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Immunoassay; Sexual steroids; Testosterone Immunoassaig; Esteroides sexuals; Testosterona Inmunoensayo; Esteroides sexuales; Testosterona The proper clinical approach to a wide range of disorders relies on the availability of accurate, reproducible laboratory results for sexual steroids measured using methods with a high specificity and sensitivity. The chemiluminescent immunoassays currently available have analytical limitations with significant clinical implications. This position statement reviews the current limitations of laboratory techniques for the measurement of estradiol and testosterone and their impact on diverse clinical scenarios. A set of recommendations are provided to incorporate steroid hormone analysis by mass spectrometry in national health systems. International societies have recommended this methodology for a decade.

Objective: Attention deficit hyperactivity disorder is a frequent comorbid condition in adults with bipolar disorder. We performed a meta-analysis aimed at assessing sociodemographic and clinical correlates of attention deficit hyperactivity disorder in bipolar disorder. Method: We searched main electronic databases up to June 2021. Random-effects meta-analyses, with relevant meta-regression and quality-based sensitivity analyses, were carried out to estimate the association between attention deficit hyperactivity disorder and putative correlates, grading the quality of evidence. Results: We included 43 studies, based on 38 independent samples. Attention deficit hyperactivity disorder participants were more likely to be males (odds ratio = 1.46; p Conclusion: Comorbid bipolar disorder/attention deficit hyperactivity disorder may have some distinctive clinical features including an earlier onset of bipolar disorder and higher comorbid alcohol/substance use disorder rates. Further research is needed to identify additional clinical characteristics of this comorbidity.

STUDY QUESTION Circulating miRNAs previously associated with androgen excess in women might be used as diagnostic biomarkers for polycystic ovary syndrome (PCOS). SUMMARY ANSWER Models based on circulating miR-142-3p and miR-598-3p expression show good discrimination among women with and without PCOS, particularly when coupled with easily available measurements such as waist-to-hip ratio (WHR) and circulating LH-to-FSH (LH/FSH) ratios. WHAT IS KNOWN ALREADY The lack of standardization of the signs, methods, and threshold values used to establish the presence of the diagnostic criteria (hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology) complicates the diagnosis of PCOS. Certain biomarkers may help with such a diagnosis. We conducted a validation study to check the diagnostic accuracy for PCOS of several miRNAs that were associated with the syndrome in a small pilot study that had been previously carried out by our research group. STUDY DESIGN, SIZE, DURATION This was a diagnostic test study involving 140 premenopausal women. PARTICIPANTS/MATERIALS, SETTING, METHODS We included 71 women with PCOS and 69 healthy control women in the study. Both groups were selected as to be similar in terms of body mass index. We used miRCURY LNA™ Universal RT microRNA PCR to analyse the five miRNAs that had shown the strongest associations with PCOS in a much smaller pilot study previously conducted by our group. We studied diagnostic accuracy using receiver operating characteristics (ROC) curve analysis. MAIN RESULTS AND THE ROLE OF CHANCE Only the expression of two miRNAs, miR-142-3p and miR-598-3p, of the five studied, was different between the women with PCOS and the non-hyperandrogenic controls. The diagnostic accuracy of the combination of these circulating miRNAs was good (area under the ROC curve (AUC) 0.801; 95% CI: 0.72–0.88) and was further improved when adding WHR (AUC 0.834, 95% CI: 0.756–0.912), LH/FSH ratio (AUC = 0.869, 95% CI: 0.804–0.934) or both (AUC = 0.895, 95% CI: 0.835–0.954). We developed several models by selecting different threshold values for these variables favouring either sensitivity or specificity, with positive and negative predictive values as high as 88% or 85%, respectively. LIMITATIONS, REASONS FOR CAUTION Patients included here had the classic PCOS phenotype, consisting of hyperandrogenism and ovulatory dysfunction; hence, the present results might not apply to milder phenotypes lacking androgen excess. WIDER IMPLICATIONS OF THE FINDINGS If confirmed in larger studies addressing different populations and PCOS phenotypes, these biomarkers may be useful to simplify the clinical diagnosis of this prevalent syndrome. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation (grants PI15/01686, PIE16/00050, PI18/01122 & PI21/00116) and co-funded by European Regional Development Fund ‘A way to make Europe’. Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) are also initiatives of the Instituto de Salud Carlos III. The authors have no competing interests to disclose. TRIAL REGISTRATION NUMBER N/A.

