Low Rate Research Articles

Provision of Home & Community Based Services to Veterans by Race, Rurality, and Neighborhood Deprivation Index.

Home and community-based services (HCBS) enable frail patients to remain at home. We examined whether there were neighborhood-deprivation, racial, or rural disparities in HCBS utilization provided to Veterans by the Department of Veterans Affairs (VA) or Medicare by comparing the adjusted utilization rate of a historically disadvantaged group with the predicted utilization rate had it been treated as the historically dominant group. Among the 2.7 million VA patients over 66 years old in 2019, 11.0% were Black, 39.2% lived in rural settings, 15.3%/29.2%/30.9%/24.7% lived in least/mild/moderate/most-deprived neighborhoods. On average, 11.2% received VA or Medicare HCBS. Veterans residing in more deprived neighborhoods had 0.11-0.95% higher adjusted probability of receiving HCBS than expected had they resided in the least deprived neighborhoods. Veterans residing in rural areas had 0-0.7% lower HCBS rates than expected had they been treated like urban Veterans. Black Veterans were 0.8-1.2% more likely to receive HCBS than expected had they been treated like White Veterans. Findings indicate that VA resources were equitably employed, aligning with probable HCBS needs, suggesting that VA's substantial and long-standing investment in HCBS for care of frail Veterans could serve as a model for other payers and providers in the U.S.

Bayesian and non‐Bayesian inference of the process capacity index Spk′$S^{\prime }_{pk}$ under progressive type‐II right censored scheme

AbstractProcess capability indices (PCIs), are widely used to gauge how well a process performs within its requirements. While greater PCIs are indicative of improved process “quality,” they do not necessarily translate into lower rejection rates. Therefore, using a loss‐based PCI to gauge process capability makes more sense. In this paper, the PCI has been considered for normal random variable. The article attempts to study the classical and the Bayesian estimation of for type‐II progressive right censored sample under symmetric as well as asymmetric loss functions, namely squared error loss function, and LINEX loss function, respectively. The Markov chain Monte Carlo simulation technique has been efficiently used here to have the approximate solution for . Through an extensive Monte Carlo simulation study along with two real life examples related to electronic industry, we compare the performances of the classical and the Bayes estimates based on symmetric and asymmetric loss functions and compared among the asymptotic confidence interval and highest posterior density credible intervals, in terms of average width and corresponding coverage probabilities of , respectively.

In-situ Rotary Cutting System for Estimating the Mechanical Parameters of Rock Masses

A rock mass in-situ rotary cutting test system (RMIRCS) was developed to estimate the mechanical properties (i.e. compressive strength and elastic modulus) of rock masses. The pressure-on-bit and torque-on-bit of the RMIRCS were investigated in detail over a wide range of revolution speed and penetration rate. A simple experimental model is proposed to describe the qualitative relationships between rotary cutting test data and mechanical parameters. The existence of a linear constraint between pressure-on-bit and torque-on-bit and the depth of rotary cutting exhibits good agreement with the proposed model. The mechanical properties obtained from the quasi-static compression tests were in agreement with those of the RMIRCS at lower revolutions rate of 300 rpm and 350 rpm, which suggests that the developed RMIRCS is valid. Furthermore, the experimental test results on rock mass demonstrated that the mechanical properties of rock masses are revolutions speed-dependent and drilling rate-dependent.

Evidence for SARS-CoV-2 infected Golden Syrian hamsters (Mesocricetus auratus) reducing daily energy expenditure and body core temperature

Golden Syrian hamsters (Mesocricetus auratus) are a well-established animal model for human infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to their susceptibility to SARS-CoV-2 infection, robust virus replication and pathological manifestations similar to human COVID-19 pneumonia. To investigate the physiological changes upon infection in this animal model, we explored the alterations in daily energy expenditure (DEE), water turnover, body mass, body temperature, and locomotor activity in non-infected and SARS-CoV-2 infected Golden Syrian hamsters for four days post SARS-CoV-2. DEE was measured using the doubly labelled water method, which allows for the accurate estimation of carbon dioxide production and, consequently, energy expenditure in animals. Additionally, we investigated total water intake (TWI), which comprises drinking water, preformed water in food, and metabolic water. Using intraperitoneally implanted data loggers, we also monitored body core temperature and locomotor activity in some of the animals. Here we provide evidence for infected hamsters exhibiting significantly lower DEE and TWI compared to non-infected animals. We also observed an increase in body weight in the non-infected animals, while infected animals experienced weight loss. Further, infected animals showed a significantly decreased body temperature, indicating a generally lowered metabolic rate.

Comparative study between the halfway technique and the standard technique for exchange of tunneled hemodialysis catheter.

