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    Adolescent Athlete Stress Fractures Associated with Vitamin D Insufficiency: Three Cases with Review of the Literature. Haase Douglas R,Brown Kevin,Templeton Kimberly J JBJS case connector CASE:The authors present 3 adolescent athletes who presented with stress fractures in their lower extremities, initially diagnosed as tumors. All 3 patients received an inconclusive magnetic resonance imaging before referral; fractures were confirmed on radiographs and computed tomography. All were found to have vitamin D insufficiency. CONCLUSIONS:Vitamin D insufficiency is a global epidemic mainly focused on adults and young-adult athletes. These case reports raise concerns about a growing prevalence of vitamin D insufficiency in adolescents, the potential risk of stress fracture, and the need for screening and possible supplementation in adolescent athletes to improve their bone health. 10.2106/JBJS.CC.20.00367
    Toxicity, gut microbiota and metabolome effects after copper exposure during early life in SD rats. Dai Juan,Yang Xiao,Yuan Ya,Jia Youzhen,Liu Guibing,Lin Nan,Xiao Hang,Zhang Lishi,Chen Jinyao Toxicology Copper, an essential microelement, can still be harmful to health and has a significant impact on the gut microbiota, which is closely related to health when copper is ingested excessively. However, the effects of low dose exposure to copper early in life on health and the gut microbiota are not well understood. Here, the effects of early-life exposure of copper on the toxicity, gut microbiota and the metabolome were investigated in Sprague-Dawley (SD) rats. The results showed that 0.20 and 1.00 mg/kg BW copper early-life exposure in SD rats significantly increased ALT, AST, and ALP levels in the blood and caused liver damage. Copper exposure had a dose-dependent effect on the alpha and beta diversity and reduced the abundance of probiotics, the ratio of Firmicutes to Bacteroidetes (F/B), and changed the abundance of fat metabolism and intestinal inflammation-related bacteria. The results of the fecal metabolome also demonstrated the effects of early-life copper exposure on liver damage and intestinal inflammation-related metabolic pathways. Together, our findings demonstrated that copper exposure during early life induced liver damage and gut microbiota dysbiosis and affected the relevant metabolic pathways. 10.1016/j.tox.2020.152395