miR-277 regulates the phase of circadian activity-rest rhythm in Drosophila melanogaster.

Circadian clocks temporally organize behaviour and physiology of organisms with a rhythmicity of about 24 h. In Drosophila, the circadian clock is composed of mainly four clock genes: period (per), timeless (tim), Clock (Clk) and cycle (cyc) which constitutes the transcription-translation feedback loop. The circadian clock is further regulated via post-transcriptional and post-translational mechanisms among which microRNAs (miRNAs) are well known post-transcriptional regulatory molecules. Here, we identified and characterized the role of miRNA-277 (miR-277) expressed in the clock neurons in regulating the circadian rhythm. Downregulation of miR-277 in the pacemaker neurons expressing circadian neuropeptide, pigment dispersing factor (PDF) advanced the phase of the morning activity peak under 12 h light: 12 h dark cycles (LD) at lower light intensities and these flies exhibited less robust rhythms compared to the controls under constant darkness. In addition, downregulation of miR-277 in the PDF expressing neurons abolished the Clk gene transcript oscillation under LD. Our study points to the potential role of miR-277 in fine tuning the Clk expression and in maintaining the phase of the circadian rhythm in Drosophila.

Study on Body Mass Index and Fasting Serum Glucose in Postmenopausal Women.

Menopause is a normal physiological period that is characterized by the completely stoppage of endometrial cycles in women between the age of 45-55 years due to lack of ovarian follicular function. Several postmenopausal syndromes such as hot flushes, night sweats, vaginal dryness, depression, irritability, headache, and sleep disturbance can occur more frequently in this period which hampers the standard of life. This study was done to assess body mass index and fasting serum glucose changes in postmenopausal women in contrast with reproductive women. This cross-sectional analytical type of study was conducted in the Department of Physiology, Mymensingh Medical College, Bangladesh from January 2021 to December 2021. Total 140 women subject's age ranged between 25-65 years were involved in this study. Among them 25-45 years aged 70 (Seventy) reproductive women were involved as control group (Group I) and 45-65 years aged 70 (Seventy) postmenopausal women were taken as study group (Group II). By Anthropometric measurements, Body Mass Index (BMI) such as height and weight were taken in meter and kilogram respectively and fasting serum glucose was measured by GOD-PAP method. Results were expressed as mean (±SD) and by unpaired Student's 't' test, statistical significance of difference among the group was calculated. The mean±SD of BMI of Group I and Group II were 23.05±4.43kg/m² and 29.01±3.12kg/m² respectively. The mean±SD of body mass index is notably increase in study group in contrast with control group. The mean±SD of fasting serum glucose of control Group I and study Group II were 4.77±2.04mmol/l and 6.11±1.61mmol/l respectively. In study Group II fasting serum glucose was increased. Due to increased fasting serum glucose caused by lower level of female sex hormones specially estrogen hormone increased chance of cardiovascular diseases in postmenopausal women. Assessment of these parameters are important for early detection and prevention of complication related to high BMI and fasting serum glucose level for leading a better life.

Patients Prefer Medical Facts and Educational Videos From Sports Medicine Surgeons on Social Media.

Purpose: To provide updated information on which sports medicine patients are most influenced by provider presence on social media, as well as their preferences in social media platforms and content. Methods: Between November 2021 and January 2022, an anonymous online, voluntary, self-administered questionnaire containing 13 questions was distributed to patients who had a clinic visit with 1 of 2 orthopaedic sports medicine surgeons at the same institution. Descriptive statistics were used to analyze the data. Results: A total of 159 responses were received for a response rate of 29.5%. The most common platforms used by patients were Facebook (110; 84%), YouTube (69; 53%), and Instagram (61; 47%). Most participants indicated that it did not make a difference if their sports medicine surgeon was on social media (N = 99, 62%), and they indicated they would not travel further to see a physician who was active on social media (N = 85, 54%). Compared with other age groups, significantly more respondents over the age of 50 years used Facebook to follow their physicians (47 of 60, 78%, P = .012). Seventy-eight (50%) patients noted that they were interested in seeing medical facts, whereas 72 (46%) were interested in seeing educational videos on their physician's social media page. Conclusions: In this study, we found that sports medicine patients prefer to see educational videos and medical facts from their surgeons on social media, most predominantly on Facebook. Clinical Relevance: Social media is a popular way to connect in our modern world. As the influence of sports medicine surgeons on social media grows, it is important to understand how this is perceived by patients.

