Lower Body Research Articles

Association of the Preoperative Controlling Nutritional Status (CONUT) Score with Clinicopathological Characteristics in Patients with Papillary Thyroid Carcinoma.

The Controlling Nutritional Status (CONUT) score is an immunonutritional test tool based on serum albumin, total cholesterol, and lymphocyte counts. It has been studied as a simple prognostic predictor for various carcinomas. This study aimed to investigate the association between preoperative CONUT scores and the clinicopathological characteristics in papillary thyroid carcinoma (PTC) patients. This study included 2,403 PTC patients who underwent total thyroidectomy between 2012 and 2016 at a single tertiary medical center. The CONUT scores were calculated based on preoperative blood tests. The clinicopathological characteristics were retrospectively reviewed. The patients were categorized by the CONUT score (relatively low, 0-2; relatively high, 3-5). Among the 2,997 PTC patients who underwent total thyroidectomy at Pusan National University Hospital between 2012 and 2016, those without preoperative blood test were excluded (n=149). Finally 2,403 patients were analyzed after excluding 439 patients taking lipid-lowering drugs and six patients without available T stage data after surgery. Based on the CONUT score, the relatively high score group had a lower body mass index (23.7±3.3 kg/m2 vs. 21.9±2.9 kg/m2, P<0.001), more advanced T stage (T stage 3/4, 5.9% vs. 11.4%, P=0.045), and higher extrathyroidal extension (2.1% vs. 7.6%, P=0.005). Patients included in this large, single-center study all had a preoperative CONUT score of 0-5, but this study demonstrated that higher preoperative CONUT scores were significantly associated with advanced T stage and extrathyroidal extension. The CONUT score, which can be easily used in clinical practice, is thought to be helpful in predicting the aggressiveness of PTC.

Similar adaptive responses in the upper body physical performance of table tennis players following the traditional and cluster set resistance and plyometric training.

Numerous studies have investigated the impact of resistance training (RT) and plyometric training (PT) set configurations (cluster sets [CS] and traditional sets [TS]) on lower body performance adaptations. However, the effects of these training modalities on upper body physical performance, particularly among Table Tennis (TT) players, remain unclear. Therefore, this study aimed to examine the effects of an 8-week RT and PT using CS and TS configurations on the physical performance attributes of male TT players. Forty young male players were recruited from a local academy and after determining their dominant hand, divided into CS-PT, TS-PT, CS-RT, TS-RT, and active control (CON) groups, each of eight. Pre- and post-interventions, the upper body muscular power (medicine ball throw), maximal strength (bench press), reaction time, and arm crank anaerobic power test were measured. Following the intervention, the CON group exhibited no changes; however, the CS-PT, TS-PT, CS-RT, and TS-RT groups displayed significant (p = 0.001) improvements in muscular power (effect size [ES] = 1.21 [large], 1.02 [medium], 0.81 [medium], 0.64 [medium]), strength (ES = 0.40 [small], 0.43 [small], 0.62 [medium], 0.63 [medium]), reaction time (ES = - 0.71 [medium], - 0.68 [medium], - 0.83 [medium], - 0.61 [medium]), peak power (ES = 1.83 [large], 1.66 [large], 0.90 [medium], 0.67 [medium]), and mean power (ES = 0.89 [medium], 0.89 [medium], 0.57 [small], 0.59 [small]), respectively. The PT groups indicated significantly greater changes than the RT groups in both muscular (CS, p = 0.021; TS, p = 0.018) and anaerobic power (peak power: CS, p = 0.017; TS, p = 0.011; mean power: CS, p = 0.024; TS, p = 0.042) performance, while the RT groups showed greater adaptive responses than the PT groups in maximal strength (CS, p = 0.033; TS, p = 0.048). In conclusion, PT is recommended for enhancing power performance, while RT is preferred for increasing strength. When various set configurations were incorporated, no further effects were noted.

Predictors of outcomes after gastric peroral endoscopic myotomy for refractory gastroparesis: a systematic review

Background: Gastroparesis is a debilitating gastroduodenal disorder for which gastric peroral endoscopic myotomy (GPOEM) has emerged as an efficacious treatment option. However, response to GPOEM varies between 50-80%, such that preoperative predictors of treatment success are needed to guide patient selection. Methods: We performed a systematic review to identify predictors of clinical and functional response to GPOEM among adult patients with gastroparesis (PROSPERO: CRD42023457359). MEDLINE, Embase, and CENTRAL databases were searched systematically for studies reporting outcomes after GPOEM in September 2023. A narrative synthesis of predictive factors on univariable and multivariable analysis was performed with consideration of response rates via meta-analysis, and evaluation of discrimination if prognostic models were developed. ROBINS-E was used for risk of bias assessment. Results: Of 1899 articles reviewed, 30 were included. The GPOEM response rate was 63.1% (95% confidence interval 56.3%-69.5%) with most studies defining clinical success on the basis of improvement in gastroparesis cardinal symptom index (87%, 26/30). Older age, shorter duration of gastroparesis, non-diabetic etiology, lower body mass index, and response to intrapyloric botulinum toxin were associated with positive response to GPOEM on multivariable analyses. Predictors on physiological tests such as EndoFLIP or gastric emptying scintigraphy were inconsistent. No prognostic models underwent external validation. Conclusion: Currently, there are limited reproducible predictors of response to GPOEM among patients with refractory gastroparesis. Robust prospective studies investigating scalable, reproducible, and actionable biomarkers of treatment response are required.

