bluuebunny/crossref_metadata_2025_split huggingface dataset:
1261-P: OGTT Model–Derived ß-Cell Function Reveals Differential Loss in Youth vs. Adults during and following Treatment Withdrawal in the Restoring Insulin Secretion (RISE) Study
Authors: UTZSCHNEIDER KRISTINA , TRIPPUTI MARK , CREE-GREEN MELANIE , HANNON TAMARA S. , NADEAU KRISTEN J. , BARENGOLTS ELENA , PALMER JERRY P. , MATHER KIEREN J. , CAPRIO SONIA , EDELSTEIN SHARON , MARI ANDREA ,   THE RISE CONSORTIUM
Published: June 2020

Loss of β-cell function is critical in the pathogenesis of T2D and may progress more rapidly in youth. We compared 3-hr OGTT model-derived measures of β-cell function in youth and adults with IGT or T2D in RISE treated for 12 mo with metformin (MET), or glargine followed by metformin (G/M) and 9 mo after treatment withdrawal. Model parameters included insulin sensitivity (OGIS), insulin secretion rate (ISR) at glucose 6.5 mM (ISR-6.5), total ISR (tISR), glucose sensitivity (GS: slope ISR vs. glucose concentration) and rate sensitivity (RS: ISR relative to glucose rate of change). Linear mixed models tested for differences by time (0-12 and 0-21 mo), age (youth vs. adults) and treatment (MET vs. G/M). Key observations included the following. Insulin sensitivity (OGIS) increased transiently in all but adults on G/M. In youth, insulin secretion (ISR-6.5 and tISR) and RS decreased relative to baseline, with GS also decreased in the G/M arm. In contrast, in adults there were no significant changes in modeled parameters at 21 mo. Insulin secretion and β-cell function parameters decreased more in youth vs. adults in the G/M arm. By treatment, GS decreased more in the G/M vs. MET arm in youth, but there were no differences in adults.
In conclusion, only youth exhibited worsening of features of β-cell function that can only be derived with mathematical modeling.

Disclosure
K. Utzschneider: Other Relationship; Self; Medtronic. M. Tripputi: None. M. Cree-Green: Advisory Panel; Self; Novo Nordisk Inc. T.S. Hannon: None. K.J. Nadeau: None. E. Barengolts: None. J.P. Palmer: None. K.J. Mather: Research Support; Self; Abbott, Merck & Co., Inc., Novo Nordisk Inc., Sanofi. S. Caprio: None. S. Edelstein: None. A. Mari: Consultant; Self; Lilly Diabetes. Research Support; Self; Boehringer Ingelheim International GmbH. T. Consortium: None.

Funding
American Diabetes Association (1-14-RISE-01); National Institute of Diabetes and Digestive and Kidney Diseases
1275-P: Higher Branched-Chain Amino Acids in Youth with Type 2 Diabetes Paradoxically Increased by Short-Term Metformin
Authors: MEYERS ABBY , CRAVALHO CELESTE K. , VILLALOBOS-PEREZ ALFREDO , MATTA SAMANTHA , MABUNDO LILIAN , COURVILLE AMBER B. , SAMPSON MAUREEN L. , OTVOS JAMES D. , CHUNG STEPHANIE T. 
Published: June 2020

Branched chain amino acids (BCAA) are important signaling molecules that are strongly related to type 2 diabetes (T2D), but the data linking BCAAs to reduced insulin sensitivity (IS) in youth is conflicting. This complex relationship of BCAAs with IS and glycemia may be further confounded by metformin that potentially alters BCAA synthesis and transport via gut mechanisms. Therefore, we compared: (1) BCAAs in 20 youth with T2D pre-metformin to 10 normal glucose tolerant (NGT) age/BMI-matched controls and (2) the change in BCAAs after 3 months of metformin in 8 youth with T2D. Fasting BCAAs were measured with nuclear magnetic resonance spectroscopy and IS and oral disposition index (oDI) calculated during a multi-sample 75g OGTT. Compared to NGT, youth with T2D had higher BCAAs and hemoglobin A1c (HbA1c) but lower IS and oDI (Table). Higher total BCAAs pre-metformin correlated with HbA1c (r=0.6, P&lt;0.001,), inversely correlated with oDI (r= -0.5, P=0.02,), but not with IS or BMI (r=0.2, P&gt;0.2). Metformin decreased HbA1c and increased leucine and isoleucine (Table), but there was no change in BMI, IS or valine (all P&gt;0.05). In youth, higher BCAAs were related to lower β-cell function relative to IS and worse glycemia. Although metformin improved glycemia, BCAAs were paradoxically increased suggesting that BCAAs may not be a useful treatment biomarker or indicator of changes in metabolic status.

