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Diurnal variation of plasma glucose levels may contribute to diagnostic uncertainty. The permissible time interval, pT(t), was proposed as a time-dependent characteristic to specify the time within which glucose levels from two consecutive samples are not biased by the time of blood collection. A major obstacle is the lack of population-specific data that reflect the diurnal course of a measurand. To overcome this issue, an approach was developed to detect and assess diurnal courses from big data.A quantile regression model, QRM, was developed comprising two-component cosinor analyses and time, age, and sex as predictors. Population-specific canonical diurnal courses were generated employing more than two million plasma glucose values from four different hospital laboratory sites. Permissible measurement uncertainties, pU, were also estimated by a population-specific approach to render Chronomaps that depict pT(t) for any timestamp of interest.The QRM revealed significant diurnal rhythmometrics with good agreement between the four sites. A minimum pT(t) of 3 h exists for median glucose levels that is independent from sampling times. However, amplitudes increase in a concentration-dependent manner and shorten pT(t) down to 72 min. Assessment of pT(t) in 793,048 paired follow-up samples from 99,453 patients revealed a portion of 24.2 % sample pairs that violated the indicated pT(t).QRM is suitable to render Chronomaps from population specific time courses and suggest that more stringent sampling schedules are required, especially in patients with elevated glucose levels. [ABSTRACT FROM AUTHOR]

Aims/Introduction: Chronic kidney disease (CKD) is a very important issue globally because of the risk of its progressing to end‐stage renal disease. We aimed to identify factors contributing to long‐term estimated glomerular filtration rate (eGFR) decline to determine an early diagnosis and prevent CKD progression. Materials and Methods: From January 2003 to December 2006, 5,507 individuals underwent health checkups at our hospital's Preventive Medicine Research Center. We ultimately enrolled 2,175 individuals. The eGFR was ≥60 mL/min/1.73 m2 at the start of observation period, which was 20 years. The event onset time was the day that the eGFR became <30 mL/min during the 20‐year period. Baseline risk factors – in particular, the effect of plasma glucose levels on the eGFR – were extracted and evaluated by using Fine and Gray analysis. Results: During the 20‐year observation, the hazard ratio (HR) of CKD progression was examined. A fasting plasma glucose (FPG) level ≥105 mg/dL was significantly associated with the risk of CKD progressing to an eGFR <30 mL/min. This trend was similar in the slope of eGFR. An FPG ≥105 mg/dL or an glycated hemoglobin level ≥6.5% was useful for intervening in CKD progression. Multivariate analysis showed that independent risk factors were an FPG level ≥105 mg/dL (HR 1.9; P < 0.001), age ≥60 years (HR 3.86; P < 0.001), obesity (HR 1.61; P < 0.01) and urinary protein (HR 1.55; P < 0.01). Conclusions: For early intervention against a reduction in the eGFR, detecting mild increases in FPG ≥105 mg/dL in patients with CKD with or without diabetes is useful. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims/Introduction Chronic kidney disease (CKD) is a very important issue globally because of the risk of its progressing to end‐stage renal disease. We aimed to identify factors contributing to long‐term estimated glomerular filtration rate (eGFR) decline to determine an early diagnosis and prevent CKD progression. Materials and Methods From January 2003 to December 2006, 5,507 individuals underwent health checkups at our hospital's Preventive Medicine Research Center. We ultimately enrolled 2,175 individuals. The eGFR was ≥60 mL/min/1.73 m2 at the start of observation period, which was 20 years. The event onset time was the day that the eGFR became

Abstract Background In the context of rheumatoid arthritis and its systemic inflammatory implications, there is an increasing interest in investigating the role of prolactin in the clinical and metabolic aspects of the disease. This study aimed to explore the potential links between serum prolactin levels, serum glucose levels, and the clinical manifestations of arthritis. Methods This exploratory, cross-sectional, observational study focused on women diagnosed with rheumatoid arthritis. The research involved assessing prolactin and blood glucose concentrations, alongside specific clinical traits such as disease-related inflammation, morning stiffness, and fatigue intensity. The presence of changes in serum prolactin (PRL) was initially compared among the groups based on disease activity intensity. Using a multinomial regression analysis, the study analyzed the impact of predetermined clinical and metabolic factors on various categories of prolactin concentration. Results Out of the 72 participants included in the study, hyperprolactinemia was detected in 9.1% of the sample. No differences in serum PRL were identified among the evaluated groups based on disease activity. Following multivariate analysis, no statistically significant differences were identified for the outcomes of inflammatory activity and morning stiffness within each PRL category when compared to the reference category for PRL. There was no increased likelihood of encountering blood glucose levels below 100 mg/dl among individuals with higher prolactin concentrations compared to those in the lowest prolactin category (OR 5.43, 95% CI 0.51–58.28). The presence of clinically significant fatigue revealed a higher likelihood of encountering this outcome among patients with intermediate PRL values (prolactin categories 7.76–10.35 with OR 5.18, 95% CI 1.01–26.38 and 10.36–15.29 with OR 6.25, 95% CI 1.2–32.51) when compared to the reference category. Conclusions The study found no discernible correlation between prolactin concentrations and worse scores for inflammatory activity of the disease, nor between prolactin concentrations and serum glucose levels. The findings regarding fatigue should be approached with caution given the exploratory nature of this study.

Introduction: The prevalence of type 2 diabetes mellitus (T2DM) continues to increase worldwide. Indonesia is no exception. The diagnoses of prediabetes and diabetes are increasing and seen in ever younger patients. Primary Health Care (PHC) plays a pivotal role in managing this disease in the community. This study aimed to determine the achievement therapy of T2DM patients in a PHC center in Surabaya, the second most populous city in Indonesia. Methods: The design of this study was cross-sectional. T2DM patients who made regular visits to a PHC center in 2018 were included in this study after providing informed consent. Respondent characteristics (age, education level, family history of T2DM, physical activity, nutrient intake), as well as BMI, blood pressure, and laboratory data, including fasting plasma glucose (FPG), haemoglobin A1c (HbA1c), serum creatinine, and albumin to creatinine ratio (ACR), were collected. Simple correlation and multiple regression analyses were performed by SPSS 17.0.0 Results: The mean age of the patients was 60.9 ± 10.0 years, and participants had been diagnosed with T2DM for a mean of 6.9 ± 8.3 years. The therapeutic goal (FPG ≤130 mg/dL and HbA1c <7%) was achieved in 30.9% and 23.8% of patients, respectively. Early microvascular abnormality screening (ACR) showed that 70.9% of the patients had increased ACR, while serum creatinine level was found to be high in 22.8% of the patients. FPG correlated to HbA1c, serum creatinine and ACR (r=0.64, p<0.001; r=0.39, p=0.001; and r=0.25, p=0.03, respectively). Conclusions: The majority of T2DM patients in our sample did not achieve their therapeutic goals in terms of FPG and HbA1c. Those who did not achieve FPG goals were less likely to meet ACR goals and were less likely to have normal serum creatinine, most probably reflecting a pattern of poor longterm follow-up. [ABSTRACT FROM AUTHOR]

Evaluation of the stability of serum and plasma analytes under different temperatures and time points is vital since it significantly affects the pre-analytical errors. The aim of the study was to determine the stability of serum total cholesterol and triglyceride and plasma glucose of healthy individuals under different storage conditions (25-30°C and 2-8°C) and at different time points (1-hour, 4-hour, 6-hour, and 24-hour). Venous blood samples were collected from healthy individuals aged between 20-50 years after a 12-hour fast. Plasma and serum were separated and stored at different temperatures (25-30°C and 2-8°C) and different time points (1-hour, 4-hour, 6-hour, and 24-hour). Results indicated a significant difference between the mean plasma glucose concentration at room temperature (25-30°C) and refrigerated temperature (2-8°C) at 1-hour (0.072%, p = 0.05). However, there were no significant differences in mean serum total cholesterol concentrations (p = 0.633) and mean serum triglyceride concentrations (p = 0.246) between these temperatures at 1-hour time point. Regarding time points (1-hour, 4-hour, 6-hour, and 24-hour), significant differences in plasma glucose concentrations occurred at 24-hour (10.03%, p = 0.001) at room temperature (25-30°C) and 6-hour (8.79%, p = 0.003) at refrigerated temperature (2-8°C) compared to the 1-hour reference values. Additionally, there were significant differences in serum total cholesterol concentration at 4-hour (12.55%, p = 0.000) and serum triglyceride at 24-hour (29.18%, p = 0.001) compared to the reference values obtained at 1-hour at room temperature (25-30°C). No significant differences were observed among the time points (1-hour, 4-hour, 6-hour, and 24-hour) for serum total cholesterol (p = 0.507) and serum triglyceride values (p = 0.761) at refrigerated temperature (2-8°C). Plasma glucose is unstable at both room temperature (25-30°C) and refrigeration (2-8°C), with recommended testing within 6 hours at room temperature (25-30°C) and stored in a refrigerator (2-8°C) if delayed. It is better to estimate serum total cholesterol within 1-hour of collection at room temperature (25-30°C) while serum triglyceride concentration within 6 hours at the same temperature to obtain accurate and reliable results. [ABSTRACT FROM AUTHOR]

