bluuebunny/crossref_metadata_2025 huggingface dataset:
OR28-2 Assessing Longitudinal Disparities in Insulin Pump Use Among Youth with Type 1 Diabetes
Authors: Bell Ronny Antonio , Bellatorre Anna , Divers Jasmin , Kahkoska Anna , Liese Angela , Mayer-Davis Elizabeth , Mendoza Jason , Pihoker Catherine , Williams Adrienne , Wisk Lauren , Wright Davene , Everett Estelle
Published: November 2022

Background

Insulin pump use provides many advantages for the management of type 1 diabetes (T1D), but studies have shown racial, ethnic, and socioeconomic inequities in the use of this technology. As the prevalence of insulin pump use has increased over the past two decades, we aimed to determine whether these inequities have increased or diminished over time.

Methods

We used data from the population-based SEARCH for Diabetes in Youth study to perform a serial cross-sectional analysis to evaluate changes over time in insulin pump use in participants <20 years old with T1D by racial and ethnic group, health insurance, household income, and formal parental education across 4 phases of the study (Phase 1: 2001-2005, Phase 2: 2006-2010, Phase 3: 2011-2015 and Phase 4: 2016-2019). Data from the last study visit were analyzed for those with multiple visits within a phase. Multivariable generalized estimating equations with a binomial distribution were used to assess probability of insulin pump use, and models were further adjusted for the other predictors–age at visit, diabetes duration, sex and clinic site--with clustering for individuals. An interaction effect between each primary predictor (race and ethnicity, health insurance, household income, education) and the phase variable was used to assess temporal changes.

Results

The prevalence of insulin pump use increased from 30% in Phase 1 to 58.3% in Phase 4 . Compared to those of non-Hispanic (NH) white race, odds of pump use in Hispanic participants was 0.08 (95% CI 0.01-0.63) in Phase 2 and 0.65 (95% CI 0.48-0.87) in Phase 4 with significantly reduced disparities over time (p=0.05). The disparities for Black participants and those of other races did not change over time, but was significantly lower than for white participants in all periods (0.28 (95%CI 0.21-0.37) and 0.43 (95%CI 0.26-0.71), respectively). Across all time periods, T hose with some high school/high school degree and those with some college had lower odds of pump use compared to those with at least a bachelor's degree 0.38 (95%CI 0.30-0.48) and 0.69 (95%CI 0.57-0.82). T hose with public insurance had lower odds for pump use compared to those with private insurance 0.84 (0.68-1.03). T hose with an income of < $25K, $25K-$49K, and $50K-74K had lower odds of pump use of 0.43 (95%CI 0.34-0.54), 0.57 (95%CI 0.46-0.71) and 0.80 (95%CI 0.65-0.97) compared to those with household incomes ≥ $75,000.

Conclusion

Over the past two decades, there have been no improvements in the ethnic, racial, and socioeconomic inequities in insulin pump use among youth with T1D. Studies that evaluate barriers or test interventions to improve technology access are needed to address the persistent inequities in diabetes care.

Presentation: Tuesday, June 14, 2022 10:00 a.m. - 10:15 a.m.
PSAT232 Understanding the Duration of Zinc 8 Transporter Antibody Seropositivity
Authors: Chavez Hilda Merino , Pena Ernesto Munoz , Suryanarayanan Sowmya , Yau Hanford , Paniagua Gabriela Zuniga , Botero Suarez Carlos S
Published: November 2022

Background

Since their recent discovery of zinc transporter 8 antibodies (ZnT8A) by Wenzlau et al. in 2007, the relevance and clinical utility of this marker has been in question. Some recent reports have shown a wide potential for both diagnostic as well as prognostic clinical applications in T1DM as they can be found years before clinical symptoms appear. Understanding the timing of the seropositivity of antibodies such as ZnT8A can help us understand how to utilize this marker for the diagnosis and prognosis of T1DM. Up to 20% of T1DM patients are reported to have ZnT8A positive with negative GAD-65 and IAA autoantibodies. The duration of seropositivity of ZnT8A is unclear. We describe 2 cases from our endocrine clinic with significant zinc 8 transporter antibody titers over 8 - 26 years after their initial diagnosis.

Clinical Cases

CASE 1: 34-year-old man diagnosed initially with T2DM 9 years prior and later re-classified as T1DM. He was treated initially with oral agents and switched over to Multiple Daily Injection (MDI) insulin about 3-4 years later. He has no family history of diabetes. Approximately 8 years after his initial diagnosis, his autoantibodies profile showed a positive zinc transporter 8 antibody of 28 U/mL (reference of < 15 U/mL), but negative GAD-65 antibodies (reference <5 IU/mL) and negative Islet cell antibodies.

CASE 2: 47-year-old man diagnosed with T2DM in 1995 and was initially started on oral hypoglycemic medications. He was later evaluated at our endocrinology clinic and reclassified as type 1 DM after his serologic testing showed a low C peptide < 0.1 ng/mL, positive zinc transporter 8 antibody of 32 U/mL (reference of < 15 U/mL), and negative islet cell antibody screen negative, and negative GAD-65 antibodies (reference <5 IU/mL). He was transitioned to continuous glucose monitoring and an insulin pump, but was too difficult for the patient to manage. He was ultimately transitioned to a basal-bolus regimen of insulin with MDI. His latest serologic testing showed a HgA1C of 9.2%.

