bluuebunny/crossref_metadata_2025 huggingface dataset:
UNDIFFERENTIATED EMBRYONAL SARCOMA OF THE LIVER: A CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Katherine Romero-Moreno , Catalina Pineda-Garcés , Luis Muñoz-Rayo , Javier Fox-Quintana , Jorge Gutiérrez-Montoya
Published: June 2023

Sarcomas represent less than 1% of all malignant tumors.
Undifferentiated Embryonal Sarcoma (UES) of the liver is the third most
common pediatric liver cancer. The main differential diagnoses are
mesenchymal hamartoma, hepatoblastoma, and biliary embryonal
rhabdomyosarcoma. Definitive diagnosis is confirmed by histopathology
and immunohistochemical. 4-year-old male patient with fever, abdominal
pain and palpable hepatomegaly was found. Magnetic Resonance Imaging
(MRI) with an unifocal cystic hepatic mass, with compression and
displacement of vascular structures, but without invasion; hamartoma was
suspected. The management was a right hepatectomy. Immunohistochemistry
studies were positive for UES. Adjuvant chemotherapy was started with a
good response.
Shear Wave Splitting Analysis using Deep Learning (SWSNet)
Authors: Chakraborty Megha , Rümpker Georg , Li Wei , Faber Johannes , Link Frederik , Srivastava Nishtha
Published: June 2023

Teleseismic shear-wave splitting analyses are typically performed by
reversing the splitting process through the application of frequency- or
time-domain operations minimizing transverse-component waveforms. These
operations yield two splitting parameters, φ (fast-axis orientation) and
δt (delay time). In this study, we investigate the applicability of a
recurrent neural network, SWSNet, for determining the splitting
parameters from pre-selected waveform windows. Due to the scarcity of
sufficiently labelled real waveform data, we generate our own synthetic
training dataset. The model is capable of determining φ and δt with a
root mean squared error (RMSE) of 9.58◦ and 0.143 s for noisy synthetic
test data. The application to real data involves a deconvolution step to
homogenize the waveforms. When applied to data from the USArray dataset,
the results exhibit similar patterns to those found in previous studies
with mean absolute differences of 11.12◦ and 0.25 s in the calculation
of φ and δt, respectively.
Relativistic runaway electron avalanche development near the electric field threshold in inhomogeneous air
Authors: Diniz Gabriel Sousa , Wada Yuuki , Ohira Yutaka , Nakazawa Kazuhiro , Tsurumi Miwa , Enoto Teruaki
Published: June 2023

Relativistic Runaway Electrons Avalanches (RREAs) development depends on
the applied electric field and the environment air density. This
dependency controls the RREA exponential growth length scale. The RREA
development affects the bremsstrahlung excess occurring due to the
passage of charged particles through the thundercloud’s electric fields,
the gamma-ray glow. We used Monte Carlo simulations to develop an
empirical model showing the RREA behavior in a realistic atmospheric
density profile. The new formulation shows how the density variation
modulates the electron population under electric field strengths near
the RREA electric field threshold. The model limits the initial RREA
altitude range as a function of the electric field strength. The new
model is valid between $\sim$ 0.6 and
$\sim$ 18 km, covering the relevant heights to
investigate the generation of ground-detected gamma-ray glows.
Aridification of northwest Australia and nutrient decline in the Timor Sea during the 40 kyr world
Authors: Zhang Yan , Andrade Tori , Ravelo Ana Christina , Gong Li , Holbourn Ann , Connock Gregory , Liu Xiaolei , Aiello Ivano W
Published: June 2023

Studying tropical hydroclimate and productivity change in the past is
critical for understanding global climate dynamics. Northwest Australia
is an ideal location for investigating Australian monsoon dynamics, the
variability of the Indonesian Throughflow (ITF), and their impact on
past productivity and warm pool evolution, which remain poorly
understood during the 40 kyr world in the mid-early Pleistocene. In this
study, we present multi-proxy records from International Ocean Discovery
Program (IODP) Site U1483 in the Timor Sea spanning the last 2000 ka,
including orbitally-resolved records from the 40 kyr world between 2000
and 1300 ka. Our results suggest that northwest Australia underwent a
step of increased aridification and that productivity in the Timor Sea
declined during the transition from ~ 1700 to
~ 1400 ka. We attribute this aridification to the
reduced moisture supply to this region caused by the ITF restriction and
warm pool contraction. We ascribe the declined productivity to a
decrease in the nutrient supply of the Pacific source water associated
with global nutrient redistribution. At orbital timescale, multiple
mechanisms, including sea level changes, monsoon, and the Intertropical
Convergence Zone (ITCZ) dynamics, and variations in the ITF and Walker
circulation could control variations of productivity and terrigenous
input in the Timor Sea during the 40 kyr world. Our bulk nitrogen and
benthic carbon isotope records suggest a strong coupling to
biogeochemical changes in the Pacific during this period. This research
contributes to a better understanding of tropical hydroclimate and
productivity changes during the 40 kyr world.
Upward Lightning at Wind Turbines: Risk Assessment from Larger-Scale Meteorology
Authors: Stucke Isabell , Morgenstern Deborah , Mayr Georg , Simon Thorsten , Zeileis Achim , Diendorfer Gerhard , Schulz Wolfgang , Pichler Hannes
Published: June 2023