Modified Capillary Feeder assay using micro-tips to measure real-time feeding in Drosophila.

Capillary Feeder assay (CAFE) is a real-time feeding assay used in Drosophila that employs micro-capillaries, which are costly. Here, we present a modified version of the assay by replacing micro-capillaries with micro-tips, hence ensuring the same principle with cost reduction by 500 times. We developed a mathematical approach to measure volume for the conical shaped micro-tips. In this protocol, we describe step-by-step procedures of pre-assay setup along with fly rearing; assay setup included with detailed analysis for volume calculations. For further verification and use of this protocol, please refer to Segu and Kannan.1.

Can Serum Magnesium Level and Visual Evoked Potentials (P100) be a Predictive in Migraineurs?: Evidence Based Study.

Background and Objective: Few dating back, the role of visual evoked potentials changes and reduced level of intracellular magnesium have appeared in migraine patients both throughout the attacks and in the interictal periods. Moreover, there is a lack of evidence regarding the correlation between magnesium levels and visual evoked potentials. To assess the changes in the levels of magnesium in migraineurs compared to a healthy control group is our prime intention. Also, to correlate serum magnesium levels with visual evoked potentials changes within the migraineurs is a secondary part of the study. Materials and Methods: After applying inclusion and exclusion criteria as per the study protocol, in total, 80 subjects were enrolled in the study. Of which 40 were migraineurs diagnosed as per the International Headache Society criteria for severe migraine headache. Rest of 40 was nonmigraineurs served as a control group of the study. All included patient was submitted to demographic profile, previous history of the disease and drug intake, thorough clinical investigation and baseline laboratory parameters. Apart from this, the measurement of visual evoked potentials changes (4th block) and magnesium levels were done as per our standard operating procedures. Results: In migraineurs, serum total Mg level was considerably lower compared to the control group (1.79 ± 0.14 mg/dl versus 2.10 ± 0.17 mg/dl, P < 0.0001) and amplitude of P100 (P < 0.0001) was negatively correlated to reduced serum Mg level (P < 0.0001). Conclusions: As expected, both elevated visual evoked potential amplitude and reduced level of brain magnesium can be a demonstration of neuronal hyperexcitability of the optic pathways associated with a dropped threshold for migraine attacks.

Use of Wrist Denervation in the Treatment of SLAC and SNAC Wrist by ASSH Members.

Background Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are common patterns of wrist arthritis, and surgical treatment options include partial and total wrist arthrodesis and wrist denervation, which maintains the current anatomy while relieving pain. Introduction The purpose of this study is to elucidate current practices within the hand surgery community with respect to the use of anterior interosseous nerve/posterior interosseous nerve (AIN/PIN) denervation in the treatment of SLAC and SNAC wrists. Methods An anonymous survey was distributed to 3,915 orthopaedic surgeons via the American Society for Surgery of the Hand (ASSH) listserv. The survey collected information on conservative and operative management, indications, complications, diagnostic block, and coding of wrist denervation. Results In total, 298 answered the survey. 46.3% ( N = 138) of the respondents used denervation of AIN/PIN for every SNAC stage, and 47.7% ( N = 142) of the respondents used denervation of AIN/PIN for every SLAC wrist stage. AIN and PIN combined denervation was the most common standalone procedure ( N = 185, 62.1%). Surgeons were more likely to offer the procedure ( N = 133, 55.4%) if motion preservation had to be maximized ( N = 154, 64.4%). The majority of surgeons did not consider loss of proprioception ( N = 224, 84.2%) or diminished protective reflex ( N = 246, 92.1%) to be significant complications. 33.5%, 90 respondents reported never performing a diagnostic block prior to denervation. Conclusion Both SLAC and SNAC patterns of wrist arthritis can result in debilitating wrist pain. There is a wide range of treatment for different stages of disease. Further investigation is required to identify ideal candidates and evaluate long-term outcomes.

