Fair Control Research Articles

6799 RZ358 Therapy. A Novel Approach to Hyperinsulinemia in Metastatic Neuroendocrine Tumor Patients

Abstract Disclosure: J. Noreña: None. T. Akcan: None. S. Patel: None. W. Madeleine: None. S. Shaheen: None. M. Tan: None. RZ358, an intravenously administered monoclonal antibody, targets a unique allosteric site on the insulin receptor. It is under investigation for hypoglycemia due to congenital hyperinsulinism. We present a case of its efficacy in treating refractory hyperinsulinemic-hypoglycemia (HH) due to a metastatic pancreatic neuroendocrine tumor (pNET). Clinical Case: A 50-year-old woman with a 6-year history of HH initially presented in 2016 with epigastric pain and was diagnosed with gastrin secreting pNET pT3N1. After Whipple surgery and cholecystectomy. A well-differentiated, WHO grade 2 NET, positive in immunohistochemistry for AE1/3, synaptophysin and Ki-67 index of 9.2% was confirmed. She presented recurrent disease with liver metastasis requiring somatostatin analogue Lanreotide. Subsequently despite Lanreotide, hypoglycemia persisted, and 72-hour fast confirmed HH. DOTATATE scan showed progression to new liver lesions. Everolimus was started and subsequently peptide receptor radionuclide therapy (PRRT) with fair hypoglycemia control. Unfortunately, her disease progressed. Oral glucose, cornstarch, and diazoxide failed. After a left hepatectomy and transarterial chemoembolization, her severe hypoglycemia improved briefly. Despite high-dose dexamethasone (up to 4 mg daily), octreotide 400 mcg every 8 hours, and high-calorie total parenteral nutrition (TPN) (over 800 grams of carbohydrates daily), she required multiple hospitalizations for persistent symptomatic hypoglycemia. Moreover, these therapies led to significant side effects, including recurrent episodes of volume overload, 240 pounds weight gain over a year, and Cushingoid features. Given RZ358's reports in reversing HH in rodents, humans, and a recent report of successful use in a malignant insulinoma case, we aimed to start RZ358 in our patient. We obtained, emergency use authorization from the FDA, IRB of Stanford University School of Medicine approval, and patient written informed consent. RZ358 was started at 6 mg/kg biweekly, along with octreotide, dexamethasone, and TPN. RZ358 dosage was later increased to 9 mg/kg weekly, allowing a substantial reduction in dexamethasone to physiological doses and a 50% reduction in TPN carbohydrate requirements. She achieved normoglycemia and returned home, but missing a single weekly RZ358 dose caused recurrent severe hypoglycemia until the next dose administration.As her disease progressed, the patient opted for comfort care, discontinuing TPN and RZ358. Conclusion: RZ358 represents a novel and unique treatment option for refractory HH in patients with metastatic NETs and can improve clinical outcomes when standard interventions fail. This case underscores the potential of RZ358, a monoclonal antibody, to treat HH beyond its approved use for congenital cases, suggesting its applicability to cases of hyperinsulinemia secondary to NETs in adults. Presentation: 6/2/2024