Background: There is no evidence of peptides-probiotics symbiosis as supplements in aquafeeds. Aim: To evaluate the effect of peptides and probiotics supplementation via diet on blood parameters and growth performance of juvenile P. brachypomus, an Amazonian fish, during the growth-out phase. Methods: 120 juvenile P. brachypomus (242.77 g) were placed into twelve 200-L tanks (10 fish/tank), housed in an indoor open system with constant water renovation (flow rate:1.50 L/min). The experiment used a completely randomized design with a 4×5 factorial arrangement [4 doses of supplementation (CD: commercial diet; PepD: CD+1.50% of peptides per CD weight; ProD: CD+40.00 mL of activated probiotics per kg of diet (Lactobacillus spp., Rhodopseudomonas spp., Saccharomycetes spp.); PepProD: CD+Pep+Pro); 5 sampling times (0, 2nd, 4th, 6th, 8th week); n=3]. Fish were fed twice a day at a feeding rate of 1% of body weight. At each sampling time, blood was collected and fish were measured for growth performance analysis. Data was analyzed by using two-way ANOVA and Tukey's test (p0.05). Plasma glucose decreased for all fish in the 2nd week (59.56 mg/dL); then, that level increased in fish fed with the CD (89.00 mg/dL), while fish fed with PepD, ProD and PepProD showed constant values (57.22 mg/dL). The plasma protein levels were constant in fish fed with the PepD and PepProD, (p>0.05), while fish fed with the CD and ProD showed non-constant and higher values. At the end of the trial, fish fed with the PepProD showed the highest weight gain and the lowest feed conversion rate (39.66 g; 0.97). Conclusion: It is possible to maintain the stability of plasma glucose and plasma protein by supplementing diets with peptides, but the peptides-probiotics symbiosis administrated via diet contributes to maintain the stability of plasma glucose and plasma protein and to improve the growth performance of juvenile P. brachypomus during the growth-out phase. [Open Vet J 2024; 14(6.000): 1384-1393]

Background: Hyperglycemia affects the outcomes of endovascular therapy (EVT) for acute ischemic stroke (AIS). This study compares the predictive ability of diabetes status and glucose measures on EVT outcomes using nationwide registry data. Methods: The study included 1,097 AIS patients who underwent EVT from the Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke. The variables analyzed included diabetes status, admission glucose, glycated hemoglobin (HbA1c), admission glucose-to-HbA1c ratio (GAR), and outcomes such as 90-day poor functional outcome (modified Rankin Scale score ≥ 2) and symptomatic intracranial hemorrhage (SICH). Multivariable analyses investigated the independent effects of diabetes status and glucose measures on outcomes. A receiver operating characteristic (ROC) analysis was performed to compare their predictive abilities. Results: The multivariable analysis showed that individuals with known diabetes had a higher likelihood of poor functional outcomes (odds ratios [ORs] 2.10 to 2.58) and SICH (ORs 3.28 to 4.30) compared to those without diabetes. Higher quartiles of admission glucose and GAR were associated with poor functional outcomes and SICH. Higher quartiles of HbA1c were significantly associated with poor functional outcomes. However, patients in the second HbA1c quartile (5.6–5.8%) showed a non-significant tendency toward good functional outcomes compared to those in the lowest quartile (<5.6%). The ROC analysis indicated that diabetes status and admission glucose had higher predictive abilities for poor functional outcomes, while admission glucose and GAR were better predictors for SICH. Conclusion: In AIS patients undergoing EVT, diabetes status, admission glucose, and GAR were associated with 90-day poor functional outcomes and SICH. Admission glucose was likely the most suitable glucose measure for predicting outcomes after EVT. [ABSTRACT FROM AUTHOR]

Objective. The objective of the study was to determine if there would be statistically significant differences or trends among apolipoprotein E genotypes in the responsiveness of members of a cluster of seven measures in older persons with type 2 diabetes mellitus (T2DM) consuming flaxseed lignan complex (FLC). The cluster of seven are abdominal obesity, hypertension, platelet hyperaggregability, hyperglycemia, dyslipidemia (decreased plasma levels of high-density lipoprotein cholesterol (HDLc), and increased plasma levels of triglycerides), increased low-density lipoprotein (LDL) oxidation and increased inflammation. All cluster members exacerbate T2DM.

The objective of the study was to determine if there would be statistically significant differences or trends among apolipoprotein E genotypes (2/2, 2/3, 2/4, 3/3, 3/4, and 4/4) for each member of the cluster of seven associated with type 2 diabetes (T2D). The cluster of seven includes abdominal obesity, hypertension, platelet hyperaggregability, hyperglycemia, dyslipidemia (decreased plasma levels of high-density lipoprotein cholesterol (HDL-C) and increased plasma levels of triglycerides)), increased low-density lipoprotein (LDL) oxidation, and increased inflammation.

Objective To investigate the correlation between urinary triclosan (TCS) levels in early pregnancy and glucose homeostasis at 28 weeks of gestation. Methods A total of 241 pregnant women undergoing prenatal examinations at the Second Central Hospital of Baoding from January 2019 to June 2020 were recruited. The primary outcome was gestational diabetes mellitus (GDM) screened by a 1 hour non-fasting, 50 g glucose load test (GLT) at a median of 28 weeks of pregnancy. Urine samples were collected in early and mid pregnancy to measure urine specific gravity (Sg) and quantify phenolic compounds (bisphenol A, benzophenone-3, and TCS) using online solid phase extraction combined with isotope dilution high performance liquid chromatography tandem mass spectrometry. Results According to GLT results, 199 women had normal GLT, while the remaining 42 had abnormal results. Women with abnormal GLT had higher BMI and lower total exercise time compared to those with normal GLT (P<0.05). Positive associations between TCS levels and gestational glucose levels were observed in early pregnancy and mid pregnancy (comparing the 2nd, 3rd, and 4th quartiles with the 1st quartile of TCS: adj. OR = 0.41, 95% CI: 0.191.05; adj. OR 0.43, 95% CI: -0.171.02; adj. OR = 0.45, 95% CI: 0.141.05) and mid pregnancy (adj. OR0.76, 95% CI: 0.191.32; adj. OR0.66, 95% CI: 0.941.22; adj. OR0.56, 95% CI: 0.041.12). Bayesian kernel machine regression (BKMR) results indicated a positive association between TCS and glucose levels in both early and mid pregnancy (P<0.05). Conclusion Urinary TCS concentration during pregnancy is positively correlated with glucose levels in late pregnancy GDM screening tests. [ABSTRACT FROM AUTHOR]

Context: Chronic kidney disease (CKD) is a worldwide health problem. Recent literature has shown an association of hemoglobin glycation index (HGI) and CKD in patients with dysglycemia. Objective: The aim of this study was to reveal the impact of HGI as a predictor for incident CKD in the general population. Methods: CKD was defined as dipstick proteinuria or estimated glomerular rate (eGFR) < 60 mL/min/1.73 m². Impact of HGI on incident CKD was assessed using the data from CKD-free health examinees (N = 23 467, 4.1% with diabetes) followed for a mean of 5.1 years: Cox proportional hazards model was employed with multivariate adjustment for age, systolic blood pressure, eGFR, fasting plasma glucose, body mass index, log[alanine aminotransferase], log[triglycerides], high-density lipoprotein cholesterol, platelet counts, smoking, and sex. Elevated level of HGI in subjects with CKD was ascertained after propensity score matching of another group of health examinees (N = 2580, 7.6% with diabetes). Results: In the former group, CKD developed in 2540 subjects and HGI was the second most robust predictor for CKD, following low eGFR. With adjustment for the 11 covariates, the hazard ratio of HGI (95% CI) for CKD was 1.293 (1.238 to 1.349) (P < .0001). The population attributable risk of HGI for CKD was 4.2%. In the latter group, among 708 subjects matched 1:1 for 9 covariates, HGI was significantly elevated in subjects with CKD (median [interquartile range] −0.208 [−0.504 to −0.156] vs −0.284 [−0.582 to 0.052], P = .03). Conclusion: HGI was a novel risk factor for CKD in the general population [ABSTRACT FROM AUTHOR]

Glucose measurement plays a central role in the diagnosis of gestational diabetes mellitus (GDM). Because of earlier reports of overestimation of glucose in the widely used tubes containing granulated glycolysis inhibitor, the study assessed the performance of fast-clotting serum tubes as an alternative sample for the measurement of glucose. Glucose concentration in fast-clotting serum was compared to lithium-heparin plasma placed in an ice-water slurry after sample collection and glucose stability at room-temperature was studied. Blood samples from 30 volunteers were drawn in four different types of tubes (serum separator tubes, fast-clotting serum tubes, lithium-heparin tubes and sodium fluoride, EDTA and a citrate buffer (NaF–EDTA–citrate) tubes, all from Greiner Bio-One). Lithium-heparin tubes were placed in an ice-water slurry until centrifugation in accordance with international recommendations and centrifuged within 10 min. After centrifugation, glucose was measured in all tubes (timepoint T0) and after 24, 48, 72, 96 and 120 h of storage at 20–22 °C. NaF–EDTA–citrate plasma showed significant overestimation of glucose concentration by 4.7% compared to lithium-heparin plasma; fast-clotting serum showed glucose concentrations clinically equivalent to lithium-heparin plasma. In fast-clotting serum tubes, mean bias between glucose concentration after 24, 48, 72, 96 and 120 h and T0 was less than 2.4%. All individual differences compared to T0 were less than 6.5%. The results fulfill the acceptance criteria for sample stability based on biological variation. Fast-clotting serum tubes can be an alternative for the measurement of glucose in diagnosis and management of GDM and diabetes mellitus, especially when prolonged transportation is necessary. [ABSTRACT FROM AUTHOR]