Upward lightning (UL) has become a major threat to the growing number of
wind turbines producing renewable electricity. It can be much more
destructive than downward lightning due to the large charge transfer
involved in the discharge process. Ground-truth lightning current
measurements indicate that less than 50% of UL could be detected by
lightning location systems (LLS). UL is expected to be the dominant
lightning type during the cold season. However, current standards for
assessing the risk of lightning at wind turbines mainly consider summer
lightning, which is derived from LLS. This study assesses the risk of
LLS-detectable and LLS-undetectable UL at wind turbines using direct UL
measurements at instrumented towers. These are linked to meteorological
data using random forests. The meteorological drivers for the
absence/occurrence of UL are found from these models. In a second step,
the results of the tower-trained models are extended to a larger study
area (central and northern Germany). The tower-trained models for
LLS-detectable lightning are independently verified at wind turbine
sites in this area and found to reliably diagnose this type of UL. Risk
maps based on cold season case study events show that high diagnosed
probabilities in the study area coincide with actual UL events. This
lends credibility to the application of the model to all UL types,
increasing both risk and affected areas.
How to Achieve a 50% Reduction in Nutrient Loads from Agricultural Catchments under Different Climate Trajectories?
Authors: Wynants Maarten , Strömqvist Johan , Hallberg Lukas , Livsey John , Lindström Göran , Bieroza Magdalena
Published: June 2023

Under persistent eutrophication of European water bodies and a changing
climate, there is an increasing need to evaluate mitigation measures for
reducing nutrient losses from agricultural catchments. In this study, we
set up a daily discharge and water quality model in Hydrological
Predictions of the Environment for two contrasting agricultural
catchments in Sweden to forecast the impacts of future climate
trajectories on nutrient loads. The model predicted a slight increase in
inorganic nitrogen (IN) and total phosphorus (TP) loads under RCP2.6,
likely due to precipitation-driven mobilisation. Under RCP4.5 and
RCP8.5, the IN loads were forecasted to decrease from 16%-26% and
21%-50% respectively, most likely due to temperature-driven increases
in denitrification and evapotranspiration. No distinct trends in TP
loads were observed. A 50% decrease in nutrient loads, as targeted by
the European Green Deal, was backcasted using a combination of
mitigation scenarios, including i) a 20% reduction in mineral
fertiliser, ii) introducing cover crops, and iii) stream mitigation by
increasing the size of floodplains and wetlands. Target TP load
reductions could only be achieved by stream mitigation, which is likely
due to legacy effects and secondary mobilisation within agricultural
streams. Target IN load reductions were backcasted with a combination of
stream mitigation, fertiliser reduction, and cover crops, wherein the
required measures depended on the climate. Overall, the diverging
responses of nutrients to climate change and mitigation scenarios
indicate that water quality management needs to be tailored to the
catchment characteristics, and to the spatial and time specific effects
of climate change.
Fine and Coarse Dust Effects on Radiative Forcing, Mass Deposition, and Solar Devices over the Middle East
Authors: Mostamandi Suleiman , Ukhov Alexander , Engelbrecht Johann P , Shevchenko Illia , Osipov Sergey , Stenchikov Georgiy
Published: June 2023

In desert regions like the Middle East (ME), dust has a profound impact
on the environment,climate, air quality, and solar devices. The size of dust particles
determines the extent of theseeffects. Dust deposition (DD) measurements show that coarse dust
particles with geometricradius r > 10 μm comprise most of the deposited mass.
Still, these particles are not represented inthe current models that are tuned to fit the observed aerosol visible
optical depth (AOD). As aresult, the existing models and reanalysis products underestimate DD and
dust emission (DE)almost three times. This is the first study to constrain the dust
simulations by both AOD and DDmeasurements to quantify the effect of coarse and fine dust using the
WRF-Chem model. Wefound that, on average, coarse dust contributes less than 10% to dust
shortwave (SW) radiativeforcing (RF) at the surface but comprises more than 70% of DE. Annual
mean net RF over theArabian Peninsula and regional seas locally reaches -25 W m-2. Airborne
fine dust particleswith radii r < 3 μm are mainly responsible for the significant
dimming (5-10%) of solarradiation, cooling the surface and hampering solar energy production.
However, dust massdeposition is primarily linked to coarse particles, decreasing the
efficiency of Photovoltaic panelsby 2-5% per day. Therefore, incorporating coarse dust in model
simulations and data assimilationwould improve the overall description of the dust mass balance and its
impact on environmentalsystems and solar devices.
The role of riverine bed roughness, egg pocket location, and egg pocket permeability on salmonid redd-induced hyporheic flows
Authors: Bhattarai Bishal , Hilliard Brandon , Reeder William Jeffery , Budwig Ralph , Martin Benjamin T. , xing Tao , Tonina Daniele
Published: June 2023

Salmon spawning activities alter streambed morphology, forming a
dune-shaped egg nest called a redd. The spawning process increases redd
sediment hydraulic conductivity, KD, and congregates large sediment
grains to form an egg pocket, such that egg pocket hydraulic
conductivity, KEP, may be higher than KD. Salmon females may create one
or more egg pockets within a single redd. Although the impact of redd
shape and KD on redd-induced hyporheic fluxes has been studied, the
effects of streambed roughness, R, egg pocket permeability, and egg
pocket location on egg pocket hyporheic fluxes have not yet been
quantified. This study investigates this knowledge gap with a set of
numerical simulations supported by flume experiments. We simulated
hyporheic flows for five egg pocket locations, five KEP values from
0.0025 to 0.02 m/s, and 12 rough streambed surfaces. Surface roughness
was scaled from a measured streambed surface in two ways - only
vertically (R1) and both vertically and horizontally (R2) - with scaling
coefficients ranging from 0.5 to 3. The measured streambed surface had a
median diameter, D50, of 1 cm and a standard deviation of 0.77 cm. The
results indicated that the dimensionless flux into the egg pocket
increases noticeably with the downstream distance of egg pockets from
the redd pit, and less strongly with KEP*. The near-surface downwelling
fluxes significantly increase with R1, but only negligibly with R2, and
for deeper egg pockets, lux into the egg pocket is minimally impacted by
surface roughness.
Electrostatic waves around a magnetopause reconnection diffusion region and their associations with whistler and lower-hybrid waves
Authors: Wang Shan , Graham Daniel Bruce , An Xin , Li Li , Zong Qiu-Gang , Zhou Xu-Zhi , Li Wenya , Liu Z.-Y.
Published: June 2023

