patients who lost weight presented a more important follow-up on long-term weight management (p < 0.05), a better dietary results (p < 0.01) as well as more physical activity (p < 0.05) that the regain group.

Conclusion

The present study demonstrated that an initial multidimensional and multidisciplinary in-hospital program with a consecutive long-term ambulatory follow-up may lead to a significant weight loss (55%) and/or weight maintenance (15%).

Practice implications

A multidisciplinary and well-designed initial treatment and long-term follow-up program is mandatory for obesity management.     

Tibolone in postmenopausal women with systemic lupus erythematosus: A pilot study

Objective

To determine the influence of the use of tibolone on the frequency of flares of systemic lupus erythematosus (SLE) in postmenopausal patients.

Methods

Thirty patients with inactive or controlled SLE were included in the study. Patients were randomized to receive a 12-month course of either tibolona (2.5 mg/day) or placebo. The following were investigated: hypoestrogenism symptoms by Kupperman index, weight; anti-dsDNA antibodies; SLE flares (frequency) assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI); and biochemical profile (total cholesterol, high-density lipoprotein cholesterol [HDL-C], triglycerides, complement components [C3/C4], α1-acid glycoprotein, urea, creatinine, 24-h proteinuria, C-reactive protein and erythrocyte sedimentation rate).

Results

The reduction in Kupperman index was greater in the patients using tibolone than in those using placebo. The mean SLEDAI was not different between the groups during the study as well as SLE flare frequency (tibolone: 2/15 [13.3%] vs. placebo: 1/15 [6.7%]; p = 0.54). All cases of flares were considered mild to moderate. Although the groups were similar at the baseline evaluation, after 6 and 12 months of treatment lower values were found in the tibolone group for triglycerides (6 months: 161.6 ± 30.9 mg/dl vs. 194.4 ± 46.5; p = 0.04; 12 months 163.7 ± 29.8 mg/dl vs. 204.1 ± 49.9 mg/dl; p = 0.02; tibolone vs. placebo group, respectively) and for HDL-C (6 months: 40.7 ± 10.7 mg/dl vs. 53.4 ± 16.5; p = 0.02; 12 months: 47.2 ± 7.9 mg/dl vs. 63.2 ± 16.3 mg/dl; p < 0.01; tibolone vs. placebo group, respectively). There were no differences between the two groups in any of the remaining variables.

Conclusion

In patients with inactive or stable SLE, the short-term use of tibolone did not significantly affect the frequency of flares. In addition, tibolone was well tolerated and effective to control hypoestrogenism related symptoms in SLE patients.     

Carotid intima-media thickness and calcification in relation to bone mineral density in postmenopausal women—The OSTPRE-BBA study

Objectives

Atherosclerosis (AS) and osteoporosis are common diseases in elderly people and may be metabolically related. The aim of this cross-sectional population-based study was to explore the association between common carotid artery intima-media thickness (cIMT), carotid artery calcification (CAC), and BMD in postmenopausal women. In addition, the association of postmenopausal hormone therapy (HT) and selected diseases with cIMT and carotid calcification was studied.

Study design

The 290 women (mean age 73.6 years) included in this Bone Brain Atherosclerosis study (OSTPRE-BBA) were randomly selected from the population-based Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study cohort, Finland.

Main outcome measures

For this cross-sectional study, cIMT was measured with B-mode ultrasound; femoral neck and total body BMD were measured with dual-energy X-ray absorptiometry.

Results

There were no statistically significant associations between mean cIMT and femoral neck T-score (p > 0.05). However, an increased maximum cIMT was significantly associated with low femoral neck T-score. In the osteoporotic group (T-score <−2.5, n = 20), the maximum cIMT was 2.51 ± 0.88 mm (mean ± SD); in the normal BMD group (T-score >−1, n = 122), it was 1.93 ± 0.64 mm (p = 0.001). The odds of having CAC were approximately four-fold higher in the osteoporotic group compared with the group with a normal femoral neck T-score (odds ratio [OR] = 4.2, p = 0.038). The maximum cIMT was smaller in HT users (1.98 ± 0.56 mm, n = 190) than in non-users (2.16 ± 0.74 mm, n = 156, p = 0.036).

Conclusions

The results of our population-based study suggest that BMD is related to AS, at least in carotid arteries. They indirectly support the hypothesis of partially shared pathophysiological mechanisms between these two disorders.     

Effects of raloxifene and hormone replacement therapy on forearm skin elasticity in postmenopausal women

Objectives

Hormone replacement therapy (HRT) increases skin elasticity in postmenopausal women. However, the effects of raloxifene, a selective estrogen receptor modulator (SERM), on skin degenerative changes in postmenopausal women remain unknown. We investigated whether raloxifene increases skin elasticity, similar to HRT, in postmenopausal women.

Methods

In a 12-month trial, 17 postmenopausal women (mean age, 66.4 ± 7.8 years) received continuous raloxifene treatment (60 mg/day), 19 women (56.2 ± 6.4 years) received continuous 17-β estradiol treatment using a patch (0.72 mg/2 days) plus cyclic medroxyprogesterone acetate (2.5 mg/day, for 12 days/month), and 11 women (58.1 ± 7.3 years) did not receive either therapy. In each subject, the skin elasticity of the forearm was measured using a suction device at baseline and at 12 months after the start of the study.

Results

Raloxifene and HRT significantly increased skin elasticity from 52.4 ± 3.8% and 64.1 ± 7.2% at baseline to 55.1 ± 4.7% and 67.4 ± 7.4% after 12 months, respectively (P < 0.05, each), but the untreated subjects did not exhibit any significant change in skin elasticity during the study. The delta value for skin elasticity was significantly higher among the raloxifene and HRT subjects than among the untreated subjects (P < 0.05, each).

Conclusions

These findings suggest that raloxifene may have a beneficial effect on skin elasticity, which undergoes degenerative changes in postmenopausal women, in addition to its effects on bone metabolism.     

Impact of genetic polymorphisms on the pathogenesis of idiopathic achalasia: Association with IL33 gene variant

Aim

To investigate the association of single nucleotide polymorphisms (SNPs) of genes involved in the regulation of immune responses, IL33, IL1RL1, IL23R, and IL10, with idiopathic achalasia in an Italian cohort of patients.

Materials and methods

A panel of eleven polymorphisms were genotyped in 116 unrelated idiopathic achalasic patients and 371 healthy subjects, by using TaqMan genotyping assays.

Results

Significant differences of allele (P = 0.0065, OR = 1.59, CI = 1.14–2.22) and genotype (P = 0.0097, OR = 1.74, CI = 1.14–2.65) frequencies of the IL33 rs3939286 variant were found between achalasic patients and controls. No association of the other investigated SNPs was detected. No differences in genotype and allele distribution were found with respect to clinical characteristics of patients.

Conclusion

We provide for the first time an association between the risk of developing idiopathic achalasia and IL-33 variant, underling the role of cytokines and inflammatory mediators on the pathogenesis of the disease.