Guidance For Management Research Articles

Cost-effectiveness of Procalcitonin (PCT) guidance for antibiotics management of adult sepsis patients in the Egyptian context

BackgroundSepsis, which is described as a life-threatening organ malfunction brought on by an unbalanced host response to infection, continues to be a significant healthcare issue that affects millions of individuals each year. It is well-known that sepsis can affect anyone around the world, but the employed survey results showed that there are significant regional variations in sepsis incidence as well as mortality rates. Although there are no definite estimates for Egypt, the highest rates were in Low-Middle-Income Countries (LMICs).Procalcitonin (PCT) is a host response marker with high specificity for bacterial infections, unlike C-reactive protein (CRP) or white blood cell count (WBC), which represent the traditional methods of detecting inflammation and infection. Its dynamic profile and superior prognostic prediction make it invaluable for assessing response to antibiotic treatment and improving clinical care for sepsis patients.Our main purpose was to evaluate the cost-effectiveness of PCT guidance compared to no PCT guidance in the antibiotic management of adult sepsis patients according to the Egyptian context.MethodsWe developed a decision tree model to compare the PCT-guided antibiotic management duration endpoint versus the conventional laboratory culture-based antibiotic management in adult sepsis patients. We employed the“Delphi technique” to reach a satisfactory consensus regarding the resources attributed to each compared alternative. The primary measure of the study was the additional cost associated with each Quality-Adjusted Life Year (QALY) gained by sepsis survivors over a one-year time horizon.Base-case, deterministic and probabilistic sensitivity analyses were conducted using TreeAge, Software.ResultsBase-case analysis showed no dominance for either alternative and resulted in an Incremental Cost-Effectiveness Ratio (ICER) value of 297,783.57 Egyptian Pounds per Quality Adjusted Life Year (L.E/QALY) in favor of the PCT guidance alternative, Deterministic sensitivity analysis revealed that the highest impact magnitudes on ICER reside with seven input parameters, the top two parameters that had the most significant influence were the costs of ICU stay with and without PCT guidance. The CEAC showed a slightly higher probability in terms of acceptability in favor of the no PCT guidance choice along the WTP scale till reaching equal probabilities at the willingness-to-pay (WTP) value point of 390,000 (state currency) after which the - probability supports the PCT guidance choice. ConclusionsIn the Egyptian context, PCT guidance has no cost-effectiveness domination over no PCT guidance in Antibiotics management for adult sepsis patients. This may be attributed to the high cost of PCT investigation that shall be resolved by standardization of its cost when applying the approach of DRG cost packages.

Spatially Selective Self-Amplified Imaging of Chemotherapy-Induced Cancer Senescence via Reversal of Impaired Ferritinophagy.

Real-time monitoring of chemotherapy-induced senescence (CIS) in cancer remains a challenging task that would lead to new insights into the adaptive mechanisms of cancer therapy and provide guidance for cancer management. Here, we designed a tailor-made nanoprobe capable of imaging CIS in a sequential activation and self-amplified manner by reversing senescence-related impaired ferritinophagy. It contains an amphipathic polymer as a spatially responsive vehicle, a Fe2+-activable dye as the reporter, and an autophagy inducer as the signal amplifier. Owing to metabolic changes, the nanoprobe preferentially enriches in senescent cancer cells, leading to in situ activation and fluorescence switching of the reporter by labile Fe2+. Meanwhile, the inducer restores ferritinophagy and promotes autophagic degradation of accumulated ferritin, facilitating conversion of ferritin-bound iron into Fe2+ for amplified imaging in senescent cancer cells yet keeping inert in nonsenescent cells. Of note, the accumulation and activation of the nanoprobe and sustained ferritin degradation occur at the same subcellular location, thus minimizing the diffusion process-induced nonspecific responses. The feasibility of this strategy is successfully demonstrated in both living cells and animal models. This work offers a new way for therapeutic evaluation and a basic understanding of the roles of senescence in cancer treatment.