We investigate electrostatic waves in a magnetopause reconnection
diffusion region event. In the electron diffusion region on the
magnetospheric side, an oblique electrostatic wave is observed. The
local distribution exhibits fast non-gyrotropic electron beams with
drifts comparable to the electron thermal speed, but the wave has a much
lower phase speed. Response of ions and possible cold electrons may
contribute to wave excitation. Near the current sheet mid-plane,
parallel electron beam-mode waves are modulated by whistler waves. In
the separatrix region, parallel waves associated with field-aligned
electron beams and perpendicular electron cyclotron waves with loss cone
distributions exhibit modulation frequencies in the lower-hybrid wave
frequency range. We infer that lower-hybrid waves scatter electrons to
produce beams and alter loss cones to modulate electrostatic waves. The
results advance our understanding about the regimes and mechanisms of
electrostatic waves in reconnection and their coupling with
lower-frequency waves.
Empirical Dynamic Modeling Reveals Complexity of Methane Fluxes in a Temperate Salt Marsh
Authors: Hill Andrew C , Forbrich Inke , Schäfer Karina VR , Vargas Rodrigo
Published: June 2023

Methane dynamics within salt marshes are complex because vegetation
types, temperature, oscillating water levels, and changes in salinity
and redox conditions influence CH4 production and emission. These
non-linear and complex interactions among variables affect the
traditionally expected functional relationships and present challenges
for interpretation and developing process-based models. We employ
empirical dynamic modeling (EDM) and convergent cross mapping (CCM) as a
novel approach for characterizing seasonal/multiday and diurnal CH4
dynamics by identifying causal variables, lags, and interconnections
among multiple biophysical variables within a temperate salt marsh using
five years of eddy covariance data. EDM/CCM is a nonparametric approach
capable of quantifying the coupling between variables while determining
time scales where variable interactions are most relevant. We found that
gross primary productivity, tidal creek dissolved oxygen, and
temperature were important for seasonal/multiday dynamics
(rho=0.73-0.80), while water level was most important for diurnal
dynamics during both the growing and dormancy phenoperiods (rho=0.72 and
0.56, respectively). Lags for top causal variables (gross primary
productivity, tidal creek dissolved oxygen, temperature, water level)
occurred between 1-5 weeks at the seasonal scale and 1-24 hours at the
diurnal scale. The EDM had high prediction capabilities for
intra-/inter-seasonal patterns and annual CH4 sums but with limitations
to represent large infrequent fluxes. Results highlight the importance
of non-linearity, causal drivers, lag times, and interconnections among
multiple biophysical variables that regulate CH4 fluxes in tidal
wetlands. This study presents a new dimension for analyzing CH4 fluxes,
which will prove helpful to test current paradigms in wetlands and other
ecosystems.
Expanding the Range of Back-Projections: Core Phase Approach for Southern Hemisphere Earthquake Imaging
Authors: Xu Liuwei , Meng Lingsen
Published: June 2023

Standard Back-Projections (BPs) use P phase recordings at large aperture
arrays within teleseismic distances (30°-90°) to image earthquake
sources. However, the majority of sizable arrays are in the northern
hemisphere, leaving many southern hemisphere earthquakes beyond the
teleseismic range. We extend the BP method by utilizing seismic waves
traveling through the Earth’s core, expanding our capability to image
earthquakes worldwide. Our core phase BPs incorporate PKIKP (150°-180°)
and PKP (145°-175°) phases. We evaluate their theoretical resolutions
using 1-D and 2-D array response functions and test uncertainties by
adding white noise to coherent waveforms. Tests show that core phase BPs
achieve resolutions and uncertainties comparable to P phase BP. We
validate the method using a synthetic model of a unilateral rupture (Mw
7.45, 2 km/s) and demonstrate accurate recovery of rupture direction,
length, and speed. Applying core phase BPs to the 2010 Mw 8.8 Chile and
2015 Mw 7.1 southeast Indian Ridge earthquakes, we compare our results
with published BPs and/or slip models, confirming the feasibility and
reliability of core phase BPs. We then apply core phase BPs to five
understudied earthquakes in the southwest Pacific region, providing
insights into these pelagic earthquakes. Core phase BPs play a crucial
role in scenarios where teleseismic arrays are unavailable, and have
weaker array-dependent effect and better performance in bilateral
rupture imaging. Finally, we discuss the limitations of core phase BPs
and outline potential avenues for future research.
Internal model control of cumene process using analytical rules and evolutionary computation
Authors: Lakshmanan Vinila , Kallingal Aparna , Sreekumar Sreepriya
Published: June 2023

Cumene is a precursor for producing many organic chemicals and is thinner in paints and lacquers. Its production process involves one of the large-scale manufacturing processes with complex kinetics. Different classical control strategies have been implemented and compared in this process for the cumene reactor. As a system with large degrees of freedom, a novel approach for extracting the state space model from the COMSOL Multiphysics implementation of the system is adopted here. Internal Modern Control (IMC) based PI and PID controllers are derived for the system. The system is reduced to the FOPDT and SOPDT model structure to derive the controller setting using Skogestad half rules. The integral time is modified for excellent set point tracking and faster disturbance rejection. From the analysis, it can be stated that the PI controller suits more for this specific process. The particle swarm optimization (PSO) algorithm, an evolutionary computation technique, is also used to tune the PI settings. The PI controllers with IMC, Zeigler Nichols, and PSO tuning are compared, and it can be concluded that the PSO PI controller settles at 45 s without any oscillations and settles down faster for the disturbance of magnitude 0.5 applied at t = 800 s. However, it is computationally intensive compared to other controller strategies.
System development for monitoring the production process of freeze-dried samples: A simple and low-cost approach
Authors: Dal-Bó Vanessa , Nogueira Altino , Freire José
Published: June 2023