Resumen La correcta aproximación clínica a un amplio grupo de situaciones depende en gran medida de la disponibilidad de resultados analíticos de esteroides sexuales que sean exactos y reproducibles, obtenidos con métodos con la especificidad y sensibilidad analíticas adecuadas. En este sentido, los inmunoanálisis quimioluminiscentes actuales presentan limitaciones analíticas con repercusiones clínicas importantes. El documento de posicionamiento revisa el estado actual en la estandarización de los métodos de medida de estradiol y testosterona y su repercusión en distintas situaciones clínicas. Se incluye asimismo una serie de recomendaciones a seguir para introducir en los sistemas nacionales de salud los análisis de esteroides por espectrometría de masas, metodología recomendada desde hace más de una década por las sociedades internacionales.

To compare body composition in patients with autonomous cortisol secretion (ACS), non-functioning adrenal incidentalomas (NFAIs) and controls without adrenal tumours.Cross-sectional study of 3 groups: patients with ACS (cortisol post-dexamethasone suppression test (DST)1.8μg/dL), NFAIs (cortisol post-DST ≤1.8μg/dL) and patients without adrenal tumours (controls). Patients of the three groups were matched according to age (±5 years-old), sex and body mass index (±5kg/m25 patients with ACS, 24 NFAIs and 24 controls were enrolled. Based on CT images, a weak positive correlation between serum cortisol post-DST and subcutaneous fat area (r=0.3, P=0.048) was found. As assessed by bioelectrical impedance, lean mass and bone mass were positively correlated with the excretion of total androgens (r=0.56, P0.001; and r=0.58, P0.001, respectively); and visceral mass was positively correlated with the excretion of glucocorticoid metabolites and total glucocorticoids (r=0.28, P=0.031; and r=0.42, P=0.001, respectively). Based on CT imaging evaluation, a positive correlation was observed between lean mass and androgen metabolites (r=0.30, P=0.036); and between visceral fat area, total fat area, and visceral/total fat area ratio and the excretion of glucocorticoid metabolites (r=0.34, P=0.014; r=0.29, P=0.042; and r=0.31, P=0.170, respectively).The USP observed in adrenal tumours, which consists in a low excretion of androgen metabolites and high excretion of glucocorticoid metabolites, is associated with a lower lean mass and bone mass and higher level of visceral mass in patients with adrenal tumours.

For more than a decade now, geophysical prospecting has been considered an integral part of archaeological research; the ability to quickly investigate large areas and locate objects buried in the ground without directly interacting with it is a key feature that makes such surveys essential for identifying and locating, with good accuracy, buried archaeological remains. In this study, two extensive magnetic and electromagnetic surveys were carried out in two different areas of the Akrai archaeological site, where given the distribution of archaeological remains already found at the site, it was likely that additional buried remains were present. The surveys were performed using a proton precession magnetometer and a multifrequency electromagnetic device with a frequency range of 2.5–250 kHz. By processing the data, the vertical magnetic gradient and electrical conductivity maps were obtained. Furthermore, 3D models of electrical conductivity distribution were reconstructed. On comparing the results, it was notable that many anomalies characterized by low vertical gradient values were identified within areas characterized by low electrical conductivity values. These anomalies detected by both surveys can be associated with good probability with buried archaeological remains made up of limestones. In fact, they exhibit shapes and sizes comparable to those of the wall remains already found at the site.

In the creative sector, "music technology" refers to a wide range of musical practices, tools and devices enabled or facilitated by computers. Yet the music technology curriculum in New Zealand, as in other parts of the world, is dominated by two specific tools: commercial Digital Audio Workstations (DAWs) and notation software. In this chapter, I problematise this limitation by showing the pedagogical issues deriving from this exclusive model and by unpacking the ideological substrate of these tools, which is firmly grounded on neoliberal practices and principles. My analysis covers the ontology of these tools—what they are, what they do—and their business model. I then compare these tools against alternative approaches to music technology based on free-to-use, open-source software and programming languages based on principles of inclusion, collaboration and creative exploration.