Conclusions

Zinc 8 transporter antibody can help differentiate type 1 from type 2 diabetes and initiate insulin therapy for better glycemic control as well as aid in prognosis and stratification strategies. The duration of seropositivity of ZnT8A has not been clearly established. Previous reports have shown that ZnT8A can be detected at an age around 3 years of age, but peaks around late adolescence and does not have a significant decline in seropositivity rates in older adults, as does IAA. This emphasizes the use of ZnT8A as a useful marker in adult and elderly patients. We describe 2 case reports which indicate that ZnT8 antibodies can remain positive for at least 8 - 26 years in the absence of other autoantibodies.

Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSUN164 Feasibility of a telehealth-delivered diabetes foot care educational program
Authors: Ju Hsiao-Hui , Cron Stanley , Jularbal Jed , Alford Jeffery , Momin Rashmi , Johnson Constance
Published: November 2022

Background

Diabetes-related nerve damage, foot ulcerations, and amputations occur as consequences of type 2 diabetes mellitus that is prevalent worldwide.

Aims

The study aims to investigate the preliminary effects and the feasibility of a telehealth educational program in patients with type 2 diabetes.

Methods

We conducted a single-arm, pre-mid-post measure study in two primary care practices in Texas. A total of 29 participants who met eligibility criteria (type 2 diabetes, Internet access, and English speaking) met with the research team once a month for 3 months via Zoom. The intervention involved telehealth visits with a board-certified family nurse practitioner/nurse educator for diabetes foot care and counseling, diabetes education, and discussion of self-management behaviors. Diabetes foot care behaviors, knowledge, and self-management activities were measured at baseline, 1.5 months, and 3 months.

Results

Initially, the mean score of the Diabetes Foot Self-Care Behavior Scale (DFSBS) was 17.75. The mean score of DFSBS increased to 21.59 at 1.5 months and rose to 25.46 at 3 months, indicating an improved frequency of foot care behaviors. Knowledge of diabetes was 70.48% correct at baseline and increased to 75.92% at 1.5 months and 83.89% at 3 months. At 1.5 months, the mean scores of the Summary of Diabetes Self-Care Activities improved by 0.4 days/week (d/w) for general diet, 0.29 d/w for exercise, 0.21 d/w for blood glucose testing, and 0.69 d/w for foot care. At 3 months, these values increased by 1.4 d/w for general diet, 1.13 d/w for exercise, 2.02 d/w for blood glucose testing, and 1.71 d/w for foot care compared with baseline. Of those enrolled, 87.18% completed the first telehealth visit, while 74.36% completed the second and third telehealth visits. Overall, 74.36% completed all three telehealth visits.

Conclusions

In two large primary care practices in Texas, a telehealth educational program that was centered on diabetes foot self-care management led to an improvement in self-care behaviors and knowledge for patients with type 2 diabetes. Clinical Implications: The promising results from this pilot study demonstrated the feasibility of a telehealth-delivered diabetes foot care educational program for patients with type 2 diabetes. Innovative strategies such as incorporating telehealth visits with in-person examinations may improve diabetes monitoring and prevent diabetes-related foot complications. Further research is needed to determine the long-term effects of a multi-disciplinary and personalized telehealth approach for monitoring diabetes foot care and self-management behaviors.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN166 Triglycerides and Glucose Index as a Predictor of Renal Impairment
Authors: Lee Seung Eun , Park Jung Hwan , Kim Dong Sun
Published: November 2022

Background

Metabolic syndrome closely associated with development of various chronic complications, including impaired kidney function. However, previous indices for insulin resistance (IR) have some limitation in precision estimating metabolic abnormality.

Objective

We investigate that higher triglycerides x glucose index (TyG) may be an alternative to predicting early impairment of kidney function. We analyzed biochemical and spirometry data from a nation-wide, population-based, case-control study (the KNHNES IV and V). The homeostasis model assessment, the quantitative insulin sensitivity check index, and TyG were uses as a surrogate marker of IR. Eligibles as cases were all native Korean who were aged 20 years or more and had no any medical illness.

Results

A total of 14534 participants were divided into 2 groups according to estimated glomerular filtration rate (eGFR, mL·min-1·1.73 m-2) as follows: Group I (n = 10189), ≥ 90 and ≤ 120; and Group II (n = 4345), ≥ 60 and < 90. Group I had lower TyG (8.43 ± 0.01 vs. 8.60 ± 0.01, P<0.0001) as compared with group II. Linear regression showed that TyG was closely associated with UACR (β = -3.3978, P<0.0001). Logistic regression analysis showed that TyG was closely associated with early impairment of kidney function (OR = 1.519, 95% CI = 1.421-1.623), and further adjustment did not attenuated this association (OR = 1.103, 95% CI = 1.005-1.210).

Conclusions

In this study, we demonstrated that TyG may be useful indicator of early renal impairment. To confirm these findings, large population-based prospective clinical should be needed.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN191 Hospital Outcomes of Intensive and Standard Inpatient Glycemic Targets: A Propensity Scored-Matched Post Hoc Analysis of Insulin-Treated Patients with Type 2 Diabetes
Authors: Fafyman Maya , Galindo Rodolfo , Gerges Amany , Migdal Alexandra , Peng Limin , Rashied Ammar , Umpierrez Guillermo , Vellanki Priyanthama , Zabala Zohyra , Zahid Syeda
Published: November 2022

Hypoglycemia and hyperglycemia are associated with poor outcomes among hospitalized patients with type 2 diabetes (T2D). Until 2012, the American Diabetes Association (ADA) and Endocrine Society hospital clinical guideline recommended a target blood glucose (BG) of 70-140 mg/dl; however, more recently a relaxed target of 140-180 mg/dl has been recommended by the ADA. Little data from randomized clinical trials (RTC) is available to support an intensive vs relaxed BG target. Accordingly, we performed a post-hoc analysis on 9 RCTs to assess hospital outcomes in non-critically ill insulin-treated patients with T2D targeting BG 70-140 mg/dl vs. 140-180 mg/dl.