Influence of outlet keys slope on downstream bed topography in trapezoidal piano key weirs: An experimental investigation

Assessing scour depth downstream of piano key weirs (PKWs) is crucial for maintaining their structural integrity. The slope of the outlet keys significantly influences flow velocity and the associated risk of downstream scouring. This study experimentally investigates the impact of various factors on scour downstream of trapezoidal PKWs, specifically focusing on weir outlet keys slope (So), particle Froude number, sediment size, bed levels, and relative drop height. The research identifies three distinct stages of scouring. Notably, changes in So significantly affect the hydraulic flow over both the inlet and outlet keys. Reducing So by 57 % led to increases of approximately 32 %, 34 %, 49 %, and 54 % in relative maximum scour depth, distance from the weir, length, and volume of the scour hole, respectively, while relative weir toe scour decreased by about 31 %. Additionally, a decrease in So shifted the locations of the maximum scour depth and sediment ridge downstream, enhancing the symmetry of the scour hole. Increasing the particle Froude number and relative drop height, along with decreasing tailwater depth and sediment size, further intensified the scour hole and sediment ridge characteristics. This study provides critical insights for mitigating downstream scouring in PKWs through a comprehensive analysis of varying So. The proposed optimal value for So, along with newly developed design equations, offers practical guidance for engineers and water resource managers in enhancing the stability of hydraulic structures.

Sustainable development and firm value: How ESG performance shapes corporate success—a systematic literature review

AbstractThis study is designed to conduct a systematic literature review aimed at assessing the influence of environmental, social, and governance (ESG) performance on firm value. Although previous studies have explored their relationship, a comprehensive systematic review on this topic is still lacking. We conducted a detailed literature search in the Scopus and Web of Science databases and identified 73 papers published between 2016 and 2023 as the sample, covering annual trends, country and industry distribution, theoretical frameworks, proxy variables, research methods, research results, and provided direction for future research. We found a significant increase in the number of studies over the past 3 years. Cross‐country studies dominated the field, with most research adopting multi‐industry analysis, while studies focusing on a single industry were relatively rare. The stakeholder theory and agency theory were the most widely applied theories. Most studies showed that ESG performance had a positive effect on firm value, reflecting the growing importance that markets and investors placed on ESG performance and its contribution to long‐term firm growth. However, some studies reported negative or insignificant effects, noting that the effects of ESG performance varied by industry, region, and market environment. This study suggests that future research should explore the independent and interactive effects of each ESG dimension on firm value, focusing on dynamic relationships across industries and regions, using new methods and models, and incorporating moderating variables. This study provides practical guidance for firm managers and policymakers to optimize ESG practices, enhancing firm value and promoting sustainability.

Perioperative immunotherapy for non-small cell lung cancer: consensus and controversy (2024 edition)

Lung cancer is the malignant tumour with the highest morbidity and mortality rate in China, among which non-small cell lung cancer (NSCLC) is the main pathological type of lung cancer, accounting for about 80% to 85%. Radial surgery is the standard treatment for early-stage NSCLC, but postoperative recurrence is an inevitable problem in clinical practice. Adding perioperative chemotherapy to surgery can only increase the 5-year overall survival rate by about 5%. There is an urgent need for better systemic treatments. In recent years, immunotherapeutic drugs, represented by PD-1/PD-L1 monoclonal antibodies, have brought breakthroughs from subsequent-line treatment to front-line treatment for NSCLC. Several Phase III studies on perioperative immunotherapy have shown that adding immunotherapy during the neoadjuvant and adjuvant treatment can significantly improve survival outcomes for patients, leading to the development of a new standard treatment for resectable NSCLC. In January 2024, the first PD-1 monoclonal antibodies (Toripalimab) were approved for perioperative treatment of NSCLC in China, starting a new era of perioperative immunotherapy. At present, there is still a lack of unified consensus on the application of perioperative immunotherapy at all levels of medical institutions. In order to privide diagnostic and treatment guidance for clinicians, promote the standardization of clinical practice for immunotherapy in resectable NSCLC, and clarify the controversial opinions regarding perioperative immunotherapy, Lung Cancer Expert Committee of the Chinese Anti-Cancer Association, Chinese Thoracic Oncology Group, Lung Cancer Expert Committee of the Chinese Medical Association Oncology Society jointly published this Consensus and Controversy to provide a guidance for the standardized management of perioperative immunotherapy for NSCLC.