The data acquisition from the freeze-drying process is important for obtaining freeze-dried samples with the desired final moisture content under various operating conditions. The current study extensively presents a simple and low-cost methodology for implementing a data acquisition system in a laboratory-scale freeze dryer. The results showed that higher drying temperatures (40?C) increased the errors involved in measuring the mass of material; nevertheless, the application of correction blank curves statistically significantly reduced those errors. In general, the system developed provided precise and accurate measurements of the temporal changes in the sample mass and temperature, and chamber pressure variations, allowing monitoring of the production process of freeze-dried samples with low final moisture contents.
Inspiration for contemporary prefabrication found in tradition
Authors: Djuric-Mijovic Danijela , Milosevic Vuk , Milanovic Danijela , Savic Jelena , Cilic Aleksandra
Published: June 2023

The paper discusses the buildings from the past that can be considered the
precursors of prefabricated buildings as we know them today, and can also be
considered as inspiration for modern prefabrication. The research platform
in the paper is represented by selected examples of buildings characteristic
of the Western Balkans, namely: "kucer", "povoznica", "tronj", a hut on
Kostan polje and a house from Kosovo. The second part of the paper presents
an example from the world, a "yurt" characteristic of various locations on
the Asian continent, which finds application in the modern world.
Flexibility, mobility and economy, the main characteristics of prefabricated
buildings as we know them today, are recognized as guiding ideas of the
analyzed examples
Transformation of public spaces as tendency of overcoming fragmentation in divided cities: Case study of Kosovska Mitrovica
Authors: Bozovic Jelena
Published: June 2023

The aim of this paper is to investigate the role of public spaces, their transformation in the Kosovska Mitrovica city divided to the southern and northern part and their importance in order to overcome this fragmentation. It is important that the development and transformation of public spaces in this divided city contribute to the materialization of accessible spaces which promote the social integration and tolerance through an inclusive processes. The applied spatial-functional analysis of the mapped public spaces in the city as well as the observation of the social interaction in common public spaces constitute the framework of this paper. Concluding remarks provide an answer to the question of whether and to what extent the transformation of public spaces in the years after the war in Northern and Southern Kosovska Mitrovica affect the interaction of different ethnic groups, as well as the tendency to overcome fragmentation in this divided city.
Induction of KLF2 by Exercise Activates eNOS to Improve Vasodilatation in Diabetic Mice
Authors: Luo Jiang-Yun , Cheng Chak Kwong , Gou Lingshan , He Lei , Zhao Lei , Zhang Yang , Wang Li , Lau Chi Wai , Xu Aimin , Chen Alex F. , Huang Yu
Published: June 2023

Diabetic endothelial dysfunction associated with diminished endothelial nitric oxide (NO) synthase (eNOS) activity accelerates the development of atherosclerosis and cardiomyopathy. However, the approaches to restore eNOS activity and endothelial function in diabetes remain limited. The current study shows that enhanced expression of Krüppel-like factor 2 (KLF2), a shear stress-inducible transcription factor, effectively improves endothelial function through increasing NO bioavailability. KLF2 expression is suppressed in diabetic mouse aortic endothelium. Running exercise and simvastatin treatment induce endothelial KLF2 expression in db/db mice. Adenovirus-mediated endothelium-specific KLF2 overexpression enhances both endothelium-dependent relaxation and flow-mediated dilatation, while it attenuates oxidative stress in diabetic mouse arteries. KLF2 overexpression increases the phosphorylation of eNOS at serine 1177 and eNOS dimerization. RNA-sequencing analysis reveals that KLF2 transcriptionally upregulates genes that are enriched in the cyclic guanosine monophosphate–protein kinase G–signaling pathway, cAMP-signaling pathway, and insulin-signaling pathway, all of which are the upstream regulators of eNOS activity. Activation of the phosphoinositide 3-kinase–Akt pathway and Hsp90 contributes to KLF2-induced increase of eNOS activity. The present results suggest that approaches inducing KLF2 activation, such as physical exercise, are effective to restore eNOS activity against diabetic endothelial dysfunction.

Article Highlights

Exercise and statins restore the endothelial expression of Krüppel-like factor 2 (KLF2), which is diminished in diabetic db/db mice. Endothelium-specific overexpression of KLF2 improves endothelium-dependent relaxation and flow-mediated dilation through increasing nitric oxide bioavailability. KLF2 promotes endothelial nitric oxide synthase (eNOS) coupling and phosphorylation in addition to its known role in eNOS transcription. KLF2 upregulates the expression of several panels of genes that regulate eNOS activity.
Metformin Disrupts Signaling and Metabolism in Fetal Hepatocytes
Authors: Swenson Karli S. , Wang Dong , Jones Amanda K. , Nash Michael J. , O’Rourke Rebecca , Takahashi Diana L. , Kievit Paul , Hennebold Jon D. , Aagaard Kjersti M. , Friedman Jacob E. , Jones Kenneth L. , Rozance Paul J. , Brown Laura D. , Wesolowski Stephanie R.
Published: June 2023

