We investigated the vascular effects of glucagon-like peptide-1 (GLP-1) and Exendin-4 in type 2 diabetic rat aortae. Studies were performed in a normal control group (NC) (0.2 ml i.p. saline, n = 10), streptozotocin (STZ)/nicotinamide diabetic control group (DC) (a single dose of 80 mg/kg STZ i.p. injection 15 min after administration of 230 mg/kg nicotinamide i.p.), GLP-1 (GLPC) control group (1 µg/kg twice daily i.p. for 1 month, n = 10), Exendin-4 control group (EXC) (0.1 µg/kg twice daily i.p. for 1 month, n = 10), GLP-1-treated diabetic group (GLPT) (1 µg/kg twice daily i.p. for 1 month, n = 10), and Exendin-4-treated diabetic group (EXT) (0.1 µg/kg twice daily i.p. for 1 month, n = 10). One month of GLP-1 and Exendin-4 treatment significantly decreased the blood glucose levels of diabetic rats (113 ± 2 mg/dl, p < 0.001, and 117 ± 1 mg/dl, p < 0.001, respectively versus 181 ± 9 mg/dl in the DC group). Sensitivity (pD₂) and maximum response (% Max. Relax) of acetylcholine-stimulated relaxations in the DC group (pD₂: 6.73 ± 0.12 and 55 ± 6, respectively) were decreased compared with the non-diabetic NC group (pD₂: 7.41 ± 0.25, p < 0.05, and 87 ± 4, p < 0.01). Treating diabetic rats with GLP-1, pD₂ values and with Exendin-4, Max. Relax %values of aortic strips to acetylcholine returned to near non-diabetic NC values (pD₂: 7.47 ± 0.15, p < 0.05, and 87 ± 3, p < 0.01, respectively). Maximal contractile responses (E_max) to noradrenaline in aortic strips from the diabetic DC group (341 ± 27 mg tension/mg wet weight) were significantly decreased compared with the non-diabetic NC (540 ± 66 mg tension/mg wet weight, p < 0.001) and the GLPT group (490 ± 25 mg tension/mg wet weight, p < 0.05). There were no significant differences in pD₂ values of aortic strips to noradrenaline from all groups. E_max to KCl in aortic strips from the DC group (247 ± 10 mg tension/mg wet weight, p < 0.01) was significantly decreased compared with non-diabetic NC group (327 ± 26 mg tension/mg wet weight). Treating diabetic rats with GLP-1 (GLPT), E_max values of aortic strips to KCl returned to near non-diabetic NC values (271 ± 12 mg tension/mg wet weight). GLP-1 and (partially) Exendin-4 treatment could improve the increased blood glucose level and normalize the altered vascular tone in type 2 diabetic rats.

Many antibody and immune escape variants in SARS-CoV-2 are now documented in literature. The availability of SARS-CoV-2 genome sequences enabled us to investigate the occurrence and genetic epidemiology of the variants globally. Our analysis suggests that a number of genetic variants associated with immune escape have emerged in global populations.

Background: Structural and functional changes in potassium channels of vascular smooth muscle cells may contribute to the development of diseases such as hypertension. We aim to investigate the vascular effects of potassium channel openers and blockers in human internal mammary artery (HIMA). Methods: Remaining segments of HIMA from 18 consecutive patients undergoing coronary artery bypass surgery were obtained to examine the vascular effects of various potassium channel openers (staurosporine, hydrochlorothiazide and cromakalim) and potassium channel blockers (4-aminopyridin [4-AP], charybdotoxin [CTX] and glibenclamide [GLBC]). Results: Noradrenaline (NA)-induced maximal contractions were inhibited by all 3 K⁺-channel blockers but only fully inhibited by 4-AP (95.6%). Only NA-induced contractions were reversed by CTX. Only K⁺-induced maximal contractions were significantly inhibited by 4-AP (95.6%, p < 0.05). Only acetylcholine-induced relaxation was fully inhibited by CTX. Only sodium nitroprusside-induced relaxations in potassium chloride-precontracted strips could be reversed by GLBC. Conclusions: Drugs affecting potassium channels may be useful in the treatment of hypertension and management of perioperative vasospasm during the coronary artery bypass surgery.