Building Effective Academic Early Warning Mechanisms: Theoretical Framework and Practical Strategies

The academic early warning mechanism plays an important role in modern educational management, by identifying and intervening in students' academic problems early on to help them complete their studies successfully. This paper explores how to build an effective academic warning mechanism from both theoretical frameworks and practical strategies, with the aim of providing reference and guidance for educational managers and teachers.

Antecedents of Customer Participation on Sharing Platforms: A Meta‐analysis

AbstractGiven the substantive influence of the digital revolution on the sharing economy, it is timely and relevant to ask why some sharing platforms (e.g. Airbnb and Uber) achieve significant success while others fail. To determine which factors encourage customers to participate in sharing goods and services on sharing platforms, and when they do so, this study conducts a meta‐analysis of empirical findings from 192 independent samples, extracted from 167 studies involving 171,344 customers. As the results clarify, customer‐related factors (customer motives, customer competence, customer satisfaction and subjective norms) are key antecedents. However, platform‐related factors (service quality of the platform, trust in the platform, performance expectancy and effort expectancy) and service‐provider‐related factors (service quality of the provider, trust in the provider and provider gender) also exert meaningful effects. To assess the generalizability of these antecedents, the meta‐analysis includes contextual moderators, namely customer type (previous provider experience), provider type (private/professional supply), platform characteristics (rivalry on the platform, prestige of ownership and services/goods) and exchange type (for‐profit/non‐profit and ownership transfer). The findings advance the literature on the sharing economy and provide specific guidance for platform managers about when to focus on certain antecedents.

The emergence of team compassion: Theoretical implications and practical interventions

With the recent experiences involving COVID-19, there is a growing need for organisations to better understand compassion in addressing employees’ suffering and boosting their well-being. Particularly, as teamwork is becoming ubiquitous, organisational scholars have identified positive benefits of compassion at the team level such as improving communication, decreasing interpersonal conflicts and boosting team effectiveness. Using a multilevel theoretical framework in reviewing compassion research, this article advances our understanding of team-level compassion by elucidating the processes through which individual-level compassion gives rise to team-level compassion. First, we delineate composition and compilation models of the emergence of team compassion and review empirical studies with respect to the two models. Second, we explain three social mechanisms in teams – social learning, emotional contagion and reciprocity – that shape the emergence of team compassion. Finally, we discuss interventions that can facilitate the emergence of team compassion and offer practical guidance for managers seeking to foster team compassion. JEL Classification: D23, I31

Risk factors of early death in heat stroke and the challenges of emergency care in Hungary - a case series study

Background and aimThe increasing frequency of heat waves worldwide is a major challenge for emergency care providers worldwide. The aim of this study was to analyze the clinical features, treatment options, and early outcomes of heat stroke patients presenting to a large academic emergency department (ED) in Hungary and to provide guidance in management for other emergency professionals.MethodsPatients presenting to the ED between June 1, 2024, and July 31, 2024, with a body temperature above 40 °C were analyzed in a retrospective cohort study. Data collection included demographic, clinical and laboratory parameters. Predictors of mortality were analyzed with Mann-Whitney U test.ResultsEight patients were included in our analysis. Three patients died in the ED (37.5%). Patients who died had significantly lower pH (7.07 vs. 7.4, p = 0.036), higher potassium (7.3 vs. 3.2 mmol/L, p = 0.036), higher calcium (1.19 vs. 0.97 mmol/L, p = 0.036), higher lactate (10.9 vs. 3.5 mmol/L, p = 0.036) and higher PaCO2 (57.2 vs. 28 mmHg, p = 0.036) at admission compared to those who did not die.ConclusionsThe risk of heat stroke due to climate change-induced heat stress and the consequent thermoregulatory disruption may now be significant in temperate climate zones where it was not previously present. Standardization of differential diagnostic and therapeutic procedures could reduce mortality. pH, potassium, lactate and calcium levels may play an important role in predicting the outcome of heat stroke.