Disclosure
A. Meyers: None. C.K. Cravalho: None. A. Villalobos-Perez: None. S. Matta: None. L. Mabundo: None. A.B. Courville: None. M.L. Sampson: None. J.D. Otvos: Employee; Self; LabCorp. S.T. Chung: None.

Funding
National Institutes of Health (to S.T.C., L.M., A.B.C.)
128-LB: Effects of Glucagon Receptor Antagonism (GRA) on Ketone Body Formation during Insulinopenia in Type 1 Diabetes (T1D)
Authors: BOEDER SCHAFER C. , INES DANIEL G. , CARTER LESLIE , GIOVANNETTI ERIN R. , ARMSTRONG DEBRA , BURKE PAIVI , PETTUS JEREMY 
Published: June 2020

Background: Diabetic ketoacidosis is a common and life-threatening complication of T1D. Glucagon stimulates ketogenesis via peripheral lipolysis and hepatic β-oxidation of free fatty acids (FFA). Blocking glucagon action may decrease ketone formation and reduce the risk of DKA.
Methods: In this pilot study, 4 participants with T1D underwent 6 hours of insulin withdrawal before and after 4 weeks of monoclonal GRA treatment (REMD-477, 70mg weekly). Serial measurements of plasma glucose, FFA, and β-hydroxybutyrate (BHB) were collected to determine the efficacy of GRA therapy in reducing ketone formation in the setting of insulinopenia.
Results: Pre- vs. post-treatment concentrations (mean ± SD; paired two-tailed t-test) after 6-hour insulin withdrawal were: Glucose (263 ± 63 vs. 235 ± 109 mg/dL; P = 0.53), FFA (1.37 ± 0.60 vs. 1.09 ± 0.77 mmol/L; P = 0.07), and BHB (1.30 ± 0.70 vs. 0.63 ± 0.54 mmol/L; P = 0.08). Glucagon concentrations increased (26.8 ± 9.9 vs. 454 ± 245 pg/mL; P = 0.04) with blockade of glucagon action. Frequent insulin draws confirmed insulinopenia.
Conclusions: These preliminary results suggest that GRA treatment may reduce ketogenesis in the clinical setting in which DKA occurs (insulinopenia). These trends will be tested in a larger, randomized study. If confirmed, this would represent a novel therapy to reduce the risk of life-threatening DKA in T1D.

Disclosure
S.C. Boeder: Consultant; Self; Cecelia Health, Science 37. Research Support; Self; Dexcom, Inc. D.G. Ines: None. L. Carter: None. E.R. Giovannetti: None. D. Armstrong: None. P. Burke: None. J. Pettus: Consultant; Self; Diasome Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., MannKind Corporation, Novo Nordisk Inc., Sanofi.

Funding
National Institutes of Health (UL1TR001442, P30DK063491)
129-OR: Abnormal Mitochondrial Activity in Pain Processing Regions of the Brain in Painful Diabetic Peripheral Neuropathy
Authors: SLOAN GORDON P. , ANTON ADRIANA , SELVARAJAH DINESH , TESFAYE SOLOMON , WILKINSON IAIN D. 
Published: June 2020

