Post Hoc Research Articles

Children with Cerebral Palsy Rehabilitation In-Session Engagement: Lessons Learnt from a Story Tool Training Program

ABSTRACT Rehabilitation aims to increase individuals’ ability to interact with their environment. Focusing on the paediatric context, rehabilitation is likely to optimise children’s development while improving and maintaining their functioning. However, children with neurodevelopmental disabilities, such as cerebral palsy, often show low engagement in rehabilitation sessions. This study aimed to assess the effectiveness of a narrative-based training program in increasing in-session engagement for children with cerebral palsy undergoing rehabilitation (i.e. targeting affective, behavioural, and cognitive dimensions). The study was conducted in three cerebral palsy rehabilitation centres and followed a one-group double-pre-test, one-post-test design. Fifteen children with cerebral palsy participated in the training program twice a week over nine weeks. The program aimed to promote children’s in-session engagement in rehabilitation through a story tool grounded in a self-regulation theory. Current data revealed the key effects of implementation time in the three dimensions of in-session engagement. Post-hoc tests of within-subjects indicated significant differences between pre-test 1 versus post-test and pre-test 2 versus post-test in the three dimensions of in-session engagement. This narrative-based intervention was a helpful tool promoting in-session affective, behavioural, and cognitive engagement in rehabilitation for this sample of children with cerebral palsy.

The Antifungal Effects of Hypericum perforatum Nanoemulsion against Candida albicans

Background Oral stomatitis is one of the common infections related to dentures (complete or partial), which is seen in the form of diffuse inflammation, mainly with Candida albicans. The aim of the present study was to investigate the antifungal effects of Hypericum perforatum nanoemulsion against Candida albicans. Materials and Methods The microdilution technique has been used in order to determine the antifungal effects of Hypericum perforatum nanoemulsion. The study has involved four groups: Hypericum perforatum oil, Hypericum perforatum nanoemulsion, distilled water as a negative control, and nystatin as a positive control. The first concentration of nanoemulsion in which no clear fungal growth was observed in the culture medium has been considered as the Minimum Inhibitory Concentration (MIC) and the first concentration in which the fungal growth was completely stopped and no fungal growth was observed in the culture medium has been considered as the Minimum Fungicide Concentration (MFC). One-way Analysis of Variance (ANOVA) has been employed to compare the results between the groups. Tukey's post-hoc test has been used to make comparisons between the groups. The significance level has been considered at less than 0.05. Results Both Hypericum perforatum oil and Hypericum perforatum nanoemulsion have been found to exhibit good antifungal activity against Candida albicans. The MIC and the MFC of the nanoemulsion form have been found to be lower than the non-nanoemulsion form (P<0.05). Among the studied groups, the nystatin group had been found to have the best effect (P<0.05). Conclusion Considering the different antifungal mechanisms and also the different resistance mechanisms of nystatin and Hypericum perforatum nanoemulsion, the prepared nanoemulsion can be used to treat and reduce the population of nystatin-resistant Candida albicans strain. However, the efficiency of these materials needs to be confirmed in larger studies on resistant strains.

Effect of replacing Bis-GMA with a biobased trimethacrylate on the physicochemical and mechanical properties of experimental resin composites.

To analyze the incorporation of cardanol trimethacrylate monomer (CTMA), derived from the cashew nut shell liquid, as a substitute for Bis-GMA in acrylic resins formulations and its effect on experimental resin composites' physicochemical and mechanical properties. The intermediary cardanol epoxy was synthesized via cardanol epoxidation, followed by the synthesis of CTMA through methacrylic anhydride solvent-free esterification. Experimental resin composites were formulated with an organic matrix composed of Bis-GMA/TEGDMA (50/50 wt %) (control). CTMA was gradually added to replace different proportions of Bis-GMA: 10 wt % (CTMA-10), 20 wt % (CTMA-20), 40 wt % (CTMA-40), and 50 wt % (CTMA-50). The composites were characterized by degree of conversion, water sorption and solubility, viscosity, thermogravimetric analysis, dynamic mechanical analysis, flexural strength and elastic modulus. Data were analyzed with one-way ANOVA and Tukey's post-hoc test (α = 0.05), except for water sorption data, which were analyzed by Kruskall-Wallis and Dunn's method. CTMA-based and control composites did not show statistically significant differences regarding degree of conversion, flexural strength and elastic modulus. CTMA reduced the viscosity and solubility compared to the Bis-GMA-based composite. The CTMA-40 and CTMA-50 exhibited significantly lower water sorption compared to the control. Also, acceptable thermal stability and viscoelastic properties were obtained for safe use in the oral cavity. Incorporating CTMA into composites resulted in similar chemical and mechanical properties compared to Bis-GMA-based material while reducing viscosity, water sorption and solubility. CTMA could be used as a trimethacrylate monomer replacing Bis-GMA in resin composites, thereby minimizing BPA exposure.

Fixed Rate vs Fixed Injection Duration In Single-Pass Contrast-Enhanced Abdominal Multi-Detector CT: Effects On Vascular Enhancement.