Effects of horizontally versus vertically loaded resistance exercises on performance and muscle architecture.

The aim of this study was to compare a training program based on horizontally (HT) versus vertically (VT) loaded exercises on performance and muscle architecture of the lower body muscles. Nineteen resistance trained individuals were randomly assigned to HT (N.=10; age: 25.9±4.2 y; body mass: 72.7±11.4 kg; height: 174.0±6.0 cm) or VT group (N.=9; age: 26.9±4.4 y; body mass: 76.2±10.8 kg; height: 174.2.0±5.8 cm). Both 6-week training programs included 4 training sessions per week and were equated for the total number of repetitions. One repetition maximum (1RM) was assessed for squat and hip thrust, together with vertical and horizontal jumps and sprint. Muscle thickness (MT) and echo intensity (EI) of vastus lateralis, vastus medialis and gluteus were also evaluated pre- and post-training period. A significantly greater increase in 1RM hip thrust was detected in HT (+17.9%; P=0.004) while greater increases in 1RM squat were found in VT (+10.5%; P=0.007). A greater increase (P=0.009) in vastus medialis MT was detected in VT (4.1%) compared to HT (-7.9%). Similar increases in MT of gluteus were registered in both groups (P<0.05). A greater improvement in standing long jump (P=0.004) was detected in HT (+7.6%) compared to VT (+1.6%), while both groups significantly improved vertical jump performance. Combining both groups, strong correlations were detected between gluteus EI and 20-m sprint (r=0.79; P<0.001). Results indicate that HT was more effective than VT for horizontal jumps while both HT and VT were equally effective on vertical jumps. Both HT and VT promoted similar changes in muscle architecture of the gluteus, but not of the vastus medialis.

Strength Training Among Male Master Cyclists—Practices, Challenges, and Rationales

Background: Cycling performance declines with age due to reduced aerobic capacity, along with reductions in muscle mass and bone density. Strength training can help counter these effects. This study aims to explore the strength training practices, challenges, and decision-making rationale of male master cyclists to optimize performance and health as they age. Methods: A total of 555 male master cyclists aged 35 and above completed an online questionnaire, distributed via social media platforms, that included Likert-type, single- and multiple-selection, and open-ended questions. Participants were then divided into two age groups: 35–49 years (n = 359) and ≥50 years (n = 196). Analyses involved descriptive statistics, Wilcoxon signed-rank tests, Mann–Whitney U-tests, and chi-square tests, with qualitative data analyzed using content analysis. Results: More cyclists engaged in strength training during the off-/pre-season, with a significant reduction in both frequency and the number of cyclists engaging in strength training during the race season. The strength training practice was focused mainly on core and lower body, employing hypertrophy and maximal strength training methods. Key challenges included fatigue induced by strength training and limited time to perform strength training. The main rationale for the strength training revolved around improving cycling performance, reducing injury risk, and the health benefits of strength training. Both age categories, but the older group in particular, reported bone health as a primary rationale for strength training. Conclusions: While strength training offers performance and health benefits, issues of fatigue and time constraints remain substantial, suggesting the need for tailored training programs to improve adherence and effectiveness.

ANÁLISE EPIDEMIOLÓGICA DE LESÕES EM UMA EQUIPE DE ATLETISMO UNIVERSITÁRIO: UM ESTUDO DE COORTE RETROSPECTIVO

This study aims to analyze the physical profiles and sports-related injuries in a track and field team. A total of 31 participants, from both genders, from the medical college’s track and field team were included. Data on their physical characteristics were collected, and participants responded to a survey adapted from the “NCAA Injury Surveillance System.” Among them, 65% reported at least one injury, with 73.9% of the injuries categorized as severe. The injury rate was 0.27 injuries per 1000 hours of exposure. Injured athletes demonstrated a practice time twice that of their uninjured counterparts. Injuries to the quadriceps and shin accounted for 52.17% of the reported injuries. This study suggests that collegiate athletics poses a substantial risk of severe sports injuries, particularly in the lower body. A key contributing factor appears to be the duration of practice time.

Abstract 4136621: Efficacy of Empagliflozin in Heart Failure with Preserved Ejection Fraction is related to the presence of echocardiographic features of diastolic dysfunction in the EMPEROR-Preserved trial.