The duration of caffeine treatment plays an essential role in its effect on sleep and circadian rhythm.

Sleep is regulated by the homeostatic system and the circadian clock. Caffeine intake promotes wakefulness in Drosophila. In humans, caffeine is consumed on a daily basis and hence it is important to understand the effect of prolonged caffeine intake on both circadian and homeostatic regulation of sleep. Furthermore, sleep changes with age and the impact of caffeine on age-dependent sleep fragmentation are yet to be understood. Hence in the present study, we examined the effect of short exposure to caffeine on homeostatic sleep and age-dependent sleep fragmentation in Drosophila. We further assessed the effect of prolonged exposure to caffeine on homeostatic sleep and circadian clock. The results of our study showed that short exposure to caffeine reduces sleep and food intake in mature flies. It also enhances sleep fragmentation with increasing age. However, we have not assessed the effect of caffeine on food intake in older flies. On the other hand, prolonged caffeine exposure did not exert any significant effect on the duration of sleep and food intake in mature flies. Nevertheless, prolonged caffeine ingestion decreased the morning and evening anticipatory activity in these flies indicating that it affects the circadian rhythm. These flies also exhibited phase delay in the clock gene timeless transcript oscillation and exhibited either behavioral arrhythmicity or a longer free-running period under constant darkness. In summary, the results of our studies showed that short exposure to caffeine increases the sleep fragmentation with age whereas prolonged caffeine exposure disrupts the circadian clock.

Traumatic orthopaedic motor vehicle injuries: Are there age and sex differences in pedestrian and cyclist accidents in a major urban center?

INTRODUCTION: Injuries caused by road traffic have become the leading cause of death in people aged 5 to 29 years, with pedestrians and cyclists being disproportionately affected. Research has demonstrated age and sex differences in road accidents in European populations. The purpose of this study was to determine age and sex-specific differences in pedestrian and cyclist accidents involving passenger cars at a single Level 1 Trauma Center in a major US metropolitan area. METHODS: We performed a retrospective chart review of 1,845 patients that presented to a single level 1 trauma center from January 1, 2016 - October 1st, 2021, and were involved in a motor vehicle vs. pedestrian or motor vehicle vs. cyclist accidents. Demographics, injury pattern, abbreviated injury scores (AIS), and hospital stay were analyzed, and the data was stratified by pedestrian vs. cyclist, biological sex, and race. Chi square analysis, t tests, and binomial logistic regression was used to examine sex and age-based differences. RESULTS: Pedestrian vs. motor vehicle collisions (N = 1359, 74%) occurred more frequently than cyclists (N = 475, 26%) with an overall mortality rate of 6%. The mean age of pedestrians and cyclists was 39 and 42 years of age, respectively. Overall, more female than male patients had hand (mean=0.05 vs. 0.02) (p = 0.03) and pelvis fractures (mean 0.28 vs. 0.19) (p = 0.007). Females had a 1.2 times higher likelihood of getting a pelvis fracture than males (95% CI, 1.06 to 1.43). Linear regression analysis found a statistically significant relationship between older age and increased AIS severity (p < .001). Half of our sample consisted of Black patients (49.6% Black vs. 42.1% white). CONCLUSION: Female pedestrians and cyclists are at increased risk of obtaining pelvis fractures when in a traumatic road accident than males, regardless of age stratification, and age is a predictor of injury severity. Our study also found that race-based differences exist, with Black patients being injured more frequently. Further research is needed to better understand demographics at risk for traumatic road accidents, as well as evaluation of city infrastructure for biking and walking.

Complementary administration of curcumin in PCOS: a systematic review.