To evaluate the effects on vascular enhancement of either a fixed rate (FR) or a fixed injection duration (FID) in single-pass (SP) contrast-enhanced abdominal multi-detector CT (CE-MDCT). Ninety-nine (54M; 45F; aged 18-86 yrs) patients with nontraumatic acute abdomen underwent a SP CE-MDCT after i.v. injection of 1.7 cc/Kg of a nonionic iodinated contrast-media (370 mgI/ml) performed with either a FR (2 cc/sec; Group A) or a FID (55 sec; Group B). In both groups, patients were further stratified according to total body weight (Kg) as follows: 40-60 (L); 61-80 (M); 81-100 (H). Signal- (SNR) and contrast-to-noise ratios (CNR) were calculated for the liver and for both abdominal aorta (AA) and main portal vein (MPV). Statistical analysis was performed by Student's T or Chi-square test for continuous and categorical data, respectively, whereas post-hoc analysis was performed by the Mann-Whitney test (p < 0.05). There were no significant differences in demographic and physical characteristics between Group A (n = 50; 53 ± 20 yrs; BMI = 23.4 ± 4.4) and B (n = 50; 51 ± 17 yrs; BMI 22.7 ± 4.2). Whereas overlapping findings were observed in the M sub-groups (n = 40), SNR and CNR were significantly higher (p < 0.01) in Group B for both AA and MPV in the high (H) weight sub-groups (n = 20) while not significant differences were observed in the low (L) weight sub-groups (n = 40) despite a significantly lower injection rate (1.6 ± 0.2 cc/sec, p < 0.01) in Group B. A FID results in an overall better vascular enhancement than a FR in SP CE-MDCT.

12542 Results Of The Foresight Trial Support The Efficacy And Safety Of Once-weekly Lonapegsomatropin In Adults With Growth Hormone Deficiency (ghd)

Abstract Disclosure: B.M. Biller: Consulting Fee; Self; HRA Pharmaceuticals, Novartis Pharmaceuticals, Sparrow, Strongbridge Biopharma. Grant Recipient; Self; Strongbridge Biopharma. A. Gilis-Januszewska: Speaker; Self; Ipsen, Novartis Pharmaceuticals, Novo Nordisk, Recordati, Teva Pharmaceutical Industries Ltd.. M. Doknic: None. A.M. Pico: None. M. Fleseriu: Consulting Fee; Self; Ascendis, GlaxoSmithKline, Johnson &amp;Johnson, Karyopharm, Novo Nordisk, Pfizer, Inc., Pharmacosmos. Research Investigator; Self; Ascendis. G. Raverot: None. A.M. Isidori: None. Y. Takahashi: None. J.M. Garcia: None. J.M. Silverstein: None. I. Bancos: None. E. Huang: Employee; Self; Ascendis Pharma, Inc. J. Kang: Employee; Self; Ascendis Pharma, Inc. A.S. Komirenko: Employee; Self; Ascendis Pharma, Inc. L. Domrzalski: Employee; Self; Ascendis Pharma, Inc. A. Shu: Employee; Self; Ascendis Pharma, Inc. K. Yuen: Advisory Board Member; Self; Amryt, Ascendis, Corcept, Crinetics, Novo Nordisk, Recordati, Strongbridge, Xeris. Grant Recipient; Self; Amryt, Ascendis, Corcept, Crinetics. Speaker; Self; Corcept, Novo Nordisk, Recordati. Background: Adult GHD (aGHD) is characterized by metabolic abnormalities due to insufficient growth hormone (GH) production. Lonapegsomatropin was designed to provide sustained release of unmodified somatropin, with the identical amino acid sequence as endogenous GH, and once-weekly injection reduces the burden of daily GH replacement therapy. MethodsForesiGHt was a randomized, parallel-3-arm, placebo(PL)-controlled (double-blind) and active-controlled (open-label) trial designed to establish the efficacy and safety of lonapegsomatropin in aGHD. It evaluated 259 adults with GHD across 21 countries who were GH treatment-naïve or not treated with GH in the prior year, randomized 1:1:1 to receive lonapegsomatropin, once-weekly PL, or daily somatropin (dGH). Fixed dosing was based on age and oral estrogen intake, and designed to be comparable across lonapegsomatropin and dGH arms. Following a 12-week (w) titration period to target maintenance dose, fixed doses were administered for 26w. ResultsBaseline (BL) characteristics were similar between arms. Lonapegsomatropin demonstrated superiority on the primary efficacy endpoint of change from BL in trunk percent fat at Week 38 vs PL (lonapegsomatropin -1.7% vs PL 0.4%, LS mean difference -2.0%, p &amp;lt; 0.0001) and on the key secondary efficacy endpoints of change from BL in total body lean mass (lonapegsomatropin 1.6 kg vs PL -0.1 kg, LS mean difference 1.7 kg, p &amp;lt; 0.0001) and change from BL in trunk fat mass (lonapegsomatropin -0.5 kg vs PL 0.2 kg, LS mean difference -0.7 kg, p = 0.0053). Mean total exposure and maintenance doses were similar for lonapegsomatropin and dGH arms, with larger changes from BL in average IGF-I SDS mean at Week 38 in the lonapegsomatropin arm (1.4) vs dGH arm (0.5). To assess outcomes at comparable weekly IGF-I exposure, a post-hoc analysis was performed in a subset of participants with average IGF-I SDS ≤1.75 SDS at Week 38. Mean IGF-I SDS for these subsets were similar (lonapegsomatropin -0.1, dGH -0.5), and comparable effects in fat and lean tissue compartments were demonstrated (change from BL in trunk percent fat mean -2.4% and -2.6% respectively; change from BL in total body lean mass mean 1.7 kg and 1.4 kg respectively). In the safety population, the incidence of severe AEs was low (lonapegsomatropin, 3.4%; placebo, 1.2%; dGH, 2.3%) and the incidence of treatment-related AEs was similar (lonapegsomatropin 24.7%, dGH 22.1%). Injection site reaction incidence was low and similar for lonapegsomatropin (4.5%), dGH (5.8%) and placebo (4.8%), and A1c levels remained stable in all treatment arms. ConclusionsThe results of the foresiGHt trial indicate that lonapegsomatropin is a safe, efficacious, and tolerable replacement for endogenous GH. Once-weekly dosing may be impactful for adults with GHD who typically manage multiple other medical therapies. Presentation: 6/3/2024