Introduction: Efficacy of SGLT2i empagliflozin in Heart Failure is seen across the LVEF spectrum and in multiple clinical subgroups, with diverse mechanisms of action. We hypothesized that objective echo evidence of diastolic dysfunction (DD) in HFpEF may predict the response to empagliflozin. Methods: We defined DD as the presence of LAVI ≥34 mL/m 2 , E/e ≥13 or LVMi &gt;115 (males) or &gt;95 (females) and created three categories with 0, 1 or ≥2 DD criteria. We report the impact of baseline DD on response to empagliflozin therapy and adverse effects. Analyses were performed using the intention-to-treat principle. For time-to-first-event analyses, differences in treatment effects across the three DD categories were assessed by a Cox proportional hazards model, with pre-specified covariates of age, gender, region, diabetes, LVEF, and eGFR. Total events were assessed using a joint frailty model, with CV death (CVD) as a competing risk. Results: Of 5988 patients in EMPEROR-Preserved 3766 (63%) had no baseline DD, 1619 (27%) one and 603 (10%) ≥2 measures. The percentage of males decreased as DD category increased, 57.2% for none, 54.2% for one and 46.6% for ≥2, p &lt;0.0001. Other demographic features significantly associated with DD categories were race, ethnicity and region and it was more common with age, with lower HR, DBP, body weight and eGFR. DD was more frequent with ischaemic aetiology and higher LVEF, but not with baseline NT−proBNP, DM or COPD. Time to HHF or CVD showed a progressive treatment effect across the three DD categories (interaction p-value 0.0014), with estimated HR’s of 0.91 (none present), 0.64 (1 present) and 0.49 (&gt;=2). A significant treatment-by-subgroup interaction was also observed for the total number of HHF, with estimated HR’s of 0.95 (none present), 0.52 (1 present) and 0.29 (≥2). In the responder analysis, ≥10 point improvement in KCCQ at week 52 showed a treatment induced change that was consistent across DD categories (interaction p-value 0.92). The safety profile was consistent across DD classes. Conclusions: Baseline echocardiographic DD predicted an improved clinical response to Empagliflozin in a graded fashion, suggesting the mode of action may target specific changes in diastolic performance.

Abstract 4120131: Absence of standard modifiable risk factors (SMuRF-less) among 5002 Middle Eastern patients with atherosclerotic cardiovascular disease: (Interim analysis from the Jo-SMuRF Study)

Introduction: A growing number of patients develop atherosclerotic cardiovascular disease (ASCVD) despite the absence of standard modifiable risk factors i.e. hypertension (HTN), type 2 diabetes (T2D), dyslipidemia (DSL), and cigarette smoking (SMuRF-less). There is scarcity of studies on prevalence and clinical profiles of SMuRF-less patients in the Middle Ease (ME). Aim: To study the prevalence and clinical features of ME patients with ASCVD who are SMuRF-less vs. those with ≥ 1 SMuRFs, presence of other risk factors and utilization of secondary preventive medications in the 2 groups, and one year survival. Methods: Clinical details of adult patients with ASCVD who participated in 5 previous registries were analyzed according to the absence or presence of ≥ 1 SMuRFs. Results: Of the 5002 patients included in the analysis, 676 (13.5%) were SMuRF-less and 4326 (86.5%) had ≥ 1 SMuRFs. Prevalence of the 4 SMuRFs in the whole cohort was 53.5% HTN, 47.8% T2D, 40.2% smoking, and 37.5% DSL, and the SMuRF group was 61.9%, 55.2%, 46.5%, and 43.4%, respectively. Compared with the SMuRFs group, patients in the SMuRFless group were younger (mean age 52±11.4 years vs. 56.3±11.5 years, respectively, p&lt;0.001) and more likely to be women than men (38.6% vs. 27.9%, p&lt;0.0001). Furthermore, SMuRF-less patients had lower mean body mass index, and less prevalence of metabolic syndrome, heart failure, and family history of ASCVD. Utilization of secondary cardiovascular prevention medications was significantly less in the SMuRF -less group than those with SMuRFs; dual antiplatelet therapy (36.4% vs. 69.5%), statins (66.3% vs. 87.4%), B blockers (57.5% vs. 70.5%), and renin-angiotensin inhibitors (35.2% vs. 55.3%, respectively, all p&lt;0.001. Of the subgroup with one year follow up after percutaneous coronary intervention (N=2641), mortality rate was not different in the 2 groups; 1.4% vs. 1.8%, p=0.98. Conclusions: In this first study of SMuRFs in ASCVD patients in the Middle East, SMuRF-less patients account for nearly 14% of the studied cohort. These patients were younger, had less comorbid disease, received less guidelines-recommended prevention medication, and had same one year event rate compared with patients who have SMuRFs.

