Green tea extract and catechol-O-methyltransferase genotype modify the post-prandial serum insulin response in a randomised trial of overweight and obese post-menopausal women.

BACKGROUND: Green tea extract (GTE) may be involved in a favourable post-prandial response to high-carbohydrate meals. The catechol-O-methyltransferase (COMT) genotype may modify these effects. We examined the acute effects of GTE supplementation on the post-prandial response to a high-carbohydrate meal by assessing appetite-associated hormones and glucose homeostasis marker concentrations in women who consumed 843 mg of (-)-epigallocatechin-3-gallate (EGCG) or placebo capsules for 11-12 months. METHODS: Sixty Caucasian post-menopausal women (body mass index ≥ 25.0 kg m-2 ) were included in a randomised, double-blind feeding study. GTE was consumed with a breakfast meal [2784.0 kJ (665.4 kcal); 67.2% carbohydrate]. Blood samples were drawn pre-meal, post-meal, and every 30 min for 4 h. Participants completed six satiety questionnaires. RESULTS: Plasma leptin, ghrelin and adiponectin did not differ between GTE and placebo at any time point; COMT genotype did not modify these results. Participants randomised to GTE with the high-activity form of COMT (GTE-high COMT) had higher insulin concentrations at time 0, 0.5 and 1.0 h post-meal compared to all COMT groups randomised to placebo. Insulin remained higher in the GTE-high COMT group at 1.5, 2.0 and 2.5 h compared to Placebo-low COMT (P < 0.02). GTE-high COMT had higher insulin concentrations at times 0, 0.5, 1.0, 1.5 and 2.0 h compared to the GTE-low COMT (P ≤ 0.04). Area under the curve measurements of satiety did not differ between GTE and placebo. CONCLUSIONS: GTE supplementation and COMT genotype did not alter acute post-prandial responses of leptin, ghrelin, adiponectin or satiety, although it may be involved in post-meal insulinaemic response of overweight and obese post-menopausal women.

'Treatment of the sportsman's groin': British Hernia Society's 2014 position statement based on the Manchester Consensus Conference.

INTRODUCTION: The aim was to produce a multidisciplinary consensus to determine the current position on the nomenclature, definition, diagnosis, imaging modalities and management of Sportsman's groin (SG). METHODS: Experts in the diagnosis and management of SG were invited to participate in a consensus conference held by the British Hernia Society in Manchester, U.K. on 11-12 October 2012. Experts included a physiotherapist, a musculoskeletal radiologist and surgeons with a proven track record of expertise in this field. Presentations detailing scientific as well as outcome data from their own experiences were given. Records were made of the presentations with specific areas debated openly. RESULTS: The term 'inguinal disruption' (ID) was agreed as the preferred nomenclature with the term 'Sportsman's hernia' or 'groin' rejected, as no true hernia exists. There was an overwhelming agreement of opinion that there was abnormal tension in the groin, particularly around the inguinal ligament attachment. Other common findings included the possibility of external oblique disruption with consequent small tears noted as well as some oedema of the tissues. A multidisciplinary approach with tailored physiotherapy as the initial treatment was recommended with any surgery involving releasing the tension in the inguinal canal by various techniques and reinforcing it with a mesh or suture repair. A national registry should be developed for all athletes undergoing surgery. CONCLUSIONS: ID is a common condition where no true hernia exists. It should be managed through a multidisciplinary approach to ensure consistent standards and outcomes are achieved.

Exercise lowers estrogen and progesterone levels in premenopausal women at high risk of breast cancer.