When indicated, tunneled hemodialysis catheters are usually inserted using the standard technique but, this technique has its complications. The halfway method is performed by exchange of an already-inserted dialysis catheter (tunneled or non-tunneled) to a tunneled one over a guidewire mounted via the old catheter. In this study, we aimed at evaluating the feasibility, safety, and durability of halfway method in comparison to the standard technique (de novo puncture). This prospective study was conducted during the period from May 2020 till May 2022 and included 87 patients with end-stage renal disease (ESRD) on regular hemodialysis (HD) in need for insertion new tunneled dialysis catheters instead of temporary or malfunctioning tunneled ones. According to the technique of catheter insertion, these patients were divided into two groups: group A (the halfway technique: catheters were exchanged over guidewires under fluoroscopic control; 48 patients) and group B (the standard technique: via de novo ultrasound-guided vein puncture; 39 patients). Instant, delayed complications and 12-months patency rates were reported and analyzed. The frequency of peri-operative bleeding complications was better in the halfway group with comparable infection rate and late catheter dysfunction results between the two groups. One year patency rates were 87.5% in halfway technique group compared to 79.5% in standard technique group, yet without statistical significance. However, there was a statistically significant shorter operative time in halfway group (15.54 ± 2.6 min vs 26.97 ± 5.6 min, p < 0.001). The halfway technique may be recommended over the standard technique of tunneled catheter insertion due to shorter operative time, lower rate of hematoma formation, with non-inferior 1-year patency rates and comparable technical success and infection rates. The advantage of access sites preservation for future demand makes this technique of great value to this group of ESRD patients.

The effect of increasing canola oil and soybean oil addition to beef cattle rations based on corn silage and barley grain on the in vitro ruminal gas production and rumen fermentation

AbstractThe purpose of the current experiment was to determine the effects of ruminal fermentation parameters of the additions of canola or soybean oils at different rates (4, 8 and 12%) to beef cattle total mix rations (TMR), based on corn silage and barley grain. The addition of 4% soybean oil to TMR positively affected in vitro gas production, net energy lactation (NEL), metabolic energy (ME), and organic matter digestion (OMd). The additions of 8% and 12% of soybean oil to TMR linearly decreased ME, NEL and OMd (p &lt; 0.05). The additions of 4, 8 and 12% canola oil to the TMR linearly decreased the in vitro gas production and estimated fermentation values (ME, NEL and OMd) (p &lt; 0.05). All doses of soybean or canola oils in TMR reduced the molarities of total short‐chain fatty acids (tSFCA), acetic (AA), butyric (BA), propionic (PA), valeric (VA), iso‐valeric (IVA) and iso‐butyric acids (IBA) for in vitro fermentation fluid (p &lt; 0.05). There was a negative correlation between the increasing dietary stearic, oleic and linoleic acid and the end‐products of in vitro rumen fermentation. However, increasing dietary α‐linolenic acids had no adverse effect on in vitro ruminal fermentation end‐products. As a result, 4% addition of the soybean oil, which included a higher rate of α‐linolenic acid and saturated fatty acids and a lower rate of oleic, linoleic acids according to those of canola oil, to the TMR positively affected in vitro ruminal fermentation. In addition, the ≥8% addition of canola or soybean oil adversely affected the in vitro fermentation values.

Patterns and trends in melanoma mortality in Spain (1999-2022).

To examine melanoma mortality trends in Spanish Autonomous Communities from 1999 to 2022, focusing on gender and age differences. Data from the National Statistics Institute were used to calculate age-standardized mortality rates (ASMRs). Joinpoint regression identified trend changes. Melanoma mortality varied significantly by region, gender, and age. Eastern Spain had higher male mortality, while western regions had lower rates. Asturias had higher female mortality, with lower rates in Andalusia, Extremadura, and Castilla-La Mancha. Men generally exhibited higher ASMRs than women, with variations across regions. While ASMRs remained stable in most areas, Madrid experienced a notable decline (AAPC: - 1.3%). A national trend reversal occurred in 2014 (AAPC: - 1.3%). For individuals aged 45-74 years, Catalonia saw a significant decrease (AAPC: - 1.1%, p < 0.05), whereas Andalusia experienced an increase (APC: 2.1% since 2007). Nationally, ASMRs for this age group declined (AAPC: - 0.7%). Among those aged 75 years and over, ASMRs varied considerably, with increases observed in Andalusia and Aragon. Nationally, male ASMRs rose (AAPC: 1.6% per year), while female rates were stable. Regional disparities were evident, with higher female mortality in the Balearic Islands and fluctuating rates in the Community of Madrid (an increase followed by a decrease after 2015). The gender gap in mortality varied across regions, with some areas showing a narrowing gap and others widening disparities. Continuous monitoring of melanoma mortality, especially among men and older adults, is crucial. Public health efforts should address regional disparities, improve early detection, and enhance treatment access to optimize outcomes nationwide.