Methods

Among 1446 patients, 640 were treated to a target of 70-140 mg/dl and 806 to a target of 140-180 mg/dl. Propensity score matching was used to reduce the bias due to confounding in the estimation of the effect of BG target. The propensity score dependent variables upon model selection included sex, admission HbA1c, and home insulin use. The final propensity score matched study sample consisted of 1,146 patients (573 patients in each BG target group).

Results

There were no differences in age, gender, BMI, diabetes duration, home insulin use or hospital admission service (medicine/surgery). Patients in the intensive target BG group had lower mean BG (day 2-10: 163.73 ± 39.79 mg/dl vs 170.15 ± 39.94 mg/dl, p=0.004), less hyperglycemia (any BG >180: 86% vs 92%, p=0.003; any BG >240: 51% vs 62%, p<.001), similar rates of hypoglycemia (BG <70: 12% vs 15%, p=0.11; BG <54: 2.5% vs 4.0%, p=0.14), and trended towards greater time in range <180 mg/dl (62.00 ± 28.14% vs 59.23 ± 27.38%, p=0.06). The composite of complication rate (acute renal failure, infection, myocardial infarction, respiratory failure and stroke) was lower (3.7% vs 6.8%, p=0.02) in the intensive control group, with similar rates of inpatient death (0.9% vs 0.3%, p=0.36). Hospital length of stay was shorter in the intensive control group (4.0 vs 6.0 days, p<.001).

Conclusion

Our results indicate that tighter glycemic target of 70-140 mg/dl leads to lower mean daily BG, less severe hyperglycemia events, similar rates of hypoglycemia, and lower length of stay and complication rates compared to a higher target of 140-180 mg/dl. Further RCTs are indicated to elucidate optimal glycemic targets in hospitalized patients with T2D.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN193 Comparing Long-Term Outcomes of Children Diagnosed with New-Onset Type 2 Diabetes in an Outpatient vs Inpatient Setting
Authors: Ranganna Adesh , DeLacey Sean , Lado Juan , Levin Laura , Swamy Anita , Bianco Monica
Published: November 2022

Background

Early identification and treatment of children and adolescents with Type 2 Diabetes (T2DM) is thought to improve long-term outcomes. However, it is unclear if severity of T2DM at presentation affects long-term clinical outcomes. Using the location of treatment initiation (inpatient compared to outpatient) as a proxy for severity of illness, we aimed to assess changes in dysglycemia and insulin requirements at diagnosis and after 3 years of follow-up.

Methods

We performed a retrospective chart review of children 8-18 years of age diagnosed with new onset type 2 diabetes and receiving diabetes care within a large tertiary care center between 1/1/2010 and 11/1/2021 for three consecutive years. Children were identified by ICD codes (ICD9 250.00, ICD10 E13.9 or E11.9). Charts were reviewed to confirm diagnosis. Exclusion criteria included medication induced diabetes, MODY, >1 positive diabetes autoantibody, BMI<85%, complicated medical history (genetic disorders, transplant, cancer, etc.), and < 3 visits in the study time frame. Chi-squared, t-tests, ANOVA, and linear regression were used for analyses.

Results

A total of 513 patients were identified by ICD code and, after exclusions, 116 were included in the analysis: 69 initially treated in an inpatient setting and 47 initially treated in an outpatient setting. The average A1C at presentation was higher in the inpatient group (11.02% ± 1.77) than the outpatient group (7.19% ± 0.72) (p<0.001). The BMI z-score at presentation was lower in the inpatient group (2.17%±0.58) than the outpatient group (2.41% ±0.35) (p=0.015), but at three years of follow-up the BMI z-score between the groups was not significantly different (2.05%±0.60) compared to (2.12% ±0.50) (p = 0.536). The average A1C remained higher in the inpatient group (9.58%±2.92) compared to the outpatient group (8.43% ±2.44) (p = 0.031). At treatment initiation the average total daily dose of insulin in the inpatient group (0.68±0.36 units/kg/day) was higher than the outpatient group (0.05±0.18 units/kg/day) (p<0.001). At three years of follow-up the average total daily dose of insulin remained higher in the inpatient group (0.50±0.46 units/kg/day) compared to the outpatient (0.29±0.36) (p=0.008 units/kg/day) group.

Conclusion

In conclusion, pediatric patients initially treated in the inpatient setting had poorer glycemic control and higher insulin requirements at baseline that persisted after three years of follow-up. These findings suggest that initial presentation may predict long-term clinical outcomes in children with T2DM.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN195 Use of Anti-Hyperglycemic Agents Before and After Roux-en-y Gastric Bypass (RYGB) and Laparoscopic Sleeve Gastrectomy (LSG)
Authors: Kuo Bryan , Vaz Cherie , Zhao Huaqing , Shah Kunal , Kesavarapu Keerthana
Published: November 2022

Introduction

Currently there is no standardized approach or guideline regarding use of anti-hyperglycemic agents in the pre and postoperative diabetes management of patients undergoing bariatric surgery. There is a need to investigate the efficacy of current anti-hyperglycemic medications in the context of bariatric surgery.