Experimental and clinical data support a role for estrogens in the development and growth of breast cancer, and lowered estrogen exposure reduces breast cancer recurrence and new diagnoses in high-risk women. There is varied evidence that increased physical activity is associated with breast cancer risk reduction in both pre- and postmenopausal women, perhaps via lowered estrogen levels. The purpose of this study was to assess whether exercise intervention in premenopausal women at increased breast cancer risk reduces estrogen or progesterone levels. Seven healthy premenopausal women at high risk for breast cancer completed a seven-menstrual-cycle study. The study began with two preintervention cycles of baseline measurement of hormone levels via daily first-morning urine collection, allowing calculation of average area under the curve (AUC) hormone exposure across the menstrual cycle. Participants then began five cycles of exercise training to a maintenance level of 300 min per week at 80-85% of maximal aerobic capacity. During the last two exercise cycles, urinary estradiol and progesterone levels were again measured daily. Total estrogen exposure declined by 18.9% and total progesterone exposure by 23.7%. The declines were mostly due to decreased luteal phase levels, although menstrual cycle and luteal phase lengths were unchanged. The study demonstrated the feasibility of daily urine samples and AUC measurement to assess hormone exposure in experimental studies of the impact of interventions on ovarian hormones. The results suggest value in exercise interventions to reduce hormone levels in high-risk women with few side effects and the potential for incremental benefits to surgical or pharmacologic interventions.

Effects of soy protein and isoflavones on circulating hormone concentrations in pre- and post-menopausal women: a systematic review and meta-analysis.

BACKGROUND Hormonal effects of soy and isoflavones have been investigated in numerous trials with equivocal findings. We aimed to systematically assess the effects of soy and isoflavones on circulating estrogen and other hormones in pre- and post-menopausal women. METHODS The Cochrane Library, MEDLINE and EMBASE (plus reviews and experts) were searched to December 2007. Inclusion of randomized or residential crossover trials of soy or isoflavones for 4 or more weeks on estrogens, SHBG, FSH, LH, progesterone and thyroid hormones in women was assessed independently in duplicate. Six percent of papers assessed were included. Data concerning participants, interventions, outcomes, potential effect modifiers and trial quality characteristics were extracted independently in duplicate. RESULTS Forty-seven studies (11 of pre-, 35 of post- and 1 of perimenopausal women) were included. In premenopausal women, meta-analysis suggested that soy or isoflavone consumption did not affect primary outcomes estradiol, estrone or SHBG concentrations, but significantly reduced secondary outcomes FSH and LH [by approximately 20% using standardized mean difference (SMD), P = 0.01 and 0.05, respectively]. Menstrual cycle length was increased by 1.05 days (95% CI 0.13, 1.97, 10 studies). In post-menopausal women, there were no statistically significant effects on estradiol, estrone, SHBG, FSH or LH, although there was a small statistically non-significant increase in total estradiol with soy or isoflavones ( approximately 14%, SMD, P = 0.07, 21 studies). CONCLUSIONS Isoflavone-rich soy products decrease FSH and LH in premenopausal women and may increase estradiol in post-menopausal women. The clinical implications of these modest hormonal changes remain to be determined.

The use of sterilised polyester mosquito net mesh for inguinal hernia repair in Ghana.

BACKGROUND: The use of alloplastic mesh is now commonplace in hernia repair. However, in developing countries, cheaper alternatives to commercial mesh are required due to the high associated cost. Whilst nylon mosquito net mesh has been trialled previously, this study aimed to assess the use of polyester mosquito net mesh in tension-free inguinal hernia repair in Ghana. METHODS: All patients undergoing inguinal hernia repair during the 5-day 'Operation Hernia' mission in 2007 were eligible for the study. A piece of sterilised 10 x 15-cm 100% polyester mosquito net mesh, manufactured and donated by Scotmas Limited, was implanted for all tension-free hernia repairs. The surgeons' ease of handling and incidence of complications at 6 weeks and 6 months were assessed. RESULTS: Ninety-five patients underwent inguinal hernia repair using a total of 106 polyester mosquito net meshes. The mean (range) age of patients was 44.3 (15-78) years. Seventy-two (76%) were repaired using local anaesthesia. At 6 weeks and 6 months, a total of seven (7%) patients suffered wound complications (five haematomas, two wound infections). Ease of practical handling improved after the first 2-5 cases. The cost of an individual 10 x 15-cm mesh was estimated at US$0.0072-0.014, and the cost of sterilisation and packaging was US$1.46 per mesh. CONCLUSIONS: Polyester mosquito net mesh represents a cost-effective alternative to commercial meshes in developing countries, with a relatively low rate of early complications and similar short-term recurrence rates. The use of local anaesthesia may enhance this further.

