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OBJECTIVES: The metabolic abnormalities that lead to diabetes mellitus (DM) following an episode of acute pancreatitis (AP) have not been extensively studied. This manuscript describes the objectives, hypotheses, and methods of mechanistic studies of glucose metabolism that comprise secondary outcomes of the Diabetes RElated to Acute pancreatitis and its Mechanisms (DREAM) Study. METHODS: Three months after an index episode of AP, participants without pre-existing DM will undergo baseline testing with an oral glucose tolerance test. Participants will be followed longitudinally in three sub-cohorts with distinct metabolic tests. In the first and largest subcohort, oral glucose tolerance tests will be repeated 12 months after AP and annually to assess changes in β-cell function, insulin secretion, and insulin sensitivity. In the second, mixed meal tolerance tests will be performed at 3 and 12 months, then annually, and following incident DM to assess incretin and pancreatic polypeptide responses. In the third, frequently-sampled intravenous glucose tolerance tests will be performed at 3 months and 12 months to assess the first-phase insulin response and more precisely measure β-cell function and insulin sensitivity. CONCLUSIONS: The DREAM study will comprehensively assess the metabolic and endocrine changes that precede and lead to the development of DM after AP.

Mechanically interlocked molecules (MIMs) possess unique architectures and nontraditional degrees of freedom that arise from well-defined topologies that are achieved through precise mechanical bonding. Incorporation of MIMs into materials can thus provide an avenue to discover new and emergent macroscale properties. Here, the synthesis of a phenanthroline-based [2]catenane crosslinker and its incorporation into polyacrylate organogels are described. Specifically, Cu(I) metalation and demetalation was used as a postgelation strategy to tune the mechanical properties of a gel by controlling the conformational motions of integrated MIMs. The organogels were prepared via thermally initiated free radical polymerization, and Cu(I) metal was added in MeOH to the pretreated, swollen gels. Demetalation of the gels was achieved by adding lithium cyanide and washing the gels. Changes in Young's and shear moduli, as well as tensile strength, were quantified through oscillatory shear rheology and tensile testing. The reported approach provides a general method for postgelation tuning of mechanical properties using metals and well-defined catenane topologies as part of a gel network architecture.

Although on-demand cargo release has been demonstrated in a wide range of microparticle platforms, many existing methods lack specific loading interactions and/or undergo permanent damage to the microparticle to release the cargo. Here, we report a novel method for electrostatically loading negatively charged molecular cargo in oligoviologen-crosslinked microparticles, wherein the cargo can be released upon activation by visible light. A water-in-oil (W/O) emulsion polymerization method was used to fabricate narrowly dispersed microparticles crosslinked by a dicationic viologen-based dimer and a poly(ethylene glycol) diacrylate. A zinc-tetraphenyl porphyrin photocatalyst was also polymerized into the microparticle and used to photochemically reduce the viologen subunits to their monoradical cations through a visible-light-mediated photoredox mechanism with triethanolamine (TEOA) as a sacrificial reductant. The microparticles were characterized by microscopy methods revealing uniform, spherical microparticles 481 ± 20.9 nm in diameter. Negatively charged molecular cargo (methyl orange, MO) was electrostatically loaded into the microparticles through counteranion metathesis. Upon irradiation with blue (450 nm) light, the photo-reduced viologen crosslinker subunits lose positive charges, resulting in release of the anionic MO cargo. Controlled release of the dye, as tracked by absorption spectroscopy, was observed over time, yielding release of up to 40% of the cargo in 48 h and 60% in 120 h in single dynamic dialysis experiment. However, full release of cargo was achieved upon transferring the microparticles to a fresh TEOA solution after the initial 120 h period.

STUDY OBJECTIVES: To explore the association of continuous positive airway pressure (CPAP) adherence with clinical outcomes in patients with type 2 diabetes and obstructive sleep apnea in a real-world setting. METHODS: This was a retrospective study of patients with type 2 diabetes diagnosed with obstructive sleep apnea between 2010 and 2017. CPAP adherence (usage for ≥ 4 h/night for ≥ 70% of nights) was determined from the first CPAP report following the polysomnography. Data including estimated glomerular filtration rate, hemoglobin A1c, systolic and diastolic blood pressure, lipid panel, and incident cardiovascular/peripheral vascular/cerebrovascular events were extracted from medical records. Mixed-effects linear regression modeling of longitudinal repeated measures within patients was utilized for continuous outcomes, and logistic regression modeling was used for binary outcomes. Models were controlled for age, sex, body mass index, medications, and baseline levels of outcomes. RESULTS: Of the 1,295 patients, 260 (20.7%) were CPAP adherent, 318 (24.5%) were CPAP nonadherent, and 717 (55.3%) had insufficient data. The follow-up period was, on average, 2.5 (1.7) years. Compared to those who were CPAP nonadherent, those who were adherent had a significantly lower systolic blood pressure (β = −1.95 mm Hg, P = .001) and diastolic blood pressure (β = −2.33 mm Hg, P < .0001). Among the patients who were CPAP adherent, a 17% greater CPAP adherence was associated with a 2 mm Hg lower systolic blood pressure. Lipids, hemoglobin A1c, estimated glomerular filtration rate, and incident cardiovascular/peripheral vascular/cerebrovascular events were not different between the 2 groups. CONCLUSIONS: Achieving CPAP adherence in patients with type 2 diabetes and obstructive sleep apnea was associated with significantly lower blood pressure. Greater CPAP use within patients who were adherent was associated with lower systolic blood pressure. CITATION: Sheth U, Monson RS, Prasad B, et al. Association of continuous positive airway pressure adherence with complications in patients with type 2 diabetes and obstructive sleep apnea. J Clin Sleep Med. 2021;17(8):1563–1569.

