Stages Of Deterioration Research Articles

Simple Nested Allele-Specific approach with penultimate mismatch for precise species and sex identification of tiger and leopard.

Accurate species and sex identification of non-invasive and forensic samples of the tiger and leopard is still confusing when using the allele-specific methods. We designed allele-specific methods with penultimate nucleotide mismatch in a nested manner for the exact identification and double-checking of forensic samples. The mismatch design is a novel concept in species and sex identification, making the allele-specific targeting precise. We developed three sets of markers, a 365bp outer and a 98bp inner marker for nested tiger species identification assay, 136bp leopard specific marker, and carnivore sex identification markers. We validated the method with tissue/blood forensic samples of various felids and herbivorous available in our lab and on known fecal samples from Vandalur Zoo. We also collected 37 scat samples at diverse stages of deterioration from the Mudumalai Tiger Reserve, Tamil Nadu, India. The 365bp targeted markers resulted in 70.2% (n = 22; 22/37) amplification success, while the 98bp FAM-labelled marker amplified 89% (n=33; 33/37) scat samples independently. The 136bp leopard markers answered four scat samples (11%) unrequited by the tiger specific markers. We evaluated species and the sex identification with these markers in another 190 non-invasive samples provided by the Mudumalai Tiger Reserve authorities. Among which 56.3% (n= 107) of samples were recognized as tiger (64 male and 43 female) and 38.9% (n= 74) as leopard (41 male and 33 female). The method supersedes any other previous methods in this regard by its high accuracy and simplicity.

Smart Cathodic Protection System for Real-Time Quantitative Assessment of Corrosion of Sacrificial Anode Based on Electro-Mechanical Impedance (EMI)

Corrosion of metal structures is often prevented using cathodic protection systems, that employ sacrificial anodes that corrode more preferentially relative to the metal to be protected. In-situ monitoring of these sacrificial anodes during early stages of their useful life could offer several insights into deterioration of the material surrounding the infrastructure as well as serve as early warning indicator for preventive maintenance of critical infrastructure. In this article, we present an Electro-Mechanical Impedance (EMI) measurement-based technique to quantify extent of corrosion of a zinc sacrificial anode without manual intervention. The detection apparatus consists of a lead zirconate titanate (PZT) transducer affixed onto a circular zinc disc, with waterproofing epoxy protecting the transducer element when the assembly is submerged in liquid electrolyte (salt solution) for accelerated corrosion by means of impressed current. We develop an analytical model for discerning the extent of corrosion by monitoring shift in resonance frequency for in-plane radial expansion mode of the disc. The model presented here accurately captures the nonlinearity introduced by partial delamination of the corrosion product (zinc oxide) from the disc, and shows excellent agreement with experimental results. Our work establishes the efficacy of the proposed technique for monitoring the state of health of sacrificial anodes in their early stage of deterioration and could thus be widely adopted for structural health monitoring applications within the internet of things.

Anatomically based radiological classification of thumb basal joint arthritis

The numerous surgical techniques proposed for treating thumb basal joint arthritis (osteotomy of the first metacarpal, trapezial osteotomy, simple trapeziectomy, trapeziectomy with implant, total joint prosthesis, arthroplasty by interposition, etc.) necessitate an anatomically based radiological evaluation of the different pathological forms of thumb basal joint arthritis. Here, the author defines three parameters: narrowing of the trapeziometacarpal (TM) joint space: TMA; TM instability and subluxation: TM I; scaphotrapeziotrapezoid damage: STT. Four stages of TM osteoarthritic deterioration are defined: TMA0: no joint narrowing (painful and unstable joint); TMA1: narrowing <50%; TMA2: narrowing>50%; TMA3: disappearance of the joint space, bone erosions. For TM instability/subluxation: TMI 0: reducible subluxation (unstable and painful TM); TMI 1: reducible subluxation but with imperfect reintegration; TMI 2: non-reducible subluxation <1/3; TMI 3: subluxation>1/3. For STT damage, STT 0: radiograph is normal but anatomical damage is visible intraoperatively; STT 1: joint space narrowing <50%; STT 2: joint space is barely visible; STT 3: presence of erosion, sclerosis, irregularities. He outlines the shortcomings of the often-used Dell and Eaton-Littler classifications. A prospective study involving multiple cases having the same anatomical and radiological appearance that are assessed with sufficient follow-up is needed to standardize the modalities of surgical treatment.