Aims: The management of painful diabetic peripheral neuropathy (pDPN) is inadequate because the disease mechanisms are not fully understood. We assessed cerebral cellular bioenergetics using phosphorus magnetic resonance spectroscopy (31P-MRS) to determine whether high energy phosphate metabolite levels are altered in the pain processing regions of the brain in pDPN.
Methods: A total of 66 subjects, 44 with type 2 diabetes (12 no-DPN, 13 painless-DPN and 19 pDPN) and 12 healthy volunteers (HV), underwent detailed clinical and neurophysiological assessments, and 31P-MRS brain imaging at 3-Tesla (Ingenia, Phillips Healthcare) with voxels placed over the right somatosensory cortex and the thalamus (TR 4s, TR 0.26ms, voxel size 21 x 21 x 40mm3). Measures reflecting cellular bioenergetics (mitochondrial function), ATP to phosphocreatine (PCr) and inorganic phosphate (Pi) ratios (ATP:PCr and ATP:Pi) were calculated.
Results: There was a significant group effect in the ATP:PCr ratio at the thalamus (p=0.016) and somatosensory cortex (p=0.025). The ATP:PCr at the thalamus was significantly higher in the pDPN group (0.50±0.06) compared to HV (0.44±0.04, p=0.024) and no-DPN (0.42±0.07, p=0.006). Moreover, the ATP:PCr ratio at the somatosensory cortex was significantly higher in pDPN (0.48 ±0.1) compared to HV (0.38 ±0.1, p=0.035). In addition, the ratio correlated with the numeric pain score ratings during the MRI scan at both brain regions.
Conclusions: This is the first study to use 31P-MRS to study cerebral energetics in human-DPN and peripheral painful neuropathies. We demonstrated significantly higher ATP:PCr ratios in patients with pDPN in the somatosensory cortex and thalamus, which correlated with pain severity. This is suggestive of increased cellular energy usage in pain processing regions of the brain, perhaps due to continuous nociceptive inputs. Altered cerebral phosphorus metabolite ratios may serve as a biomarker of neuropathic pain in diabetes.

Disclosure
G.P. Sloan: None. A. Anton: None. D. Selvarajah: None. S. Tesfaye: Advisory Panel; Self; Mitsubishi Tanabe Pharma Corporation, Wörwag Pharma. Speaker’s Bureau; Self; Abbott, AstraZeneca, Grunenthal Group, Napp Pharmaceuticals, Novo Nordisk Inc., Pfizer Inc. I.D. Wilkinson: None.
1309-P: Adolescent Preferences on the Use of Social Media by Diabetes Care Teams to Support Diabetes Management
Authors: MALIK FAISAL , MORENO MEGAN A. , MANGIONE-SMITH RITA , PIHOKER CATHERINE , ELLYSON ALICE M. , GILL HARSIMRAT , CHALMERS KRISTEN , CHRISTAKIS DIMITRI 
Published: June 2020

Objective: To examine adolescent preferences related to the use of social media (SM) as a tool to manage their type 1 diabetes (T1D) with their diabetes care team.
Methods: Adolescents with T1D (13-18 years old) in the Seattle, WA area were surveyed from August-December 2019 about their SM use and interest in communicating with their diabetes care team over SM.
Results: 232 adolescents with T1D completed the survey (response rate = 53%); mean age 15.1 years, 94% used SM, 85% used SM at least once/day. Approximately 70% indicated that if given the option, they were very likely or somewhat likely to communicate with their diabetes provider on SM. Over 72% shared they were very likely or somewhat likely to use SM direct messaging to ask urgent questions and 64% would use it for non-urgent questions. A majority of participants agreed that they would want to receive educational material (62%) and insulin dose adjustment support over SM (58%); Figure. Most agreed that SM communication would facilitate increased independent communication (61%) and positively impact patient-care team relationships (63%). A minority of participants (38%) reported privacy concerns.
Conclusions: Adolescents with T1D expressed interest in using SM to support diabetes management and increase direct engagement with their diabetes care team. Healthcare teams should explore the use of SM to provide tailored support to adolescents with T1D.

Disclosure
F. Malik: None. M.A. Moreno: None. R. Mangione-Smith: None. C. Pihoker: None. A.M. Ellyson: None. H. Gill: None. K. Chalmers: None. D. Christakis: None.

Funding
National Institutes of Health (K23DK119465)
1312-P: Pancreas Volume in Individuals with MODY 1, 2, 3, and 5
Authors: WRIGHT JORDAN J. , WILLIAMS JONATHAN M. , VIROSTKO JOHN , HILMES MELISSA A. , DU LIPING , KANG HAKMOOK , GREELEY SIRI ATMA W. , RUSSELL WILLIAM E. , MOORE DANIEL J. , POWERS ALVIN C. 
Published: June 2020