Day-case inguinal hernia repair in the elderly: a surgical priority.

PURPOSE: To compare patients over 70 years old with those under 50 years old undergoing inguinal hernia repair. PATIENTS AND METHODS: Fifty patients aged >70 years (group A) and 50 patients age <50 years (group B) underwent local anaesthetic mesh repair. The mean age for group A was 77.2 years (range 70-85) and for group B it was 40.2 years (range 17-49). There were 46 patients with comorbidities in group A and seven in group B. There were 30 patients with cardiac comorbidities in group A and two in group B. RESULTS: There were no major complications, infections, haematomas or unplanned admissions in either group. Patients >70 years of age had less post-operative discomfort and recovered more quickly than patients aged <50 years. The number of days of analgesic use and time to return to normal activities was longer in the younger group, 6.0 versus 3.4 and 21 versus 13, respectively. There was no significant difference between the groups in patients having discomfort at 3 months post-operatively. More patients were satisfied in the older group, though the difference was not statistically significant. CONCLUSION: Elective inguinal hernia repair under local anaesthetic in the elderly has a good outcome, even if there are significant comorbidities. Ambulatory surgery is feasible in this age group and age alone or co-existing disease should not be a barrier to elective day-case inguinal hernia repair.

Soy consumption for reduction of menopausal symptoms.

AIMS: To review current research on the effects of soy consumption on menopausal symptoms. METHODS: To review results of recent meta-analyses and individual clinical trials. MAIN RESULTS: One recent meta-analysis reported that isoflavone supplementation was associated with a 34% reduction in hot flashes, with increased efficacy as the baseline number of flashes and isoflavone dose increased. A second review concluded that consumption of at least 15 mg genistein, rather than total isoflavones, is responsible for the reduction in symptoms. Results of these two reviews are supported by most subsequent randomized controlled trials. CONCLUSIONS: Consumption of 30 mg/day of soy isoflavones (or at least 15 mg genistein) reduces hot flashes by up to 50 %. This total reduction includes that provided by "the placebo effect". The greatest benefit may be realized when the isoflavone-rich food or supplement is taken in divided doses by subjects who experience at least four hot flashes/day.

Groin hernias in women.

A consecutive series of 255 women with primary groin hernias repaired electively over a five-year period, was reviewed. There were 271 hernias; the majority, 182 (67%) were indirect inguinal hernias, 35 (14%) were direct, and 54 (20%) were femoral. There were no major post-op complications and no recurrences. Most patients presented with a swelling but in 13 cases there was pre-operative discomfort only. Groin pain in women should arouse suspicion of an occult hernia. Lichtenstein repair for inguinal hernia is easier than in men, and as effective.

Consumption of isoflavone-rich soy protein does not alter homocysteine or markers of inflammation in postmenopausal women.

BACKGROUND/OBJECTIVE: To investigate the effect of soy protein containing isoflavones on homocysteine (Hcy), C-reactive protein (CRP), soluble E-selectin (sE-selectin), soluble vascular adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecule-1 (sICAM-1). SUBJECT/METHODS: In a randomized crossover design, 34 postmenopausal women consumed soy protein isolate (26+/-5 g protein containing 44+/-8 mg isoflavones per day) or milk protein isolate (26+/-5 g protein per day) for 6 weeks each. Fasting blood samples were collected at the end of each diet period and end points analyzed by enzyme-linked immunosorbent assay. RESULTS: Concentrations of Hcy, CRP, sE-selectin, sVCAM-1 and sICAM-1 were not different between soy and milk diet treatments. Results did not differ by equol production status or by baseline lipid concentration. Adjustment for intake of folate and methionine did not alter the Hcy results. CONCLUSIONS: These data suggest that decreasing vascular inflammation and Hcy concentration are not likely mechanisms by which soy consumption reduces coronary heart disease risk.

