Schistocins: Novel antimicrobial peptides encrypted in the Schistosoma mansoni Kunitz Inhibitor SmKI-1.

BACKGROUND: Here we describe a new class of cryptides (peptides encrypted within a larger protein) with antimicrobial properties, named schistocins, derived from SmKI-1, a key protein in Shistosoma mansoni survival. This is a multi-functional protein with biotechnological potential usage as a therapeutic molecule in inflammatory diseases and to control schistosomiasis. METHODS: We used our algorithm enCrypted, to perform an in silico proteolysis of SmKI-1 and a screening for potential antimicrobial activity. The selected peptides were chemically synthesized, tested in vitro and evaluated by both structural (CD, NMR) and biophysical (ITC) studies to access their structure-function relationship. RESULTS: EnCrypted was capable of predicting AMPs in SmKI-1. Our biophysical analyses described a membrane-induced conformational change from random coil-to-α-helix and a peptide-membrane equilibrium for all schistocins. Our structural data allowed us to suggest a well-known mode of peptide-membrane interaction in which electrostatic attraction between the cationic peptides and anionic membranes results in the bilayer disordering. Moreover, the NMR H/D exchange data with the higher entropic contribution observed for the peptide-membrane interaction showed that schistocins have different orientations upon the membrane. CONCLUSIONS: This work demonstrate the robustness for using the physicochemical features of predicted peptides in the identification of new bioactive cryptides. Besides, it demonstrates the relevance of combining these analyses with biophysical methods to understand the peptide-membrane affinity and improve further algorithms. GENERAL SIGNIFICANCE: Bioprospecting cryptides can be conducted through data mining of protein databases demonstrating the success of our strategy. The peptides-based agents derived from SmKI-1 might have high impact for system-biology and biotechnology.

MiRNA-128-3p induces osteogenic differentiation of bone marrow mesenchymal stem cells via activating the Wnt3a signaling.

OBJECTIVE: To clarify the biological function of miRNA-128-3p in influencing the progression of osteoporosis by inducing osteogenic differentiation of MSCs via activating the Wnt3a signaling. PATIENTS AND METHODS: Dynamic expression levels of miRNA-128-3p in osteogenically differentiated MSCs at the different time points were detected by qRT-PCR. The binding sites in the seed sequence of miRNA-128-3p and Wnt3a were predicted using the bioinformatic tool, and their interaction was further confirmed by Dual-Luciferase reporter assay. Co-regulation of miRNA-128-3p and Wnt3a on relative levels of osteogenesis-associated genes, ALP activity and mineralization ability in glucocorticoid-induced MSCs were assessed. RESULTS: MiRNA-128-3p was gradually upregulated with the prolongation of osteogenic differentiation of MSCs. Overexpression of miRNA-128-3p reversed the declines in glucocorticoid-induced expression levels of osteogenesis-associated genes (Bglap, RUNX2 and BMP-2), ALP activity and mineralization ability in MSCs. Wnt3a was able to bind miRNA-128-3p. Its level was positively regulated by miRNA-128-3p in MSCs. Enhanced ALP activity and mineralization ability in glucocorticoid-induced MSCs overexpressing Wnt3a were partially abolished by knockdown of miRNA-128-3p. CONCLUSIONS: By positively regulating Wnt3a, miRNA-128-3p alleviates the progression of osteoporosis through inducing osteogenic differentiation of MSCs.

PTH promotes rabbit tibial fracture healing via the Notch signaling pathway.