Development of a regression model for effective labour management of an IT project

The object of the study is human resource management in IT projects, where the diversity of cultural characteristics and communication practices can affect the efficiency of task performance. The main problem addressed in this study is to identify the key factors that affect the effectiveness of human resource management in IT projects and to identify problem areas that need to be adjusted to improve the productivity and quality of teamwork. The study findings showed that the effectiveness of human resource management in IT projects largely depends on four main aggregate indicators: communication and interaction, cultural factors, leadership and management, and technical and professional skills. In particular, the model found that improved communication and interaction, as well as leadership and management, have the greatest positive impact on overall performance. Instead, cultural differences can create barriers that negatively affect teamwork performance. The findings are explained by the fact that effective communication and interaction are fundamental to coordinating teamwork, ensuring clarity of tasks, and timely information exchange. Leadership and management determine team motivation, conflict resolution strategies, and the overall direction of activities. The negative impact of cultural factors is explained by language barriers, differences in work approaches, and other cultural characteristics that can make it difficult to understand and cooperate. These findings can be used in practice in IT projects where multicultural teams work. They provide valuable guidance for leaders and managers on which aspects of management to focus on to improve team effectiveness. In particular, effective communication practices should be implemented, leadership skills and strategic planning should be developed, and cultural sensitivity should be taken into account, as well as training and development of technical and professional skills of team members. This will help overcome cultural barriers, improve collaboration, and increase the overall productivity of IT projects.

THE INFLUENCE OF WORK DISCIPLINE AND PHYSICAL WORK ENVIRONMENT ON EMPLOYEE PERFORMANCE AT THE SAVINGS AND LOAN COOPERATIVE IN BOGOR REGENCY

This study investigates the influence of work discipline and the physical work environment on employee performance at the Savings and Loan Cooperative in Bogor Regency. Recognizing the cooperative’s strategic role in the Indonesian economy, particularly in supporting member welfare, this research emphasizes the need for effective human resources. Work discipline and a conducive physical work environment are essential factors contributing to employee productivity. A quantitative approach was employed, with a saturated sampling technique applied to a population of 70 employees. Data was collected via a questionnaire that was validated and tested for reliability, ensuring the accuracy of the measurements. Statistical tests, including multiple linear regression and classical assumption testing, were utilized to analyze the data. Results indicate that both work discipline and the physical work environment positively and significantly impact employee performance, individually and collectively. The findings highlight the importance of maintaining high work discipline and optimizing the work environment to enhance employee performance. These insights serve as valuable guidance for cooperative management in establishing policies that foster a disciplined and supportive workplace conducive to achieving organizational goals.

Development and Assessment of a Point-of-Care Application (Genomic Medicine Guidance) for Heritable Thoracic Aortic Disease.