9286 RZ358 Therapy. A Novel Approach To Hyperinsulinemia In Metastatic Neuroendocrine Tumor Patients

Abstract Disclosure: J. Noreña: None. T. Akcan: None. S. Patel: None. M. Welsh: None. S. Shaheen: None. M. Tan: None. RZ358, an intravenously administered monoclonal antibody, targets a unique allosteric site on the insulin receptor. It is under investigation for hypoglycemia due to congenital hyperinsulinism. We present a case of its efficacy in treating refractory hyperinsulinemic-hypoglycemia (HH) due to a metastatic pancreatic neuroendocrine tumor (pNET). Clinical Case: A 50-year-old woman with a 6-year history of HH initially presented in 2016 with epigastric pain and was diagnosed with gastrin secreting pNET pT3N1. After Whipple surgery and cholecystectomy. A well-differentiated, WHO grade 2 NET, positive in immunohistochemistry for AE1/3, synaptophysin and Ki-67 index of 9.2% was confirmed. She presented recurrent disease with liver metastasis requiring somatostatin analogue Lanreotide. Subsequently despite Lanreotide, hypoglycemia persisted, and 72-hour fast confirmed HH. DOTATATE scan showed progression to new liver lesions. Everolimus was started and subsequently peptide receptor radionuclide therapy (PRRT) with fair hypoglycemia control. Unfortunately, her disease progressed. Oral glucose, cornstarch, and diazoxide failed. After a left hepatectomy and transarterial chemoembolization, her severe hypoglycemia improved briefly. Despite high-dose dexamethasone (up to 4 mg daily), octreotide 400 mcg every 8 hours, and high-calorie total parenteral nutrition (TPN) (over 800 grams of carbohydrates daily), she required multiple hospitalizations for persistent symptomatic hypoglycemia. Moreover, these therapies led to significant side effects, including recurrent episodes of volume overload, 240 pounds weight gain over a year, and Cushingoid features. Given RZ358's reports in reversing HH in rodents, humans, and a recent report of successful use in a malignant insulinoma case, we aimed to start RZ358 in our patient. We obtained, emergency use authorization from the FDA, IRB of Stanford University School of Medicine approval, and patient written informed consent. RZ358 was started at 6 mg/kg biweekly, along with octreotide, dexamethasone, and TPN. RZ358 dosage was later increased to 9 mg/kg weekly, allowing a substantial reduction in dexamethasone to physiological doses and a 50% reduction in TPN carbohydrate requirements. She achieved normoglycemia and returned home, but missing a single weekly RZ358 dose caused recurrent severe hypoglycemia until the next dose administration.As her disease progressed, the patient opted for comfort care, discontinuing TPN and RZ358. Conclusion: RZ358 represents a novel and unique treatment option for refractory HH in patients with metastatic NETs and can improve clinical outcomes when standard interventions fail. This case underscores the potential of RZ358, a monoclonal antibody, to treat HH beyond its approved use for congenital cases, suggesting its applicability to cases of hyperinsulinemia secondary to NETs in adults. Presentation: 6/2/2024

6799 RZ358 Therapy. A Novel Approach To Hyperinsulinemia In Metastatic Neuroendocrine Tumor Patients

Abstract Disclosure: J. Noreña: None. T. Akcan: None. S. Patel: None. W. Madeleine: None. S. Shaheen: None. M. Tan: None. RZ358, an intravenously administered monoclonal antibody, targets a unique allosteric site on the insulin receptor. It is under investigation for hypoglycemia due to congenital hyperinsulinism. We present a case of its efficacy in treating refractory hyperinsulinemic-hypoglycemia (HH) due to a metastatic pancreatic neuroendocrine tumor (pNET). Clinical Case: A 50-year-old woman with a 6-year history of HH initially presented in 2016 with epigastric pain and was diagnosed with gastrin secreting pNET pT3N1. After Whipple surgery and cholecystectomy. A well-differentiated, WHO grade 2 NET, positive in immunohistochemistry for AE1/3, synaptophysin and Ki-67 index of 9.2% was confirmed. She presented recurrent disease with liver metastasis requiring somatostatin analogue Lanreotide. Subsequently despite Lanreotide, hypoglycemia persisted, and 72-hour fast confirmed HH. DOTATATE scan showed progression to new liver lesions. Everolimus was started and subsequently peptide receptor radionuclide therapy (PRRT) with fair hypoglycemia control. Unfortunately, her disease progressed. Oral glucose, cornstarch, and diazoxide failed. After a left hepatectomy and transarterial chemoembolization, her severe hypoglycemia improved briefly. Despite high-dose dexamethasone (up to 4 mg daily), octreotide 400 mcg every 8 hours, and high-calorie total parenteral nutrition (TPN) (over 800 grams of carbohydrates daily), she required multiple hospitalizations for persistent symptomatic hypoglycemia. Moreover, these therapies led to significant side effects, including recurrent episodes of volume overload, 240 pounds weight gain over a year, and Cushingoid features. Given RZ358's reports in reversing HH in rodents, humans, and a recent report of successful use in a malignant insulinoma case, we aimed to start RZ358 in our patient. We obtained, emergency use authorization from the FDA, IRB of Stanford University School of Medicine approval, and patient written informed consent. RZ358 was started at 6 mg/kg biweekly, along with octreotide, dexamethasone, and TPN. RZ358 dosage was later increased to 9 mg/kg weekly, allowing a substantial reduction in dexamethasone to physiological doses and a 50% reduction in TPN carbohydrate requirements. She achieved normoglycemia and returned home, but missing a single weekly RZ358 dose caused recurrent severe hypoglycemia until the next dose administration.As her disease progressed, the patient opted for comfort care, discontinuing TPN and RZ358. Conclusion: RZ358 represents a novel and unique treatment option for refractory HH in patients with metastatic NETs and can improve clinical outcomes when standard interventions fail. This case underscores the potential of RZ358, a monoclonal antibody, to treat HH beyond its approved use for congenital cases, suggesting its applicability to cases of hyperinsulinemia secondary to NETs in adults. Presentation: 6/2/2024

