These data indicate that prolonged administration of melatonin may improve the day-night rhythm of BP, particularly in women with a blunted nocturnal decline.

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Continuous combined oral HRT with17beta-estradiol plus norethisterone acetate reduces homocysteine levels, mainly after a methionine load. This effect seems to be independent of vitamin status and may have positive implications for the prevention of cardiovascular diseases in PMW.

aspect of medical care is important and relevant for endocrinologists. We also believe that screening guidelines should be derived based on published medical evidence in consideration of relevant social, legal, and economic applications. However, at present, we do not think there is a sufficient medical or legal basis to recommend calcitonin screening in all patients with thyroid nodule(s). We are grateful to Dr. Deftos for the letter (1) that gives us the opportunity to make some observations regarding routine measurement of serum calcitonin (Ct) in patients with thyroid nodule(s). In our opinion, there are several lines of evidence (reviewed in Refs. 2 and 3) that support the serum Ct measurement in association with fine-needle aspiration cytology (FNAC) as the most accurate tests for discovering medullary thyroid carcinoma (MTC). In addition, our experience on more than 10,000 patients demonstrates that when MTC is diagnosed by Ct screening, it has a better outcome likely due to the statistically significant lower stage of the disease at the diagnosis (2). Unfortunately, Hodak and Burman (3) could not discuss this issue because our paper was published just before their editorial. It is known that MTC is the most aggressive differentiated thyroid tumor, with a survival rate of 50% at 10 yr, and that the best prognostic factor is the stage of disease, with intrathyroidal tumors showing the best prognosis (4). The possibility of performing an early MTC diagnosis offered by the routine serum Ct measurement must be taken into account if we want to improve our capability to cure a disease that can be definitively cured only by the completeness of the initial surgical treatment. It is in fact well known that nowadays conventional chemotherapy and radiotherapy are ineffective to cure advanced MTC (5).Serum Ct measurement is a reliable test when performed in referral centers that have accurately defined their own cut-off values for basal and pentagastrin-stimulated Ct. A detailed description of the method and its practical usefulness is very well described in the "Laboratory Medicine Practice Guidelines for the Diagnosis and Monitoring of Thyroid Disease," recently published in the official journal of the American Thyroid Association and validated by a total of 84 independent reviewers from different countries (6).One of the main arguments against the routine use of serum Ct measurement is the possibility of false-positive tests, particularly when baseline values are between 10 and 100 pg/ml. This is not the real scenario when the test is strictly applied to patients with thyroid nodules but not to other benign thyroid disorders, such as Hashimotos' thyroiditis, where confounding factors still exist. In our experience in more than 10,000 patients, all presenting with thyroid nodule(s), false-positive results were very rare, and, rather than false positive, they were due to other well-known benign conditions associated with increased serum Ct concentrations, such as renal failure, that can be easily recognized by caref...

Low- or high-dose HT similarly influences fasting homocysteine levels. Low-dose HT seems to be more effective than high-dose HT in reducing the post-methionine homocysteine increase.

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Background Exercise training improves peak oxygen uptake (VO2) in heart failure with preserved ejection fraction (HFpEF), but the underlying mechanisms are unknown. In other cardiovascular diseases, exercise training improves vascular function and increases levels of circulating endothelium-repairing cells. We aimed to investigate the effects of moderate continuous training (MCT) and high intensity interval training (HIIT) on vascular function and cellular endothelial repair in HFpEF. Methods This was a prespecified subanalysis of the Optimizing Exercise Training in Prevention and Treatment of Diastolic Heart Failure randomized trial. HFpEF patients (n=180) were randomized to HIIT, MCT or attention control. At baseline and after 12 weeks, we measured peak VO2, fingertip arterial tonometry (n=109), brachial artery flow-mediated dilation (n=59), aortic pulse wave velocity (n=94), and flow cytometry (n=136) for endothelial progenitor cells (CD45dimCD34+VEGFR2+) and angiogenic T cells (CD3+CD31+CD184+). Changes in these parameters were compared between groups using linear mixed models. Parameters were correlated using Spearman's rho. Results At 3 months, we did not observe significant differences between HIIT, MCT and control group regarding changes in vascular function throughout the vascular tree (fingertip arterial tonometry, brachial artery flow-mediated dilation and central arterial stiffness, Table 1) or levels of circulating endothelium-repairing cells (endothelial progenitor cells and angiogenic T cells, Table 1). Results were similar at 12 months and when restricting analysis to patients with at least 70% adherence to training sessions. Patients with higher peak VO2 at baseline had lower numbers of circulating endothelial progenitor cells (rho=−0.22, p=0.011). Conclusions In patients with HFpEF, exercise training did not change vascular function or levels of endothelium-repairing cells. Thus, improved vascular function likely does not contribute to the change in peak VO2 after training. These findings are in contrast with the benefits of exercise on vascular function in heart failure with reduced ejection fraction and coronary artery disease. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EU Framework Programme 7 Table 1