Gene silencing approaches for the treatment of hepatitis C virus infection

Hepatitis C virus (HCV) infection is a worldwide concern. Only minor portion of the ‎infected patients can clear the virus whereas the majority (more than 70%) progress to ‎advanced stages of liver deterioration which in most cases lead to liver cirrhosis and ‎cancers if remained untreated. Current standard treatment for hepatitis C is the ‎combination treatment with polyethylene glycol pegylated interferon-α and ribavirin ‎‎(PEG-IFN-α/RBV). Conventional treatment for hepatitis is reported to show variable ‎degree of success and, most recently, the combination of two or more agents has shown ‎great promise. Conventional therapy for HCV, however, is time consuming and expensive ‎and could considerably reduce the quality of life for most of the patients. Gene therapy is ‎an emerging branch of science aimed at the manipulation of genetic sequences. Gene ‎therapy has been recently introduced to virology as a novel anti-viral class of medicines. ‎The innovative idea is to target the HCV viral genome by clipping or blocking to arrest ‎the viral replication. This can be achieved by gene silencing techniques such as siRNA. ‎This will cause viral degradation by hindering the viral genome functionality pre- or post-‎translational to offer a specific and promising tool which has not been investigated ‎thoroughly. Results from using siRNA in vitro are promising, however, this area of ‎research is still evolving.‎

A Capacitive Sensor for Detecting Insulation Degradation by Sensing 2-FAL in Transformer Oil

A capacitive sensor for assessing early degradation of transformer insulation by detecting 2-furfuraldehyde (2-FAL) at the sub-ppm level in transformer oil is presented in this paper. The sensor uses a molecularly imprinted polymer (MIP) in which 2-FAL sensitive receptors are created. The 2-FAL molecules in the oil are adsorbed on the receptor cavity of the MIP which results in a change in the sensor capacitance. The sensing film is prepared by the sol-gel technique using methacrylic acid, divinyl benzene, and azobis. The sensor is successfully tested from sub-ppm to ppm of 2-FAL concentration. The average sensitivity of the sensor is 0.379 pF/ppm, and the average standard deviation is 0.035 pF at 1 kHz in the range of 0–10 ppm. The sensor shows piecewise linear characteristics for sub-ppm and higher ppm ranges. The resolution of the sensor is 0.1 ppm in the sub-ppm range, and hence, it can be used for anticipating early failure as well as provide warning during an advanced stage of deterioration. The average repeatability index of the sensor is ±0.033%, which indicates negligible drift and stability of sensing film.

Emerging water pollution in the world's least disturbed lakes on Qinghai-Tibetan Plateau.

Qinghai-Tibet Plateau (QTP) Lake Region has largest abundance and size distribution of lakes in China. Being relatively away from major human activities, the water quality of these lakes has not attracted concerns in the past. However, dramatic climate change and intensified anthropogenic activities over the past 30 years have exerted multiple pressures on the water environment of the lakes, resulting in elevated nutrient concentrations in major freshwater lakes of the region. Rapid water quality deterioration and eutrophication of the lakes were first found in Lake Hurleg in the northeast of the plateau. Analyses of driving forces associated with these changes indicate that both the intrinsic characteristics of the QTP lakes and climate change were responsible for the vulnerability to human activities than other lakes in different regions of China, with accelerated urbanization and extensive economic development in the lake basin playing a decisive role in creating water pollution events. Under combination pressures from both natural and anthropogenic effect, the increasing rate of nutrient concentrations in Lake Hurleg has been 53-346 times faster than in Lake Taihu and Lake Dianchi during the deterioration stage. The result suggests the current development mode of Lake Hurleg basin is not suitable for setting protection targets for the QTP lake region more broadly due to its extremely poor environmental carrying capacity. To stop worsening the lake water environment condition, it is necessary to review the achievements made and lessons learned from China's fight against lake pollution and take immediate measures, inform policies into the development mode in the QTP lake region, and avoid irreversible consequences and ensure good water quality in the "Asian Water Tower."