The progression from prediabetes to type-2 diabetes depends on multiple pathophysiological, clinical, and epidemiological factors that generally overlap. Both insulin resistance and decreased insulin secretion are considered to be the main causes. The diagnosis and approach to the prediabetic patient are heterogeneous. There is no agreement on the diagnostic criteria to identify prediabetic subjects or the approach to those with insufficient responses to treatment, with respect to regression to normal glycemic values or the prevention of complications. The stratification of prediabetic patients, considering the indicators of impaired fasting glucose, impaired glucose tolerance, or HbA1c, can help to identify the sub-phenotypes of subjects at risk for T2DM. However, considering other associated risk factors, such as impaired lipid profiles, or risk scores, such as the Finnish Diabetes Risk Score, may improve classification. Nevertheless, we still do not have enough information regarding cardiovascular risk reduction. The sub-phenotyping of subjects with prediabetes may provide an opportunity to improve the screening and management of cardiometabolic risk in subjects with prediabetes. [ABSTRACT FROM AUTHOR]

Аim: to evaluate metabolic risk factors and their impact on quality of life in patients with pancreatic cancer (PC) and in patients with acute or exacerbated chronic pancreatitis.Materials and methods. Forty-five patients with PC (group 1) and 141 patients with acute pancreatitis or exacerbated chronic pancreatitis (group 2) in an observational multicenter clinical cross-sectional uncontrolled study were examined. Clinical, laboratory and instrumental examination of patients and assessment of risk factors (lipid profile, blood plasma glucose, obesity, arterial hypertension) were carried out in accordance with clinical recommendations. Patients completed the SF-36 questionnaire once to assess quality of life at hospital admission before treatment.Results. In group 1, indicators of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) in blood serum (3.7 ± 0.2; 2.2 ± 0.2 and 0.8 ± 0.1 mmol/L) were lower than in group 2 (5.1 ± 0.1; 3.1 ± 0.1 and 1.2 ± 0.1 mmol/L; p < 0.05). Arterial hypertension was more common in group 1 (55.6 %) than in group 2 (34.8 %; p = 0.013). The presence of arterial hypertension increases the chance of having PC by 2.7 times (p < 0.05). Body mass index parameters, including obesity, as well as parameters of triglycerides, and fasting plasma glucose, did not differ between the groups. Logistic regression analysis revealed a direct relationship with PC HDL hypocholesterolemia (Exp B = 4.976; p < 0.001) and arterial hypertension (Exp B = 2.742; p = 0.027) and an inverse relationship — with hypercholesterolemia (Exp B = 0.204; p = 0.002). The chance of having PC was not associated with age, fasting plasma glucose ³ 7.0 mmol/L, obesity. Quality of life indicators were higher in group 1 than in group 2 on four SF-36 scales: bodily pain (68.1 ± 5.1 and 36.8 ± 2.0; p < 0.001), general health (51.1 ± 2.5 and 38.0 ± 1.7 points; p < 0.001), social functioning (74.7 ± 3.0 and 64.5 ± 2.2 points; p = 0.007), role emotional functioning (28.2 ± 5.2 and 12.5 ± 3.1 points; p = 0.007) and in the general domain “physical component of health” (40.2 ± 1.0 and 33.6 ± 0.8 points; p < 0.001). In group 1 with HDL hypocholesterolemia compared with its absence, the indicators of role emotional functioning (22.2 ± 5.1 and 51.9 ± 13.7 points; p = 0.020) were lower, with arterial hypertension compared with its absence — role physical functioning (5.0 ± 4.0 and 25.5 ± 7.5 points; p = 0.036) and role emotional functioning (16.0 ± 5.1 and 43.3 ± 8.8 points; p = 0.007) were lower.Conclusions. In patients with PC arterial hypertension was more common and the levels of total cholesterol, LDL-C and HDL-C were lower than in patients with acute or exacerbated chronic pancreatitis. The chance of having PC is directly associated with HDL hypocholesterolemia, with arterial hypertension, inversely — with hypercholesterolemia, and is not associated with age, fasting plasma glucose ³ 7 mmol/L, or obesity. In patients with PC, quality of life indicators were higher on four SF-36 scales and on the general domain “physical component of health” than in the group with acute or exacerbated chronic pancreatitis. In patients with PC metabolic factors significantly worsened self-assessment of quality of life in terms of role functioning; in patients with acute or exacerbated chronic pancreatitis there was no such association.

Fasting is practiced by various religions in the world. The previous studies show the effect of fasting on biochemical markers in healthy subjects; however, no study is available on its effect on gene expression or epigenetic markers. In the present study, miR126, a microRNA, was measured in serum samples of healthy adult subjects, and their correlation with biochemical profile was carried out during the short-term fasting of the Navratri festival. A total of 30 subjects who underwent fasting for 07 days during the Navratri festival were recruited for the study. The fasting blood samples were obtained at three different time points; day 1 of fasting, day 7 of fasting, and day 7 after completion of fasting period. The miR126 expression, fasting plasma glucose, and lipid profile were measured in all the three samples. The miR126 levels showed a decreasing trend with a significant difference across the three time points (p-value = 0.006). Fasting plasma glucose increased continuously across three time points without showing any statistical significance. Serum total cholesterol (p = 0.001) and triglycerides (p = 0.001) levels were decreased initially and then increased after resuming normal diet. There was a medium-level negative correlation (−0.332) between baseline fasting glucose level and miR126 level (p = 0.068). The study revealed that serum levels of total cholesterol and triglyceride were more dynamic than the miR126 levels. A significant decrease in the miR126 expression across three time points is a promising outcome of this pilot study and indicates its role in short-term fasting. However, the fasting plasma glucose showed heterogeneous values without significant correlation with miR126 levels. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the impact of UV-B irradiated oyster mushroom powder (referred to as Oyster-D) on blood sugar and TNF-α levels in type 2 diabetic rats induced with streptozotocin (STZ) over 28 days. Twenty-five male rats were divided into five groups: (A) negative control with STZ induction, (B), (C), (D) treated with Oyster-D at doses of 2000 IU, 4000 IU, 8000 IU, and (E) a normal group without STZ induction. Following treatment, blood samples were collected to analyze fasting plasma glucose (FPG) levels using the GOD-PAP method, while TNF-α levels were assessed using the ELISA method. Statistical analysis included One-Way ANOVA and Post Hoc LSD for mean FPG level differences and Kruskal Wallis and Mann-Whitney tests for mean TNF-α levels. The results revealed a significant reduction in mean FPG levels after treatment in the negative control compared to the Oyster-D treatment groups at doses of 2000 IU, 4000 IU, and 8000 IU (p<0.05). Additionally, a notable increase in mean TNF-α levels was observed in the negative control group relative to the Oyster-D treatment group at a dose of 8000 IU (p<0.05). Overall, Oyster-D exhibited potential in reducing blood sugar levels and elevating TNF-α levels in male Wistar rats induced with STZ, suggesting its possible utility in managing hyperglycemia and TNF-α expression in diabetes. [ABSTRACT FROM AUTHOR]

Diel variation of dissolved oxygen content in aquaculture is common. Generally, the dissolved oxygen content in the pond is the highest in the afternoon and the lowest in the early morning. Siniperca chuatsi usually feeds in the early morning because of its unique feeding habits, therefore the low dissolved oxygen level may affect its metabolism. In this study, S. chuatsi was subjected to different oxygen conditions, a control group (> 5 mg/L) and an experimental group (dissolved oxygen changed with sunlight) for 24 h to determine glucose metabolism systemically. The following results were obtained: (1) Dissolved oxygen level in the experimental group that underwent periodic variation was the lowest at 07:00, with an average dissolved oxygen level of 0.93 mg/L; and the dissolved oxygen was the highest at 17:00, with an average dissolved oxygen level of 10.58 mg/L. (2) At T3 and T4, the plasma content of experimental group significantly decreased and lactic acid content increased significantly; liver glycogen and ATP content decreased, whereas lactic acid content increased significantly. (3) At T3 and T4, the activities of the key enzymes involved in glucose metabolism in liver varied; the activity of aerobic metabolism enzyme citrate synthase (CS) significantly decreased while that of anaerobic metabolism enzyme lactate dehydrogenase (LDH) increased significantly; the activity of glycolysis enzyme hexokinase (HK), phosphate fructose kinase (PFK), pyruvate kinase (PK) increased significantly and the activity of glycogenolytic enzyme glycogen phosphorylase (GP) exhibited no significant difference. (4) At T3 and T4, the expression of hk, pfk, pk, ldh-a, gp genes in the experimental group increased significantly, the expression of cs significantly decreased, and the expression of glucose transporter 2 (glut2) was not significant difference. Thus, when diel variation periodically changed dissolved oxygen level in the pond, lower dissolved oxygen level lead to change in glucose metabolism, from aerobic metabolism to anaerobic metabolism, and the energy utilization mode of S. chuatsi had changrd.

