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As far as the reproductive health, we advise vitamin D supplementation in selected populations, only during specific moments of the ovarian cycle, to support the luteal phase. However, ambiguities about dosage and timing of the supplementation still emerge from the clinical studies published to date and further studies are required.Objective The genetic variants near the melanocortin-4 receptor gene (MC4R), a key protein regulating energy balance and adiposity, have been related to obesity and cardiovascular risk factors. However, qualitative and quantitative aspects of diet may modulate the association of this polymorphism with obesity and cardiovascular diseases (CVDs). The aim of this study was to evaluate interactions among MC4R rs17782313, the Dietary Approaches to Stop Hypertension (DASH) diet and risk factors for CVDs. Method This cross-sectional study was conducted on 266 Iranian women categorized by body mass index (BMI) range of 25-40 kg/m2 as overweight or obese. CVD risk factors included waist circumference (WC), lipid profile, blood pressure, insulin circulation and fasting blood sugar (FBS). Insulin and FBS were used to calculate homeostatic model assessment insulin resistance (HOMA-IR) Body composition was assessed by a multi-frequency bioelectrical impedance analyzer, InBody 770 scanner. Results The findings of this study show that high adherence to the DASH diet in the CC groups were associated with decreased SBP and DBP compared to the TT group. In addition, a significant difference between women with high adherence to the DASH diet compared to low adherence was observed for body weight (p less then 0.001), fat free mass (FFM) (p = 0.01) and BMI (p = 0.02). Women with the CC genotype had higher insulin (mg/dl) (mean and SD, for TT 14.6 ± 4.6, TC 17.3 ± 9.2, CC 15.3 ± 4.8, p = 0.04) and HOMA-IR (mean for and SD, TT 3.1 ± 1.07, TC 3.9 ± 2.4, CC 3.2 ± 1.1, p = 0.01) than TT group. Inclusion of potential confounding variables (age, physical activity, BMI and daily caloric intake) did not attenuate the difference. Conclusion Among overweight/obese Iranian women with the CC genotype, incorporating the DASH diet may serve as a dietary prescription to decrease CVD risk. A dietary intervention trial is warranted.

The aim of this study was to determine the presence of protease-activated receptor 2 (PAR2) and matriptase proteins and quantify PAR2 and matriptase mRNA expression in the articular cartilage and synovial membrane of cats with and without osteoarthritis (OA).

A total of 28 articular cartilage samples from adult cats (14 OA and 14 normal), 10 synovial membranes from adult cats (five OA and five normal) and three cartilage samples from 9-week-old fetal cats were used. The presence of PAR2 and matriptase in the cartilage and synovial membrane of the adult samples was detected by immunohistochemical (IHC) staining, while real-time PCR was used for mRNA expression analyses in all samples.

PAR2 was detected in all OA and normal articular cartilage and synovial membrane samples but confined to only a few superficial chondrocytes in the normal samples. Matriptase was only detected in OA articular cartilage and synovial membrane samples. PAR2 and matriptase mRNA expression were, however, detected in all cartilagcular tissues is a novel and important finding, and supports the hypothesis that serine proteases are involved in the pathogenesis of feline OA. The consistent presence of PAR2 and matriptase protein in the cytoplasm of OA chondrocytes suggests a possible involvement of proteases in cartilage degradation. Napabucasin manufacturer Further investigations into the PAR2 and matriptase pathobiology could enhance our understanding of the proteolytic cascades in feline OA, which might lead to the development of novel therapeutic strategies.Purpose Coronavirus Disease 2019 (COVID-19) can cause conjunctivitis in up to 31.6% of patients. Additionally, retinal findings compatible with retinal microvascular ischemia have also been associated with coronavirus disease in asymptomatic patients. We describe a case of bilateral retinal changes compatible with microangiopathy occurring during the late phase of COVID-19. Case report A 50-year-old man with bilateral pneumonia and positive polymerase chain reaction for SARS-CoV-2 developed an arcuate visual field defect in his left eye. Funduscopy revealed multiple, bilateral cotton-wool spots without haemorraghes. OCT-angiography revealed multifocal areas of retinal microvascular ischemia in the superficial plexus, the largest of which corresponded to the arcuate scotoma observed in the automated perimetry. Conclusion Visual field defects due to retinal microangiopathy can occur during the late phase of COVID-19. Vascular changes observed in the retina may mimic what may be happening in other, less-accessible organs.

Genetic variants of the neuronal nicotinic acetylcholine receptor (nAChR) cause autosomal dominant sleep-related hypermotor epilepsy. Approximately 30% of autosomal dominant sleep-related hypermotor epilepsy patients are medically intractable. In preclinical models, pathogenic nAChR variants cause a gain of function mutation with sensitivity to acetylcholine antagonists and agonists. Nicotine modifies the activity of nAChRs and can be used as targeted therapy.