12548 Mammary De Novo Lipogenesis During A Hyperinsulinemic-euglycemic Clamp

Abstract Disclosure: T.M. Fordham: None. M. Ramos-Roman: None. E.J. Parks: Consulting Fee; Self; Simply Good Foods. Stock Owner; Self; Sagimet Biosciences. Other; Self; Past President of The Obesity Society. Introduction: The mammary produces large amounts of medium-chain saturated fatty acids. Long-chain saturated fatty acids found in human milk primarily derive from the maternal diet or from the mobilization of stored triglycerides. Previous studies have established the importance of insulin in stimulating mammary differentiation, milk synthesis, and lipogenesis. However, no studies have assessed how changes in insulin concentrations alter human mammary de novo lipogenesis (DNL) nor what effect gestational diabetes may have on insulin’s relationship to lipogenesis during lactation. Through the utilization of stable isotopes and the hyperinsulinemic-euglycemic clamp technique, we tested the differing concentrations of insulin to stimulate mammary DNL. Methods: Eight women (32±4 yrs) with (GDM, n=4) or without (NGT, n=4) recent gestational diabetes and overweight or obesity (28.2±2.9 kg/m2) were recruited to participate in this study at 6 weeks postpartum. The night before the study, participants orally consumed 3 doses of 70% deuterated water to label newly made fatty acids. Participants arrived in the morning for IV placement and immediately pumped milk contralaterally for 20 minutes. Milk was pumped two hours later, again at the end of step 1 of the clamp (10 mU/m2/min) and once more after step 2 (either 20 or 40 mU/m2/min). Milk triglycerides were extracted and prepared for analysis by gas chromatography-mass spectrometry. The incorporation of deuterium into milk triglyceride-fatty acids was the primary outcome. Results: Fasting insulin concentrations were significantly associated with newly-made 16:0 in milk triglycerides (r=0.85, P=0.01). Of all measured triglyceride 16:0, 1.6±1.0% were made de novo. This percentage increased 1.5-fold by the end of step 2 of the clamp (P=0.06). Fasting milk DNL 14:0 was 12.3±4.8% which was significantly greater than DNL 16:0 (P&amp;lt;0.01). DNL 14:0 increased 1.7-fold during step 2 (P=0.04). For both milk triglyceride 12:0 and 14:0 derived from DNL, a significant effect across clamp-stage was observed (P&amp;lt;0.001 for both), but not an effect of group (P=0.12, P=0.11, respectively). Bonferroni posthoc analyses revealed that the insulin effect was significant for both groups for 12:0 (GDM, P=0.02; NGT, P &amp;lt;0.01) and 14:0 (GDM, P&amp;lt;0.01; NGT, P=0.01). Interpretation: The present study is the first to assess the acute effect of a hyperinsulinemic-euglycemic clamp on the synthesis of newly-made triglyceride fatty acids in human milk. These results suggest that the increases in mammary DNL may be fatty acid specific, favoring that of lauric and myristic acids, but not longer chain fatty acids like palmitate. Mammary lipogenesis was stimulated by insulin in all subjects regardless of recent gestational diabetes diagnosis. The role mammary DNL plays in overall milk fat content deserves further investigation. Presentation: 6/3/2024

8366 Weight Reduction is Associated with Improved Quality of Life in Patients in SURMOUNT-3

Abstract Disclosure: T.H. Gibble: Employee; Self; Eli Lilly &amp; Company. Stock Owner; Self; Eli Lilly &amp; Company. D. Cao: Employee; Self; Eli Lilly &amp; Company. Stock Owner; Self; Eli Lilly &amp; Company. T.D. Forrester: Employee; Self; Eli Lilly &amp; Company. Stock Owner; Self; Eli Lilly &amp; Company. J.F. Brumm: Employee; Self; Eli Lilly &amp; Company. Stock Owner; Self; Eli Lilly &amp; Company. Tirzepatide, a once-weekly glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, is approved in the US for treatment of type 2 diabetes and obesity. In SURMOUNT-3, a phase 3, 72-week, randomized, double-blind clinical trial in adults with obesity/overweight, after 12 weeks intensive lifestyle intervention, treatment with tirzepatide resulted in significantly greater weight reduction than placebo. This post-hoc analysis assessed whether weight reduction was associated with patient-reported outcomes (PRO) improvements in adults treated with tirzepatide. Of 806 adults with obesity (body mass index [BMI] ≥30 kg/m2)/overweight (BMI ≥27 kg/m2) + ≥1 obesity-related complication enrolled in SURMOUNT-3, 579 achieved ≥5% weight reduction with 12 weeks of intensive lifestyle intervention and were randomized to placebo (N=292) or tirzepatide (10/15mg, N=287) for 72 weeks. Adults completed patient-reported outcomes (PRO) questionnaires at randomization and endpoint (72 weeks or early discontinuation), including Short Form-36 Version 2 Health Survey acute form (SF-36v2) and Impact of Weight on Quality of Life-Lite Clinical Trials Version (IWQOL-Lite-CT). Mean change in SF-36v2 norm-based and IWQOL-Lite-CT scores from randomization to endpoint were summarized descriptively by weight reduction targets (≥5%, ≥10%, ≥15%, ≥20%, ≥25%) for adults who received TZP, using the last observation carried forward method. At endpoint, adults with weight reduction showed improvements from randomization in most PRO scores. For SF-36v2, improvements by weight reduction target were seen for General Health (≥5%, 2.6; ≥10%, 2.7; ≥15%, 3.0; ≥20%, 3.3; ≥25%, 3.4), Physical Functioning (3.4, 3.4, 3.8, 4.4, 4.3), Mental Health (0.4, 0.4, 0.7, 0.8, 0.4), Bodily Pain (2.3, 2.5, 3.1, 3.7, 3.9), Role-Physical (1.9, 1.8, 2.2, 2.9, 2.8), Vitality (1.3, 1.3, 1.5, 1.8, 1.4), Social Functioning (0.8, 0.9, 1.1, 2.2, 2.4), Role-Emotional (0.9, 0.8, 1.0, 1.5, 0.9), and Physical Component Score (3.2, 3.3, 3.8, 4.5, 4.7); improvements were less consistent for Mental Component Score (-0.1, -0.2, -0.1, 0.3, -0.2). For IWQOL-Lite-CT, improvements by weight reduction target were seen for total (18.2, 18.6, 19.7, 22.9, 24.1), Physical Function composite (13.6, 14.1, 14.9, 17.1, 17.3), Physical Composite (14.3, 14.9, 15.7, 18.3, 19.3), Physical Pain/Discomfort Composite (16.0, 16.7, 17.8, 21.1, 24.1), and Psychosocial Composite Scores (20.3, 20.6, 21.8, 25.3, 26.7). Adults meeting greater weight reduction targets generally showed greater improvements from randomization in PRO scores. Weight reduction was associated with improvement in most domains of health-related quality of life, including those relating to physical function and mental health. Adults who lost the most weight generally showed the greatest quality of life improvements. Presentation: 6/1/2024