Chromolaena odorata is a potential feed source but is low in methionine, which might affect the rumen function. Therefore providing efficient nutrient/s might improve rumen function. The study aimed to assess the efficacy of a concentrate containing Chromolaena odorata meal, hydroxy methionine analog (HMA), and palm oil on blood metabolites of fattened cattle. Sixteen Bali cattle (Bos sondaicus) with an average body weight of 130.5kg ± 32.5 were allotted into four dietary treatments (and four replicates) using a Completely Randomized Block Design with 4 cattle in each Group. The treatments were concentrates with no addition of palm oil and/or HMA as the control diet (Group I), added with 3 g HMA (CMA) (Group II), added with 0.5% palm oil (Group III) and (CPO) added with a combination of 3 g HMA and 0.5% palm oil (CMO) Group IV). The concentrate was offered to the animals at a rate of 2% liveweight, whilst rice straws were provided ad libitum as the source of fiber. The concentrate contained 18% crude protein and 12 MJ ME/kg DM to target a live weight gain of at least 0.6 kg/day. Blood metabolites measured were total cholesterol levels, plasma glucose, plasma proteins, and plasma urea. Collected data were subjected to analysis of variance with the significance level set at an alpha value of ≤ 0.05. The results showed that providing concentratecontaining. C. odorata with or without HMA and/or palm oil (Group IV) only significantly affected blood plasma proteins, whereas other blood metabolites were unaffected. It might be concluded that there is no benefit of adding palm oil or methionine analog to chromolaena-based concentrate for fattened cattle since it will not affect the concentration of blood metabolites. [ABSTRACT FROM AUTHOR]

Background and objectives: The purpose of this study is to determine whether diabetes individuals who have a variation in the MnSOD gene are more likely to experience cardiovascular problems. This is accomplished by determining the prevalence of MnSOD gene polymorphism in type 2 diabetic patients who either have or do not have cardiovascular disease, as well as in healthy control subjects. To determine whether or not this MnSOD polymorphism results in decreased SOD activity. Method: To conduct this case-control investigation, ethical approval was obtained. This investigation was conducted between February 2023 to May 2023 at Government Medical College Sircilla, Telangana, India. Seventy patients with diabetes that had been ongoing for more than five years were included in the investigation after receiving informed consent. The diagnosis is based on the clinical history, fasting plasma glucose levels, and electrocardiogram (ECG) findings. Result: The genotype and allele frequency of the SOD2 gene are displayed for those with type 2 diabetes, those without the disease, and healthy controls. More people with diabetes and cardiovascular disease (n = 25; 71.42%) have the TT genotype than people with diabetes and no cardiovascular disease (n = 15; 42.85%) or controls (n = 10; 28.5%). There is a significant (P = 0.006) difference in the frequency of the TT genotype among diabetic CVD cases. Genetics and SOD activity interacted. The SOD activity was lower in people with the TT genotype. SOD activity ranges from 86U/L in TT to 187U/L in CC, with CT falling in the middle at 145U/L. It's 0.000. The SOD activity was lower in people with the TT genotype. Conclusion: This study compared diabetics with and without cardiovascular disease for SOD2 gene (T>C) substitution polymorphism. 35 diabetics with and without cardiovascular disease were compared. T2DM patients with cardiovascular disease had a higher SOD2 TT genotype rate than those without CVD and controls. TT genotype differs significantly amongst diabetics with and without cardiovascular disease. Diabetes patients with cardiovascular disease had reduced serum SOD activity, which may contribute to cardiovascular illness. The TT genotype was associated with cardiovascular disease due to its low serum superoxide dismutase (SOD) activity. After controlling for variables, the TT genotype predicts cardiovascular disease complications. [ABSTRACT FROM AUTHOR]

Hypoglycemia represents one of the most frequent metabolic disturbances of the neonate, associated with increased morbidity and mortality, especially if left untreated or diagnosed after the establishment of brain damage. The aim of this study was to review and compare the recommendations from the most recently published influential guidelines on the diagnosis, screening, prevention and management of this common neonatal complication. Therefore, a descriptive review of the guidelines from the American Academy of Pediatrics (AAP), the British Association of Perinatal Medicine (BAPM), the European Foundation for the Care of the Newborn Infants (EFCNI), the Queensland Clinical Guidelines-Australia (AUS), the Canadian Pediatric Society (CPS) and the Pediatric Endocrine Society (PES) on neonatal hypoglycemia was carried out. There is a consensus among the reviewed guidelines on the risk factors, the clinical signs and symptoms of NH, and the main preventive strategies. Additionally, the importance of early recognition of at-risk infants, timely identification of NH and prompt initiation of treatment in optimizing the outcomes of hypoglycemic neonates are universally highlighted. All medical societies, except PES, recommend screening for NH in asymptomatic high-risk and symptomatic newborn infants, but they do not provide consistent screening approaches. Moreover, the reviewed guidelines point out that the diagnosis of NH should be confirmed by laboratory methods of BGL measurement, although treatment should not be delayed until the results become available. The definition of NH lacks uniformity and it is generally agreed that a single BG value cannot accurately define this clinical entity. Therefore, all medical societies support the use of operational thresholds for the management of NH, although discrepancies exist regarding the recommended cut-off values, the optimal treatment and surveillance strategies of both symptomatic and asymptomatic hypoglycemic neonates as well as the treatment targets. Over the past several decades, ΝH has remained an issue of keen debate as it is a preventable cause of brain injury and neurodevelopmental impairment; however, there is no clear definition or consistent treatment policies. Thus, the establishment of specific diagnostic criteria and uniform protocols for the management of this common biochemical disorder is of paramount importance as it will hopefully allow for the early identification of infants at risk, the establishment of efficient preventive measures, the optimal treatment in the first hours of a neonate's life and, subsequently, the improvement of neonatal outcomes. [ABSTRACT FROM AUTHOR]

AbstractWe aimed to identify the complications of gestational diabetes mellitus (GDM) associated with poor control of fasting plasma glucose (FPG) and postload plasma glucose (PPG) on the 75-g oral glucose tolerance test (OGTT). This retrospective study included 997 singleton pregnancy GDM patients who were assigned to poor or good glycaemic control groups. Multivariate analysis indicated that poor FPG control and poor PPG control were both independent predictors of hypertensive disorder complicating pregnancy (HDCP) (odd ratio (OR) of 2.551 (95% CI [1.146–5.682], p = .022) and OR of 2.084 (95% [1.115–3.894], p = .021) compared with good glycaemic control groups, respectively). Poor PPG control promoted the rate of caesarean delivery (1.534 (95% CI [1.063–2.214]), p = .022), whereas good PPG control increased the risk of premature rupture of membranes (PROM) (0.373 (95% CI [0.228–0.611]), p

Background: Measurement of venous plasma glucose concentration (P-Glucose) requires preanalytical precautions: rapid cooling, rapid centrifugation, and using tubes with enzyme inhibitors. A special routine for measuring a biomarker that is critical and frequent in metabolic control is logistically demanding and expensive. We revisit and quantify the diagnostic outcome of using venous serum glucose concentration (S-Glucose) to diagnose diabetes mellitus (DM), using glycated hemoglobin (B-HbA1c) as the reference procedure for diagnosis. Methods: Data from 301 participants, with simultaneous measurements of B-HbA1c, fasting S-Glucose and P-Glucose, without diabetes medication or established diagnosis were included. The WHO definition of DM as a B-HbA1c value ≥ 47.5 mmol/mol (6.5%) was used to define DM. The optimal concentration cutoff for S-Glucose was identified using the receiver operating characteristic curve and the cumulative data analysis tools. The diagnostic performance was evaluated by the diagnostic sensitivity, specificity, and the positive likelihood ratio of the S-Glucose measurements. Results: The correlation between S-Glucose and P-Glucose was 0.999. S-Glucose had a diagnostic sensitivity and specificity of 91% and 99% and P-Glucose of 97% and 95%, respectively, to diagnose DM when a cutoff value of 6.9 mmol/L (125 mg/dL) was used and in relation to the diagnosis established by B-HbA1c. Conclusion: The diagnostic sensitivity and specificity of S-Glucose equals those of P-Glucose when compared to the WHO B-HbA1c criteria. In comparison, S-Glucose instead of P-Glucose saves costs, optimizes the use of the patient sample, and improves the logistics of samples and reagents. [ABSTRACT FROM AUTHOR]

To investigate the prevalence of diabetes mellitus (DM) in acute pancreatitis (AP) patients and to explore the extent to which inflammatory stress affects plasma glucose (PG) levels in AP patients. A retrospective analysis of 2163 AP patients was performed. The PG differences among AP patients under differing pancreatic necrosis conditions and inflammation severity were compared. Receiver operating characteristic curves were used to assess whether fasting PG in the inflammatory stage of AP might be used for DM screening. The overall DM prevalence was 19.97% in AP patients, 32.41% of whom had newly diagnosed DM (based on HbA1c levels in patients who self-reported no DM). The DM prevalence was 46.93% in hyperlipidemic AP patients, 44.14% of whom had newly diagnosed DM. In patients with and without pancreatic necrosis, the optimal PG thresholds for the screening of newly diagnosed DM were 10.40 mmol/L and 8.21 mmol/L, respectively, with an AUC of 0.959 ± 0.034 (P < 0.001) and 0.972 ± 0.006 (P < 0.001), respectively. For hospitalized AP patients and fasting PG levels exceeding 10 mmol/L (with necrosis) or 8 mmol/L (without necrosis) (P < 0.001), HbA1c testing is recommended to investigate the presence of comorbid undiagnosed DM. [ABSTRACT FROM AUTHOR]

The progression from prediabetes to type-2 diabetes depends on multiple pathophysiological, clinical, and epidemiological factors that generally overlap. Both insulin resistance and decreased insulin secretion are considered to be the main causes. The diagnosis and approach to the prediabetic patient are heterogeneous. There is no agreement on the diagnostic criteria to identify prediabetic subjects or the approach to those with insufficient responses to treatment, with respect to regression to normal glycemic values or the prevention of complications. The stratification of prediabetic patients, considering the indicators of impaired fasting glucose, impaired glucose tolerance, or HbA1c, can help to identify the sub-phenotypes of subjects at risk for T2DM. However, considering other associated risk factors, such as impaired lipid profiles, or risk scores, such as the Finnish Diabetes Risk Score, may improve classification. Nevertheless, we still do not have enough information regarding cardiovascular risk reduction. The sub-phenotyping of subjects with prediabetes may provide an opportunity to improve the screening and management of cardiometabolic risk in subjects with prediabetes.