Probiotic capsules do not lower plasma lipids in young women and men.

OBJECTIVE: To investigate the effect of probiotic capsules on plasma lipids. DESIGN: A randomized, single-blinded, placebo-controlled, parallel-arm trial. SUBJECTS: Fifty-five normocholesterolemic subjects ages 18-36 (33 premenopausal women and 22 men). INTERVENTION: Each subject consumed either three probiotic capsules each containing a total of 10(9) colony-forming units Lactobacillus acidophilus and Bifidobacterium longum and 10-15 mg fructo-oligosaccharide or three placebo capsules daily for 2 months (men) or two menstrual cycles (women). Plasma lipids were measured before and following the intervention (during the early follicular phase for women). RESULTS: Plasma concentrations of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and triglyceride were not altered by consumption of probiotic or placebo capsules and were not different between treatment groups following the intervention. CONCLUSIONS: These results do not support a beneficial effect of Lactobacillus acidophilus strain DDS-1 and Bifidobacterium longum strain UABL-14 on plasma lipids in normocholesterolemic young women and men. SPONSORSHIP: Supported by the Minnesota Agricultural Experiment Station and UAS Laboratories.

Simultaneous repair of bilateral groin hernias using local anaesthesia: a review of 199 cases with a five-year follow-up.

BACKGROUND: There has been controversy concerning the simultaneous repair of bilateral groin hernias and the method of anaesthesia. METHODS: A consecutive series of 199 bilateral inguinal hernias was repaired by the Lichtenstein non-tension mesh technique over a two-year period (1997-98). In 96% of them local anaesthesia was used. These were reviewed after five years. RESULTS: There were no increased recurrence or infection rates, with both between 0.5-1%. Pulmonary and urinary complications did not occur. The cost of this technique is substantially less than sequential or laparoscopic operations. DISCUSSION: The reasons advanced for sequential repair of bilateral hernias have been the lower risks of infection and recurrence. Neither of these fears is evident from this study. Furthermore, the use of local anaesthesia permits the operation to be done in a day care clinic. CONCLUSIONS: Simultaneous bilateral repair of inguinal hernias using local anaesthesia is as effective as sequential repair, at lower cost and with less total time off work.

Consumption of Lactobacillus acidophilus and Bifidobacterium longum do not alter urinary equol excretion and plasma reproductive hormones in premenopausal women.

OBJECTIVE: To confirm the results of an earlier study showing premenopausal equol excretors to have hormone profiles associated with reduced breast cancer risk, and to investigate whether equol excretion status and plasma hormone concentrations can be influenced by consumption of probiotics. DESIGN: A randomized, single-blinded, placebo-controlled, parallel-arm trial. SUBJECTS: In all, 34 of the initially enrolled 37 subjects completed all requirements. INTERVENTION: All subjects were followed for two full menstrual cycles and the first seven days of a third cycle. During menstrual cycle 1, plasma concentrations of estradiol (E(2)), estrone (E(1)), estrone-sulfate (E(1)-S), testosterone (T), androstenedione (A), dehydroepiandrosterone-sulfate (DHEA-S), and sex-hormone-binding globulin (SHBG) were measured on cycle day 2, 3, or 4, and urinary equol measured on day 7 after a 4-day soy challenge. Subjects then received either probiotic capsules (containing Lactobacillus acidophilus and Bifidobacterium longum) or placebo capsules through day 7 of menstrual cycle 3, at which time both the plasma hormone concentrations and the post-soy challenge urinary equol measurements were repeated. RESULTS: During menstrual cycle 1, equol excretors and non-excretors were not significantly different with respect to subject characteristics, diet, or hormone concentrations. Significant inverse correlations were found between E(2) and body mass index (BMI) (P=0.02), SHBG and BMI (P=0.01), DHEA-S and dietary fiber (P=0.04), and A and protein:carbohydrate ratio (P=0.02). Probiotic consumption failed to significantly alter equol excretor status or hormone concentrations during menstrual cycle 3, although there were trends towards decreased concentrations of T (P=0.14) and SHBG (P=0.10) in the probiotic group. CONCLUSIONS: We were unable to verify a previously reported finding of premenopausal equol excretors having plasma hormone concentrations different from those of nonexcretors. Furthermore, a 2-month intervention with probiotic capsules did not significantly alter equol excretion or plasma hormone concentrations.