Abstract 4116486: Association of assessment of clinical congestion in patients with heart failure compared with assessment using bioimpedance and microwave spectroscopy

Background: Physicians have to find a balance between decongestion therapy and the risk of dehydration so non-invasive methods assessing congestion are of great importance. Purpose: The study aimed to compare the clinical assessment of congestion to bioimpedance and microwave spectroscopy. Methods: 27 hospitalized HF patients with congestion (40% females) (Congestion Group) and 59 HF patients without fluid overload (66% females) (NON-Congestion Group) were included. Clinical examination, chest x-ray, laboratory results, echocardiography, non-invasive body mass analysis (Tanita Pro), NT-poBNP, and selected modern biomarkers concentrations [GDF-15, galectin-3, FABP, copeptin, VEGF were performed. Additionally, we assessed pulmonary congestion using a proprietary sensor with a microwave spectroscopy method based on analyzing the dielectric properties of an object (patent applications P.442466). Results: There were no differences in body mass index, blood pressure values, left ventricular ejection fraction (LVEF), and echocardiographic parameters of diastolic left ventricular function between groups. In the Congestion Group, we observed significantly more patients in NYHA Class 3 and 4 (p&lt;0.001), lower values of fT3 (median 2.4 vs 2.7; p=0.02), higher a FIB-4 index (p=0.04), lower GFR MDRD (median 52.7 vs 66.7;p=0.04), higher concentrations of: NT-proBNP (pg/ml) (median 545 vs 101; p&lt;0.001), galectin-3 (ng/ml) (median 15.01 vs 11.35; p=0.01), GDF-15 (pg/ml) (median 2069.27 vs 734.64; p=0.01), FABP (pg/ml) (median 293.6 vs 101; p=0.008) compared to NON-Congestion Group, and a larger number of detected congestion in chest x-ray (p&lt;0.01) and more patients with limb edema (p= 0.0037). The patients with congestion also needed longer hospitalizations (p=0.008). Patients with congestion had lower total body water content in kg and intracellular water (ICW) (kg) (p=0.02 and p=0.01, respectively), and the higher extracellular water/total body water index (ECW/TBW) (p=0.001) assessed in bioimpedance and significantly higher Absorption Loss evaluated with the use of microwave spectroscopy (p=0.02). In a multiple logistic regression model, the factor that was independently associated with clinically diagnosed congestion was NT-proBNP &gt;1095 pg/ml (OR 111.6, 95% CI: 2.6-50.6; p=0.001) (Figure 1). Conclusions: Absorption Loss and ECW/TBW are valuable new diagnostic tools in diagnosing lung congestion in patients with heart failure.

Abstract 4119744: Evaluation of Neuropsychological development and Factors Affecting it in Children With Cyanotic and Acyanotic Congenital Cardiac Disease After Surgical Treatment

Objective: To evaluate neuropsychological development in children with cyanotic and acyanotic congenital heart diseases (CHDs) after surgical treatment and analyze the risk factors. Methods: 89 children who received follow-up in Fuwai Hospital after surgical treatment of CHDs were recruited in this study and 90 normal children were recruited as the control group. The children with CHDs were divided into cyanotic CHDs group and acyanotic CHDs group. Neuropsychological development was assessed according to Pediatric-psychological mental test scale and statistical analysis was employed. Results: The acyanotic CHDs group achieved better distribution of development quotient than cyanotic CHDs group (p &lt; 0.05) but worse than the normal control group (p = 0.004). The proportion in cyanotic CHDs group with developmental quotient below the moderate level was higher than that of the normal control group (p &lt; 0.001), but there was no significant difference between the cyanotic CHDs group and acyanotic CHDs group (p = 0.055). Multivariate regression analysis indicated that for cyanotic CHDs group, younger age at cardiac surgery, lower body mass, lower preoperative blood glucose level, lower BIS level, and prolonged duration of tracheal intubation after surgery were linked with lower scores in the test scale (p &lt; 0.05); for acyanotic CHDs group, younger age at cardiac surgery, lower body mass, lower temperature during surgery and prolonged duration of tracheal intubation after surgery were linked with lower scores in the test scale(p &lt; 0.05). Conclusion: Distinct neuropsychological impairment could be present in children with cyanotic CHDs. Younger age at cardiac surgery, body mass, preoperative blood glucose level, BIS level during surgery, temperature during surgery and duration of tracheal intubation after surgery were perioperative factors that could influence long-time neuropsychological development in children with CHDs.