OBJECTIVE: To explore the effect of parathyroid hormone (PTH) on the expression of Jagged1 in the rabbit tibial fracture healing, and its function and mechanism in this process via the Notch signaling pathway. MATERIALS AND METHODS: A total of 60 New Zealand white rabbits were randomly divided into control group (n=30) and experimental group (n=30). Then, a rabbit tibial fracture model was established. After surgery, the rabbits in experimental group were given 10 µg/kg PTH (1-34) once a day for 5 days a week, while those in control group were given an equal volume of normal saline. Six rabbits were randomly selected from each group at 1, 2, 3, 4, and 6 weeks after surgery to collect right tibia specimens. Next, X-ray examination, bone mineral density (BMD) test, histological detection, and serum biochemical test were performed. Additionally, the messenger ribonucleic acid (mRNA) expression levels of Notch1 and Jagged1 in the Notch signaling pathway were measured via polymerase chain reaction (PCR) assay. Their protein levels were detected through Western blotting analysis. RESULTS: The healing and BMD in experimental group were better than those in control group since cortical and medullary bridging was observed in the rabbits of experimental group at the 6th week after surgery. Plasma level of alkaline phosphatase (ALP), P content, and the product of Ca and P significantly increased (p<0.05) in experimental group. The pathological morphology of the calluses stained with hematoxylin-eosin (HE) in experimental group was overtly superior to that in control group. The PCR results revealed that both mRNA and protein levels of Notch1 and Jagged1 were lower in control group than those in experimental group (p<0.05). CONCLUSIONS: PTH (1-34) promotes the rabbit tibial fracture healing by regulating Jagged1 ligand molecules in the Notch signaling pathway.

Measures of body fatness and height in early and mid-to-late adulthood and prostate cancer: risk and mortality in The Pooling Project of Prospective Studies of Diet and Cancer.

BACKGROUND: Advanced prostate cancer etiology is poorly understood. Few studies have examined associations of anthropometric factors (e.g. early adulthood obesity) with advanced prostate cancer risk. PATIENTS AND METHODS: We carried out pooled analyses to examine associations between body fatness, height, and prostate cancer risk. Among 830 772 men, 51 734 incident prostate cancer cases were identified, including 4762 advanced (T4/N1/M1 or prostate cancer deaths) cases, 2915 advanced restricted (same as advanced, but excluding localized cancers that resulted in death) cases, 9489 high-grade cases, and 3027 prostate cancer deaths. Cox proportional hazards models were used to calculate study-specific hazard ratios (HR) and 95% confidence intervals (CI); results were pooled using random effects models. RESULTS: No statistically significant associations were observed for body mass index (BMI) in early adulthood for advanced, advanced restricted, and high-grade prostate cancer, and prostate cancer mortality. Positive associations were shown for BMI at baseline with advanced prostate cancer (HR = 1.30, 95% CI = 0.95-1.78) and prostate cancer mortality (HR = 1.52, 95% CI = 1.12-2.07) comparing BMI ≥35.0 kg/m2 with 21-22.9 kg/m2. When considering early adulthood and baseline BMI together, a 27% higher prostate cancer mortality risk (95% CI = 9% to 49%) was observed for men with BMI <25.0 kg/m2 in early adulthood and BMI ≥30.0 kg/m2 at baseline compared with BMI <25.0 kg/m2 in early adulthood and BMI <30.0 kg/m2 at baseline. Baseline waist circumference, comparing ≥110 cm with <90 cm, and waist-to-hip ratio, comparing ≥1.00 with <0.90, were associated with significant 14%-16% increases in high-grade prostate cancer risk and suggestive or significant 20%-39% increases in prostate cancer mortality risk. Height was associated with suggestive or significant 33%-56% risks of advanced or advanced restricted prostate cancer and prostate cancer mortality, comparing ≥1.90 m with <1.65 m. CONCLUSION: Our findings suggest that height and total and central adiposity in mid-to-later adulthood, but not early adulthood adiposity, are associated with risk of advanced forms of prostate cancer. Thus, maintenance of healthy weight may help prevent advanced prostate cancer.

Effect of broiler breast abnormality and freezing on meat quality and metabolites assessed by 1H-NMR spectroscopy.