We reviewed next-generation sequencing epilepsy panels from a single laboratory (GeneDx) from patients at Children's Medical Center Dallas between 2011 and 2015 and identified patients with nAChR variants. Retrospective review of records included variant details, medical history, neuroimaging findings, and treatment history.

Twenty-one patients were identified. Four patients were prescribed nicotine patches for intractable seizures. Three of 4 patients had a clinical response, with >50% seizure reduction.

Treatment with a nicotine patch can be an effective therapy in epilepsy patients with nAChR gene variants. We propose consideration of transdermal nicotine treatment in intractable epilepsy with known nAChR variants as an experimental therapy. Further clinical trials are needed to fully define therapeutic effects.

Treatment with a nicotine patch can be an effective therapy in epilepsy patients with nAChR gene variants. We propose consideration of transdermal nicotine treatment in intractable epilepsy with known nAChR variants as an experimental therapy. Further clinical trials are needed to fully define therapeutic effects.

Transitioning from trainee to independent surgeon is challenging, with teaching and mentoring learners adding complexity. This study aimed to identify benefits and challenges of teaching and mentoring residents early in surgical practice.

A mixed-methods survey with multiple choice and open-ended questions was developed for early career (first 3years) and experienced (more than 3years) surgeons working with residents. The survey was initially piloted by 6 surgeons, revised according to feedback and distributed on Twitter. Quantitative and qualitative analyses were performed.

Seventy-three valid responses were analyzed, 21 (25%) from early career surgeons and 53 (75%) from experienced surgeons. The majority were women (62%), practiced in academics (78%) and lived in the United States (76%). Most of the early career and experienced surgeons selected the operating room as the most teaching challenging location (62% early career; and 60% experienced). Top teaching challenges of early career surgeons were thith regard to teaching and mentoring.

Meckel's diverticulum is a congenital abnormality often associated with the pediatric population. When seen in the adult population, management is controversial. This study sought to determine demographic and outcome differences between diverticulectomy and small bowel resection in adults diagnosed with Meckel's diverticulum.

An analysis of the American College of Surgeons National Surgical Quality Improvement database (2015-2018) was performed, capturing patients with a postoperative diagnosis of Meckel's diverticulum. Inclusion criteria included diverticulectomy or small bowel resection, and exclusion criteria included other major procedures such as colectomy or concomitant diverticulectomy and a small bowel resection. Demographics and outcomes were analyzed between those receiving diverticulectomy or resection.

506 patients undergoing surgical treatment of Meckel's diverticulum were captured. The majority of these patients were white (79.05%), male (68.77%), and averaged 46years old. The 2 populatione segment of small bowel should be individualized to each patient, their pathology, and clinical picture.

Field vital signs are integral in the American College of Surgeons (ASA) Committee on Trauma (COT) triage criteria for trauma team activation (TTA). Reliability of field vital signs in predicting first emergency department (ED) vital signs, however, may depend upon prehospital time. The study objective was to define the effect of prehospital time on correlation between field and first ED vital signs.

All highest level TTAs at two Level I trauma centers (2008-2018) were screened. Exclusions were unrecorded prehospital vital signs and those dead on arrival. Demographics, prehospital time (scene time + transport time), injury data, and vital signs were collected. Differences between field and first ED vitals were determined using the paired Student's t test. Propensity score analysis, adjusting for age, sex, injury severity score (ISS), and mechanism of injury compared outcomes among patients with ISS ≥16. Multivariate linear regression determined impact of prehospital time on vital sign differences between ical providers must be cognizant of this pitfall during the prehospital assessment of trauma patients.

A hyperkinetic gallbladder is defined as a hepatobiliary iminodiacetic acid (HIDA) scan ejection fraction (EF) of >80%. This condition is poorly described, and there is no current consensus on optimal management. The intent of this study was to determine if cholecystectomy improves symptoms in patients with a hyperkinetic gallbladder when compared to those managed nonoperatively and if there were variables predictive of symptom improvement with or without cholecystectomy.

This retrospective study included patients from 3 academic hospitals in the Atlanta metro area between the years 2006 and 2018. All patients with an EF >80% were included. Following voluntary exclusion patients were contacted by phone. Each patient was administered a questionnaire regarding their surgical history, medical management, and current symptom profile via Otago score. Institutional Institutional Review Board approval was obtained.

4785 HIDA scans were performed, and 194 reported an EF >80% (incidence 15.7%). 96% of ty.We believe this to be the first case report of jejunosigmoid bypass harboring small bowel adenocarcinoma. The mechanism of malignant degeneration could be similar to that of carcinogenesis of ureterosigmoidostomy that is of historical interest. This case represents an example of why it is imperative for surgeons to be diligent in their preparation and workup of a patient before a complex operation, especially in patients with peculiar or unknown surgical histories.