2-hour Test Research Articles

MP10-03 INFLUENCE OF SGLT2 INHIBITORS ON 24-HOUR URINE PARAMETERS AMONG KIDNEY STONE PATIENTS IN THE MEDICARE POPULATION

You have accessJournal of UrologyCME1 Apr 2023MP10-03 INFLUENCE OF SGLT2 INHIBITORS ON 24-HOUR URINE PARAMETERS AMONG KIDNEY STONE PATIENTS IN THE MEDICARE POPULATION Joseph Crivelli, Ryan Hsi, Mary Oerline, John Asplin, Naim Maalouf, and John M Hollingsworth Joseph CrivelliJoseph Crivelli More articles by this author , Ryan HsiRyan Hsi More articles by this author , Mary OerlineMary Oerline More articles by this author , John AsplinJohn Asplin More articles by this author , Naim MaaloufNaim Maalouf More articles by this author , and John M HollingsworthJohn M Hollingsworth More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003225.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sodium/glucose cotransporter 2 inhibitors (SGLT2is) are widely used for patients with type 2 diabetes. Recent epidemiologic studies have shown a reduction in stone events in diabetic patients treated with SGLT2is, but changes in urine chemistries that may account for this have not been identified. The purpose of this study was to evaluate the effect of SGLT2is on urine chemistry and supersaturation among patients with kidney stone disease. METHODS: From a Medicare-Litholink database (years 2010-2018), we identified patients who received two, 24-hour urine tests, of which the first was performed without SGLT2i use, and the second was collected during SGLT2i use. Patients were excluded if they started using alkali citrate, thiazide, or xanthine oxidase inhibitor between the two collections, and excluded if the creatinine excretions in the 2 collections differed by >30%. Bivariate comparisons using the t-test were compared between 24-hour urine variables with p<0.05 considered statistically significant. RESULTS: Among 30 patients identified, the cohort had mean±SD age 66.6±8.9 years, 80% were male, and all with Medicare Part A/B available information (n=24) had a baseline diagnosis of diabetes mellitus type 2. The SGLT2i used included canagliflozin (in 56.7%), dapagliflozin (20.0%), and empagliflozin (23.3%). The mean±SD time from the first to second collection was 18.5±17.4 months. Comparison of 24-hour parameters between the first collection (pre-SGLT2i) and the second collection (on SGLT2i) is shown in the Table 1. Notable findings include a trend to higher 24-hour urine volume by 0.38 L/day (p=0.065), and significantly lower urine pH (p=0.046), with non-significant changes in urine excretion rate of calcium, oxalate, citrate, uric acid, and phosphorus. This resulted in a significant reduction in urine supersaturation with respect to calcium phosphate (likely from combination of greater urine volume and slightly lower pH), but non-significant changes in SS calcium oxalate and uric acid. CONCLUSIONS: Chronic SGLT2i use is associated with a lower urine pH with non-significant changes in volume and the excretion of major stone-related electrolytes. Larger studies are needed to confirm these findings and explore the impact of SGLT2i on stone recurrence rate. Source of Funding: Supported by National Institutes of Health Grant 1R01DK121709 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e114 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Crivelli More articles by this author Ryan Hsi More articles by this author Mary Oerline More articles by this author John Asplin More articles by this author Naim Maalouf More articles by this author John M Hollingsworth More articles by this author Expand All Advertisement PDF downloadLoading ...

Diarrhea don’ts: Reducing inappropriate stool cultures and ova and parasite testing for nosocomial diarrhea

Diarrhea that develops in patients after 72 hours of hospitalization is likely to have a nosocomial or iatrogenic etiology. Testing with stool cultures and stool ova and parasites (O&P) is not recommended. Our goal was to reduce this inappropriate testing within a large, urban safety-net hospital system. This was a quality improvement project. We created a best practice advisory (BPA) within the electronic medical record that fires when a stool culture or O&P order is placed 72 hours after admission for any immunocompetent patient. It states that stool testing is low yield and offers the option to remove the order. We measured weekly counts of stool culture and stool O&P orders pre- and postintervention. We also measured the BPA acceptance rate, the 24-hour stool testing reorder rate, and Clostridioides difficile infection rates. Data were analyzed using Welch tests as well as a quasi-experimental pre- and postintervention interrupted time series regression analysis. Stool culture orders decreased by 24.4% (P < .001). There was a significant level difference and slope difference with linear regression. Five of the 11 hospitals had a significant reduction in stool culture orders. Stool O&P orders decreased by 18.2% (P < .01). Three of the 11 hospitals had a significant reduction in stool O&P orders. Our intervention successfully reduced inappropriate stool testing within a large safety-net hospital system.