Programming remotely activated soft actuators that respond quickly and reversibly while traveling defined distances is a major challenge in materials science. Recently, the precise fabrication of highly functional, photoresponsive soft actuators composed of fused yet competing spiropyran-based bilayered hydrogels that respond to a single visible light source was achieved. When combined with photoinactive hydrogels in precise patterns, a series of extravagant “walkers” that undergo predetermined origami-like shape changes is possible.

Despite decades of research on strategies to address disparities in diabetes screening, prevention and treatment, disparities particularly by race/ethnicity and socioeconomic status persist. An innovative approach to diabetes screening was therefore piloted in the Emergency Department (ED) at the University of Illinois Hospital in Chicago from February to April 2021. A best practices advisory (BPA) was built into the electronic medical records system that flagged ED patients at risk for diabetes for a provider to add a A1c test to an already planned blood specimen. The criteria were: all patients age >= 45 years, or patients age 18-44 years with a BMI >= 25; and, with no history of diabetes in the chart and no A1c performed in the last 3 years. Of the 8441 ED visits during the pilot timeframe, the BPA was triggered in 2691, and 2118 visits had a A1c resulted. Approximately half of the results (52%, n=1098) were abnormal. Of the abnormal results, 70% were in the prediabetes range (A1c 5.7-6.4%) and 30% in the diabetes range (A1c >= 6.5%; with 62 of the A1c results >=10%) . As A1c results were not immediately available in the ED, study staff successfully contacted 352 patients with an abnormal result by phone; the remaining were sent a letter informing them of their abnormal result. Of the 352, the average age was 52.2 years, 55% were female, 65% Non-Hispanic Black, 20% Hispanic, 15% Non-Hispanic White/Other. Half were on either Medicare or Medicaid, and 4% uninsured. The median income of the patients’ zipcodes fell at the 44th percentile of the U.S. income. During this initial phase, our novel screening in the ED identified a significant number of patients with undiagnosed diabetes, particularly minority and poor patients, indicating this approach could be leveraged to further stymie health disparities. Future research will now test the linkage of these new patients to diabetes education and care within the health care system. Disclosure K.K.Danielson: None. B.Rydzon: None. Y.Eisenberg: None. B.T.Layden: None. J.Lin: Research Support; Gilead Sciences, Inc., Novo Nordisk. Funding Novo Nordisk (G2111)

Craniofacial microsomia (CFM) is the second most common congenital craniofacial malformation characterized by asymmetric malformation of the ear and mandible. Numerous studies have reported the importance of child perspective and psychosocial issues in patients with craniofacial abnormalities. However, clinical tools to evaluate child and caregiver perspectives in patients with microtia with or without CFM have been limited or not reported in the literature. The authors aimed to (1) To develop a tool for measuring patient and caregiver evaluation of facial appearance as it relates to microtia and craniofacial microsomia (CFM). (2) To utilize this tool in comparing children, between 7 and 20 years of age, and caregiver perspectives towards facial appearance in patients with microtia with or without craniofacial microsomia (CFM). A prospective single center study conducted from 2016 to 2017 using newly developed 13-item (Microtia) and 27-item (CFM) 5-point Likert scale Likert scale questionnaires given to patients with CFM and caregivers at a craniofacial center. Aged 7 to 20 (N = 25) and their caregivers. A total of 25 patients (13 male, 12 female; mean age at time of survey 13.2 ± 3.7) met criteria for the study. The Likert scale developed and presented in this study may be a useful tool for clinical use in investigating patient and caregiver perspectives for planning surgical timeline. Based on our pilot data it is important to incorporate all voices into decision-making on timing.

This cross-sectional study describes a screening program that was developed to screen for type 2 diabetes in an urban emergency department setting in the US.

Objectives Women with a history of gestational diabetes (GDM) are at 7-fold increase in the risk of developing diabetes. Insufficient sleep has also been shown to increase diabetes risk. This study aimed to explore the feasibility of a sleep extension in women with a history of GDM and short sleep, and effects on glucose metabolism. Methods Women age 18–45 years with a history of GDM and actigraphy confirmed short sleep duration (t-tests. Results Mean (SD) sleep duration increased within the Sleep-Extend group (n=9, +26.9 (42.5) min) but decreased within the controls (n=5, − 9.1 (20.4) min), a mean difference (MD) of 35.9 min (95% confidence interval (CI) − 8.6, 80.5). Fasting glucose increased, but less in Sleep-Extend vs. control groups (1.6 (9.4) vs 10.4 (8.2) mg/dL, MD − 8.8 mg/dL (95% CI − 19.8, 2.1), while 2-h glucose levels after an OGTT did not differ. Compared to controls, Sleep-Extend had decreased fatigue score (MD − 10.6, 95%CI − 20.7, − 0.6), and increased self-report physical activity (MD 5036 MET- minutes/week, 95%CI 343, 9729. Fitbit compliance and satisfaction in Sleep-Extend group was high. Conclusion Sleep extension is feasible in women with a history of GDM, with benefits in fatigue and physical activity, and possibly glucose metabolism. These data support a larger study exploring benefits of sleep extension on glucose metabolism in these high-risk women. Trial registration ClinicalTrials.gov, NCT03638102 (8/20/2018)