9286 RZ358 Therapy. A Novel Approach to Hyperinsulinemia in Metastatic Neuroendocrine Tumor Patients

Abstract Disclosure: J. Noreña: None. T. Akcan: None. S. Patel: None. M. Welsh: None. S. Shaheen: None. M. Tan: None. RZ358, an intravenously administered monoclonal antibody, targets a unique allosteric site on the insulin receptor. It is under investigation for hypoglycemia due to congenital hyperinsulinism. We present a case of its efficacy in treating refractory hyperinsulinemic-hypoglycemia (HH) due to a metastatic pancreatic neuroendocrine tumor (pNET). Clinical Case: A 50-year-old woman with a 6-year history of HH initially presented in 2016 with epigastric pain and was diagnosed with gastrin secreting pNET pT3N1. After Whipple surgery and cholecystectomy. A well-differentiated, WHO grade 2 NET, positive in immunohistochemistry for AE1/3, synaptophysin and Ki-67 index of 9.2% was confirmed. She presented recurrent disease with liver metastasis requiring somatostatin analogue Lanreotide. Subsequently despite Lanreotide, hypoglycemia persisted, and 72-hour fast confirmed HH. DOTATATE scan showed progression to new liver lesions. Everolimus was started and subsequently peptide receptor radionuclide therapy (PRRT) with fair hypoglycemia control. Unfortunately, her disease progressed. Oral glucose, cornstarch, and diazoxide failed. After a left hepatectomy and transarterial chemoembolization, her severe hypoglycemia improved briefly. Despite high-dose dexamethasone (up to 4 mg daily), octreotide 400 mcg every 8 hours, and high-calorie total parenteral nutrition (TPN) (over 800 grams of carbohydrates daily), she required multiple hospitalizations for persistent symptomatic hypoglycemia. Moreover, these therapies led to significant side effects, including recurrent episodes of volume overload, 240 pounds weight gain over a year, and Cushingoid features. Given RZ358's reports in reversing HH in rodents, humans, and a recent report of successful use in a malignant insulinoma case, we aimed to start RZ358 in our patient. We obtained, emergency use authorization from the FDA, IRB of Stanford University School of Medicine approval, and patient written informed consent. RZ358 was started at 6 mg/kg biweekly, along with octreotide, dexamethasone, and TPN. RZ358 dosage was later increased to 9 mg/kg weekly, allowing a substantial reduction in dexamethasone to physiological doses and a 50% reduction in TPN carbohydrate requirements. She achieved normoglycemia and returned home, but missing a single weekly RZ358 dose caused recurrent severe hypoglycemia until the next dose administration.As her disease progressed, the patient opted for comfort care, discontinuing TPN and RZ358. Conclusion: RZ358 represents a novel and unique treatment option for refractory HH in patients with metastatic NETs and can improve clinical outcomes when standard interventions fail. This case underscores the potential of RZ358, a monoclonal antibody, to treat HH beyond its approved use for congenital cases, suggesting its applicability to cases of hyperinsulinemia secondary to NETs in adults. Presentation: 6/2/2024

Artificial Intelligence in Fraud Detection and Financial Risk Mitigation: Future Directions and Business Applications

AI in fraud detection and financial risk management has taken this role of prevention and combating fraud closely related to organizations and the losses they incur a next level. This paper aims to discuss the use of artificial intelligence models in the process of detecting frauds and preventing and reducing financial risks in such markets as banking, insurance, and fintech. Today, through machine learning algorithms, deep learning techniques, and data analysis, the AI improves the speed, accuracy and effectiveness of fraud detection. This paper discusses the current AI models and business use incorporating the success story and the business outcomes which has encountered sometime to have the best result. Furthermore, the paper examines other important issues of AI application management such as data security and liberation, and complete fairness control. Using examples as well as statistical data in this AI for business article, we show how corporations have managed to minimize their risks while lowering their expenses with the use of artificial intelligence technology. This research outlines ideas on how organizations can implement AI into fraud detection systems and what can be done in future to enhance the solutions. This paper adds to the emerging body of knowledge on AI’s impact on finance and security, and demonstrates AI’s ability to influence the future of the industry.