Novel type of whisker-tip cantilever based on GaN microrods for atomic force microscopy

High-resolution scanning probe microscopy (SPM) is a fundamental and efficient technology for surface characterization of modern materials at the subnanometre scale. The bottleneck of SPM is the probe and scanning tip. Materials with stable electrical, thermal, and mechanical properties for high-aspect-ratio (AR) tips are continuously being developed to improve their accuracy. Among these, GaN is emerging as a significant contender that serves as a replacement for standard Si probes. In this paper, for the first time, we present an approach that demonstrates the application of GaN microrods (MRs) as high-AR SPM probes. GaN MRs were grown using molecular beam epitaxy, transferred and mounted on a cantilever using focused electron beam-induced deposition and milled in a whisker tip using a focused ion beam in a scanning electron/ion microscope. The presence of a native oxide layer covering the GaN MR surface was confirmed by X-ray photoelectron spectroscopy. Current-voltage map measurements are also presented to indicate the elimination of the native oxide layer from the tip surface. The utility of the designed probes was tested using conductive atomic force microscopy and a 24-hour durability test in contact mode atomic force microscopy. Subsequently, the graphene stacks were imaged.

The Efficacy of Chlorella Supplementation on Multiple Indices of Cycling Performance

This study investigated the effects of chlorella supplementation on submaximal endurance, time trial performance, lactate threshold, and power indices during a repeated sprint performance test by fourteen male trained cyclists. Participants ingested 6 g/day of chlorella or placebo for 21-days in a double-blinded randomized counter-balanced cross-over design, with a fourteen-day washout period between trials. Each completed a 2-day testing period comprising a 1-hour submaximal endurance test at 55% external power output max and a 16.1 km time trial (Day-1), followed by a lactate threshold (Dmax) and repeated sprint performance tests (3 X 20 s sprints interspersed by 4-mins) (Day-2). Heart rate (b.min−1), RER, V̇O2 (ml·kg−1·min−1), lactate and glucose (mmol/L), time (secs), power output (W/kg), and hemoglobin (g/L) were compared across conditions. Following chlorella supplementation (chlorella vs. placebo for each measurement) average lactate and heart rate were significantly lower (p < 0.05) during submaximal endurance tests (1.68 ± 0.50 mmol/L vs. 1.91 ± 0.65 mmol/L & 138 ± 11b.min−1 vs. 144 ± 10b.min−1), average power and peak power (W/kg) were significantly higher during repeated sprint bouts (9.5 ± 0.7 W/kg vs. 9.0 ± 0.7 W/kg & 12.0 ± 1.2 W/kg vs. 11.4 ± 1.4 W/kg), hemoglobin significantly increased (149.1 ± 10.3 g/L) in comparison to placebo (143.4 ± 8.7 g/L) (p = 0.05). No differences existed between conditions for all oxygen consumption values, 16.1 km time trial measures and lactate threshold tests (p > 0.05). In conclusion, chlorella may pose as an additional supplement for cyclists to consider, particularly for those cyclists who want to improve their sprinting.

Phytoremediation of Diesel Contaminated Water DCW Exposed on Clarias gariepinus Using Moringa Seed Extract MSE as the phytoremediant

Phytoremediation of diesel contaminated water (DCW) for freshwater fish Clarias gariepinus (12.6 ±1.4g and mean length 8.6 ± 0.7cm) was conducted at the research farm of the Enugu State University of Science and Technology Enugu. 180 juveniles were purchased and acclimatized for 7 days. A 24-hour range finding test determined the LC50 value of 1.2 mg/l DCW. A 96-hour static bioassay acute toxicity experiment was then conducted in plastic tanks with 10 fish in each, and diesel of different concentrations. Mortality rate was observed in the various test concentrations. The LC50 concentration was 0.12 mg/l, improved to 0.30 mg/L with MSE-treated diesel. Histopathology of the gills of affected fish showed elevated damage, necrosis, telangiectasia and oedema in DCW exposed fish, but limited damage in MSE-treated DCW exposed fish. The results of the experiment showed that diesel has detrimental effects on C. gariepinus and could cause high mortality at higher concentrations. Moringa seed extract (MSE) was used as a phytoremediant to ameliorate the mortality and gill histological damages of the experimental fish. Therefore, diesel contaminated water should be ameliorated to a safety level of 0.003 mg/l with MSE to protect fish species and other aquatic organisms.