Metabolic surgery is the most effective method for weight loss in the long-term treatment of morbid obesity and its comorbidities. The primary aim of this study was to examine factors associated with percent total weight loss (%TWL) after metabolic surgery among an ethnically diverse sample of patients. A retrospective review was performed on 1012 patients who underwent either a sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) at our institution between January 2008 and June 2015. African Americans had a lower %TWL than non-Hispanic/Latino Whites at 6, 9, 12, 18, and 48 months. At all timeframes, there was a negative association between pre-surgery TWL and %TWL after surgery. Female sex was negatively associated with %TWL at 3 months only. Higher initial BMI was also associated with greater post-operative %TWL at 18, 24 and 36 months. Older patients had lower %TWL at 6, 9, 12 and 24 months post-surgery. Patients who received RYGB had greater %TWL than those who received SG at 3, 6, 9, 12, 24 and 36 months. African Americans had a lower %TWL than non-Hispanic/Latino Whites at most time points; there were no other significant race/ethnicity or sex differences. BMI (greater initial BMI), age (lower) and RYGB were associated with a greater post-operative %TWL at certain post-surgery follow-up time points. A limitation of this study is that there was missing data at a number of time points due to lack of attendance at certain follow-up visits.

Access to specialized medical care is critical to decrease complications and minimize long-term morbidity, yet racial disparities in cleft surgery persist as time to initial reconstruction remains delayed among minority patients. Research has demonstrated an average 3-week delay in surgery for minority patients nationally. A retrospective chart review of patient demographics, visit timing, and surgical history was performed for patients who underwent primary cleft lip with or without palate (CL + P) reconstruction between 2002 and 2016 at an urban craniofacial center. Of the 89 children who underwent surgery, 87% were ethnic minorities (58% Hispanic, 25% African-American, 4% Asian/Other). Caucasian children were the earliest to receive CL (3.5 months) and CP (13-months) repair. Minority children trended toward a delay in CL repair, with surgery for African-Americans at 5-months (P = 0.06) and Hispanics at 4.8-months (P = 0.07). Time from first visit to CL surgery showed significant delays for minority, non-English speaking, and public insurance patients; however, for CP repair, male children were delayed from first visit to surgery compared to females (P = 0.03). While there was no statistical difference in age at CL or CP surgical repair among our racial/ethnic cohorts, there were significant racial/ethnic differences in timing spent in the preoperative period for CL. However, racial/ethnic differences decreased as the patients spent more time within the healthcare system. Thus, established, interdisciplinary cleft/craniofacial centers well versed in minority patients can minimize the complex social and cultural factors that contribute to delays in cleft care.

Allogeneic islet cell transplantation (ICT) can be an effective therapy for many patients with brittle type 1 diabetes, as it may reestablish hypoglycemic awareness and better attain optimal glycemic control. The ICT program at the University of Illinois at Chicago (UIC) began in 2004 and we herein present the summary of all patients’ outcomes to date. The 43 patients receiving ICT at UIC include 10 patients in the phase1/2 trial, 20 patients in the phase 3 trial, 10 patients in the Clinical Islet Transplant Consortium trials (CIT-02, n=2; CIT-06, n=4; CIT-07, n=4), and 3 University of Chicago patients transplanted with islets manufactured at UIC. Overall, the sample had a mean baseline age of 46.7 years, BMI 23.4, HbA1c 7.4%, and insulin dose 0.48 units/kg/day, and 74.4% were female, and 95.3% Non-Hispanic white. Single ICTs were performed in n=18, two ICTs in n=18, and three ICTs in n=7. Thirty seven completed 1-year follow-up after last ICT. The following results at 1-year post-last ICT are presented respectively for the phase 1/2 trial (21 ICTs), phase 3 trial (35 ICTs), and supplemental group (CIT and University of Chicago; 19 ICTs). The primary outcome of attaining both an HbA1c ≤6.5%, and no severe hypoglycemic episodes (SHEs) between 1-month and 1-year post-last ICT, was achieved in: 90%, 50%, and 54%. Insulin independence was attained in: 80%, 60%, and 54%. Graft failure occurred in: 0%, 25%, and 39%. In the two UIC trials combined, HbA1c decreased from 7.4% at baseline to 6.0%; and SHEs decreased from 1.0/month at baseline to 0.1/month. At 5-years post-last ICT in the two UIC trials, 11 of 15 (73.3%) still met the criteria for a successful primary outcome. In terms of safety, the frequency of serious adverse events across the three groups, respectively, were: 50%, 50%, and 54%. Despite the documented risks of ICT for type 1 diabetes primarily due to the chronic use of immunosuppression, many patients may potentially benefit in terms of eliminating SHEs and optimizing glycemic control. Disclosure K.K. Danielson: None. Y. Li: None. J. Oberholzer: Research Support; Self; JDRF. Stock/Shareholder; Self; Sigilon Therapeutics. Other Relationship; Self; CellTrans Inc., Sigilon Therapeutics. Funding American Diabetes Association (1-16-ICTS-022 to K.K.D.); National Institutes of Health (U42RR023245, UL1RR029879, UC4DK114839, U01DK070431, R01DK091526)

