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关键词： continuous glucose monitors   insulin pumps   pregnancy   type 1 diabetes  

摘要： Objective The use of continuous glucose monitors (CGM) and insulin pumps has revolutionized the care of patients with type 1 diabetes (T1D). Few data are available regarding the use of diabetes technology use in the pregnant T1D population. This study was conducted to evaluate temporal trends of diabetes technology use and predictors of use among pregnant individuals with TID in the United States from 2009 to 2020. Study Design Market Scan Research Databases from 2009 to 2020 were used to identify pregnant individuals with T1D who were and were not using CGM and/or insulin pumps. Joinpoint regression analysis was used to estimate the average annual percent change (AAPC) in diabetes technology use over time. Unadjusted and adjusted log-linear Poisson regression models were developed to assess the associations between the outcomes of CGM and insulin pump use and demographic and clinical predictors. Associations were reported as adjusted risk ratios (ARR) with 95% confidence intervals (CI). Results Among 9,201 pregnancies with T1D, CGM use increased from 2.3% in 2009 to 13.7% in 2020 (AAPC: 13.9%;95% CI: 11.7-17.1), while insulin pump use remained unchanged from 10.9% in 2009 to 11.8% in 2020 (AAPC: -2.4%;95% CI: -4.4 to 0.4). Medicaid insurance and obesity were associated with a lower likelihood of CGM use and insulin pump use, while a high obstetric comorbidity index score was associated with a higher likelihood of insulin pump use (ARR: 1.26;95% CI: 1.05-1.51). Conclusion From 2009 to 2020, CGM use among pregnant individuals with T1D increased, while insulin pump use remained unchanged. Use varied by patient demographic and clinical factors, most notable for lower likelihood of CGM use and insulin pump use with Medicaid insurance. Although CGM use increased over time, overall CGM use remained lower than expected despite the known benefits of CGM use in improving neonatal outcomes in pregnancies complicated by T1D.

关键词： Determinantal rings   1-Generic matrices   Rational singularities  

摘要： We show that the quotient ring by the ideal of maximal minors of a 1-generic matrix has rational singularities. This answers a conjecture of Eisenbud (Amer J Math 110(3):541-575, 1988) that such rings are normal, and generalizes a result of Conca et al. (Adv Math 335:111-129, 2018) that generic Hankel determinantal rings have rational singularities in characteristic zero.

关键词： Pancreatic ductal adenocarcinoma   Neoadjuvant chemoradiotherapy   Gemcitabine   S-1   Hypofractionated radiotherapy  

摘要： BackgroundNeoadjuvant chemoradiotherapy (NACRT) is increasingly used for pancreatic ductal adenocarcinoma (PDAC), yet the optimal regimen remains unclear. This phase II trial evaluated the feasibility and efficacy of a short-course NACRT regimen comprising gemcitabine, S-1, and hypofractionated radiotherapy in patients with resectable (R) or borderline resectable (BR) *** and MethodsPatients received NACRT with gemcitabine (1000 mg/m2 on days 1 and 8), oral S-1 (60 mg/m2/day for 14 days), and hypofractionated radiotherapy (30 Gy in 10 fractions over 2 weeks). The primary endpoint was the R0 resection rate. Secondary endpoints included treatment completion, adverse events, tumor response, and *** total, 54 patients were enrolled. Treatment completion ranged from 87 to 98%. Among 49 patients who underwent resection, 96% achieved R0 resection. A College of American Pathologists tumor regression score of 2 or lower was observed in 49% of tumors. Median follow-up was 24 months. In the intention-to-treat analysis, 1-, 3-, and 5-year overall survival rates were 78, 53, and 42%, respectively. Among resected patients, the median recurrence-free survival was 18 months. Patients with R-PDAC had survival comparable to those reported with longer NACRT regimens, while those with BR-PDAC had less favorable *** short-course NACRT regimen was feasible and yielded favorable survival outcomes, achieving a high R0 resection rate in patients with R-PDAC. By contrast, patients with BR-PDAC may benefit from more intensive treatment, although this requires further validation. These findings support the clinical utility of short-course NACRT and highlight the importance of treatment stratification on the basis of resectability status.

关键词： Anti-inflammatory   trans-cinnamic acid   Pleurisy   ICAM-1  

摘要： Natural phenolic acid compounds have been extensively studied for their anti-inflammatory properties, particularly in the context of inflammation-associated diseases. In this study, we investigated the anti-inflammatory effects of trans-cinnamic acid on neutrophil accumulation during inflammatory processes using both in vivo and in vitro approaches. For the in vivo experiments, LPS-induced pleurisy was used in mice pretreated with trans-cinnamic acid. Inflammatory parameters, including plasma leakage, leukocyte infiltration, and proinflammatory cytokine levels (IL-6 and TNF-alpha), were quantified in the pleural exudate. In vitro, the effects of trans-cinnamic acid on neutrophil chemotaxis toward CXCL1 were assessed using the Boyden chamber assay. Additionally, human endothelial ***926 cells were stimulated with TNF-alpha to evaluate neutrophil adhesion and the expression of the adhesion molecule ICAM-1 following trans-cinnamic acid treatment. Pretreatment with trans-cinnamic acid significantly inhibited LPS-induced pleurisy in mice by reducing protein-rich exudate formation, neutrophil infiltration, and local concentrations of TNF-alpha and IL-6. In vitro, trans-cinnamic acid did not alter CXCL1-induced neutrophil chemotaxis, nor the secretion of CXCL8 produced by TNF-alpha-stimulated ***926 cells. However, it markedly reduced neutrophil adhesion to TNF-alpha-activated ***926 cells. This reduction was associated with the downregulation of ICAM-1 expression at both the mRNA and protein levels. Overall, these findings demonstrated that trans-cinnamic acid exerted anti-inflammatory effects by inhibiting vascular permeability and leukocyte recruitment, particularly through the suppression of ICAM-1-mediated neutrophil adhesion to endothelial cells. These results support trans-cinnamic acid as a promising candidate for the development of new therapeutic agents targeting inflammatory diseases.