INTRODUCTION: The clinical benefit of curcumin, the active ingredient in turmeric, among women diagnosed with polycystic ovarian syndrome (PCOS) is unclear. In this systematic review, we aim to provide a brief review of the existing literature on the association between curcumin supplementation and PCOS. EVIDENCE ACQUISITION: Published articles relevant to the topic was obtained through extensive search using relevant keywords such as "polycystic ovarian syndrome," "PCOS," "turmeric," and "curcumin." Inclusion criteria included studies that investigated PCOS and turmeric/curcumin, while studies that investigated the use of curcumin in other gynecological disorders, infertility, rodent studies, and non-RCTs were excluded. EVIDENCE SYNTHESIS: A total of 14 articles were found and only five studies were incorporated based on the exclusion criteria. The main findings were that curcumin supplementation aids in improvement of lipid and glycemic profiles, Body Mass Index (BMI) and lowers androgen levels associated with PCOS. CONCLUSIONS: We shed light on additional therapeutic management for PCOS other than the conventional treatment. Further studies are required with larger sample sizes and diverse patient population to derive definitive conclusions regarding benefits of curcumin supplementation in PCOS.

Surgical Outcomes and Feasibility of Transvaginal Sacrospinous Ligament Fixation through Anterior Approach for Women with Pelvic Organ Prolapse.

Introduction: Supporting vaginal vault or apex is a central component of primary therapy and to prevent recurrence of prolapse. This study aims to review the surgical outcomes and feasibility of the anterior approach following both sacrospinous fixation (SSF) and sacrospinous hysteropexy (SSHP) in a single center over a specific period. And also to review its impact on quality of life. Materials and Methods: This was a retrospective study that included all women who underwent unilateral SSF or SSHP through anterior approach for pelvic organ prolapse (POP) from May 2021 to May 2023 after institutional ethical approval for the study. The anterior approach was undertaken in 47 patients which were included in final review. A retrospective case note review to assess urinary symptoms was undertaken at baseline and 3 months by urinary distress inventory 6 score. The main outcome measure was recurrence of prolapse, predominant compartment for prolapse, presenting complaints, concomitant surgeries performed, and associated urinary complaints. Results: The mean age was 56.17 ± 11.95 years and the average body mass index was 26.12 ± 3.11 kg/m2. Except for 4 cases of SSHP, remaining women were postmenopausal at the time of surgery. Ten women presented with urinary complaints as their chief complaint. On examination, POP Quantification evaluation, 35 cases have Ba as leading point, 10 have Ap as their leading point and in two cases C was the leading point. Conclusion: Anterior unilateral sacrospinous ligament fixation is a safe, effective strategy to treat POP and other concomitant surgery can also be well combined with it.

Far Anterior Medial Portals in Complicated Elbow Arthroscopic Procedures: Safety Profile in a Cadaveric Model.

Purpose: The purpose of this study is to describe the placement and evaluate the safety of the far anterior proximal and distal anteromedial portals by comparing them to previously defined portal techniques in a cadaveric model of the elbow. Methods: Six paired (left and right) fresh, frozen cadaveric elbow joints were dissected. .62-mm Kirschner wires were placed at the literature-defined distal and proximal portal sites on right elbows. The proposed "far anterior" distal and proximal portals were established on the matched left elbows. The elbows were dissected to display the median and ulnar nerves. Digital calipers were used to measure distances from wires to nerves. Results: For the distal portal, the literature-defined portals were a significantly greater distance (P = .014) from the ulnar nerve (31.22 mm) compared to the far anterior portals (24.65 mm). For the proximal portal, the far anterior portals were a significantly greater distance (P = .026) from the ulnar nerve (26.98 mm) than the literature-defined portals (13.75 mm). There was no significant difference between the far anterior and literature-defined proximal and distal portal techniques in relation to the median nerve. Conclusions: Analysis of elbow arthroscopy anteromedial portal technique shows the far, anterior, proximal, and distal portals are a safe distance from the ulnar and median nerves. A portal modification that may address complicated elbow conditions is a more anterior placement of the medial portals to allow for better visualization and access. Clinical Relevance: The elbow is a difficult joint in which to perform arthroscopic surgery. One option our institution has used for safe portal modification to address complicated elbow conditions is a further anterior placement of the medial portals to allow better visualization and access.