The effect of sunglass filters on contrast sensitivity, monocular eye closure, and blinking rate in people with intermittent exotropia

ABSTRACT Clinical relevance Transient monocular eye closure and photosensitivity under bright light have been reported in people with intermittent exotropia (IXT). The exact mechanism of these symptoms has not been established. Background This study examines the effect of sunglass filters on contrast sensitivity (CS), transient monocular eye closure, and blinking rate under bright light in people with IXT. Methods Forty participants with IXT and complaints of photosensitivity were included in the study. The binocular CS test was performed under mesopic and photopic conditions with and without glare, and with and without two filters with different grades of light transmission (filter 1: 44–80%; filter 2: 20–43% light transmittance). The effect of two filters on transient eye closure, contrast sensitivity, and blinking rate was assessed under bright light. Also, participants were divided into 3 groups based on their degree of control of fusion (good, fair, and poor control). Results The mean age of the participants was 12.0 years ± 8.0 (standard deviation) (range: 7–40 years). There was no significant difference between the age (p = 0.139), stereopsis (p = 0.134), as well as the near and far degree of deviation (p = 0.516, and p = 0.237) between the three groups of fusion control. Under mesopic conditions with glare, mean binocular CS was significantly higher with filters (p < 0.001). Without filters, 57.5% of the participants exhibited monocular eye closure under a photopic setting with additional glare. No participant showed eye closure using filter 2. People in the poor control group showed exodeviation before monocular eye closure (62.5% without filter and 12.5% with filter 1, p = 0.01). The blinking rate decreased from 36.0 ± 4.0 blinks per minute without filter to 21.0 ± 3.0 using filter 1, and 20.0 ± 3.0 with filter 2. Conclusion In people with IXT, wearing sunglass filters of different transmittance reduces monocular eye closure and blinking rate under bright light. To improve these symptoms, sunglasses can be considered for IXT.

Changeable factors for diabetes mellitus type II patients and compare it with healthy control

A study has been analysed “Changeable factors for diabetes mellitus type II patients and compare it with healthy control.” A random sample total 150 well-informed, informed consented subjects of either male and female 35-70 years of age group has been selected from Bihar. 100 patients suffering from diabetes mellitus type II were placed in group 1 (serving as cases) and fifty (50) apparently healthy individuals with matched age were place in group 2 (serving as a healthy control). The number of the disease population is believed to be approx. 70-90 per% of apparently healthy Indians have under vitamin D level across all the regions and age groups. In the present, diabetic cases had 19.09±5.34 ng/ml of serum vitamin D level. Healthy control subjects had 26.55±3.61 ng/ml of serum. The results been showed that 53% male and 47% female participants among cases. 40% male and 60% female participants among healthy control. Diabetes mellitus of patients, 17 cases were under good control, 28 were under fair control and 55 were under poor control. Diabetic cases had 19.09±5.34 ng/ml of serum vitamin D level. Healthy control subjects had 26.55±3.61 ng/ml of serum vitamin D.

Transient eye closure and ocular preference in patients with intermittent exotropia

PurposeTo assess the relationship of sensory and motor ocular dominance to transient eye closure (TEC) under bright light conditions in patients with intermittent exotropia. MethodsForty patients (age range, 7-40 years) with intermittent exotropia were included in this prospective study. Motor and sensory ocular dominance were evaluated using the hole-in-the-card and Worth 4-Dot tests. Presence of any outward eye deviation or TEC was assessed and recorded in all participants under bright light conditions. Based on the fusion control grade of exodeviation, patients were assigned to good, fair, and poor control groups, and the results were compared. ResultsA total of 23 patients (58%) showed TEC under bright light: 18 (45%) in the good control group, 14 (35%) in the fair control group, and 8 (20%) in the poor control group. Eighteen patients (56%) with good and fair control showed TEC in the dominant eye. Five (63%) with poor control closed their nondominant eyes, and in all of them, outward eye deviation was observed before TEC. The angle of deviation at far and near and the degree of near stereopsis were not related to presence of TEC (P = 0.70, P = 0.06, and P = 0.34, resp.). ConclusionsIn patients with intermittent exotropia who exhibit TEC under bright light, those with good control tend to close the dominant eye, whereas in the majority of patients with poor control, spontaneous deviation occurs and is then followed by TEC of the nondominant eye.