Metformin is used by women during pregnancy to manage diabetes and crosses the placenta, yet its effects on the fetus are unclear. We show that the liver is a site of metformin action in fetal sheep and macaques, given relatively abundant OCT1 transporter expression and hepatic uptake following metformin infusion into fetal sheep. To determine the effects of metformin action, we performed studies in primary hepatocytes from fetal sheep, fetal macaques, and juvenile macaques. Metformin increases AMP-activated protein kinase (AMPK) signaling, decreases mammalian target of rapamycin (mTOR) signaling, and decreases glucose production in fetal and juvenile hepatocytes. Metformin also decreases oxygen consumption in fetal hepatocytes. Unique to fetal hepatocytes, metformin activates stress pathways (e.g., increased PGC1A gene expression, NRF-2 protein abundance, and phosphorylation of eIF2α and CREB proteins) alongside perturbations in hepatokine expression (e.g., increased growth/differentiation factor 15 [GDF15] and fibroblast growth factor 21 [FGF21] expression and decreased insulin-like growth factor 2 [IGF2] expression). Similarly, in liver tissue from sheep fetuses infused with metformin in vivo, AMPK phosphorylation, NRF-2 protein, and PGC1A expression are increased. These results demonstrate disruption of signaling and metabolism, induction of stress, and alterations in hepatokine expression in association with metformin exposure in fetal hepatocytes.

Article Highlights

The major metformin uptake transporter OCT1 is expressed in the fetal liver, and fetal hepatic uptake of metformin is observed in vivo. Metformin activates AMPK, reduces glucose production, and decreases oxygen consumption in fetal hepatocytes, demonstrating similar effects as in juvenile hepatocytes. Unique to fetal hepatocytes, metformin activates metabolic stress pathways and alters the expression of secreted growth factors and hepatokines. Disruption of signaling and metabolism with increased stress pathways and reduced anabolic pathways by metformin in the fetal liver may underlie reduced growth in fetuses exposed to metformin.
131-OR: Glycemic Measures in Childhood as Predictors of Future Diabetes-Related Microvascular Complications
Authors: VAZQUEZ LAURA , VAZQUEZ ARREOLA ELSA , HANSON ROBERT L. , SINHA MADHUMITA
Published: June 2023

The United States Preventive Services Task Force recently questioned the benefits of risk-based screening for prediabetes/T2D in asymptomatic children with overweight/obesity due to lack of long-term health outcomes data. We examined associations of HbA1c and 2-hour post-load plasma glucose (2-hr PG), obtained during childhood (5 - <18 years) in a longitudinal study in an American Indian community (1965-2007), with future albuminuria [albumin creatinine ratio (ACR) ≥ 30 mg/g], severe albuminuria (ACR ≥ 300 mg/g), and retinopathy (at least one microaneurysm or hemorrhage or proliferative retinopathy on direct ophthalmoscopy). We compared the performance of childhood glycemic measures in predicting these complications using area under the ROC curve (AUC). In children without T2D at baseline, higher HbA1c (HR=3.09 per 1%, 95% CI: 1.17-8.22) and 2-hr PG (HR= 1.48 per 1 mmol/L, 95% CI: 1.31-1.67) significantly increased retinopathy risk. Children with T2D based on baseline HbA1c had the highest incidence of albuminuria, severe albuminuria, and retinopathy compared to those with prediabetes and normal HbA1c levels. AUCs for HbA1c, 2-hr PG, or FPG were not significantly different (Figure). Higher levels of glycemia in childhood associated with future microvascular complications demonstrating the utility of screening tests performed in high-risk children in predicting long-term health outcomes.

Disclosure

L.Vazquez: None. E.Vazquez arreola: None. R.L.Hanson: None. M.Sinha: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases
1785-PUB: Dyslipidemia Management in Patients with the First Acute Coronary Event—A Retrospective Observational EMR-Based RWE Study
Authors: CHRISTOPHER JOHANN , GUPTA ANKUR , PAKSHIRAJAN BALAJI , KOTAK BHAVESH P. , GAURAV KUMAR , RATHOD RAHUL T. , HUSSAIN NAQVI SYED MUJTABA , KANURU VASU PRAVEEN C. , T ABHISHEK
Published: June 2023

Backgroud: The understanding of the current state of evidence-based lipid management after ACS is critical for improving outcomes after the first coronary event. The present study was conducted to evaluate the real-world prescribing patterns of statin therapy over one year in adults presenting with the first ACS event.

Material & Methods: The data of 527 patients with the first event of ACS receiving Statins based therapy from 10 healthcare centers across India were considered for the analysis starting from January 2018 to December 2020. The various doses of Statins based therapy at the time of ACS event and at Visit 1 and at the end of 12 months and the percentage of patients who have achieved guideline LDL levels were analysed.

Results: The most common statins used are Atorvastain 80mg & 40mg, Rosuvastatin 40mg OD. Dose of Atorvastatin & Rosuvastatin was reduced from High intensity to moderate intensity in 21.97% & 2.64% patients during visit 1. After 12 months, the dose of Atorvastatin was further reduced in 7.98% and 31.20% on Rosuvastatin. The desired LDL as per Indian & global guidelines of <30mg/dl, <55mg/dl, <70mg/dl, <100mg/dl is achieved in only 2.66%, 19.37%, 47.94%, 91.52% patients on statin based therapy respectively.

Conclusion: The Doses of statins were reduced from High intensity to moderate/low intensity therapy despite patients were not achieving desired LDL levels as per Indian & Global guidelines. The present study emphasizes the use of right intensity statins in ACS patients to achieve desired cardiac outcomes.