Age and Female Sex Are Important Risk Factors for Stress Fractures: A Nationwide Database Analysis.

BACKGROUND: Stress fractures are caused by micro-trauma due to repetitive stress on bone, common in active individuals and athletes. Previous studies demonstrate that the weightbearing bones of the lower extremities incur stress fractures most often, especially in women and older adults. HYPOTHESIS: Prior literature does not quantify the difference in frequency of stress fractures among different genders, age groups, or body mass indices (BMIs). We hypothesized that older female patients would have higher rates of lower extremity stress fractures than male patients. STUDY DESIGN: Epidemiological research. LEVEL OF EVIDENCE: Level 3. METHODS: Records of female and male patients with lower extremity stress fractures from 2010 to 2018 were identified from the PearlDiver administrative claims database using the International Classification of Diseases (ICD)-9/ICD-10 codes. Stress fractures were classified by ICD-10 diagnosis codes to the tibial bone, proximal femur, phalanges, and other foot bones. Comorbidities were incorporated into a regression analysis. RESULTS: Of 41,257 stress fractures identified, 30,555 (70.1%) were in women and 10,702 (25.9%) were in men. Our sample was older (>60 years old) (37.3%) and not obese (BMI <30 kg/m2, 37.1%). A greater proportion of female patients with stress fracture were older (P < 0.001) and had foot stress fractures (P < 0.001), while a greater proportion of male patients with stress fracture were younger than 19 years (P < 0.001) and had metatarsal (P < 0.001), hip (P = 0.002), and tibia stress fractures (P < 0.001). CONCLUSION: Stress fractures commonly occur in women and older adults with low BMIs. Metatarsal and tibia stress fractures were the most common, and a greater proportion of women had foot stress fractures. CLINICAL RELEVANCE: Our study examined the large-scale prevalence of different lower extremity stress fractures among a wide patient population sample of varying ages and BMIs. These findings can help clinicians identify active populations at greater risk for stress fracture injuries.

Musculoskeletal Injuries and Conditions Among Homeless Patients.

INTRODUCTION: The purpose of this study was to analyze existing literature on musculoskeletal diseases that homeless populations face and provide recommendations on improving musculoskeletal outcomes for homeless individuals. METHODS: A comprehensive search of the literature was performed in March 2020 using the PubMed/MEDLINE (1966 to March 2020), Embase (1975 to April 2020), and CINHAL (1982 to 2020) databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for accuracy of reporting, and the Newcastle-Ottawa Scale was used for quality assessment. RESULTS: Twenty-nine articles met inclusion criteria. Seven studies observed an increased prevalence of musculoskeletal injuries among the homeless population, four observed increased susceptibility to bacterial soft-tissue infection, four observed increased fractures/traumatic injuries, three described increased chronic pain, and six focused on conditions specific to the foot and ankle region. DISCUSSION: Homeless individuals often have inadequate access to care and rely on the emergency department for traumatic injuries. These findings have important implications for surgeons and public health officials and highlight the need for evidence-based interventions and increased follow-up. Targeted efforts and better tracking of follow-up and emergency department usage could improve health outcomes for homeless individuals and reduce the need costly late-stage interventions by providing early and more consistent care.

Post-transcriptional modulators and mediators of the circadian clock.