关键词： anxiety   hypoglycaemia   stigma   time below range   type 1 diabetes  

摘要： Aims This study aimed to evaluate the association of stigma related to type 1 diabetes with CGM-derived data and psychological outcomes in adults with type 1 diabetes. Methods In this cross-sectional study, 104 adults with type 1 diabetes undergoing continuous glucose monitoring (CGM) completed the Type 1 Diabetes Stigma Assessment Scale (DSAS-1), Patient Health Questionnaire-9 (PHQ-9), generalized anxiety disorder-7 (GAD-7), and Diabetes Distress Scale (DDS). Thirty-day standard CGM data with >= 70% sensor wear time of CGM was analysed. Linear regression was used to evaluate the potential relationship between the DSAS-1 scores and CGM-derived hypoglycaemia metrics. Results Higher DSAS-1 total score was independently associated with increased time below range <3.0 mmol/L (adjusted beta = 0.011 per point;95% CI: 0.0018,0.0202;p = 0.019) but not with <3.9 mmol/L. Elevated stigma associated with anxiety (adjusted OR, 1.086;95% CI:, 1.035,1.152;p = 0.002) with no significant link to depression. Item-level analyses identified DSAS-1 items related to differential treatment (items 15 and 19) and blame/judgement (items 11, 14, and 17) as being significantly associated with clinically significant hypoglycaemia. Associations were consistent across subgroups, especially among participants with a longer diabetes duration and a higher coefficient of variation of CGM glucose levels, calculated as glucose standard deviation divided by mean glucose and expressed as a percentage. Conclusions In adults with type 1 diabetes using CGM, perceived stigma was significantly correlated with more time spent in hypoglycaemia and greater anxiety. Further studies are needed to identify causal relationships between stigma and clinically significant hypoglycaemia in people with type 1 diabetes.

关键词： GLP-1 receptor agonist   colonoscopy   lower endoscopy   Boston Bowel Preparation Scale  

摘要： Background: Poor colon preparation may negatively affect colonoscopy accuracy, result in cancelation, or need for repeat procedure. The glucagon-like peptide-1 receptor agonist (GLP-1RA) class of medications delay gastric emptying, although the clinical impact of this on the quality of colon preparation is not ***: This was a retrospective matched cohort study in a multi-center, outpatient setting. Colonoscopy reports for patients prescribed GLP-1RA at the time of procedure were compared to a cohort matched for diabetes and cirrhosis who were not prescribed GLP-1RA at the time of procedure. The primary endpoint was a composite of indicators for inadequate bowel ***: The current study's objective is to analyze the effects of GLP-1RA medications on the quality of colonoscopy ***: There were 503 patients in each cohort and baseline characteristics were similar. Use of GLP-1RA at the time of colonoscopy was associated with a greater odds of the composite outcome (125 vs 56, odds ratio [OR] = 2.6;95% CI, 1.9-3.7). There were also increased odds for individual outcome components including proceduralist documenting inadequate, suboptimal, or poor bowel preparation, narrative comments related to inadequate bowel preparation, and recommendation for extended bowel preparation with future colonoscopy. Repeat procedure was also more common in the GLP-1RA cohort (26 vs 9, OR = 3.0;95% CI, 1.4-6.5).Conclusion and Relevance: This study assessed the impact of the GLP-1RA class of medication on the quality of bowel preparation for lower endoscopies. Glucagon-like peptide-1 receptor agonist use increased the odds of inadequate bowel preparation and repeat procedure.

关键词： Inverters   Circuits   Circuit faults   Voltage   Harmonic analysis   Switches   Real-time systems   Photovoltaic systems   Integrated circuit modeling   Digital twins   Digital twin (DT)   grid integration   power electronics converter (PEC)   single-phase inverter   solar photovoltaics (SPV)  

摘要： This paper introduces a smart Digital Twin (DT) framework for a single-phase grid-integrated solar photovoltaic (SPV) inverter system that ensures advanced fault diagnostics and optimized operational performance. The DT is mathematically formalized using state-space equations modelling, functioning as a virtual counterpart to the physical system (PS). Real-time synchronization is achieved through high-fidelity sensor data acquisition within PS, enabling continuous monitoring and adaptive control. A rigorously formulated objective function, integrating empirical PS data and mathematically inferred parameters, underpins the optimization process, ensuring a superior digital representation. The critical system parameters, including ON-state resistance variations of switches, capacitance drifts, and inductor losses, are dynamically calibrated through an Electrostatic & Electromagnetic Field Discharge-Hybrid Optimization (E2FD-HO), a physics-driven optimization algorithm. The DT not only enables data-driven fault diagnostics but also proactively mitigates operational instabilities through real-time predictive control strategies. The control for the system is implemented within the FPGA-based controller (NI-sbRIO-9636) and the proposed DT framework is implemented on the OPAL-RT setup. The results of DT in comparison to hardware results of PS demonstrate an exceptional percentage matching score (PSM) of DT & PS, above than 98.5%, confirms its robustness and predictive precision. The developed DT offers a transformative approach to SPV inverter diagnosis, advancing circuit-level intelligence in smart energy systems.