Disclosure

J.Christopher: None. A.Gupta: None. B.Pakshirajan: None. B.P.Kotak: Employee; Dr. Reddy’s Laboratories Ltd. K.Gaurav: None. R.T.Rathod: None. M.Syed: None. V.C.Kanuru: None. A.T: None.
1797-PUB: Perspectives of Primary Care Providers on the Acceptability of a Brief Video to Decrease the Use of Diabetes-Stigmatizing Language
Authors: JOINER KEVIN , AGAPIOU ALEXANDRA , ADAMS MACKENZIE , PIATT GRETCHEN
Published: June 2023

Diabetes stigma is recognized to negatively impact health-related outcomes and quality of life in adults living with type 2 diabetes (T2D). The American Diabetes Association provides guidance for health care providers to decrease the use of diabetes-stigmatizing language. The aim of this qualitative study is to explore primary care providers’ (PCPs’) perspectives on the acceptability of a brief video that we developed to decrease the use of diabetes-stigmatizing language in patient-PCP encounters. PCPs were recruited online from professional organizations and via snowball sampling to participate in a single individual interview via Zoom (December 2021- October 2022). Trained interviewers conducted the interviews via Zoom using a semi-structured interview guide. A qualitative descriptive approach was used in the analysis. Eighteen PCPs were interviewed (44% aged 30-39 years old, 78% female, 78% non-Hispanic White, and 50% nurse practitioners). Qualitative description resulted in 3 major themes. Some PCPs perceive that the language used in patient-PCP encounters appears to play an outsized role in the culture of the clinic as far as endorsing or confronting diabetes stigma. Some PCPs perceive that they already advocate for decreasing the use of diabetes-stigmatizing language by being a role model for fellow PCPs and other colleagues. Some PCPs voiced their perspectives about the potential barriers to shifting PCPs away from the use of diabetes-stigmatizing language, including differing points of view regarding practices for establishing authority and the difficulties of breaking engrained habits. These findings support the acceptability of the video among PCPs for addressing diabetes-stigmatizing language in patient-provider encounters in primary care.

Disclosure

K.Joiner: None. A.Agapiou: None. M.Adams: None. G.Piatt: None.
1800-PUB: The Long-Term Effect of Glucagon-Like Peptide 1 Receptor Agonists on Glycemic Control Is Predominantly Related to Weight Loss
Authors: AL-BADRI MARWA , DHAVER SHILTON E. , SALAH TAREQ , KIBAA KARIM , KHATER ABDELRAHMAN , MCCARRAGHER RYAN , DEMATTOS LILY , AL-ROOMI FATIMAH , HAMDY OSAMA
Published: June 2023

Glucagon-like-peptide-1 receptor agonists (GLP-1 RAs) are established treatment options for type 2 diabetes (T2D). In addition to their glycemic benefit, they also induce weight loss by hypothalamic suppression of appetite. However, it is not clear if weight reduction is the main driver for glycemic improvement.

We retrospectively evaluated 256 patients with T2D; treated with either exenatide (n=84), dulaglutide (n=99), or semaglutide (n=73) without interruption for 2.5 years. Body weight and A1C were measured every 6 months. Average age was 61.8±11.9 yrs, 51.5% female, diabetes duration 12.9±8.3 yrs, weight 103.1±20.7 kg, BMI 35.7±7.5 kg/m2 and A1C 8.2±1.5%. We classified them collectively and in each medication group into tertiles according to percentage weight loss at 2.5 years. One tertile gained weight and the other 2 lost weight. In the entire cohort, A1C strongly correlated with weight change (p<0.001). The average weight change in each tertile was -12.2±5.7%, -3.5±1.4%, and +2.8±3.4% respectively. The average change in A1C was -0.98±1.8%, -0.56±1.4% and -0.19±1.9 respectively. The same observations were reproducible in each medication group (Figure 1).

These data strongly suggest that long-term improvement in glycemic control with GLP-1 RAs is predominantly related to percentage weight loss, and the one third that gained weight had a nonsignificant change in A1C.

Disclosure

M.Al-badri: None. S.E.Dhaver: None. T.Salah: None. K.Kibaa: None. A.Khater: None. R.Mccarragher: None. L.Demattos: None. F.Al-roomi: None. O.Hamdy: Advisory Panel; Abbott Nutrition, Nemaura Medical, L-Nutra Inc., Twin Health, Consultant; Sanofi, Research Support; Novo Nordisk, Eli Lilly and Company, Gilead Sciences, Inc., Stock/Shareholder; Healthimation.
1815-PUB: Overactive Bladder Syndrome—An Emerging Complication of SGLT2 Inhibitor–Associated Urogenital Infections
Authors: GAUTAM ASHISH , AGRAWAL PRABHAT K. , PURSNANI NIKHIL , YADAV SHAILENDRA K. , GUPTA VINAY , DHAWAN ANCHAL
Published: June 2023

Introduction: Recurrent urogenital infections (UGI) are common side effect of SGLT2i’s. Incidence of UGI’s is varies from 0% to 14.4 % including all SGLT2i’s & special population groups. Moderate or recurrent UGI causes prolonged morbidity even after treatment like incontinence, increased frequency & overactive bladder syndrome (OAB). OAB is defined symptomatically by presence of urgency, with or without urge incontinence without apparent pathological or metabolic disease. Exact etiology is still obscured. We conducted this retrospective observational study among people with DM2 who recovered from UGI due to SGLT2i’s

Aims and Objectives: Retrospectively assess disorders of micturition developed after recovery from SGLT2i’s associated UGI.

Methods: Two hundred & thirty-four subjects having DM2 who suffered SGLT2i’s associated any of UGI during previous 3 months, defined clinically or by microbiological investigations were enrolled. Exclusions h/o UGI before SGLT2i’s use, BPH, urogenital defects & uncontrolled glycaemic targets. After recovery from UGI following data was collected 1, increase in urinary frequency 2, prolonged burning or itching during micturition 3, urgency & dribbling 4, straining 5, incontinence 6, asymptomatic.