Prognosis for Type 1 Diabetes with Diabetic Nephropathy between 2000 and 2020 - Changes in Kidney Function Decline Over Time and Development of Cardiovascular Disease, Kidney Failure, and Mortality

IntroductionIndividuals with type 1 diabetes (T1D) and diabetic nephropathy (DN) experience progressive kidney function decline and high risk of cardiovascular disease (CVD) and mortality. This study explored changes in kidney function decline in new-onset DN between 2000-2020 and provided an updated prognosis for risk of kidney failure, CVD, and mortality. MethodsRegister-based cohort study in T1D with new-onset DN (severely increased albuminuria) between 2000-2020 at Steno Diabetes Center Copenhagen, Denmark. Data was derived from electronic health records and national registers. Kidney function development was expressed as trajectories of estimated glomerular filtration rate (eGFR) and measured GFR (mGFR) using mixed-effects models. The prognosis was presented in probabilities of developing complications, stratified by sex, prior CVD, and risk factor control by using simulations based on Poisson regression analysis. ResultsThe cohort comprised 591 individuals with median (IQR) age at DN onset of 53 (39-66) years and 57% were male. In 283 participants, mGFR were available. Plots of eGFR trajectories illustrated tendencies towards higher eGFR in more recent years, but this was not confirmed in mGFR trajectories. Poor risk factor control, prior CVD and male sex impacted mortality and morbidity rates negatively. For men/women with fair risk factor control and no prior CVD, the 10-year mortality rate from onset of DN was 28/26%. For men/women with poor risk factor control and CVD prior to DN onset, the 10-year-mortality rate was 62/62%. ConclusionThe results do not support an improved prognosis for T1D and DN, emphasizing the urgent need for new therapeutic approaches.

The Improvement of the Criminal Procedure Mechanism for Selecting and Applying a Measure of Restraint in the Form of Prohibition of Certain Actions

Introduction: the court’s choice to prohibit certain actions corresponds to the general trend of humanization and liberalization of criminal procedure legislation and the more active application of measures of restraint not related to the detention of a person. The relevance of the issue of imposing prohibitions on certain actions in accordance with Art. 105.1 of the Criminal Procedure Code of the Russian Federation is also determined by the need to restrict the constitutionally significant rights and freedoms of citizens suspected or accused of crimes in order to create conditions for unhindered judicial proceedings, which are ensured by judicial control and other legal guarantees of fairness and proportionality of the chosen prohibitions. The purpose of the study is to eliminate doubts and ambiguities that arise when selecting and applying a prohibition on certain actions and to formulate proposals for improving the legal regulation of the measure of restraint in question. In the course of the study, such methods of cognition as formal legal in the form of studying the norms of law, specifically sociological and comparative law, were applied. Results: the paper formulates proposals to improve the criminal procedure mechanism for selecting and applying a prohibition on certain actions. Conclusions: the recommendations set out in the paper are aimed at developing uniform investigative and judicial practice and can be used in the educational process when teaching criminal procedure sciences, as well as in the practical activities of preliminary investigation officers, prosecutors, and courts.

Comparing Fair Control of Hyperglycemia contrary to Intensive Control in Patients after Coronary Artery Bypass Grafting Procedure

Comparing Fair Control of Hyperglycemia contrary to Intensive Control in Patients after Coronary Artery Bypass Grafting Procedure

145-OR: Assessing the Current State of Diabetes Care in Long-Term Facilities Using Continuous Glucose Monitoring