OBJECTIVE: Children with complex health needs (CCHN) have both medical (e.g., chronic conditions) and health-related social needs (e.g., potentially adverse social determinants of health) that require ongoing healthcare and support from multiple community service providers. National standards developed for populations defined by health needs (CYSHCN) provide a framework for stakeholders to plan system-level improvements in care delivery for CCHN, but improvement efforts should reflect the priorities of their families and providers. This article describes a process of prioritizing system-level efforts to improve the health and well-being of CCHN and families in North Carolina (NC), using systematic stakeholder engagement and modified Delphi expert ratings. METHODS: We surveyed stakeholders with experience caring for CCHN using an open-ended, 3-item instrument to identify opportunities to improve systems of care. Using directed qualitative content analysis, we synthesized responses into a master list of potential improvement topics. Using a modified Delphi approach, a 16-member advisory committee rated all topics for importance and urgency, on 9-point Likert scales over two rounds; then ratings for each topic were ranked (low, medium, high) to establish relative priority. RESULTS: 47 individuals from 31 counties around NC provided survey responses, yielding 59 improvement topics in 10 domains. Through the modified Delphi method process, 21 topics (36%) received the highest rankings, largely representing access to community- and home-based services, equity, and enhancement of the pediatric workforce. CONCLUSIONS: Priorities identified by stakeholders will inform advocacy, policy, and improvement efforts. Next steps for the coalition include developing improvement projects to implement stakeholder-recommended actions for the highest-priority topics.

Assessment for cardiovascular autonomic neuropathy (CAN) in patients with type 1 diabetes mellitus remains time-consuming in the clinical setting. We aimed to examine the diagnostic performance of a portable point-of-care diagnostic tool (POCD) for assessing sural nerve conduction during the screening of CAN.Nerve amplitude (AMPCVThe combination of AMP

Many modern digital products use Machine Learning (ML) to emulate human abilities, knowledge, and intellect. In order to achieve this goal, ML systems need the greatest possible quantity of training data to allow the Artificial Intelligence (AI) model to develop an understanding of “what it means to be human”. We propose that the processes by which companies collect this data are problematic, because they entail extractive practices that resemble labour exploitation. The article presents four case studies in which unwitting individuals contribute their humanness to develop AI training sets. By employing a post-Marxian framework, we then analyse the characteristic of these individuals and describe the elements of the capture-machine. Then, by describing and characterising the types of applications that are problematic, we set a foundation for defining and justifying interventions to address this form of labour exploitation.

Temperate forests are particularly threatened by urbanization and fragmentation, with over 20% (120lJ000 km2) of recently urbanized land in the U.S. subsuming natural forests. We leveraged a unique, well-characterized urban-to-rural and forest edge-to-interior gradient to identify the combined impact of these two land use changes - urbanization and forest fragmentation - on soil microbial community in native, remnant forests. We found evidence of mutualism breakdown between trees and their fungal root mutualists (ectomycorrhizal (ECM) fungi) with urbanization, where ECM fungi colonized fewer tree roots and had less connectivity in soil microbiome networks in urban forests compared to rural forests. However, urbanization did not reduce the relative abundance of ECM fungi in forest soils; instead, forest fragmentation alone led to strong reductions in ECM fungal abundance. At forest edges, ECM fungi were replaced by plant and animal pathogens, as well as copiotrophic, xenobiotics-degrading, and nitrogen-cycling bacteria, including nitrifiers and denitrifiers. Urbanization and fragmentation interacted to generate “suites” of microbes, with urban interior forests harboring highly homogenized microbiomes, while edge forests microbiomes were more heterogeneous and less stable, showing increased vulnerability to low soil moisture. When scaled to the regional level, we found that forest soils are projected to harbor high abundances of fungal pathogens and denitrifying bacteria, even in rural areas, due to extreme, widespread forest fragmentation. Our results highlight the potential for soil microbiome dysfunction - including increased greenhouse gas production - in temperate forest regions that are subsumed by urban expansion, both now and in the future.Significance StatementUrbanization and forest fragmentation are increasingly altering Earth’s ecosystems, yet the effects on soil microbiomes, crucial for plant health and climate regulation, remain unclear. Our data indicate that, in forested land, these two combined, compounding stressors reshape the soil microbiome in ways that could lead to more pathogen infections of plants and animals, higher rates of N loss due to denitrification, and the possibility of tree symbiont extinctions. By identifying the specific environmental stressors that lead to these microbiome shifts, our analysis can be used to inform urban development and forest management plans to mitigate impacts on the soil microbiome to sustain environmental quality and the ecosystem services that remnant native forests provide to society in the coming decades.ClassificationBiological Sciences/Ecology

