Fighting the flu - Devising a novel approach to address patient concerns with the seasonal influenza vaccine - South Burlington, VT

In Vermont, it is estimated that influenza-like illness is responsible for $8.9 million annually in direct medical costs. The flu vaccination rate ranges from 33% to 56% across the nation, and Vermonters are vaccinated at a rate of approximately 49% each year. This program aims to provide a novel educational material to patients, specifically addressing concerns with the safety of the seasonal influenza vaccine.https://scholarworks.uvm.edu/fmclerk/1252/thumbnail.jp

Living in Recovery:Perceptions of Health Care and Comorbidities in Rural New England

Introduction: Alcohol and Drug Abuse: In the USA, abuse of tobacco, alcohol, and illicit drugs is costly, exacting more than $700 billion annually in costs related to crime, lost work productivity, and health care. 9% of Vermont residents and 8% of US residents report alcohol or illicit drug abuse, and 10% of US adults consider themselves to be in recovery from drugs or alcohol. Health Care and Recovery: Persons with drug addictions are approximately twice as likely to suffer from mood and anxiety disorders compared to the general population. Aside from mental health disorders, other common comorbidities include dental problems, insomnia, and migraines. The majority of people in recovery report having a primary care physician, but they receive fewer preventative health care interventions compared to the general population. The Turning Point Center of Chittenden County: The Turning Point Center is a non-profit organization that provides a safe, substance-free environment and peer-to-peer recovery activities to assist in recovery from addiction.https://scholarworks.uvm.edu/comphp_gallery/1231/thumbnail.jp

Creation of a Ureterocystostomy in a Transplanted Cadaveric Kidney with the Use of a Radiofrequency Guide Wire

A duplicated collecting system (DCS) is a common anatomical variant of the kidney. As surgeons now perform more donor cadaveric transplants than in the past, the discovery of an occluded DCS may occur in the post-transplant setting. Over a dozen articles have reported on the use of DCS in the renal transplant setting. However, to our knowledge, this case report is the first to describe the creation of a ureterocystostomy with the use of a radiofrequency (RF) guide wire, involving a previously unidentified DCS in a transplanted kidney. Keywords: Duplicated collecting system, Duplicated ureter, Ureterocystostomy, Cadaveric renal transplant, Radiofrequency guide wire, Occluded urete

Beta-adrenergic receptors are critical for weight loss but not for other metabolic adaptations to the consumption of a ketogenic diet in male mice

Objective: We have previously shown that the consumption of a low-carbohydrate ketogenic diet (KD) by mice leads to a distinct physiologic state associated with weight loss, increased metabolic rate, and improved insulin sensitivity [1]. Furthermore, we identified fibroblast growth factor 21 (FGF21) as a necessary mediator of the changes, as mice lacking FGF21 fed KD gain rather than lose weight [2]. FGF21 activates the sympathetic nervous system (SNS) [3], which is a key regulator of metabolic rate. Thus, we considered that the SNS may play a role in mediating the metabolic adaption to ketosis. Methods: To test this hypothesis, we measured the response of mice lacking all three β-adrenergic receptors (β-less mice) to KD feeding. Results: In contrast to wild-type (WT) controls, β-less mice gained weight, increased adipose tissue depots mass, and did not increase energy expenditure when consuming KD. Remarkably, despite weight-gain, β-less mice were insulin sensitive. KD-induced changes in hepatic gene expression of β-less mice were similar to those seen in WT controls eating KD. Expression of FGF21 mRNA rose over 60-fold in both WT and β-less mice fed KD, and corresponding circulating FGF21 levels were 12.5 ng/ml in KD-fed wild type controls and 35.5 ng/ml in KD-fed β-less mice. Conclusions: The response of β-less mice distinguishes at least two distinct categories of physiologic effects in mice consuming KD. In the liver, KD regulates peroxisome proliferator-activated receptor alpha (PPARα)-dependent pathways through an action of FGF21 independent of the SNS and beta-adrenergic receptors. In sharp contrast, induction of interscapular brown adipose tissue (BAT) and increased energy expenditure absolutely require SNS signals involving action on one or more β-adrenergic receptors. In this way, the key metabolic actions of FGF21 in response to KD have diverse effector mechanisms