The present study aimed at investigating the impact of the current growth-related abnormalities (White-Striping-WS, Wooden Breast-WB, and Spaghetti Meat-SM) affecting broilers Pectoralis major muscles on the main quality traits, the oxidative stability of both the lipid and protein fraction as well as the water mobility assessed in fresh and frozen/thawed meat. In addition, Nuclear Magnetic Resonance spectroscopy (1H-NMR) was applied to quantify free amino acids, histidine-containing dipeptides and metabolites involved in energy-generating pathways. Overall, the occurrence of WS, WB, and SM abnormalities remarkably affected the quality traits (pH, color, and water holding capacity) and oxidative stability of the meat, with the WB condition leading to the most detrimental effects. However, overall, freezing and subsequent thawing only partially worsened the aforementioned traits. Significant variations in free amino acids and histidine-containing dipeptides were found between abnormal muscles and their unaffected counterpart by 1H-NMR spectroscopy and, aside from the occurrence of muscular defects, their content was remarkably reduced in frozen/thawed meat. The findings obtained by analyzing the metabolites through 1H-NMR spectroscopy allowed to advance the knowledge concerning the impact of freezing and subsequent thawing on meat quality traits and provided useful information concerning the underlying mechanisms responsible for the development of WS, WB, and SM abnormalities in broilers.

[Sacral neuromodulation preliminary outcomes in male patients with idiopathic dysuria].

Objective: To assess the effectiveness and safety of sacral neuromodulation (SNM) therapy for men with idiopathic dysuria. Methods: From January 2012 to December 2016, a total of 26 patients treated with SNM therapy from multi-center across the country were retrospectively studied. The age ranged from 19 to 86 years with an average age of 45.2 years. Patients suffered from one or multiple urinary symptoms such as frequency of urination, urgency, urinary retention, etc. All patients had received more than two types of conservative therapy including oral and behavioral therapy, but had poor or no improvement. The voiding diary, urgency score and the quality of life score before implantation, in stageⅠ after implantation and stage Ⅱ after permanent implantation were recorded and compared. Results: A total of 22 patients chose to receive IPG at the end of stageⅠ therapy while 4 patients refused further stage Ⅱ therapy because of dissatisfactory effect. The conversion rate of stage Ⅰ to stage Ⅱ was 84.6% (22/26). The average follow-up time was 19.2 months, ranging from 3 to 63 months. The baseline of residual urine, voiding frequency and average voiding amount and those after stage Ⅰ therapy were [5 (0, 137.5) ] ml vs [0 (0, 40) ] ml, 14.6±6.1 vs 9.1±2.8, [100 (80, 135) ] ml vs [190 (150, 210) ] ml, respectively. The differences were statistically significant(all P<0.05).However, no significant differences were found in urination volume and quality of life (QoL) before and after implantation(P>0.05). During an average follow-up time of 19.2 months after the permanent implantation, over 80% patients had an improvement of residual urine volume by more than 50% after permanent implantation while the improvement was 55.6% after stage Ⅰ therapy, suggesting that the improvement of residual urine volume might be positively correlated with the duration of regulation. No significant differences were found in other parameters between stage Ⅰ and Ⅱ therapy. No adverse events like wound infection and electrode dislocation happened during our study. Conclusions: SNM is an effective and safety procedure for male patients with idiopathic dysuria, with a relatively high transfer rate. The medium-term curative effect is stable. The duration of regulation may be positively correlated with the improvement of residual urine.

Gaping of pectoralis minor muscles: magnitude and characterization of an emerging quality issue in broilers.