Reinforcement learning for optimal policy learning in condition‐based maintenance

Condition-based maintenance (CBM) involves taking decisions on maintenance or repair based on the actual deterioration conditions of the components. The long-run average cost is minimised by choosing the right maintenance action at the right time. In this study, the CBM decision-making problem is modelled as a continuous semi-Markov decision process (CSMDP). It consists of a chain of states representing various stages of deterioration, a set of maintenance actions, their costs and scheduled inspection policy. The application of a reinforcement learning (RL) algorithm based on the average reward for CSMDPs in CBM is described. The RL algorithm is used to learn the optimal maintenance decisions and inspection schedule based on the current health state of the component.

Experimental and modeling study on the triaxial mechanical behavior of sulfate-deteriorated mortar

Considering the significance of sulfate attack to structure durability and frequent existence of multiaxial loadings, it is relevant to study the triaxial mechanical behavior of sulfate-deteriorated cementitious materials. The triaxial compression tests with three confining pressures were conducted in previous study. To give a reliable constitutive model, this research investigated the triaxial mechanical behavior of sulfate-deteriorated mortar in experimental and modeling aspects. All stress–strain curves of the mortar samples immersed in 5% Na2SO4 solution up to 270 d were shown and analyzed. The ingress of sulfate decreased the axial strain at improvement stage, but slightly increased the strain at deterioration stage. The volume of mortar sample changed from contraction to dilation with loading, indicating a non-associated flow rule. A nearly linear relationship between the square root of triaxial failure stress and elastic modulus of mortar was observed, proved by other research results as well. The lateral confinement attenuated the negative effect of sulfate deterioration on the two mechanical indexes. On the basis of elastoplasticity theory and experimental results, an elastoplastic model considering sulfate deterioration was proposed. The effect of sulfate deterioration was implemented to the elastic modulus, failure criterion and hardening law through 2nd polynomial. Numerical simulations showed that the proposed model can well reproduce the compression behavior of sulfate-deteriorated mortar with different confining pressures.

Flow structure at different stages of heat transfer deterioration with upward, mixed turbulent flow of supercritical CO2 heated in vertical straight tube

The mixed turbulent heat transfer characteristics of supercritical CO2 heated in a straight tube of diameter d = 4 mm are experimentally and numerically investigated at a pressure p = 8 MPa, mass flux G = 278 kg/(m2s), heat flux q = 15–35 kW/m2, and inlet Reynolds number Rein ≥ 14000. To identify the key factor affecting the heat transfer deterioration (HTD), the flow structures at different conditions are comparatively analyzed. The results show that the HTD accompanying abrupt increase in the wall temperature is mainly caused by buoyancy force rather than thermal acceleration. The M-type velocity profiles are observed at the initial, stable, and recovery stages of the HTD. The location of the salient point of the M-type velocity plays a major role in the different regions of the HTD. Similar to the salient point of the M-shaped velocity, the location at which the local fluid temperature Tb(r) is equal to the pseudo-critical temperature Tpc can also be an effective criterion for predicting the onset of HTD. Both the salient point of the M-shaped velocity and the location of Tb(r) = Tpc demonstrate that the flow structure at the buffer layer (y+ = 5–30) is the dominant factor that influences the onset of HTD. An analysis of the thermal resistance in cross section also confirms that the buffer layer is the dominant region for the HTD. Based on the analysis of the flow states at the buffer layer, a new correlation model is developed for accurately predicting the heat transfer coefficient of supercritical CO2 under the HTD condition.

Levosimendan and Global Longitudinal Strain Assessment in Sepsis (GLASSES 1): a study protocol for an observational study

IntroductionCardiogenic shock is a condition of low cardiac output that represents the end stage of a progressive deterioration of cardiac function. The main cause is ischaemic heart disease, but there...