7216 Absence Of Weight Gain In C57Bl/67 Female Mice On A High-Fat Diet Protects The Skeleton From Bone Loss

Abstract Disclosure: C. McAndrews: None. C. Chlebek: None. S. Costa: None. C.J. Rosen: None. Background: Obesity is associated with both systemic metabolic changes that increase the risk of comorbidities and reduced bone quality that increases the risk of fracture. The effects of high-fat diet consumption have been well studied in preclinical models where high-fat diet-feeding induces obesity, but there have been no studies to investigate the effects of high-fat diet-feeding in animals that do not become obese. Therefore, we characterized components of systemic metabolism and bone mineral content in non-obese C57Bl/6J mice that were fed a high-fat diet. Methods: Female C57Bl/6J mice aged 8 weeks received either a high-fat (60% kcal fat, n = 31) or control (10% kcal fat, n = 17) diet for 12 weeks. Body composition, areal bone mineral density (BMD) and bone mineral composition (BMC) were assessed after the feeding period using dual energy x-ray absorptiometry (Faxitron UltraFocus-DXA). Glucose (GTT) and insulin (ITT) tolerance testing were performed at the conclusion of the study. Changes in body weight were calculated as the difference between baseline and experiment end. High-fat diet-fed animals were classified as obese (HFD-O, n = 24) if they weighed more than 25 g or had greater than 25% body fat as evaluated via DXA, and were otherwise considered non-obese (HFD-NO, n = 7). In a small subset of animals, subcutaneous inguinal fat pads were harvested and weighed (n=5-7/group). Differences between groups were assessed with one-way ANOVAs and Tukey post-hoc analyses. Results: HFD-O mice weighed more than HFD-NO and control animals, whereas the body weights of HFD-NO mice were not significantly different from control (p &amp;lt; 0.001). Fat percent was increased in HFD-O mice compared to HFD-NO and control animals (p &amp;lt; 0.001). Subcutaneous inguinal fat mass was increased in both HFD-O and HFD-NO mice compared to control (p &amp;lt; 0.001). Fasting blood glucose did not significantly differ between groups. Glucose tolerance was worsened in both HFD-O and HFD-NO mice compared to control (p &amp;lt; 0.001), but there were no significant differences in insulin tolerance between groups. BMD was decreased in HFD-O mice compared to HFD-NO and control animals (p &amp;lt; 0.001). DISCUSSION: The consumption of a high-fat diet in mice induces deleterious metabolic changes irrespective of weight gain. However, high-fat diet-induced bone loss does not occur in the absence of weight gain. These findings suggest that certain adipokines derived from larger adipose depots may drive high-fat diet-induced bone loss and warrant further investigation. Acknowledgements: This work was supported by the 2023 Endocrine Society Research Experiences for Graduate and Medical Students (REGMS) Program. Presentation: 6/1/2024