Methods

The primary aim was to describe the patterns of use of anti-hyperglycemic agents in the pre-operative and post-operative period in patients undergoing bariatric surgery. A secondary aim was to evaluate the association between various anti-hyperglycemic agents on diabetes control. This study was a single-center retrospective chart review that identified patients with type 2 diabetes and obesity who underwent bariatric surgery between the years 2013 to 2020. Patients were identified using ICD-10 codes and surgical CPT codes. Demographic data, anthropometric data, and markers of diabetes were collected immediately preoperatively, day of surgery, 6 months postoperatively and 1-year postoperatively.

Results

132 patients with obesity and T2DM underwent RYGB (n=61) and LSG (n=71). The RYGB group had significantly higher pre-surgery weight (132+30 kg vs 125+27kg, P=0.066), BMI (45.0+6 kg/m2 vs 42.7+5.7 kg/m2, P=0.013), and HbA1c (7.44+0.9% vs 7.2+0.7%, P=0.062) compared to the LSG group. Post-surgical weight loss was greater in the RYGB group 38+14 kg (29% TBWL) compared to the LSG group 30+14 kg (25% TBWL) (p=0.004) at 1-year. HbA1c reduction was significantly better in RYGB group 1.52% (n=42) compared with the LSG group 1.05% (n=47) (P=0.034) at 1-year.

Medication analysis prior to surgery showed that 88% (n=113) were taking at least 1 anti-hyperglycemic agent, with a mean of 1.6 medications per patient. The last dose of all anti-hyperglycemic agents was the day prior to surgery. In the immediate postoperative course, no agents were initiated in both groups. Post-surgical medication analysis at 1-year showed complete elimination of anti-hyperglycemic agent use in 42% (n=26) of RYGB group and 59% (n=42) in LSG group.

Patients on metformin prior to bariatric surgery had a greater delta 1-year post-operative HbA1c (mean -0.558+0.2786) (p=0.05) compared to patients not on metformin in LSG group. This trend was not seen in patients on metformin therapy in the RYGB group. Patients on insulin prior to bariatric surgery had a positive delta 1-year post-operative HbA1c (mean 0.781+0.2761) (p=-.007) compared to patients not on insulin in LSG group. These trends were not seen in patients using either metformin or insulin therapy in the RYGB group.

Conclusion

In patients with T2DM undergoing bariatric surgery, metformin monotherapy was associated with greater post-operative 1-year HgA1c reduction in LSG group. This suggests possible benefit from treatment with metformin in patients undergoing LSG bariatric surgery.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN199 SGLT2-Inhibitor Prescription Rates in Individuals with Diabetic Nephropathy at a Teaching Outpatient Clinic
Authors: Abdulwahid Tiba , lloyd Jacob , Selk Karen
Published: November 2022

Introduction

Type 2 diabetes mellitus is one of the leading causes of kidney failure worldwide. According to the CREDENCE trial published in June 2019, SGLT2 inhibitors have significant benefits in renal outcomes even in individuals with more advanced diabetic kidney disease specifically in terms of slowing disease progression. The American Diabetes Association (ADA) recommends using SGLT2-Inhibitor for patients with type 2 diabetes and diabetic kidney that have GFR>=30 ml/min/1.73 m2 and urinary albumin >300 mg/g creatinine. However, we hypothesize that SGLT2-inhibitor is under-prescribed in those individuals. The aim of this study is to assess the rate of SGLT2-inhibitor prescription in those individuals.

Methods

We performed a retrospective observational study of individuals seen at an outpatient multispecialty medical building at a tertiary teaching hospital from February 2020 to July 2021. We chart audited 482 individuals seen at least 3 times at the clinic with the diagnosis of diabetes on their electronic medical record. We included only individuals with type 2 diabetes, who have GFR >=30 ml/min/1.73 m2 and urinary albumin>300 mg/g creatinine. We performed an analysis looking at the rate of SGLT2-inhibitor prescription in the clinic.

Results

A total of 36 individuals were included in our final analysis with mean age [standard deviation] of 63 [9.9], 72.2% Male, 80.5% African American, BMI of 33.37 [8.0], HbA1C of 8.9 [2.4], Albumin/creatinine 1395.7 mg/g [1432.3], GFR 53.92 ml/min/1.73 m2 [17.5] and 97.2% had health insurance. Only 7 individuals (19.4%) of the qualified cohort were prescribed SGLT2-inhibitor at the clinic.

Conclusion

SGLT2-inhibitor is under-prescribed at the clinic, with only 19.4% of the qualified cohort being prescribed SGLT2-inhibitor. Although the cost of the medication is likely a confounding factor however this could also be due to a knowledge gap among providers about the standards of diabetes care guidelines. We plan to take steps to create awareness regarding the under-prescription of SGLT2-inhibitor among providers and provide educational interventions to help improve the prescription rate of SGLT2-inhibitor and potentially decrease the rate of decline in kidney function in our patient population.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN238 COVID 19 induced Type 1 Diabetes Mellitus
Authors: Ahsun Sana , Patamopron Lekprasert , Win Kay Khine
Published: November 2022

Introduction

There have been some case reports where patients presented with uncontrolled hyperglycemia without previous diagnosis of diabetes but very limited literature supporting the fact that COVID 19 infection can lead to the development of new onset Type 1 diabetes.