Genetic testing can determine familial and personal risks for heritable thoracic aortic aneurysms and dissections (TAD). The 2022 American College of Cardiology/American Heart Association guidelines for TAD recommend management decisions based on the specific gene mutation. However, many clinicians lack sufficient comfort or insight to integrate genetic information into clinical practice. We therefore developed the Genomic Medicine Guidance (GMG) application, an interactive point-of-care tool to inform clinicians and patients about TAD diagnosis, treatment, and surveillance. GMG is a REDCap-based application that combines publicly available genetic data and clinical recommendations based on the TAD guidelines into one translational education tool. TAD genetic information in GMG was sourced from the Montalcino Aortic Consortium, a worldwide collaboration of TAD centers of excellence, and the National Institutes of Health genetic repositories ClinVar and ClinGen. The application streamlines data on the 13 most frequently mutated TAD genes with 2286 unique pathogenic mutations that cause TAD so that users receive comprehensive recommendations for diagnostic testing, imaging, surveillance, medical therapy, and preventative surgical repair, as well as guidance for exercise safety and management during pregnancy. The application output can be displayed in a clinician view or exported as an informative pamphlet in a patient-friendly format. The overall goal of the GMG application is to make genomic medicine more accessible to clinicians and patients while serving as a unifying platform for research. We anticipate that these features will be catalysts for collaborative projects aiming to understand the spectrum of genetic variants contributing to TAD.

THE IMPACT OF SERVICE QUALITY, PRODUCT QUALITY, AND BRAND IMAGE ON CUSTOMER LOYALTY THROUGH THE MEDIATION OF CUSTOMER SATISFACTION AMONG PRIMA FRESHMART CUSTOMERS

As the retail industry for fresh produce in Indonesia becomes increasingly competitive, it creates an urgency for retailers to maintain relevant position in the market. Retailers need to cultivate loyal customers to ensure sustained performance and growth. Prima Freshmart, a specialized retailer that focuses on poultry products, is currently dealing with the challenge of having low customer loyalty rates based on the results of a preliminary survey. In order to understand how service quality, product quality, and brand image impact customer loyalty among Prima Freshmart's clientele, a study was conducted with 194 participants who completed questionnaires. The data was then analyzed using SmartPLS 4 software. The findings indicate that service quality, product quality, and brand image have a significant and positive influence on customer satisfaction. Furthermore, customer satisfaction has a significant and positive effect on customer loyalty and acts as a mediator in the relationship between service quality, product quality, brand image, and customer loyalty. These discoveries offer potential guidance for Prima Freshmart's management to enhance service quality, product quality, and brand image in order to improve customer satisfaction and loyalty. This research provides valuable insights that can be applied to both theoretical and practical aspects of customer retention strategies in the retail sector.

An empirical study on the relationship between emotional labor and work performance among university teachers.

This study is based on the theory of emotional events and explores the relationship between emotional labor and the job performance of university teachers. Relevant data was obtained through a questionnaire, and a structural equation model was constructed for path analysis. The study found that the surface performance of university teachers has a significant negative impact on relationship performance and task performance; deep performance and proactive authenticity of university teachers have a significant positive impact on relationship performance, task performance, and adaptability performance, respectively; the passive reality of university teachers has a significant negative impact on relationship performance, task performance, and adaptability performance. Based on research findings, this study proposes suggestions for the performance evaluation mechanism of university teachers, including improving the recruitment methods, increasing the emotional labor assessment and incentive mechanism, focusing on alleviating negative emotions of teachers, strengthening the awareness guidance and education of school management and teachers on emotional labor, establishing training courses on emotional labor for teachers, arranging various activities reasonably, and creating a good working atmosphere. Ultimately, these suggestions aim to help university teachers recognize the significance of emotional labor, promote their educational and teaching work, and provide new methods and paths for improving the work performance of university teachers.

Development of an online prediction system for soil organic matter and soil moisture content based on multi-modal fusion