This article explores the concept of intimacy in the relationship between a musician and their instrument, specifically in the context of designing digital and accessible musical interfaces (DMI/AMI) with disabled musicians. We argue that current DMI/AMI design frameworks are lacking in their consideration of this relationship and that this deficiency can prevent designers from understanding the specific needs and desires of disabled musicians. The paper presents an autoethnographic study of the lived experience of the first author, a disabled musician, to provide insight into the evolution of his musician-instrument relationships and his definition of “success” in this context. The authors propose that incorporating these types of lived experiences into the AMI design process, and considering cultural probes or provocations related to phenomenological experiences and characteristics that contribute to a successful musician-instrument relationship, could lead to more effective and tailored DMI/AMI designs with disabled musicians.

Expansion of shrubs has been observed in a number of biomes and in response to diverse global change drivers. Noting shrub expansion in coastal forests affected by sea level rise, we began to monitor shrub populations in a transgressing loblolly pine forest in coastal Virginia. Forest study plots spanned a gradient of salinity and progression toward a ghost forest state, from high forest with a relatively closed canopy, to mid and low forest, where there were few remaining live canopy trees. Shrubs of the species Morella cerifera were censused for 3 years from 2019 to 2021. Shrub distributions were compared to distributions of the invasive grass Phragmites australis to test if competition with this invasive species played a role in the observed shrub distribution. Shrubs were most abundant in the mid forest, whereas P. australis was most abundant in the low forest, but we did not detect a negative correlation between changes in occupancy of P. australis and shrubs. Rapid growth of shrubs in the mid and high forest radically changed the forest understory structure during the study period. Basal area of shrubs in the mid and high forest tripled, and shrub occupancy increased from 45 to 66% in the high forest, with high patchiness between plots. A flooding event salinized the site in late 2019, during the study. Following the flood, soil porewater salinities in the low forest remained above levels known to cause mortality in M. cerifera for several months. We postulate that high salinity, rather than competition with P. australis, filters M. cerifera from the low forest, whereas moderate salinity in the mid and high forest favors M. cerifera growth and expansion. The increase in shrubs appears to be a hallmark of salt-affected maritime forest, with the shrub front occurring in advance of other indicators of transgression such as P. australis invasion.

Background The polycystic ovary syndrome (PCOS) is associated with insulin resistance, obesity and cardiometabolic comorbidities. We here challenged the hypothesis, using state-of-the art proton nuclear magnetic resonance spectroscopy metabolomics profiling, that androgen excess in women induces also a certain masculinization of intermediate metabolism that is modulated by obesity. Methods Participants were 53 Caucasian young adults, including 17 women with classic PCOS consisting of hyperandrogenism and ovulatory dysfunction, 17 non-hyperandrogenic women presenting with regular menses, and 19 healthy men, selected in order to be similar in terms of age and body mass index (BMI). Half of the subjects had obesity defined by a body mass index ≥ 30 kg/m2. Subjects maintained the same diet unrestricted in carbohydrates for 3 days before sampling and maintained their lifestyle and exercise patterns prior and during the study. Plasma samples were submitted to proton nuclear magnetic resonance spectroscopy metabolomics profiling. Results Obesity associated a metabolomics profile mainly characterized by increased branched chain and aromatic aminoacids. Regardless of obesity, this unfavorable profile also characterized men as compared with control women, and was shared by women with PCOS. Notably, the negative impact of obesity on metabolomics profile was restricted to women, with obese men showing no further deterioration when compared with their non-obese counterparts. Conclusions Serum metabolomics profiling by proton nuclear magnetic resonance spectroscopy reveals sexual dimorphism, and masculinization of intermediate metabolism in women with PCOS, further suggesting a role for sex and sex hormones in the regulation of intermediate metabolism.