Aims: To profile acute glycaemic dynamics during graded exercise testing (GXT) and explore the influence of glycaemic indicators on the physiological responses to GXT in adults with type 1 diabetes using insulin pump therapy. Methods: This was a retrospective analysis of pooled data from four clinical trials with identical GXT protocols. Data were obtained from 45 adults with type 1 diabetes using insulin pumps [(30 females); haemoglobin A1c 59.5 ± 0.5 mmol/mol (7.6 ± 1.0%); age 49.7 ± 13.0 years; diabetes duration 31.2 ± 13.5 years; V̇O2peak 29.5 ± 8.0 ml/min/kg]. Integrated cardiopulmonary variables were collected continuously via spiroergometry. Plasma glucose was obtained every 3 min during GXT as well as the point of volitional exhaustion. Data were assessed via general linear modelling techniques with age and gender adjustment. Significance was accepted at p ≤.05. Results: Despite increasing duration and intensity, plasma glucose concentrations remained similar to rest values (8.8 ± 2.3 mmol/L) throughout exercise (p =.419) with an overall change of +0.3 ± 1.1 mmol/L. Starting glycaemia bore no influence on subsequent GXT responses. Per 1% increment in haemoglobin A1c there was an associated decrease in V̇O2peak of 3.8 ml/min/kg (p <.001) and powerpeak of 0.33 W/kg (p <.001) concomitant with attenuations in indices of peripheral oxygen extraction [(O2 pulse) −1.2 ml/beat, p =.023]. Conclusion: In adults with long‐standing type 1 diabetes using insulin pump therapy, circulating glucose remains stable during a graded incremental cycle test to volitional exhaustion. Glycaemic indicators are inversely associated with aerobic rate, oxygen economy and mechanical output across the exercise intensity spectrum. An appreciation of these nexuses may help guide appropriate decision making for optimal exercise management strategies. [ABSTRACT FROM AUTHOR]

Background: The goal was to investigate the correlations of peripheral blood Omentin-1 and leptin (LEP) levels with bone metabolism and plasma glucose in patients with type 2 diabetes mellitus (T2DM) complicated with osteoporosis (OP). Methods: One hundred patients with T2DM admitted from September 2019 to September 2021 were divided into group A (n = 36, OP with T-score ≤ -2.5), group B (n = 50, osteopenia with T-score between -1 and -2.5), and group C (n = 14, non-OP with T-score > -1) according to the values of bone mineral density (BMD). Thirty healthy adults physically examined in the same period were selected as group D. The levels of peripheral blood Omentin-1 and LEP, bone metabolism, and plasma glucose were compared among the four groups. The correlations of peripheral blood Omentin-1 and LEP levels with bone metabolism and plasma glucose were explored by Pearson's analysis. Results: In group A, the levels of Omentin-1 and LEP in peripheral blood were lowest, the serum levels of beta Cterminal cross-linked telopeptides of type I collagen (β-CTX) and osteocalcin (OCN) were highest, the serum level of total N-terminal propeptide of type I procollagen (tPINP) was lowest, and the levels of fasting plasma glucose (FPG), 2-hours postprandial plasma glucose (2hPG) and glycosylated hemoglobin A1c (HbA1c) were highest, sequentially followed by those of group B, group C, and group D (p < 0.05). Omentin-1 and LEP in peripheral blood were negatively correlated with β-CTX, OCN, 2hPG, and HbA1c and positively correlated with tPINP and FPG (p < 0.05). Conclusions: The expressions of Omentin-1 and LEP in peripheral blood have correlations with bone metabolism and plasma glucose in patients with T2DM complicated with OP. [ABSTRACT FROM AUTHOR]

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Cardiovascular diseases (CVD) are the leading causes of death in technologically developed and developing countries. Copper, an active redox element, is involved in energy production through various mechanisms. Copper and coronary artery disease can be associated directly, through its direct effect on the vascular endothelium, or indirectly through lipoprotein metabolism. Hence an evaluation of copper in the coronary artery disease individual is important. The aim is to compare the relationship of serum copper levels between coronary artery disease patients and control individuals based on age, sex, hypertension and diabetes mellitus. Materials and methods: The study design was a case-control study in which proven coronary artery disease patients attending cardiology OPD were selected as cases. Control individuals were mainly selected from the master health check-up. Serum copper levels, plasma glucose, cholesterol, serum triglycerides, and serum HDL & LDL cholesterol were done. Glycated haemoglobin (HbA1C) was also measured. The data were analyzed using IBM SPSS software version 24. Result: The correlation of serum copper level with other quantitative parameters is determined by calculating Pearson's correlation coefficient among cases and controls. Conclusion: The serum copper level is significantly (p = 0.001) higher in CAD patients than in age, sex, DM, and HT-matched controls. The serum copper level has a significant (p = 0.001) effect on disease, and the adjusted odds ratio is 1.032 (CI 1.011--1.054). In addition, the serum copper level has a significant (0.01) negative correlation with LDL cholesterol and total cholesterol. [ABSTRACT FROM AUTHOR]

Bin-Bin Liu,1,&ast; Zi-Ru Niu,2,&ast; Xiao-Jiao Jia,3 Xiao-Li Liu,3 Qiang Lu3 1Department of Functional Inspection, Qinhuangdao First Hospital, Qinhuangdao, 066000, People’s Republic of China; 2Department of Endocrinology and Metabolic Diseases, Hebei Medical University, Shijiazhuang, 050000, People’s Republic of China; 3Department of Endocrinology, Qinhuangdao First Hospital, Qinhuangdao, 066000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qiang Lu, Department of Endocrinology, Qinhuangdao First Hospita l, No. 258 of Wenhua Road, Haigang District, Qinhuangdao, 066000, People’s Republic of China, Tel +86-0335-5908385, Fax: +86-0335-3032042, Email qianglu_123@163.comBackground: Cardiopulmonary exercise tests (CPETs) are widely used non-invasive and reliable functional evaluation methods. This study investigated the correlation between cardiopulmonary endurance indices and plasma glucose levels and abdominal visceral fat in males with new-onset type 2 diabetes.Methods: A total of 136 male individuals, who had been treated in the First Hospital of Qinhuangdao City, were selected to form a new-onset type 2 diabetes group (66 cases) and a control group (70 cases); individuals were divided into three groups (Q1, Q2, and Q3) from low to high according to their anaerobic threshold (AT) oxygen uptake (VO2), AT VO2/kg (VO2 per kg of body weight), peak VO2, peak VO2/kg, AT heart rate (HR), peak HR, and HR recovery after 1 minute. A cardiopulmonary exercise test was used to determine the VO2 of each group of subjects for VO2 max and AT VO2/kg, HR, and HR recovery after 1 minute. The differences in fat areas and plasma glucose levels were compared under different cardiorespiratory endurance indicators.Results: Compared with the control group, the abdominal visceral fat (AVF) area, fasting plasma glucose (FPG), and postprandial plasma glucose (PPG) levels increased in the new-onset type 2 diabetes group. Concurrently, AT VO2, AT VO2/kg, peak VO2, peak VO2/kg, AT HR, peak HR, and 1-minute HR recovery all decreased, and the difference between the groups was statistically significant (P< 0.05). The higher the AT VO2 and peak VO2 values, the lower the PPG level (P< 0.05) and the smaller the area of abdominal visceral fat (P< 0.05). The AT VO2/kg and peak VO2/kg values were negatively correlated with the abdominal visceral fat area, while other indicators had no obvious relationship with either plasma glucose levels or the area of fat.Conclusion: The levels of blood glucose and visceral fat are correlated with cardiopulmonary function. With the increase in blood glucose levels and visceral fat, the indices of cardiopulmonary function gradually decrease. The correlation between different cardiopulmonary function indices and blood glucose levels and visceral fat was different.Keywords: cardiopulmonary function, type 2 diabetes, abdominal visceral fat, plasma glucose

Gestational diabetes mellitus (GDM) , gestational hypertension, macrosomia, low birth weight, and premature delivery can directly affect short- and long-term maternal and infant health. Fasting plasma glucose can be obtained conveniently and rapidly during pregnancy. Numerous studies have verified that early- and mild-pregnancy fasting plasma glucose are associated with GDM, large for gestational age, and neonatal birth weight. But there is still some controversy about whether they associate with gestational hypertension and cesarean section. Furthermore, further studies are needed to examine their long-term influence on related diseases of pregnant women and their offspring in childhood and adulthood. This paper gives a summary of recent advances in the associations of early- and mid-pregnancy fasting plasma glucose with pregnancy outcome, providing a reference for future studies that profoundly explore relevant issues.