7706 Racial Disparities in Thyroid-Related Procedure Reoperation Rates: Insights from NSQIP Database

Abstract Disclosure: H.A. Erol: None. A. Liu: None. K. Wardwell: None. S. Woodruff: None. Background: Racial disparities in health outcomes are well-documented, with specific conditions affecting racial groups differently. However, the influence of race on endocrine surgery outcomes remains an evolving field of study. This research seeks to evaluate the effect of race on unplanned reoperations using the National Surgical Quality Improvement Program(NSQIP)-database and to investigate additional risk factors for reoperations in this cohort. Methods: We analyzed the NSQIP-database for thyroid-related procedures from 2012-2021 using CPT codes. Patient demographics, including age, sex, height/weight, ASA classification, and comorbid conditions, were assessed for unplanned reoperations. Univariate, multivariable logistic regression, and adjusted residual analyses were conducted assessing individual variables, adjusted odds ratios(ORs), and for post-hoc analyses. Results: Over the 10-year period, 169,251 patients were identified, with an overall reoperation incidence of 1.32%. Univariate analysis revealed that race correlated with increased reoperation rates, with the highest incidence observed among American Indian/Alaska Native (2.13%) patients, followed by Native Hawaiian/Pacific Islander (1.93%), Black/African American(1.84%), White (1.22%), and Asian(1.08%) patients. In multivariate logistic regression analysis, Black/African American (OR 1.452, 95% CI 1.293-1.630, p &amp;lt; 0.001) and American Indian/Alaska Native (OR 1.775, 95% CI 1.039-3.031, p = 0.036) patients had a higher risk of reoperation compared to White patients. Other factors associated with increased reoperation risk included male gender, higher ASA class, smoking, partially dependent functional status, ventilator dependency, hypertension, dialysis, disseminated cancer, bleeding disorders, and systemic inflammatory response syndrome or sepsis. Most reoperations were hematoma related(63.02%), with statistical significance noted among different ethnicities and types of reoperations. White patients had lower rates of hematoma-related procedures, fewer tracheostomies, and more additional thyroid procedures. Black/African American patients had more tracheostomies and fewer lymphatic-related or additional thyroid procedures. Conclusions: Using the NSQIP-database, Black/African American and American Indian/Alaska Native patients were at a greater risk of reoperation following thyroid surgeries, even after accounting for multiple variables. Black/African American patients also had disparate types of reoperations. These findings highlight the impact of race on thyroidectomy-related outcomes. Further research is imperative to comprehensively understand the role of race in surgical outcomes and to address healthcare disparities and inequities. Presentation: 6/2/2024

12548 Mammary De Novo Lipogenesis During A Hyperinsulinemic-euglycemic Clamp

Abstract Disclosure: T.M. Fordham: None. M. Ramos-Roman: None. E.J. Parks: Consulting Fee; Self; Simply Good Foods. Stock Owner; Self; Sagimet Biosciences. Other; Self; Past President of The Obesity Society. Introduction: The mammary produces large amounts of medium-chain saturated fatty acids. Long-chain saturated fatty acids found in human milk primarily derive from the maternal diet or from the mobilization of stored triglycerides. Previous studies have established the importance of insulin in stimulating mammary differentiation, milk synthesis, and lipogenesis. However, no studies have assessed how changes in insulin concentrations alter human mammary de novo lipogenesis (DNL) nor what effect gestational diabetes may have on insulin’s relationship to lipogenesis during lactation. Through the utilization of stable isotopes and the hyperinsulinemic-euglycemic clamp technique, we tested the differing concentrations of insulin to stimulate mammary DNL. Methods: Eight women (32±4 yrs) with (GDM, n=4) or without (NGT, n=4) recent gestational diabetes and overweight or obesity (28.2±2.9 kg/m2) were recruited to participate in this study at 6 weeks postpartum. The night before the study, participants orally consumed 3 doses of 70% deuterated water to label newly made fatty acids. Participants arrived in the morning for IV placement and immediately pumped milk contralaterally for 20 minutes. Milk was pumped two hours later, again at the end of step 1 of the clamp (10 mU/m2/min) and once more after step 2 (either 20 or 40 mU/m2/min). Milk triglycerides were extracted and prepared for analysis by gas chromatography-mass spectrometry. The incorporation of deuterium into milk triglyceride-fatty acids was the primary outcome. Results: Fasting insulin concentrations were significantly associated with newly-made 16:0 in milk triglycerides (r=0.85, P=0.01). Of all measured triglyceride 16:0, 1.6±1.0% were made de novo. This percentage increased 1.5-fold by the end of step 2 of the clamp (P=0.06). Fasting milk DNL 14:0 was 12.3±4.8% which was significantly greater than DNL 16:0 (P&amp;lt;0.01). DNL 14:0 increased 1.7-fold during step 2 (P=0.04). For both milk triglyceride 12:0 and 14:0 derived from DNL, a significant effect across clamp-stage was observed (P&amp;lt;0.001 for both), but not an effect of group (P=0.12, P=0.11, respectively). Bonferroni posthoc analyses revealed that the insulin effect was significant for both groups for 12:0 (GDM, P=0.02; NGT, P &amp;lt;0.01) and 14:0 (GDM, P&amp;lt;0.01; NGT, P=0.01). Interpretation: The present study is the first to assess the acute effect of a hyperinsulinemic-euglycemic clamp on the synthesis of newly-made triglyceride fatty acids in human milk. These results suggest that the increases in mammary DNL may be fatty acid specific, favoring that of lauric and myristic acids, but not longer chain fatty acids like palmitate. Mammary lipogenesis was stimulated by insulin in all subjects regardless of recent gestational diabetes diagnosis. The role mammary DNL plays in overall milk fat content deserves further investigation. Presentation: 6/3/2024

Utilization of Black Soldier Fly and Housefly as Biodegradation Agents of Dairy Wastes and source of Animal Feed

Accumulation of dairy wastes and shortage of nutritious feed remain the major challenges in dairy cattle production. Such wastes may sustainably be biodegraded by black soldier fly (BSF) larvae and housefly (HF) larvae into their which ca be used as animal feed. This study was done to compare the capacity of using black soldier fly larvae (BSFL) and housefly larvae (HFL) to manage dairy wastes and use of such larvae as livestock feed. Biomass reduction rate, biomass reduction index, bioconversion rate, feed conversion ratio and nutritional profile of resultant BSF and HF prepupae raised on cow dung (CD) and dairy shed effluent (DSE) were determined. In order to ascertain whether the substrates had an effect on BSFL and HFL, analysis of variance (ANOVA) was used, and multiple mean comparisons at P≤0.05 were done using the Tukey HSD post-hoc test. Housefly larvae reared on DSE had the highest biomass reduction rate and biomass reduction index, even though HFL had a shorter development time than BSFL (P≤0.05). Housefly prepupae reared on DSE had the highest crude protein content of 60.1 % of all the HF prepupae counterparts and BSF prepupae reared on DSE and CD (P≤0.05), Hence HF prepupae could be an alternative source of animal feed. Depending on the needs and purpose, utilization of fly larvae to manage dairy waste is viable and effective option