Individuals with new-onset type 1 diabetes (T1D) have a smaller pancreas volume, which declines further during the first years after diagnosis. Whether this reflects the insulin deficiency associated with T1D or the underlying process leading to T1D is not clear. Mutations in several genes that are active in the pancreas and/or pancreatic islet cells cause varying degrees of insulin deficiency, resulting in Maturity Onset Diabetes of Youth (MODY). To determine whether decreased pancreas volume is associated with these other forms of diabetes, we used a standardized MRI protocol that has been validated in over 500 scans to measure pancreas volume normalized to body weight (pancreas volume index, PVI). Individuals with mutations in HNF4A (MODY 1, ages 19-71, PVI 0.79 ± 0.07 mL/kg, N=4), GCK (MODY 2, ages 9-55, PVI 0.97 ± 0.10 mL/kg, N=5), or HNF1A (MODY 3, ages 16-60, PVI 0.80 ± 0.09 mL/kg, N=7) had pancreas volume similar to controls (ages 8-65, 0.96 ± 0.03 mL/kg, N=78, p&gt;0.59). Pancreas volume was not different in individuals with MODY 1, 2, or 3 who required insulin replacement therapy compared with those not on insulin (PVI 0.82 ± 0.08 vs. 0.89 ± 0.09 mL/kg, N=9 and 7, p=0.56). Individuals with a mutation in HNF1B (MODY 5), a less common mutation that can be associated with pancreatic hypoplasia, had widely variable pancreas volume (PVI 0.90 ± 0.36 mL/kg, N=3). Further studies to assess pancreas size in other forms of MODY are needed and may provide insight into why the pancreas volume is reduced in T1D.

Disclosure
J.J. Wright: None. J.M. Williams: None. J. Virostko: None. M.A. Hilmes: None. L. Du: None. H. Kang: None. S.W. Greeley: None. W.E. Russell: None. D.J. Moore: None. A.C. Powers: None.

Funding
JDRF (3-SRA-2019-759-M-B, 3-SRA-2015-102-M-B)
134-OR: Effects of PCSK9 Inhibitors on Glucose Metabolism and ß-Cell Function in Humans
Authors: MOFFA SIMONA , MEZZA TERESA , ASSUNTA CEFALO CHIARA MARIA , CINTI FRANCESCA , SORICE GIAN PIO , IMPRONTA FLAVIA , CAPECE UMBERTO , MARI ANDREA , GIACCARI ANDREA 
Published: June 2020

PCSK9 inhibitors are monoclonal antibodies effective in reducing LDL-C and cardiovascular events by neutralizing circulating PCSK9. Since PCSK9 is also expressed in other organs, including pancreas, studies on PCSK9 KO mice, have shown impaired insulin secretion. Other murine models in which PCSK9 was silenced only in the liver (mimicking the action of PCSK9i) had normal glucose metabolism. The aim of our study was to evaluate the effect of PCSK9 inhibitors on glucose metabolism and beta cell function in humans. 11 nondiabetic subjects candidate for PCSK9i therapy were enrolled in the study. All subjects underwent an OGTT at baseline and after 6 months of therapy, at which point surrogate insulin sensitivity indices were obtained (Matsuda; OGIS). During OGTT, insulin secretion parameters were derived from C-peptide levels by deconvolution; we evaluated basal insulin secretion rate, total insulin secretion rate and β-cell glucose sensitivity, for 6 of the 11 enrolled subjects. All patients showed a 53.3% reduction in LDL cholesterol after 6 months of therapy; the mean LDL-C baseline level (B) was 202.5 ± 45 mg/dl, while mean LDL-C post therapy (PT) value was 94.6 ± 27 mg/dl. Glycemic and insulinemic curves showed no significant differences between baseline and follow-up. Matsuda index (B 4.1 ± 1, PT 3.4 ± 0.7 mL min-1kg-1) and OGIS (B 396.9 ± 32, PT 386.2 ± 28 ml min-1m-2), showed no differences between baseline and post-therapy evaluation. There were no significant differences in insulin secretion parameters: basal insulin secretion rate (B 63.7 ± 34, PT 66.4 ± 23 pmol min-1m-2), total insulin secretion rate (B 48.7 ± 17, PT 46.9 ± 16, nmol m-2) and β-cell glucose sensitivity (B 117.5 ± 69, PT 141.2 ± 47 pmol min-1m-2mM-1) obtained from c-peptide deconvolution. Our study, although preliminary and in a small sample of patients, suggests that PCSK9is does not cause alterations in glucose metabolism and beta cell function. Further studies and a longer follow-up may provide us with further data to confirm our observations.