Abstract 4136846: Sex Differences in Hypertension Diagnosis among Young Adults

Background: Young adults, especially men, may experience delays in diagnosis of hypertension, which subsequently affect timely treatment and control of high blood pressure (BP). Question: Compared with young adult women, how soon are young adult men diagnosed with hypertension after having high BPs during clinical encounters? Aim: To estimate the time to first diagnosis of hypertension in young adult men and women, and to identify factors associated with a delayed diagnosis of hypertension. Methods: Using electronic health records, we identified adults aged 18-39 years with systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, based on average of three consecutive separate outpatient BPs within two years of each other, between 2009-2016 from Kaiser Permanente Southern California. We followed them from the third qualifying BP until hypertension diagnosis, membership disenrollment, end of study (12/31/2019), or death, whichever occurred first. We used the cumulative incidence function and Cox proportional hazards models to estimate the time to first diagnosis of hypertension and identify factors associated with diagnosis. Results: Among 2,443 young adults (mean age 31 years, 57% men) with high BP, 37% were diagnosed with hypertension during a median of 5.9 years. Compared with women, a lower percentage of men were diagnosed with hypertension (30% vs 47%) and men received their diagnoses later (median time to diagnosis: 2.3 vs 1.4 years) ( Figure ). Among the total population, 19% of men and 12% of women did not have follow-up BP measures within one year following their third qualifying high BP. Among those diagnosed, 80% initiated with antihypertensive medications within one year following their diagnosis. Factors associated with a delayed diagnosis of hypertension included being male, younger, having lower systolic or diastolic BP, a lower body mass index, and the absence of dyslipidemia or (pre)diabetes. Conclusion: This study highlights that young adult men are at a higher risk of delayed hypertension diagnosis, emphasizing the need for healthcare system level interventions to improve the recognition, diagnosis, and treatment of hypertension in this population.

De-intensification of basal-bolus therapy by replacing prandial insulin with once-weekly subcutaneous semaglutide in individuals with well-controlled type 2 diabetes: A single-centre, open-label randomised trial (TRANSITION-T2D).

The study aims to examine the outcome of replacement of prandial insulin with once-weekly subcutaneous semaglutide in people with type 2 diabetes reasonably controlled on multiple daily insulin injections (MDI). This single-centre, randomised, open-label trial enrolled a statistically predetermined sample of 60 adults with HbA1c ≤7.5% (58 mmol/mol) receiving MDI, with a total daily dose (TDD) ≤120 units/day. Participants were assigned 2:1 to subcutaneous semaglutide 1.0 mg plus insulin degludec, or to continue MDI. The primary outcome was percentage of subjects maintaining HbA1c ≤7.5% (58 mmol/mol) at Week 26. At Week 26, 90% of semaglutide and 75% of MDI subjects maintained HbA1c ≤7.5% (≤58 mmol/mol) (p = 0.18). Mean changes (95% CI) in HbA1c, weight and percentage body weight for semaglutide versus MDI, respectively, were -0.5% (-0.7, -0.3) versus 0.0% (-0.3, 0.3; p = 0.009); -8.9 kg (-9.9, -7.8) versus 1.5 kg (-0.1, 3.1; p < 0.001); and -8.6% (-9.6, -7.6) versus 1.4% (0.0, 2.8; p < 0.001). Insulin TDD decreased 56.0% (-62.3, -49.7) with semaglutide and increased 6.7% (-2.5, 16.0) with MDI (p < 0.001). Among semaglutide subjects, 58% reduced insulin TDD > 50%, 97.5% stopped prandial insulin and 45% lost >10% body weight. Participant treatment satisfaction scores trended higher with semaglutide. Hypoglycaemia frequency was similar between groups. In people with type 2 diabetes well controlled (HbA1c ≤7.5% [≤58 mmol/mol]) on MDI ≤120 units/day, replacing multiple daily injections of prandial insulin with once-weekly subcutaneous semaglutide can maintain and even improve HbA1c, lower body weight and lessen the burden of management.

Abstract 4145857: The effect of homebase exercise training on single ventricle heart (SVH) function, exercise performance, body composition and quality of Life in children and adolescents living with a Fontan circulation

Objectives: Fontan patients have impaired exercise capacity. Exercise training has been shown to improve exercise performance. We aim to determine the effect of exercise training on SVH function, and its correlation with exercise capacity, body composition and self-reported QOL. Methods: 31 paediatric Fontan patients were prospectively recruited to complete 3x30 minute homebased HIIT sessions per week for 20 weeks. Baseline physical activity levels, including structured sports participation, daily step-counts and active-zone-minutes (AZM) were recorded by accelerometer (Fitbit inspire3). Patients were considered active if they met 2 of the 3 criteria: 1/Structured sports training ≥ 2 per week (moderate-vigorous intensity &gt;30 minutes) 2/Daily steps ≥ 10k 3/AZM ≥60 minutes per day Bio-impedance-analysis, cardiopulmonary exercise tests, echocardiography including deformation imaging and PedQL questionnaires were performed at baseline and upon completion. Results: 28 participants completed the programme. 86% had good compliance (completed &gt;45/60 sessions). 17 male (60.7%), mean age 14.3±2.03 years, 14 LV-dominant, 14 non-LV dominant (9RV, 5BiV). No serious adverse events reported. The exercise duration improved from 7.56±2.6 to 9.16±2.5 minutes, p&lt;0.001 and peak workload from 110±43.6 to 129±45.8 watts, p&lt;0.001. Indexed oxygen consumption (VO 2 /kg peak) improved from 30.9±7.1 to 32.2±7ml/min/kg, p=0.003 and oxygen pulse, O 2 pulse peak from 9.1±2.6 to 9.7±3 mL/beat, p&lt;0.001. Submaximal analysis showed normal %predicted VO2 (&gt;40%) and improvement of O 2 pulse, p=0.024. LV systolic function showed improved MAPSE from 1.65±0.2 to 1.86±0.2, p=0.017, and improved apical rotation from 2.3±3.8 to 5.9±3.1, p=0.043. RV systolic function showed improved TAPSE of 1.4±0.2 to 1.6±0.3, p=0.032 and FAC of 44±5.6% to 49±10.5%, p=0.170. Self-reported QOL scores were higher in Fontan children who were physically active at baseline, with a downward trend noted when poor compliance was evident (Child’s QOL V3.0 91.21±0.7 to 86.1±5.2, p=0.018 (Table 2). Although no significant change in body composition, a higher appendicular skeletal muscle mass, SMMa% and lower body fat% were noted pre and post exercise training in the active Fontan group (Table 3), Conclusions: We observed significant improvements in both the submaximal and peak exercise performance in paediatric Exercise training associated with improvement of single ventricle longitudinal systolic function and ventricular mechanics.

