暂无摘要。

Hormone replacement therapy (HRT) significantly decreases the frequency and intensity of vasomotor symptoms (VMS). It is recommended to evaluate clinical efficacy of HRT on VMS. The absence of reduction in VMS after adaptation of the modalities of the HRT suggests the possibility of atypical VMS. They should be evoked in the following clinical circumstances: when they do not give way with an adapted HRT (compliance and good use); when they appear or reappear long after menopause; when there are changes to the usual VMS; when they are associated with other functional signs. A first and second-line assessment is offered, after an interview and a detailed clinical examination, which will guide further explorations. The treatment is above all etiological when the results are positive. When the results are negative, an adaptation of the HRT can be proposed.

Cardiovascular risk is one of the major challenges of menopausal hormone therapy (MHT). Thus, during a consultation of menopause, it is essential to considering the classic cardiovascular risk factors but also those more specific to women in order to evaluate the level of cardiovascular risk: high risk, intermediate risk or low risk. Cardiovascular disease (myocardial infarction or ischemic stroke) are rare disease in women compared to men. However, they represent the leading cause of death in women after menopause in France. Publications of randomized trials have widely questioned the expected benefit of MHT on arterial risk. It should be noted that almost all of these trials concerned the combination of orally conjugated equine estrogens (ECE) associated or not with medroxyprogesterone acetate. Meta-analyses of all randomized trials show an increased risk of ischemic stroke associated with the use of oral MHT while the use of transdermal estrogen therapy combined with progesterone will be safe. The risk of coronary heart disease is not increased and appears to be significantly reduced when the MHT is started less than 10 years after menopause or before the age of 60. These results suggest that the timing of initiation of the MHT, the type of MHT and all of the risk factors should be carefully considered before starting MHT.

The incidence of venous thromboembolism (VTE) increases with age with an annual incidence of 1.25/1000 women in the 40-59 age group. Menopausal hormone therapy (MHT) may also increase the risk of VTE. This risk must be assessed during the first consultation before initiating MHT and assess each renewal of the MHT. MHT with oral estrogen combined (or not) with progestin increases the risk of VTE by about 70%. Using transdermal estrogen does not appear to increase the risk of VTE in women. VTE risk appears to be modulated by the type of progestin combined in MHT. The risk of VTE associated with MHT with transdermal estradiol appears to be safe in women using micronised progesterone and pregnane derivatives and higher in women using norpregnane derivatives . To limit the risk of VTE associated with MHT, transdermal estradiol use is recommended. In women at risk of VTE, MHT with oral estrogen is contraindicated. MHT with transdermal estradiol associated (or not) with micronised progesterone or dydrogesterone may be used in women with low or moderate risk of VTE.

暂无摘要。

Sirtuins (SIRT1-SIRT7) are a family of NAD+-dependent protein deacetylases that are linked to post-translational regulation of many metabolic processes. There are few reports available for chicken sirtuins (designated cSIRT1-cSIRT7), whose expression and regulation in the liver have yet to be explored. In the present study, we characterized the expression and regulation of sirtuin family members in chicken liver. The results showed that the sirtuin family members in chicken share the same conserved functional SIR2 domains. All the sirtuin family members were expressed extensively in all tissues examined, and the expression levels of cSIRT1, cSIRT2, cSIRT4, cSIRT6, and cSIRT7 in the liver increased significantly with sexual maturity. However, all sirtuin family members were downregulated (P < 0.05) in chicken livers and cultured primary hepatocytes treated with 17β-estradiol. We concluded that the expression levels of some chicken sirtuin family members in the liver were upregulated with sexual maturation, but might not be regulated directly by estrogen. Whereas estrogen could be used as an inhibitor of all sirtuins, both in vivo and in vitro.

OBJECTIVE: Establishment of guidelines for post-partum contraception.
METHODS: Systematic review of publications between 1960 and 2015 from database Medline, Embase, Cochrane Library and recommendations of international societies.
RESULTS: The most recent French data show that approximately 2% of women with induced abortion have deliver within 6 months before this abortion and 4% had a child six to twelve months earlier (Evidence Level [EL] 3). A contraceptive counseling is ideally recommended after delivery to avoid unplanned pregnancies (grade C). Among non-breastfeeding women, the shorter median delay for recovery ovulation is 39 days after delivery (EL4). Starting effective contraception later 21 days after delivery in women who does not want closely spaced pregnancy is recommended (grade B), and to prescribe it at the maternity (Professional consensus). In breastfeeding women, the recovery of ovarian activity is dependent on breastfeeding characteristics. Only exclusive breastfeeding with very specific conditions can be used for contraception over a six months period (EL2). For all other breastfeeding conditions, contraceptive strategies are the same than without breastfeeding (grade B). According to the post-partum risk of venous thromboembolism, the combined hormonal contraceptive use before six post-partum weeks is not recommended (grade B). In women with vascular risk factors, the evaluation of benefit risk balance of this use between 6th and 12th post-partum weeks is recommended (Professional consensus). Progestin only contraceptives with low dose are allowed in earlier post-partum (grade B), except at the acute phase of severe thromboembolic event (Professional consensus). In women who want intra-uterine device (IUD) as contraception, it is recommended to prescribe IUD at the hospital and to insert the IUD during the postnatal consultation (grade B). In breastfeeding women, progestin contraception\'s (oral or subcutaneous) are permitted immediately after delivery (grade B). For women at short interpregnancy interval risk, long acting reversible contraceptives (implant or IUD) started at the hospital is suggested (grade B).
CONCLUSIONS: The wide contraceptive choice permits to find the best strategy for each woman while respecting post-partum period specificities.