Effect of a Telephone Health Coaching Intervention on Hypertension Control in Young Adults

Uncontrolled hypertension (ie, a 24-hour ambulatory systolic blood pressure of ≥130 mm Hg and diastolic blood pressure of ≥80 mm Hg or clinic systolic blood pressure of ≥140 mm Hg and diastolic blood pressure of ≥90 mm Hg) in young adults is a US public health burden. To evaluate the effect of a telephone coaching and blood pressure self-monitoring intervention compared with usual care on changes in systolic and diastolic blood pressures and behaviors at 6 and 12 months. This randomized clinical trial included male and female participants aged 18 to 39 years with uncontrolled hypertension confirmed by 24-hour ambulatory blood pressure testing. This was a geographically diverse, multicentered study within 2 large, Midwestern health care systems. Data were collected from October 2017 to February 2022 and analyzed from February to June 2022. The My Hypertension Education and Reaching Target (MyHEART) intervention consisted of telephone coaching every 2 weeks for 6 months, with home blood pressure monitoring. Control participants received routine hypertension care. The co-primary clinical outcomes were changes in 24-hour ambulatory and clinic systolic and diastolic blood pressure at 6 and 12 months. The secondary outcomes were hypertension control (defined as ambulatory systolic blood pressure <130 mm Hg and diastolic blood pressure <80 mm Hg or clinic systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg) and changes in hypertension self-management behavior. A total of 316 participants were randomized (159 to the control group and 157 to the intervention group) from October 2017 to December 2020. The median (IQR) age was 35 (31-37) years, 145 of 311 participants (46.6%) were female, and 166 (53.4%) were male; 72 (22.8%) were Black, and 222 (70.3%) were White. There were no differences in baseline characteristics between groups. There was no significant difference between control and intervention groups for mean 24-hour ambulatory systolic or diastolic blood pressure or clinic systolic or diastolic blood pressure at 6 or 12 months. However, there was appreciable clinical reduction in blood pressures in both study groups (eg, mean [SD] change in systolic blood pressure in intervention group at 6 months, -4.19 [9.77] mm Hg; P < .001). Hypertension control did not differ between study groups. Participants in the intervention group demonstrated a significant increase in home blood pressure monitoring at 6 and 12 months (eg, 13 of 152 participants [8.6%] checked blood pressure at home at least once a week at baseline vs 30 of 86 [34.9%] at 12 months; P < .001). There was a significant increase in physical activity, defined as active by the Godin-Shephard Leisure-Time Physical Activity Questionnaire, in the intervention group at 6 months (69 of 100 [69.0%] vs 51 of 104 [49.0%]; P = .004) but not at 12 months (49 of 86 [57.0%] vs 49 of 90 [54.4%]; P = .76). There was a significant reduction in mean (SD) sodium intake among intervention participants at 6 months (3968.20 [1725.17] mg vs 3354.72 [1365.75] mg; P = .003) but not 12 months. There were no significant differences in other dietary measures. The MyHEART intervention did not demonstrate a significant change in systolic or diastolic blood pressures at 6 or 12 months between study groups; however, both study groups had an appreciable reduction in blood pressure. Intervention participants had a significant reduction in dietary sodium intake, increased physical activity, and increased home blood pressure monitoring compared with control participants. These findings suggest that the MyHEART intervention could support behavioral changes in young adults with uncontrolled hypertension. ClinicalTrials.gov Identifier: NCT03158051.