Changing patterns in paediatric medical emergency team (MET) activations over 20 years in a single specialist paediatric hospital

BackgroundThe Medical Emergency Team (MET) model was first introduced in the early 1990s and aimed to intervene at an earlier stage of patient clinical deterioration. This study aimed to describe the changes in patient demographics, patterns of activation and clinical outcomes of MET activations at our specialist paediatric hospital across a 20-year period providing the longest duration Medical Emergency Team data set published to date. MethodsThis single-centre observational study prospectively collected data about MET events at a single specialist paediatric hospital in Australia from 1995 to 2014. Patient demographics, activation patterns and clinical outcomes from MET activations were analysed for the 20-year period. Results771 MET events were included in analysis. Most MET events involved children aged <5 years (median age 36 months) with decreased incidence on weekends and night shift. The most frequent reasons stated for MET activation were seizure and respiratory compromise and the most commonly recorded MET interventions were bag-valve-mask ventilation and intravascular access. There was an increase in MET event frequency (MET events per 1000 hospital separations) in the second decade of the service compared to the first (3.25 vs 1.42, p ​< ​0.001) with fewer events for cardiopulmonary arrest but more for respiratory, cardiovascular or neurological compromise. ConclusionsThis study describes the longest duration MET data set published to date. The 20-year span of data demonstrates increased utilisation of the MET system and activation for patients earlier in their deterioration. The data should inform both health service planning and educational requirements for MET providers.

Hybrid Halloysite Nanotubes as Smart Carriers for Corrosion Protection.

Novel hybrid halloysite nanotubes (HHNTs) were developed and used as smart carriers for corrosion protection of steel. For this purpose, as-received halloysite nanotubes (HNTs) were loaded with a corrosion inhibitor, imidazole (IM), by vacuum encapsulation. In the next step, a layer by layer technique was employed to intercalate another inhibitor, dodecylamine (DDA), in the polyelectrolyte multilayers of polyethylenimine and sulfonated polyether ether ketone, leading to the formation of HHNTs. During this process, IM (5 wt %) was successfully encapsulated into the lumen of HNTs, while DDA (0.4 wt %) was effectively intercalated into the polyelectrolyte layers. Later, the HHNTs (3 wt %) were thoroughly dispersed into the epoxy matrix to develop smart hybrid self-healing polymeric coatings designated as hybrid coatings. For a precise evaluation, epoxy coatings containing as-received HNTs (3 wt %) without any loading denoted to as reference coatings and modified coatings containing HNTs loaded with IM-loaded HNTs (3 wt %) were also developed. A comparative analysis elucidates that the hybrid coatings demonstrate decent thermal stability, improved mechanical properties, and promising anticorrosion properties compared to the reference and modified coatings. The calculated corrosion inhibition efficiencies of the modified and hybrid coatings are 92 and 99.8%, respectively, when compared to the reference coatings. Noticeably, the superior anticorrosion properties of hybrid coatings can be attributed to the synergetic effect of both the inhibitors loaded into HHNTs and their efficient release in response to the localized pH change of the corrosive medium. Moreover, IM shows an active release in both acidic and basic media, which makes it suitable for the protection of steel at the early stages of damage, while DDA being efficiently released in the acidic medium may contribute to impeding the corrosion activity at the later stages of deterioration. The tempting properties of hybrid coatings demonstrate the beneficial role of the development of novel HHNTs and their use as smart carriers in the polymeric matrix for corrosion protection of steel.

Performance Degradation Prediction Based on a Gaussian Mixture Model and Optimized Support Vector Regression for an Aviation Piston Pump.