Continuous positive airway pressure (CPAP) treatment has been shown to be beneficial to patients with obstructive sleep apnea (OSA) by reducing blood pressure and possibly slowing progression of chronic kidney disease. However, there is a dearth of research on the effects of CPAP treatment, especially compliance, on these outcomes in patients with type 2 diabetes (T2D) in a real world setting. Methods: A single-center, retrospective chart review was conducted on patients with T2D who were diagnosed with OSA between 2010 and 2018. The first available CPAP report following the polysomnography was used to determine compliance (CPAP usage for >4 h/night for >70% of nights). Data such as estimated glomerular filtration rate (eGFR), A1C, blood pressure, lipid panel, and incident cardiovascular/peripheral vascular/cerebrovascular events (CVD, PVD and CVA) were extracted from the charts. Mixed-effects linear regression modeling of longitudinal repeated measures within patients was utilized for continuous outcomes, and logistic regression modeling was used for incident events. All models were controlled for age, sex, body mass index (BMI), medications, and baseline levels of outcomes. Results: Of the 1,295 patients, 239 (18.4%) were compliant and 339 (26.2%) were non-compliant with CPAP, while 717 (55.3%) had insufficient data. Compared to those who were CPAP non-compliant, those who were compliant had a significantly lower systolic blood pressure (β=-2.28 mmHg, p=0.0002), lower diastolic blood pressure (β=-2.52 mmHg, p Conclusion: T2D patients with OSA who were compliant with CPAP had significantly lower blood pressure as well as higher HDL. However, eGFR, A1C, or cardiovascular events did not significantly differ by CPAP compliance in this study. Disclosure S. Reutrakul: None. B. Prasad: None. A. Sahni: None. S. Matani: None. U. Sheth: None. K.K. Danielson: None. M. Carlucci: None. T. Mercado: None. M. Smith: None.

Background: Intrinsically photosensitive retinal ganglion cells (ipRGCs) control non-visual light responses (e.g. pupillary light reflex and circadian entrainment). Patients with diabetic retinopathy (DR) show reduced ipRGC function, as inferred by abnormalities in the post illumination pupil response (PIPR). We explored whether ipRGC function in DR is associated with circadian outputs and sleep/wake behavior. Methods: Forty-five participants (15 without diabetes, 15 with type 2 diabetes (T2D) and no DR, 15 with T2D and DR) participated. ipRGC function was inferred from the PIPR (pupil size following stimulus offset). Circadian outputs were melatonin amplitude (overnight urinary 6-sulfatoxymelatonin (aMT6s)) and timing (dim light melatonin onset (DLMO)), and evening salivary cortisol levels. Sleep/wake patterns were measured with wrist actigraphy and insomnia symptoms were assessed subjectively. Results: Patients with T2D and DR had smaller PIPR and lower urinary aMT6s than other groups (p

Interest in the design and development of artificial molecular muscles has inspired scientists to pursue new stimuli-responsive systems capable of exhibiting a physical and mechanical change in a material in response to one or more external environmental cues. Over the past few decades, many different types of stimuli have been investigated as a means to actuate materials. In particular, materials that respond to reduction and oxidation of their constituent molecular components have shown great promise on account of their ability to be activated either chemically or electrochemically. Here, we introduce a novel redox-responsive mechanism of actuation in hydrogels by describing a systematic investigation into the radical-based self-assembly of a series of unimolecular viologen-based oligomeric links, present at only 5 mol % of the polymer linkers in a three-dimensional network. The actuation process results in an overall reversible contraction of a family of hydrogels, down to 35% of their original volume ...

Introduction Experimental and epidemiological data have linked insufficient sleep to increased diabetes risk. Women with a history of gestational diabetes (GDM) have a 7-fold greater risk of developing type 2 diabetes. This pilot study explored the feasibility of a sleep extension intervention in women with a history of GDM and short sleep, and the effects on glucose metabolism. Methods Women age 18–45 years with a history of GDM (at least 1 year postpartum) and actigraphy confirmed short sleep duration ( Results Twelve women (mean (SD) age 40.3 (4.5) years) participated (n=8 Sleep Extend, n=4 control). Compared to baseline, nightly sleep duration increased in Sleep Extend group (+30.6 (48.8) minutes) but decreased in the control group (-6.8 (22.9) minutes). Both fasting and 2-h glucose levels from OGTT increased in both groups but were greater in the control group (Sleep extend vs. healthy living: fasting glucose +2.1 (9.8) vs. +12.8 (7.3) mg/dL; 2-h glucose +8.2 (21.9) vs. +20.0 (19.4) mg/dL). Self-reported sleep quality improved in both groups. When compared controls, Sleep Extend participants reported improved fatigue symptoms (Promis fatigue score change -5.1 (9.3) vs. 7.0 (1.0), p=0.008), and self-reported physical activity tended to increase (+1614 (3659) vs. -2900 (3922) MET-minutes/week). Combining all participants, an increase in sleep duration correlated with a decrease in fatigue (r= -.62, p=0.04) and anxiety symptoms (r= -.69, p=0.02). Conclusion Sleep extension through coaching and use of remote monitoring is feasible in women with a history of GDM. It appears to decrease fatigue and may improve glucose metabolism and physical activity. Support (if any) NIDDK P30 DK092949

