ROUX-en-Y gastric bypass surgery improves metabolic syndrome-related erectile dysfunction in mice via the IRS-1/PI3K/AKT/eNOS pathway.

Objective: Although many clinical studies have shown that ROUX-en-Y gastric bypass (RYGB) surgery significantly improves metabolic syndrome-related erectile dysfunction (MED), the role and mechanism are unclear. Aim: In this study we used a mouse model to explore how RYGB improves MED induced by a high-fat diet (HFD). Methods: We established a mouse model of metabolic syndrome by feeding an HFD for 16 weeks. The mice were randomly assigned to the standard chow diet (SCD), HFD, or RYGB groups. Body weight, fasting blood glucose, plasma insulin, and total plasma cholesterol were analyzed. Erectile responses were evaluated by determining the mean systolic blood pressure and the intracavernosal pressure (ICP). Penile histologic examination (Masson's trichrome and immunohistochemical stain) and Western blot were performed. Result: Compared with the SCD group, the ICP in the sham group was significantly lower, and the ICP of the RYGB was significantly increased. Masson's trichrome and immunohistochemical staining showed that the content of endothelium and smooth muscle in the corpus cavernosum of mice with MED was significantly reduced. Western blot analysis showed a significant decrease in α-smooth muscle actin and a significant increase in osteopontin in penile tissue in the sham group, which was improved by RYGB surgery. Furthermore, RYGB significantly increased IRS-1/PI3K/Akt/eNOS phosphorylation. Clinical Translation: In this study we explored the mechanism of bariatric surgery to improve erectile dysfunction associated with metabolic syndrome and provided a theoretical basis for clinical research. Strengths and Limitations: First, we did not investigate the mechanism by which RYGB affects the IRS-1/PI3K/Akt/eNOS signaling pathway. Second, the effect of the IRS-1/PI3K/Akt/eNOS signaling pathway on the function of corpus cavernosum endothelial cells and smooth muscle cells remains to be investigated in cellular studies. Conclusion: This study demonstrated that RYGB may not only improve metabolic parameters but also restore erectile function in MED patients. The mechanism of the therapeutic effect of RYGB may be reactivation of the IRS-1/PI3K/Akt/eNOS pathway.

Consenting surgical patients for the risk of contracting COVID-19 during the hospital stay.

BACKGROUND/AIMS: Postoperative pulmonary complications occur in half of patients with perioperative COVID-19 and are associated with high mortality. The Royal College of Surgeons of England published guidance on recovery of surgical services during and after the COVID-19 pandemic. One part of this toolkit looked at unique considerations during the COVID-19 pandemic, in particular the risk of contracting COVID-19 while in the hospital. This quality improvement project sought to assess consent forms from the authors' surgical department to see if patients were being consented for the risks associated with COVID-19 during their stay in the hospital. METHODS: Over an 8-week period in October and November 2020, consent forms for patients under the general surgery department were audited four times against the Royal College of Surgeons of England's standards. Patients were included in the study if they were deemed to have capacity to consent to a procedure. Posters in the hospital, generic emails and teaching sessions were used as the interventions after each cycle of the audit. RESULTS: Baseline measurement showed that fewer than 37% of patients were consented for the risk of contracting COVID-19; this rose to almost 61%, 71% and 85% in the second, third and fourth parts of the project respectively. Year 1 and 2 core surgical trainees and clinical fellows below registrar level showed the greatest improvement, from consenting only 8% of patients up to 100% of patients, while specialty registrars showed improvement in consenting from 52% to 73%. The change was sustained 2 years after the initial interventions, with almost 60% of patients consented for the risk associated with in-hospital COVID-19 infection in March 2023. CONCLUSIONS: Errors or omission of important elements in documentation of patient consent can delay operations, expose hospital trusts to medicolegal risk and ultimately may represent a failure to fully respect patient autonomy. This project sought to evaluate consenting practice during the presence of COVID-19 in society. While the teaching session showed some improvement in the consenting for the risk of COVID-19, emails and visual posters increased the consent rates further.

Orphans in Syria and Iraq Juggling Balls: Wars, COVID-19, and the NGO's financial crisis.

The COVID-19 pandemic's impact varies between and within nations, causing new forms of inequality. Refugee and orphan children in conflicted areas are more likely to suffer due to poverty, vulnerability, and limited access to essential services including reduction in donor funding. This qualitative study is the first to assess the effects of the COVID-19 pandemic and the financial crisis on Iraqi and Syrian orphaned children and their mothers. The Modified Grounded Theory was used for the preliminary analysis to expand the range of themes. This study has identified five major themes: financial crisis, low educational attainment, child labour, mental health issues, violence, and social problems. The impact of COVID-19 children and adolescents' mental health is of great concern. These multiple crises may significantly impact orphan children and adolescents' cognitive, mental health, and physical development. It is critical to address mental health issues during the current crisis and to plan for possible future pandemics and their intersecting outcomes. A Holistic approach requires providers to be aware of their clients' intersecting circumstances and needs using a range of lenses, including the person in the environment, family dynamics, culture, politics, and structural challenges. Offering food, medical supplies, and housing are considered basic needs.

Forensic evaluation of mitochondrial DNA heteroplasmy in Gujarat population, India.

BACKGROUND: Owing to its high copy number and its small size, mtDNA analysis is the most reliable choice when biological materials from crime scenes are degraded or have mixed STR profiles. AIM: To examine the occurrence of heteroplasmy along with its frequency and pattern in both HV1 and HV2 regions of the mtDNA among unrelated individuals from India. SUBJECTS AND METHODS: Mitochondrial DNA control region [hypervariable region one (HV1) and hypervariable region two (HV2)] were analysed in blood and buccal tissues of 104 unrelated individuals from the Indian state of Gujarat. RESULTS: A high frequency of point heteroplasmy (PH) and length heteroplasmy (LH) was revealed. PH was detected in 7.69% of the population, with a higher frequency observed in blood than in buccal samples. However, there were no statistically significant differences in PH between the two tissues (Chi-square = 0.552, p ≥ 0.05). A total of six PH positions were detected: three at HV1, and another three at HV2. The studied population showed 46.15% LH in the HV1 and HV2 regions of both tissues. The LH positions observed in the Gujarat population were the same as those previously reported at HV1 np16184-16193 and HV2 np303-315. CONCLUSIONS: Our findings suggest that differences in the pattern of heteroplasmy found in different tissues can complicate the forensic analysis, on the other hand, the probability of a match between the questioned and reference samples increases when the heteroplasmy is identical in both tissues. Variability of PH among persons and even within tissues recommends analysing multiple tissue samples before drawing a conclusion in forensic mtDNA analyses.