BackgroundThere is a paucity of data on whether pre-operative walking and functional capacity has a direct association with post-operative gastrointestinal function in patients who have undergone surgery to treat gynecologic cancers.ObjectiveTo explore the relationship between pre-operative walking and post-operative recovery of bowel function.MethodsThis randomized trial was performed from January 1, 2018 to August 31, 2018. All patients had a diagnosis of endometrial or ovarian cancer and were scheduled for comprehensive staging. Group A served as the control group who did not walk regularly on the last night before surgery. Patients in group B walked for 30 min at an average speed of 3 km/h from 20.00 to 20.30 and 21.30. to 22.00 on the last night before surgery under the supervision of a nurse or doctor. The study was registered with clinicaltrials.gov (no: NCT03553121).ResultsA total of 85 patients were enrolled: 43 patients were assigned to the walking group and 42 to the control group. There were no significant differences in demographics between the groups. Median age was 57.3±8.5 in the control and 59.9±9.1 in the walking group. In addition, 28 patients had endometrial cancer and 14 had ovarian cancer in the control group. 33 patients and 10 patients in the walking group had endometrial and ovarian cancer, respectively. The mean time to first flatus was shorter in the walking group than in the control group (32.5±10.4 vs 40.6±16.9 hours, respectively; p=0.010). In addition, the time to first defecation was significantly shorter in the walking group (62.8±26.7 vs 91.4±51.8 hours; p=0.002). Patients who walked before surgery were less likely to have post-operative paralytic ileus (25.0% vs 60.7%; p=0.003). Walking before the operative period and laparoscopic surgery independently protected against the development of post-operative paralytic ileus.ConclusionWalking before surgery expedited time to bowel motility and ability to tolerate food. In addition, this method significantly decreased the risk of post-operative paralytic ileus.We consider that walking before surgery may be integrated into the pre-operative management of patients under going surgery for gynecologic cancers.Clinical trial registrationclinicaltrial.org record number: NCT03553121

Vulvar cancers, which constitute 5% of all gynecologic cancers, are the fourth most common female genital cancers, preceded by uterine, ovarian and cervical cancers. The treatment methods employed for vulvar cancers have changed over the years, with previously applied radical surgical approaches, such as en bloc resection, being gradually suspended in favor of treatment approaches that require dissection of less tissue. While the removal of less tissue, which today's approaches have focused on, prevents morbidity, this method seems to result in higher risks of recurrence. It is therefore important that the balance between preventing the recurrence of the disease and forefending against postoperative complications and vulvar deformity be properly understood. As a working assumption, if patients with vulvar cancer are diagnosed at an early stage, properly evaluated and administered appropriate treatment, the most positive results can be obtained. This paper aims to highlight this assumption and demonstrate, through the provision of actual data, how to plan the treatment approach for patients who are diagnosed early. Statements extracted from the National Comprehensive Cancer Network (NCCN) Guidelines Version 1.2016 Sub-Committees on vulvar squamous cell carcinoma and articles by the European Society of Gynaecological Oncology (ESGO) regarding Vulvar Cancer Recommendations were used to obtain updated information.