Three-Phase Well-Flow-Measurement and Well-Testing Unit Provides Accuracy, Agility

_ This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper URTeC 3719030, “Not Measured, Not Improved: Agile Three-Phase Well-Flow-Measurement and Well-Testing Unit,” by Bali Singh and Bruce Gerrard, SPE, Apache, and David Reasoner, SPE, NeoTek Energy, et al. The paper has not been peer reviewed. _ The complete paper highlights well-test challenges, provides an overview of common problems, and describes the broader impact of inaccurate or infrequent well tests, with a focus on production testing of wells in the Permian Basin. Many of these challenges, however, apply to onshore oil and gas fields around the world. To overcome the measurement challenges in a cost-effective manner, the industry has taken multiple approaches to create various inline test devices with limited success. The authors introduce a measurement system that is agile for transport and can be installed anywhere with a small footprint while delivering reasonably accurate results. Introduction Measurement-system design included the following requirements: - Able to measure oil, water, and gas flow rates with reasonable accuracy - Agility allowing the system to be moved rapidly and easily by using a trailer behind a work truck - Installable and operational within 6 hours - Maximum 8×8-ft footprint - Must run standalone or in series with any other measurement system for validation testing - No requirement for additional infrastructure—capable of operation under its own power and communication with cellular or satellite phones and modems Theory and Methods Industry Practices: Importance of Accurate Well Tests. The standard test requirement for regulatory reporting in most provinces and states in North America is two 24-hour well tests per month. The 2 or more days of testing in a test separator, and the remaining days tested in a group separator, are used to estimate total monthly production volume allocated to the well. A sales meter is used to measure group production from a satellite for allocating revenues to the working-interest (WI) holders of each well or lease. In almost all fields, the production measured at the sales node does not match the combined production from multiple group lines that are run into the sales line. This poses a challenge because the sum of group lines is different from the volume measured by the sales meter. The challenge is addressed by prorating the difference between the sales meter and group lines back to the individual wells, called the proration factor. In the event of disagreement among WI owners, a large proration factor may cause custody-transfer issues. The good news is that the industry has developed many products used in specific applications to increase testing frequency and accuracy. The proposed measurement system fits well into this application and into much broader measurement categories. The measurement system was tested at Apache with highly favorable results and is ready to be deployed to optimize production allocation, well-test accuracy, and metering accuracy.

Wilson’s Disease: A Review

Wilson’s disease is a disease that results from a genetic disorder that causes copper accumulation. Wilson’s disease has presented challenges for physicians during the last century, but it can be diagnosed and treated over time. Diagnosing Wilson’s disease is challenging for doctors because of its wide range of clinical manifestations and complexity. Studies that can help diagnose Wilson’s disease include a 24-hour copper urine examination and neurological tests, such as a CT scan or MRI, and liver function tests. There is also a scoring system to help medical personnel diagnose this disease. Correct diagnosis and adequate therapy can be provided, such as penicillamine, trientine, zinc, and, most rarely, liver transplantation. It is also necessary to monitor the side effects of treatment and its effectiveness of treatment. When receiving therapy, Wilson’s disease has a better prognosis than if it is not treated.

Targeted education and outreach to neighbors of homes with high gross alpha radioactivity in domestic well water

Gross alpha, a measurement of radioactivity in drinking water, is the most frequent laboratory test to exceed primary drinking water standards among wells tested under the New Jersey Private Well Testing Act (NJ PWTA). Certain geological factors prevalent in New Jersey (NJ) are primarily responsible for the presence of radioactivity in private well drinking water and thus, many of the estimated one million private well users in NJ may be at-risk of water contamination from naturally occurring radionuclides. Neighbor-based private well outreach methodology was utilized to identify high risk wells in both northern and southern NJ regions and offer free private well testing for radionuclides. Previously tested wells with gross alpha exceeding or equal to 3.7 becquerels per liter (Bq L-1; 100 pCi/L) were selected (n = 49) to identify neighbors (n = 406) within 152.4 m (500 feet). Invitation letters were mailed to selected neighbors and some of the previously tested high wells (n = 12) offering free water sampling for the following parameters: gross alpha (48-hour rapid test), combined radium-226 and radium-228 (Ra-226 + Ra-228), uranium-238 (U-238), radon-222 (Rn-222) and iron. Overall, 70 neighbors and 5 high PWTA wells participated in this free water testing opportunity. For neighboring wells, gross alpha results revealed 47 (67.1%) wells exceeding the gross alpha MCL of 0.555 Bq L-1 (15 pCi/L) mainly due to radium activity in the raw/untreated water. Of those with water treatment (n = 62), 12 (19.4%) treated water samples exceeded the gross alpha MCL. Targeting neighbors of known highly radioactive wells for private well testing is an effective public health outreach method and can also provide useful insight of regional contaminant variations.