Aim To evaluate the prevalence and incidence of type 2 diabetes in patients with nonfunctioning adrenal incidentalomas (NFAI) or adrenal incidentalomas (AI) with autonomous cortisol secretion (ACS).Methods In this single-center retrospective study, all patients with adrenal incidentalomas ≥ 1cm and ACS or NFAI studied between 2013–2020 were included. ACS was defined by a post-dexamethasone suppression test (DST) serum cortisol concentration ≥ 1.8µg/dl, in the absence of signs of hypercortisolism, and NFAI was defined as a DST Results Inclusion criteria were met by 231 patients with ACS and 478 with NFAI. At diagnosis, type 2 diabetes was present in 24.3% of patients. No differences were found in the prevalence of diabetes (27.7% vs. 22.6%, P = 0.137) between patients with ACS and NFAI. However, fasting plasma glucose values and glycated haemoglobin levels were significantly higher in patients with ACS than with NFAI (112 ± 35.6 vs 105 ± 29mg/dl, P = 0.004; and 6.5 ± 1.4 vs. 6.1 ± 0.9%, P = 0.005, respectively). Furthermore, patients with type 2 diabetes had higher urinary free cortisol (P = 0.039) and late-night salivary cortisol levels (P = 0.010) than those without type 2 diabetes. After a median follow-up of 28 months, no differences were found in the incidence of diabetes between the groups (HR 1.17, 95% 0.52–2.64).Conclusion Type 2 diabetes was present in one fourth of our cohort. We found no differences in its prevalence or incidence between the groups. However, glycemic control might be worse among diabetic patients with ACS. Higher concentrations of urinary and salivary cortisol were found in patients with than without type 2 diabetes.

We aimed to determine, in patients with type 1 diabetes (T1DM), the impact of excluding hyperglycemia as a criterion from the International Diabetes Federation (IDF) definition of the metabolic syndrome (MetS), both on its prevalence and on its association with micro and macrovascular complications and markers of subclinical inflammation.A cross-sectional design, including 280 patients with T1DM. We defined MetS by three different models: (i) the standard IDF criteria, (ii) a modification consisting of excluding of hyperglycemia as a criterion (modified IDF criteria) and (iii) a modification consisting in changing the hyperglycemia by insulin resistance (MetS + IR model) defined by the estimated glucose disposal rate. Microvascular complications and cardioautonomic neuropathy were assessed. We measured an inflammatory panel including high sensitivity C reactive protein, erythrocyte sedimentation rate, homocysteine, and fibrinogen concentrations.After excluding hyperglycemia, the prevalence of MetS was 6.4% (95%CI: 4.1 to 9.9) compared with 20.7% (95%CI: 16.3 to 25.8) using standard IDF criteria. After adjusting for duration of diabetes, all three MetS definitions increased the odds for having microvascular complications [OR: 6.012 (2.208-16.307) for modified definition; OR: 5.176 (2.555-10.486) for standard definition and [OR: 3.374 (1.649-8.456) for MetS+IR model]. However, the both modified IDF models for MetS showed better predictive performance than standard criteria for suffering from neuropathy, nephropathy, cardiovascular disease and were associated with markers of subclinical inflammation.The prevalence of MetS significantly varies as a function whether or not hyperglycemia is included as a diagnostic criterion. The subset of patients fulfilling the modified MetS definitions may reflect better the concept of metabolic syndrome in T1DM. These modified definitions were accompanied by a poorer metabolic control and lipid profile, showing the worse inflammatory biomarker profiles and higher odds for micro- and macrovascular complications. In patients with T1DM, the inclusion of insulin resistance instead of hyperglycemia as a criterion of MetS may be of interest in routine clinical practice.

Electroconvulsive therapy (ECT) is a highly therapeutic and cost-effective treatment for severe and/or treatment-resistant major depression. However, because of the varied clinical practices, there is a great deal of heterogeneity in how ECT is delivered and documented. This represents both an opportunity to study how differences in implementation influence clinical outcomes and a challenge for carrying out coordinated quality improvement and research efforts across multiple ECT centers. The National Network of Depression Centers, a consortium of 26+ US academic medical centers of excellence providing care for patients with mood disorders, formed a task group with the goals of promoting best clinical practices for the delivery of ECT and to facilitate large-scale, multisite quality improvement and research to advance more effective and safe use of this treatment modality. The National Network of Depression Centers Task Group on ECT set out to define best practices for harmonizing the clinical documentation of ECT across treatment centers to promote clinical interoperability and facilitate a nationwide collaboration that would enable multisite quality improvement and longitudinal research in real-world settings. This article reports on the work of this effort. It focuses on the use of ECT for major depressive disorder, which accounts for the majority of ECT referrals in most countries. However, most of the recommendations on clinical documentation proposed herein will be applicable to the use of ECT for any of its indications.