Effect of Mediterranean Diet Composition on Metabolic Syndrome Marker Parameters Based on NCEP-ATP III Criteria

Metabolic syndrome refers to a cluster of metabolic abnormalities in the body, including central obesity, elevated blood pressure, high glucose, and triglyceride levels, as well as low HDL levels. The Mediterranean diet, known for its specific composition, is believed to mitigate metabolic syndrome. This study aims to assess the impact of adhering to the Mediterranean diet on individuals with metabolic syndrome. It employs an observational analytic approach, utilizing a prospective cohort of 30 participants who followed the Mediterranean diet regimen as part of their treatment at a clinic in Bandung City. Systematic Random Sampling was used to select participants, and blood pressure was measured at the beginning (T1) and end (T2) of the study. Data on dietary intake were collected using the Relative Mediterranean Diet (rMED) scale via a Food Frequency Questionnaire (FFQ). Statistical analyses, including ANOVA and Tukey’s post-hoc test, were conducted to compare dietary compositions across adherence groups and to assess the impact of the Mediterranean diet on metabolic syndrome components. The findings revealed that participants, with an average age of 57.94 years and 69.44% female, experienced significant improvements in certain metabolic syndrome components, such as waist circumference (fruit and nut intake), triglycerides (vegetable intake), HDL (meat intake), and blood glucose (dairy product intake). However, no significant effects were observed for legumes, seeds, fish, and olive oil components on MetS. Keywords: components, Mediterranean diet, MetS, NCEP-ATP III

Effect of the Composition of the Mediterranean Diet on Body Mass Index, Waist Circumference, Fat Level, and Visceral Fat in Patients with Obesity

Excessive and unhealthy fat storage is known as obesity. Both monounsaturated and polyunsaturated fatty acids are highly encouraged in the Mediterranean diet. Obese patients at a Bandung clinic were studied to examine how the Mediterranean diet affects their BMI, waist size, fat percentage, and visceral fat. Analytical observational methods utilizing prospective cohort observations were employed. A systematic random sample technique was used to carry out the sampling. Participants were 34 overweight individuals who had twelve monthly food pattern assessments and two monthly examinations for body mass index (BMI), waist size, fat percentage, and visceral fat. To compare proportions between the rMED adherence groups and to look for differences in the composition of the Mediterranean diet on BMI, waist circumference, fat content, and visceral fat, we used the ANOVA test and Tuckey’s post-hoc test. In addition, the eight tenets of the Mediterranean diet were assessed using linear regression. The average age of the obese patients who followed the Mediterranean diet was 57.54 years, and 79.41% of them were female. It was found that the components of vegetables, fruits, nuts, seafood, and dairy products had a substantial impact on the body mass index of the participants, while the components of vegetables, fruits, nuts, legumes, seeds, meat, fish, olive oil, and dairy products did not have a significant impact on the waist circumference, fat content, or visceral fat. Keywords: body mass index, fat content Mediterranean diet composition, obesity, visceral fat, waist circumference

The Effect of the Mediterranean Diet Components on Blood Pressure, Mean Arterial Pressure, and Pulse Pressure in Hypertensive Patients

According to the 2018 Basic Health Research Data (RISKESDAS), the prevalence of hypertension in West Java was 39.6%, while in Cimahi City it was 41.83%. The composition of the Mediterranean diet contains a high proportion of MUFA and PUFA which act as anti-inflammatory, antioxidant, and cardioprotective with a potential to lower blood pressure. The aim of this study is to determine the impact of Mediterranean diet components on blood pressure in patients with hypertension. The study uses observational analytic methods as the design and also employs a prospective cohort sample of 36 patients with hypertension for three months, using a systematic random sampling technique. The research subjects were checked for blood pressure in the first month (T1) and the last month of the study (T2). The relative Mediterranean Diet (rMED) was used as a source of data on component intakes by administering the Food Frequency Questionnaire (FFQ) 12 times within three months. The differences in Mediterranean diet composition and blood pressure in all Mediterranean diet adherence groups were examined using the ANOVA test and Tuckey’s post-hoc test, as well as to test comparisons of proportions between rMED adherence groups. The impact of each component of the Mediterranean Diet on blood pressure was evaluated using a linear regression analysis test. The results showed that the average age of hypertensive patients who underwent the Mediterranean diet was 57.94 years and 69.44% were female. The components of fruit and nuts, vegetables, and fish have a significant effect on systolic blood pressure. Fish components have a significant effect on diastolic blood pressure. The components of vegetables and fish have a significant effect on the mean arterial pressure (MAP). Fruit and nut components have a significant effect on pulse pressure. The limitations of this study are the short research time, the absence of salt consumption restrictions on the Mediterranean diet, and the presence of smoking and physical activity as confounding activities. Keywords: blood pressure, composition, Mediterranean diet, mean arterial pressure, pulse pressure

Marginal bone loss and soft tissue health around two-implant mandibular overdenture retained with milled versus selective laser melted cobalt chromium bar: a randomized clinical trial