Previous studies have investigated reconstructive decisions after mastectomy and such studies document a preference among African American women for autologous tissue-based procedures and among Latin American women for implant-based reconstructions, however, there is a paucity of studies evaluating the current relationship between ethnicity and reconstructive preferences. This institutional review provides a unique, up-to-date evaluation of an understudied urban population composed of majority ethnic minority patients and explores reconstructive trends. Consecutive breast reconstruction patients were entered into a prospectively maintained database at the University of Illinois at Chicago and affiliate hospitals between July 2010 and October 2013. Demographics and oncologic characteristics including tumor stage, pathology, BRCA status, and adjuvant treatment were reviewed, and reconstructive trends were assessed by racial group with a focus on reconstructive procedure, mastectomy volume, and implant characteristics. Statistical analysis was performed using SAS (version 9.2). One-hundred and sixty breast reconstructions were performed in 105 women; of which 50 per cent were African American, 26 per cent Hispanic, 22 per cent Caucasian, and 2 per cent Asian. Age, tumor stage, prevalence of triple negative disease, chemotherapy, and radiation treatment was comparable between groups. Rates of obesity, hypertension, and diabetes mellitus were slightly higher in African American and Hispanic cohorts, with more African American patients having one or more of these comorbidities as compared with the Caucasian and Hispanic cohorts ( P = 0.047). Despite comparable positive BRCA testing rates, significant differences were seen in the percentage of bilateral mastectomy; 68 per cent African American, 48 per cent Caucasian, and 30 per cent Hispanic ( P = 0.004). Hispanics predominantly underwent flap-based reconstruction (56%), while African American (74%) and Caucasian (60%) patients had a preference toward tissue expander reconstruction ( P = 0.04 across all groups). African American and Hispanic presented with increased mastectomy weights and thus required higher implant volumes as compared with Caucasians that approached significance ( P = 0.06 and P = 0.06). Implant size utilization followed a unimodal distribution for Caucasians, peaking at 500 cc; while African American and Hispanic demonstrated a bimodal distribution, peaking once at 550 cc and again at the max implant volume of 800 cc. This study of a large proportion of minority patients in an urban geographic setting offers an evolving understanding of breast reconstruction patterns. The data demonstrated unique findings of increased rates of bilateral implant-based reconstruction in African American women and unilateral flap-based reconstructions in Hispanic patients. Reconstructive decision-making seems to be greatly influenced by cultural and geographically driven preferences.

Aims: While cytokines play a role in the etiology of type 1 diabetes, cytokines later in the disease are less understood. We therefore investigated associations of pro-inflammatory tumor necrosis factor-α levels measured at prolonged disease duration with C-peptide at diagnosis, long-term glycemic control, diabetes duration, clinical factors, and health behaviors. Methods: Data and blood were collected during an ancillary study to the longitudinal Wisconsin Diabetes Registry, a population-based cohort followed since diagnosis of type 1 diabetes. The ancillary study was conducted at 13–18 years diabetes duration, and enrolled premenopausal women age 18–45 years (n=87). Results: Higher tumor necrosis factor-α levels at 13–18 years diabetes duration were independently associated with longer duration (p=0.0004) and worse current renal function (p=0.02). Additionally, diabetes duration modified both of the positive associations of tumor necrosis factor-α levels (both interactions p≤0.01) with mean glycemic control during the previous 10 years (significant only in women with longer durations) and current daily caffeine intake (significant only in women with shorter durations). In women with C-peptide measured at diagnosis (n=50), higher tumor necrosis factor-α levels at 13–18 years duration were associated with lower C-peptide (p=0.01), independent of glycemic control during the previous 10 years. Conclusions: Lower residual C-peptide at diagnosis and poor long-term glycemic control independently predicted higher pro-inflammatory tumor necrosis factor-α levels years later. The novel relationship with C-peptide needs confirmation in a larger cohort. Given the association between tumor necrosis factor-α and diabetes complications, further longitudinal studies may help clarify the potentially complex associations between glycemic control, inflammatory cytokines, and complications.

Breast reconstruction is an important aspect of treatment after breast cancer. Postmastectomy reconstruction bears a significant impact on a woman's postsurgical confidence, sexuality, and overall well-being. Previous studies have inferred that women under age 40 years have unique characteristics that distinguish them from an older cohort. Identifying age-dependent trends will assist with counseling women on mastectomy and reconstruction. To identify age-dependent trends, 100 consecutive women were sampled from a prospectively maintained breast reconstruction database at an urban academic institution from June 2010 through June 2013. Women were placed into two cohorts 2, and Fischer's exact were used to compare

Laparoscopic adrenalectomy (LA) is accepted as the gold standard treatment for most adrenal pathologies. Open surgery is still considered the standard of care for large tumors and malignancies. In the past decade, robotic adrenalectomy (RA) has become an alternative to the laparoscopic and open approaches. The aim of this study was to analyze perioperative and postoperative outcomes in a series of consecutive nonselected patients undergoing a RA, to determine whether factors that negatively affect outcomes in LA (body mass index [BMI], size, and side of the tumor) have the same impact in RA.This is a single-center single-surgeon retrospective study with 43 patients who underwent a RA. Patients were divided into different groups according to tumor size (cutoff values of 5 or 8 cm), tumor side (left/right), and BMI (cutoff value of kg/mThere were no significant differences between the groups with tumors5 cm versus ≥5 cm regarding gender, age, race, BMI, American Society of Anesthesiologists (ASA) score, history of previous abdominal surgery, tumor side, and histopathological diagnosis (all P values ≥.06). There were no significant differences in any of the outcomes analyzed with respect to the tumor size (all P values ≥.14) except for a higher occurrence of complications in patients with tumors ≥8 cm versus8 cm (P = .03). There were no significant differences in any outcomes related to side (left versus right) of the tumor nor BMI (30 versus ≥30 kg/mPatient's BMI, tumor side, and size did not demonstrate a negative impact on perioperative and postoperative outcomes of RA. This approach could potentially expand the indications of minimally invasive surgery.