8654 Real-World Performance Of The Medtronic Extended Infusion Set In The United States

Abstract Disclosure: T. Kwa: Employee; Self; Medtronic Minimed. G. Zhang: Employee; Self; Medtronic Minimed. J. Kiehl: Employee; Self; Medtronic Minimed. V. Putcha: Employee; Self; Medtronic Minimed. A. Patel: Employee; Self; Medtronic Minimed. S. Chattaraj: Employee; Self; Medtronic Minimed. O. Cohen: Employee; Self; Medtronic Minimed. R.A. Vigersky: Employee; Self; Medtronic Minimed. Real-World Performance of the Medtronic Extended Infusion Set in the United States Objective: The Medtronic extended infusion set (EIS) is the first and only infusion set approved for up to 7-day use and its pivotal trial established clinical safety and efficacy.[1] The purpose of this retrospective analysis was to assess real-world EIS performance and overall glycemic outcomes based on United States (US) data uploaded by MiniMed™ 770G system (MM770G) users at an aggregate level. Methods: Infusion set occlusion alarm events and time in (TIR, 70-180 mg/dL), below (TBR, &amp;lt;70 mg/dL) and above (TAR, &amp;gt;180 mg/dL) range of EIS-MM770G users (N=393) with &amp;gt;30-day device use in the U.S. were analyzed and compared against the data of a cohort of the same median age of 50 years (N=77219) using the MM770G with a standard 2/3-day infusion set (at an aggregate level). Results: EIS users experienced a lower occlusion alarm rate (median 0.011 alerts/patient day) compared to 0.016 alerts/patient day with the standard set (p = 0.005). TIR for EIS users was 69.4%, which was numerically greater than the 69.1% for standard set users (p = 0.258). While TAR was not significantly different (28.9% for EIS and 29.0% for standard set, p = 0.995), TBR was significantly lower (0.5% for EIS and 1.3% for standard set, p = 0.000). The difference in the total daily dose (TDD) of insulin between the two groups (53.0 units for EIS, 49.4 units for standard set) was not statistically significant (p = 0.961). Conclusion: Since the U.S. launch, the EIS has continued to perform similarly to the pivotal trial results and an early real-world analysis of EIS use outside of the US.2 The decreased burden of fewer set changes comes with a lower occlusion alarm rate and does not compromise time spent in target range.

6676 Exposure to Neighborhood Violence Rewires Glucocorticoid Receptor Binding and Drives Proliferation and Invasiveness in Lung Tumor Samples

Abstract Disclosure: H. Heath: None. J. Yoo: None. S. Akter: None. A. Jain: None. V. Sharma: None. H. McGee: None. A. Soliman: None. A. Mohamed: None. A.K. Matthews: None. R. Winn: None. Z. Madak Erdogan: None. S. Kim: None. Background: Despite the lower rates and frequency of smoking, Black men experience a higher incidence of lung cancer compared to white men. This health disparity is even more prevalent in Black men from Chicago, suggesting local neighborhood factors impacting tumorigenesis. Preliminary data indicate that, compared to white men, Black men are more likely to reside in neighborhoods with high levels of violence and have elevated levels of hair cortisol. Objective: To understand the link between lung tumorigenesis and exposure to neighborhood violence, our objective is to investigate the chromatin recruitment of the receptor for cortisol, called the glucocorticoid receptor (GR), and to correlate this recruitment with target gene expression levels. Methods: Utilizing CUT &amp; RUN, we identified the gene binding sites of GR using 15 lung tumor and corresponding healthy tissue samples from lung cancer patients living in Chicago. GR recruitment to chromatin was correlated with the neighborhood homicide rate obtained using patients’ zip codes. Spatial transcriptome profiles for these 15 lung tumor samples were obtained from the Space Ranger pipeline and gene expression hot spots of GR target genes were visualized using Loupe Browser (10x Genomics). Results: GR recruitment to regulatory regions of chromatin increases with greater zip code level violence rates. In patients from high violence neighborhoods, tumor samples had higher magnitude of binding compared to normal neighboring tissue. In tumor samples from patients living in high violence compared to low violence neighborhoods, GR binding is seen in genes that are associated with increased tumor aggressiveness. Hot-spot analysis of these genes found strong co-expression of genes associated with proliferation and invasion in samples from high violence but not low violence neighborhoods. Conclusion: Exposure to neighborhood violence may impact tumor biology via increased GR recruitment to genes associated with proliferation and invasion. Presentation: 6/2/2024