Realizing accurate determination of in situ soil organic matter (SOM) content and soil moisture (SM) content in the field is of great importance for improving agricultural production efficiency. However, the feature information of a single sensor is limited, and there is still a certain gap in modeling accuracy compared to traditional laboratory methods. The variations of SM in the field also interfere with data collection, limiting the application of single sensor. In order to realize the efficient detection of in-situ SOM and SM content, this study developed an online detection system for SOM and SM content based on the fusion of characteristic wavelengths, visible images and thermal imaging image features. Firstly, based on a vehicle-mounted platform, a visible-thermal imaging camera and a characteristic wavelength integration device were integrated in a deep pine plow to realize the simultaneous acquisition of in-situ soil multi-sensor data. Then, a lightweight multimodal network was constructed to obtain thermal visible light image features and characteristic wavelength features through branch networks, achieving deep fusion of different modal data and predicting SOM and SM content. Finally, output the forecasting results of SOM and SM content, and transmit the predictive information to the cloud platform for storage. It was verified that the Multi-modal proposed in this study worked best in the laboratory environment, with a predicted R2 of 0.91 and RMSE of 2.9 g/kg for SOM, and a predicted R2 of 0.92 and RMSE of 0.77 % for SM. Compared with single image or characteristic spectral data, the fusion of visible image and characteristic wavelength effectively improved the prediction accuracy of SOM. The real-time prediction of SM was realized by fusing thermal imaging data, and the elimination of the moisture effect of visible images and characteristic wavelengths was also realized with the help of deep fusion of Multi-modal network. After field validation, the R2 of the Multi-modal system was 0.84 and the RMSE was 5.0 g/kg for SOM, and the R2 of the SM was 0.88 and the RMSE was 1.03 %. Despite the differences in soil types between the validation field and the sampling field, the system still demonstrated strong generalization and achieved high accuracy prediction of in-situ SOM and SM in the field, which effectively improves the efficiency and applicability of field. The efficiency and applicability of soil testing effectively improve the efficiency and provide technical guidance for precision management in the field.

GIG ECONOMY – FLEXIBLE COOPERATION OR A FORM OF PRECARIZATION?

The aim of the article is to analyse the gig economy in terms of the risk of precarisation. The considerations are based on literature review and own research (online survey of a group of 198 freelancers and 182 employees). The author of the article tries to get to know their perspective on financial stability and attitudes towards the risk of precarisation. The final conclusions allow us to assess the extent to which the respondents – freelancers – feel the stability and prospects of their work. For comparison, the same study was also conducted among full-time employees – enabling a comparison of the attitudes and feelings of both groups. The final conclusions provide guidance for managers and employees/gigs. Empirical research was preceded by theoretical considerations. The limitations of the study result from the inherent weaknesses of survey research (respondents may provide subjective or inaccurate statements).

Designing a Nurse-Led eHealth Cardiac Rehabilitation Program: Insights From Participant Experiences and Qualitative Feedback.

This study examines the perspectives of individuals with coronary heart disease (CHD) on a nurse-led eHealth cardiac rehabilitation (NeCR) program, which included a website, tele-monitoring device, and social media chatroom. Using a descriptive qualitative approach, semi-structured interviews were conducted with 18 participants to capture their feedback and experiences with the NeCR program. Participants found the NeCR program valuable in addressing gaps in cardiac rehabilitation services in China, empowering them to make behavioral changes and enhancing their social motivation. However, they also highlighted the need for a more user-friendly website, better symptom management during exercise, and stronger privacy protections in the peer networking chatroom. The study concludes that the NeCR program is feasible in providing accessible rehabilitative services at home post-discharge. Recommendations include improving the self-monitoring platform for ease of use, incorporating immediate symptom management guidance during exercise, and ensuring a secure environment for online peer support. These findings offer crucial insights for developing patient-centered eHealth cardiac rehabilitation services, emphasizing the importance of user-friendly design, effective symptom management features, and privacy protection in promoting participant engagement with e-platforms. ChiCTR1800020411 (http://www.chictr.org.cn/showprojen.aspx?proj=33906).