BackgroundTo assess marginal bone loss and soft tissue health around two-implant mandibular overdenture retained with milled versus selective laser-melted cobalt chromium (Co-Cr) bars.MethodThis research was set to be a parallel, triple-blinded, randomised controlled trial. Twenty completely edentulous patients received new conventional complete dentures according to conventional techniques. Two implants were placed at mandibular canine areas bilaterally, and patients were randomly allocated into two equal groups: the milled Co-Cr bar group and the selective laser melted (SLM) Co-Cr bar group. Marginal bone loss (MBL), modified plaque index (mPI), modified gingival index (mGI), and probing depth (PD) were evaluated at 0-month (baseline), 6-month, and 12-month follow-up visits. Repeated measures ANOVA test and Bonferroni’s post-hoc test were used for parametric data as PD, while for non-parametric data as MBL, mGI, and mPI, Mann-Whitney U test and Friedman’s test were used. A P-value ≤ 0.05 was set as the statistical level of significance. The study protocol was approved by the Faculty Research Ethics Committee at Minia University (636 4/10/2022). Registration for the clinical trial was made retrospectively on clinicaltrials.gov with ID NCT06401200 at 04/30/2024.ResultsThe follow-up period (one year) was completed without a dropout. Regarding MBL, no statistically significant difference was found between the two groups throughout the study. However, the milled group showed significantly increased MBL from 0- to 6-month follow up period. In both groups, mPI increased significantly from 0- to 6-months post-loading. On the other hand, no statistically significant difference between the two groups was found regarding mPI and mGI throughout the study follow-up periods. The PD was significantly lower in the milled compared to the SLM group at the 6- and 12-month follow up period.ConclusionTwo-implant mandibular overdenture retained with milled or SLM Co-Cr bar can provide an acceptable treatment option for completely edentulous patients regarding marginal bone loss and soft tissue outcomes.

Leveraging Ensemble Models and Follow-up Data for Accurate Prediction of mRS Scores from Radiomic Features of DSC-PWI Images.

Predicting long-term clinical outcomes based on the early DSC PWI MRI scan is valuable for prognostication, resource management, clinical trials, and patient expectations. Current methods require subjective decisions about which imaging features to assess and may require time-consuming postprocessing. This study's goal was to predict multilabel 90-day modified Rankin Scale (mRS) score in acute ischemic stroke patients by combining ensemble models and different configurations of radiomic features generated from Dynamic susceptibility contrast perfusion-weighted imaging. In Follow-up studies, a total of 70 acute ischemic stroke (AIS) patients underwent magnetic resonance imaging within 24hours poststroke and had a follow-up scan. In the single study, 150 DSC PWI Image scans for AIS patients. The DRF are extracted from DSC-PWI Scans. Then Lasso algorithm is applied for feature selection, then new features are generated from initial and follow-up scans. Then we applied different ensemble models to classify between three classes normal outcome (0, 1 mRS score), moderate outcome (2,3,4 mRS score), and severe outcome (5,6 mRS score). ANOVA and post-hoc Tukey HSD tests confirmed significant differences in model style performance across various studies and classification techniques. Stacking models consistently on average outperformed others, achieving an Accuracy of 0.68 ± 0.15, Precision of 0.68 ± 0.17, Recall of 0.65 ± 0.14, and F1 score of 0.63 ± 0.15 in the follow-up time study. Techniques like Bo_Smote showed significantly higher recall and F1 scores, highlighting their robustness and effectiveness in handling imbalanced data. Ensemble models, particularly Bagging and Stacking, demonstrated superior performance, achieving nearly 0.93 in Accuracy, 0.95 in Precision, 0.94 in Recall, and 0.94 in F1 metrics in follow-up conditions, significantly outperforming single models. Ensemble models based on radiomics generated from combining Initial and follow-up scans can be used to predict multilabel 90-day stroke outcomes with reduced subjectivity and user burden.

Diuretic dosing and outcomes with torsemide and furosemide following hospitalization for heart failure: The TRANSFORM-HF trial.

The TRANSFORM-HF trial found no difference in clinical outcomes between torsemide versus furosemide after hospitalization for heart failure. This analysis aimed to assess the impact of diuretic dosing on the primary and secondary clinical outcomes. This post-hoc analysis of TRANSFORM-HF categorized patients into three groups by discharge diuretic dose: (1) ≤40 mg, (2) >40-80 mg, and (3) >80 mg of furosemide equivalents. The associations between discharge dose and 12-month clinical events, and change in Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS), were assessed. Overall, 2379 patients were included, aged 65 years (interquartile range 56-75), 883 (37.1%) women, and 812 (34.2%) Black. Furosemide had adjusted hazard ratios (aHR) for all-cause mortality of 1.21 (95% confidence interval [CI] 0.91-1.59) for discharge dose group 2 and 1.40 (95% CI 1.04-1.88) for group 3, compared with group 1. For torsemide, aHRs were 1.74 (95% CI 1.32-2.30) for group 2 and 1.58 (95% CI 1.14-2.19) for group 3. No evidence of heterogeneity for the association between increased mortality and higher dose was found by loop diuretic type (pinteraction = 0.17). Higher doses of furosemide and torsemide were associated with increased risk of all-cause hospitalization and the composite of all-cause mortality and hospitalization, without evidence of heterogeneity by loop diuretic type (pinteraction > 0.2). Changes in KCCQ-CSS from baseline at 12 months was similar across dose groups for both drugs. Following hospitalization for heart failure, higher loop diuretic dosing was independently associated with worse clinical and patient-reported outcomes. The correlation between higher loop diuretic dose and outcomes was consistent, regardless of loop diuretic used.