8361 Impact of Social Vulnerability on Glycemic Control in Primary Care Patients with Diabetes

Abstract Disclosure: J.N. Tich: None. S.R. MacLeod: None. V. Zhang: None. T. Love: None. R.J. Fortuna: None. Introduction: According to the CDC, 29.7 million Americans are diagnosed with diabetes (DM), contributing to morbidity, mortality and strain on the healthcare system. The impact of social determinants of health (SDOH) and social vulnerability (SV), as measured by the social vulnerability index (SVI), on DM care and control is evident. In populations with lower educational attainment levels, lower income and higher rates of poverty, prevalence of DM and rates of complications are higher. However, less is understood about how the intersectionality between SDOH/SV and race impacts diabetes control. Aims: We sought to examine the impact of SV and race on DM control in primary care patients in Upstate NY. Methods: We examined 26,010 patients with DM in Upstate NY. We defined DM control based on national HEDIS standards. SVI were calculated for each patient based on census track data. The SVI is calculated based on 16 variables in four themes: socioeconomic status, household characteristics, racial/ethnic minority status, and housing/transportation. SVI scores range from 0 (lowest vulnerability) to 1 (highest vulnerability). In addition to calculated SVI scores, we examined patient-reported SDOH, including food insecurity, housing insecurity, transportation, and social isolation. Race and ethnicity related parameters were self-reported. We report preliminary descriptive data. Results: Overall, 73.6% of patients were controlled with a HgA1c &amp;lt;8% based on the HEDIS definition. Control rates varied based on race (white 75.9% Black 66.1%; Asian 73.7%; other race 66.6%), calculated SVI, and patient reported SDOH. Within each racial category, diabetes control rates worsened with increasing SVI. Patients who expressed food insecurity had lower rates of DM control than those who had no food insecurity (68.8% vs 79.7%). Similarly, patients with housing insecurity had lower control rates (67.5%) compared to those who had greater housing security (80.0%). Patients with unmet transportation needs had lower rates of diabetic control (67.4%) compared to those with stable transportation (80.6%). Additional statistical tests and multivariate regression models are pending. Conclusions: Across a large sample of patients with diabetes, increasing SV was associated with worsening glycemic control across all racial groups studied. In preliminary analyses, both race and SVI appear to be independently associated with DM control. SVI did not fully mitigate the influence of rate on DM control. Within same SVI category, non-white participants appeared to have a more negative impact on DM control compared to white participants. While SDOH are well known influences, these findings specifically demonstrate the link between SV and glycemic control, highlighting the fact that at the same SVI quartile, non-white participants may be more vulnerable to dysglycemia. Presentation: 6/2/2024 6/2/2024

8347 EARLY CHILDHOOD GROWTH FOLLOWING PRE-PREGNANCY METABOLIC AND BARIATRIC SURGERY

Abstract Disclosure: M.J. Hilaire: None. A. Babcock: None. G. White: None. C. Masson: None. C.A. LeDuc: None. V. Thaker: None. Background and Aims: Metabolic and bariatric surgery (MBS) is known to improve metabolic profile. There is conflicting data on the effects of pre-pregnancy MBS on the offspring growth. We aimed to assess offspring early life growth trajectory born to mothers with MBS before conception compared to those who did not. Methods: Records from pregnancies of women who gave birth at Columbia University Irving Medical Center between January 2020 and March 2023 were collected from the clinical databases and electronic health records. The gestational conditions and offspring early life weight, length and BMI trajectory were compared for: pre-pregnancy BMI &amp;lt; 25, BMI 25-35, BMI &amp;gt; 35 and prior MBS. Mixed effect models were used to compare the longitudinal anthropometric trajectories. Sensitivity analyses was done with propensity matching of the pre-pregnancy MBS group by maternal age, parity, pre-pregnancy BMI and race/ethnicity. Results: Of the 22,111 deliveries with data (51% Hispanic/Latino), 455 (76% Hispanic/Latino) had pre-pregnancy MBS- predominantly sleeve gastrectomy (SG, 57%) or Roux-en-Y Gastric Bypass (RYGB, 41%). Antepartum BMI was 32.5 kg/m2 (SD 6.3) for those with pre-pregnancy MBS with 89.8% pregnancies occurring 1-10 years after surgery. There was a higher proportion of multiparous individuals (42% vs 19-31%) in the MBS group. Pre-pregnancy MBS was associated with lower gestational weight-gain, diabetes, and hypertension compared to those with BMI &amp;gt; 35. For offspring, there was no difference in the birth weight, proportion of SGA was higher (6.6% vs 2.5-2.7%, p &amp;lt; 0.01), LGA was lower (2.0% vs 3.6-5.6%, p &amp;lt; 0.01) and NICU admission rate was comparable (20% vs 15-25%). Offspring anthropometric data till age 36 months was available for approximately 50% of the births. Comparison of longitudinal weight trajectories showed no difference in the offspring between those born after RYGB and BMI &amp;lt; 25 kg/m2 (p =0.8), while those born after SG had persistent rise (p =0.04), adjusting for maternal age, parity, time since surgery and race/ethnicity. In the SG group, boys had higher weight trajectories compared to girls. (p &amp;lt; 0.001). The length trajectories and head circumference at birth were similar across groups. Conclusions: Gestational conditions improved with pre-pregnancy MBS. Pre-pregnancy RYGB, but not SG, was followed by favorable offspring weight trajectory that may have a role in long-term metabolic programming. This study is limited by lack of availability of information on pregnancy glycemic profiles, eating behaviors, dietary patterns, and other social determinants of health. Presentation: 6/3/2024