Background: Early risk stratification is recommended in daily clinical practice to predict adverse outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Complete blood count and blood glucose analysis is routinely performed on admission. Hence, this study was undertaken to find out the predictive value of white blood cell (WBC) indices and glycemia to know adverse outcomes in STEMI. Methods: In an observational study conducted between December 2015 and October 2018 at a tertiary center, 400 patients with acute STEMI were included. Results: We had 400 patients of STEMI. In this study, mean total leukocyte count (TLC), total neutrophil count (TNC), neutrophil-to-lymphocyte ratio (NLR), and plasma glucose were higher in those with complications (13,449.8/mm3, 10,460.5/mm3, 5.20 and 180.8 mg%) than those without complications (11,318.3/mm3, 8581.9/mm3, 4.15, and 151.1 mg%) (P < 0.05). The cutoff point of TLC >13 × 1000 cells/mm3 had a sensitivity of 73.5% and specificity of 63% in predicting postmyocardial infarction mortality (area under the curve = 0.68, P < 0.001). Patients with acute hyperglycemia (≥140 mg%) had higher incidence of hypotension (31.12% vs. 17.64%, P < 0.05), left ventricular failure (32.14% v/s. 21.1%, P < 0.05), ventricular arrhythmias (13.26% vs. 6.86%, P < 0.05), and higher inhospital mortality (P = 0.0001). Multivariate analysis predicting inhospital mortality as dependent variable TLC >13 × 1000 cells/mm3, TNC >10.5 × 1000 cells/mms3, NLR ≥5.20, and plasma glucose >140 mg/dl were the variable found to be statistically significant (P < 0.05). Conclusion: The WBC indices (TLC, TNC, and NLR) and plasma glucose on admission are independent predictors of major cardiovascular events and inhospital mortality in STEMI.

Introduction: Leptin is an adipocyte derived hormone encoded by ob gene which serves as a relay link between metabolic signals and brain that regulate the hypothalamic pituitary ovarian axis. Leptin is related with obesity, which is a most important cause of Polycystic Ovarian Syndrome (PCOS) in women of reproductive age group. Aim: To evaluate leptin concentration and to analyse its correlation with Body Mass Index (BMI) and insulin resistance in PCOS. Materials and Methods: This case-control study was conducted from December 2018 to December 2019 at Department of Biochemistry in collaboration with Department of Obstetrics and Gynaecology, MKCG Medical College and Hospital, Berhampur, Odisha, India. A total of 60 PCOS subjects, aged between 15-30 years (30 obese PCOS and 30 lean PCOS) and 30 age-matched, normal ovulatory healthy controls were included in the study. Parameters such as serum leptin, fasting plasma insulin, Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), Fasting Plasma Glucose (PPG), Postprandial Plasma Glucose (PPPG) were estimated using commercial kits. One-way Analysis of Variance (ANOVA) test was used for data analysis and the Pearson's correlation method was used to find the correlation between the parameters. Results: The mean age of women in all the three PCOS groups was found to be 22.4±3.13 years. The BMI of obese PCOS patients (31.9±4.7 kg/m²) and lean PCOS patients (21.4±2.2 kg/m²) were higher than that of healthy controls (20.7±1.8 kg/m²) which was statistically significant (p-value <0.001). The serum leptin in obese PCOS were significantly higher (28.0±17.8 ng/mL) than lean PCOS (5.8±2.2 ng/mL) and fasting plasma insulin in lean PCOS were (10.9±2.4 µIU/mL) significantly lower than obese PCOS (30.2±14.8 µIU/mL). Mean serum leptin levels had significant positive correlation with BMI in lean and obese PCOS and insulin resistance in obese PCOS. Conclusion: In the present study, high leptin concentration was observed in PCOS patients and there was positive correlation of leptin with BMI in both lean and obese PCOS groups and leptin was positively correlated with insulin resistance in obese PCOS. [ABSTRACT FROM AUTHOR]

We aimed to identify the complications of gestational diabetes mellitus (GDM) associated with poor control of fasting plasma glucose (FPG) and postload plasma glucose (PPG) on the 75-g oral glucose tolerance test (OGTT). This retrospective study included 997 singleton pregnancy GDM patients who were assigned to poor or good glycaemic control groups. Multivariate analysis indicated that poor FPG control and poor PPG control were both independent predictors of hypertensive disorder complicating pregnancy (HDCP) (odd ratio (OR) of 2.551 (95% CI [1.146–5.682], p =.022) and OR of 2.084 (95% [1.115–3.894], p =.021) compared with good glycaemic control groups, respectively). Poor PPG control promoted the rate of caesarean delivery (1.534 (95% CI [1.063–2.214]), p =.022), whereas good PPG control increased the risk of premature rupture of membranes (PROM) (0.373 (95% CI [0.228–0.611]), p <.001). Conclusively, poor control FPG and PPG dissimilarly affect pregnancy complications in GDM; these findings may help clinicians in the effective implementation of measures to prevent pregnancy complications in GDM. What is already known on this subject? Previous studies displayed that GDM patients with 2-h PPG elevated at 24–28 week of gestation had a 2.254-fold increased risk of postpartum dysglycaemia. Abnormal plasma glucose in GDM mother increased the probability of childhood obesity in the offspring. With the implementation of China's second-child policy, the incidence of GDM is rising. What do the results of this study add? Our results indicated that the older patients with GDM, the greater the risk of abnormal plasma glucose control. In addition, maternal age and prenatal BMI were notably correlated with poor plasma glucose control of FPG and PPG, respectively. We also found that both poor FPG and PPG control notably increased the incidence of HDCP in pregnant women. The incidence of PROM was higher in the good PPG control group compared with the poor PPG control group. What are the implications of these findings for clinical practice and/or further research? This study displayed that the effects of poor FPG and PPG control on pregnancy complications and newborn outcomes were heterogeneous, which might be related to the specificity of plasma glucose metabolism at different time points. Good glycaemic control, especially PPG control, was of great significance for improving pregnancy complications and perinatal conditions. [ABSTRACT FROM AUTHOR]

Background There has been growing interest in studying postprandial glucose responses using continuous glucose monitoring (CGM) in nondiabetic individuals. Accurate measurement of glucose responses to meals can facilitate applications such as precision nutrition and early detection of diabetes. Objectives We aimed to quantify the discordance between simultaneous postprandial glucose measurements made using plasma and CGM. Methods We studied 10 nondiabetic older adults who randomly consumed 9 predefined meals of varying macronutrient compositions. Glucose was measured for 8 h after the meal by the CGM, blood samples for plasma collection were taken regularly, and plasma glucose was quantified using gold-standard laboratory measurement and a fingerstick blood glucose meter. The primary outcome measured was the mean absolute relative difference (MARD) of CGM and fingerstick measurements relative to the gold standard. Secondary outcomes were Bland–Altman statistics, Clarke Error Grid, and time in range metrics. Additional subgroup analyses were performed by stratifying the postprandial glucose measurements based on the macronutrient composition of the meals. Results When compared against the gold-standard postprandial glucose measurements, the fingerstick meter was more accurate (MARD: 8.0%; 95% CI: 7.6%, 8.6%) than the CGM (MARD: 13.7%; 95% CI: 13.1%, 14.3%; P  < 0.0001). After the meals, Bland–Altman analysis demonstrated that the CGM underestimated the 8-h gold-standard glucose rise by 12.8 mg/dL on average (P  < 0.0001), whereas the fingerstick meter did so by 5.5 mg/dL on average (P  < 0.0001). The CGM underestimated the time spent in the 70–180 mg/dL range (P  = 0.002) and overestimated the time spent <70 mg/dL (P  < 0.0001) compared with the other 2 methods. Conclusions We discovered discordance between gold standard, fingerstick, and CGM in measuring plasma glucose concentrations after a meal. Consequently, emerging applications of CGM in healthy individuals, such as precision nutrition and diabetes onset prediction, may need to account for these discordances. This trial was registered at clinicaltrials.gov as NCT04928872. [ABSTRACT FROM AUTHOR]

Introduction: Leptin is an adipocyte derived hormone encoded by ob gene which serves as a relay link between metabolic signals and brain that regulate the hypothalamic pituitary ovarian axis. Leptin is related with obesity, which is a most important cause of Polycystic Ovarian Syndrome (PCOS) in women of reproductive age group. Aim: To evaluate leptin concentration and to analyse its correlation with Body Mass Index (BMI) and insulin resistance in PCOS. Materials and Methods: This case-control study was conducted from December 2018 to December 2019 at Department of Biochemistry in collaboration with Department of Obstetrics and Gynaecology, MKCG Medical College and Hospital, Berhampur, Odisha, India. A total of 60 PCOS subjects, aged between 15-30 years (30 obese PCOS and 30 lean PCOS) and 30 age-matched, normal ovulatory healthy controls were included in the study. Parameters such as serum leptin, fasting plasma insulin, Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), Fasting Plasma Glucose (PPG), Postprandial Plasma Glucose (PPPG) were estimated using commercial kits. One-way Analysis of Variance (ANOVA) test was used for data analysis and the Pearson’s correlation method was used to find the correlation between the parameters. Results: The mean age of women in all the three PCOS groups was found to be 22.4±3.13 years. The BMI of obese PCOS patients (31.9±4.7 kg/m2) and lean PCOS patients (21.4±2.2 kg/m2) were higher than that of healthy controls (20.7±1.8 kg/m2) which was statistically significant (p-value

We investigated the effects of vitamin A (VA) status on metabolism of Zucker rats with different genders and genotypes, and of short-term refeeding of a VA sufficient (VAS) diet on VA deficient (VAD) animals. First, male and female Zucker lean (ZL) and fatty (ZF) rats at weaning were fed a VAD or VAS diet for 8 weeks. Second, male VAD ZL rats were fed a VAS diet for 3 (VAD-VAS3d) or 7 (VAD-VAS7d) days. The body weight (BW), blood parameters, and hepatic expressions of genes for metabolism were determined. VA deficiency reduced BW gain in ZL and ZF rats of either gender. VAD ZL rats had lower plasma glucose, insulin, and leptin levels than VAS ZL rats. VAD-VAS3d and VAD-VAS7d rats had higher plasma glucose, insulin, and leptin levels than that in the VAD rats. The hepatic mRNA levels of Gck, Cyp26a1, Srebp-1c, Igf1, Rarb, Rxra, Rxrg, Pparg, and Ppard were lowered by VA deficiency. Refeeding of the VAS diet for 3 days restored the Gck and Cyp26a1 expressions, and for 7 days restored the Gck, Cyp26a1, Igf1, and Rxrb expressions significantly. The 7-day VA replenishment partially restored the hepatic gene expressions and metabolic changes in VAD ZL rats.