Islet cell transplantation is a promising functional cure for type 1 diabetes; however, maintaining long-term islet graft function and insulin independence is difficult to achieve. In this short report we present a patient with situs inversus, who at the time of islet transplantation had a 26-year history of type 1 diabetes, complicated by hypoglycemic unawareness and severe hypoglycemic events. After a single allogeneic islet transplant of a low islet mass, and despite developing de novo anti-insulin and anti-GAD65 autoantibodies, the patient has remarkably maintained insulin independence with tight glycemic control and normal metabolic profiles for 10 years, after receiving prolonged non-T-cell depleting immunosuppression.

Increased cardiovascular disease (CVD) risk is a clinically significant feature of type I diabetes (T1D). Several CVD markers were shown to regress or stabilize after functionally curing T1D via islet cell transplant (ICT), yet the inverse is unknown: does recipients’ CVD health at first ICT predict clinical outcomes following ICT. In 30 patients receiving 1-3 ICTs, CVD markers and basic labs were measured at first ICT (e.g., lipids, blood pressure, blood counts/chemistries, and carotid intima-media thickness [CIMT]), along with clinical outcomes (e.g., C-peptide/insulin from four distinct metabolic tests) measured serially after first ICT (mean [range] 2.1 [0.3-8.7] years). Multivariable regression of repeated measures determined longitudinal associations, adjusting for recipient demographics, BMI, ICT number, and islet equivalents transplanted. Mean (SD) age, T1D duration, and BMI at first ICT were 47.3 (11.5) and 29.4 (12.0) years, and 22.9 (1.9), respectively; 80% female. Lower LDL/HDL pre-ICT predicted greater fasting C-peptide (n=759 observations, p=0.01) and multiple measures of stimulated C-peptide and insulin (n=68-76, all p≤0.04); lower triglycerides pre-ICT (n=811, p=0.003) and systolic blood pressure day of first ICT (n=1142, p=0.007) predicted greater fasting C-peptide. Low (normal) hemoglobin and percent eosinophils the day of first ICT also predicted greater fasting C-peptide (n=1142, all p=0.002) and stimulated C-peptide and insulin (n=73-107, all p≤0.048). Lower recipient CIMT pre-ICT predicted greater acute insulin response post-ICT (n=42, p=0.04). Multiple traditional CVD protective factors, along with lower hemoglobin and eosinophils (both recently shown to be CVD protective factors), at first ICT predicted better outcomes. These results may be clinically significant as improving CVD health pre-ICT (e.g., with diet, exercise, and/or medications) may further support its success. Disclosure K.K. Danielson: None. R.S. Monson: None. Y. Li: None. B. Rydzon: None.

Background Women with type 1 diabetes (T1DM) have an elevated fracture risk. We therefore compared the associations of health behaviours and clinical factors with bone mineral density (BMD) and bone remodelling between premenopausal women with and without T1DM to inform potential interventions. Methods Participants included women with T1DM (n = 89) from the Wisconsin Diabetes Registry Study and age-matched and race-matched controls without diabetes (n = 76). Peripheral (heel and forearm) and central (hip and spine) BMD, markers of bone resorption and formation, bone cell signalling, glycaemic control, and kidney function were assessed. Health behaviours and medical history were self-reported. Results In controls, but not in women with T1DM, older age was associated with lower bone resorption (p ≤ 0.006) and formation (p = 0.0007). Body mass index was positively associated with heel and forearm BMD in both controls and T1DM women (all p

Islet cell transplantation can functionally cure type 1 diabetes, and also improve carotid-intima media thickness. This study provides a preliminary description of changes in coronary artery calcium following islet transplantation, and associated factors. Coronary artery calcium was measured in 14 patients with type 1 diabetes (11 had measures both pre- and post-transplant [mean 2.3 years]) in the University of Illinois at Chicago's clinical trial. Multivariable mixed-effects linear regression of repeated measures was used to quantify calcium change, and determine if this change was longitudinally associated with risk/protective factors. Thirteen of the patients were female, with mean baseline age, diabetes duration, and BMI of 47.6 and 28.7 years and 23.1, respectively. Over half (57%) had detectable coronary artery calcium pre-transplant. Minimal change (0.39 mm3/year, p=0.02) occurred in coronary artery calcium levels pre- to post-transplant. No patient met criteria for calcium progression. Coronary artery calcium was positively associated with total and small VLDL particles (p≤0.02), statin dose (p=0.02), and urine albumin-to-creatinine ratio (p=0.04); and negatively associated with free fatty acids (p=0.03), total HDL (p=0.03), large HDL particles (p=0.005), and tacrolimus dose (p=0.02). Islet transplant may stabilize coronary artery calcium, with optimal management of lipids and kidney function remaining key therapeutic targets. [NCT00679041] This article is protected by copyright. All rights reserved.

Background Individuals with type 1 diabetes may have low IGF-1, related to insulinopenia and insulin resistance. There are few longitudinal studies of IGF-1 levels to establish its pattern in type 1 diabetes with duration and age, and to examine whether IGF-1 tracks within individuals over time. We examine age and duration trends, and the relationship of IGF-1 to gender, glycaemic control, insulin level and other factors. Methods Participants in the Wisconsin Diabetes Registry Study, an incident cohort study of type 1 diabetes diagnosed May 1987–April 1992, were followed for up to 18 years with IGF-1 samples up to age 45 for women and age 37 for men. Results IGF-1 is lower with type 1 diabetes than in normative samples. Although, the pattern across age resembles that in normative samples with a peak in adolescence and slow decline after age 20, the adolescent peak is delayed for women with type 1 diabetes. There was low to moderate tracking of IGF-1 within an individual. Higher insulin dose was associated with higher IGF-1 as was puberty, and female gender. Adjusted for these factors, IGF-1 declined rapidly across early diabetes duration. Lower HbA1c was most strongly related to higher IGF-1 at Tanner stages 1 and 2. Conclusions IGF-1 is low in type 1 diabetes, with a delayed adolescent peak in women and is especially influenced by glycaemic control in early and pre-adolescence. High variability within an individual is likely a challenge in investigating associations between IGF-1 and long-term outcomes, and may explain contradictory findings. Copyright © 2014 John Wiley & Sons, Ltd.