Introduction: Recommendations for diabetes care in long term care facilities (LTCF) focuses on avoidance of hypoglycemia and symptomatic hyperglycemia. Using continuous glucose monitoring (CGM), we evaluated the current state of glycemia in LTCF residents with multiple comorbidities. Methods: We conducted a cross-sectional study using CGM in 8 LTC facilities in the United States. A masked Dexcom G6 pro CGM was placed for 10 days on residents with diagnosis of diabetes mellitus (DM) who were on any oral or injectable hypoglycemic medications. Clincial and demographic information were collected from medical records. Results: We evaluated 65 residents (mean age 65 years, 50% female). Fourteen percent of the cohort was on sulfonylurea medications and 68% were on insulin. CGM data showed 26% of the cohort with &amp;gt;1% time spent in hypoglycemia (time &amp;lt;70 mg/dL). A larger burden of hyperglycemia was seen with 54% of the cohort spending &amp;gt;10% time &amp;gt;250mg/dL, 37% spending &amp;gt;25% time &amp;gt;250 mg/dL, and 14% spending &amp;gt;90% time &amp;gt;250 mg/dL. Only 44% of the cohort had &amp;gt;50% Time-in-Range (70-180 mg/dL). The latest A1C was &amp;lt;7% in 45% of the cohort, 7-8% in 27%, 8.1-9% in 12%, and &amp;gt;9% in 16%. Fingerstick reading frequency was 2 or fewer times/day in 74% of the cohort, 3 times/day in 13%, and 4 or more times/day in 13%. On average, this cohort had 13 comorbidities, with 85% having functional disabilities. There was 14% with dementia and 42% with obesity (BMI&amp;gt;30). All 100% of the participants had polypharmacy(≥5 medications/day). Conclusions: In this multi-morbid cohort of residents with diabetes living in LTCF, we identified a high burden of both hypoglycemia and severe hyperglycemia, despite fair control of A1C. More consistent use of CGM could help identify glycemic excursions to improve therapeutic decision-making. Disclosure C. Slyne: None. K. Roberts: None. C.D. Conery: None. H. Brabant: None. N. Krakoff: None. E. Toschi: Consultant; Vertex Pharmaceuticals Incorporated, Sanofi. M. Munshi: Consultant; Sanofi. Funding Supported by an investigator initiated grant from Dexcom

#2895 Erythropoietin Resistance Index (ERI) between mortality and metabolic changes in a cohort of hemodialysis patients. What acts below the surface?

Abstract Background and Aims The management of anemia in hemodialysis patients (HD-ps) is influenced by many factors, including inflammation, martial balance (MB) and mineral metabolism (MM). Recent data would identify the Erythropoietin Resistance Index (ERI) as an indicator of mortality risk in HD-ps. The objective of the present study was to evaluate the relationship of ERI with inflammation, MB and MM, as well as all-cause mortality in a cohort of HD-ps. Method An observational-retrospective study was performed on 100 HD-ps, excluding those with acute or chronic infections (3 months), neoplasia, or immunosuppressive therapy. Mortality was considered primary outcome along a 2-year follow-up (FU). Results HD-ps, predominantly males, had advanced mean age, good Hb values and fair biochemical control. ERI showed significant correlations with some elements of inflammation, MM and BM (Table 1), including c-terminal fragment of Fibroblast Growth Factor 23 (cFGF23). At multivariate, ERI remained influenced by cFGF23 (p = 0.009), iron (p = 0.002) and transferrin (p = 0.007). Furthermore, after 2 years of FU, 42% of HD-ps died. As shown in Table 2, HD-ps that faced the primary outcome (death) were older, had lower levels of albumin, hemoglobin and transferrin, and higher levels of IL6, parathormone (PTH), reactive C protein (PCR), and ERI (p &amp;lt; 0.035). In multivariate, ERI (p = 0.011), age (p = 0.001) and albumin (p = 0.010) remained significant for the outcome studied. Conclusion Our data, albeit on few HD-ps, show a possible association between ERI and mortality. ERI was found to be related to several factors, including cFGF23, itself a factor implicated in maintaining a baseline inflammatory state. The results suggest the possible presence of some pathological mechanisms that can act silently with a negative impact on survival. Certainly, increased numbers and a prospective design could better clarify the explored relationships in the future.

Effects of robot-assisted walking training on balance, motor function, and ADL depending on severity levels in stroke patients.

Despite the explosive increase in interest regarding Robot-Assisted Walking Training (RAWT) for stroke patients, very few studies have divided groups according to the severity levels of patients and conducted studies on the effects of RAWT. The purpose of this study was to present a definite basis for physical therapy using the robot-assisted walking device through a more detailed comparison and analysis and to select the optimal target of RAWT. This study was designed as a prospective and randomized controlled trial to investigate the effect of RAWT on balance, motor function, and Activities of Daily Living (ADL) depending on severity levels in stroke patients. 100 participants were randomly divided into study and control groups in equal numbers. The study group was 49 and the control group was 47. One from the study group and three from the control group were eliminated. The study period is four weeks in total, and RAWT is performed five times a week for 40 minutes only for study group. During the same period, all group members had 30 minutes of Conventional Physiotherapy (CP) five times a week. The results of this study clearly confirmed that RAWT combined with CP produces more significant improvement in patients with stroke than the CP alone. And they indicated that RAWT had a more considerable effect in the poor or fair trunk control group for trunk balance and in the high fall risk group for balance. In motor function, RAWT showed its value in the severe and marked motor impairment group. The total or severe dependence group in ADL experienced more improvements for RAWT. This study can be concluded that the lower the level of physical functions, the more effective it responds to RAWT. As demonstrated in the results of this study, the potential of current robotic technology appears to be greatest at very low functional levels of stroke patients. Patients with low functional levels among stroke patients may benefit from robot rehabilitation.