7248 Spliceosome component TCERG1 regulates the aggressiveness of somatotroph adenoma

Abstract Disclosure: K. Kim: None. The role of the spliceosome in the development of pituitary tumors is not well understood, despite preliminary studies indicating abnormal expression of oncogenic splicing variants in these neuroendocrine tumors. We aimed to identify differentially expressed spliceosome components in growth hormone (GH)-secreting pituitary tumors and investigate their roles in pathogenesis.We performed transcriptome analysis of 20 somatotroph adenomas and 6 normal pituitary tissues to select dysregulated spliceosome components. Clinical characteristics were analyzed based on gene expression in 64 patients with acromegaly. GH secreting pituitary adenomas were confirmed by 75 g oral glucose tolerance and immunohistochemical staining. Proliferation, invasion, and hormonal activity of GH secreting pituitary adenoma cells were investigated after modulating gene expression.TCERG1 expression was significantly higher in somatotroph adenomas than in normal cells (log2 fold change 0.59, adjusted P=0.0002*). Genotype-phenotype analysis revealed that patients with higher TCERG1 expression had lower surgical remission rates than those with lower expression (63.64% vs. 95.45%, P=0.009*). TCERG1 expression was significantly higher in groups with cavernous sinus (CS) invasion or Ki67 index over 1.5 (2.06 vs. 1.65, P=0.011*; 2.02 vs. 1.66, P=0.043*). TCERG1 overexpression led to a 16.91% increase in proliferation after 72 h (P&amp;lt;0.001*) and a 249.47% increase in invasion after 48 h in GH3 cells (P=0.026*). Conversely, TCERG1 silencing significantly decreased cell proliferation (10.15% at 72 h, P&amp;lt;0.001*) and invasion (96.87% at 48 h, P=0.029*). Vimentin was increased, but E-cadherin was decreased in both TCERG1 overexpressed GH3 cells and somatotroph adenomas. And TCERG1 silence reversed the expression of the genes (CDH2, SNAI1, ZEB2, and VIM) in GH3 cells. Additionally, GH secretion increased when TCERG1 was overexpressed in GH3 cells. Spliceosome machinery provide novel insights into the pathogenesis of GH-secreting pituitary tumor and highlight the potential role of TCERG1 as a therapeutic target. Presentation: 6/2/2024

ABCG Transporters in the Adaptation of Rice to Salt Stresses

The ATP-binding cassette (ABC) proteins are a diverse family of transmembrane transporter proteins widely identified in various organisms. The ABCG transporters belong to the G subfamily of the ABC transporter family. Rarely research on ABCG transporters involved in salt tolerance of rice was found. In this study, the evolutionary relationships, conserved motifs, intra- and inter-species homologous genes, and cis-acting elements of ABCG subfamily members were analyzed, and the expression changes of these genes under salt stress at 0 h, 3 h, and 24 h were detected. Based on these results, the candidate gene OsABCG7, which is induced by salt stress, was selected for further studies. Yeast experiments confirmed that the OsABCG7 gene might be involved in the regulation of salt tolerance. The abcg7 mutant showed a higher degree of leaf wilting and a lower survival rate, exhibiting a salt-sensitive phenotype. Systematic analysis of this family in rice helps design effective functional analysis strategies and provides data support for understanding the role of ABCG transporters under salt stress.

Cats and dogs as hosts of Blastocystis – what is the evidence?

Blastocystis is one of the most common intestinal parasites observed in human and non-human hosts. Recent meta-analyses have indicated a potential role for pets such as dogs and cats as reservoir hosts of Blastocystis, but the data underpinning this hypothesis are of mixed quality. Reviewing data for 45,894 samples tested for Blastocystis by DNA-based methods and 11,908 subtype observations, a model was developed for calculating indices that could be used for evaluating individual species as natural hosts of Blastocystis, based on weighted products of positivity rates and subtype distributions. Data from cats and dogs were analysed, using other well-sampled hosts (pig, cattle, sheep, goat, and human) as references. Data from cats and dogs meeting the inclusion criteria were entered into the model. The overall positivity rates for pigs, cattle, sheep, goats, humans, dogs, and cats were 40 %, 40 %, 35 %, 28 %, 25 %, 6 %, and 5 %, respectively, with statistically significant lower positivity rates in cats and dogs (p < 0.0001). Indices indicating Blastocystis specificity to host ranged between 0.16 (humans) and 0.49 (cattle) for the reference hosts, whereas indices for cats and dogs were only 0.01 and 0.02, respectively. Finally, indices for ST specificity to host were higher for reference hosts (range, 0.66-0.93) than for cats (0.62) and dogs (0.56). Taken together, the analyses indicate that cats and dogs are not natural or reservoir hosts of Blastocystis and that the sporadic subtype pattern observed in these hosts might indicate exposure to Blastocystis through contaminated water/feed, including Blastocystis colonizing prey animals.