Hypoglycemia represents one of the most frequent metabolic disturbances of the neonate, associated with increased morbidity and mortality, especially if left untreated or diagnosed after the establishment of brain damage. The aim of this study was to review and compare the recommendations from the most recently published influential guidelines on the diagnosis, screening, prevention and management of this common neonatal complication. Therefore, a descriptive review of the guidelines from the American Academy of Pediatrics (AAP), the British Association of Perinatal Medicine (BAPM), the European Foundation for the Care of the Newborn Infants (EFCNI), the Queensland Clinical Guidelines-Australia (AUS), the Canadian Pediatric Society (CPS) and the Pediatric Endocrine Society (PES) on neonatal hypoglycemia was carried out. There is a consensus among the reviewed guidelines on the risk factors, the clinical signs and symptoms of NH, and the main preventive strategies. Additionally, the importance of early recognition of at-risk infants, timely identification of NH and prompt initiation of treatment in optimizing the outcomes of hypoglycemic neonates are universally highlighted. All medical societies, except PES, recommend screening for NH in asymptomatic high-risk and symptomatic newborn infants, but they do not provide consistent screening approaches. Moreover, the reviewed guidelines point out that the diagnosis of NH should be confirmed by laboratory methods of BGL measurement, although treatment should not be delayed until the results become available. The definition of NH lacks uniformity and it is generally agreed that a single BG value cannot accurately define this clinical entity. Therefore, all medical societies support the use of operational thresholds for the management of NH, although discrepancies exist regarding the recommended cut-off values, the optimal treatment and surveillance strategies of both symptomatic and asymptomatic hypoglycemic neonates as well as the treatment targets. Over the past several decades, ΝH has remained an issue of keen debate as it is a preventable cause of brain injury and neurodevelopmental impairment; however, there is no clear definition or consistent treatment policies. Thus, the establishment of specific diagnostic criteria and uniform protocols for the management of this common biochemical disorder is of paramount importance as it will hopefully allow for the early identification of infants at risk, the establishment of efficient preventive measures, the optimal treatment in the first hours of a neonate’s life and, subsequently, the improvement of neonatal outcomes.

Early identification of the risk factors associated with development of diabetic foot ulcer (DFU) can be facilitated using machine learning techniques. The aim of this study is to find out the association of various clinical and biochemical risk factors with DFU and develop a prediction model using different machine learning algorithms. Eighty each of type 2 diabetes mellitus (T2DM) with DFU and (T2DM) without DFU were enrolled for this observational study. Clinical and laboratory data were analysed using different machine learning algorithms: Support vector machines (SVM-Poly K), Naive Bayes (NB), K-nearest neighbour (KNN), random forest (RF) and three ensemble learners: Stacking C, Bagging and AdaBoost for constructing prediction models for discriminating between the two groups (stage I classification) and ulcer type classification (stage II classification). Ensemble learning performed better than individual classifiers in terms of various performance evaluation metrics. New risk factors like ApoA1 and IL-10 for development of DFU in diabetes mellitus were identified. IL-10 along with uric acid could discriminate the grades of ulcers according to its severity. Decision fusion strategy using Stacking C algorithm resulted in enhanced prediction accuracy for both the stages of classification which can be used as a complementary method for computational screening for DFU and its subtypes. Current methodology for T2DM with DFU/T2DM without DFU and ulcer type classification [ABSTRACT FROM AUTHOR]

Objectives: The aim of study is to evaluate plasma glucose control in diabetic patient on hemodialysis by measure plasma glycated albumin and HbA1c and correlate them with parameters like serum electrolytes blood urea, serum creatinine, hemoglobin, serum albumin, total serum bilirubin, serum uric acid, parathyroid hormone, serum ferritin; to evaluate the effects of these parameters on the level of diabetic control. Methods: This is a cross sectional study which included type 2 diabetic patients on hemodialysis these patients are currently undergoing hemodialysis and are on hemodialysis for more than three months. Total 50 type 2 diabetic patients on hemodialysis; between ages of 47-62 years of either gender were selected randomly and comparison done between the effect of different factors on HbA1c and glycated albumin. Results: There were 50 patients enrolled in this study with a mean age of 54.5 ± 4.7 (range: 47-62) years. Males represented 58% (29 patients) while female represent 42% (21 patients) of the studied group with male to female ratio of 1.38 to one. The duration of diabetes (DM) ranged 4-20 years and two thirds of the cases had duration of 15 years or less. Regarding the treatment of DM, 35 patients (70%) were on soluble insulin while 15 patients neither receive insulin nor oral antidiabetic agent and their treatment was off. Poor glycemic control was significantly associated with younger age, patients aged <50 years were more frequent among the poor glycemic. Good glycemic control had significantly lower HbA1C% level. Conclusion: Most of our diabetic patient on HD has controlled diabetes reflected by the level of HbA1c and GA. Serum ferritin levels is positively correlate with HbA1c levels in diabetic patient on hemodialysis which suggests that serum ferritin levels can be a marker of glycemic control in type 2 DM. [ABSTRACT FROM AUTHOR]

Objective: Plasma glucose has been correlated with in-hospital mortality among many diseases including infections. We aimed to study the plasma glucose at the admission of hospitalized patients with COVID-19 at a tertiary care referral hospital at Jodhpur, India and its relation with mortality. Design: A hospital-based clinical study of plasma glucose of COVID-19 patients conducted from May 15 to June 30, 2020 after ethical approval. Measurements: Random blood samples at admission were collected for plasma glucose, interleukin-6 (IL6) and high sensitivity C-reactive protein (hsCRP) after written informed consent was obtained. Plasma glucose was analyzed by the automated analyzer, IL6 by chemiluminescent immunoassay and hsCRP by immune-turbidimetric assay. Results: A total of 386 patients were studied (female 39.6%); 11.1% had severe disease and 4.1% expired. There were 67 (17.4%) patients with known diabetes mellitus (DM). Patients with a history of DM had three times higher mortality (6/67, 9%) than those without DM (10/309, 3.1%). Patients with moderate and severe disease according to ICMR and WHO grading had higher plasma glucose than those with asymptomatic or mild disease (P < 0.0001). Plasma glucose levels at admission were significantl y higher in non-survivors when compared to those who survived (297 ± 117 vs 131 ± 73; P < 0.0001). COVID-19 patients showed increased mortality with incremental plasma glucose levels. The hazard ratio for mortality was 1.128 (95% CI 0.86–14.860), 1.883 (95% CI 0.209–16.970), and 4.005 (95% CI 0.503–32.677) in random plasma glucose group of >100–200, >200–300 and >300 mg/dL, respectively, compared to those with random plasma glucose of

Mohammed Abdu Seid,1 Baye Dagnew2 1Unit of Human Physiology, Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia; 2Department of Human Physiology, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Mohammed Abdu Seid Email mameabdu54@gmail.comBackground: Diabetes mellitus, the commonest metabolic disorder, leads to cardiovascular diseases, neurological problems, kidney injury, and visual disturbances. Such complications can be prevented by maintaining plasma glucose level in the normal range, including ophthalmic complications. Hence, this study intended to pinpoint predictors of poor plasma glucose maintenance in type II DM people with ophthalmic complication.Methods: We conducted a cross-sectional survey using simple random sampling approach to recruit participants. An interviewer-based questionnaire was used and ophthalmic complication was determined by visual acuity test. We used statistical package for social sciences version 23 to analyze the data and descriptive statistics were calculated. Predictors were ascertained using multivariable logistic regression at p≤ 0.05. Besides, AOR with 95% CI was also estimated to show extent of association.Results: The prevalence of poor plasma glucose maintenance was 65.1% (56.6– 73.6). Poor plasma maintenance was predicted by the absence of formal education (OR: 0.67; 0.20– 2.23), DM history of family members (OR=4.29; 1.33– 13.83), longer duration of diabetes (OR: 3.02; 1.09– 8.63), insulin use (OR=10.05; 2.72– 52.35), and less physical exercise (OR=2.91; 1.47– 5.76).Conclusion: Study subjects with no education, DM history of family members, prolonged DM, insulin medication, and inadequate exercise had higher rate of poor plasma glucose maintenance. Health professionals should educate patients on the importance of self-adherence to plasma glucose monitoring, and encourage them to practice recommended physical activity.Keywords: maintenance, plasma glucose, predictors, ophthalmic complication, type II diabetes