Disclosure
S. Moffa: None. T. Mezza: None. C. Cefalo: None. F. Cinti: None. G. Sorice: None. F. Impronta: None. U. Capece: None. A. Mari: Consultant; Self; Lilly Diabetes. Research Support; Self; Boehringer Ingelheim International GmbH. A. Giaccari: Speaker’s Bureau; Self; Amgen, AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Mundipharma, Novo Nordisk A/S, Sanofi-Aventis.
1370-P: Pregnant Dyslipidemia Affects Postpartum Metabolism in Gestational Diabetes Mellitus Patients
Authors: XIAO HUANGMENG , PEI LING , LI ZETING , HUANG XIAOYU , YUE SHUFAN , CAO XIAOPEI 
Published: June 2020

Women with gestational diabetes mellitus (GDM) have higher rate of dyslipidemia during pregnancy than those without GDM. However, whether this higher level of blood lipid during pregnancy in GDM women has effects on postpartum metabolism is rarely reported. The purpose of this study is to assess the influence of dyslipidemia during pregnancy on postpartum metabolism in women with history of GDM . A total of 443 women with history of GDM were enrolled in this retrospective cohort study. All of them have completed revisit at 4-12 week postpartum. The demographic and pregnant medical records were collected. In the postpartum revisit, 75g-OGTT test and physical examination were performed. The serum lipid level and insulin concentration were measured. Pregnant dyslipidemia were categorized according to the criteria of Williams obstetrics in pregnancy. The relationship between pregnant dyslipidemia and postpartum metabolism was statistically analyzed. On the whole, postpartum blood lipid levels showed a downward trend comparing with those during pregnancy. However, 39.4% of those GDM women presented dyslipidemia at 4-12 week postpartum, including 61.2% of mixed hyperlipidemia, and 38.8% of single component dyslipidemia. Women with pregnant dyslipidemia had higher postpartum total cholesterol level, TG level as well as LDL-c level. The triglyceride (TG) level during pregnancy were positively correlated with postpartum fasting blood glucose level, fasting insulin level and insulin resistance index (HOMA-IR). On the other hand, the HDL-c level during pregnancy were negatively correlated with postpartum fasting blood glucose and HOMA-IR.
In conclusion, the abnormally increased blood lipid levels during pregnancy in GDM women are relative to the postpartum hyperglycemia and hyperlipidemia. Management of pregnant dyslipidemia may be beneficial to the postpartum metabolism in GDM women.

Disclosure
H. Xiao: None. L. Pei: None. Z. Li: None. X. Huang: None. S. Yue: None. X. Cao: None.

Funding
Sun Yat-sen University (2017001); Science and Technology Planning Project of Guangzhou (201803010101)
1373-P: Adherence to Healthy Lifestyle on Subsequent Risk of Type 2 Diabetes (T2D) among Women with a History of Gestational Diabetes Mellitus (GDM): A Prospective Cohort Study
Authors: QIAN FRANK , CHAVARRO JORGE E. , LEY SYLVIA H. , TOBIAS DEIRDRE , YEUNG EDWINA , LI MENGYING , LIU AIYI , MILLS JAMES , SUN QI , HU FRANK , ZHANG CUILIN 
Published: June 2020

Background: Women with a history of GDM are at exceptionally high risk of T2D but adopting a healthy lifestyle may mitigate this risk.
Methods: We analyzed 4,287 women with a prior clinician diagnosis of GDM from the Nurses’ Health Study II cohort as part of the Diabetes and Women’s Health Study. Healthy lifestyle factors, which were assessed every 2-4 years, included no current smoking, normal body mass index (&lt;25 kg/m2), regular moderate-to-vigorous physical activity (&gt;500 MET-min/week), high-quality diet (above median for the Alternative Healthy Eating Index), and moderate alcohol consumption (&gt;0-15 g/day). Self-reported incident T2D was confirmed via validated supplementary questionnaire (98% concordance with medical records). Multivariate-adjusted Cox models were used to calculate the hazard ratio (HR) and 95% confidence interval (CI), adjusting for demographic, reproductive, and clinical characteristics.
Results: We ascertained 835 incident T2D cases during a median 27.9 years of follow-up. Compared to women reporting no healthy lifestyle factors, HR (95% CI) for risk of T2D among those with 1, 2, 3, 4, or 5 factors were 0.91 (0.64, 1.30), 0.62 (0.44, 0.87), 0.45 (0.31, 0.64), 0.33 (0.22, 0.48), and 0.13 (0.06, 0.28), respectively (P&lt;trend&lt;0.001) (Table 1). When number of health lifestyle factors was modeled continuously, each additional factor was associated with a 29% lower risk of T2D, HR (95% CI): 0.71 (0.67, 0.76). In addition, &gt;86% (population attributable risk [PAR]%: 86.3%; 95% CI: 70.6%, 93.7%) of T2D cases were theoretically preventable if participants had adherence to all 5 healthy lifestyle factors.
Conclusion: Adherence to healthy lifestyle factors was associated with a substantially lower likelihood of progressing to T2D in women with a history of GDM, and strategies to improve long-term adherence are warranted.