Amaç: Bu çalışmanın amacı; minimal-invazif bir teknik olarak tanımlanan transobturator tape (TOT) operasyonunun etkinliğinin ve komplikasyonlarının değerlendirilmesidir. Yöntemler: 2011-2012 yılları arasında saf stres üriner inkontinans (SÜİ) veya mikst üriner inkontinans (MÜİ) nedeniyle subüretral gergisiz vajinal TOT operasyonu yapılan 120 hasta çalışmaya alındı. Tüm operasyonlar dıştan-içe Obtryx™ (Boston Scientific, Natick, MA, USA) marka kit ile gerçekleştirildi. Hastalar postoperatif 1. ve 3. aylarda kontrollere çağrılarak ürojinekolojik muayeneleri yapıldı, operasyon başarısı ve perioperatif komplikasyonları değerlendirildi. Bulgular: Olguların tamamı multipardı ve yaş ortalaması 49,6±11,3 idi. Hastaların 47 (%39,2) tanesi postmenopozal, 73 (%60,8) tanesi ise premenopozal idi. Transobturator tape operasyonu olan olgulardan 36 (%30) tanesi ek cerrahi operasyon geçirdi. Olguların objektif kür oranı %91,7 ve subjektif kür oranı %88,3 idi. Tedavi başarısızlığı %8,3 olarak bulundu. Transobturator tape operasyonuna bağlı kan transfüzyonu gereksinimi sadece 1 hastada gerekli oldu. İntraoperatif 200ml üzerinde kanama 4 hastada izlendi. Vajinal forniks perforasyonu sadece 3 vakada izlendi. Perineal ağrı 2 olguda mevcuttu. De novo urge inkontinans postoperatif 5 hastada izlendi ve antikolinerjikler ile tedavi edildi. Vajinal erozyon görülen 4 hastada mesh eksize edildi ve vajen mukozası tekrar sütüre edildi. Sonuç: Stres üriner inkontinans cerrahi tedavisinde minimalinvazif, komplikasyon oranı düşük ve kür oranı yüksek bir yöntem olan transobturator tape operasyonu diğer tekniklere üstünlük sağlamıştır. Cerrahi tecrübe arttıkça komplikasyon oranları azalmakta ve bunların yönetimi kolaylaşmakta-dır.Objective: The aim of this study is to evaluate the effectiveness and complications of TOT (trans-obturator tape) operation which is a minimally-invasive technique. Methods: 120 patients who had suburethral tension-free vaginal TOT operation due to pure stress urinary incontinence (SUI) or mixt urinary incontinence (MUI) between 2011-2012 were reviewed. All of the operations were performed outside to inside with the Obtryx™ (Boston Scientific, Natick, MA, USA) trademark kit. Postoperatively patients were called at 1st and 3rd months; urogynecologic examinations were done, the success and perioperative complications of the operations were evaluated Results: All of the patients were multiparaous and median age was 49,6±11,3 years. Forty-seven (%39.2) patients were postmenaupausal and thirty-six patients (%30) who had TOT operation had extra surgery. Objective cure rates of the patients were %91.7 and subjective cure rates of the patients were %88.3. Treatment failure was %8.3. Only one patient had blood transfusion requirement due to TOT operation. Intraoperatively, 4 patients had bleeding more than 200 ml. Three patients had vaginal fornix perforation. Two patients had perineal pain. De novo urge incontinence was seen in 5 patients postoperatively and was treated with anticholinergic drugs. Mesh excisions were done...

Coronavirus disease (COVID-19) emerged from a city in China and has now spread as a global pandemic affecting millions of individuals. The causative agent, SARS-CoV-2 is being extensively studied in terms of its genetic epidemiology using genomic approaches. Andhra Pradesh is one of the major states of India with the third-largest number of COVID-19 cases with limited understanding of its genetic epidemiology. In this study, we have sequenced 293 SARS-CoV-2 genome isolates from Andhra Pradesh with a mean coverage of 13,324X. We identified 564 high-quality SARS-CoV-2 variants, out of which 15 are novel. A total of 18 variants mapped to RT-PCR primer/probe sites, and 4 variants are known to be associated with an increase in infectivity. Phylogenetic analysis of the genomes revealed the circulating SARS-CoV-2 in Andhra Pradesh majorly clustered under the clade A2a (94%), while 6% fall under the I/A3i clade, a clade previously defined to be present in large numbers in India. To the best of our knowledge, this is the most comprehensive genetic epidemiological analysis performed for the state of Andhra Pradesh.

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.