Performance degradation prediction plays a key role in realizing aviation pump health management and condition-based maintenance. Thus, this paper proposes a new approach that combines a Gaussian mixture model (GMM) and optimized support vector regression (SVR) to predict aviation pumps’ degradation processes based on the pump outlet pressure signals. Different from other feature extraction methods in which the information of intrinsic mode functions (IMFs) is not fully utilized, some useful IMF components are firstly chosen, and the corresponding multi-domain features are extracted from each selected component. Considering that it is not the case that all features are equally sensitive to degradation assessment, PCA is used to select more sensitive degradation features. Since the distribution of these extracted features is a stochastic process in feature space, meanwhile, self-information quantity can describe the uncertainty of system by measuring the average information quantity contained in the probability distribution, self-information quantity based on GMM is defined as degradation index (DI) to describe the degradation degree of the pump quantitatively. Finally, an SVR model is constructed to predict the degradation status of the pump. To achieve higher prediction accuracy, phase space reconstruction theory is first employed to determine the number of the inputs of the SVR model, then a new method combining particle swarm optimization (PSO) with grid search (GS) is developed to optimize the parameters of the SVR model. Finally, both the online data and historical data are utilized for the construction of the SVR model, respectively. The effectiveness of the proposed approach is validated by full life cycle data collected from an aviation pump test rig. The results demonstrate that the DI extracted from pump outlet pressure signals can effectively identify and track the current deterioration stage, and the established SVR model has better prediction ability when compared with previously published methods.

Clinical Use of Short-Course and Low-Dose Corticosteroids in Patients With Non-severe COVID-19 During Pneumonia Progression.

Background: The emerging coronavirus disease 2019 (COVID-19) has become a serious public health concern with a high number of fatalities. It is unclear whether corticosteroids could be a candidate for an early intervention strategy for patients with COVID-19.Methods: In this retrospective cohort study, we analyzed data from 28 corticosteroid-treated patients with non-severe but advanced COVID-19, in which short-course and low-dose corticosteroids were administered because of unremitting or worsening clinical conditions during hospitalization. To compare the effect of corticosteroids on viral clearance, 44 corticosteroid-untreated patients were included as controls.Results: At the time of admission, corticosteroid-treated patients (n = 28) had a more advanced baseline illness compared with corticosteroid-untreated patients (n = 44), as reflected by poorer blood laboratory parameters (lymphocytes, C-reactive protein, and lactate dehydrogenase) and more extensive chest computed tomography (CT) abnormalities. Corticosteroids were given because of radiological evidence of pneumonia progression (26/28) and/or unremitting fever (22/28) after admission. The median time from illness onset to corticosteroid treatment was 9 days (IQR, 7–10). The median duration and accumulated dose of corticosteroid treatment were 4.5 days [interquartile range (IQR), 3–5] and 140 mg of methylprednisolone (IQR, 120–200). Intravenous immunoglobulin (20 g per day for 3–5 days) was co-administered with corticosteroids. With the corticosteroid treatment, all patients achieved an abatement of fever within 1 day, and 78.6% (22/28) of the patients achieved radiological remission when evaluated about 3 days later. Only one (3.6%) patient progressed to severe COVID-19, and all patients recovered and were discharged without any sequela. The median time from illness onset to viral clearance was similar, as compared with 44 corticosteroid-untreated patients with relatively milder disease [18 (IQR 14.3–23.5) days vs. 17 (IQR, 12–20) days, p = 0.252]. When adjusted for age, sex, underlying comorbidities, baseline blood laboratory parameters, viral load, and chest radiological findings, the causal hazard ratio of corticosteroid treatment for the viral clearance was 0.79 (95%CI, 0.48–1.30, p = 0.34).Conclusion: Short-course and low-dose applications of corticosteroids, when co-administered with intravenous immunoglobulin, in non-severe COVID-19 patients during the stage of clinical deterioration may possibly prevent disease progression, while having a negligible impact on the viral clearance.