Clinical Case

A 30-year-old African American man presented to the office with a diagnosis of new onset DM towards the end of March 2021. He did not have any significant medical history other than prediabetes with a prior HbA1c of 6% and COVID 19 infection in 2020. He had no family history of DM. He was very sick with the COVID 19 infection and lost 20 pounds of weight around that time. He did not get hospitalized and did not have any blood work done. A couple of months after recovery from his COVID 19 illness he developed leg cellulitis. He decided to seek help for this problem and was started on some antibiotics and antifungals, but they did not help much. His leg swelling and pain did not improve so he went to the ER. At that time his work-up showed a HbA1c of 15.5%. Patient was also having polydipsia and polyuria by that time. He was given a new set of antibiotics and was discharged to follow-up with a primary care provider. His PCP started him on Metformin and Lantus insulin for new onset DM2. He was then referred to Endocrinologist for further management. At the time of his endocrine office visit his symptoms of polyuria and polydipsia had improved a lot.His Anti GAD 65 antibodies were positive with a value of 41 (neg <5). C-peptide level was 1.9 which was in the range (1.1-4.4). IAA–2 autoantibodies were positive with a value of more than 120 (neg<7.5). ZNT 8 antibodies and Insulin antibodies were negative. An increase in the number of antibodies is associated with a higher likelihood of type 1 DM. Only less than 3% of type 2 diabetics have positive antibodies. As per the laboratory interpretation our patient had type 1 diabetes. After starting insulin treatment, the HbA1c improved to 6.6% from 15.5%. Patient is currently on continuous glucose monitoring with insulin therapy and has a good glycemic control.

Conclusion

Our case highlights the importance that SARS-CoV-2 infection is an independent risk factor for the development of new onset type 1 DM and increased risk of complications in preexisting diabetics. There have been studies showing that patients who presented with DKA precipitated by COVID-19 infection had worse outcomes than patient's presenting with DKA without COVID-19 infection. Mortality was higher for COVID-19 in diabetic patients as well.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
Zebrafish embryos hatch early in response to chemical and mechanical indicators of predation risk, resulting in underdeveloped swimming ability of hatchling larvae
Authors: Wisenden Brian D. , Paulson Daniel C. , Orr Megan
Published: November 2022

Plasticity in hatching time allows embryos to maximize fitness by balancing the benefits and costs of remaining bound within the chorion against the benefits and costs of emerging as a free-swimming larva. Here, in the first experiment, we exposed zebrafish (Danio rerio) embryos to either chemical cues from crushed embryos (simulating egg predation) or to blank water control. Embryos exposed to alarm cues hatched sooner, and had shorter body lengths and underdeveloped fins, relative to larvae from the water treatment. Burst swimming speed was significantly slower for larvae that hatched from the alarm cue treatment than for larvae from the water treatment. In a second 2×2 experiment, we exposed zebrafish embryos to either chemical alarm cues from conspecific embryos, mechanical disturbance (magnetic stir bar) to simulate a predator probing the substrate for developing embryos, both chemical and mechanical indicators of risk, or neither (control). We found similar effects in terms of earlier time to hatch at an earlier stage of development and poorer swimming performance of hatchling larvae. In the second experiment, these effects occurred in response to mechanical disturbance with or without the presence of chemical alarm cues. Alarm cues alone produced no effects in the second experiment. Taken together, these data indicate that zebrafish embryos demonstrate a facultative trade-off between risk of predation acting on two stages of their life history.
iPSCs derived from esophageal atresia patients reveal SOX2 dysregulation at the anterior foregut stage
Authors: Raad Suleen , David Anu , Sagniez Melanie , Paré Bastien , Orfi Zakaria , Dumont Nicolas A. , Smith Martin A. , Faure Christophe
Published: November 2022

A series of well-regulated cellular and molecular events result in the compartmentalization of the anterior foregut into the esophagus and trachea. Disruption of the compartmentalization process leads to esophageal atresia/tracheoesophageal fistula (EA/TEF). The cause of EA/TEF remains largely unknown. Therefore, to mimic the early development of the esophagus and trachea, we differentiated induced pluripotent stem cells (iPSCs) from EA/TEF patients, and iPSCs and embryonic stem cells from healthy individuals into mature three-dimensional esophageal organoids. CXCR4, SOX17 and GATA4 expression was similar in both patient-derived and healthy endodermal cells. The expression of the key transcription factor SOX2 was significantly lower in the patient-derived anterior foregut. We also observed an abnormal expression of NKX2.1 (or NKX2-1) in the patient-derived mature esophageal organoids. At the anterior foregut stage, RNA sequencing revealed the critical genes GSTM1 and RAB37 to be significantly lower in the patient-derived anterior foregut. We therefore hypothesize that a transient dysregulation of SOX2 and the abnormal expression of NKX2.1 in patient-derived cells could be responsible for the abnormal foregut compartmentalization.
Microdoses of Recombinant Human Erythropoietin Enhance Time Trial Performance in Trained Males and Females
Authors: BREENFELDT ANDERSEN ANDREAS , GRAAE JONATHAN , BEJDER JACOB , BONNE THOMAS C. , SEIER SØREN , DEBERTIN MAREN , EIBYE KASPER , HOSTRUP MORTEN , NORDSBORG NIKOLAI B.
Published: November 2022

Purpose

We investigated the effects of recombinant human erythropoietin (rHuEPO) administration on exercise endurance, maximal aerobic performance, and total hemoglobin mass (tHb). We hypothesized that frequent, small intravenous injections of epoetin β would increase time trial performance, peak oxygen uptake (V̇O2peak), and tHb in both males and females.