The clinical application of metagenomic next-generation sequencing in immunocompromised patients with severe respiratory infections in the ICU.

Early targeted antibiotic therapy is crucial for improving the prognosis of immunocompromised patients with severe respiratory infections (SRIs) in the intensive care unit (ICU). Metagenomic next-generation sequencing (mNGS) has shown significant value in pathogen detection, but research on lower respiratory tract microorganisms remains limited. This study enrolled 234 patients with SRIs in the ICU, and individuals were categorized into immunocompromised and immunocompetent groups. We compared the diagnostic performance of mNGS using bronchoalveolar lavage fluid (BALF) with conventional microbiological tests (CMTs) and analyzed the value of mNGS in immunocompromised patients with SRIs in the ICU. Among all patients, the pathogenic microorganism detection rate of mNGS was higher than that of CMTs (94.02% vs 66.67%, P < 0.05), both in the immunocompromised group (95.0% vs 58.75%, P < 0.05) and the immunocompetent group (93.51% vs 71.43%, P < 0.05). mNGS detected more pathogens than CMTs did (167 vs 51), identifying 116 organisms that were missed by CMTs. The proportion of antibiotic regimen adjustments based on mNGS results was significantly higher compared to CMTs in both the immunocompromised (70.00% vs 17.50%, P < 0.05) and immunocompetent groups (48.70% vs 15.58%, P < 0.05). In the immunocompromised group, patients who had their antibiotic treatment adjusted on mNGS results had improved prognosis, with significantly lower ICU mortality (8.93% vs 50%, P < 0.05) and 28-day mortality rates (30.36% vs 68.75%, P < 0.05) than CMTs. In the immunocompetent group, no statistically significant differences were observed in ICU mortality or 28-day mortality (20.00% vs 33.33%, P > 0.05; 42.67% vs 45.83%, P > 0.05). mNGS shows significant value in detecting pathogens in immunocompromised patients with SRIs in ICU. For immunocompromised patients who respond poorly to empirical treatment, mNGS can provide an etiological basis, helping adjust antibiotic regimens more precisely and thereby improving patient prognosis.

6376 Wnt/beta-catenin Pathway is Associated with Cell Proliferation in Growth Hormone-producing Pituitary Tumors

Abstract Disclosure: S. Kuwabara: None. H. Kameda: None. H. Nomoto: None. K. Cho: None. A. Nakamura: None. Y. Ishi: None. H. Motegi: None. M. Fujimura: None. T. Atsumi: None. Objective: It has been well recognized that the Wnt/β-catenin pathway regulates cell proliferation, and that translocation of β-catenin from the cytoplasm to the nucleus promotes cell proliferation. There have been, however, limited reports on the Wnt/β-catenin pathway in growth hormone-producing pituitary tumors (GHomas), and we aimed to investigate the impact of the Wnt/β-catenin pathway on cell proliferation in GHomas. Methods: We performed three types of experiments with patient pathological specimens, disease model cell lines, and primary culture of GHoma cells. 1.The intracellular localization of β-catenin was evaluated using immunofluorescence staining of pathological specimens from GHoma patients and subsequently its association with clinical data was analyzed. 2.The Wnt/β-catenin inhibitor iCRT14 was administered to rat GHoma cells GH1, using the WST-1 assay to measure cell viability and real-time PCR to assess GH and cell cycle genes expression. 3. The Wnt/β-catenin inhibitor iCRT14 was added to cultured cells obtained from GHoma patients to evaluate cell viability and gene expression. Results: 1. Samples from 26 cases (42%) exhibited strong dot-like expression of β-catenin in the nucleus (dot pattern (DP) group), and samples from 36 cases (58%) showed β-catenin expression in the cytoplasm or cell membrane (non-DP group). Tumors in the DP group had a larger size than non-DP group (diameters 18.3±9.2 vs. 13.4±7.4 mm, p&amp;lt;0.05), and the postoperative remission rate was lower (23 vs. 50%, p&amp;lt;0.05). 2. Viability evaluation using WST-1 assay showed a maximum decrease of 25%. Gene expression showed concentration-dependent reduction in GH gene expression by up to 40% (p&amp;lt;0.05) and cyclin D1 gene up to 50% (p&amp;lt;0.05) following iCRT14 administration. 3. Among 6 cases, 3 showed a tendency toward cell growth inhibition, and 4 showed a tendency toward decreased cyclin D1 gene expression. Conclusion: It is suggested that the Wnt/β-catenin pathway is activated in the DP group because of the nucleus accumulation of β-catenin, and given the larger tumor size and lower postoperative remission rate in DP group, the Wnt/β-catenin pathway may stimulate cell proliferation in GHomas. In addition, cyclin D1-mediated effects were considered. Wnt/β-catenin pathway could play a role in GHomas growth, therefore this pathway would be a potential therapeutic target for treating affected patients. Presentation: 6/3/2024

