IGF-1 Acts through Kiss1-expressing Cells to Influence Metabolism and Reproduction.

Objective: Kisspeptin, encoded by the Kiss1 gene, ties puberty and fertility to energy status; however, the metabolic factors that control Kiss1-expressing cells need to be clarified. Methods: To evaluate the impact of IGF-1 on the metabolic and reproductive functions of kisspeptin producing cells, we created mice with IGF-1 receptor deletion driven by the Kiss1 promoter (IGF1RKiss1 mice). Previous studies have shown IGF-1 and insulin can bind to each other's receptor, permitting IGF-1 signaling in the absence of IGF1R. Therefore, we also generated mice with simultaneous deletion of the IGF1R and insulin receptor (IR) in Kiss1-expressing cells (IGF1R/IRKiss1 mice). Results: Loss of IGF1R in Kiss1 cells caused stunted body length. In addition, female IGF1RKiss1 mice displayed lower body weight and food intake plus higher energy expenditure and physical activity. This phenotype was linked to higher proopiomelanocortin (POMC) expression and heightened brown adipose tissue (BAT) thermogenesis. Male IGF1RKiss1 mice had mild changes in metabolic functions. Moreover, IGF1RKiss1 mice of both sexes experienced delayed puberty. Notably, male IGF1RKiss1 mice had impaired adulthood fertility accompanied by lower gonadotropin and testosterone levels. Thus, IGF1R in Kiss1-expressing cells impacts metabolism and reproduction in a sex-specific manner. IGF1R/IRKiss1 mice had higher fat mass and glucose intolerance, suggesting IGF1R and IR in Kiss1-expressing cells together regulate body composition and glucose homeostasis. Conclusions: Overall, our study shows that IGF1R and IR in Kiss1 have cooperative roles in body length, metabolism, and reproduction.

The evaluation and analysis of irritable bowel syndrome-related short videos on social media (TikTok).

BACKGROUND: TikTok is one of the fastest growing social media platforms. Irritable bowel syndrome (IBS) has recently become a trending topic of interest among TikTok users. AIM: To better understand the quality and accuracy of information presented in the most popular IBS-relevant videos on TikTok. METHODS: We reviewed videos with the tag 'IBS'. We excluded those not relevant to IBS or lasting <10 s or >10 min. Baseline characteristics about the videos were collected. Two independent reviewers assessed each video using DISCERN and Patient Education Materials and Assessment Tool (PEMAT) tools, two validated instruments to assess the quality of patient education materials. RESULTS: Of 100 videos, 33% were uploaded by participants with a defined medical background. The median DISCERN score of videos uploaded by participants with a medical background was 2.43 (2.00-3.10); from participants with a non-medical background, it was 1.37 (1.23-1.70) (p < 0.01). The median PEMAT Understandability scores of videos uploaded by participants with or without a medical background were 92.86 (86.61-95.00) and 80.95 (75.76-89.58), respectively (p < 0.01). The median PEMAT Actionability scores of videos uploaded by participants with or without a medical background were 100.00 (66.67-100.00) and 0.00, respectively (0.00-45.83; p < 0.01). CONCLUSION: Videos posted by medical professionals are easier to understand and to act on, and are more reliable and unbiased, and more likely to recommend shared decision making about treatment.

Trends in female representation in gastroenterology fellowships in the United States.

Background: Women have historically been underrepresented in gastroenterology (GI). Currently they compose only a small percentage of practicing GI physicians in the United States. Despite the rise in women graduating medical school, the percentage of current female GI fellows has remained low in recent years. In this study, we sought to examine the trends of female representation in GI over the past 10 years, to further elucidate the disparity, and to illustrate if any major changes have occurred. The findings were compared to those for other specialties to shed light on the relationship between them. Methods: This retrospective study used data on the gender of residents obtained through the Accreditation Council for Graduate Medical Education Data Resource Books from 2009-2019. Chi-square statistical testing was used to compare representation percentages across groups. Significance was determined at the P<0.05 level, while P<0.01 was also reported. Results: Over a 10-year period from 2009-2019, an average of 33.6% of GI fellowship positions were filled by women, an increase of only 3.3% since 2009. Chi-square analysis of proportions across groups demonstrated a significantly lower percentage of female representation in GI in comparison to other specialties. Conclusions: Despite an increase in the number of women entering and graduating from medical school within the last decade, the number of female gastroenterologists remains a poor reflection of it. GI continues to have a significantly lower female representation than other specialties over the last decade.