This article examines a corpus of over forty Italian civic histories produced from the mid-thirteenth to mid-fourteenth century, when the wealth of many of the peninsula's inhabitants increased significantly. Evidence from this corpus demonstrates that attitudes about wealth in historical writing changed over time and argues for a shift from a more static to a more dynamic representation of material goods in these texts. The novel mechanisms for accruing wealth that developed in the Italian urban context were important factors in the historigraphic turn, but as the period wore one, changes in the types of people writing history also contributed to modified presentations of wealth in their writings. Whether describing the display of luxury or its regulation, civic improvements or the destruction of a town's buildings by warring factions, taxation in a city or the corruption of its offiicials, views towards material goods in medieval Italian urban histories were neither wholly positive nor negative. Rather, the historiographic value of material goods was complex. The frequency with which wealth was a topic of discussion in civic histories highlights how the peninsula's inhabitants were coming to terms with the influx of wealth and the material goods they could acquire as members of their urban communities.

Introduction Mental health (MH) clinical pharmacy specialists (CPS) are increasingly functioning as integral providers in MH care teams. MH providers may delegate many medication management tasks to the CPS. As there is a shortage of primary care and specialist MH providers, CPS are increasingly being utilized in MH care clinics. We assess provider and CPS perceptions of the contributions of CPS to MH clinical teams in the Veterans Health Administration. Methods We examined the roles and functions of CPS in MH clinics through surveys (n = 374) and semistructured interviews (n = 16) with MH CPS and other members of MH clinical teams (psychiatrists, nurse practitioners, registered nurses, social workers) to gain insight into how CPS were integrated in these settings. We assessed perceptions of CPS contributions to MH teams, interactions between CPS and other providers, and challenges of integrating CPS into MH clinical teams. Results Contributions of CPS in MH were received positively by clinical team members. Clinical pharmacy specialists providing comprehensive medication management were especially valuable in the management of clozapine. The knowledge and training of CPS reassured providers who frequently referred to them with questions about medication and medication therapy management. MH CPS were also perceived to be received well by patients. Discussion The integration of MH CPS into MH teams was well received by team members and patients alike. The MH CPS have become important members of the MH team and are widely viewed as being able to improve access, quality, and workflow.

Background Sex differences characterize cardiovascular outcomes in patients with type 1 diabetes. Cardioautonomic neuropathy is a common complication of type 1 diabetes that associates increased morbi-mortality. Data regarding the interplay between sex and cardiovascular autonomic neuropathy are scarce and controversial in these patients. We aimed to address sex-related differences in the prevalence of seemingly asymptomatic cardioautonomic neuropathy in type 1 diabetes, and their associations with sex steroids. Methods We conducted a cross-sectional study including 322 consecutively recruited patients with type 1 diabetes. Cardioautonomic neuropathy was diagnosed using Ewing's score and power spectral heart rate data. We assessed sex hormones by liquid chromatography/tandem mass spectrometry. Results When considering all subjects as a whole, asymptomatic cardioautonomic neuropathy prevalence was not significantly different between women and men. When age was taken into account, the prevalence of cardioautonomic neuropathy was similar among young men and those > 50 years. However, in women > 50 years, the prevalence of cardioautonomic neuropathy doubled that of young women [45.8% (32.6; 59.7) vs. 20.4% (13.7; 29.2), respectively]. The OR of having cardioautonomic neuropathy was 3.3 higher in women > 50 years than in their younger counterparts. Furthermore, women presented more severe cardioautonomic neuropathy than men. These differences were even more marked when women were classified according their menopausal status instead of age. Peri- and menopausal women had an OR 3.5 (1.7; 7.2) of having CAN compared with their reproductive-aged counterparts [CAN prevalence: 51% (37; 65) vs. 23% (16; 32), respectively]. A binary logistic regression model (R2: 0.161; P = 0.001) displayed age > 50 years as a significant determinant of cardioautonomic neuropathy only in women. Androgens were positively associated with heart rate variability in men, and negatively in women. Accordingly, cardioautonomic neuropathy was associated with increased testosterone/estradiol ratio in women but to decreased testosterone concentrations in men. Conclusions Menopause in women with type 1 diabetes is accompanied by an increase in the prevalence of asymptomatic cardioautonomic neuropathy. This age-related excess risk of cardioautonomic neuropathy is not observed in men. Men and women with type 1 diabetes have opposite associations between circulating androgens and indexes of cardioautonomic function. Trial registration ClinicalTrials.gov Identifier: NCT04950634.