Methods

We included 48 healthy, recreational to trained males (n = 24, mean ± SD V̇O2peak = 55 ± 5 mL O2·kg−1⋅min−1) and females (n = 24; V̇O2peak of 46 ± 4 mL O2·kg−1⋅min−1) in a counterbalanced, double-blind, randomized, placebo-controlled study design stratified by sex. Time trial performance, V̇O2peak, and tHb were determined before and after intravenous injections of either rHuEPO (9 IU·kg bw−1 epoetin β) or saline (0.9% NaCl) three times weekly for 4 wk.

Results

A time–treatment effect (P < 0.05) existed for time trial performance. Within the rHuEPO group, mean power output increased by 4.1% ± 4.2% (P < 0.001). Likewise, a time–treatment effect (P < 0.001) existed for V̇O2peak, where the rHuEPO group improved V̇O2peak and peak aerobic power by 4.2% ± 6.1% (P < 0.001) and 2.9% ± 4.0% (P < 0.01), respectively. A time–treatment effect (P < 0.001) existed for tHb, where the rHuEPO group increased tHb by 6.7% ± 3.4% (P < 0.001). A main effect of “sex” alone was also evident (P < 0.001), but no sex-specific interactions were found. No changes were observed in the placebo group for mean power output, V̇O2peak, peak aerobic power, or tHb.

Conclusions

Microdoses with intravenous rHuEPO provide a sufficient erythropoietic stimuli to augment tHb and enhance aerobic-dominated performance in both trained males and females.
The current status of interventional radiology in the undergraduate medical curriculum and the way forward
Authors: Osman Filzah Hanis , Koe Jasmine Sze Ern , Lau Elisa Shi Wei , Nagaraj Dhikshitha , Ng Helen Hoi-Lam , Ng Alexander , Asif Aqua , Uberoi Raman , Lakshminarayan Raghuram , Chan Vinson Wai-Shun , Wah Tze Min
Published: November 2022

Interventional radiology (IR) is underrepresented in undergraduate medical school curricula. Despite the introduction of a suggested undergraduate curriculum for IR by the British Society of Interventional Radiology (BSIR), current evidence suggests there is inadequate knowledge and awareness of IR amongst medical students. As a result of this, there is a lack of visibility of the subspeciality amongst medical students and junior doctors contributing to the shortage of IR trainees resulting in an IR workforce crisis in the UK. The uptake of the proposed undergraduate IR curriculum remains unclear, highlighting the need for a thorough audit and improvement of IR teaching in undergraduate medical education. In this commentary, we discuss the importance of including IR in the undergraduate curriculum, the evidence surrounding undergraduate IR education, the reasons for the potential lack of interest in IR from medical students and future steps to ensure optimal IR exposure in undergraduate medical school curricula.
Definitive-intent (chemo)radiotherapy for sinonasal undifferentiated carcinoma
Authors: Wang Li , Wang Jie , Tang Tianci , Yan Li , Song Xinmao
Published: November 2022

Objective:

The current study aimed to investigate the value of definitive-intent (chemo)radiotherapy in treating sinonasal undifferentiated carcinoma (SNUC) in a single institution.

Methods:

The medical records of 21 patients with SNUC treated with definitive-intent (chemo)radiotherapy between 2011 and 2021 in one single institution were retrospectively reviewed. We analyzed the treatment efficiency and long-term survivals.

Results:

A total of 21 patients were included in this cohort, 12 patients presented with T4 stage at diagnosis, and 6 in T1/T2, 3 in T3 stage. Nine patients (42.9%, 9/21) showed cervical lymph node metastases. All the patients were scheduled to receive definitive (chemo)radiotherapy and five patients had been performed surgery for residual tumor after (chemo)radiotherapy. 66.7% (14/21) of patients had a complete response after the completion of treatment, 23.8% (5/21) of partial response, one of stable disease, and one of progressed disease. The 3-year overall survival of the entire group were 86.2%, and the 3-year progress-free survival were 66.3%, respectively. 52.4% of the patients (11/21) presented orbit invasion, compared with patients without orbit invasion, the patients who had orbit invasion were not found to have significantly poor 3-year overall survival (87.5% vs 83.3%, p = 0.38) and 3-year progression-free survival (75.0% vs 55.3%, p = 0.59).

Conclusion:

Definitive-intent (chemo)radiotherapy could be the preferred treatment for patients with advanced SNUC, and salvage surgery should be performed for the lesions showing stable disease, progressed disease, or residual tumor.

Advances in knowledge:

The value of definitive chemoradiotherapy in treating sinonasal undifferentiated carcinoma.
CT-based radiomics nomogram for the pre-operative prediction of lymphovascular invasion in colorectal cancer: a multicenter study
Authors: Li Manman , Gu Hongmei , Xue Ting , Peng Hui , Chen Qiaoling , Zhu Xinghua , Duan Shaofeng , Feng Feng
Published: November 2022

Objective:

To develop and externally validate a CT-based radiomics nomogram for the pre-operative prediction of lymphovascular invasion (LVI) in patients with colorectal cancer (CRC).

Methods:

357 patients derived from 2 centers with pathologically confirmed CRC were included in this retrospective study. Two-dimensional (2D) and three-dimensional (3D) radiomics features were extracted from portal venous phase CT images. The least absolute shrinkage and selection operator algorithm and logistic regression were used for constructing 2D and 3D radiomics models. The radiomics nomogram was developed by integrating the radiomics score (rad-score) and the clinical risk factor.