Recently, a certain number of broiler abattoirs located in different Countries around the World have signaled an emerging quality issue termed "gaping" because of the separation of the fiber bundles affecting the external portion of the bipinnate pectoralis minor muscle. Thus, after defining the criteria to classify the muscles as Normal (NORM), Moderate (MOD), or Severe (SEV) cases, the incidence of gaping under commercial conditions was assessed on a total of 8,600 P. minor obtained from broiler chickens belonging to 43 flocks during a 6-mo period. Then, a total of 180 P. minor were selected based on previously defined criteria to evaluate the main quality traits (pH, color, water-holding/-binding capacity and tenderness), proximate composition, water mobility, and thermal properties as well as metabolic profile through 1H-Nuclear Magnetic Resonance spectroscopy. The average incidence of gaping defect was found to be 16.8% (8.8 and 8.0% MOD and SEV cases, respectively). As for the main quality traits, a reduction in ultimate pH was observed as the severity of the gaping defect increased, with SEV muscles displaying significantly lower values in comparison with NORM (5.96 vs. 6.02; P < 0.01), while MOD showed intermediate values (5.99). Concurrently, if compared with their NORM counterpart, MOD and SEV exhibited higher lightness (53.6 and 54.2 vs. 51.8; P < 0.01) coupled with higher (P < 0.05) cooking losses and longer (P < 0.05) transversal relaxation time of extra-myofibrillar water fraction. Overall, no significant differences were found concerning proximate composition and thermal properties. With regard to the metabolic profile, a significantly lower (P < 0.001) glutamine concentration was found in MOD and SEV muscles that, concurrently, revealed significant (P < 0.05) variations in the metabolites involved in energy-generating pathways. Overall, these findings evidenced that the gaping defect affecting broilers' P. minor muscles have strong similarities with the pale-soft-exudative condition previously described in poultry and likely results from the biochemical processes taking place during the post-mortem conversion of muscle to meat.

Antimicrobial alumina nanobiostructures of disulfide- and triazole-linked peptides: Synthesis, characterization, membrane interactions and biological activity.

Due to the its physical-chemical properties, alumina nanoparticles have potential applications in several areas, such as nanobiomaterials for medicinal or orthodontic implants, although the introduction of these devices poses a serious risk of microbial infection. One convenient strategy to circumvent this problem is to associate the nanomaterials to antimicrobial peptides with broad-spectrum of activities. In this study we present two novel synthesis approaches to obtain fibrous type alumina nanoparticles covalently bound to antimicrobial peptides. In the first strategy, thiol functionalized alumina nanoparticles were linked via disulfide bond formation to a cysteine residue of an analog of the peptide BP100 containing a four amino acid spacer (Cys-Ala-Ala-Ala). In the second strategy, alumina nanoparticles were functionalized with azide groups and then bound to alkyne-decorated analogs of the peptides BP100 and DD K through a triazole linkage obtained via a copper(I)-catalyzed cycloaddition reaction. The complete physical-chemical characterization of the intermediates and final materials is presented along with in vitro biological assays and membrane interaction studies, which confirmed the activity of the obtained nanobiostructures against both bacteria and fungi. To our knowledge, this is the first report of aluminum nanoparticles covalently bound to triazole-peptides and to a disulfide bound antimicrobial peptide with high potential for biotechnological applications.

Fruit and vegetable intake and risk of incident of type 2 diabetes: results from the consortium on health and ageing network of cohorts in Europe and the United States (CHANCES).

BACKGROUND/OBJECTIVES: There is limited information to support definitive recommendations concerning the role of diet in the development of type 2 Diabetes mellitus (T2DM). The results of the latest meta-analyses suggest that an increased consumption of green leafy vegetables may reduce the incidence of diabetes, with either no association or weak associations demonstrated for total fruit and vegetable intake. Few studies have, however, focused on older subjects. SUBJECTS/METHODS: The relationship between T2DM and fruit and vegetable intake was investigated using data from the NIH-AARP study and the EPIC Elderly study. All participants below the age of 50 and/or with a history of cancer, diabetes or coronary heart disease were excluded from the analysis. Multivariate logistic regression analysis was used to calculate the odds ratio of T2DM comparing the highest with the lowest estimated portions of fruit, vegetable, green leafy vegetables and cabbage intake. RESULTS: Comparing people with the highest and lowest estimated portions of fruit, vegetable or green leafy vegetable intake indicated no association with the risk of T2DM. However, although the pooled OR across all studies showed no effect overall, there was significant heterogeneity across cohorts and independent results from the NIH-AARP study showed that fruit and green leafy vegetable intake was associated with a reduced risk of T2DM OR 0.95 (95% CI 0.91,0.99) and OR 0.87 (95% CI 0.87,0.90) respectively. CONCLUSIONS: Fruit and vegetable intake was not shown to be related to incident T2DM in older subjects. Summary analysis also found no associations between green leafy vegetable and cabbage intake and the onset of T2DM. Future dietary pattern studies may shed light on the origin of the heterogeneity across populations.

