bluuebunny/crossref_metadata_2025_split huggingface dataset:
PSUN166 Triglycerides and Glucose Index as a Predictor of Renal Impairment
Authors: Lee Seung Eun , Park Jung Hwan , Kim Dong Sun 
Published: November 2022

Abstract

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 &lt; 90. Group I had lower TyG (8.43 ± 0.01 vs. 8.60 ± 0.01, P&lt;0.0001) as compared with group II. Linear regression showed that TyG was closely associated with UACR (β = -3.3978, P&lt;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

Abstract

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 &gt;180: 86% vs 92%, p=0.003; any BG &gt;240: 51% vs 62%, p&lt;.001), similar rates of hypoglycemia (BG &lt;70: 12% vs 15%, p=0.11; BG &lt;54: 2.5% vs 4.0%, p=0.14), and trended towards greater time in range &lt;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&lt;.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

Abstract

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, &gt;1 positive diabetes autoantibody, BMI&lt;85%, complicated medical history (genetic disorders, transplant, cancer, etc.), and &lt; 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&lt;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&lt;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

Abstract

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

Abstract

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&gt;=30 ml/min/1.73 m2 and urinary albumin &gt;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 &gt;=30 ml/min/1.73 m2 and urinary albumin&gt;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

Abstract

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 &lt;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&lt;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

ABSTRACT
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

ABSTRACT
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

ABSTRACT

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.
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.