Self-management in young and middle-aged patients with hypertension: a systematic review and meta-synthesis of qualitative studies

BackgroundThere has been a sharp increase in the prevalence of hypertension in young and middle-aged people at high risk of the disease. Despite the fact that good self-management can be effective in controlling blood pressure, patients do not perform well in this area, resulting in poor blood pressure control. It is therefore particularly important to gain a thorough understanding of patients’ attitudes to self-management and the factors that influence them. The aim of this study was to synthesise the qualitative research on attitudes, motivations and challenges of self-management in young and middle-aged hypertensive patients, to analyse the synthesised results using the COM-B model and to propose appropriate improvement actions.MethodsFrom the time of construction until May 2023, the system searched PubMed, Web of Science, ProQuest, Embase, MEDLINE, CINAHL, PsyCINFO and CNKI databases. The analyses were carried out using a thematic synthesis approach to summarise the key findings. The findings were then mapped and analysed using the COM-B model.ResultsA total of 11 studies were included, involving 250 patients between the ages of 18 and 64. Four themes with ten sub-themes were identified: Poor disease recognition (low disease perception, fuzzy disease knowledge); Barriers to doctor-patient interactions (short communication time, unmet knowledge needs, incomplete guidance for disease management); Living in a hostile environment (heavy workload, lack of companionship, ignorance of families); Expectations for a healthy body (responsibility of family roles, witness the cruelty of illness). Analysis of the composite results based on the COM-B model showed that low disease perceptions, barriers to doctor-patient interactions and life circumstances with enemies on all sides were the main challenges faced by young and middle-aged hypertensive patients, whereas the expectation of a healthy body was a motivation to promote self-management of blood pressure in patients.ConclusionsThis study shows that family responsibilities are a particular motivator for self-management in young and middle-aged hypertensive patients. In response to the problems they face, we believe that meeting patients’ knowledge needs, improving healthcare professionals’ communication skills and valuing the role of community hospitals are effective ways to promote patient self-management. In the future, telemedicine, mobile healthcare and intelligent monitoring devices will provide a solution to reduce the burden on medical resources.Systematic review registrationPROSPERO CRD42018100810.

6630 Crooke Cell Pituitary Adenoma Without a Cushingoid Appearance

Abstract Disclosure: J. Hodge: None. S. Idriss: None. I. Jamal: None. R. Panta: None. Background: Crooke cell pituitary adenomas are corticotroph adenomas with Crooke’s cell changes, which are cytoplasmic accumulation of cytokeratin filaments in response to glucocorticoid excess. They are aggressive, invasive tumors, typically macroadenomas, with a high rate of Cushing’s disease and post -treatment (surgery and/or radiotherapy) recurrence. We present a case of Crooke cell pituitary adenoma without a Cushingoid appearance. Clinical Case: A 66-year-old Hispanic male with a 16-year history type II diabetes mellitus with retinopathy, presented with a pituitary macroadenoma at age 60. This was found incidentally when he had a brain CT for evaluation of vertigo. Subsequent brain MRI demonstrated a large 2.4 x 2.0 x 1.7 cm pituitary macroadenoma with extension into the suprasellar cistern and the left cavernous sinus. He was asymptomatic, without Cushingoid features. Hormonal evaluation revealed central hypogonadism and hypothyroidism, mildly elevated prolactin of 39.3 (4-15.2 ng/mL) and morning cortisol level of 12.7 (6-18.4 ug/dL). A 24-hour urine cortisol was normal. He was started on testosterone and thyroid hormone replacement therapy. His diabetes mellitus became progressively difficult to control with a peak HbA1C of 10.1%, about 7 years prior the macroadenoma finding. His HbA1C remained persistently elevated in the 8.1-9.5% range despite being on 6 anti-hyperglycemic agents, including basal insulin. A morning ACTH level 4 years after the initial visit, was 115 (6-50 pg/mL) with a cortisol level of 13.7 (6-18.4 ug/dL). Repeat morning ACTH and cortisol levels 7 months later were very similar. 5 years after the macroadenoma finding, he was noted to have worsening glaucoma, which was believed to be due to optic nerve compression. Therefore, he underwent endoscopic transphenoidal resection for tumor debulking. Pathology supported the diagnosis of Crooke cell corticotroph pituitary adenoma. Repeat brain MRI 3-months post-surgery demonstrated residual tumor, but normal optic chiasm and optic tracts. He had an abnormal dexamethasone suppression test prior to surgery (cortisol 6.4 ug/dL) and continued to do so post-operatively (cortisol 3.7 ug/dL with persistently elevated ACTH). Just prior to his surgery, testosterone replacement therapy was held. Total testosterone level after surgery was normal 309.6 (280-800 ng/dL) and free testosterone 7 (5-21 ng/dL); he remained off replacement therapy. Conclusion: Crooke cell pituitary adenomas are rare with limited data on prognosis and guidance for clinical management. Some patients may have subtle features of hypercortisolism, such as difficult to control diabetes mellitus, without an overt Cushingoid appearance. Presentation: 6/1/2024