Experiences of surgical continence management approaches for cloacal anomalies: a qualitative analysis based on 6 women.

STUDY OBJECTIVE: The aim of this qualitative study was to gain insight into health care experiences of young women diagnosed with cloacal anomalies, with a special focus on continence management. DESIGN: Qualitative analysis of one-to-one interviews. SETTING: A tertiary center for congenital anomalies of the urogenital tract in London. PARTICIPANTS: Six women aged 16 to 24 with cloacal anomalies. INTERVENTIONS: Tape-recorded one-to-one semi-stuctured interviews with a skilled interviewer. MAIN OUTCOME MEASURE(S): The taped interviews were transcribed and analyzed verbatim using interpretative phenomenological analysis according to the research question. Organizing themes across all of the accounts were identified. RESULTS: Two organizing themes concerning our research interests are summarized. The first theme Personal Agency in the Hands of Experts focuses on the interviewees' appreciation of their life-saving surgical care and their involvement in treatment decisions. The second theme Compromises and Trade-Offs focuses on what it was like to live with the more traditional versus the more advanced continence methods. Reliability emerged as a key priority in terms of continence treatment outcome. Gratitude may have interfered with the women's honest communications during treatment decision and evaluation consultations. CONCLUSIONS: A more developed approach to communication about the complex interventions proposed, founded on a nuanced understanding of users perspectives, can enhance informed decision making about continence management approaches. Despite these specific gaps, the interviewees were appreciative of their care and optimistic about life.

Maternal request for caesarean section: audit of a care pathway.

This report is based on an audit of the delivery outcome of a specific care pathway for women who had made a maternal request for caesarean section (MRCS). The study took place in a UK inner city National Health Service maternity unit with 6,000 births per year. All 31 multiparous and 16 nulliparous women on the pathway were included. All of the former group had delivered vaginally, all reported having experienced their previous birth as traumatic, and all subsequently delivered vaginally. Of the 16 nulliparous women, six delivered by planned caesarean section; four delivered vaginally; four had an instrumental delivery and two had an emergency caesarean section. A designated multidisciplinary care pathway that incorporates education and support may have the potential to help more women to achieve a normal delivery. More research is needed to assess its potential for reducing unnecessary caesarean deliveries and for improving user experience.

The normal vulva in medical textbooks.

When a healthy woman expresses concerns about her vulva, the doctor's response should be informed by clinical knowledge. For many doctors, accumulation of such knowledge would have begun with undergraduate teaching and medical textbooks. The aim of this study is to examine the information on female genital morphology in medical textbooks. A total of 59 gynaecology and anatomy textbooks were searched for information on the dimensions of vulval constitutent parts. No textbook gave measurements for all vulval structures. Vaginal length was reported in 21/59 textbooks, clitoral size in 15/59 and labia minora in 1/59. Where measurements appear, they suggest narrower ranges than recent reports. Information of vulval morphology is scanty and inaccurate in medical textbooks. The general lack of professional resources means that doctors may consciously or non-consciously rely upon personal experiences and popular culture to form their opinions, as do their patients.

Quality of obstetric and midwifery care for pregnant women who have undergone female genital mutilation.

Despite the availability of professional guidelines for the pregnancy management of women affected by female genital mutilation (FGM), this study demonstrated major deficits in identification, management and safeguarding.

Adult recall of childhood female genital cutting and perceptions of its effects: a pilot study for service improvement and research feasibility.

This study aimed to gather information from service users of an African Women's Clinic for the purposes of planning service improvement and estimating research feasibility. The report is based on 17 interviews with Somali speaking women who had experienced female genital cutting in childhood. With language barriers removed, a high percentage of clinic attendees responded positively to the invitation to participate in research. They willingly discussed their experiences of FGM and expressed their negative viewpoints about the practice of FGM, suggesting that psychosocial and psychosexual research may be feasibly carried out in specialist contexts. The results also point to the need for psychological and educational input for service improvement.