A comparison of hemoglobin A1c and the 1-hour glucose challenge testing in early pregnancy

A comparison of hemoglobin A1c and the 1-hour glucose challenge testing in early pregnancy

UV light-induced oxygen doping in graphitic carbon nitride with suppressed deep trapping for enhancement in CO2 photoreduction activity

• Oxygen (O) element is introduced in the bulk graphitic carbon nitride (CN) for the first time through a precursor pretreatment by ultraviolet (UV) light irradiation. • The doped O non-metal photocatalyst of CN increased visible light absorption and enhanced carrier density. • The optimized sample has lower charge recombination and suppressed electron deep trapping. • The optimized sample shows enhanced photoreduction activity of CO2 to CH4. While photoreduction of CO 2 to CH 4 is an effective means of producing value-added fuels, common photocatalysts have poor activity and low selectivity in photocatalytic CO 2 -reduction processes. Even though creating defects is an effective photocatalyst fabrication route to improve photocatalytic activity, there are some challenges with the facile photocatalyst synthesis method. In this work, an O element is introduced into a graphitic carbon nitride (CN) skeleton through a precursory ultraviolet light irradiation pretreatment to increase the visible light absorption and enhance the carrier density of this modified non-metal CN photocatalyst; the charge transfer dynamics thereof are also studied through electrochemical tests, photoluminescence spectroscopy, and nanosecond transient absorption. We verify that the optimized sample exhibits lower charge recombination and a suppressed 84 ns electron-trapping lifetime, compared to the 103 ns electron-trapping lifetime of the CN counterpart, and thereby contributes to robust detrapping and a fast transfer of active electrons. Through density functional theory calculations, we find that the improved light absorption and increased electron density are ascribed to O-element doping, which enhances the CO 2 adsorption energy and improves the CO 2 -to-CH 4 photoreduction activity; it becomes 17 times higher than that of the bare CN, and the selectivity is 3.8 times higher than that of CN. Moreover, the optimized sample demonstrates excellent cyclic stability in a 24-hour cycle test.

The role of speed-based strategy instruction on learning and transfer of motor sequences in a complex task

Abstract Study aim: The purpose of this study was to investigate the impact of speed-based strategy instruction on motor sequence learning and transfer. Material and methods: Male participants (n = 30, 18 to 24 years old) were assigned to one of the groups based on instruction. Motor sequence learning was examined using the complex dynamic arm movement task. Two sets of speed and control instructions completed ten blocks of 100 trials in the acquisition phase followed by the retention and transfer test after 24 hours. Results: Mixed analysis of variance (2×10 and 2×4) and the independent samples t-test were used to examine the data. The results demonstrated that element response time and error of prediction in both groups were significantly improved in the acquisition phase (P &lt; 0.05), but in the 24-hour retention test, the speed group had a significantly better element response time than the control group (P &lt; 0.05). Furthermore, the findings of the independent samples t-test in the transfer test revealed that element duration and error rate were significantly better in the speed group than the control group (P &lt; 0.05). Conclusions: According to the data, when compared to the conventional technique, in which participants were not given any special instructions, the speed-based instruction resulted in greater acquisition of the acquired motor sequence and better transfer of a new sequence.

A narrative review of the role of the Male Stress Incontinence Grading Scale in the surgical management of male stress urinary incontinence.

Surgical treatment for male stress urinary incontinence (SUI) includes transobturator slings and artificial urinary sphincters (AUSs). Historically, 24-hour pad weights have been used to objectively grade the severity of male SUI and guide management decisions. In 2016, the Male Stress Incontinence Grading Scale (MSIGS) was developed as a scoring system for the standing cough test (SCT). This test can be performed at the time of initial consultation and is non-invasive, with significantly less burden to the patient compared to historical measures of male SUI. A review of the reconstructive literature was conducted using PubMed and Google Scholar, reviewing articles that discuss the development of MSIGS, its correlation with objective measures of male SUI, and its use in guiding the choice of anti-incontinence surgical management. MSIGS has been shown to have a strong positive correlation with the 24-hour pad weight test and the subjective patient-reported pads per day (PPD). An MSIGS of 3 or 4 is used to recommend a patient for AUS placement and a score of 1 or 2 for male sling placement. Patient reported satisfaction rates were 95% for AUS and 96.5% for sling. Further, over 91% of men in the study reported they would recommend their selected procedure to other men with a similar condition. The MSIGS is a non-invasive, efficient, and cost-effective way to evaluate men with SUI. The in-office SCT can be quickly and easily adopted into any clinical practice and provides immediate objective information that can be used to better counsel patients on anti-incontinence surgery selection.