Tension-free mesh repair of umbilical hernia as a day case using local anaesthesia.

BACKGROUND: Umbilical hernias are a common surgical problem with a high recurrence rate using conventional suture techniques. This prospective study examined the feasibility of tension-free mesh repair as a day case using local anaesthetic (LA) for all primary umbilical hernias. METHOD: Fifty-four patients (eight women) were operated on; 49 using LA. Through a periumbilical skin incision the margins of the sac were freed from the edges of the defect, and a space was made in the extraperitoneal plane. In defects <3 cm in diameter, a cone of polypropylene (pp) mesh was inserted and attached with nonabsorbable sutures. In defects >3 cm, a flat piece of pp mesh was inserted into the extraperitoneal space as a sublay. No attempt was made to close the fascial defect. RESULTS: Postoperative pain was graded as mild ( n=37) and moderate ( n=17). No patient had severe postoperative pain. Seven superficial wound infections responded to oral antibiotics. In no case it was necessary to remove the mesh. There were no other complications. Patients were recalled between 2 and 6 years postopertively-mean follow-up 43 months (28- 67). There were no recurrences. CONCLUSION: Umbilical hernia repair can be carried out safely and securely under LA with a tension-free mesh technique (cone or a sublay patch) with a low morbidity, negligible recurrence rate, and a high degree of patient satisfaction. It should be the procedure of choice for all such hernias.

Reproducibility over time of measurements of androgens, estrogens and hydroxy estrogens in urine samples from post-menopausal women.

Sex steroid concentrations in urine samples from post-menopausal women have been associated with risk of various chronic diseases. The basic requirement for the assessment of risk in such large-scale epidemiological studies is that subjects be ranked accurately by their average, long-term hormone levels. We examined the reproducibility over time of measurements of urinary testosterone (T), 5alpha-androstane-3alpha, 17beta-diol (ADIOL), estrone (E1), estradiol (E2), 2-hydroxy estrone and 2-hydroxy estradiol, (2(OH)-E), 16alpha-hydroxyestrone (16alpha(OH)-E1) and the ratio of 2(OH)-E and 16alpha(OH)-E1, in a representative sub-sample of post-menopausal women (n = 43) participating in an ongoing prospective cohort study. Women collected three first morning urine voids on different occasions, with average time difference between the first and the third urine sample of 5.1 years. T, ADIOL, E1 and E2 were measured by radio immunoassay after enzymatic hydrolysis, solid-phase extraction and HPLC purification of the samples, while 2(OH)-E and 16alpha(OH)-E1 were assayed by solid-phase enzyme immunoassay after enzymatic hydrolysis. Intra-class correlation co-efficients (ICCs) over time were very good for T (r = 0.85), acceptable for E2, E1 and ADIOL (r > 0.55), but low for 2(OH)-E, 16alpha(OH)-E1 and their ratio (r < 0.46). The adjustment for creatinine concentrations did not increase these correlations.

Prospective study of open preperitoneal mesh repair for recurrent inguinal hernia.

BACKGROUND: Recurrent inguinal hernia presents a significant clinical problem with high re-recurrence and complication rates, particularly when an anterior approach is used. This study evaluated the open preperitoneal approach for repair of recurrent inguinal hernia. METHODS: This was a prospective cohort study of 101 consecutive patients with 114 recurrent inguinal hernias. All were operated on using an open preperitoneal technique and prosthetic mesh by the method of Stoppa or Wantz. Follow-up was at 2-6 weeks, 15 and between 42 and 54 months. RESULTS: There were no major complications. There was one infection and one case of retention of urine. There were no testicular complications. There were five recurrences, all within 6 months of operation, four of which were among the first 20 cases. Modifications to the original technique were made, and one recurrence occurred in the remaining 81 patients (1 per cent) or 106 hernias (1 per cent). CONCLUSION: Preperitoneal mesh repair gives results far superior to those of the commonly used anterior approach. It is safer and easier to learn than laparoscopic repair and is the procedure of choice for complex multirecurrent inguinal hernia.