Detrusor botulinum toxin A injection significantly decreased urinary tract infection in patients with traumatic spinal cord injury.

STUDY DESIGN: The study was designed as a single-arm clinical trial. OBJECTIVES: To investigate the effect of detrusor botulinum toxin A (BoNTA) injection on urinary tract infection (UTI) in patients with spinal cord injury (SCI). SETTING: The study was performed in a national rehabilitation research center of China. METHODS: Between September 2010 and May 2012, 41 male inpatients with neurogenic detrusor overactivity (NDO) caused by traumatic SCI, mean age 36.0±8.8 years, duration of SCI since inclusion 21.5±17.3 months, received an injection of 300 U BoNTA into detrusor. Before and 3 months after injection, each patient kept a bladder diary, underwent video-urodynamic investigation and urine culture. All UTIs occurring in the 6 months before and the 6 months after injection were recorded. RESULTS: Before injection, the mean number of UTI over 6 months was 1.39±1.36. After injection, the mean significantly decreased to 0.78±0.96 (P=0.023). The mean maximum detrusor pressure during filling decreased significantly in the patients of detrusor overactivity (n=24) compared with patients of normo-active detrusor (n=17) after injection (35.4±12.2 vs 20.9±7.9 cmH(2)O, P=0.000), meantime, the decrease of UTI was significant in the former (1.29±1.21 vs 0.41±0.62 cmH(2)O, P=0.015) while no significant in the latter (1.46±1.47 vs 1.04±1.08, P=0.319). CONCLUSION: Detrusor BoNTA injection significantly decreased UTI in SCI patients with NDO. This effect seems to be related to the decrease of detrusor pressure.

Intravenously transplanted bone marrow stromal cells promote recovery of lower urinary tract function in rats with complete spinal cord injury.

OBJECTIVES: There is increasing evidence that intravenously injected neural progenitor cells promote recovery of bladder function in rodents, following contusive spinal cord injury through migrating into the injured spinal cord tissue and differentiating into central nervous system cells. The present study was aimed to clarify whether intravenously transplanted bone marrow stromal cells (BMSCs) could improve lower urinary tract (LUT) function in rats with spinal cord transection (SCT). METHODS: A total of 22 rats underwent experimentation in three groups, including group 1-sham operation, group 2 (BMSC)-SCT plus BrdU (5-bromo-2'-deoxyuridine) labeled BMSCs transplantation at day 9 after SCT, group 3-SCT control. All rats were investigated urodynamically on day 28 after transplantation. RESULTS: BMSCs identified by BrdU immunohistochemistry survived in the injured spinal cord and lumbar level 3-4 (L(3-4)). Voiding pressure, episodes of non-voiding contractions and residual urine volumes were significantly decreased in BMSC rats, compared with the controls. Bladder capacity was similar in both groups. In four out of eight BMSC rats and one out of seven controls, the tonic and bursting external urethral sphincter electromyographic activity were detected during cystometry. Silent periods during bursting were shorter and activity periods were longer in BMSC rats compared with sham rats. CONCLUSION: Intravenously transplanted BMSCs survived in the L(3-4) and had beneficial effects on the recovery of LUT function in the rats after SCT.

In vitro antioxidant activities of endophytic fungi isolated from the liverwort Scapania verrucosa.