Comparative Analysis of Air Conditioning Performance with 0.5 PK Capacity Using Environmentally Friendly Refrigerants

In accordance with the Montreal Protocol, R22 will be completely banned from its use from January 1, 2030. Research looking for alternative refrigerants replacing R22 has experienced a significant increase. One of the replacement refrigerants that have gradually expanded their use are hydrocarbon refrigerants, few of which are R32, R290, and R410a. However, there are no experiments using the same test equipment for use on R32, R410a and R290 refrigerants. In addition, a more detailed study comparing the respective those refrigerants has not been found. This study aims on knowing the performance of machines that use R32, R290, and R410a refrigerants. This research uses 0.5 PK air conditioner. This research has begun with the preparation of tools and materials. Preparatory steps include assembly and setting up test installations, vacuuming, refrigerant filling and leak tests. The testing and the data retrieval steps are carried out after the system operates for about 30 minutes, i.e. until the system is working normally. Data collection is carried out with the change parameter or replacing the refrigerant. After obtaining data, analysis on Coefficient of Performance (COP), electricity costs, and economical refrigerant needs is carried out. The results have shown that the COP of R32 had the highest value from the 1-hour test, which has been 49.1. The most economical electricity cost is assumed to live for 24 hours in 1 month, namely in R32 refrigerant with a total amount of $12.46. The most economical refrigerant capacity operational cost is R290 refrigerant with a total amount of $9.01.

Effectiveness of additional antireflux surgery after resection of oesophagogastric junction cancer: protocol for a systematic review and meta-analysis

IntroductionGastro-oesophageal reflux is common in patients with oesophagogastric junction (OGJ) cancer following radical surgery. We aim to conduct a systematic review to investigate the effectiveness and clinical value of additional...

Heart rate turbulence assessed through ergometry after myocardial infarction: a feasibility study.

Coronary artery disease is an important cause of morbidity and mortality. The impact of ventricular arrhythmias with impaired cardiac vagal activity is one of the most recently studied prognostic factors. However, there are no studies evaluating the phenomenon of heart rate turbulence (HRT) during physical exertion. To study the behavior of HRT during exercise testing, among individuals after myocardial infarction. Feasibility study conducted in a university hospital among individuals 4-6 weeks after myocardial infarction. All subjects underwent 24-hour Holter monitoring and ergometric stress testing. We considered that abnormal HRT was present if the turbulence onset was ≥ 0% or turbulence slope was ≤ 2.5 mm/relative risk interval. All 32 subjects were asymptomatic. Their median age was 58 years (interquartile range 12.8) and 70% were male. Abnormal HRT was associated with ventricular dysfunction in this population. We found no differences regarding the behavior of HRT, in relation to age, gender, smoking, systemic arterial hypertension, diabetes mellitus or dyslipidemia. Ergometric stress testing detected premature ventricular beats (PVB) in approximately 44% of the examinations, and these occurred both during the active phase of effort and in the recovery period. The low occurrence of several isolated PVB in beta-blocked subjects made it difficult to perform statistical analysis to correlate HRT between ergometric and Holter testing. The data obtained in this study do not support performing HRT through ergometric stress testing among patients who remain on beta-blockers post-myocardial infarction, for the purpose of assessing cardiac vagal activity.

Significance of the Pee-Value: Relevance of Urine Studies for Patients with Myeloma Undergoing Transplantation