Nonlinear guided wave mixing in pipes for detection of material nonlinearity

Pipes have multiple applications in daily life and they are subjected to different types of defects. Nonlinear guided wave has attracted significant attention in detecting microstructural change at early stage of material deterioration. Extensive research using wave mixing with different wave modes has focused on plate-like structures. However, limited experimental studies have been conducted on the detection of material nonlinearity in pipes using two interacting guided waves. This study investigates nonlinear features generated due to mixing of torsional guided waves and material nonlinearity in pipes at low frequency range. The nonlinear theory of elasticity is implemented in a three-dimensional (3D) finite element (FE) method to simulate the effect of material nonlinearity on torsional guided wave mixing. The phenomenon of nonlinear features generated due to torsional guided wave mixing is investigated by 3D FE models. There is good agreement between the data obtained in the laboratory and numerical simulation results. This study demonstrates the existence of the combinational harmonic generation experimentally and provides physical insight into the phenomenon of nonlinear wave mixing. The findings of this study can further advance the damage detection techniques based on material nonlinearity in wave mixing.

Signs and symptoms that trigger nurses’ concerns about deteriorating conditions in hospitalized pediatric patients: a scoping review protocol

The objective of this scoping review is to identify and map the signs and symptoms that trigger nurses' concerns about the deteriorating conditions of hospitalized pediatric patients. Standardized observations and risk assessments of hospitalized pediatric patients are important in modern health systems. The Pediatric Early Warning Score (PEWS) is based on objective criteria, such as vital parameters, but does not include subjective criteria, such as nurses' worry. A Dutch study has shown that adding indicators for "worry" or "concern" to an early warning system based on vital signs improves the prediction of unplanned adult admissions to intensive care units. However, this has not been studied in a pediatric population. Clarifying the signs and symptoms that trigger nurses' concerns about pediatric patients' conditions could possibly help them take actions based on their intuitive feelings and obtain medical support for pediatric patients in the early stages of deterioration. This review will consider studies that include nurses working in hospital settings who care for pediatric patients (up to 18 years of age). Specifically, this scoping review will explore the signs and symptoms that underlie nurses' concerns about a pediatric patient's condition when the patient's vital signs are not a cause of worry. This scoping review will be conducted in accordance with the JBI methodology for scoping reviews. The review will search MEDLINE (via PubMed), CINAHL, Embase, Scopus and Swemed databases. The review will also search for unpublished PhD dissertations using the ProQuest Dissertations and Theses.

Reed Bed System for the Improvement of Laguna Lake Waters

Laguna lake is the biggest lake and considered one of the most important inland bodies of water in the Philippines due to its many uses. However, the lake has faced growing pressures (i.e., population expansion, urbanization, industrialization, deforestation, and land conversion) on its ecosystems over the past decades. These activities have led to the degradation of the lake’s water quality and ecosystem.The Department of Environment and Natural Resources (DENR) provided a water quality standard for freshwater in determining trends and in the evaluation of stages of deterioration or enhancement in quality of water which include 1) Class AA (Public Water Supply Class I); 2) Class A (Public Water Supply Class II); 3) Class B (Recreational Water Class I); Class C (Propagation and growth of fish class); and Class D (Navigable Waters). The classification of Laguna Lake falls under Class C, which means it is suitable for fishery. With this, intervention for the improvement of the water in Laguna Lake is highly needed. This study aims to design and assess the effectiveness of the reed bed system for the improvement of Laguna Lake. Results show that using reed bed water treatment; the total coliform will meet the standards of DENR after three years of treatment, which can be used as a source of water for irrigation, recreational area, and propagation of fishes. The concentration of ammonia will meet the standards of DENR after two and a half years by using reed bed water treatment, and inorganic phosphate will meet the standards of DENR after three years by using reed bed water treatment.

Adaptive Control Strategy of Energy Storage System Participating in Primary Frequency Regulation

In order to solve the capacity shortage problem in power system frequency regulation caused by large-scale integration of renewable energy, the battery energy storage-assisted frequency regulation is introduced. In this paper, an adaptive control strategy for primary frequency regulation of the energy storage system (ESS) was proposed. The control strategy combined virtual droop control, virtual inertial control, and virtual negative inertial control. The virtual inertial control was used to reduce the frequency change rate, and the virtual droop control was used to reduce the steady-state frequency deviation. The virtual droop control and the virtual inertia control were adopted in the frequency deterioration stage to slow down the frequency drop. While in the frequency recovery stage, the virtual negative inertia control worked together with the virtual droop control to accelerate the frequency recovery. Besides, the coefficients of the control methods were related to the state of charge (SOC) of ESS to avoid over-charging and over-discharging of the battery. Finally, a simulation model was built in MATLAB/SIMULINK, and case studies were conducted to verify the proposed control strategy. Results showed that the proposed method could meet the demand for frequency regulation and was beneficial to the cycle life of ESS.