Results:

The rad-score was significantly higher in the LVI+ group than in the LVI- group (p < 0.05). The area under the curve (AUC), accuracy, sensitivity and specificity of the 3D radiomics model were higher than those of the 2D radiomics model. The AUCs of 3D and 2D radiomics models in the training set were 0.82 (95% CI: 0.75–0.89) and 0.74 (95% CI: 0.66–0.82); in the internal validation set were 0.75 (95% CI: 0.65–0.85) and 0.67 (95% CI: 0.56–0.78); in the external validation set were 0.75 (95% CI: 0.64–0.86) and 0.57 (95% CI: 0.45–0.69); respectively. The AUCs of the nomogram integrating the optimal 3D rad-score and clinical risk factors (CT-reported T stage, CT-reported lymph node status) in the internal set and external validation set were 0.82 (95% CI: 0.73–0.91) and 0.80 (95% CI: 0.68–0.91), respectively.

Conclusion:

Both 2D and 3D radiomics models can predict LVI status of CRC. The nomogram combining the optimal 3D rad-score and clinical risk factors further improved predictive performance.

Advances in knowledge:

This is the first study to compare the difference in performance of CT-based 2D and 3D radiomics models for the pre-operative prediction of LVI in CRC. The prediction of the nomogram could be improved by combining the 3D radiomics model with the imaging model, suggesting its potential for clinical application.
Tourette syndrome research highlights from 2021
Authors: Hartmann Andreas , Andrén Per , Atkinson-Clement Cyril , Czernecki Virginie , Delorme Cécile , Debes Nanette Marinette , Szejko Natalia , Ueda Keisuke , Black Kevin
Published: November 2022

We summarize selected research reports from 2021 relevant to Tourette syndrome that the authors consider most important or interesting. The authors welcome article suggestions and thoughtful feedback from readers.
Cointegration and causality relationship of Indian stock market with selected world markets
Authors: Ali Farman , Suri Pradeep , Kaur Tarunpreet , Bisht Deepa
Published: November 2022

Background: The purpose of this study is to explore the trends and causes of established and emerging nations' stock market integration with India. The National Stock Exchange (NSE) indices act as a counterweight to international market indices.

This study investigates the sustained interest of foreign investors in the Indian stock market in the wake of capital market reforms, as well as whether it moves in tandem with other markets in Asia and the United States.

Methods: Our study examined the possibility of cross-country cointegration between the largest economies and indices around the world using multiple financial econometric models, such as Augmented Dickey-Fuller, Unit Root, Correlation, and Johansen Cointegration.

Results: The findings of this study significantly support the notion that Indian and international financial markets are highly integrated. Vector error correction model indicates that the Indian market (NSE) is highly cointegrated with the US market (National Association of Securities Dealers Automated Quotations) and increased volatility signifies global contagion.

Conclusion: A cursory examination of the data reveals distinct investment and portfolio diversification options for global investors. This could assist regulators in formulating more effective rules regarding price discovery processes.
Assessment of medication-related burden among a sample of Iraqi patients with systemic lupus erythematosus and its relationship with disease activity: a cross-sectional study
Authors: Kadhim Abbas Hawraa , Jabbar Kadhim Dheyaa , Isho Gorial Faiq , Shareef Laith G.
Published: November 2022

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with high morbidity and disability. The routines involved in taking medications, side effects, the nature of medicines, difficulties with the healthcare system, and disruptions to social activities all contribute to patients frequently experiencing medication-related burdens (MRB). The current study aimed to assess the perceived MRB among a sample of SLE patients from Iraq and to look for any possible relationship between MRB and disease activity.

Methods: The current study was cross-sectional on diagnosed SLE patients who arrived at Baghdad Teaching Hospital/Medical City/Rheumatology department from September 2021 to January 2022. MRB was measured using the Living with Medicines Questionnaire (LMQ).

Results: The study recruited 156 SLE patients. The patients were 35.8 ±11.7 years old on average. Great majority of them were women (96.8 %). The average LMQ score was 117.30± 18.37. The results showed that most patients (69.87%) experienced a moderate level of burden, followed by a low level (19.87%), high level (7.69%), and no burden at all (2.56%). No patients experienced an extremely high level of burden (0.0%). The mean burden scores for two LMQ domains—relationships with health care professionals (HCPs) and effectiveness of prescription medications—were the lowest (below average).

Conclusions: Many of the SLE patients in this study reported experiencing MRB. Healthcare professionals should implement strategies to reduce this burden, particularly for low-income patients.
Рredicting epizootic risks of leptospirosis
Authors: Kozishkurt E. , Talalaev K. , Melnik O. , Sovirda O. , Gerasimenko E. , Kostolonova L.
Published: November 2022

Leptospirosis is an infectious disease of humans and animals that is caused by pathogenic spirochetes of the genus Leptospira. It is considered the most common zoonosis in the world and is associated with settings of poor sanitation and agricultural occupations involving contact with animals or water. The authors have analyzed the present day world and particular Ukrainian situation with leptospirorsis and pointed out the urgent measures which could prevent its prevalence.
Carpal tunnel syndrome: correlation of the severity of the clinical picture and electrophysiological studies
Authors: Almigdad Ahmad , Odat Mazen , Almanasir Ghandi , Megdadi Noor , Sharadgeh Sulieman
Published: November 2022