Result: Out of 273, subjects 173 (M 110, F 63) were asymptomatic after recovery whereas 37 (M 17, F 20) developed urgency & dribbling. There was significant association between UGI & urgency & dribbling, X2=143.1, p<.00001. Frequencies of other complications were also high suggesting significant association between UGI & complication after recovery, X2=39.0, p<.00001. Out of 100 symptomatic subjects 41 were male & 59 were female, X2 with Yates correction is 3.538. The p-value is .059978. Not significant at p<.05

Conclusion: OAB is a common complication developed after recovery from post SGLT2i’s associated urogenital infections. Both genders are equally prone. Urgency & dribbling are most common among all symptoms

Disclosure

A.Gautam: None. P.K.Agrawal: None. N.Pursnani: None. S.K.Yadav: None. V.Gupta: None. A.Dhawan: None.
1827-PUB: Multidisciplinary Patient-Centered Care Delivered Remotely Improves Glycemic Outcomes and Patient Reported Outcomes
Authors: MINSKY NOGA , AHARON-HANANEL GENYA , JABARIN AMNA , ARNON LIAT , MOROZOV NICOLE , HALPERIN DANIA , SHALOM MOSHE , TARSHISH ELIZABETH , KOLOBOV TATYANA , TIROSH AMIR , TAMIR ORLY
Published: June 2023

Lack of access to specialized multidisciplinary teams familiar with advanced technologies for T1D care remains a barrier to achieving glycemic targets and patient-centered goals. Since launching a T1D virtual clinic in 2018, we have treated 123 adults with T1D who had previously received standard care. There was a significant improvement in glycemic indices and in validated and self-originated patient reported outcome measures at 6 and 12 months as compared to baseline (table 1). Mean baseline HbA1c was 8.1%, and this improved to 7.6% and 7.3% at 6 and 12 months respectively (p< 0.001). Average sensor glucose declined by 5.5% over 6 months (p<0.001). While TIR increased significantly by 10.4% over 12 months, TBR decreased. Diabetes Treatment Satisfaction Questionnaire scores improved significantly, as did Diabetes Self-Management Questionnaire scores. According to a 5-point scale survey, there was improved satisfaction with the availability of the physician, nurse and dietitian beyond the appointment time and with the guidance received beyond scheduled visits. Remote care was associated with improved satisfaction regarding saving time and reducing expenses by curtailing office visits. In conclusion, transitioning from a standard T1D care to a virtual clinic is associated with improved glycemic control, higher patient satisfaction and better self-care behaviors.

Disclosure

N.Minsky: None. A.Tirosh: Advisory Panel; Medtronic, Novo Nordisk, Sanofi, Eli Lilly and Company, Research Support; Medtronic, Sanofi, Speaker's Bureau; Medtronic, Novo Nordisk, Sanofi, Eli Lilly and Company. O.Tamir: Other Relationship; Novo Nordisk. G.Aharon-hananel: Speaker's Bureau; Eli Lilly and Company, Novo Nordisk. A.Jabarin: None. L.Arnon: None. N.Morozov: None. D.Halperin: None. M.Shalom: None. E.Tarshish: None. T.Kolobov: None.

Funding

European Foundation for the Study of Diabetes (9366); Israel Ministry of Health
1831-PUB: Improving Accessibility of Patients with Type 1 Diabetes to Treatment by a Diabetes Nurse Practitioner
Authors: WAIZINGER ORIT
Published: June 2023

Background: Treatment of type 1 diabetes (T1D) is complex, requires therapeutic intensity and understanding patient needs. The COVID-19 pandemic has led to a rapid and dramatic increase in the use of telemedicine to maintain treatment continuum and response to patients. Dedicated software, developed to transfer data from patients’ glucose sensors and insulin pumps to the treating team, facilitates personalized therapeutic interventions. Diabetes Nurse Practitioners (DNPs) have the knowledge, treatment skills and expertise for analyzing patient data transferred by the software; hence, they are an essential resource for managing diabetes treatment in these patients. The lack of suitable infrastructure and staff members who specialize in T1D has led to the establishment of a dedicated DNP unit within a diabetes clinic in Israel. The unit’s services are provided by frontal and telemedicine sessions to patients aged 18-40 with T1D. Its aims include continuous and regular monitoring of patients, achieving glycemic control according to patients’ personal targets, and preventing acute and late complications. The DNP provides comprehensive advice and training, assesses, and evaluates the patients' conditions, adjusts their therapy and refers them to appropriate care providers based on their medical and emotional conditions. Each session lasts 30-45 minutes. The summary of each session is sent to the diabetes doctor and to the primary clinic’s team.

Methods: Analysis of patient data treated by the dedicated DPN unit between January and July 2022.

Results: A total of 143 patients underwent 537 sessions; 55% were frontal visits and 44.4% were telemedicine visits (online or by phone). improved glycosylated hemoglobin was noted in 61% of patients. One patient was hospitalized.

Conclusions: DNPs are an important factor for improving the quality of care of patients with T1D by providing personalized care, continuous contact and better access to services through remote consultation.

Disclosure

O.Waizinger: None.
1838-PUB: Impact of COVID-19 on New-Onset Pediatric Diabetes Diagnoses
Authors: SIMMS KATHERINE , GREEN SARAH , SHAH MAMTA , SAREINI MEDINA , CHIN CINDY
Published: June 2023

Introduction: Global trends show an increased number of pediatric patients with newly diagnosed diabetes who present in severe diabetic ketoacidosis (DKA) during the COVID-19 pandemic.

Methods: Medical records were reviewed for pediatric patients <18 years of age with new onset diabetes mellitus (DM) diagnosed two years pre-pandemic and two years during the COVID pandemic. Data collected included demographic, biochemical, and hospitalization data.

Logistic regression was used to investigate the relationship between BMI, hemoglobin A1c, duration of hospital stay, DKA, and pandemic time frame.