Examining hypothalamic-pituitary-adrenal axis genetic variation on cortisol and alpha-amylase reactivity during an explicit negative-evaluative stress induction.

Prior work consistently links additive genetic variation in the hypothalamic-pituitary-adrenal (HPA) axis-a multilocus genetic profile score (MGPS)-to depression risk in the context of stress exposure. However, despite that HPA MGPS variants were selected based on evidence that they elevate cortisol reactivity, there are surprisingly few tests of whether an HPA MGPS elevates cortisol reactivity to lab-based stress. Similarly, despite neurobiological connections and coordination between the HPA axis and the sympathetic nervous system (e.g., in the paraventricular nucleus and locus coeruleus), no work has tested whether an HPA MGPS influences sympathetic nervous system reactivity to stress. We investigated whether an HPA MGPS moderates the relation between lab-based stress and: (1) HPA activity indexed by cortisol, and/or (2) sympathetic activity indexed by salivary alpha-amylase, sAA. Emerging adults (N=152; mean age=19.5, largest subsample 44.4% Black/African American) were randomly assigned to one of two Trier Social Stress Test variations, a non-evaluative control, or an explicitly negative-evaluative condition. Participants provided DNA and repeated saliva samples for sAA and cortisol. The HPA MGPS did not significantly moderate the relationship between stress condition and cortisol or sAA reactivity, respectively; moreover, post-hoc tests highlight that individual polymorphisms showed non-significant effects in opposite directions from each other, cancelling out in aggregate. Findings suggest that the HPA MGPS's associations with cortisol reactivity are not as straightforward as initially believed. We speculate that the relationships of some HPA variants to biomarker reactivity may vary between modest lab-based stressors and the explicit negative-evaluative induction used here.

Incremental prognostic value of 18F-FDG myocardial ischemic memory imaging for major adverse cardiovascular events in patients with suspected unstable angina

BackgroundThe additional prognostic value of 18F-FDG PET myocardial ischemic memory imaging for patients with suspected unstable angina (UA) is not well established. This study aimed to determine whether 18F-FDG PET imaging provides incremental prognostic information for predicting major adverse cardiac events (MACE) compared to clinical risk factors, GRACE score, and coronary artery calcium score (CACS) in suspected UA patients. MethodsIn this post-hoc analysis of a prospective study, 265 suspected UA patients (62.3% male, mean age 65.0±9.4 years) were enrolled. 18F-FDG positive was defined as focal or focal on diffuse uptake patterns. MACE included cardiovascular death, acute myocardial infarction, heart failure, rehospitalization for UA, and stroke. Multivariable Cox regression was used to identify predictors of MACE, and the incremental prognostic value of 18F-FDG PET imaging was assessed using C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). ResultsOver a median follow-up of 25 months, 51 patients (19.2%) experienced MACE. 18F-FDG positive (HR=3.220, 95% CI: 1.630-6.360, P<0.001) , as well as 18F-FDG standardized uptake ratio (SUR) (HR=1.330, 95%CI: 1.131-1.564, P=0.0006) and Extent (HR=1.045, 95%CI: 1.028-1.062, P<0.0001), were independent predictors of MACE. The addition of 18F-FDG PET imaging significantly improved risk stratification beyond clinical factors, the GRACE score, and CACS, with improved C-index (0.769 vs 0.688, P=0.045), NRI (0.324, P=0.020), and IDI (0.055, P=0.027). Conclusion18F-FDG PET myocardial ischemic memory imaging significantly improves prognostic assessment for suspected UA patients, providing valuable additional risk stratification beyond clinical risk factors, GRACE score, and CACS.

Effect of Listerine and Chlorhexidine mouthwashes with antidiscoloration system on the colour change of CAD/CAM conventional and novel lithium disilicate ceramics

Background It has been reported that using mouthwashes can discolour the surface of teeth. Their effect on the stainability of newly introduced lithium disilicate ceramics is, however, unknown. Objective: The purpose of this in vitro study was to investigate how mouth washes affected the color change of new and conventional lithium disilicate (LS2) ceramics that were finished using various techniques. Materials and Methods A total of 56 ceramic slices were produced from conventional LS2 (E Max CAD, Ivoclar) and a novel virgilite based LS2 (Cerec Tessera, Dentsply Sirona). According to the finishing method, the specimens were divided into glazed and polished subgroups. Each subgroup was further subdivided into two based on immersion in chlorhexidine (CHXD) or Listerine (LIST) mouth washes. A handheld spectrophotometer was used to measure the color attributes, and color differences (ΔE00) were then counted using specific equation. Data were analyzed using ANOVA and Tukey’s post-hoc tests. Results Significant differences in color change (ΔE00) values were observed between conventional and novel LS2 ceramics, as well as between different finishing methods and mouth-rinse solutions. Chlorhexidine induced higher color differences than Listerine, with average ΔE00 values of 0.959 and 0.885, respectively (p &lt; 0.001). The polished specimens generally exhibited higher ΔE00 values than the glazed specimens, with average values of 1.071 and 0.792 for conventional LS2, and 0.836 and 0.786 for novel LS2 (p &lt; 0.001). However, most color changes did not exceed the perceptibility and acceptability thresholds. Conclusion Using CHXD and LIST mouth washes affected the color change of polished or glazed conventional and novel lithium disilicate ceramics. In general, the stainability of polished specimens was higher than that of glazed ones. There was more discoloration on specimens immersed in CHXD than those immersed in LIST. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1178-1184