The endogenous circadian timekeeping system drives ~24-h rhythms in gene expression and rhythmically coordinates the physiology, metabolism and behavior in a wide range of organisms. Regulation at various levels is important for the accurate functioning of this circadian timing system. The core circadian oscillator consists of an interlocked transcriptional-translational negative feedback loop (TTFL) that imposes a substantial delay between the accumulation of clock gene mRNA and its protein to generate 24-h oscillations. This TTFL mediated daily oscillation of clock proteins is further fine-tuned by post-translational modifications that regulate the clock protein stability, interaction with other proteins and subcellular localization. Emerging evidence from various studies indicates that besides TTFL and post-translational modifications, post-transcriptional regulation plays a key role in shaping the rhythmicity of mRNAs and to delay the accumulation of clock proteins in relation to their mRNAs. In this review, we summarize the current knowledge on the importance of post-transcriptional regulatory mechanisms such as splicing, polyadenylation, the role of RNA-binding proteins, RNA methylation and microRNAs in the context of shaping the circadian rhythmicity in Drosophila and mammals. In particular, we discuss microRNAs, an important player in post-transcriptional regulation of core-clock machinery, circadian neural circuit, clock input, and output pathways. Furthermore, we provide an overview of the microRNAs that exhibit diurnal rhythm in expression and their role in mediating rhythmic physiological processes.

Surgeon Decision-Making for Individuals With Obesity When Indicating Total Joint Arthroplasty.

BACKGROUND: Obesity is a risk factor for complications after total joint arthroplasty (TJA). This study analyzed the impact of individual surgeon demographics, financial concerns, and other factors in determining patient candidacy for TJA based on body mass index (BMI). METHODS: A 21-question survey was approved by the American Association of Hip and Knee Surgeons Research Committee for distribution to its membership. Objective questions asked about surgeon or hospital BMI thresholds for offering TJA. Subjective questions asked about physician comfort discussing topics including obesity, bariatric surgery, and weight loss before TJA, as well as insurance and age considerations. RESULTS: For TJA procedures, 49.9% of surgeons had a BMI cutoff at 40, 24.5% at 45, and 8.3% at 50. At a BMI cutoff of 40, 23.8% of surgeons felt their patient volume would be adversely affected, whereas at a BMI cutoff of 35, 50% of surgeons felt their patient volume would be adversely affected. Surgeons were more likely to not perform total hip arthroplasty on patients with morbid obesity than total knee arthroplasty (P = .037). Significantly more academic surgeons did not have cutoffs for total hip arthroplasty (P = .003) or total knee arthroplasty (P < .001) compared with all other practice settings. CONCLUSION: There are myriad factors that affect surgeon BMI thresholds for offering elective TJA including poor outcomes, hospital thresholds, financial considerations, and the well being of the patient. Further work should be performed to minimize the risks associated with TJA while providing the best possible care to patients with morbid obesity.

Effect of initial moisture content and sample storage duration on compost stability using the ORG0020 dynamic respiration test.

Biological tests are widely used to assess composting process status and finished material stability. Although compost stability is known to be influenced by moisture content (MC) and storage duration, there is a lack of data supporting boundary limits for standardised testing. Using the ORG0020 dynamic respiration test we assessed the stability of materials from different commercial composting sites processing only green waste or mixed green and food waste. Samples were tested at three different MC following adjustment with the 'fist' test within the range 40-60%. The results showed manipulation of MC within this range could have significant impact on measured stability for some but not all samples. Two samples reported significantly higher activity when MC was manipulated from ~50% to ~60%. For storage duration, samples showed significant decrease in measured activity over several weeks of cold storage. However, there was no significant difference in stability for samples tested up to nine days from receipt. The results of this research will support decisions relating to the boundary limits for moisture content and storage time for the ORG0020 test. The results will also provide insight to the wider range of biological tests used to assess compost stability.

Variability of Cutting and Thermal Dynamics Between New and Used Acetabular Reamers During Total Hip Arthroplasty.