Medial rectus resection versus plication in basic type intermittent exotropia

Purpose To compare the efficacy of unilateral recession-resection (RR) versus unilateral recession-plication (RP) in basic-type intermittent exotropia (X (T)). Patients and methods A prospective study included 27 patients, aged 10–45 years with a diagnosis of basic type of X (T), divided into two groups: group I (14 patients) underwent RR and group II (13 patients) underwent RP, follow-up period was 3 months following surgery. Successful outcome defined as postoperative exophoria/exotropia less than 10 Prism diopters (PD) to esophoria/esotropia less than 5 Prism diopters. Results Postoperative, the success rate was 71.43% in group I and 76.92% in group II, without significant difference (P=0.683). Patients with fair and good control of deviation preoperatively had more chances of success than patients with preoperative poor control (OR=12.0, 95% CI = 1.482–97.179, P=0.020), other factors including the age, preoperative angle, surgical procedure, errors of refraction had no significant association with successful surgical outcome. Conclusion Both the RR and RP procedures exhibit comparable effectiveness in treating basic-type X (T). Plication may be chosen as a substitute tightening technique due to its additional benefits over resection. Poor Preoperative control of deviation decreased the chances of a successful outcome.

Telemedicine for type 2 diabetes during COVID-19 pandemic: experience from a tertiary diabetes center.

Telemedicine was largely employed during COVID-19 pandemic to guarantee continuity of care in a period of dramatic reduction of face-to-face visits. The aim of this study was to describe the clinical characteristics of a cohort of patients with type 2 diabetes followed by tele-visits and to evaluate the changes in the glyco-metabolic control during a 12-month follow-up. This retrospective observational study included 136 adults aged >18 years with at least three tele-visits over a 12-month follow-up period, in a Diabetes Center of the Southern Italy, from April 2020 to March 2022. Data related to glycemic and lipid profile, therapy, presence of micro or macrovascular complications, and other clinical features were extracted at three time points, at first visit (T0), after 6 months (T1) and after 12 months (T2). Mean diabetes duration and median HbA1c values were 11.6 years and 7.0%, respectively. Thirty-eight participants (27.9%) presented macro- or microvascular complications. Glycemic control remained stable over time, without clinically significant changes of HbA<inf>1c</inf> (T0 vs. T1 vs. T2, median [IQR], 7.0 [6.2-7.3], 6.6 [6.0-7.5], 6.9 [6.2-7.5], P=0.095) and fasting glucose. Lipid profile slightly improved, although without significant clinical change. Glucose lowering therapy was modified in 84 patients (61.8%) and remained unchanged in 52 patients (38.2%) during the follow-up. No participant in the study developed any complications during the 12-month follow-up. People with type 2 diabetes followed by telemedicine were adults with fair glucose control generally free from chronic complications, whose diabetes control did not worsen during a 12-month follow-up.

Customer Service Through Artificial Intelligence in Anjiela Technology Company: A Comprehensive Study

This quantitative descriptive research examined the impact of Artificial Intelligence (AI) on customer service at Anjiela Technology Company in China. Using a sample of 100 customers, data were collected via a structured survey covering AI's influence on customer satisfaction, efficiency, personalization, accuracy, and user-friendliness. The findings highlight AI's positive impact on customer satisfaction, while also identifying areas for improvement, such as reducing wait times and enhancing personalization. Additionally, the study underscores the importance of trust and transparency in AI adoption, addressing customer concerns about data privacy, fairness, and user control. Recommendations include enhancing AI training, addressing technical challenges, improving data quality, ensuring ethical compliance, and enhancing transparency through collaboration among different units within the organization. In conclusion, this research underscores AI's potential for improving customer service and emphasizes the need to address challenges and ethical considerations for effective implementation.

