Nutritional insults during pregnancy and lactation are health risks for mother and offspring. Both fructose and low protein diets are linked to hepatic steatosis and insulin resistance in non-pregnant animals. We hypothesized that dietary fructose or low protein intake during pregnancy may exacerbate the already compromised glucose homeostasis to induce gestational diabetes and fatty liver. Therefore, we investigated and compared the effects of low protein or fructose intake on hepatic steatosis and insulin resistance in unmated controls and pregnant and lactating rats. Sprague-Dawley rats were fed either a control (CT), a 63% fructose (FR) or an 8% protein (LP) diet. Glucose tolerance test at day 17 of the study revealed greater (P < 0.05) blood glucose at 10 (75.6 vs. 64.0 ± 4.8 mg/dl) and 20 (72.4 vs. 58.6 ± 4.0 mg/dl) min after glucose dose and greater area under the curve (4302.3 vs. 3763.4 ± 263.6 mg·dl−1·min−1) for FR-fed dams compared with CT-fed dams. The rats were euthanized at 21 days postpartum. Both the FR- and LP-fed dams had enlarged (P < 0.05) livers (9.3, 7.1 vs. 4.8 ± 0.2 % body weight) and elevated (P < 0.05) liver triacylglycerol (216.0, 130.0 vs. 19.9 ± 12.6 mg/g liver weight) compared with CT-fed dams. FR induced fatty liver and glucose intolerance in pregnant and lactating rats, but not unmated control rats. The data demonstrate a unique physiological status response to diet resulting in the development of gestational diabetes coupled with hepatic steatosis in FR-fed dams, which is more severe than a LP diet.

The aim of the current study is to determine the effects and the mechanisms of inclusion of dietary whey protein, high calcium and high vitamin D intake with either a high sucrose or high fat base diets on body composition of rodents. Male Wistar rats were assigned to either no whey protein, suboptimal calcium (0.25%) and vitamin D (400 IU/kg) diet (LD) or a diet containing whey protein, high calcium (1.5%) and vitamin D (10,000 IU/kg) diet (HD) and either high fat (40% of energy) or high sucrose (60%) base diets for 13 weeks. Liver tissue homogenates were used to determine [ 14 C] glucose and [ 14 C]palmitate oxidation. mRNA expression of enzymes related to energy metabolism in liver, adipose and muscle as well as regulators of muscle mass and insulin receptor were assessed. The results demonstrated that there was reduced accumulation of body fat mass (P = 0.01) and greater lean mass (P = 0.03) for the HD compared to LD fed group regardless of the background diet. There were no consistent differences between the LD and HD groups across background diets in substrate oxidation and mRNA expression for enzymes measured that regulate energy metabolism, myostatin or muscle VEGF. However, there was an increase in insulin receptor mRNA expression in muscle in the HD compared to the LD groups. In conclusion, elevated whey protein, calcium and vitamin D intake resulted in reduced accumulation of body fat mass and increased lean mass, with a commensurate increase in insulin receptor expression, regardless of the level of calories from fat or sucrose.

Objective To investigate the short-and long-term efficacy and influential factors of focused ultrasound for the treatment of nonneoplastic epithelial disorders of the vulva (NNEDV).Design A retrospective observational study.Setting A gynaecologic department in a single centre in China.Population Patients with NNEDV were included in this study: 85 patients were diagnosed with lichen simplex chronicus (LSC), 44 patients with vulva lichen sclerosus (VLS), and seven patients with lichen planus (LP).Methods A total of 136 eligible patients with NNEDV were treated with focused ultrasound. After the treatment, based on changes in the degree of symptom severity and local skin signs (lesion size, skin colour and elasticity) before and after treatment, the treatment effectiveness for each patient was assessed. We further analysed the relations among pathologic type, age, course and curative rate. Statistical analysis was performed using the Chisquare (McNemar) test.Main outcome measures Improvement in the symptoms and physical signs and the predictive factors.Results Symptom relief was observed in all patients. The appearance and colour of the vulva returned to normal after the ultrasound treatment. Complete remission (CR) occurred in 68 of 136 (50%) patients (41 patients with LSC and 12 patients with VLS). The response rate was 93.38% (127/136). Seven patients who had a poor response to the first session of treatment were treated again with ultrasound therapy and a good response was observed. No severe complications were observed. There was no significant difference in treatment results among the different pathological types (P > 0.05). However, the course of the disease and the age of the patients were related to the treatment results (P < 0.05).Conclusions NNEDV can be treated with focused ultrasound effectively and safely. The course of the disease and the age of the patients may be predictive factors.Keywords Focused ultrasound, non-neoplastic epithelial disorders of the vulva efficacy, related factors.Tweetable abstract Patients with non-neoplastic epithelial disorders of the vulva can be safely and effectively treated with focused ultrasound. No significant difference in treatment results was observed between the different types of non-neoplastic epithelial disorders of the vulva.

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Background: Improved stroke risk stratification may improve stroke prevention. We aimed to study the value of a novel Doppler method, superb microvascular imaging (SMI), in correlating plaque thickness and evidence of intra-plaque neovascularization with a history stroke and TIA involving any cerebrovascular territory among community residents considered at high stroke risk.Methods: We selected residents aged at least 40 years from the Donghuashi community in China who had at least three stroke risk factors (including a history of stroke or TIA) and carotid plaque thickness of at least 1.5 mm (but without heavy calcification) and no history of carotid endarterectomy or stenting. In this cross-sectional study, each subject underwent carotid plaque examination with standard ultrasound and SMI. SMI evidence of plaque neovascularization was categorized as none or mild (Grade 1) or moderate or marked (Grade 2) and correlated with past history of stroke or TIA.Results: A total of 131 individuals (mean age 69 ± 8 years, 63% male) met the study inclusion criteria. SMI revealed no or mild neovascularization in 74 subjects (56.5%) and moderate or marked neovascularization in 57 subjects (43.5%). Subjects with moderate or marked neovascularization were more likely to have a history of any territory stroke or TIA, 43.9 vs. 17.6% (P = 0.001). Multivariate logistic regression analyses showed a thicker plaque (odds ratio: 2.272, 95% CI: 1.351–3.822, P = 0.002) and a history of stroke or TIA (odds ratio: 4.017, 95% CI: 1.719–9.387, P = 0.001) significantly correlated with evidence of moderate to marked intra-plaque neovascularization.Conclusions: Moderate to marked intraplaque neovascularization detected by SMI was more likely in subjects with a history of any territory stroke or TIA or thicker plaque. This indicates a potential new role of SMI in stratifying future risk of stroke or other arterial disease complications.