INTRODUCTION: International Myeloma Working Group (IMWG) criteria require 24-hour urine specimens as part of response assessments, which can be cumbersome for patients to collect. This requirement is particularly onerous before autologous stem cell transplantation (ASCT), a period relatively soon after diagnosis with many concurrent testing requirements. The necessity of urine testing to complete response (CR) determinations and its prognostic impact on progression-free survival (PFS) have been questioned in subgroup analyses of clinical trials (Dejoie 2016; Lahuerta 2019). However, the real-world importance of urine testing to IMWG response criteria more broadly has not been ascertained. METHODS: We analyzed all patients with multiple myeloma (MM), excluding those with oligosecretory disease or progressive disease during induction, who underwent first ASCT at our institution between 2016-2019. Patients with measurable serum M-protein (>1 g/dL) and light-chain (LC)-only disease were included. Patients with missing diagnostic or pre-ASCT data precluding IMWG response assessments were excluded. Evaluable urine studies were defined as a documented urine immunofixation (UIFE) value or, if UIFE was missing, a presumptive +UIFE if urine protein electrophoresis showed a paraprotein. For patients with a documented negative UIFE at diagnosis, -UIFE was presumed if urine studies were not repeated before ASCT. For patients with evaluable baseline and pre-ASCT urine testing, we assessed responses using both traditional IMWG criteria and 'urine-free’ IMWG criteria, whereby urine testing results were systematically removed as options or requirements to achieve any given response depth. We hypothesized that urine-free criteria would yield discordant responses in <10% of patients, a proportion we determined a priori to be clinically irrelevant. RESULTS: Of 347 screened patients, 66 (19%) were excluded due to missing data precluding pre-ASCT response assessments by traditional IMWG criteria. Compared to patients (n=281) with sufficient data, these 66 excluded patients were more likely to have LC-only disease and to have been transplanted before 2018. Of 281 patients evaluable for responses by both traditional and urine-free IMWG criteria, 11 patients (4%) had discordant responses (Figure 1). Discordance rates were 14% (9/63) among patients with LC-only disease and 1% (2/218) among patients with measurable serum M-proteins. Of these 11 discordant responses, 7 were superior with urine-free criteria while 4 were inferior (Table 1). DISCUSSION: In our retrospective study, response depths changed in only 4% of patients when urine requirements were systematically removed from IMWG criteria. Rates of discordance varied by paraprotein biology: 1% of patients with a measurable serum M-protein had discordant responses, versus 14% of patients with LC-only disease. This calls into question the common practice of requiring repeat 24-hour urine assessments for all patients prior to ASCT, since its utility may be practically limited to patients with LC-only disease. Interestingly, omitting urine from IMWG response criteria did not uniformly shift responses in either direction. Limitations of our data include missing data in 66 patients (who had predominantly LC-only disease) as well as lack of generalizability to ASCT-ineligible patients. However, our study is important in demonstrating that 24-hour pre-ASCT urine testing may be unnecessary for many patients with MM, particularly those with a measurable serum M-protein at diagnosis. Further research is needed to assess whether urine-free or traditional response criteria better reflect underlying disease biology in terms of their ability to prognosticate PFS. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Third Trimester Ultrasound Stratifies Risk of Peripartum Complications in Pregnancies Complicated by Impaired Glucose Tolerance.

The objective of our study was to investigate the effect of impaired glucose metabolism (IGM) and ultrasound (US) findings consistent with hyperglycemia on maternal and neonatal outcomes. This was a retrospective case-control study of singleton, nonanomalous pregnancies with an elevated 1-hour glucose screening test (GST) completed after 23 weeks of gestation. IGM was defined as a 1-hour GST of >130, but less than two abnormal values on 3-hour glucose tolerance test (GTT). Gestational diabetes was defined as two or more abnormal values on 3-hour GTT. Ultrasound evidence of hyperglycemia was defined as abdominal circumference >95th centile and/or polyhydramnios. Individuals with IGM were divided into those with ultrasound evidence of hyperglycemia (impaired glucose metabolism consistent with ultrasound findings [IGM-US]) and those without IGM. Maternal demographics, delivery outcomes (gestational age at delivery, delivery mode, shoulder dystocia, lacerations), postpartum hemorrhage, and neonatal outcome (birth weight centile [BW%], neonatal intensive care unit admission, hypoglycemia, and glucose) were recorded. Composite morbidity was tabulated. Delivery and neonatal outcome variables were compared in individuals with IGM-US, IGM, and gestational diabetes mellitus (GDM). Odds ratios were calculated and adjusted for maternal age, BMI, and gestational weight gain. A total of 637 individuals with an abnormal 1-hour GST were included (122 with IGM-US, 280 with IGM, and 235 with GDM). When compared to the IGM group, IGM-US had higher rates of cesarean delivery and BW% > 90th centile at delivery (adjusted odds ratio [aOR]: 1.7 [1.1-2.8] and aOR: 5.9 [2.7-13.0], respectively). Individuals with GDM also demonstrated similar rates with BW% > 90% but not cesarean section(aOR: 3.9 [1.8-8.5] and aOR: 1.4 [0.9-2.1], respectively). The remaining maternal and fetal outcomes were similar. Women with impaired glucose tolerance should have a third-trimester ultrasound to identify an increased risk of perinatal complications. · Women with elevated blood glucose screening should be evaluated with third-trimester ultrasound to identify risks for perinatal morbidity.. · The third-trimester ultrasound identifies individuals at risk for cesarean section.. · Counseling should be completed with individuals with polyhydramnios or accelerated growth..