6805 Impact of Feeding Types on Catch-Up Growth in Early Infancy Among Small-for-Gestational-Age Infants: A Nationwide Korean Study

Abstract Disclosure: J. Choi: None. Y. Choe: None. S. Yang: None. Purpose: The study aimed to compare growth patterns and catch-up growth (CUG) in small-for-gestational-age (SGA) infants up to age four, based on feeding type during the first 4-6 months, using nationwide data. Methods: A total of 42,295 children born SGA (21,917 boys, 52.%) who underwent the first (4-6 month), 2nd (9-12 month), 3rd (18-24 month) and 5th (42-48 month) National Health Screening Program for Infants and Children (NHSPIC) under the National Health Insurance Service from 2007 to 2014 were included. The study population was categorized into two groups based on the primary milk feeding type recorded in the self-reported questionnaire during the first round of NHSPIC: the ”Breastfed”group, and the "Formula-fed" group. Catch-up growth (CUG) was defined as a Height Standard Deviation Score (Ht SDS) of 3rd percentile or above at the 5th NHSPIC visits. We used propensity scores to 1:1 match breastfed and formula-fed group based on sex, birth weight, cesarean section, socioeconomic status, residance. Multivariate logistic regression analysis was performed to evaluate the effect of milk feeding type on CUG at 4 years of age. Results: 49.1% of infants (n = 20,774) were breastfed and 50.9% (n = 21,521) were formula-fed. The median birth weight was 2.7 kg (interquartile range: 2.5-2.9 kg), and 98.7% of the children (n = 41,752) achieved CUG by the 5th NHSPIC round. Following propensity score matching, both groups included 19,308 infants. At four years of age, the breastfed group showed a lower likelihood of achieving CUG compared to the formula-fed group (aOR 0.794, 95% CI 0.665-0.948). During the 1st NHSPIC round, the breastfed group had a significantly lower weight Z-score (mean: -0.05, range: -0.64 to 0.41) than the formula-fed group (mean: 0.14, range: -0.42 to 0.78, p &amp;lt; 0.001). This trend was more pronounced from the 1st to 2nd round, with greater decreases in both weight and height Z-scores for the breastfed group (weight difference: -0.36, range: -0.74 to 0.02; height difference: -0.21, range: -0.62 to 0.20) compared to the formula-fed group (weight difference: -0.17, range: -0.53 to 0.20; height difference: -0.13, range: -0.53 to 0.28, p &amp;lt; 0.001). However, from the 2nd round, the breastfed group demonstrated faster gains in both weight and height (p &amp;lt; 0.001). Conclusion : In a study of Korean SGA infants, those breastfed during the first 4-6 months post-birth had lower CUG rates at four years compared to formula-fed infants. The breastfed group exhibited less weight and height gain, especially between the 1st and 2nd NHSPIC rounds, aligning with the initial phase of solid food introduction. These findings may suggest the need for enhanced nutritional supplementation for breastfed SGA infants. Further research is necessary to explore other factors that may impact growth during this critical developmental period. Presentation: 6/3/2024

Gambaran Kebahagiaan Lanjut Usia yang Tinggal di Panti Tresna Werdha Sabai Nan Aluih Sicincin

This study focuses on the happiness of the elderly living in Panti Tresna Werdha Sabai Nan Aluih Sicincin, Padang Pariaman. An important part to help the elderly overcome the problems they face. This study aims to describe how happy the elderly are in the shelter, where happy elderly tend to be more open to new activities and have lower mortality and death rates. The method used is descriptive qualitative, with the main informant being the shelter officer and the elderly as supporting informants, and the study was conducted from January to June 2022. The results of the study show that the happiness of the elderly is reflected in their daily activities, such as skills guidance, health, religion, arts, social, to mutual cooperation and gymnastics. The elderly also fill their free time by reading the Qur'an and cleaning the environment. They feel happy because they are treated well, do not feel lonely, and consider the residents and staff of the shelter as family. Most of the elderly are comfortable living in the shelter and do not want to go home, even want to be buried there, showing that their happiness has been fulfilled at Panti Tresna Werdha Sabai Nan Aluih Sicincin.