High calcium (Ca) and vitamin D (D) intakes may lead to reduced fat mass (FM) accretion. We examined the effects of high Ca and D intake on body composition, substrate oxidation (Ox) and gene expression of related liver enzymes. Male Wistar rats (n=32, 200 gms) were fed high fat (HF, 40%) or high sucrose (HS, 60%) diets with either low levels (LoDCa) of Ca (0.25%) and D (400 IU) or high levels (HiDCa) of Ca (1.5%) and D (10,000 IU) for 14 weeks. FM and lean body mass (LBM) were determined by DEXA. 14C‐palmitate and 14C‐glucose Ox were measured in liver and muscle tissue homogenates. Phosphoenolpyruvate carboxy kinase (PEPCK), fatty acid synthase, and carnitine palmitoyl transferase‐1 gene expression was assessed by real time RT PCR. There were no differences in feed intake or weight gain for HiDCa vs. LoDCa or HF vs. HS groups. FM was lower (73%, P<0.05) and LBM higher (106%, P<0.05) with HiDCa diet compared to LoDCa, regardless of HF or HS. Liver glucose Ox was decreased (P<0.05) for rats fed HiDCa only with HF diets. There was no effect of Ca or D intake on expression of liver enzymes. Gene expression of PEPCK was higher in HF diets as compared to HS diets (P<0.05). Thus, HiDCa diet reduces fat accretion and increases LBM, independent of dietary energy source. HiDCa altered substrate oxidation in liver with HF, but not with HS diets, suggesting this is not the mechanism of action of HiDCa in modulating body composition. Supported by NIH DK069965.

Objectives To evaluate the efficacy of ultrasound and contrast-enhanced ultrasound (CEUS) in disease activity assessment of Takayasu arteritis (TA) with carotid involvement. Methods This is a cohort study of 115 patients of TA with carotid involvement. We investigated correlations between clinical data, sonographic features and CEUS enhancement at the site most prominent lesion of each patient. Disease activity was assessed by the NIH Kerr criteria. Sonographic findings were compared with follow-up examinations. CEUS was repeated after a three to seven months interval in 35 patients to evaluate change of CEUS enhancement after treatment. Results Extensiveness of CEUS enhancement at most prominent carotid lesions had significant correlations with disease activity by the Kerr criteria (P &lt; 0.001). The specificity of extensive enhancement for indicating active disease was 95%, while sensitivity was 67%. Patients with active disease showed greater arterial wall thickness and more prominent reduction of arterial wall thickness after treatment. Most of patients (68%) with subsided active disease after treatment featured decrease of CEUS enhancement. Conclusions Extensiveness of enhancement by CEUS and arterial wall thickness by ultrasonography may be useful markers for initial and follow-up assessment of disease activity of TA with common carotid artery involvement.

Background Evidence of the association between serum lipid profiles and intraplaque neovascularization (IPN) is still limited. We aimed to study the value of a novel Doppler method, superb microvascular imaging, in correlating serum lipid profiles and evidence of IPN in a population with a high risk of stroke. Methods and Results A community‐based cross‐sectional study was conducted in Beijing, China. Residents (aged ≥40 years) underwent questionnaire interviews, physical examinations, and laboratory testing in 2018 and 2019. Subjects with a high risk of stroke were then selected. Standard carotid ultrasound and carotid plaque superb microvascular imaging examinations were then performed on the high–stroke‐risk participants. Logistic regression was used to evaluate the relationship between serum lipid profiles and carotid plaque IPN. Overall, a total of 250 individuals (mean age, 67.20±8.12 years; 66.4% men) met the study inclusion criteria. Superb microvascular imaging revealed carotid plaque IPN in 96 subjects (38.4%). Subjects with IPN were more likely to be current smokers (34.0% versus 46.9%, P =0.046), and their identified carotid plaques were much thicker (2.35±0.63 mm versus 2.75±0.80 mm, P =0.001). Serum lipids, including total cholesterol, non–high‐density lipoprotein cholesterol, and low‐density lipoprotein cholesterol were positively associated with the presence of IPN (4.33±1.00 mmol/L versus 4.79±1.12 mmol/L, P =0.001; 2.96±0.92 mmol/L versus 3.40±1.01 mmol/L, P =0.001; 2.18±0.76 mmol/L versus 2.46±0.80 mmol/L, P =0.005, respectively), and after adjustment for other confounders, the positive relationship remained significant. Furthermore, non–high‐density lipoprotein cholesterol (odds ratio, 2.62 [95% CI, 1.35–5.06]) was significantly associated with the presence of carotid plaque IPN even after adjusting for low‐density lipoprotein cholesterol. Conclusions Total cholesterol, non–high‐density lipoprotein cholesterol, and low‐density lipoprotein cholesterol were positively associated with the presence of carotid IPN in a Chinese high–stroke‐risk population. Further prospective studies should be conducted to better understand how much finding IPN adds to current stroke prediction tools.