Purpose: This study aimed to correlate the severity of carpal tunnel syndrome (CTS) in terms of the clinical picture with electrophysiological studies to determine whether the severity could be predicted through one measure based on correlations with another.Methods: This cross-sectional correlational study enrolled 96 patients (139 hands) whose nerve conduction studies (NCS) confirmed the diagnosis of CTS, and to whom the Boston Carpal Tunnel Questionnaire (BCTQ) was administered to determine the subjective and clinical CTS severity. The severity of both measures was correlated. Results: The patients’ mean age was 49.84±12.23 years. Most (67.7%) were female. The NCS severity grades were as follows: mild, 46%; moderate, 32.4; severe, 9.4%; and very severe, 12.2%. The sensory and motor NCS parameters were significantly correlated with the BCTQ severity. The patients’ overall mean scores for symptom severity had substantive predictive accuracy for the patients’ CTS severity measured with the NCS. Similarly, most of the functional severity score items had significant predictive accuracy for the patients’ NCS-based carpal tunnel severity score.Conclusion: The clinical severity of CTS was strongly correlated with the severity based on nerve conduction. This correlation was more notable for symptom severity scores than for functional status scores. Night pain and numbness demonstrated the strongest associations of all BCTQ items with the NCS. Although clinical severity (based on the BCTQ) predicts the nerve conduction severity, we still recommend performing NCS for patients with a clinical diagnosis of CTS as a confirmatory objective measure and for medico-legal reasons.
Overcoming the Impact of Online Games through Literacy for Junior High School Students in South Tangerang City
Authors: Romadlan Said , Muhammad Maududi Mukhlis
Published: November 2022

Background: A form of communication technology widely played today is an online game, which is a type of game that utilizes computer networks. However, this type of game can cause addictive effects in the long run, such as in the case of Islamic Junior High School students Raudlatul Hikmah, thereby leading to decreased learning performance. This research aims to provide online game literacy training, such as the development, characteristics, and forms of online gaming, regulation, ethics, and the effects of online games, and tips on overcoming them.
Contribution: This research contributes to students' understanding of the development characteristics and forms of online games, as well as the regulations, ethics, and their effects, to overcome its negative impacts.
Method: Methods applied include sharing experiences in using online games, presentations and discussions on its literacy, and  questionnaire and guided group discussions on online game problems.
Results: The results showed that on the average, 82% of students understand the development, characteristics, and types of online games. Meanwhile, 96% understand its effects, while 85% have adequate knowledge of the tips needed to overcome the associated adverse effects.
Conclusion: In conclusion, the objectives set by this training program can meet the target of providing online game literacy for Islamic Junior High School students Raudlatul Hikmah
Learning in the Digital Age During the COVID-19 Pandemic for School Improvement
Authors: Lee Bih Ni
Published: November 2022

Background: Digital learning became increasingly popular when the COVID-19 disaster hit. Even though, its implementation is still less popular after no special indicators are used to create systematic learning. Comprehensive access to online education with fifth generation (5G) mobile technology coverage will enhance the quality of learning in the face of the digital age.
Contribution: The contribution of this study is to increase the awareness of online learning during the COVID-19 pandemic. It recognizes the importance of strengthening online learning when schools close. It also highlights digital technologies and practices for school improvement and enters an endemic era.
Method: Synthesis method. Researcher synthesized information naturally to help others see connections between things.
Results: The presence of the COVID-19 threat has opened a new norm in pedagogical methods in Malaysia. The use of technology has long been championed since 2013. Its importance became apparent after the emergence of the pandemic in early 2020. Not because of pandemic had to give way to technology but the times need change according to the currents of modernity and high technology. Since then, we have faced the threat of a pandemic and through a life of new norms.  The convenience of computers and smartphones has changed the current learning process.
Conclusion: The COVID-19 pandemic has affected the structure of Learning and Teaching in Malaysian educational institutions. Education institutions were also instructed to close and the live or face-to-face method of Learning and Teaching was changed to fully online Learning and Teaching. The education system will undergo changes of learning in the digital age. Digital learning also continues to be the new norm of pedagogy in the future.
Promoting kidney health in cardiovascular disease: part one
Authors: Murphy Fiona , Byrne Gobnait
Published: November 2022

The prevalence of chronic kidney disease is increasing in both developed and developing countries. Many of the risk factors for chronic kidney disease are also risk factors for cardiovascular disease. Therefore, it is important that cardiac nurses use the three levels of prevention (primary, secondary and tertiary) to reduce the prevalence of chronic kidney disease when caring for patients. The promotion of a healthy lifestyle, coupled with an adequate fluid intake to prevent dehydration, is key to primary prevention. As part of secondary prevention, screening for chronic kidney disease is necessary for high-risk groups, such as patients with diabetes and hypertension, and those who take nephrotoxic drugs. Finally, tertiary prevention aims to reduce the impact of both chronic kidney disease and cardiovascular disease on outcomes and quality of life, and can include cardiac rehabilitation. This article is the first of two-part series on the interrelationship between chronic kidney disease and cardiovascular disease. Part one of this series will address the importance of promoting kidney health in adults living with cardiovascular disease, while part two will discuss how nurses can help patients to live well with these conditions.
Diagnostic test accuracy of assessment tools for detecting delirium in patients with acute stroke: commentary of a systematic review
Authors: Ghosh Malabika , Hamer Oliver , Hill James
Published: November 2022

Delirium is a common presentation after acute stroke. Post-stroke delirium is related to poor recovery, higher rates of mortality, falls and longer hospital stays. Delirium can lead to challenging behaviour, such as anger, aggression and confusion. Therefore, it is important to promptly identify delirium for early management and to reduce the negative impact on post-stroke recovery and outcomes. An important aspect of identifying delirium depends on the use of efficient, easy to use and validated assessment tools. A wide range of tools are available, although it is not known how accurately they can identify post-stroke delirium. This article critically appraises a systematic review that identified delirium screening tools for patients with acute stroke.