• The conventional medicines to mitigate hyperglycemia, such as metformin, is controversial for prediabetes due to the possible side effects. • We found that Zhenyuan Capsule, a patented Chinese herbal medicine consisting of ginseng berry saponins, could additionally reduced 2-h postprandial plasma glucose by 0.98 mmol/l, alleviated insulin resistance and raised HDL-C level by 0.25 mmol/l in prediabetic patients on the background of lifestyle interventions. • The current study supported Zhenyuan capsule as a complementary therapy for prediabetic patients, providing benefits for glucose metabolism and cardiovascular health, which is particularly significant for the individuals who have not achieved satisfactory outcomes with lifestyle interventions. Prediabetes strongly increases the risk of type 2 diabetes and cardiovascular events. However, lifestyle intervention, the first-line treatment for prediabetes currently, was inconsistently beneficial for glucose metabolism, and the conventional medicines, such as metformin, is controversial for prediabetes due to the possible side effects. This study was designed to evaluate the effects of Zhenyuan Capsule, a Chinese patented medicine consisting of ginseng berry saponins extracted from the mature berry of Panax Ginseng, on the glucose metabolism of prediabetic patients as a complementary therapy. In this randomized, double-Blinded, placebo-controlled, crossover trial, 195 participants with prediabetes were randomized 1:1 to receive either placebo followed by Zhenyuan Capsule, or vice versa, alongside lifestyle interventions. Each treatment period lasted 4 weeks with a 4-week washout period in between. The primary outcomes were the changes in fasting plasma glucose (FPG) and 2-h postprandial plasma glucose (2-h PG) from baseline. Secondary outcomes includes the changes in fasting and 2-h postprandial insulin and C-peptide, the homeostatic model assessment-insulin resistance (HOMA-IR) index and quantitative insulin sensitivity check index (QUICKI) from baseline. Blood lipids and adverse events were also assessed. Compared with placebo, Zhenyuan Capsule caused remarkable reduction in 2-h PG (-0.98 mmol/l) after adjusting treatment order. Zhenyuan Capsule also reduced the fasting and 2-h postprandial levels of insulin and C-peptide, lowered HOMA-IR index (-1.26), and raised QUICKI index (+0.012) when compared to placebo. Additionally, a significant increase in high density lipoprotein cholesterol (HDL-C; +0.25 mmol/l) was found in patients with Zhenyuan Capsule. No serious adverse event occurred during the study. Among prediabetic patients, Zhenyuan Capsule further reduced 2-h PG level, alleviated insulin resistance and raised HDL-C level on the background of lifestyle interventions. The study protocol is registered with the Chinese Clinical Trial Registry (ChiCTR2000034000). [Display omitted] [ABSTRACT FROM AUTHOR]

Simple Summary: Tillandsia recurvata is an epiphyte that contains adequate protein and energy levels regardless of the season and can be used as forage for small ruminants. We evaluated the effects of substituting sorghum stubble for T. recurvata in adult goats for 89 d, including an adaptation period of 14 d, at three different levels: 0% (control), 30%, and 60%. At the last phase of the trial, control goats gained more weight than goats consuming T. recurvata. Overall, the metabolic status was similar among treatments, whereas some variables tested of the complete blood count differed among treatments. Interestingly, the inclusion of T. recurvata in goats' diets at 30% gained or at 60% decreased 1% live weight; without signs of health disturbance. Using up to 60% T. recurvata in the diet did not negatively affect animal health; however, under the conditions of this study, supplemental protein would be required when T. recurvata completely replaced sorghum stubble. The use of T. recurvata as a supplement for goats would improve the nutrition of grazing goats in the dry season compared to the current diet obtained from arid rangelands and would alleviate host trees invaded by this aggressive epiphyte. Tillandsia recurvata is an epiphyte that grows on the canopy of many trees in tropical and subtropical areas of America. The objective of this study was to evaluate the effect of partial or complete substitution of sorghum stubble with T. recurvata on liveweight change, metabolic profile, and complete blood count of goats fed increasing levels (0, 30, and 60%, dry matter basis) of T. recurvata. Thirty non-pregnant three-year-old, non-lactating, healthy mixed-breed goats, ten animals per treatment (T0, T30, and T60), were adapted to diets and facilities for 14 days (d-14). Blood samples were collected at d-15, 28, and 56. At the last phase of the trial (from days 67 on), control goats tended to gain more (p = 0.09) weight than their counterparts consuming T. recurvata. Plasma protein, glucose, triglycerides, calcium, and phosphorus concentrations did not differ among dietary treatments (p > 0.05). Dietary treatment influenced red blood cells (higher for T60; p < 0.01), white blood cells (higher for T30; p < 0.05), mean corpuscular volume (higher for T0; p < 0.001), and mean corpuscular hemoglobin concentration (higher for T0; p < 0.01), although not the rest of the blood variables (p > 0.05). The hematocrit percentage tended to be higher (p = 0.06) in T30 than T0 and T60. It was concluded that replacing sorghum stubble with T. recurvata did not modify the metabolic status and maintained live weight of goats. Nevertheless, the use of T. recurvata as feed for goats would improve the nutrition of these animals in the dry season compared to the current diet obtained from an arid rangeland, reducing production costs, and would alleviate the damage caused by this aggressive epiphyte to host trees. [ABSTRACT FROM AUTHOR]

The experiment aimed to determine the effect of substituting 50% of soy protein for lupin protein in feed mixtures intended for the nutrition of high-yield Isa Brown laying hens, on selected biochemical blood plasma indicators. The trial was designed as a long-lasting feeding experiment (51 weeks) and involved a total of 180 hens divided in three experimental groups (control group C and experimental groups WLS and WDLS). At the end of the laying cycle, blood samples were taken from the hens by puncture of the vena basilica and subsequently, the required blood plasma indicators were analysed in the laboratory. The results demonstrated that the long-term feeding of white lupin (variety Zulika) did not affect the molar concentration of plasma inorganic phosphorus (P), magnesium (Mg), sodium (Na), potassium (K), chloride (Cl), uric acid (UAC) and the activity of alanine aminotransferase (AST). By contrast, the substitution of soy protein for lupin protein in the diets of the experimental groups of laying hens led to the statistically significant (p ≤ .05) decrease of total plasma protein (TP), total cholesterol (Chol), calcium (Ca) and triacylglycerides (TAG) and to an increase (p ≤ .05) of alkaline phosphatase activity (ALP).Highlights Replacement of soya protein with white lupin protein reduced cholesterol and triacylglycerides in blood plasma Feedstuff including white lupin protein did not affect negatively the health status of the layers

Embelin has been reported to possess variety of pharmacological activities such as androgenic antagonists, antiangiogenic, antibacterial, anticancer, anticonvulsant, antidiabetic, antidepressant, antihelmintic, antifertility, antihyperlipidemic, anti-inflammatory, antimalarial, antimitotic, antiobesity and antioxidant properties. The current research work aimed to study the hypoglycemic effect of embelin-chitosan nanoparticles (ECNPs) diabetic rats provoked by streptozotocin (STZ). Embelin nanoparticles (ENPs) were created by combining chitosan, a natural biopolymer, and glutaric acid, a new cross-linker. STZ 50 mg/kg was given intravenously into Sprague-Dawley rats weighing 250–300 g (75–90 days) to induce experimental diabetes. The antidiabetic efficacy of orally administered ECNPs in diabetic rats developed by STZ was investigated, as well as histological examination. When compared to diabetic control rats, ECNPs (25 mg/kg body weight and 50 mg kg body weight) and standard glibenclamide (10 mg/kg body weight) treated rodents exhibited a remarkable drop in glucose contents. Furthermore, histological research showed that ECNPs-treated rats were harmless up to amount of 25 mg/kg bwt. Thus current investigation reveals that ECNPs have antidiabetic potential and may be beneficial in treating hyperglycemia in people. [ABSTRACT FROM AUTHOR]

BACKGROUND: Portable blood glucose meters are the main method for detecting the blood glucose status of clinical patients. OBJECTIVE: To investigate the accuracy of detecting blood glucose in haemodialysis patients by sampling two blood glucose meters through the haemodialysis line. METHODS: Convenient sampling was used to select 80 patients with maintenance haemodialysis. The patients were sampled through the arterial end of the haemodialysis line within three minutes of being put on the machine. One specimen was tested by glycemeter1, which can identify the type of blood in the arteries and veins, and glycemeter2, which can only detect blood glucose in the capillaries for bedside blood glucose testing. The other specimen was sent to the laboratory biochemical analyser for blood glucose testing. RESULTS: When the blood glucose value of the first blood glucose meter (No. 1) was compared with the laboratory biochemical analyser, the correlation coefficient was r = 0.805 (p < 0.05), the out of value of the first blood glucose meter accounted for 4.4%, and the consistency reached 95% (p < 0.05). When the blood glucose value of the second blood glucose meter (No. 2) was compared with the laboratory biochemical analyser, the correlation coefficient was r = 0.800 (p < 0.05), the out of value of the second blood glucose meter accounted for 4.4%, and the consistency reached 95% (p < 0.05). CONCLUSIONS: For patients with maintenance haemodialysis, the blood glucose values detected by the two bedside blood glucose meters using arteriovenous mixed blood in the pipeline do not affect the accuracy and can respond more realistically. [ABSTRACT FROM AUTHOR]