Results: A total of 175 cases of new onset DM were diagnosed during the study period; 54% post-pandemic. This represents a 16% increase in incident cases in the post-pandemic period. The sample was 55.4% male, 74.9% White/Caucasian, and 33.1% non-Hispanic. Type 1 DM comprised 136 cases. Inpatient diagnoses were the same in both the pre- and post-pandemic periods, n=75. Outpatient diagnoses during the pandemic period (n=19) were significantly higher than in the pre-pandemic period (n=6), X2(1) = 5.83, p < 0.05. The overall logistic regression model was statistically significant, X2(7) =18.35, p < 0.05. Hemoglobin A1c (p < 0.05, OR = 0.756, 95% CI [0.606, 0.945]) and length of hospital stay (p < 0.05, OR = 0.586, 95% CI [0.381, 0.902]) were significantly different between the two time periods, but BMI percentile (p = 0.869) and bicarbonate levels (p = 0.962) were not.

Discussion: There was an increased incidence of new onset DM diagnosed in pediatric patients post-COVID. Surprisingly, outpatient cases accounted for the increased number. This study showed that during the pandemic, patients presented with a higher hemoglobin A1c and stayed longer in the hospital than prior to the pandemic.

Disclosure

K.Simms: None. S.Green: None. M.Shah: None. M.Sareini: None. C.Chin: None.
1839-PUB: Baseline FFA and IR after One Year of TB Treatment in People with Prediabetes—Pilot Study from South India
Authors: KUMPATLA SATYAVANI , DEVARAJAN ARUTSELVI , KORNFELD HARDY , VISWANATHAN VIJAY
Published: June 2023

Background: Association of TB and prediabetes (PreDM)/insulin resistance (IR) and FFA remains unclear. Aim was to assess FFA and IR in TB with and without PreDM and to see the changes in IR in PreDM after 1 year of TB treatment.

Methods: A prospective study done from Jan 2017 to Sep 2019 in people with newly diagnosed PTB and PreDM (OGTT) in TB clinics and grouped as TB without PreDM (n=30) (group1) and TB with PreDM (n=37) (group2). Control without TB/PreDM (n=30) was included. Anthropometric, and biochemical details were noted. Insulin was measured by electro chemiluminescence and FFA by enzymatic end point method. IR was calculated by HOMA.

Results: Age was similar in groups (1vs.2; 40vs44). 2 hr glucose was significantly higher in group 2 than group1 (162vs. 108;p<0.001). BMI, WC, fasting glucose and HbA1c were similar between groups. Mean IR was higher in group 2 than group1 (1.3vs.1; p=0.7). Median FFA was higher in TB PreDM (20.9) than without Pre DM (17.8) and control (14.9) (Figure1). High FFA (23vs.20) (p=0.4) and high IR (1 vs. 0.6) (p=0.2) were observed in BMI ≥vs.<18.5 among TBPreDM. In group 2, baseline IR was high (0.82) and reduced to 0.71 and also those who remained PreDM (0.52) and who reverted to normal (0.44 from 0.71) after 1 year completion of TB treatment.

Conclusion: High FFA and IR was noted in TBPreDM and those with high BMI. Improvement in IR was noted 1 year after completion of TB treatment.

Disclosure

S.Kumpatla: None. A.Devarajan: None. H.Kornfeld: None. V.Viswanathan: None.

Funding

Indian Department of Biotechnology and Civilian Research; Development Foundation Global (USB1-31149-XX-13)
1845-PUB: Key Lifestyle Behaviours among Diabetics, Prediabetics, and Nondiabetics in India
Authors: MOHAN SAILESH , JARHYAN PRASHANT , PRABHAKARAN DORAIRAJ
Published: June 2023

Purpose: To assess prevalence of key lifestyle behaviours including maintaining a body mass index (BMI) <25Kg/m2, engaging in physical activity for ≥150 min/week, consuming >5 servings of fruits & vegetables daily, & no tobacco use among diabetics, pre-diabetics, & nondiabetics.

Methods: We conducted a large population-based survey among 12284 participants aged ≥30 years residing in rural and urban North and South India. Participants were selected using multistage cluster random sampling. Trained personnel collected data using a questionnaire, conducted anthropometry & collected bio-samples. Diabetes was defined as FPG ≥ 126 mg/dl or HbA1C ≥ 6.5% or self-reported physician diagnosis or being on treatment & prediabetes as FPG ≥ 100 mg/dl & <126 mg/dl or HbA1C ≥ 5.7% & <6.5%.

Results: Age-standardized prevalence of diabetes was 17.4% (95% CI: 16.7-18.1) & prediabetes was 31.3% (30.7-31.9). Diabetics were more likely to be overweight/obese [BMI≥25Kg/m2: 60.7% (58.6-62.7)], & less physically active [physical activity (PA) <150 min/week: 30.6% (28.8-32.6), compared to pre-diabetics [BMI: 49.1% (47.5-50.7); PA: 22.3% (21.0-23.7)] & nondiabetics [BMI: 36.6% (35.4-37.8); PA: 22.2% (21.1-23.2)]. Mean (±SD) waist circumference (WC) was higher among diabetics [92.8 cm (±11.9)] compared to pre-diabetics [88.0 cm (±12.6)] & nondiabetics [83.7 cm (±12.5)] with more diabetics [65.4% (63.4-67.4)] having WC above World Health Organization’s recommended cut-off compared to pre-diabetics [54.2% (52.6-55.8) & nondiabetics [43.4% (42.4-44.6)]. Consumption of fruits & vegetables was low among all groups. Diabetics were less likely to be current tobacco users [21.7% (19.9-23.4)] compared to pre-diabetics [26.2% (24.8-27.7)] & nondiabetics [28.1% (27.0-29.2)].

Conclusions: Tailored clinic based, and population wide health promotion programs focussed on improving diet and physical activity are warranted to advance diabetes prevention and control in India.

Disclosure

S. Mohan: None. P. Jarhyan: None. D. Prabhakaran: None.