Abstract 4115222: Distinct Demographic, Cognitive, and Psychosocial Factors Associated with Different Types of Self-Care in Patients with Type 1 Diabetes and in Patients with Type 2 Diabetes

Background: Poor self-care in patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) leads to increased diabetes complications and health costs. While the goal of self-management for patients with T1DM and T2DM is to maintain normal blood glucose levels, the major methods for achieving this differ (exogenous insulin delivery vs. a combination of self-care techniques, respectively). This implies that factors associated with self-care in the two groups may differ. Hypothesis: Distinct demographic, cognitive, and psychosocial factors are associated with overall self-care, diet, exercise, blood glucose testing, foot care, and smoking in patients with T1DM and T2DM, in separate models. Methods: In this cross-sectional, correlational study, data were collected from 148 patients with T1DM (n = 64, mean age: 51.3 years) or T2DM (n = 84, mean age: 62.5) using REDCap during 2023. The participants were recruited from various organizations, institutions, and ResearchMatch in the United States. Several multiple regression analyses were done to test the hypothesis. Results: Patients with T1DM had better self-care, including overall diabetes self-care, exercise, and blood glucose testing than the T2DM group. Older age (p = .003), lower body mass index (BMI) (p = .040), and stronger knowledge (p = .028) in the T1DM group (F[10,53]= 2.290, p = .026, R 2 = .302), while lower BMI (p = .045) and higher levels of self-efficacy (p &lt; .001) in the T2DM group were associated with better overall diabetes self-care (F[10,73] = 3.219, p = .002, R 2 = .306). Older age, lower BMI, stronger knowledge, stronger resilience, and lower self-esteem were associated with better self-care in diet, blood glucose testing, and/or foot care in the T1DM group, while lower BMI, stronger knowledge, higher levels of self-efficacy, and less severe depressive symptoms were associated with better self-care in diet, exercise, and/or blood glucose testing in the T2DM group. None were associated with smoking in both groups. Diabetes distress, self-compassion, and social support were not associated with any types of self-care. Conclusions: Factors associated with self-care differed based on types of self-care and types of diabetes, thus, supporting the hypothesis. When healthcare providers provide interventions to improve diabetes self-care in individual patients with diabetes, they need to consider types of diabetes, types of self-care, and distinct factors associated with each type of self-care.

Genetic Characterisation of Feeding Patterns in Lactating Holstein Cows and Their Association With Feed Efficiency Traits.

Feeding behaviour traits, such as number, duration or intake per feeder visit, have been associated with feed efficiency in dairy cattle. Those traits, however, do not fully capture cows' feeding patterns throughout the day. The goal of this study was to propose a new phenotype for characterising within-day feeding patterns and estimate its heritability and genetic correlations with dry matter intake (DMI), secreted milk energy, metabolic body weight and residual feed intake. Feeding patterns were evaluated using 4.8 million bunk visits from 1684 midlactation Holstein cows collected from 2009 to 2023 with an Insentec system. Feed efficiency traits were available from 6099 lactating Holstein cows at six research stations across the United States. Daily bunk visits were ordered, with Time 0 designated as the time of first feed delivery. Intake proportions were calculated by visit for each cow by dividing feed intake per visit by the total intake of the cow for that day. Feeding patterns were characterised by the area under the curve of cumulative feed intake proportions for each cow throughout the day. The feeding pattern phenotype per cow was defined as the average of areas under the curve across days, whereas consistency of feeding pattern was calculated as the natural logarithm of variance of daily area under the curve values. Estimates of heritability and genetic correlations were performed using Bayesian inference with an animal model, considering lactation, days in milk and cohort (trial-treatment) as fixed effects and animal as a random effect. Heritability estimates for average area under the curve and variance of daily area under the curve were 0.35 ± 0.05 and 0.16 ± 0.05, respectively. The genetic correlation between average area under the curve and secreted milk energy was -0.30 ± 0.14. Genetic correlations between average area under the curve and DMI, metabolic body weight and residual feed intake were not statistically significant. Variance of daily area under the curve was genetically correlated with DMI (0.47 ± 0.15), secreted milk energy (0.40 ± 0.17) and metabolic body weight (0.28 ± 0.13). The genetic correlation between variance of daily area under the curve and residual feed intake was not significant. Overall, we provided a reliable method to truly characterise feeding patterns in midlactation dairy cows. Feeding pattern and its consistency were heritable, indicating that a significant proportion of phenotypic variation is explained by additive genetic effects. Genetic correlation estimates indicate that cows with more consistent daily feeding patterns have lower DMI, lower secreted milk energy and lower metabolic body weight.