Background Oxytocin, a hormone most commonly associated with parturition and lactation, may have additional roles in diabetes complications. We determined oxytocin levels in premenopausal women with type 1 diabetes mellitus (T1DM) compared with non-diabetic controls and examined associations of oxytocin with health behaviours, clinical factors, biomarkers, kidney function and bone health. Lower oxytocin was hypothesized for T1DM. Methods A cross-sectional study of premenopausal women with T1DM (n = 88) from the Wisconsin Diabetes Registry Study, a population-based cohort of incident T1DM cases, and matched non-diabetic controls (n = 74) was conducted. Results Women with T1DM had lower oxytocin levels than controls adjusting for caffeine and alcohol use (p = 0.03). Health behaviours associated with oxytocin differed between women with and without T1DM: oxytocin was negatively associated with hormonal contraceptive use (quantified as lifetime contraceptive oestrogen exposure) in women with T1DM (p = 0.003), whereas positively related to hormonal contraceptive use (quantified as never/former/current) in controls (p

Background The superomedial pedicle vertical scar breast reduction is gaining popularity for its round, projecting breast and shorter incision when compared with the traditional Wise-pattern reduction using an inferior pedicle. However, there is a paucity of large-volume institutional outcomes studies identifying how this technique fares against more traditional methods of reduction. Methods A retrospective review of a prospectively maintained database of bilateral breast reductions over a 3-year period was performed. One hundred superomedial breast reductions (50 patients) were matched to 100 inferior pedicle breast reductions (50 patients). Matching was implemented based on age (±3 years) and size of reduction (±200 g). Patient demographics, size of reduction, nipple-areola complex sensitivity, minor and major postoperative complications, and symptomatic relief were assessed. Statistical analysis was performed with SAS Version 9.2. Results Two hundred twelve patients underwent 424 bilateral breast reductions between January of 2009 and June of 2012 at a single institution. Mean volume of tissue reduced was 815 g per breast (range, 200 to 2068 g) and 840 g per breast (range, 250 to 2014 g), respectively. All patients achieved symptomatic relief. No statistical difference in major or minor complications was seen between the two cohorts. No statistical difference in major or minor complications was seen between the two cohorts. No significant difference in complications was seen between small- and large-volume reductions. Conclusion Superomedial pedicle vertical scar breast reduction is a novel, alternative mammaplasty technique with excellent functional and aesthetic outcomes which can be used for a wide range of macromastia without a significant difference in complication rates when compared with traditional Wise pattern inferior pedicle reduction mammaplasty. Clinical question/level of evidence Therapeutic, III.

Epidemiological data indicate that 20-50% of patients on dialysis for end-stage renal disease (ESRD) are obese (body mass index [BMI] ≥30 kg/m2) (1). Obese patients with chronic renal failure have longer wait times until kidney transplantation (2) and inferior patient outcomes (3-7). In the US, for example, patients with a BMI 40 kg/m2 (2). Higher BMIs in kidney transplant recipients are associated with excess risk of surgical site infections (SSIs), which negatively impact graft survival (8). Obesity is also associated with comorbidities such as diabetes, although data on whether obesity increases mortality in kidney transplanted patients remains unclear (8,9). Provider perceptions of these risks accompanied by the expectation of some centers to give obese patients time to lose weight are the main reasons why a number of transplant centers are reluctant to list obese patients for transplantation (2,10). Unfortunately, many of these obese patients have diabetes and hypertension likely secondary to their obesity (11) and such patients who remain on dialysis have a very high mortality rate. The 5-year mortality rate for diabetic and hypertensive dialysis patients is 75 and 70%, respectively (1). A recent study demonstrated that obese patients who did not present with any SSIs had the same kidney transplant success rate as patients with a normal BMI (8). If surgical procedures could be developed that prevent SSIs and demonstrate successful outcomes, transplant centers may become less reluctant to list obese patients for kidney transplantation. Although any benefit would still have to be weighed against potential increased risks from obesity-related comorbidities. The prevalence of obesity and ESRD is higher among racial and ethnic minority populations, including African-Americans and Hispanics, compared to Non-Hispanic whites (12-15). These observations suggest developing kidney transplantation options for obese patients with ESRD may also help to reduce health disparities in racial and ethnic minorities. We therefore developed a new, minimally invasive, robotic-assisted kidney transplantation method using a short epigastric incision. This method avoids any incision in the infection prone lower quadrants of the abdomen. We hypothesized a priori that the robotic approach would reduce SSIs and improve outcomes in obese kidney transplant patients. Herein, we present our experience and outcomes of the patients undergoing minimal invasive, robotic kidney transplantation at a single institution compared to patients who underwent the conventional open procedure.