We investigated in vitro antioxidant activities of 49 endophytic fungi isolated from the liverwort Scapania verrucosa. Based on morphological and molecular identification, the endophytic fungi isolated were classified into seven genera (Hypocrea, Penicillium, Tolypocladium, Chaetomium, Xylaria, Nemania, and Creosphaeria), all belonging to one family (Xylariaceae). By screening with the 2,2'-azino-di(3-ethylbenzthiazoline-6-sulfonic acid) (ABTS) decolorization assay, the ethyl acetate extracts of five endophytic fungi (T7, T21, T24, T32, and T38 strains), which exhibited remarkable Trolox equivalent (TE) antioxidant capacity (ranging from 997.06 to 1248.10 µmol TE/g extract), were selected and their antioxidant capacity was further evaluated by assays for 2,2'-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging, hydroxyl radical scavenging, reducing power, and ferrous ion chelating. The ethyl acetate extracts of two endophytic fungi (T24 and T38) were found to have comparable scavenging abilities on both DPPH-free radicals (93.9 and 88.7%, respectively, at 50 µg/mL) and hydroxyl radicals (97.1 and 89.4%, respectively, at 2 mg/mL) when compared with those of the positive controls (ascorbic acid and butylated hydroxytoluene, respectively). Although their reducing powers were similar to that of butylated hydroxytoluene, as indicated by absorbance (0.35 and 0.30 at 50 µg/mL, respectively), only the T38 strain's ethyl acetate extract showed ferrous ion chelating ability (92.9% at 1 mg/mL) comparable to that of the EDTA-2Na control. These endophytic fungi in S. verrucosa are a potential novel source of natural antioxidants.

Clinical characteristics of well women seeking labial reduction surgery: a prospective study.

OBJECTIVE: To assess clinical characteristics and expectations in well women requesting elective labial reduction surgery. DESIGN: Prospective study of women attending an outpatient gynaecology clinic. SETTING: General gynaecology clinic at a Central London teaching hospital. SAMPLE: Women requesting labial reduction surgery and referred by their general practitioner. METHODS: The labia minora width and length were measured for all participants for comparison with published normal values. The presenting complaint was recorded, along with demographic details, expectations of surgery and sources of information regarding appearance of the labia. MAIN OUTCOME MEASURES: Labial measurements, reported symptoms and expectations of surgery. RESULTS: The labia of all participants were within normal published limits, with a mean (SD) of 26.9 (12.8) mm (right labia), and 24.8 (13.1) mm (left labia). The majority of complaints were regarding appearance or discomfort. Expectations were to alter the appearance with surgery. CONCLUSIONS: All women seeking surgery had normal-sized labia minora. Clear guidance is needed for clinicians on how best to care for the worried well woman seeking surgery.

The effects of micronutrient supplementation on vasomotor symptoms in postmenopausal women.

OBJECTIVE: Estrogen is the most effective treatment for vasomotor symptoms. Given its potential risks, herbal preparations and nutritional supplements have been developed as alternative remedies. The main aim of this double-blind, randomized, placebo-controlled trial was to assess any impact of a nutritional supplement containing 12 vitamins and nine minerals on the frequency and severity of hot flushes in postmenopausal women over a 3-month period. SUBJECTS AND METHODS: Ninety-one postmenopausal women were randomized to either the placebo (n = 45) or the treatment arm (n = 46). Seventy out of the 91 women completed the study (36 from the treatment group and 34 from the placebo group). At baseline and the 14-week post-intervention assessments, study participants completed questionnaires on the frequency and severity of hot flushes and night sweats, the Profile of Mood State questionnaire, the World Health Organization Quality of Life Questionnaire, the National Adult Reading Test and the Rey Auditory-Verbal Learning Test. Between assessments, the women also completed hot flush diaries. RESULTS: There was a significant decrease (p < 0.01) in the number (±standard error of the mean) of hot flushes experienced per week for treatment (pre 31.3 ± 4.7; post 23.1 ± 4.8) and placebo groups (pre 28.1 ± 4.7; post 17.3 ± 4.0). A significant decrease (p < 0.001) in the number of night sweats experienced per week was also observed in the treatment (pre 6.1 ± 1.0; post 4.2 ± 0.7) and placebo groups (pre 5.9 ± 0.7; post 3.7 ± 0.7). CONCLUSIONS: This study demonstrates a significant placebo effect on hot flushes and night sweats, as consistent with other studies. The micronutrient supplement containing 21 vitamins and minerals was not superior over placebo in effects on hot flushes and night sweat experiences.