Anthropometric Studies of Schoolchildren During the First Decades of the 20th Century in Spain and Argentina.

The practice of anthropometry in schools at the beginning of the 20th century originated in Europe and Latin America in conjunction with the emergence of hygienism and epidemiological auxology. The aim of this work is to deepen the knowledge of these practices in Spain and Argentina and to compare the available growth data in order to identify possible differences between the populations. The anthropometric data of 1693 boys and girls aged 7-15 years (877 Spanish; 816 Argentinean) from the period between 1903 and 1913 were analyzed. The data were taken from the Reports and Memoirs of the School Colonies of the National Pedagogical Museum (Spain) and the Archives of Pedagogy and Related Sciences of the Faculty of Law and Social Sciences of the National University of La Plata (UNLP) (Argentina). The most pronounced differences in weight and height were observed between the ages of 11 and 12. The weight growth of Spanish schoolchildren was 22% (boys) and 24% (girls) lower than that of their Argentine counterparts, while linear growth was about 7% lower for both sexes. In addition, the Spanish had a lower body mass index up to the age of 12 years. Argentine boys and girls of La Plata were taller and heavier than their Spanish counterparts of Madrid during the same period (between 1903 and 1913). These results can be attributed to the higher standard of living that characterized the Argentine population at that time.

Retrospective Cohort Study of Associated Factors for Intestinal Complications in Pediatric Liver Transplantation.

Intestinal complications (IC) represent serious adverse events after liver transplantation (LT), however limited research has been conducted in pediatric cohorts. This study aims to describe IC after pediatric LT and to identify associated factors. Retrospective review of 153 patients having undergone LT, aged 0-18 years, treated in the Swiss Pediatric Liver Center in Geneva. Pre-, per- and postoperative data were analyzed. IC were defined as pathologies or lesions directly associated with LT and attributable to the surgical procedure. 16/153 (11%) patients developed IC: 10/16 mechanical obstructions, 4/16 intestinal perforations and 2/16 sub-mesocolic abscesses. IC patients had a significantly lower Body Mass Index (BMI) (15.5 vs. 16.4, p = 0.019). Children with IC had significantly higher incidence of previous Kasai hepatoportoenterostomy associated with Ladd procedure (13% vs. 2%, p = 0.055), a history of intraoperative iatrogenic intestinal perforation(s) (31% vs. 5%, p = 0.003) and prolonged LT surgery duration (536 vs. 415 min, p = 0.007). Significantly more children with IC had received basiliximab (69% vs. 40%, p = 0.048). Patients with IC exhibited a higher incidence of post-LT sub-occlusions (p < 0.001) and an increased requirement for post-LT parenteral nutrition (p = 0.027). Additionally, IC patients underwent significantly more reoperations (p < 0.001). One in 10 children post-LT experiences IC, which are associated with significant morbidity. Pre-LT nutritional status appears as an associated factor with IC, along with the necessity for adhesiolysis during LT, often leading to prolonged operative time. These associated factors should alert medical teams to promote early IC diagnosis in patients after LT.

Sex-dependent shifts in body size and condition along replicated elevational gradients in a montane colonising ectotherm, the common wall lizard (Podarcis muralis).

In ectothermic animals, elevational gradients, such as mountainous environments, are often associated with shifts in body size, although patterns differ across taxa and contexts. Mountain landscapes are characterised by relatively rapid shifts in biotic and abiotic conditions along an elevational gradient, commonly referred to as elevational zonation. Such zonation can reduce the geographic scale at which organisms experience the effects of climate change. The upslope range shifts will expose organisms at the colonization front to sub-optimal conditions. We can expect these challenging conditions to influence many life-history traits including growth rates and reproductive output. We tested the hypothesis that body size varies across elevational gradients in a contemporary montane colonizer, the common wall lizard (Podarcis muralis). Further, we assessed active body temperatures and available environmental temperatures in an attempt to discern a potential abiotic factor that might drive such a pattern. We quantified body size in lizards along four replicate transects ranging from 400 to 2400m above sea level in the Pyrenees. Male body size decreased with increasing elevation. While female body size was invariant, females at higher elevation exhibited lower body condition. These results suggest that the effects of abiotic limitations or selective pressures experienced at the high-elevation colonisation front are sex-specific. Furthermore, lizards from both sexes were able to maintain similar field active body temperatures across elevation, despite reduced ambient temperature. If available temperatures limit activity periods or necessitate higher thermoregulatory investment, as suggested by our results, then further warming may benefit lizards and favour further upslope migration.