Membranous nephropathy and autoimmune hepatitis in the setting of acute Helicobacter pylori infection: a case report.

BACKGROUND: Membranous nephropathy (MN) is the leading cause of nephrotic syndrome in adults worldwide. A growing body of evidence indicates a pathogenic and autoimmune correlation between Helicobacter pylori infection, MN, and autoimmune liver disease. CASE PRESENTATION: A 47-year-old African American woman presented to our institution with epigastric pain and vomiting. In-patient hospital workup included a thorough abdominal evaluation including esophagogastroduodenoscopy and liver biopsy, which revealed active H. pylori infection and autoimmune hepatitis. The patient was incidentally also found to have nephrotic-range proteinuria. Renal workup including kidney biopsy established the diagnosis of MN. Proteinuria improved after initiation of triple therapy for H. pylori infection. CONCLUSION: This case adds to the growing evidence of a correlation between H. pylori infection, MN, and autoimmune liver disease. This report demonstrates a unique case of a patient with MN, autoimmune hepatitis (AIH)/primary biliary cholangitis (PBC), and HP who underwent triple-eradication antibiotic treatment that resulted in an ultimate resolution of all these conditions.

Neurological Predictors of Clinical Outcomes in Hospitalized Patients With COVID-19.

Introduction: Multiple risk factors of mortality have been identified in patients with COVID-19. Here, we sought to determine the effect of a history of neurological disorder and development of neurological manifestations on mortality in hospitalized patients with COVID-19. Methods: From March 20 to May 20, 2020, hospitalized patients with laboratory confirmed or highly suspected COVID-19 were identified at four hospitals in Ohio. Previous history of neurological disease was classified by severity (major or minor). Neurological manifestations during disease course were also grouped into major and minor manifestations. Encephalopathy, ischemic or hemorrhagic stroke, and seizures were defined as major manifestations, whereas minor neurological manifestations included headache, anosmia, dysgeusia, dizziness or vertigo, and myalgias. Multivariate logistic regression models were used to determine significant predictors of mortality in patients with COVID-19 infection. Results: 574/626 hospitalized patients were eligible for inclusion. Mean age of the 574 patients included in the analysis was 62.8 (SD 17.6), with 298 (51.9%) women. Of the cohort, 240(41.8%) patients had a prior history of neurological disease (HND), of which 204 (35.5%) had a major history of neurological disease (HND). Mortality rates were higher in patients with a major HND (30.9 vs. 15.4%; p = 0.00002), although this was not a significant predictor of death. Major neurological manifestations were recorded in 203/574 (35.4%) patients during disease course. The mortality rate in patients who had major neurological manifestations was 37.4% compared to 11.9% (p = 2 × 10-12) in those who did not. In multivariate analysis, major neurological manifestation (OR 2.1, CI 1.3-3.4; p = 0.002) was a predictor of death. Conclusions: In this retrospective study, history of pre-existing neurological disease in hospitalized COVID-19 patients did not impact mortality; however, development of major neurological manifestations during disease course was found to be an independent predictor of death. Larger studies are needed to validate our findings.

Characterization of Vibrio cholerae isolates from freshwater sources in northwest Ohio.

Vibrio cholerae is a natural inhabitant of aquatic ecosystems worldwide, typically residing in coastal or brackish water. While more than 200 serogroups have been identified, only serogroups O1 and O139 have been associated with epidemic cholera. However, infections other than cholera can be caused by nonepidemic, non-O1/non-O139 V. cholerae strains, including gastroenteritis and extraintestinal infections. While V. cholerae can also survive in freshwater, that is typically only observed in regions of the world where cholera is endemic. We recently isolated V. cholerae from several locations in lakes and rivers in northwest Ohio. These isolates were all found to be non-O1/non-O139 V. cholerae strains, that would not cause cholera. However, these isolates contained a variety of virulence genes, including ctxA, rtxA, rtxC, hlyA, and ompU. Therefore, it is possible that some of these isolates have the potential to cause gastroenteritis or other infections in humans. We also investigated the relative motility of the isolates and their ability to form biofilms as this is important for V. cholerae survival in the environment. We identified one isolate that forms very robust biofilms, up to 4x that of our laboratory strains. Finally, we investigated the susceptibility of these isolates to a panel of antibiotics. We found that many of the isolates showed decreased susceptibility to some of the antibiotics tested, which could be of concern. While we do not know if these isolates are pathogenic to humans, increased surveillance to better understand the public health risk to the local community should be considered.