BACKGROUND: Aseptic loosening of the acetabular component remains one of the leading causes of early failure of total hip arthroplasty. Poor apposition of bone onto the implant surface can be due to inaccurate reaming and osteonecrosis of the acetabular bone due to the heat generated while reaming. METHODS: New and used acetabular reamers were tested on an MTS system using a clinically relevant force of 87.6 N. A thermal profile and depth achieved by the reamers were analyzed and compared between the 2 cohorts. Heat generated and force required for the community used reamers to achieve the same depth as the new reamers were subsequently analyzed. RESULTS: The new reamers achieved a depth 3.4 mm deeper than the community reamers (P < .001). The new reamers generated 4.1°C less heat than the community reamers (P = .007) under the same force and time. When programmed to ream to the average depth of the new reamers, the community reamers generated 16.8°C more heat (P = .002) and required forces 95-318% greater than the 87.6 N force used by the new reamers. CONCLUSIONS: Community use of reamers will cause variations in depth of penetration and increased temperatures at a clinically generated force vs new reamers. When community reamers were forced to the same depths the new reamers achieved, a significantly greater amount of heat was generated, and an increased amount of time was needed, both of which are known risk factors for osteonecrosis.

Only time will tell: the interplay between circadian clock and metabolism.

In most organisms ranging from cyanobacteria to humans, the endogenous timekeeping system temporally coordinates the behavioral, physiological, and metabolic processes with a periodicity close to 24 h. The timing of these daily rhythms is orchestrated by the synchronized oscillations of both the central pacemaker in the brain and the peripheral clocks located across multiple organs and tissues. A growing body of evidence suggests that the central circadian clock and peripheral clocks residing in the metabolically active tissues are incredibly well coordinated to confer coherent metabolic homeostasis. The interplay between nutrient metabolism and circadian rhythms can occur at various levels supported by the molecular clock network, multiple systemic mechanisms, and the neuroendocrine signaling pathways. While studies suggest the reciprocal regulation between circadian clock and metabolism, it is important to understand the precise mechanisms and the underlying pathways involved in the cross-talk among circadian oscillators and diverse metabolic networks. In addition to the internal synchronization of the metabolic rhythms, feeding time is considered as a potential external synchronization cue that fine tunes the timing of the circadian rhythms in metabolic peripheral clocks. A deeper understanding of how the timing of food intake and the diet composition drive the tissue-specific metabolic rhythms across the body is concomitantly important to develop novel therapeutic strategies for the metabolic disorders arising from circadian misalignment. This review summarizes the recent advancements in the circadian clock regulation of nutrient metabolism and discusses the current understanding of the metabolic feedback signals that link energy metabolism with the circadian clock.

The Value of Duodenal Biopsies in the Evaluation of Megaloblastic Anemia.

Introduction Megaloblastic anemia is one of the common causes of anemia in India. Duodenal biopsies are routinely performed in the investigation of megaloblastic anemia. The present study was undertaken to analyze the value of duodenal biopsy in megaloblastic anemia and to correlate endoscopic findings with biopsy. As a secondary aim, the study has also analyzed the hematological profile and vitamin B 12 and folate status of these patients. Materials and Methods All the cases of megaloblastic anemia with bone marrow studies diagnosed at PSG Institute of Medical Sciences and Research during the two year period from January 2016 to December 2017 were retrieved. Clinical and laboratory findings (serum vitamin B 12 and folate levels) and endoscopic findings were retrieved from hospital records of the patients. Duodenal biopsies of these patients reported in the histopathology department were retrieved and reviewed. Statistical analysis was done using SPSS software 20.0. Results There were 93 cases of megaloblastic anemia diagnosed on bone marrow biopsies. Tropical sprue was diagnosed in 49.5% of cases, followed by intraepithelial lymphocytosis (17.2%), peptic duodenitis (17.2%), and no significant pathology in 16% of cases. Pancytopenia was present in 54.8% of cases. Isolated vitamin B 12 deficiency including low levels was present in 48.38% and folate deficiency was seen in 4.3% cases; 34.48% cases had both vitamin B 12 and folate deficiency. Conclusion The incidence of tropical sprue in megaloblastic anemia is 49.5% in the study. Duodenal biopsy is valuable in the work up of megaloblastic anemia, irrespective of the endoscopic changes in identifying the etiology.