Association Between Daily Sample Collection Time and Results of Testosterone Testing in Adult Males

Abstract Introduction/Objective Serum testosterone levels in men have diurnal fluctuation with levels peaking between 7 AM and 10 AM, reaching an early evening nadir around 7 PM. For evaluation of male hypogonadism, fasting total testosterone levels should be measured in the early morning (8 to 10 AM). Testosterone measurements made beyond peak times may yield misleading results. We aim to investigate specimen collection times and compare with testosterone levels. Methods/Case Report We examined specimen collection times for testosterone testing (n=3075) for adult males (age &amp;gt;16 years) over a four-year period (July 2016-June 2020). Collection times were grouped into 2-hour intervals and test interpretations were grouped as either “low” or “high/normal”. Collection times were categorized as either morning (between 6 AM and 12 PM) or non-peak times (between 12 PM and 6 AM) A chi-square analysis was performed to investigate the possible relationship between low testosterone levels and specimen collection time. Results (if a Case Study enter NA) Approximately two-thirds of testosterone test samples were collected outside the recommended timeframe of 8-10 AM and accounted for 70% of low testosterone levels. The chi-square test showed that there is a significant (p=0.005) overall relationship between specimen collection times and testosterone levels. A correspondence plot of chi-square residuals showed a positive relationship between low testosterone levels collected at non-peak times. Conversely, there was a negative relationship between low testosterone levels collected in the morning. Conclusion Low testosterone levels measured on specimens collected outside of peak morning hours may be difficult to interpret and may lead to additional unnecessary repeat testing or treatment.

Preeclampsia Incidence and Its Maternal and Neonatal Outcomes With Associated Risk Factors.

Background and objective Preeclampsia is a hypertensive disorder that usually arises after 20 weeks of pregnancy. It is considered a major cause of maternal and fetal mortality worldwide. High blood pressure and high proteinuria are the two main characteristics of preeclamptic patients. Preeclampsia leads to eithersevere or mild conditions, but in both cases, it affects the organs of the mother and fetus.This studywas conducted to determine the prevalence of preeclampsia and associated risk factors (family history, age, hypertension, and diabetes) and to investigateits fetal and maternal outcomes. Methodology This prospective study was conducted at three healthcare units in the Multan district and involved patients with gestational hypertension.Patients were diagnosed on the basis of blood pressure values, urine tests, and throughDoppler ultrasound. Further investigations were conducted, including a complete hemogram and a 24-hour test for proteinuria. Results for preeclampsia-related maternal and perinatal outcomes were documented andstatistical analysis was performed to analyze the data. Results A total of 142patients were diagnosed with gestational hypertension and preeclampsia during the two-year study period. Our findings showed 8.67% cases of gestational hypertension and 3%of preeclampsia. The majority of the preeclamptic patients were less than 24 years of age (33.3%), belonged to lower socioeconomic classes (44.4%), and had low educational levels (81.1%). A close association of family history (36.67%) with diabetes (15.5%)and chronic hypertension (5.55%) was observed in these patients. Maternal and fetal outcomes were relatedto maternal blood pressure.A significant incidence of premature births (45.6%) and a majority of cesarean cases(63.4%) withsevere complicationswere observed. Data from preeclamptic patients showed high albuminuria levels (42.2%) with problems like renal infection, pulmonary edema, and severe anemia. During the study period, aneonatal death rate of11.1% wasobserved as well as issues likerespiratory tract syndrome, asphyxia, and growth retardation. Conclusion This study showed that poor economic and educational levels are significantly associated with this disease. A high rate of maternal and neonatal morbidity with neonatal mortality was investigated.Mild to severe outcomes wereobserved in the form of cesarean deliveries and preterm births. Serious complications leadto ICUadmissions causing a serious burden on healthcare units. Paying more attention to the healthcare needs of pregnant women helps to identify preeclampsia earlier and also minimizes the complications associated with it.