Association Between Finger Plethysmographic Features and Impedance-Based Thoracic Fluid Content Measurement in a Lower Body Negative Pressure Model of Hemorrhagic Shock.

Timely identification of the need for lifesaving intervention in battlefield conditions may be improved through automated monitoring of the injured warfighter. Technologies that combine maximal noninvasive insight with minimal equipment footprint give the greatest opportunity for deployment at scale with inexperienced providers in forward areas. Finger photoplethysmography (PPG) signatures are associated with impending hemorrhagic shock but may be insufficient alone. Transthoracic impedance (TTI) monitoring is a complementary modality to PPG and able to identify volume loss and estimate functional cardiovascular parameters. We sought to understand how PPG features correlate with volume loss estimation from TTI during lower body negative pressure (LBNP) challenge. We hypothesized that features of the PPG waveform would correlate with thoracic fluid content (TFC) as measured by TTI. We obtained physiologic monitoring data from healthy adult subjects in LBNP hemorrhagic shock models after local Institutional Review Board and DoD Human Research Protection Office approval. Subjects were excluded for pregnancy, age >45 years, and conditions prohibitive of LBNP exposure. Subjects were instrumented with noninvasive sensors, including a finger PPG sensor and a TTI monitor. Subjects underwent a stepwise LBNP exposure program of -10 mmHg every 10 minutes and notified laboratory staff at first sign of near syncope, terminating the sequential program. TTI data were continuously streamed to a custom program written in MATLAB and time synchronized. To calculate PPG measures, we downsampled data to 250 Hz, screened, and parsed each beat. We featurized each beat to include a systolic, diastolic, and dicrotic notch peak, beat length and area under the curve (AUC), peak-to-peak systolic/diastolic interval, and leading/trailing slopes, all normalized to instantaneous heart rate. Thoracic fluid content was normalized to subjects' pre-LBNP baselines. We summarized all PPG features and the TFC using means (SD) generated as a subject average for each step. We used generalized estimating equation models to examine the relationship between TFC and PPG features while controlling for LBNP stage and subject. Thirty-two subjects were enrolled; 4 participants were excluded because of sensor malfunction. Twenty-eight subjects had a mean (SD) age of 25.11 (6.66) years. A total of 35.7% of subjects were female. Photoplethysmography analysis demonstrated a decreased systolic-diastolic peak interval, diastolic peak height, and beat AUC with decreased LBNP pressure. End-stage baseline normalized TFC showed an average decrease of 14.68% (±4.98%) (range: 7.54% to 27.69%). The strongest average correlations between stage TFC and PPG occurred in beat length (0.68) and normalized AUC (0.69). In generalized estimating equation models incorporating all stages, beat length, normalized AUC, and the systolic-diastolic interval were all significantly associated with time as a function of LBNP level (P < .001). Thoracic fluid content began decreasing at 12.8 (4.7) minutes, the normalized AUC decreased at 20.7 (7.2) minutes, the beat length decreased at 20.9 (7.0) minutes, and the systolic-diastolic time interval decreased at 30.6 (16.7) minutes. While both PPG features and impedance-based TFC trend congruently in the perishock state following LBNP exposure, peripheral pulse wave signals lag redistribution of thoracic fluid volume. Photoplethysmography features of beat length and normalized AUC may serve as a surrogate for TFC when direct thoracic sensing is not available.

Diversity of the immune microenvironment and response to checkpoint inhibitor immunotherapy in mucosal melanoma.

Mucosal melanoma (MucM) is a rare cancer with a poor prognosis and low response rate to immune checkpoint inhibition (ICI) compared with cutaneous melanoma (CM). To explore the immune microenvironment and potential drivers of MucM's relative resistance to ICI drugs, we characterized 101 MucM tumors (43 head and neck [H&N], 31 female urogenital, 13 male urogenital, 11 anorectal, and 3 other gastrointestinal) using bulk RNA-Seq and immunofluorescence. RNA-Seq data show that MucM has a significantly lower IFN-γ signature levels than CM. MucM tumors of the H&N region show a significantly greater abundance of CD8+ T cells, cytotoxic cells, and higher IFN-γ signature levels than MucM from lower body sites. In the subcohort of 35 patients with MucM treated with ICI, hierarchical clustering reveals clusters with a high and low degree of immune infiltration, with a differential ICI response rate. Immune-associated gene sets were enriched in responders. Signatures associated with cancer-associated fibroblasts, macrophages, and TGF-β signaling may be higher in immune-infiltrated, but ICI-unresponsive tumors, suggesting a role for these resistance mechanisms in MucM. Our data show organ region-specific differences in immune infiltration and IFN-γ signature levels in MucM, with H&N MucM displaying the most favorable immune profile. Our study might offer a starting point for developing more personalized treatment strategies for this disease.