Limited data exist to inform our basic understanding of micronutrient requirements in pregnancy.

Women and pregnant people have historically been underrepresented in research; this may extend to the basic research informing nutrient reference values, such as the United States' and Canada's Dietary Reference Intakes (DRIs). After screening the DRI reports for 23 micronutrients, we extracted metadata from 704 studies. Women were excluded in 23% of studies, and they accounted for a smaller proportion of the sample size (29%). Pregnant or lactating people were included in 17% of the studies. Studies that used rigorous design elements, such as controlled feeding and stable isotope studies, were the most likely to include men only. The majority of studies (>90%) did not report race and ethnicity. Although nutrient reference values are intended for use in the general population, we find that the basic science informing these values may not be generalizable. We call urgently upon funders and researchers to address fundamental gaps in knowledge with high-quality research.

Management of primary pterygium with intra-lesional injection of 5 flurouracil and bevacizumab (Avastin).

BACKGROUND: To assess the efficacy of combined 5FU and Avastin injections in the treatment of primary pterygium METHODS: Sixteen eyes with primary pterygium received intralesional 5 fluorouracil and Avastin (2.5-5 mg) injections every 2 weeks for a maximum of five injections. Fourteen eyes of 14 patients received five injections, one eye received three injections and one eye received two injections. All eyes were followed at monthly intervals for 3 months after last injection. Tissue was obtained by surgical excision of primary pterygium from four eyes who received injections and three eyes with primary pterygium who did not receive injections (control) and subjected to immunohistological examination for beta fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), von-Willebrand factor (vWF), lymphatic vessel endothelial hyaluronan receptor (LYVE-1) and collagen-I. RESULTS: Pterygium progression was arrested in all patients. Sixty-two percent of patients had improvement of redness while 89% had reduced thickness of the lesion. VEGF, bFGF, EGF, vWF, LYVE-1 and collagen-I were all reduced in the injected samples. CONCLUSIONS: The injection of 5 fluorouracil and Avastin act synergistically to arrest progression and induce atrophy in primary pterygium. This is related to the effect of agents on fibroblasts, collagen, and vascular tissues. Such medical intervention is a safe and viable option in the management of primary pterygium though excision of residual tissue is still required in some cases. Longer follow up is needed to ascertain whether this will reduce the recurrence rate following excision.

Gender, side to side and BMI differences in long thoracic nerve conduction velocity: A novel technique.

OBJECTIVES: The purpose of this study was to describe a new technique to record long thoracic nerve conduction velocity through the axilla as well as to assist in establishing normative values for latency and amplitude of the long thoracic nerve and to evaluate side to side, gender and BMI differences. METHODS: 26 healthy subjects (12 males/14 females) participated in the study with data collected bilaterally resulting in 52 limbs studied. Surface recording was over the serratus anterior muscle with the recording electrode located on the rib closest to a distance within a standardized range of 22-24 cm distal to the acromion. Stimulation was delivered at the mid axillary line, then again in the supraclavicular region. A caliper was used to measure the distance between the two stimulation sites in order to calculate the nerve conduction velocity. RESULTS: The normal value (mean + 2 SD) for distal latency is <2.7 msec, while the normal value for velocity (mean - 2 SD) is >61.0 m/s. Absolute amplitude values were not calculated. Side to side difference normal values for distal latency, amplitude and velocity are 0.7 msec, 70.3% and 8.5% respectively. A two way analysis of variance (ANOVA) revealed a significant gender and BMI difference in both distal (0.02) and proximal amplitude (0.05) means. There was no significant interaction between gender and BMI for latency or velocity values for either stimulation site. CONCLUSIONS: The distal latency values are not significantly different from those reported previously, however long thoracic nerve conduction velocity has not been described before and would be an appropriate way to monitor velocity through the proximal portions of the brachial plexus. Men who qualified as overweight with a BMI greater than 25 demonstrated a larger amplitude when compared with average weight men and women. In contrast women with BMI greater than 25 demonstrated a much smaller amplitude when compared with overweight men and average weight men and women. SIGNIFICANCE: Absolute amplitude normal values are not reported as BMI may impact the ability to record an accurate amplitude for both men and women. Long thoracic nerve conduction velocity and latency appear to be more reliable measures.

Deep anterior lamellar keratoplasty: dissection plane with viscoelastic and air can be different.

AIMS: To investigate and define the nature of big bubbles (BB) formed by injection of viscoelastic in deep anterior lamellar keratoplasty. METHODS: Intrastromal injections of 0.1 and 0.3 mL of sodium hyaluronate 1.2% and 0.6% were made into sclera-corneal discs (n = 32) at superficial (anterior-third), midstromal (middle-third) and deep (posterior-third) levels to simulate deep anterior lamellar keratoplasty. Postinjection optical coherence tomograms (OCT) were obtained with the needle in situ. The samples were sectioned and examined histologically. Twelve control samples were injected with air. RESULTS: With superficial injections (n=8) only intrastromal accumulation of viscoelastic was noted. With midstromal injections (n=10) intrastromal accumulation of viscoelastic (n=6) and intrastromal big bubbles (IBB) (n=4) with substantial and variable stromal tissue in the walls were noted. No type 1, type 2 or mixed BB were noted. With deep injections (n=14), type 1 BB (n=4), IBB (n=4) and mixed BB (n=6) were obtained.There was no difference in the results with the two different concentrations of viscoelastic used. With air injection (n=12), 10 type 1 and 1 type 2 BB and 1 mixed BB were obtained. No IBB was noted. CONCLUSIONS: BB obtained by injection of viscoelastic and air can be different. The former tends to occur at the site of injection, especially with midstromal injections, takes the form of tissue separation by stretch and tearing and does not cleave in a consistent plane like air. Surgeons should be aware of IBB created by viscodissection and not confuse it for a type1 BB. Intraoperative OCT should help identify IBB.

Corticosteroid timing and length of stay for children with asthma in the Emergency Department.

OBJECTIVE: The aim of this study was to evaluate the relationship between time of corticosteroid administration to children with asthma exacerbations in the Emergency Department (ED) and length of stay (LOS). We hypothesized administration within 60 minutes would be associated with a 10- minute or greater decrease in mean LOS. METHODS: A retrospective chart review of 882 patients was conducted. Children between the ages of 2 and 18 years presented to the Connecticut Children's Medical Center's (CCMC's) ED with an acute asthma exacerbation were included. Children were excluded if they did not receive oral corticosteroids in the ED, had significant co-morbidities, were currently taking corticosteroids, or had taken them within the past 7 days. Children receiving corticosteroids within 60 minutes of triage were compared with children receiving corticosteroids for 61 minutes or later. The primary outcome was mean LOS. RESULTS: Children treated with corticosteroids within 60 and 61 minutes or later had similar age, gender, insurance, and disposition. Children treated with corticosteroids within 60 minutes had a 25-minute decrease in LOS compared with children treated for 61-minute or later (95% CI: 15-35), p < .0001. CONCLUSIONS: Administering corticosteroids to pediatric asthma patients in the ED within an hour of triage is associated with a 25-minute mean decrease in LOS. With large numbers of asthma visits, a 25-minute decrease in LOS for each child could have a significant impact on patient throughput in the ED.