Lack of effect of isoflavonic phytoestrogen intake on leptin concentrations in premenopausal and postmenopausal women.

OBJECTIVE: To assess the effect of soy isoflavone ingestion on plasma leptin concentrations in premenopausal and postmenopausal women. DESIGN: Randomized, crossover studies, with blinding of participants and laboratory personnel. SETTING: Procedures involving free-living individuals were carried out at the University of Minnesota General Clinical Research Center. PATIENT(S): Fourteen regularly cycling premenopausal women, and 18 postmenopausal women. INTERVENTION(S): Each premenopausal participant consumed, on a daily basis, each of three soy protein powders containing different levels of isoflavones for three menstrual cycles plus 9 days, with plasma samples collected every other day the last 6 weeks of each diet period. Similarly, each postmenopausal participant consumed each of the three powders for 93 days, with plasma samples collected daily on days 64 to 66 and 92 to 94 of each diet period. The powders, dosed on a per-kilogram body weight basis, provided mean isoflavone intakes of 8, 65, and 130 mg/day, for the control, low-isoflavone, and high-isoflavone diet periods, respectively. MAIN OUTCOME MEASURE(S): Plasma leptin concentrations. RESULT(S): Isoflavone intake had essentially no effect on leptin concentrations in either premenopausal or postmenopausal participants. Concentrations in the premenopausal women were higher during the periovulatory and midluteal phases as compared to the early follicular and midfollicular phases. CONCLUSION(S): Despite the well-documented effect of estrogens to enhance leptin production, even high levels of isoflavone consumption do not alter leptin concentrations in women. Further studies are needed to more precisely delineate the nature of estrogenic and/or antiestrogenic effects of isoflavones in humans.

Soy isoflavones improve plasma lipids in normocholesterolemic and mildly hypercholesterolemic postmenopausal women.

BACKGROUND: Soy-protein consumption is known to reduce plasma total and LDL cholesterol concentrations. However, the responsible soy component or components and the magnitude of effects in normocholesterolemic and mildly hypercholesterolemic subjects are unclear. OBJECTIVE: The present study examined the effects of soy isoflavone consumption on plasma concentrations of triacylglycerol, apolipoprotein (apo) A-I, apo B, lipoprotein(a), and total, LDL, and HDL cholesterol and on LDL peak particle diameter in normocholesterolemic and mildly hypercholesterolemic postmenopausal women. DESIGN: In a randomized crossover trial, fasting plasma samples were obtained from 18 postmenopausal women throughout three 93-d periods of daily isolated soy protein (ISP) consumption providing an average of 7.1 +/- 1.1 (control), 65 +/- 11 (low isoflavone), or 132 +/- 22 (high isoflavone) mg isoflavones/d. RESULTS: Compared with values measured during the control diet, the plasma LDL cholesterol concentration was 6.5% lower (P < 0.02) during the high-isoflavone diet and the ratio of LDL to HDL cholesterol was 8.5% and 7.7% lower during the low- and high-isoflavone diets, respectively (P < 0.02). Isoflavone consumption did not significantly affect plasma concentrations of total or HDL cholesterol, triacylglycerol, apo A-I, apo B, or lipoprotein(a) or the LDL peak particle diameter. CONCLUSIONS: Consumption of isoflavones as a constituent of ISP resulted in small but significant improvements in the lipid profile in normocholesterolemic and mildly hypercholesterolemic postmenopausal women. Although the effects were small, it is possible that isoflavones may contribute to a lower risk of coronary heart disease if consumed over many years in conjunction with other lipid-lowering strategies.