Qi M, Morch Y, Lacik I, Formo K, Marchese E, Wang Y, Danielson KK, Kinzer K, Wang S, Barbaro B, Kollarikova G, Chorvat D Jr, Hunkeler D, Skjak-Braek G, Oberholzer J, Strand BL. Survival of human islets in microbeads containing high guluronic acid alginate crosslinked with Ca2+ and Ba2+. Xenotransplantation 2012; 19: 355–364. © 2012 John Wiley & Sons A/S. Abstract: Background: The main hurdles to the widespread use of islet transplantation for the treatment of type 1 diabetes continue to be the insufficient number of appropriate donors and the need for immunosuppression. Microencapsulation has been proposed as a means to protect transplanted islets from the host’s immune system. Methods: This study investigated the function of human pancreatic islets encapsulated in Ca2+/Ba2+–alginate microbeads intraperitoneally transplanted in diabetic Balb/c mice. Results: All mice transplanted with encapsulated human islets (n = 29), at a quantity of 3000 islet equivalent (IEQ), achieved normoglycemia 1 day after transplantation and retained normoglycemia for extended periods of time (mean graft survival 134 ± 17 days). In comparison, diabetic Balb/c mice transplanted with an equal amount of non-encapsulated human islets rejected the islets within 2 to 7 days after transplantation (n = 5). Microbeads retrieved after 232 days (n = 3) were found with little to no fibrotic overgrowth and contained viable insulin-positive islets. Immunofluorescent staining on the retrieved microbeads showed F4/80-positive macrophages and alpha smooth muscle actin–positive fibroblasts but no CD3-positive T lymphocytes. Conclusions: The Ca2+/Ba2+–alginate microbeads can protect human islets from xenogeneic rejection in immunocompetent mice without immunosuppression. However, grafts ultimately failed likely secondary to a macrophage-mediated foreign body reaction.

BACKGROUND: In the treatment of refractory antibody-mediated rejection (AMR), splenectomy has been associated with surprisingly rapid recovery of renal function. The mechanism is still unclear. METHODS: We review 11 recipients, who underwent rescue splenectomy (RS) as a treatment of AMR within 3 months after kidney transplantation. At transplantation, all patients had undergone desensitization for initially positive crossmatch to their prospective donors. The cellular populations of the spleen were analyzed by immunohistochemistry. For comparison, we obtained spleen specimens from eight controls who were non-transplantation patients. RESULTS: Rejection occurred in all the patients early after transplantation (mean [SD], 7.1 [5.7] days). One graft was lost 4 weeks after kidney transplantation. A significantly higher number of plasma cells (PCs) (P=0.049) and lower number of T and B lymphocytes (P=0.02 and P=0.005, respectively) were detected in the RS group compared with the control group. By analyzing the PC variations in the RS group, significantly lower numbers of PCs were detected in the spleens of patients who received rituximab before splenectomy (P=0.0004). In contrast, a higher number of PCs were found in patients (n=3) who did not respond to splenectomy and subsequently underwent bortezomib treatment and recovered their renal function (P=0.02). CONCLUSIONS: Splenectomy may reverse AMR by debulking PCs. Our analysis suggests that patients with a very high load of PCs may not be rescued by splenectomy alone and may need additional treatments.

OBJECTIVE Insulin resistance is greater in racial/ethnic minorities than in non-Hispanic whites (NHWs) for those with and without type 2 diabetes. Because previous research on insulin resistance in type 1 diabetes was limited to NHWs, racial/ethnic variation in an estimated measure of insulin resistance in type 1 diabetes was determined. RESEARCH DESIGN AND METHODS The sample included 79 individuals with type 1 diabetes diagnosed at age RESULTS Mean current age was 13.5 years (range 3.2–32.5) and diabetes duration was 5.7 years (0.1–19.9). eGDR was inversely associated with age. Compared with that in NHWs, age-adjusted eGDR was significantly lower among nonwhites (NHB, other/mixed, and Hispanic: Δ = −1.83, P = 0.0006). Age-adjusted eGDR was negatively associated with body fat, triglycerides, urinary albumin/creatinine, acanthosis nigricans, parental obesity, and parental insulin resistance and positively related to HDL and sex hormone–binding globulin. In multivariable analysis, lower eGDR was significantly associated with older age, nonwhite race/ethnicity, acanthosis, and lower HDL. CONCLUSIONS Minorities with type 1 diabetes are significantly more insulin resistant, as measured by eGDR, than NHWs. Exploring potential mechanisms, including disparities in care and/or physiological variation, may contribute to preventing racial/ethnic differences in insulin resistance–associated outcomes.

Use of four or more prescription medications is considered a risk factor for falls in older people. It is unclear whether this polypharmacy-fall relationship differs for adults with diabetes.We evaluated the association between number of prescription medications and incident falls in a multi-ethnic population of type-2 diabetes patients in order to establish an evidence-based medication threshold for fall risk in diabetes.Baseline survey (1994-1997) with 5 years of longitudinal follow-up.Eligible subjects (N = 46,946) had type-2 diabetes, wereor=18 years old, and enrolled in the Kaiser Permanente Northern California Diabetes Registry.We identified clinically recognized incident falls based on diagnostic codes (ICD-9 codes: E880-E888). Relative to regimens of 0-1 medications, regimens including 4 or more prescription medications were significantly associated with an increased risk of falls [4-5 medications adjusted HR 1.22 (1.04, 1.43), 6-7 medications 1.33 (1.12, 1.58),7 medications 1.59 (1.34, 1.89)]. None of the individual glucose-lowering medications was found to be significantly associated with a higher risk of falls in predictive models.The prescription of four or more medications was associated with an increased risk of falls among adult diabetes patients, while no specific glucose-lowering agent was linked to increased risk. Baseline risk of falls and number of baseline medications are additional factors to consider when deciding whether to intensify diabetes treatments.