7081 A Spotlight on Marine Lenhart Syndrome

Abstract Disclosure: R. Alshantti: None. A.M. San Hernandez: None. J. Wu: None. C.P. Barsano: None. M.F. Siddiqui: None. Introduction: Marine-Lenhart Syndrome is a rare condition with a prevalence of 0.8-4.1% of cases with Graves’ disease. It is defined by the coexistence of Graves’ disease and autonomously functioning thyroid nodule(s). It is an under-recognized cause of hyperthyroidism. A limited number of cases have been reported in the literature. We report an interesting case of Marine-Lenhart Syndrome characterized by the presence of elevated thyroid stimulating immunoglobulins (TSI) and an autonomous right thyroid nodule. Case Description: A 37-year-old man with a history of hyperthyroidism from Graves’ disease and a right thyroid nodule was referred to endocrinology clinic. He was diagnosed with hyperthyroidism in 2015 at an outside facility. He had elevated thyroid stimulating immunoglobulins (TSI) and a 2.9 cm right thyroid nodule which was biopsied and had benign cytopathology. Hyperthyroidism was treated with methimazole (MMI) but without subsequent remission of Graves’ disease. He ran out of MMI and re-presented with symptomatic hyperthyroidism with fatigue, tremors, and hyperdefecation. There was no ocular involvement or thyroid compressive symptoms. Biochemical work up was consistent with uncontrolled hyperthyroidism (suppressed TSH 0.01 uIU/mL [Ref range: 0.45-5.33], and elevated FT4 2.58 ng/dl [Ref range: 0.70-2.20], elevated free T3 8.7 pg/ml [Ref range: 2.5-3.9], and mildly elevated TSI 0.72 IU/L [Ref range: 0.54 or less]. MMI was therefore reinitiated. Thyroid Uptake scan demonstrated an increased focal 24-hour Iodine-131 uptake of 57% in the right lobe with suppression of the left lobe. Thyroid ultrasound support the finding of large right thyroid nodule (2.3 x 2.4 x 3.9 cm) with diffuse heterogeneous thyroid. The presence of TSI, lack of control of hyperthyroidism for more than 2 years of treatment, and presence of a functioning thyroid nodule raise the suspicion of Marine-Lenhart Syndrome. Indeed, the findings of an autonomously functioning right thyroid nodule with concomitant Graves’ disease establish the diagnosis of Marine-Lenhart Syndrome. The option of RAI ablation vs total thyroidectomy was discussed with the patient. The patient opted for thyroidectomy. Conclusion: Based on studies, approximately 35% of patients with Graves’ disease have thyroid nodule(s) and only 2.7% are functioning adenomas. The combination of positive TSI or TrAb and functioning thyroid nodules has been termed Marine-Lenhart syndrome. The syndrome was named after David Marine and Carl Lenhart who initially described it in 1911. Unlike Graves’ disease, patients with Marine-Lenhart Syndrome have a lower remission rate with thioamides, require definitive treatment with RAI ablation at a high dose or total thyroidectomy, and may easily be misdiagnosed by many endocrinologists. Presentation: 6/2/2024

8152 Benefits of Inpatient Diabetes Management by a Specialized Diabetes Team

Abstract Disclosure: M. Bojarian: None. A. Ohri: None. C. Buettner: None. Background: Inpatient dysglycemia is associated with poor clinical outcomes such as prolonged length of stay (LOS), increased risk of ICU admission, and in-hospital mortality. The benefits of managing diabetic patients in the hospital with a dedicated diabetes team, as opposed to standard care on episodes of hypoglycemia or hyperglycemia, reduction in LOS, and 30-day readmission rates, remain uncertain. A potential confounder is the likelihood that patients receiving a diabetes consult may be sicker than those without a consult. Given the growing evidence supporting the role of specialized diabetes teams in improving care for diabetes patients, we sought to examine these benefits at our hospital. We plan to address confounding variables through propensity score matching. Objective: To assess whether diabetes patients experience reduced LOS, hypoglycemia, hyperglycemia, and 30-day readmission rates when managed by a specialized diabetes team compared to inpatients managed by a hospitalist team. Material and Methods: This quality improvement study compared LOS, hypoglycemia (glucose &amp;lt;70 mg/dL), hyperglycemia (glucose &amp;gt;180 mg/dL), and 30-day readmission rates in diabetes patients managed by a specialized diabetes team versus a hospitalist team at our hospital between June 2022 and December 2022. Results: 5676 patients with diabetes were admitted between June and December 2022 at our hospital, and a specialized diabetes team managed 417 patients (7.34%). In a preliminary analysis in which no propensity matching was performed yet, the 30-day readmission rate was significantly lower (87,16.6%) in patients who received a diabetes consult compared to patients who did not receive a diabetes consult (320,17.9%). The rate of hypoglycemia was higher (24.4%) in the specialized diabetes consult group than in the non-diabetes consults group (19.9%). Additionally, LOS was longer in patients with a specialized diabetes consult (7.1 vs. 3.1 days), and hyperglycemia (glucose &amp;gt;180 mg/dL) was more prevalent in the specialized diabetes consult group (78.9%) compared to the non-diabetes consult group (39.2%). Conclusion: In this retrospective analysis, patients managed by a specialized diabetes team showed lower readmission rates despite longer hospitalization and increased dysglycemic episodes. This could be attributed to sicker patients receiving diabetes consults, influencing dysglycemia rates. To account for such confounders, ongoing propensity score matching aims to provide a clearer understanding. Reduced readmission rates suggest improved care transitions, potentially resulting in significant cost savings for the healthcare system. Presentation: 6/1/2024