Joint Property Division in Indonesia: A Gender Equality Viewpoint

The distribution of joint property regulated under the Compilation of Islamic Law is considered very effective due to the legal certainty guaranteeing that ex-husbands and wives receive a half share. However, these provisions cannot be fully applied to estranged husbands and wives because family background conditions vary. There are certain conditions where husbands and wives have multiple roles, and this occurrence needs to be more profoundly studied. Therefore, this study is presented to analyze the distribution of joint assets according to the roles assigned in the household. This research employed a normative-legal method and statutory and conceptual approaches. The primary data in this study is the Compilation of Islamic Law (KHI). The researcher analyzed activity profiles, access and control between husband and wife as specified in KHI norms by using a gender equity analysis tool. The results show that the fair value of the distribution of joint assets which refers to the division of roles between husband and wife contained in the KHI has set different roles between the two, in which the husband works outside the house while the wife serves as a housewife. Meanwhile, currently, all roles performed by husbands can also be performed by wives and the other way around, while unchangeable roles remain in the biological or reproductive role. So the division of roles cannot be interpreted literally because the husband or wife has flexible and fair access and control.&#x0D; &#x0D; Keywords: joint property; gender equality; spouses rights.

COVID-19 Pneumonia and Increased Insulin Requirement in Known Diabetic Patients: A Prospective Observational Study.

Background COVID-19-related critical illness affects multiple organs and causes a variety of metabolic derangements in the body's physiology that are not proven with the current level of evidence. Insulin resistance and deranged blood sugar control due to COVID-19 have been major problems when managing diabetic patients with hyperglycaemia when they are admitted with COVID-19 pneumonia. There is a lack of abundant literature to prove the excess insulin requirements of COVID-19 and to quantify their insulin needs scientifically. This study aims to quantify the degree of insulin dose increments in these patients. Materials and methods The study is a single-centre prospective observational study done in COVID-19 wards at a tertiary care hospital in India. The diabetic patients admitted with COVID-19 pneumonia between June 2020 and December 2020 were included in the study. Seventy-five patients with fair control of diabetes (HbA1C <7.5) were included in the study. Their average daily insulin requirement was calculated for the first seven days of admission. This was tabulated and compared to their baseline insulin requirement before being unwell due to COVID-19. A sub-group analysis was also done to show the relation between severity of illness and glycaemic dysregulation. Result Invariably, all patients were found to be hyperglycaemic on admission. Insulin need has increased to 1.5 to 2.5 times the baseline values in the first 24 hours of admission. This insulin dose requirement stayed high around the same levels for all seven days of observation. The average mean value of the daily insulin dose for the seven days of study was calculated to be 132 units. This is more than twice the mean baseline daily insulin requirement of 62 units during the pre-COVID-19 period. Subgroup analysis showed that the severe group had poor glycaemic control, requiring higher doses compared to their own baseline and also to the moderate group. Conclusion COVID-19 pneumonia significantly increases insulin resistance and insulin requirements during illness in fairly controlled known diabetic patients with insulin. Managing this COVID-19-induced hyperglycaemia requires 1.5 to 2.5 times the baseline insulin doses.

ASSESSMENT OF DIABETES MELLITUS AND RISK OF BREAST CANCER: A PROSPECTIVE STUDY ON THE LOCAL POPULATION

Diabetes mellitus (DM), characterized by impaired insulin function or resistance, has gained prominence as a multifaceted health concern. Recent epidemiological studies suggest a potential link between DM and breast cancer risk. This retrospective cohort study, conducted in a Liaquat National Hospital, Karachi from January 2022 to June 2023, aimed to investigate the role of DM in the risk of breast cancer in a population of 120 participants with documented diabetes diagnoses. The participants, with a mean age of 55±8.1 years and fair glycemic control (HbA1c: 7.5%), exhibited a 30% higher likelihood of breast cancer, as indicated by a statistically significant odds ratio of 1.30 (95% CI: 1.05 - 1.60, p &lt; 0.05). Hormonal analyses revealed mean insulin levels of 45 μU/mL, IGF-1 at 150 ng/mL, estrogen at 30 pg/mL, and SHBG at 40 nmol/L in the subset with DM Stratifying by menopausal status and diabetes duration revealed nuanced associations, emphasizing the importance of considering these factors in understanding the DM-breast cancer relationship. Notably, individuals with diabetic nephropathy demonstrated 40% higher odds of breast cancer, remaining significant after adjustments. This study sheds light on the intricate connections between DM and breast cancer risk, emphasizing the need for tailored screening, surveillance, and preventive strategies in clinical management.