Disclosure
F. Qian: None. J.E. Chavarro: None. S.H. Ley: None. D. Tobias: None. E. Yeung: None. M. Li: None. A. Liu: None. J. Mills: None. Q. Sun: None. F. Hu: None. C. Zhang: None.
1382-P: Does Tight Gestational Diabetes Mellitus Control Have an Impact on the Maternal and Neonatal Outcome Compared with General Populations? Which Factors Predict the Adverse Pregnancy Outcomes?
Authors: THOMAKOS PETROS , KEPAPTSOGLOU OLGA , BARRETO CAROL , TROUVA ANASTASIA , TROUVAS DIMITRIS , ZOUPAS CHRISTOS S.P. 
Published: June 2020

The prevalence of adverse outcomes in GDM pregnancies compared to the general population are still high in studies, which used ADA treatment criteria. Our goal was to compare outcomes of tight controlled GDM pregnancies achieving optimal glycemic patterns with normal pregnancies. A cross-sectional study of 280 singleton pregnancies: 140 GDM with a mean FBG ≤90 and 1h PP ≤ 120mg/dL vs. 140 normal pregnancies, age and BMI matched. FBG and 1h PP BG for each participant was determined by the average of their SMBG readings. Clinical characteristics - age: 35.7±5 vs. 35.4±5 years; BMI: 23.1±5 vs. 23.7±4 kg/m2; OGTT 0’: 94.1±14.4, 60’: 186.1±27.7, 120’: 161,2±20.4 mg/dL; HbA1c: 5.2±0.6 vs. 4.8±0.3 %, p&lt;0.001; FBG: 83.7±8 mg/dl; 1h PP BG: 106.5±11 mg/dl; GDM diagnosis week: 25.8±4; starting insulin week: 26.8±5; insulin dose: 46.3±13 iu/day. Obstetric and neonatal history between groups: Weight gain: 11.8±4 vs. 10.4±2 kg, p=0.03; delivery week: 37.7±2 vs. 38.1±1, p=0.01; neonatal birth weight: 3050±327 vs. 3200±355 g, p&lt;0.001; SGA: 5.7 vs. 4.3%; LGA: 5.7 vs. 3.6 %; women hypoglycemia episodes: 21.4 %; pre-eclampsia rate: 4.2 vs. 2.8 %; RDS: 10 vs. 7.1 %; Neonatal hypoglycemia: 6.4 vs. 5.7%, NICU admittance: 17.8 vs. 6.4%, p=0.02, Caesarean section: 60 vs. 23.6 %, p&lt;0.001. No cases of severe maternal hypoglycemia and perinatal mortality. An association between: maternal-fetal complications and increased 1h PP BG (r=303), 1h (r=348), 2h (r=228) OGTT values. No association between adverse fetal outcome and maternal hypoglycemia. Tight metabolic control with early insulin therapy minimizes adverse pregnancy outcomes. Performing GDM screenings before 24-28 weeks in women &gt;35 years of age is recommended. Outcome of the pregnancies was not adversely affected by maternal hypoglycemia. 1h PP BG and 1h and 2h OGTT values predicts outcome in GDM pregnancies. More research is needed to understand the optimal BG targets in GDM management.

Disclosure
P. Thomakos: None. O. Kepaptsoglou: None. C. Barreto: None. A. Trouva: None. D. Trouvas: None. C.S.P. Zoupas: None.