El crimen de los oligarcas corcirenses (Th. III 70.4)

En Th. III 70.4 se acusa a un grupo de oligarcas de Corcira por ‘cortar estacas’ (τέμνειν χάρακας) ilegalmente en dos santuarios locales. Los comentaristas discuten el significado de esta acusación. Ofrecemos apoyo detallado a la conclusión de Hornblower, según la cual se acusa a los oligarcas corcirenses de cortar árboles jóvenes de terreno sagrado para usarlos como puntales de viñas en sus campos privados. Nuestro argumento sitúa el relato de Tucídides en un marco filológico, ecológico y social más amplio, y sugiere que los detalles de la acusación ayudan a establecer el abuso de recursos naturales controlados por la comunidad y el sistema judicial como fases preliminares en el deterioro social que terminó produciendo la stasis en Corcira e implícitamente también en otros lugares.

SUN-689 Treatment of Hepatitis C Has Time-Dependent Relationship with Type 2 Diabetes Progress

IntroductionHepatitis C virus (HCV) is not only related to hepatic impairment but also associated with metabolic complications, such as glucose intolerance and lipid dis-regulation. In addition, HCV can affect pancreatic Beta-cells function. There are multiple controversial reports regarding the relationship between antiviral treatment and diabetes mellitus (DM) development. We performed continuous observation of a long-term nursing home facility DM patient treated with HCV.Case Presentation52 y/o white male nursing home patient history of hepatitis C and type 2 diabetes mellitus was treated with ledipasvir/sofosbuvir (90 mg - 400 mg) for 12 weeks. Prior to HCV treatment patient DM control was treated with oral medications (metformin and glipizide) with fast glucose level fluctuating 143±44 mg/dl; 2 hours postprandial level 205±57mg/dl; HbA1c 7.0%. There was no significant change of finger sticks during the 12 weeks of HCV treatment fast glucose 121 ±27 mg/dl and 2 hours postprandial level 176±62 mg/dl.DM management remained the same treatment plan. In the first three months after HCV treatment course patient DM was progressively getting worse with fast glucose level 221±56mg/dl; 2 hours postprandial levels 300±71 mg/dl. HbA1c 8.7% (3 months after HCV treatment). Oral DM medications were doubled dosages and maximum dosage of pioglitazone was added on. In addition, insulin sliding scale and long acting insulin accumulated daily dosage around 120 units. Starting from four months after HCV treatment patient DM was gradually improving evidenced by fast glucose levels 92±10mg/dl and 2 hours postprandial levels 117±30 mg/dl; HbA1c 5.6% with the same management strategies. Seven months after HCV treatment patient DM was stable with fast glucose levels 91±8 mg/dl and 2 hours postprandial levels 115±29 mg/dl; HbA1c 4.8% and insulin sliding scale and glipizide were discontinued. Long acting insulin dosage was decreased to 74 units daily. Eighteen months after HCV treatment patient fast glucose levels and 2 hours postprandial levels were in normal range and HbA1c 5.6%.DiscussionBased on our observation there are four phases of DM development related to the HCV treatment: phase I silence stage (during 3 month HCV treatment) DM is stable; phase II deterioration stage (First 3 month after HCV treatment) DM is progressively getting worse; phase III recovery stage (4 to 6 month after HCV treatment) DM is gradually improving; phase IV stabilization stage (6 month after HCV treatment) DM is stabilized and improved.ConclusionAnti-viral treatment of HCV has possible intrinsic time-dependent relationship with DM development.