12455 Bone Mineral Density Improvement After Resolution Of Endogenous Cushing Syndrome

Abstract Disclosure: C. Plessias: None. N. Charoenngam: None. T. Rittiphairoj: None. T. Suenghataiphorn: None. T. Srikulmontri: None. P. Wattanachayakul: None. M. Kurt: None. Bone Mineral Density Improvement After Resolution of Endogenous Cushing Syndrome: a Meta-analysis and meta-regression Patients with endogenous Cushing syndrome (eCS) are known to have decreased bone mineral density (BMD) and are prone to fragility fractures. Treatment of eCS have been shown in multiple studies to result in improvement in BMD. However, the degree of BMD improvement after resolution of eCS remains inadequately explored due to limited sample sizes in existing studies. Through systematic review, meta-analysis, and meta-regression techniques, we aimed to identify all available evidence to evaluate BMD improvement after resolution of eCS. Potentially eligible studies were identified from the PubMed and EMBASE databases from inception to February 2024, utilizing a search strategy incorporating terms related to "Bone mineral density" and "Cushing syndrome". Eligible studies must include adult or pediatric patients diagnosed with any form of eCS, encompassing Cushing disease (CD), adrenal adenoma, mild autonomous cortisol secretion or ectopic ACTH-secreting tumors, who received treatment resulting in CS resolution. These studies must either present lumbar spine (LS) or femoral neck (FN) BMD measurements in the form of T-score, Z-score or actual BMD values before and after CS resolution, or report mean differences (MD) of BMD, or provide individual BMD data. Point estimates with corresponding standard errors were extracted from each study and combined using the generic inverse variance method. Meta-regression analysis was utilized to explore the impact of time after resolution of eCS on BMD improvement.A total of 5,085 records were identified from the databases. After systematic review, 14 studies, including a total of 386 patients, were deemed eligible for analysis. The meta-analysis demonstrated that resolution of eCS resulted in statistically significantly improvement of LS BMD (pooled MD: Z-score: +0.76, 95%CI 0.50 – 1.02, I2 76%; T-score: +0.87, 95%CI 0.55 – 1.19, I2 78%; actual BMD: +0.092 g/cm2, 95%CI 0.060 – 0.124, I2 74%) and FN BMD (pooled MD: Z-score: +0.54, 95%CI 0.32 – 0.76, I2 75%; T-score: +0.38, 95%CI 0.25 – 0.51, I2 0%; actual BMD: +0.041 g/cm2, 95%CI 0.021 – 0.062, I2 0%). The meta-regression analysis revealed a statistically significant association between follow-up time and improvements in LS T-score BMD (predicted LS T-score improvement = 0.42 + 0.062 × year, p = 0.027) and FN Z-score BMD (predicted FN Z-score improvement = 0.35 + 0.037 × year, p = 0.003), but not with LS Z-score and FN T-score.In summary, our study presents the extent of improvement in LS and FN BMD following the resolution of eCS based on all available data in the literature. These findings have clinical significance as they offer guidance for management of osteoporosis following the resolution of eCS. Presentation: 6/3/2024